A review of medical consent requirements and the Georgia Families 360 program required timelines for services and assessment

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1 A review of medical consent requirements and the Georgia Families 360 program required timelines for services and assessment Amber Hammontree, LPC Clinical Trainer Georgia Families 360 GAPEC March 2016

2 Learning objective for informed medical consent To review informed medical consent The elements of informed medical consent Discuss who can provide medical consent for youth in the Georgia Families 360 (GF 360 ) program 2

3 What is informed medical consent? Informed medical consent is the process by which the treating health care provider discloses appropriate information to a competent patient or legal guardian so that the patient or guardian may make a voluntary choice to accept or refuse treatment. 3

4 Informed medical consent (cont.) The elements of informed consent include a discussion about the following: The nature of the decision/procedure Reasonable alternatives to the proposed intervention The relevant risks, benefits and uncertainties related to each alternative Assessment of patient or legal guardian understanding The acceptance of the intervention by the patient or legal guardian 4

5 Informed medical consent and Division of Family and Children Services youth The Division of Family and Children Services (DFCS) is the medical consenter for all youth (under the age of 18) in the custody of DFCS since they have been granted legal guardianship by the judicial system. DFCS may allow/request an alternate individual (e.g., foster parent or group home staff) to accompany the youth to medical appointments, however, all medical related decisions need to be approved by DFCS prior to the start of treatment. (This includes changes of medications, approval of provider changes and changes in the treatment or frequency. 5

6 Informed medical consent and DFCS youth (cont.) Since DFCS is the legal guardian, Amerigroup Community Care cannot release personal health information (PHI) to other individuals unless authorized by DFCS. This includes changes to the designated primary care physician (PCP) or providing the Amerigroup member identification number. 6

7 Informed medical consent and DFCS youth (cont.) When DJJ detains a youth, they are responsible for making decisions about where the youth is placed during the detainment. DJJ does not assume parental custody of the youth. The youth s parent/ legal guardian remains the primary caretaker of the youth. Since DJJ does not assume parental custody, the youth s parent/legal guardian would need to approve the start of treatment. The youth s Juvenile Probation Parole Specialist (JPPS) would be made aware of treatment related concerns in order to ensure the health and safety of the youth during the detainment. 7

8 Learning objectives for required timelines for services and assessment for youth entering DFCS custody Understanding the timelines for new members entering the Georgia Families 360 program Learning about the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) exam, routine dental cleanings and Trauma Assessments (TA) To review ongoing care for Georgia Families 360 members 8

9 Timelines for Georgia Families 360 members entering care When new members enter the GF360 program, they are assigned to their Regional Care Coordination team (CCT). The initial contact from the GF360 CCT will be made by the intake and compliance team (ICT). The ICT will contact the member s DFCS case manager (DFCS CM) and placement provider to start the initial appointment process. 9

10 Timelines (cont.) The ICT will assist with scheduling the initial medical (EPSDT exam), dental cleaning and trauma assessment. The ICT will assist with identifying providers in the area of the placement and ensure that the appointments are completed within the specified time frames. 10

11 Medical, dental and trauma assessment timelines Appointment type Early Periodic Screening, Diagnosis and Treatment (EPSDT) exam Dental cleaning Trauma assessment Days to complete the appointment 10 days from eligibility date 10 days from eligibility date 15 Days from eligibility date EPSDT exams are completed for all members Dental cleanings start at age 3 Trauma assessments are completed with members age 5 and older 11

12 Timelines (cont.) Once the ICT has ensured that all of the initial appointments have been completed, the member is transitioned to the ongoing GF360 CC. The GF360 CC will contact the member s DFCS CM and them the member s welcome letter. This letter will contain the member s Amerigroup identification number and the GF360 CC s contact information. The GF360 CC will review the member s medical, dental and behavioral health needs with the DFCS CM and/or the placement provider in order to complete the initial assessment, health risk screener and individualized care plan. 12

13 Welcome letter initial assessment, health risk screener and individualized care plan Letter/Assessment Welcome letter sent to DFCS CM Individual assessment Health risk screener Individualized care plan Days to complete Within 30 days of eligibility date Within 30 days of eligibility date Within 30 days of eligibility date Within 30 days of eligibility date 13

14 What is an EPSDT exam? The EPSDT exam is the child health component of Medicaid that is completed for all children under age 21. The EPSDT exams are completed at different intervals depending on the member s age. It is designed to address problems early, improve conditions and intervene as early as possible. Early Periodic Screening Diagnosis Treatment Identifying problems early, starting at birth Checking children's health at periodic, age-appropriate intervals Doing physical, mental, developmental, dental, hearing, vision and other screening tests to detect potential problems Performing diagnostic tests to follow up when a risk is identified Treating the problems found 14

15 EPSDT exam (cont.) EPSDT exam includes: Health & developmental history Physical examination Immunizations appropriate to age and health history Assessment of mental/behavioral health Family planning services and adolescent maternity care TB risk review and skin test Nutrition review Vision and hearing screening Dental referrals 15

16 Periodicity Table INFANCY EARLY CHILDHOOD MIDDLE CHILDHOOD ADOLESCENCE AGE 1 Prenatal 2 Newborn d 4 By 1 mo 2 mo 4 mo 6 mo 9 mo 12 mo 15 mo 18 mo 24 mo 30 mo 3 y 4y 5 y 6 y 7 y 8 y 9y 10 y 11 y 12 y 13 y 14 y 15 y 16 y 17 y 18 y 19 y 20 y 21 y HISTORY Initial/Interval MEASUREMENTS Length/Height and Weight Head Circumference Weight for Length Body Mass Index 5 Blood Pressure 6 SENSORY SCREENING Vision 7 Hearing 8 DEVELOPMENTAL/BEHAVIORAL ASSESSMENT Developmental Screening Autism Screening Developmental Surveillance Psychosocial/Behavioral Assessment Alcohol and Drug Use Assessment 11 Depression Screening 12 PHYSICAL EXAMINATION 13 PROCEDURES 14 Newborn Blood Screening 15 Congenital Heart Defect Screening Critical 16 Immunization 17 Hematocrit or Hemoglobin 18 Lead Screening 19 or 20 or 20 Tuberculosis Testing 21 Dyslipidemia Screening 22 STI/HIV Screening 23 Cervical Dysplasia Screening 24 ORAL HEALTH 25 or or or or Fluoride Varnish 26 ANTICIPATORY GUIDANCE 16

17 Ongoing care Once the initial appointments have been completed, the GF360 CC will continue to monitor the completion of routine EPSDT exams and dental cleanings. The GF360 CC will assist with scheduling EPSDT exams according to the periodicity table and dental cleanings every six months. 17

18 Questions 18