All program transmittals: November 12 November 15, 2013

Transcription

1 All program transmittals: November 12 November 15, 2013 To go directly to the transmittal, mouse over the transmittal number (left column), hold down Ctrl, and click on the transmittal number. Transmittal # APD-PT Issue Subject/Topic date 11/12/13 Consideration of natural supports for K-option and State Plan Personal Care (SPPC) in-home service plans - To comply with the Center for Medicare and Medicaid Services (CMS), revisions have been made to the natural support portion of the Oregon Administrative Rules (OAR) in Chapter 411, Division 015. Chapter 411, Division 030 and Chapter 411, Division 034. See transmittal for full details. Natural Support Considerations: Do not factor in natural supports when determining service eligibility. Assess for natural supports related to the service plan only, not service eligibility. Once the individual is determined service priority level (SPL) 1-13 eligible, natural supports may be used to reduce the hours in the plan if the consumer is willing to continue receiving services from their natural supports, the natural supports are willing to provide the services and have the skills and abilities. To assist in the process Natural Supports, Putting the Puzzle Together added to the APD Case Management Tools. The direct web link this document is: This document is also located at the end of this transmittal. OARs associated with the revised natural supports are: (5) Current Limitations (19) Definitions (38) Definitions (25) Definitions Note: (9) and (10) will match the definition wording in (38) once these two rules are filed permanently.

2 APD-AR APD-IM APD-IM /12/13 Keys Amendment - Annual Public Notification of Standards for Residential Facilities - Please print and post the attached letter and rules summary in a public place during the month of December Section 1616(e) of the Social Security Act (the Keys Amendment) requires, in part, that States annually make available for public review a summary of standards (rules) developed for residential facilities. The facilities covered by this requirement provide both room and board and continuous protective oversight to SSI-eligible and other residents. Within the Oregon Health Authority and the Department of Human Services, both the Addiction and Mental Health Services and Aging and People With Disabilities and Developmental Disabilities programs have residential facilities providing these services. 11/15/13 Specific Need Contract Homes Statement of Work Declarations - Based on the Adult Foster Home Collective Bargaining Agreement, Appendix C, there has been a change to Specific Need Contract Homes who provide care for individuals with needs related to bariatric care, traumatic brain injuries, memory care, or have needs related to neurological or neuro-gerontological care. This change is memorialized in new contracts for existing providers who currently have Specific Need Contracts in Adult Foster Homes serving these populations and meet the intent of the article. See transmittal for Bargained rates for the new contract levels. The Specific Need Home Licensees have notified the Department which contract type they would like to continue to serve individuals under. No actions are required at this time related to this from Field Staff. Additional information regarding Statements of Work can be found at: See transmittal for a list of specific need contract AFHs and their declared chosen level. 11/15/13 Recruitment for Long Term Care Community Nursing Services - Request for Application (RFA) 3694 was released on November 14, 2013 for self-employed nurses who want to

3 provide Long Term Care (LTC) Community Nursing Services. Any nurse interested in this opportunity should check the Oregon Procurement Information Network (ORPIN) for additional information at Refer to Request for Application (RFA) Information will also be available in the Provider Alert section of the LTC Community Nursing website at Applications will be accepted from any county in Oregon if the nurse is willing to serve individuals with intellectual or developmental disabilities or a caseload that combines all eligible persons. If a nurse is not willing or able to provide services for individuals with developmental disabilities then the service areas which are open for this recruitment are limited to the counties listed in the transmittal. Community Developmental Disabilities Programs (CDDP) are encouraged to direct nurses willing to provide LTC Community Nursing Services to the ORPIN site listed above. CDDP management will be expected to assist in the orientation for successful applicants who complete the contracting and provider enrollment process and who plan to provide services to individuals in their county. Nurses who currently work for Children s Intensive In-Home Services (CIIS) and who want more referrals might be considered for this recruitment and if interested will need to apply for a second DHS contract and provider number. Local DHS and AAA offices in the counties noted above should direct nurses interested in serving aged or persons with disabilities to the ORPIN website. During this procurement process nurses can be directed to the following resources: Information on Long Term Care Community Nursing For questions related to ORPIN or the RFA process

4 SS-AR SS-IM SS-IM For questions related to business tax status, the NPI or enrollment form(s) 11/15/13 Case Splits and Good Cause for Noncooperation with Support - To ensure client safety, it is very important fore workers who are splitting cases review absent parents for good cause coding and add good cause coding to the absent parent on the newly created case at the time the case is split. Both cases must have the good cause coding. If good cause coding is not correctly coded on both cases, DCS could send information to the absent parent that could place the child, parent, or caretaker relative in danger. Action Required: When splitting cases, review for good cause coding on an absent parent; When good cause coding is on an absent parent, add good cause coding to that same absent parent on the new split medical case; Good Cause codes: o Code Y, to indicate there is good cause for non-cooperation with support; o - Leave blank to indicate that cooperation with support does not cause a safety risk. 11/15/13 New and Adjusted TANF Time Limit Screen - Adults and minor parent head of households who receive Temporary Assistance for Needy Families (TANF) are not eligible to receive cash benefits for longer than 60 months unless they meet certain exemptions. See transmittal for details, 11/15/13 Date of Request and Change Report for OCCS Medical Programs form - Effective immediately, the Date of Request (DOR) and Change Report for OCCS Medical Programs form (7210M) has been split into two forms: OCCS DOR form (7210M) will be used only to establish a DOR for OCCS medical programs; and Medical Change form (MEDC) will be used to communicate reported changes between DHS, AAA, and OHP Customer

5 Service (5503), and between DHS and AAA offices. 7210M s submitted prior to this change will still be honored. Duplicates should not be sent. 7210M - Date of Request for OCCS Medical Programs: The 7210M should be used for current OCCS or APD medical beneficiaries who want to reapply for benefits or who have experienced a change that appropriately establishes a DOR. The 7210M will be used internally within 5503 for DHS and AAA to send DORs to OHP Customer Service, and for DHS and AAA offices to send DORs to one another. The 7210M should not be used in the following scenarios: An individual not currently receiving OCCS or APD medical benefits. Provide a date-stamped 7210 Application for Health Coverage packet, including the application and the application guide, instead. An individual reports they are currently receiving benefits through the OMIP. Provide a date-stamped 7210 and write OPHP-OMIP on the top of the first page of the application. An individual is found eligible for TANF and also wants medical. TANF eligibility no longer guarantees medical eligibility. Be careful not to give the impression customers will be automatically eligible for medical programs; their eligibility will have to be determined using new policy as of 10/01/13. Provide a date-stamped 7210 instead. An individual wishes to add another individual, other than a newborn, to their medical case, and the individual is not currently receiving OCCS or APD medical benefits. This should be treated as a request for benefits, not a change report. Provide a date-stamped 7210 instead. There is record the individual has recently submitted a DOR or an application that is not yet been processed. If a DOR or application not been processed is found, customers should be referred to contact the OHP Customer Service for follow up. *Note: If 7210 Application for Health Coverage packet is needed, oc room@oce.oregon.gov. In the include: - Which form you would like to order (7210 packet);

6 - Quantity of English, quantity of Spanish; - Shipping address; and - Branch number. - Once the order is placed, you can expect delivery in 2-3 business days. MEDC - Change Report: Use the MEDC when: DHS/AAA Staff: To report a change in circumstances for individuals with a medical case at OHP Customer Service. OHP 5503: Use to report a change in circumstances to DHS/AAA when individuals with an OCCS medical case are receiving DHS/AAA program benefits. To send: To send forms to OHP Customer Service, fax completed forms to Do not the form. If unable to fax to OHP 5503, 7210s, 7210Ms, and MEDCs may be sent via shuttle or mail. 1. Review document for urgent medical need or pregnancy. If the document identifies urgent medical need or pregnancy, it must be faxed to allow it to be prioritized. 2. If the document does not identify urgent medical need or pregnancy, shuttle 5503 or mail to OHP Customer Service at the following address within the same or next business day: Mail to: Oregon Health Plan PO Box Salem, OR To send forms to DHS (SSP and APD)/AAA, completed forms to the appropriate branch case transfer box.