Presentation on theme: "HCBS Quarterly – April 2006 HCBS News ` Incident Report Issues ` Goal Development ` Narratives on Goals ` SCL and Children ` Billing Issues ` Elderly."— Presentation transcript:
HCBS Quarterly – April 2006 HCBS News ` Incident Report Issues ` Goal Development ` Narratives on Goals ` SCL and Children ` Billing Issues ` Elderly Waiver Issues ` QA Forms
HCBS News A fond farewell: –Lori Hamand – HCBS Specialist for North Central Iowa has left the HCBS waiver program for another position. She will be working with the CMHW. Welcome back!: –Don Reineke has returned to the SW Iowa region effective 4/1/2006 –Jay Grey has returned to the Ames region effective 4/1/2006
Incident Report Issues The following are problems in incident reporting: –Minor incidents are being sent to BLTC – only major incidents should be sent to BLTC –Other consumers – who are not the subject of the incident report – are being referenced by name rather than by initials or an ID distinction –Description does not support why it is an incident –Actions of staff are not clear or inconsistent with the description –Resolution or follow-up does not address the incident –Incident occurred sans service delivery and does not relate to service delivery
Incident Report Issues Beyond fundamentals of the report, service delivery problems have been identified: –Police being called to resolve disagreements between consumers – non-physical issues –IR confirms SCL is being delivered in providers home –IR confirms staff not present during paid for time –Staff actions are the impetus for the incident When these issues occur, the agency should do an internal review of staffing issues and address actions in the resolution/follow-up
Goal Development Consumer CM/SW Provider
Goal Development Goals are driven by consumer issues, not family, provider, etc… –Mom is an artist – she wants her daughter to be creative and learn to draw – the daughter has no interest and resists the idea this would not be an appropriate goal – mom can chose to work with the daughter herself on the skill or let her dabble during art class at school – you cannot force a person to enjoy an activity –The provider has access to a large, integrated community center – the agency has numerous consumers with an activity goal – the agency implements an SCL out-to-eat goal on Thursdays to address this activity goal for all consumers. This is the only option provided to consumers for the activity goal. The service implementation is provider, not consumer driven
Goals Goal implementation should address the identified issue(s), in accord with the IAC and directives of the IDT. –Consumer goal – Mary will participate in an activity two times per week The agency records that the agency has met this goal when the consumer works puzzle books in her room or attends a medical appointment. The consumer and CM did not see these activities as meeting the goal. Attending an activity is not necessarily skill development. Since the agency did not assist the consumer with either activity, this goal was not met.
Goals The adult consumer has a goal to be safe in his home and community. –The mother wants him supervised from 5PM to 11PM every night. –The consumer is his own guardian and doesnt want staff in his home at all times. He does have anxiety issues sometimes during the night. –Skill development would address the issues that keep him at risk in his home or community (you need to determine who is being served, the mother or the consumer?)
Goals and Documentation Documentation is much more than begin time/end time, date of service, service provided, staff signature, etc. Documentation supports the intent of the goal(s) and insures the skill development/support is being delivered Documentation validates proves the agency is following the directives of the service plan and the team Documentation insures authorized goals are being addressed
Insuring Consumer Services Begins with the consumer – services relate to the consumers needs, hopes, dreams,etc… IDT helps identify how these needs will be met – not everything is waiver related An assessment identifies the barriers to achieving hopes, dreams, safety/health issues. The case manager develops a service plan and the provider develops a plan based on the CMs plan The provider(s) deliver and document services according to the plan
Key to Consumer Goal Attainment Direct support staff must: –Know the consumers goal(s) –Know how the consumer learns and how to optimize the learning process –Know the action steps to achieve the goals action steps are what the staff will DO to assist the consumer to LEARN the goal –Review narrative/documentation in accord with the expectation(s) of the plan
Supporting Direct Care Staff Providers can assist staff by: Training staff prior to working with consumers – this training, at a minimum, should include: Specific consumer issues –learning patterns, etc… Implementing services based on those issues Provide documentation training individualized to the staffs learning patterns Give ongoing feedback to staff on job performance Implement staffing patterns that address the IDT directives and meet the consumer needs
Goals and Action Steps HCBS reviews indicate two types of goal writing; –The IDT develops the goal and identifies the actions steps for those goal(s) – plan is prescriptive: CM Goal - John will cook a meal once a week CM action steps: –John will prepare a grocery list of ingredients –John will go to the store and buy the ingredients –Staff will assist John to prepare the meal –The IDT team develops a basic goal and the provider develops steps to implement the goal. CM Goal – John will cook a meal once a week CM action step – staff will assist John as needed.
The Importance of Action Steps Provides direction to staff on skill development and documenting the service delivery Relates specifically to the individual consumer Takes into account the preferred learning method of the consumer Provides consistency in service delivery Helps to insure consumer success Correct documentation of the action step provides valuable information to the IDT Helps in future planning. Justifies billing Medicaid for the service time
SCL Services and Children
SCL and Children IAC (1)b(MR) (2)b (BI)…(SCL) activities do not include ….vocational services, academics, day care, medical services, MCM or other CM…services are individualized supportive services provided in a variety of community-based, integrated settings… IAC (1)b(4)(MR) and 78.43(2)c(4) (BI) Consumers aged 17 or under…living in the family home, legal rep, or foster family shall receive services based on development of adaptive, behavior, or health skills…duration of services shall be based on age appropriateness and individual attention span…
SCL and Children SCL delivery time frames for children should be based on the childs attention span and age appropriateness – 52 hours a month of SCL is a guideline, not an entitlement – this amount of time should not be marketed to families Basic monitoring and supervision for a child = day care – SCL is not to be used as child care or respite
Children and SCL Transporting the consumer from the home to school or from the school to the home is the responsibility of the school, not the waiver – if the parent chooses not to use the school transportation, then it is the parents role to transport, not the waiver SCL should not be utilized as a coverage service during school holidays and breaks – the service order should always relate to the childs needs and not as a convenience service for families
Billing Issues Troubleshooting Claims for Targeted Medical Care The provider must be enrolled as a waiver provider for the service. The consumer must be an eligible consumer. Units billed must match the parameters of Chapter 79. Service delivery identified in ISIS must be matched W Code for the correct service Consumer ID Provider ID Begin date – end date
Elderly Waiver Issues When consumers receive CDAC, essential piece is to keep CDAC agreements up to date and reflective of service components currently being provided. SWs should ensure CDAC agreements are up to date. Provider communicates any needed service changes to AAA CM and SWs SW shares information with other team members – hospitalization/institutionalization, etc. NODs sent from the SW – should reflect changes –Beginning/end dates for services should = what has been ordered in the plan
Waiver Services and RCFs State supplemental money pays for the following: -- room & board, personal cares, supervision Providers may receive a maximum of $25 per day from State Supp for the above services This cost may not cover all personal cares/supervision needs When waiver services are accessed, you must FIRST take into account what State Supp is paying for. Waiver does not pay for room and board costs related to the RCF Waiver may cover cost of services beyond what is provided under the State Sup
Quality Assurance in ISIS
HCBS ISIS Support Staff Lezlie Tate- Denise Pottorff- Elaine Harper- BE NICE TO THEM!!!!
With ISIS, Remember: You may make entries for current and future months. Changes to previous months require a QA form. Please plan ahead to reduce the number of QA forms that you need to complete. If a QA form is needed, the CM or SW must complete the form. Waiver staff can not do this for you.
The QA Process # 1 - FIRST CHECK TO VERIFY WHAT IS ALREADY ENTERED IN ISIS: a.Verify the current service plan span dates b.Verify the current services entered, the provider entered, the rate entered, and the date span entered c.Verify that the provider has not been paid if you are reducing the units or the rate
The QA Process #2 – ENTER THE CHANGING DATA ON THE QA FORM a.Enter the Consumer SID, and Name b.Enter your name and phone number c.Enter the current service plan dates
Backdating Multiple Services First, all services you are changing must be in ISIS, if they are not there, you will need to enter them in for the current month. Enter the dates that you want in the correct service plan date section-it is not necessary to enter each individual service in the service span section. State in your QA what services that you want to have backdated.
Changing a Rate Enter the general info and then enter the info in the service plan section as it currently appears Enter the correct info Enter the end date of the old rate On a new line enter the start date of the new rate and the new rate information For Daily rates you must prorate the # of days for old and new, if the rate changes in the middle of the month Enter the end date of the old rate and the number of units, I.e. 12/1/04-12/10/04, 10 units and then enter a new line with the start date of the new rate through the end of that month, I.e. 12/11/04-12/31/04, 21 units-DO NOT ENTER 31 UNITS HERE.
QA and Respite Changes If you are changing the rate or the provider for MR waiver respite recipients, complete the following: Verify through MY REPORTS how much respite the consumer has received in during the current plan year – depending on how frequently the provider bills, you may need to contact the respite provider for the most recent info Complete a QA form with the current info in the service plan section Enter the number of units received by the consumer in the correct info section Subtract the $ received from the $7050 to determine how much respite the consumer can still be paid-enter the number of units based on this amount or less
QA forms IMW Completes form # (Request for ISIS changes) for changes in beginning or ending date of the waiver eligibility. TCM or SW Completes form # (Request for Medicaid Changes) for changes in the service plan to prior months QA
QA forms, Scenario #1 A daily SCL consumer is hospitalized from 1/5/06 to 1/8/06. The IMW must be notified by the SW or TCM of the dates consumers hospitalization. The IMW completes a QA form to suspend waiver on ISIS for those dates – this allows payment to the hospital. Daily SCL provider can receive payment on the FIRST and LAST day of hospitalization The Daily SCL provider can not bill for 1/6 and 1/7 because the person was hospitalized.
QA forms – Scenario #2 Consumer goes into a hospital on 1/5/06 to 1/8/06. The IM must be notified by the SW or CM consumer dates consumer is hospitalized. The IM completes a QA form to suspend waiver on ISIS for those dates. Hourly rate SCL Providers can receive payment only for the hours they provided services – SCL can not be given in the hospital. For this scenario, there is no further action needed by the SW or TCM. The provider can only bill for services provided, if any, on 1/5 and 1/8.
QA forms-Scenario #3 Provider has had a change in rates and wants to make the change effective in a previous month. Service Worker or CM, via a QA form, will enter the general info and then enter the info in the service span section as it currently appears. –Enter the correct info –enter the end date of old rate –On a new line enter the start date of the new rate and the new rate –For daily rates, you must prorate if the rate changes in the middle of the month –Enter the end date of the old rate and number of units, I.e. 2/1/06 to 2/10/06, 10 units and then enter a new line with the start date of the new rate through the end of that month, I.e. 2/11/06to 2/28/06, 18 units-DO NOT ENTER 28 UNITS.
QA forms – Scenario #4 Consumer is changing the respite providers. The SW or CM verifies on MY REPORTS how much respite that consumer has received in the consumers service plan year. –Complete a QA form with that current info in the service plan section –Enter the number of units received by the consumer in the correct info section –Subtract the $ amount already utilized from the $7050 to determine how much respite can still be paid-then enter the number of units based on this amount.