Frequently Asked Questions (FAQ) from DAHS Webinar- April

Transcription

1 Q1: Is there a place on Form 3050 to document the individual s allergies and Resuscitation code status? Page 1 of 6 A1: Allergy information and resuscitation code status are not requested on Form 3050, but can be included in the Additional Information/Notes section of the form. Q2: When Physician order indicates monitoring and Intervention, we have had Prior Approval Nurse (PAN) at DADs indicating this is not necessary and disqualifies the consumer on that opinion. Does PAN nurse override Physician order? Is there clarity at DADs for PAN nurse to now adhere to the new forms since they are now detailed? A2: If ordered treatments/monitoring/intervention are related to a medical diagnosis as documented on Form 3055 DAHS Physician s Orders and requires that ordered treatment/monitoring/intervention to be performed by a Licensed or Registered Nurse, then this portion of the eligibility criteria is met. The DADS nurses apply the medical eligibility requirements from in Rule (3) as follows: To be eligible for day activity and health services (DAHS), an applicant/client must: have a medical diagnosis, a related functional disability, and physician s orders requiring care, monitoring, or intervention by a licensed nurse. The information provided on the completed forms determines if medical eligibility criteria is met. Q3: Does the State intend to use same rules for DAHS as nursing facilities, because it seems that a higher level of skilled care is being requested on the new forms. A3: No changes have been made to the scope of skilled care in DAHS. The form revisions are intended to help DAHS providers ensure health and safety of individuals served. Q4: Will dementia patients that do not have meds to take at DAHS but do require monitoring interventions be disqualified without meds or blood pressure? A4: Individuals with dementia who do not have BP checks or take medications at DAHS may still be eligible if they have a functional disability related to a medical diagnosis. Medication administration by the DAHS nurse for a diagnosis of hypertension is an example of medical diagnosis and physician orders requiring care, monitoring or intervention by a licensed nurse as required in (3). It should be noted that the medication must be related to the individual s diagnoses as listed on Form The Form 3055 instructions state: If the only skilled need is for over-the-counter PRN medications to be administered at DAHS, the applicant does not meet the medical eligibility criteria for DAHS.) Q5: DADS has indicated that Managed Care will not be asking for these forms. For about 6 months now, we have had managed care asking for forms 3050, & 3049 to reauthorize services. A5: DAHS forms 3049, 3050 and 3055 are for individuals receiving DAHS through a DADS contract. DADS policy staff was initially advised the MCOs would not be using the new DADS forms; however, the MCOs can request that their contractors use specific forms. Please consult with your MCO for guidance on which forms to use for individuals receiving DAHS in managed care. DADS Contract Mangers will not be looking to see if the new forms are used with individuals receiving DAHS through managed care. Q6: DAHS program nurses feel that the training has just reiterated what is stated on the forms. The training does not go through what is required on each section of the form.. Can we have trainers come out to local areas for face to face training at least within the region? A6: The DAHS Forms Webinar is comprised of a Power Point presentation intended to review revisions made to the DAHS forms. Please contact your regional contract manager with any request for additional training in

2 Page 2 of 6 regard to the implementation of the new forms. Decision to provide regional face-to-face training will be based on the level of demand for training and the resources available in specific regions. Questions about the forms and requirements for completing the forms can be directed to the DAHS@dads.state.tx.us mailbox and policy staff will provide responses to specific questions. Q7: When licensure comes to renew a facility license, the nurse does ask for DADS forms irrespective of whether the insurance source is the State or managed care. Can you update if this will no longer be the case? A7: The licensing surveyor does not know the payment source of the individuals served and no particular assessment form is required for licensure. The provider may develop an assessment tool or the DADS DAHS forms as an assessment tool to develop the plan of care. The method of assessment must be the same for all individuals served. Q8: On Form 3050 Sec III B How should medication be recorded if it is not to be administered while at DAHS? A8: Medications taken away from the DAHS facility are documented in Section III D Medications Taken at Home. Q9: Form 3055 does not seem to have a place for Physician to specify the Skilled Care in Sec III of Can you clarify how this plays out? A9: The ordered treatments/monitoring/interventions in Section III of Form 3055 are entered into Section III, A. of Form 3055 titled Ordered treatments/monitoring/intervention. Form 3055 (Physician s Orders) has Section III which is titled Physician s Orders. A physician s order is required for treatment including procedures, monitoring or intervention to be administered at the DAHS facility. The treatments ordered by the physician (as listed on Form 3055) are then documented by the DAHS facility on the Form 3050, Individual Service Plan, in section IIIA, Special Treatments, Monitoring, Intervention Ordered by the Physician to be Administered at DAHS. Q10: Will the consumer be disqualified if no medications are administered at DAHS? A10: Please review DAHS medical eligibility criteria in : the need for assistance with medication is not the only criteria contained within the medical eligibility criteria for DAHS. While medication administration is one of the most common needs, which falls within the eligibility criteria, it is not the only physician order that requires care, monitoring or intervention by a licensed nurse. Q11: Where do we document non-skilled care documentation to support service? What forms do we use? Can you give another example of the required documentation and for other examples of non-skilled care? A11: Any progress note or service record system, such as a checklist, the DAHS provider uses is acceptable, as long as the following information can be verified: The identity of the individual served The identity of the service provider The date the service was provided The tasks performed during the non-skilled service delivery Non-skilled care would be assistance with toileting, assistance with eating, assistance with transfer, dietary counseling/education, basic health teaching about proper eating habits, hygiene. Form 3050, section IV- Plan of Care: Personal Care at the DAHS Facility, provides check boxes for the provider to note the most common non

3 Page 3 of 6 skilled support services that would likely be provided at a DAHS facility. If the provider wants to list additional non-skilled tasks, they can note these in the Additional Information/Notes section of the form. Q12: Can either an RN or an LVN complete the 3049, 3050, and 3055 forms? A12: The completion of Form 3049 assessment can be completed by an RN or LVN. The nursing assessment and the physician s orders provide the foundation for the DAHS Individual Service Plan. Form 3050, can be completed by the RN or LVN. An RN/LVN may enter updates on Form An LVN may update the Individual Plan of Care for review and approval by the RN. Ideally Form 3055, Physicians Orders is completed by the physician; however a DAHS RN /LVN may complete Form 3055 prior to sending to physician for review, approval and signature. Q13: RN consultant was told from licensing dept. that the RN consultants must do all initial assessments at all times due to RN Licenses is that correct or continue with the LVN doing assessments. A13: See response to Question # 12. Q14: When completing Form 3050 Section H, Health Teachings, in order to match information from physicians orders on Form 3055, would the correct thing be to include health teachings under Section 3 on 3055? A14: Health teaching does not require a physician s order so there is not a need to indicate health teaching on Form Q15: All new documents must be completed for DADS members only? A15: Yes, DAHS Forms 3049, 3050 and 3055 must be completed for new and ongoing individuals receiving DAHS through a DADS contract. Q16: What is an acceptable form of editing a form 3049 (in lieu of using white out) to avoid the need to create a new form? A16: Information to be deleted may be struck-through with a single line and initialed and dated in the margin of the strike-though line by the nurse making the change to the form. If new information is added, the nurse adding the information must initial and date next to the addition. Q17: Where do we document the changes? A17: Strike-through lines for deletions and dated initials, as well as additional written information with dated initials of the nurse can be done on the form itself as long as it is legible. Q18: Do we have to get all clients tested for TB? A18: The licensing standards found at 40 Texas Administrative Code, Chapter 98, Section 98.61(b)(5) require a provider to develop written policies for the control of communicable diseases in employees and clients, which include tuberculosis (TB) screening and a provision of a safe environment. If your policy states you will have all clients tested for TB, DADS will expect to see evidence of that this has been done. Q19: My question is on Form 3055 section V. Is this the correct section to include Tylenol, Pepto Bismol, and Mylanta, which are over-the-counter PRN medications to be administered by LVN or RN or should this information go in section VIII? A19: OTC medications, such as those listed in this question, are documented in Section VIII, Medications: Over-the-counter PRN medications on Form 3055.

4 Page 4 of 6 Q21: Existing DADS DAHS individuals need the new forms completed on them, but they do not get sent in to the regional nurse. A21: Only initial individuals receiving DAHS through DADS contracts must be sent to the DADS regional nurse. Q22: Can any questions/answers from DAHS providers in each region be sent to the DADS regional nurse for that region? A22: The regional nurses commonly answer questions from DAHS providers in their regions related to Forms 3049, 3050 and 3055 completed for specific DAHS applicants/individuals. For policy questions related to entering information on the new DAHS forms send questions to: DAHS@dads.state.tx.us. Q23: Will we be able to review the PowerPoint again after the webinar, or can we get a link to print the PowerPoint screens? A23: Yes the DADS Forms PowerPoint recording is posted on the DADS website. The PowerPoint handout is also posted and available for download and printing. Q24: Can you add demographic info to multipage forms? A24: Given the length of the forms and the fact that the DADS Regional Nurse does not need this information to determine program eligibility, the decision was made not to include demographic information. The DAHS provider must use Forms 3049, 3050 and 3055 as published for individuals receiving DAHS through a DADS contract. The DAHS program can collect this information and maintain it separate from the required forms if the facility determines it is necessary. Q25: Your answer re: therapy: Form 3050 states that DAHS must have the physician orders. Does the physician have to provide that to the DAHS program? A25: In order for DADS Regional Nurses to determine eligibility for DAHS, the physician orders are required. If skilled care is being administrated by the DAHS nurse, the Adult Day Care licensing standards require a physician s order to administer that care. Q26: Please explain Section F on Form why is this necessary? DAHS is not able to bill for these services and these services will change, per the therapy/rehabilitation provider. Is a therapy provider required to share their orders with DAHS? A26: No, therapy providers are not required to share their orders, the physician must provide therapy orders. In some situations the DAHS provider may obtain a copy of therapy orders from the individual given to them by the therapy provider. Form 3050 is the Service Plan. Services provided by the DAHS provider are documented on the Service Plan, Section IIIF, Therapies/Rehabilitation, to be administered at DAHS. For example, a plan developed by the Physical therapist for a home exercise program after an individual completes PT would be documented here. Q27: Why are contract managers auditing nursing services? This will be surveyed at the nursing survey. You mentioned medical/nursing outcomes will be reviewed by the contract manager -- do they understand medical/nursing delegation rules/ outcome assessment w/ consideration to risk adjustment for each individual patient? I feel contract managers are crossing over the non-skilled/skilled scope of practice.

5 Page 5 of 6 A27: Contract Managers are not determining the appropriateness of a nurse s clinical judgment. DADS Contract Managers review all the forms to establish what treatments, interventions and monitoring activities are supposed to be occurring while an individual is attending DAHS. Contract Managers look at other documentation sources such as progress notes, medication logs, and nursing notes to determine if the services were delivered in accordance with the forms. Q28: Will the contract managers utilize the form 3050 for audit purposes? Can the daily non-skilled care be documented on a form that we have developed previously? Our form has worked well in the past. A28: DADS Contract Managers will be reviewing Form 3050 to establish what treatments, interventions and monitoring activities are supposed to be occurring while an individual is attending DAHS. Form 3050 as the individual service plan, contains that information. Contract Managers will be looking at other documentation sources such as progress notes, medication logs, nursing notes to determine if the services were delivered in accordance with Form 3050, Form 3055 and any supplemental physician orders. As is stated in policy, Form 3055 and any supplemental physician orders should align with Form Q29: Totally agree a clinical training would be of great help for nursing duties. A29: DADS will work with nursing staff at DADS to schedule a clinical webinar in the future. Q30: Can we put set up help only in 3050 section IV? A30: Section IV of F3050 asks for the Personal Care provided at the DAHS facility. Set up help is information that would be appropriate to include on the form in this section. An example of set up help for eating (section IV-C) would be to unwrap all the food items, and place the food and utensils within reach for the individual. An example of set up help for bathing (section IV-E) would be to have all the items the individual needs for bathing set within the individual s reach. DADS suggests set up help be documented in section IV as One- Person Physical Assistance and then it be noted on the same line under Comments for One-Person Physical Assistance that it is set-up help. Q31: Are any of these forms going to affect the PHC/CAS or F/C programs? A31: No. Q32: When is the form 3050 not needed? And these forms are to be used for Title XX or all STAR+Plus as well? A32: Form 3050 is a required DAHS Form for DADS contracted programs. Yes, these forms are also used for Title XX DADS DAHS individuals. Consult your MCO for questions on required forms for DAHS individuals in STAR+Plus managed care. Q33: Where on 3050 are you supposed to document monthly frequency or is it a monthly assessment that we use? A33: All of the following sections on F3050 have a column for Frequency: Section IIIA, Special Treatments, Monitoring, and Intervention Ordered by Physician to be Administered at DAHS; Section IIIB, IIIC, IIID, and IIIE Medications; Section IIIF Therapies/Rehabilitation to be Administered at DAHS; Section IIIH Health Teaching, Training and Skill Practice. If a physician orders something monthly, then monthly would be noted in the frequency column. In addition Section IV Personal Care provided at the DAHS has a column for frequency. Q34: Does the 3055 need to be updated annually?

6 Page 6 of 6 A34: DAHS PM Section 5213, Physician Orders, indicates a new Form 3055 is needed upon initial request for DAHS. The current physician s orders and any supplemental orders on file must be accurately reflected in the individual s service plan. Form 3055, DAHS Physician Orders, form instructions indicate physician orders are completed for initial approval for DAHS, new orders as determined by the DAHS nurse due to changes in the individual's condition; and new supplemental physician's orders for nursing services. Q35: If client requires reminder to take medications, how would it be documented? Monthly/Daily? A35: Document monthly that the individual is reminded daily to take his/her medication. Q36: If client has an order for daily BP check, and client does not attend ADC on certain days, does facility nurse need to document that client did not attend ADC, therefore no BP check? A36: Document BP readings only on days it is taken. The attendance log would be used to verify the BP was not needed on a day in which the individual did not attend. Q37: Did you indicate that the nurse can identify needs in the 3049 that are reflected in the 3050 but are not necessarily reflected in the 3055? A37: Yes, needs identified during the assessment should be reflected on the individual plan of care and decision made by the nurse as to whether the physician needs to be advised of any new medically related issues not reflected in the physician s orders. The nurse can identify any skilled care needs on the Health Assessment (Form 3049); then an order for the skilled care should be obtained on the Physicians Orders (Form 3055); the skilled care provided at the DAHS should be documented on the Service Plan (Form 3050). Q38: So the clients that we already have don t need a 3049 unless they were enrolled after October? A38: No, starting in October 2013, all DADS DAHS providers must administer new DAHS Forms 3049, 3050 and 3055 for all DADS DAHS initial and ongoing individuals. Administration of the new DADS DAHS forms must be complete by Q39: Could 3055 be faxed? A39: Yes Q40: Does this form have to be filled out for home health aides at a home health agency? A40: No, these forms apply only to DADS DAHS initial and ongoing individuals.