Provider Documentation Training NC Innovations Waiver

Transcription

1 Provider Documentation Training December 17, 2012 A New Multi-County Area Authority Merging The Durham Center and Wake LME

2 According to the North Carolina Innovations Technical Guide (Version 1.0 June 2012), Providers of NC Innovation services are required to: Develop and implement short-range goals. Develop and implement task analysis/strategies. Ensure short-range goals and task analysis are in place prior to plan implementation. Ensure short-range goals and task analysis or strategies are signed by the participant or legally responsible person. A New Multi-County Area Authority Merging The Durham Center and Wake LME

3 Alliance Behavioral Healthcare has developed a standardized format for short term goals. providers in Cumberland, Durham, Johnston, and Wake will begin using the new format when developing short term goals for participants with January 2013 birthdays. A New Multi-County Area Authority Merging The Durham Center and Wake LME

4 Documenting: Completing the Individual Support Plan Short Range Goals

5 Long Range Outcome Section: The information in this section will be developed by the team at the annual plan meeting. Will be documented by the care coordinator on the ISP. Will be restated by the service provider on the short range goal format. A New Multi-County Area Authority Merging The Durham Center and Wake LME

6 Important things to remember when thinking about Long Range Outcomes: They are the individual s desired life outcomes. They are broad in scope, but must still be attainable for the individual. It is expected that the same long range outcome will not remain on the plan year after year. Obtaining a specific service is never an appropriate outcome. A New Multi-County Area Authority Merging The Durham Center and Wake LME

7 Where am I now in Relationship to the Outcome section: The information in this section will be developed by the team at the plan meeting. Will be documented by the care coordinator on the ISP. Will be restated by the service provider on the short range goal format. A New Multi-County Area Authority Merging The Durham Center and Wake LME

8 What are the prerequisite skills needed section: The service provider will indicate the necessary skills that the individual should already possess in order to work on the short term objective identified. Does the individual supported possess these skills? The service provider will include specific, detailed information regarding the individual s current skills as they relate to the short range goal. A New Multi-County Area Authority Merging The Durham Center and Wake LME

9 Short Range Goals section: Should directly relate to the achievement of the Long Range Outcome. All goals should be measurable (for habilitative services), observable, and attainable. All goals should describe the desired behavior based upon the individual s wants/needs. A New Multi-County Area Authority Merging The Durham Center and Wake LME

10 Short Range Goals: There are 3 parts to each Short Range Goal. Condition is/are the circumstance(s) in which the behavior will occur. Behavior is the clearly defined action that the individual will do. Criteria is the measurement of performance. A New Multi-County Area Authority Merging The Durham Center and Wake LME

11 Example: At least one time per week, Patty will wash her clothes with 3 or less verbal prompts for 2 consecutive months. Condition At least one time per week Behavior Patty will wash her clothes Criteria with 3 or less verbal prompts for 2 consecutive months A New Multi-County Area Authority Merging The Durham Center and Wake LME

12 Support to Reach Goal list the service/support necessary to achieve the long range outcome. Who will provide support/location(s) Identify the provider who will be responsible for providing the service/support and the location of where the service will occur (using the location codes). A New Multi-County Area Authority Merging The Durham Center and Wake LME

13 Estimated Frequency for each location There will be two parts to this section. 1. List the total hours per week of the service (10 hours per week) 2. Break out the time spent at each location to run the goal. (10% at home, 90% in community) Target Date should be no longer than 1 year and in most instances will be the last day of the individual s birth month.

14 Schedule to run goal- state the typical times that the individual would work on the particular goal during the week. If there is flexibility that may be needed to run the goal, explain that in this section. This will be included in the schedule completed by the Care Coordinator. Materials needed list the items that will be needed in order to complete the goal. Positive Reinforcement list the forms of praise that the person responds positively to in order to foster goal progression. Note-this should not be a form of bribery. What is written here should not conflict with anything that may be outlined in an individual s behavior support plan. A New Multi-County Area Authority Merging The Durham Center and Wake LME

15 Task Analysis: Steps for person supported list the steps for task completion or strategies for the person supported. Goals around behavioral needs may be more appropriate to have strategies listed in this section. A task analysis would be used to assist a participant with a specific self-help or daily living skill. A strategy is a long-term plan of action designed to achieve a particular outcome. Strategies are used to make a problem easier to understand and solve. Staff s actions This section lists the actions the staff will take in order to assist the individual to complete the task outlined in the short range goal. The actions listed should be specific and staff should have an intervention that correlates to each step the individual will take.

16 Quarterly Progress Summary Documenting: The Quarterly Progress Summary

17 Quarterly Progress Summary Quarterly Review/Progress Summary: Service providers are required to complete quarterly progress summaries for habilitative services to reflect the participant s progress toward the shortrange goal and long-range outcomes that have been implemented in the Individual Support Plan.

18 Quarterly Progress Summary The following Innovations Services require a quarterly progress summary: Community Networking Day Supports In-home skill building Intensive In Home Supports Personal Care Residential Supports Supported Employment

19 Quarterly Progress Summary The progress summary should contain at a minimum: Participant s name Medicaid Number Date of the quarterly review and dates that the review covers The goals reflected in the current ISP Progress towards goals Recommendations for continuation, revision or termination of an outcome Signature of the individual who completed the review.

20 Quarterly Progress Summary The progress summary should be completed quarterly based on the participant s ISP year and should be completed separately for each service. The quarterly progress note shall be documented within seven (7) working days of the close of the quarterly progress period.

21 Quarterly Progress Summary If a progress summary is not documented in this time frame, it shall be considered a late entry. The documentation shall be noted as a late entry and should include at a minimum the date the documentation was made and the date when the documentation should have been entered. Example: Late entry made on 5/18/13 for 5/7/13

22 Quarterly Progress Summary If at the time the quarterly progress summary is completed by the QP and NO changes to the goals are needed based on the individual s progress, this would be noted in the progress summary and no changes to the short range goal plan are required. If at the time the quarterly progress summary is completed by the QP and changes to the goals ARE needed based on the individual s progress, this would be noted in the progress summary and within the ISP (goal review section). The QP is responsible for obtaining the guardian and/or participant s signatures on the plan as required.

23 No changes to goal(s) needed: Changes needed to goal(s): Note in progress summary. QP must sign the summary. Note in progress summary. QP must sign the summary. No changes to plan needed. No signatures needed on plan. Make revisions to the short-range goal plan. Signatures are required on the plan.

24 The individual and guardian should be involved in these discussions and should agree with whether or not changes are made. All changes should be communicated to the Care Coordinator and a copy of the revised goal(s) should be provided to the participant and/or guardian. You do not need to wait until quarterly review time to make needed changes to the short-range goals. If you see something is not working during a quarter, you can and should make the needed change(s) at that time. Person centered planning is a dynamic process and should contain review and revision of the plan as often as the participant s life circumstances/needs change. (NC Innovations Technical Guide Version 1.0-June 2012)

25 Although short range outcomes will not be submitted to Utilization Management for service authorization review, providers should have appropriate and adequate documentation in place at all times. *Note: There may be instances where Utilization Management has questions and would like to see additional information in order to complete the review process. They may ask for short-range goals to be submitted during these times. Providers will be expected to make all documentation available to Care Coordinators, the MCO and others (Evaluators, etc.) as needed.

26 Back-Up Staffing Documenting: Back-Up Staffing

27 Back-Up Staffing All participants will have a back-up staffing plan outlined in their ISP. This will be discussed by the team at the annual plan meeting and documented by the Care Coordinator. The purpose is to ensure that the health and safety needs of the participant are met. The plan outlines whether back-up staff are paid or unpaid, their contact information, and whether any specialized training is required.

28 Back-Up Staffing It is the responsibility of the direct care service provider to ensure that back-up staff is available in the event the regularly scheduled staff is unable to provide the medically necessary services as scheduled. Failure to provide back-up staffing is considered a Level I incident. The provider will be responsible for completing a Back-Up Staffing Incident Report Form. Forms should be submitted to Alliance Quality Management within 72 hours of the incident. Back-up staffing incident reports are NOT included in the Quarterly Incident Report Summary submitted to Alliance s Quality Management Department.

29 Back-Up Staffing The Back-Up Staffing Incident Report is completed even if the participant/guardian declines the back-up staff offered. There is a place to note this on the report. Be prepared to report on the following: description of the incident, how the participant was affected by the lack of staff and service provision, how the time was covered, and any follow-up provided.

30 General Information As a direct care service provider, please take the time to familiarize yourself with all the requirements and guidelines under the. You should be familiar with the NC Innovations Technical Guide: ions_manual_ pdf

31 I/DD Specialist Contact Information Cumberland Durham Vince Wagner Sara Wilson Johnston Wake Lori Caviness Tammy Ramirez Tanya Held

32 I/DD Specialist Contact Information The Provider Network Department of Alliance also hosts a NC Innovations Conference Call for service providers every Friday afternoon from 2:00-3:00pm to address provider questions regarding Innovations services. For more information:

33 General Information Questions? Comments?