ISP Manual Lesson 4: Service Implementation, Utilization, and Monitoring. Welcome to the fourth lesson in the ISP Manual 2012 Update course.

Transcription

1 Welcome to the fourth lesson in the ISP Manual 2012 Update course. 1

2 This webcast includes spoken narration. To adjust the volume, use the controls at the bottom of the screen. While viewing this webcast, there is a pause and reverse button that can be used throughout the presentation. The written version of the narration appears to the right of the screen. 2

3 Hello. My name is Jennifer Fraker. I will be the presenter for lesson 4. I am a Human Service Program Specialist Supervisor for the Office of Developmental Programs. I supervise the Individual Support Planning Unit in the Bureau of Supports for People with Intellectual Disabilities. A few of the responsibilities of the Individual Support Planning Unit are to oversee and manage the supports coordination organization qualification and monitoring process, Individual Support Plan, and the Supports Intensity Scale and PA Plus. 3

4 Certificates of Achievement will be available to the Administrative Entities and provider staff as well as Supports Coordinators and SC Supervisors after completing all course requirements. For SCs and SC Supervisors, course requirements include successful completion of a pretest and a post test. Please view and then save or print your certificate in order to receive credit for this course. 4

5 As we continue this training on the ISP Manual, it is important to note that the manual is one attachment to the ISP Bulletin. In order to have a thorough understanding of the requirements for the development and implementation of Individual Support Plans, your review of the bulletin and listed attachments is necessary in addition to completing this training. This training supports but does not replace the actual content and information contained in the ISP Manual. 5

6 This lesson will focus on Service Implementation,. It will compromise of: Section 7 Implementation of Services Section 8 Addressing Changes in Need throughout the Year Section 9 Updating ISPs Section 10 Service Utilization and Section 11 Monitoring of Services Please take a moment and review the objectives for this lesson on the slide. 6

7 Authorized Waiver services should begin with reasonable promptness to ensure the health and safety of the individual. The reasonable promptness standard is forty five (45) calendar days after the effective date of the Waiver enrollment date, unless otherwise indicated in the ISP. Authorized services must also be implemented as written per the current approved ISP, including the type, amount, frequency, and duration listed in the Outcome Actions section of the ISP. Those responsible for service implementation are accountable for services as indicated in the ISP, and are responsible for documentation to support the provision of services as per Department standards referenced in 55. Pa. Code, Chapter 51 Office of Developmental Program s Home and Community Based Services Regulations. 7

8 Section 9 of the ISP Manual describes how to update an ISP. ISP Teams should review services at least annually and as needs change throughout the year unless the service requires a 6 month review. As previously discussed in lesson 3, services that require a 6 month review are: residential habilitation (licensed and unlicensed), job finding, and pre vocational. ODP requires that this 6 month review will be conducted and documented using the bi annual format. It is important to emphasize that ISP decisions made by teams, Bureau of Hearings and Appeals (BHA) or the Secretary of Public Welfare, are specific to the circumstances or needs of the individual at the time the decision was made and, in most cases, are not considered permanent or lifetime decisions. It is expected that these types of ISP decisions are revisited at least annually at the Annual Review ISP Meeting. If, at any time, the team or AE who is expected to authorize services based on individual needs, determines the services that were included in the ISP as a result of previously made decisions are not needed, it is expected that the ISP be revised to reflect the current needs. 8

9 There are seven ISP formats in HCSIS that are used in creating and updating ISPs. It is recommended that if any of the ISP formats are utilized, all information and/or changes known at the time such as demographic changes be completed as well. The SC is the person responsible for creating and updating ISPs in HCSIS using one of the seven formats. The following slides will cover the seven ISP formats in HCSIS. 9

10 Which format is to be used when creating an ISP for the first time in HCSIS or when there is not a current ISP in HCSIS? Please answer the question, and click submit. 10

11 Yes, that is correct. Use the Plan Creation format in HCSIS when developing an ISP for the first time. A fiscal year renewal is used to renew the ISP for the following fiscal year. The ISP will reflect a fiscal year begin date of July 1 st and a fiscal year end date of June 30 th. The start date of the HCSIS ISP coincides with the start date of the fiscal year, or July 1 st. The fiscal year ISP expires at the end of the fiscal year, or June 30 th. ISPs are based on a fiscal year basis in order to create service authorizations that encompass the full fiscal year. The ISP created through a fiscal year renewal will pre populate with information from the previous ISP. Therefore, care should be taken to ensure all information including services continue to be accurately reflected. This process of renewing plans on the fiscal year promotes efficiency in provider billing, as well as the ability to generate reports that accurately reflect all services and payments by fiscal year. Additionally, as major changes to the waivers typically occur at the beginning of the fiscal year, it allows for easier maintenance of any changes that are made. 11

12 Match the ISP format to it s description by clicking and dragging the format. Click submit when finished. 12

13 Select all of the statements that correctly identify when to use the Annual Review Update ISP format in HCSIS, and then click submit. 13

14 In thinking about services and supports, there are four key pieces of information that need to be documented in the ISP. They are the type, frequency, duration, and amount of the service and support. Match the term to it s correct definition, and click submit. 14

15 There may be times when an individual experiences a change in need throughout the year. This could be due to things such as illness, injury, or a change in living arrangement. Individuals enrolled in one of the waivers must have his or her assessed needs addressed within the scope and limitation of the applicable waiver. The change in need must be reflected in the individual s ISP. 15

16 Select all of the statements that correctly identify the SC s role when an individual has a change in need. When finished, click submit. 16

17 Within seven (7) calendar days of verification of the change in need that impacts currently authorized services or funding, a Critical Revision format in HCSIS will be used. The SC will update the ISP and submit it for approval and authorization, as applicable. If the change in need does not impact services or funding, a General Update format in HCSIS will be used. This format is used to update information in the ISP and does not require any additional approval process. The PUNS should also be updated as appropriate. More information regarding PUNS will be discussed in Lesson 5. 17

18 When a change in need will cause an individual enrolled in the P/FDS Waiver to exceed the P/FDS cap, the individual should be considered for enrollment in the Consolidated Waiver. If capacity is not available, a PUNS should be initiated to assess the needs. If a request for an exception to exceed the established limits or service conditions as detailed in the approved Waiver service definitions, a Request for an Exception to established limits or maximum number of service units (DP 1023) form must be completed by the Supports Coordination Organization and forwarded to the appropriate AE who will review it and forward it to the appropriate Regional Program Manager. 18

19 The AE must approve and authorize or deny the revised ISP within 14 calendar days. If new services or funding is denied by the AE, the AE must provide the individual with information regarding their due process rights. 19

20 Service utilization is one important piece of ISP development. Service utilization can be seen in HCSIS by looking at the Service Details screen or by requesting the Individual s Expense Summary Report. HCSIS info represents claims approved for payment, not necessarily services delivered. 20

21 Please answer the question, and click submit. 21

22 Please answer the question, and click submit. 22

23 The SC s role in service utilization is to monitor and verify the type, duration, amount and frequency of services and supports outlined in the ISP on a regular basis and summarize that information on an annual basis. The SC should have conversations about service utilization with the individual, family, provider and ISP team. There are five guiding principles that should be addressed when looking at service utilization on a particular ISP. They are: 1. Determine if the designated service has the desired effect to address the specified need, which promotes achievement of an outcome. 2. Determine if there is an established limit associated with the service. 23

24 3. Determine that units on the ISP are necessary based on the individual's current needs and not above the established limit. 4. Previous year s utilization should be reviewed. 24

25 5. Service utilization should be reviewed as one of the ways to assist determining continued need and skill attainment. The team should also look at the frequency and duration section of the Outcome Actions to ensure that the service is being delivered as it should be. The SC should document these conversations in the individual s service notes and monitoring tools in HCSIS. Documentation should include the reason for any under or over utilization that has occurred. Once the ISP is implemented, there may be times when someone over or underutilizes services and supports. This is when an individual receives more or less of a service than originally planned for. The next four slides present the types of service utilization issues that could occur. 25

26 Question A life event has occurred for the individual that is a permanent change in his service need. What type of service utilization issue is this? Please answer the question, and click submit. 26

27 Question The individual is frequently not home when service delivery is identified in the ISP to occur. What type of service utilization issue is this? Please answer the question, and click submit. 27

28 Question A family member that is a caregiver for the individual is hospitalized for a minor surgery. What type of service utilization issue is this? Please answer the question, and click submit. 28

29 Question Billing is not occurring regularly or successfully so that services rendered are not reflected when looking at utilized units. What type of service utilization issue is this? Please answer the question, and click submit. 29

30 Question In the ISP, the individual is authorized to receive a service 3 times a week. The service notes indicate that the service is only being provided twice a week. What type of service utilization issue is this? Please answer the question, and click submit. 30

31 Recognizing the type of service utilization issue that is occurring helps to identify the direction of resolution. 31

32 ODP exercises oversight of ISPs through its Monitoring Processes to ensure that ISPs are: implemented as written include implementation of services and Outcomes and ensures that ISPs for Waiver individuals are developed in accordance with the current approved Waivers. SC monitoring of services, as documented in the approved and authorized ISP, verifies that the individual is receiving the appropriate type, amount, duration and frequency of services to address the individual s assessed needs and desired outcomes. 32

33 For waiver participants, SC monitoring must take place at the minimum frequency outlined in the current, approved Consolidated and P/FDS Waivers, Appendix D 2, Service Plan Implementation and Monitoring. For individual s enrolled in the Consolidated Waiver, the SC should monitor at a minimum of three face to face visits in a three month span. One of the face to face visits needs to occur at the individual s residence. One of the three visits needs to occur at the individual s day service. And one of the three visits needs to occur at any place agreeable to the individual. If the individual does not receive a day service, then two of the three visits can occur at any place agreeable to the individual. 33

34 Monitoring frequency for individual s enrolled in the P/FDS waiver is dependent upon whether the individual lives with a family member or not. If the individual lives with a family member, the SC must have face to face contact with the individual at least once every 6 calendar months. One of the two face to face monitorings must be conducted at the individual's home. At least every 3 calendar months, contact can be via a phone call. For individuals in any other living arrangement including but not limited to their own home, personal care homes or in a domiciliary care home, the SC needs to have contact with the individual every month. At least every 3 calendar months the SC needs to conduct a faceto face monitoring. At least one of the face to face monitoring visits every 6 calendar months must take place in the individual s home. 34

35 If the SC has contact with the individual and monitors at the minimum frequency and location that was just reviewed, that is considered statutory monitoring. It is statutory because what is defined in the Waivers is being adhered to. Any deviations of the minimum monitoring frequency is considered non statutory. The only individuals that may request a deviation outside of the minimum monitoring frequency are those that live at home with their family members. Deviations that involve monitoring at a frequency less than what is identified in the approved Waivers must be approved by ODP. For more information, please refer to ODP Informational Packet # titled, Instruction on Request for Deviation in Monitoring Frequency. 35

36 Please be reminded that Certificates of Achievement will be available to Administrative Entity and provider staff as well as Supports Coordinators and SC Supervisors after completing all course requirements. For SCs and SC Supervisors, course requirements include successful completion of a pretest and a post test and viewing then saving or printing your certificate. Please return to where you initiated this webcast to complete the course requirements and access the Certificate. 36

37 You have completed the Service Implementation, lesson. Addressing changes in need was reviewed. How to update an ISP was identified. Service Utilization was explained and Monitoring requirements were described. The next lesson to view is Specific Waiver Policies and Resources. Thank you for participating in this lesson. 37