Welcome The Freedom to Succeed
|
|
- Neal Cunningham
- 5 years ago
- Views:
Transcription
1 Welcome The Freedom to Succeed Liberty Healthcare PCS Provider Training May 2016
2 AGENDA 9:00-9:15 am Welcome and Introductions Denise Hobson, Director of Clinical Services Liberty Healthcare 9:15-9:45 am Review of PCS Policy Requirements 9:45-10:40 am Understanding the Beneficiary s Assessment Lyneka Judkins, Chief Operations Officer Liberty Healthcare Denise Hobson, Director of Clinical Services Liberty Healthcare 10:40-11:00 am Break 11:00 11:15 pm Proposed Policy 3L and Eligibility Updates Lyneka Judkins, Chief Operations Officer Liberty Healthcare 11:15 11:30 am Internal DMA Audit Lyneka Judkins, Chief Operations Officer 11:30 12:30 pm Q&A Session Liberty Healthcare 2
3 Review of PCS Policy Requirements (Interactive Presentation) The Freedom to Succeed
4 Test Your Knowledge 4
5 PCS ICD-10 Transition Forms When is an ICD-10 Transition Form required for a beneficiary? Before their annual review if scheduled after 10/1/2015 What are the two ways a provider may submit the transition form to Liberty? Fax or Upload into QiReport Where are the 3 places a PCS Provider can locate an ICD-10 Transition Form? DMA Website, LHC Website, Annual Notification Letter 5
6 PCS ICD-10 Transition Form Completed forms can be submitted to Liberty in one of two ways: Fax The PCS Provider or Practitioner can fax the form directly to Liberty at Upload The PCS Provider can upload the completed form to Supporting Docs through the provider portal. 6
7 PCS ICD-10 Transition Form To upload the Transition Form through the provider portal, select the Referrals tab on the top toolbar, then click Supporting Docs from the left index bar: 2. Select Supporting Docs to upload form. 1. Select the Referrals tab. 7
8 PCS ICD-10 Transition Form Where is the DMA 3137 PCS ICD-10 Transition Form located? 1. Liberty website: 2. N.C. Division of Medical Assistance (DMA) PCS webpage under Forms. 8
9 Completing the Service Plan How many days does the PCS Provider have to complete the required Service Plan? 7 Business Days How many days does the PCS Provider have to get the completed Service Plan signed and uploaded into QiReport? 14 Business Days When is a Service Plan required for a beneficiary? Every time a PCS Provider receives and accepts a referral in QiReport How should the PCS Provider proceed when the amount of approved hours does not match the hours reflected in the assessment? Complete a manual Service Plan, upload into QiReport, and Call Liberty 9
10 Discharges How many days does the PCS Provider have to complete a discharge when the beneficiary is no longer under their care? 7 Business Days How does a PCS Provider discharge a PCS beneficiary? Through QiReport If the beneficiary is not approved for PCS that is reimbursed by Medicaid, but remains under the care of the PCS Provider, do they have to discharge in QiReport? Yes. Does the PCS Provider need to discharge a beneficiary if they are hospitalized for a brief time? If the beneficiary has been approved for PCS and the PCS Provider will resume care once the beneficiary is discharged from the hospital, then a discharge is NOT required in QiReport 10
11 Discharges The PCS Provider is required to discharge a beneficiary from QiReport if they are no longer providing PCS that is reimbursed through Medicaid. 2. Select Discharge to discharge beneficiary. 1. Select the Referrals tab. 11
12 Provider Acceptance How many days does the PCS Provider have to respond to a referral for PCS? 2 Business Days What happens if the PCS Provider does not respond in 2 business days? The referral will be rejected and the next provider selection will be sent a referral Where can the PCS Provider locate their referrals and respond? In QiReport on the Referrals page Does the time the PCS Provider takes to accept a beneficiary effect their PA s? Yes. PA s are made effective based off of the provider acceptance date, with exception of initial assessments. 12
13 Provider Acceptance The PCS Provider should check their Referrals tab daily for any new PCS referrals. 2. Select beneficiary to accept/reject. 1. Select the Referrals tab. 13
14 Preadmission Screening and Resident Review (PASRR) Who requires a PASRR screen? Any Medicaid beneficiary seeking admission into an Adult Care Home after January 1, 2013; including those who are private pay and become Medicaid eligible after this date. Who does not require a PASRR screen? Any individual who was admitted into the Adult Care Home prior to 1/1/2013 regardless of payer, private pay individuals, and those who reside in the 5600 A or C settings What is the purpose of the PASRR screen? To evaluate for serious mental illness If a beneficiary is transferred from a nursing home to an Adult Care Home and has a PASRR with an A code, do they require another PASRR? Yes; the beneficiary must have a PASRR with an Adult Care Home code. 14
15 Preadmission Screening and Resident Review (PASRR) The following are acceptable Adult Care Home Codes for PASRR: 15
16 Quality Improvement Program What form is required to be completed and submitted to DMA? DMA 3136 Internal Quality Improvement Program Attestation Form The DMA 3136 Form is required to be submitted by what date? December 31 st of each year 16
17 Quality Improvement Program What are the requirements for the PCS Provider regarding an Internal Quality Improvement Program? Develop, and update at least quarterly, an organizational Quality Improvement Plan or set of quality improvement policies and procedures that describe the PCS CQI program and activities; Implement an organizational CQI Program designed to identify and correct quality of care and quality of service problems; Conduct at least annually a written beneficiary PCS satisfaction survey for beneficiaries and their legally responsible person; Maintain complete records of all CQI activities and results; 17
18 Understanding the Beneficiary s Assessment
19 Where It All Starts.. PCS request is dropped in QIR queue for scheduling Scheduling schedules visit with the beneficiary and time and date are established Assessor receives the assignment and contacts beneficiary the day before to confirm appointment Assessor conducts the assessment based on the beneficiary s demonstrated ability to perform ADLs Assessor submits the assessment and a decision generates 19
20 What The Assessor Captures In An Assessment Available caregivers Daily medicine regimen Diagnosis information Paid supports/non Paid supports Demonstrations of a beneficiary s ability to perform their activities of daily living (ADLS) 20
21 What The Assessor Captures In An Assessment Special assistive tasks Exacerbating conditions that impact their ability to perform their ADLs Home safety evaluation Provider choice Need frequency 21
22 Activities of Daily Living (ADLs) Bathing Dressing Mobility Toileting Eating 22 22
23 Understanding Assessment Fields Demonstrated Ability Beneficiary attempts to demonstrate how they would perform an ADL task. Check If Required Assistance Level IADL Task Needs Frequency Need Fully Met PCS Need Frequency Weekend The beneficiary requires assistance to complete task. Level of assistance the beneficiary requires to complete the task. Identified if there is an assistance need for the indicated ADL. Number of days the beneficiary performs the task. Number of days the beneficiary has an alternate caregiver other than the PCS aide to assist with meeting the need. Auto-populated number of days of unmet need for PCS service. Task need is inclusive of weekend need. 23
24 24
25 Bathing: What Is Assessed? A beneficiary s ability to demonstrate/perform the following tasks: Bathe by means of shower, tub bath, bed bath,or sponge bath Hair care - shampooing and combing hair Nail care - cleaning/cutting nails Skin care - applying lotion/washing hands and feet Mouth care - brushing teeth, dentures etc. and reinserting Shaving - face, legs, axilla (armpit) areas 25
26 Bathing Section 26
27 Dressing: What Is Assessed? A beneficiary s ability to demonstrate/perform the following tasks: Don clothing/socks/shoes Remove clothing/socks/ shoes Manage clothing and shoe fasteners Manage TEDS (compression stockings) - removing and applying Manage splints/bracesremoving and applying Manage - removing and applying Manage prostheticsremoving and applying 27
28 Dressing Section 28 Factoid: TED is an acronym for thromboembolism-deterrent hose!
29 Mobility: What Is Assessed? A beneficiary s ability to demonstrate/perform the following tasks: Transfer to/from the bed Transfer to/from chair Ambulate room to room by limb or assistive device Negotiating stairs within the home only to areas of service provision Perform range of motion (ROM) Turn and reposition in bed 29
30 Mobility Section 30
31 Toileting: What Is Assessed? A beneficiary s ability to demonstrate/perform the following tasks: Remove /pull up/ fasten garment Perform hygiene after toileting/incontinence Transfer to and from the bedside commode or toilet 31
32 Toileting Section 32
33 Eating: What Is Assessed? The beneficiary ability to demonstrate/perform the following tasks: Cutting food Ability to feed self Use of utensils Ability to lift limb to mouth Ability to perform tube feedings Ability to clean meal service area Clean utensils/dishes/empty trash Perform meal prep: opening packages Perform meal prep: heat and assemble food 33
34 Eating Section 34
35 Special Assistive Tasks: What Is Assessed? A beneficiary s ability to demonstrate/perform the following tasks: Break up fecal impactions IV fluids O² therapy Ostomy Sterile dressing changes Suctioning Urinary catherization Wound irrigation Tube feeding and g tube management 35
36 Delegated Medical Monitoring Tasks A beneficiary s ability to demonstrate/perform the following tasks: BP monitoring Blood glucose monitoring Med self-administration reminders Other treatment monitoring IV fluids 36
37 Delegated Medical Monitoring Tasks 37
38 Special Assistive Tasks Section 38
39 Conditions Affecting Beneficiary ADL Performance/Assistance Time Exacerbating conditions or conditions affecting ADL performance allow the assessor to identify those that affect the beneficiary s ability to perform their ADLs. All body systems are covered in these conditions: Respiratory System Cardiovascular Gastrointestinal Neurological Behavioral Sensory Impairment, and Musculoskeletal system 39
40 Conditions Affecting ADL Performance Time 40
41 Safety And Environmental Conditions 41
42 Provider Choice /Return Frequency 42
43 How Does The Beneficiary Qualify For Services? The beneficiary must have: At least 3 Limited Overall Self -Performance Capacity Ratings out of the 5 ADLs and have unmet needs. At least 1 extensive or greater overall self performance capacity and one or more limited assist or greater overall self performance capacity and have unmet needs. 43
44 How Many Hours Can A Beneficiary Receive? 80 Hours For a beneficiary who does not meet the criteria for Session Law Hours EPSDT on the initial assessment hour generation. All EPSDT assessments go to DMA for final hour calculation/evaluation Up to 130 Hours For a beneficiary who meets the criteria for Session Law
45 BREAK
46 Proposed Policy 3L and Eligibility Updates
47 Proposed Policy 3L & Eligibility Updates Policy 3L has been revised and will be open for public comment; The proposed policy will be located on the DHHS website here: Finalized changes will go into effect July 1, 2016; Questions about proposed changes should be submitted through the public comment page or via at 47
48 Proposed Policy 3L & Eligibility Updates Section Medicaid not covered specific criteria Medicaid shall not cover PCS when: 13. Independent medical information does not validate the assessment, PCS hours may be reduced, denied, or terminated based on the additional information. *13. added to existing Medicaid not covered specific criteria. 48
49 Proposed Policy 3L & Eligibility Updates Section EPSDT Additional Requirements for PCS Medicaid may authorize services that exceed the PCS service limitations if determined to be medically necessary under EPSDT based on some or all of the following documents submitted by the provider before PCS is rendered: a. Work and School verification, where applicable, for the beneficiary s caregiver, legal guardian, or power of attorney.. b. Verification from the Exceptional Children s program per county if PCS is being requested in school setting; or c. Health record documentation or d. Physician documentation of primary caregiver s limitation that would prevent the caregiver from caring for the beneficiary, if applicable. e. Any other independent records that address ADL abilities and need for PCS. If additional information does not validate the assessment, PCS hours may be reduced, denied, or terminated based on additional records. 49
50 Proposed Policy 3L & Eligibility Updates Section Requirements for PCS Expedited Assessment Process To qualify for the expedited process the beneficiary shall: a. be medically stable; b. eligible for Medicaid or pending Medicaid eligibility; c. have a Pre-Admission Screening and Resident Review (PASRR) if seeking admission to an Adult Care Home licensed under G.S. 131 D-2.4; d. in process of being discharged from the hospital following a qualifying stay; e. in process of being discharged from a skilled nursing facility; f. be under adult protective services; or g. be an individual served through the transition to community living initiative *LME MCO transition coordinators are responsible for requesting the expedited PCS process for individuals served through the transition to community living initiative. 50
51 Proposed Policy 3L & Eligibility Updates Pettigrew v. Brajer (Pashby v. Wos) PCS will be amended to include additional program requirements agreed upon in this settlement; identified action items include: Updates to Eligibility Criteria Implementation of a Reconsideration Process Reinstatement and Reassessment of Qualifying Individuals 51
52 Proposed Policy 3L & Eligibility Updates Pettigrew v. Brajer (Pashby v. Wos) Updates to Eligibility Criteria: The Settlement requires that DMA will assure the PCS eligibility criteria is the same regardless of residential setting. In Adult Care Homes clean-up and basic meal preparation tasks are covered services paid for by State/County Special Assistance. Effective July 1, 2016, clean-up and basic meal preparation services that duplicate State/County Special Assistance (Section M, tasks 6-9 on the assessment) will be scored as needs met. 52
53 Proposed Policy 3L & Eligibility Updates Pettigrew v. Brajer (Pashby v. Wos) Implementation of a Reconsideration Process: Beneficiaries 21 and older who receive an initial approval for less than 80 hours per month may submit a Reconsideration Request to the IAE if they do not agree with the initial level of service determined. Section 5.6 Reconsideration Request for Initial Authorization for PCS 53
54 Proposed Policy 3L & Eligibility Updates Section 5.6 Reconsideration Request for Initial Authorization for PCS When is reconsideration appropriate? The request for increasing hours above the initial approval are not based on a Change of Status; The beneficiary is able to provide supporting documentation that specifies, explains, and supports why additional authorized hours of PCS is needed and which ADLs and tasks are not being met with the current hours. *Form and instructions will be made available on the DMA website. 54
55 Proposed Policy 3L & Eligibility Updates Section 5.6 Reconsideration Request for Initial Authorization for PCS The Process: 1. After receiving an initial approval for an amount of hours less than 80 hours per month, a beneficiary must wait 30 days before submitting a request for reconsideration. 2. The beneficiary must submit a request to increase hours above the initial approval no earlier than 31 calendar days and no later than 60 calendar days from the date of the approval notification. 3. The Request for Reconsideration form and supporting documentation should provide information indicating why the beneficiary believes that the prior assessment did not accurately reflect the beneficiary s functional capacity or why the prior determination is otherwise insufficient. 55
56 Proposed Policy 3L & Eligibility Updates Section 5.6 Reconsideration Request for Initial Authorization for PCS The Process: 4. Upon receipt of a completed reconsideration request for additional hours, a reassessment may be scheduled or the previous assessment modified. A reconsideration request is not considered complete without supporting documentation as indicated in 5.6(d). 5. If the reconsideration determines a need for additional PCS hours, additional hours will be authorized according to Policy. This constitutes an approval and no adverse notice or appeal rights are provided. The provider will have to complete a new service plan. 6. If the reconsideration determines that the PCS hours authorized during the initial assessment are sufficient to meet the beneficiary s needs, an adverse decision will be issued with appeal rights. 56
57 Proposed Policy 3L & Eligibility Updates Pettigrew v. Brajer (Pashby v. Wos) Reinstatement and Reassessment of Qualifying Individuals: Those denied or terminated under Clinical Coverage Policy 3L, prior to the amendment effective 7/1/16 whom: Were determined to have cognitive impairment or a mental health diagnosis with no third party present during the assessment; and Were denied or terminated due to receipt of hospice services. 57
58 Proposed Policy 3L & Eligibility Updates Pettigrew v. Brajer (Pashby v. Wos) Qualifying Individuals for Reinstatement or Reassessment will be: Sent a letter with instructions on how to begin the process; If previously terminated from PCS, reinstated at the hours prior to termination (will be reassessed within 6 months under PCS policy effective 7/1/2016); If previously denied PCS, reassessed under PCS policy effective 7/1/
59 Proposed Policy 3L & Eligibility Updates Pettigrew v. Brajer (Pashby v. Wos) Reinstatement and Reassessment of Qualifying Individuals, the PCS Provider must: Accept the referral from the beneficiary once the reinstatement is processed; and Provide Medicaid with a PCS ICD-10 Transition Form before the provider can bill Medicaid for your PCS services. However, this does not need impact effective start days for services. *Providers may see the beneficiary displayed in their portal, but services should not begin until after formal acceptance and delivery of an approval letter. 59
60 Provider Manual New Version Coming July 2016! Located on the Liberty Healthcare website at: Will include all new policy updates in addition to a few revisions. 60
61 PCS Internal Audit The Freedom to Succeed
62 PCS Internal Audit In spring of 2015, PCS underwent an internal audit conducted by Office of the Internal Auditor (OIA). This audit was concluded in July of Two areas of concern identified by OIA were Supervisory Visits and Aide Training requirements. As a result of the PCS program internal audit, DMA began conducting audits of PCS providers in January
63 PCS Internal Audit The PCS internal audit is an independent audit conducted by DMA PCS nurse consultants and is not associated with DMA Program Integrity (pre or post-payment review). Although, this audit process is independent from Program Integrity; audit findings that are non-compliant with the PCS policy will be reported to DMA Program Integrity. 63
64 PCS Internal Audit Process PM Receives random sample of Beneficiaries for identified Month DMA verifies Provider Fax Number and Contact Information Forwarded to DMA Staff Faxed to DMA within 5 Calendar Days by Provider DMA Requests by Fax specific documents from Provider for RN Supervisory Visits and PCS Aide Training DMA Completes QI Parameter Review Tool for each Beneficiary in sample Results will be documented internally by DMA PM Review of Provider Compliance DMA will follow up with the Provider for any missing documentation Faxed to DMA within 2 Calendar Days by Provider Providers determined not in Compliance submitted to PI Providers may request the results of their audit two weeks after submission of documentation 64
65 PCS Internal Audit DMA will conduct the PCS internal audit on a quarterly basis; randomly selecting between beneficiaries each quarter for review of Supervisory visits and/or Aide Training Requirements. Providers will have five (5) calendar days from the date of contact to submit documentation via fax to DMA. Providers are contacted via telephone call with a follow-up fax sheet that requests required documentation. 65
66 PCS Internal Audit Documentation on Supervisory visits will be audited based on PCS Clinical Coverage Policy Section 7.10 b. (1-9). Documentation on Aide Training Requirements will be audited based on PCS Clinical Coverage Policy Section (a g). Providers must submit corresponding aide task sheet for date requested by DMA staff. * Aide Training documentation requested for residents who reside in an Adult Care Home will be requested for first shift aides on the date requested. 66
67 Question and Answer Session
68 The Freedom to Succeed Liberty Healthcare PCS Provider Training May 2016
Welcome The Freedom to Succeed
Welcome The Freedom to Succeed Liberty Healthcare PCS Provider Training September 2015 AGENDA 9:00-9:15 am Welcome and Introductions Lacey Barnes, Executive Director Beth Oakley, Training & Development
More informationPersonal Care Services (PCS): An Overview of PCS and The Request for Independent Assessment for PCS Attestation of Medical Need Form (DMA 3051)
Personal Care Services (PCS): An Overview of PCS and The Request for Independent Assessment for PCS Attestation of Medical Need Form (DMA 3051) January 2018 OBJECTIVES At the conclusion of this training,
More informationClinical Coverage Policy 3L, Personal Care Services (PCS) Benefit Program
THE STATE OF NORTH CAROLINA Department of Health and Human Services Clinical Coverage Policy 3L, Personal Care Services (PCS) Benefit Program Provider Manual Effective August 2017 Table of Contents Introduction:
More informationClinical Coverage Policy 3L, Personal Care Services (PCS) Benefit Program
THE STATE OF NORTH CAROLINA Department of Health and Human Services Clinical Coverage Policy 3L, Personal Care Services (PCS) Benefit Program Provider Manual Effective May 2015 Table of Contents Introduction:
More information5. Personal Care Services
5. Personal Care Services Chapter IV - Services to Children A. Overview A child who requires personal care services is a child with a chronic medical condition or with medical needs requiring specialized
More informationMEDICAL POLICY EFFECTIVE DATE: 08/25/11 REVISED DATE: 08/23/12, 08/22/13
MEDICAL POLICY SUBJECT: PERSONAL CARE AIDE (PCA) AND PAGE: 1 OF: 7 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical
More informationPERSONAL CARE SERVICES SERVICE SPECIFICATIONS
PERSONAL CARE SERVICES SERVICE SPECIFICATIONS OBJECTIVE Personal Care Aide (PCA) Service enables a customer to achieve optimal function with Activities of Daily Living (ADL) and Instrumental Activities
More informationELDERLY SERVICES PROGRAM (ESP SM ) HOME CARE ASSISTANCE (HCA) SERVICE SPECIFICATION. EFFECTIVE October 01, 2017 (BCESP) (WCESP)
ELDERLY SERVICES PROGRAM (ESP SM ) HOME CARE ASSISTANCE (HCA) SERVICE SPECIFICATION EFFECTIVE October 01, 2017 (BCESP) (WCESP) HOME CARE ASSISTANCE SERVICE SPECIFICATION TABLE OF CONTENTS 1.0 OBJECTIVE
More informationAdditional Safeguards Session Law House Bill 492. Personal Care Services State Plan Amendment May 23,
Additional Safeguards Session Law 2013-306 House Bill 492 Personal Care Services State Plan Amendment 13-009 May 23, 2014 1 Session Law 2013-306 House Bill 492 Purpose: Direct the Department of Health
More informationOAR Training Guide and SPPC Exception Criteria Revised May 2015
State Plan Personal Care Services (SPPC) OAR Training Guide and SPPC Exception Criteria Revised May 2015 1 State Plan Personal Care The state plan personal care program is known by many different names:
More informationPersonal Care Services (PCS) Primary Care Practice Webinar February 11 th, 2015
Personal Care Services (PCS) Primary Care Practice Webinar February 11 th, 2015 Important Housekeeping Webinar will be recorded and posted to the following websites: CCNC: www.communitycarenc.org DMA:
More informationELDERLY SERVICES PROGRAM (ESP SM ) HOME CARE ASSISTANCE (HCA) SERVICE SPECIFICATION EFFECTIVE NOVEMBER 1, 2014 (HCESP)
ELDERLY SERVICES PROGRAM (ESP SM ) HOME CARE ASSISTANCE (HCA) SERVICE SPECIFICATION EFFECTIVE NOVEMBER 1, 2014 (HCESP) HOME CARE ASSISTANCE SERVICE SPECIFICATION TABLE OF CONTENTS 1.0 OBJECTIVE pg. 3 2.0
More informationLong-Term Care Services and Supports Transmittal Letter (LTCSSTL) No
March 22, 2012 Long-Term Care Services and Supports Transmittal Letter (LTCSSTL) No. 12-03 TO: Director, Ohio Department of Aging Director, Ohio Department of Developmental Disabilities Director, Ohio
More informationNURSING ASSESSMENT AND MONITORING TOOL Member last name First name Middle name Medicaid number
Contact Us 888-287-2443 MEDICALLY FRAGILE NURSING ASSESSMENT AND MONITORING TOOL Member last name First name Middle name Medicaid number Street address Date of birth City County State OK Zip Nurse completing
More informationPERSONAL CARE/RESPITE SERVICE SPECIFICATIONS (These rules are subject to change with each new contract cycle.)
PERSONAL CARE/RESPITE SERVICE SPECIFICATIONS (These rules are subject to change with each new contract cycle.) 1.0 Definition Personal Care/Respite (PC/R) services enable a client to achieve optimal function
More informationKentucky Medically Frail Provider Attestation v5
P a g e 1 Kentucky Medically Frail Provider Attestation v5 This Attestation is to be completed by an enrolled Medicaid Provider whose scope of expertise qualifies them to assess the Member for medical
More informationEnhancing QiRePort To Support On-Line PCS Service Planning (Update/Status Report) PCS Regional Provider Training Sessions: October 13-30, 2014
Enhancing QiRePort To Support On-Line PCS Service Planning (Update/Status Report) PCS Regional Provider Training Sessions: October 13-30, 2014 Today s Presentation Provide An Overview Of The Proposed Enhancements
More informationPrivate Duty Nursing for Clinical Coverage Policy No: 3G-2. DRAFT Table of Contents
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 1.1.1 Skilled Nursing... 1 1.1.2 Nursing Care Activities... 1 1.1.3 Substantial... 2 1.1.4 Complex... 2
More informationPERSONAL CARE VIRGINIA DEPARTMENT FOR THE AGING SERVICE STANDARD
PERSONAL CARE VIRGINIA DEPARTMENT FOR THE AGING SERVICE STANDARD Definition services provide personal assistance, stand-by-assistance, supervision or cues for persons with the inability to perform one
More informationAttachment A - Comparison of OASIS-C (Current Version) to OASIS-C1 (Proposed Data Collection)
Attachment A - Comparison of OASIS-C (Current Version) to (Proposed Data Collection) OASIS-C M0010 CMS Certification Number S M0010 CMS Certification Number M0014 Branch State S M0014 Branch State S M0016
More informationEnhancing QiRePort To Support On-Line PCS Service Planning (Update/Status Report)
Attention: The implementation date for the new QiRePort functionality Is June 10, 2015 Enhancing QiRePort To Support On-Line PCS Service Planning (Update/Status Report) PCS Regional Provider Training Sessions:
More informationPERSONAL CARE WORKER (PCW) - Job Description
PERSONAL CARE WORKER (PCW) - Job Description Definition Provides unskilled personal care and household services for stable, maintenance clients in their homes in compliance with a service plan. Level of
More informationA Review of Medicaid Personal Care Services
A Review of Medicaid Personal Care Services June 2017 What is Personal Care Services (PCS)? The PCS program is designed to provide personal care services to qualifying individuals that need assistance
More informationRESIDENT SCREENING SHEET
Department of County Human Services Aging, Disability & Veterans Services Adult Care Home Program RESIDENT SCREENING SHEET MCAR 023-080-200 through 023-080-225: To be completed by the operator before you
More informationActivities of Daily Living (ADL) Critical Element Pathway
Use this pathway for a resident who requires assistance with or is unable to perform ADLs (Hygiene bathing, dressing, grooming, and oral care; Elimination toileting; Dining eating, including meals and
More information(2 [1]) Attendant A[n] person [employee of a provider agency] who provides the authorized tasks to an individual [the client].
February 13, 2008/8R013 Subchapter A, Introduction 47.1. Purpose. This chapter establishes the requirements for provider agencies contracting to provide inhome attendant services to eligible individuals
More informationAPD & MHA RESIDENT SCREENING SHEET
Department of County Human Services Aging, Disability & Veterans Services Adult Care Home Program APD & MHA RESIDENT SCREENING SHEET MCAR 023-080-200 through 023-080-225: To be completed by the operator
More informationOAR Changes. Presented by APD Medicaid LTC Policy
OAR 411-015 Changes 1 Presented by APD Medicaid LTC Policy Table of Contents 2 Service Priority OAR 411-015 Project Overview Why Are We Making These Changes Overarching Changes Changes to ADLS (each ADL
More informationSkilled skin care should be provided by an agency licensed to provide home health
8.5.D. LIMITATIONS OF PERSONAL CARE In order to delineate the types of services that can be provided by a personal care worker, the following are examples of limitations where skilled home healthcare would
More informationCLASS/DBMD Habilitation Plan
Form 3596 Instructions CLASS/DBMD Plan 09-2014 PURPOSE The Plan is used to plan, document and justify the amount and frequency of authorized habilitation services. services consist of at least habilitation
More informationWillis Senior High School Career and Technical Education Health Science Technology Education Certified Nursing Assistant Syllabus
Willis Senior High School Career and Technical Education Health Science Technology Education Certified Nursing Assistant Syllabus 2017-2018 WK 1: Aug 17-18 WK 2: Aug 21-Aug25 WK 3: Aug28-Sept1 WK 4: Sept
More informationCategorization of In-Home Support Services (IHSS) Services Use only for IHSS Services
Table 1: Limits and Restrictions Categorization of In-Home Support Services (IHSS) Services Use only for IHSS Services Personal Care Family members that have been designated as a client s Authorized Representative
More informationNovember 14, Chief Clinical Operating Officer Division of Medical Assistance Department of Health and Human Services
Department of Health and Human Services Division of Medical Assistance Response To Questions from the Adult Care Home Transition Subcommittee of the Blue Ribbon Commission November 14, 2012 Presenter:
More informationKANSAS MEDICAL ASSISTANCE PROGRAM. Fee-for-Service Provider Manual. HCBS Frail Elderly
Fee-for-Service Provider Manual HCBS Frail Elderly Updated 02.2016 PART II Section BILLING INSTRUCTIONS Page 7000 HCBS FE Billing Instructions................. 7-1 7010 HCBS FE Specific Billing Information.............
More informationUnderstanding Your CARE Tool Assessment. September 2010 for equal justice
Understanding Your CARE Tool Assessment September 2010 for equal justice 1 Table of Contents 1. General Information... 1 2. Qualifying for Personal Care Hours... 2 3. Cognitive Issues... 3 4. Complex Medical
More informationKentucky Medically Frail Provider Attestation v5
Page 1 of 8 Kentucky Medically Frail Provider Attestation v5 This Attestation is to be completed by an enrolled Medicaid Provider whose scope of expertise qualifies them to assess the Member for medical
More informationPROVIDER REQUIREMENTS. Providers must meet the following requirements in order to participate in the program:
Standards of Participation PROVIDER REQUIREMENTS Providers must meet the following requirements in order to participate in the program: Possess a current license for Personal Care Attendant Services issued
More informationOASIS ITEM ITEM INTENT TIME POINTS ITEM(S) COMPLETED RESPONSE SPECIFIC INSTRUCTIONS DATA SOURCES / RESOURCES
OASIS Item Guidance (M1800) Grooming: Current ability to tend safely to personal hygiene needs (specifically: washing face and hands, hair care, shaving or make up, teeth or denture care, or fingernail
More informationMinnesota Statutes, section 256B.0655 PERSONAL CARE ASSISTANT SERVICES. Subdivision 1. Definitions. For purposes of this section and sections
Minnesota Statutes, section 256B.0655 PERSONAL CARE ASSISTANT SERVICES. Subdivision 1. Definitions. For purposes of this section and sections 256B.0651, 256B.0653, 256B.0654, and 256B.0656, the terms defined
More informationNursing Facility 90 Day Redetermination Online Referral for Medicaid Level of Care
12/15/2014 Nursing Facility 90 Day Redetermination Online Referral for Medicaid Level of Care Quarterly MDS Assessment Results This screen will be completed based on certain values from the first quarterly
More informationState-Approved Curriculum NURSE AIDE I TRAINING PROGRAM July 2013 Appendix and Resources
State-Approved Curriculum NURSE AIDE I TRAINING PROGRAM July 2013 Appendix and Resources DHSR N.C. Division of Health Service Regulation North Carolina Department of Health and Human Services Division
More informationMEDICAL REQUEST FOR HOME CARE
MEDICAL REQUEST FOR HOME CARE HCSP- M11Q 12/09/2014 Return Completed Form to: 1. CLIENT INFORMATION GSS District Office Address Zip Code Attn: Case Load No. Borough Tel. No. Date Returned to/received bygss
More informationTexas Medicaid. Provider Procedures Manual. Provider Handbooks. Home Health Nursing and Private Duty Nursing Services Handbook
Texas Medicaid Provider Procedures Manual Provider Handbooks January 2018 Home Health Nursing and Private Duty Nursing Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims
More informationRequest for Information Documenting Patient s Functional Limitations (Form Attached)
Request for Information Documenting Patient s Functional Limitations (Form Attached) Your patient applied for, or is a recipient of, In-Home Supportive Services (IHSS). The IHSS program provides attendant
More informationOASIS-B1 and OASIS-C Items Unchanged, Items Modified, Items Dropped, and New Items Added.
Items Added. OASIS-B1 Items UNCHANGED on OASIS-C OASIS-C Item # M0014 M0016 M0020 M0030 M0032 M0040 M0050 M0060 M0063 M0064 M0065 M0066 M0069 M0080 M0090 M0100 M0110 M0220 M1005 M1030 M1200 M1230 M1324
More informationState of West Virginia DEPARTMENT OF HEALTH AND HUMAN RESOURCES Office of Inspector General Board of Review PO Box 6165 Wheeling, WV 26003
Joe Manchin III Governor State of West Virginia DEPARTMENT OF HEALTH AND HUMAN RESOURCES Office of Inspector General Board of Review PO Box 6165 Wheeling, WV 26003 Martha Yeager Walker Secretary January
More informationPERSONAL and HOME CARE SERVICES HANDBOOK
PERSONAL and HOME CARE SERVICES HANDBOOK MENU OF PERSONAL and HOME CARE SERVICES Personal/Home Care Services Incidental home health aide Incidental Nursing RN/LPN Nurse Visit weekly/monthly Charges $15.00
More informationDISCLOSURE OF SERVICES
DISCLOSURE OF SERVICES NOTE: The use of the term we refers to the boarding home named at the top of the page. The boarding home licensee shall disclose to the residents, the residents legal representative
More informationAmended Date: October 1, Table of Contents
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Private Duty Nursing... 1 1.2 Definitions... 1 1.2.1 Skilled Nursing... 1 1.2.2 Substantial... 1 1.2.3 Complex... 1 1.2.4
More informationPCA Services: Assessment, Eligibility and Appeal. Patricia M. Siebert Minnesota Disability Law Center November 29, 2012 PACER Center
PCA Services: Assessment, Eligibility and Appeal Patricia M. Siebert Minnesota Disability Law Center November 29, 2012 PACER Center 1 What will we cover tonight? Overview of changes in the PCA law (MS.
More informationTable of Contents. 1.0 Description of the Procedure, Product, or Service Definitions Hospice Terminal illness...
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 1.1.1 Hospice... 1 1.1.2 Terminal illness... 1 2.0 Eligibility Requirements... 1 2.1 Provisions... 1 2.1.1
More informationExhibit A. Part 1 Statement of Work
Exhibit A Part 1 Statement of Work Contractor shall provide Basic Neurological services as described herein to Medicaid eligible Clients who are authorized to receive services at the Contractor s owned
More informationWhat is a retrospective Level of Care and what is the process for submitting a retrospective Level of Care?
Last updated 9/14/2011 The following are Frequently Asked Questions (FAQs) associated with Connecticut Level of Care and PASRR Level I/II processes. To read to the corresponding response to the questions
More informationSteps for Success. Personal Care Assistance
Steps for Success Personal Care Assistance Why are you here? An overview of: PCA Program guidelines Eligibility Covered services How a person gets services 2 Why are you here? Program policy requirements
More informationResident Name Medicaid # - - If Pending Medicaid, Social Security # - - Medicare # Date of Birth / / Responsible Party. Responsible Party Address
URSIG FACILIT LEVEL OF CARE REQUEST FOR ADMISSIO Resident ame Medicaid # - - Room # Room Certified for Medicaid es o If Pending Medicaid, Social Security # - - Medicare # Date of Birth / / Marital Status
More informationSkills Standards RESIDENTIAL CARE AIDE OD68604 MEETS OSDH NURSE AIDE REGISTRY CERTIFICATION REQUIREMENTS
Skills Standards RESIDENTIAL CARE AIDE OD68604 MEETS OSDH NURSE AIDE REGISTRY CERTIFICATION REQUIREMENTS Competency-Based Education: OKLAHOMA S RECIPE FOR SUCCESS BY THE INDUSTRY FOR THE INDUSTRY Oklahoma
More informationALABAMA CARES SCOPE OF SERVICES IN-HOME RESPITE CARE
ALABAMA CARES SCOPE OF SERVICES IN-HOME RESPITE CARE Operating Agency-SARCOA RC-Respite Care PC-Personal Care RCW-Respite Care Worker PCW-Personal Care Worker POC-Plan of Care DSP-Direct Service Provider-(In
More informationHAWAII HEALTH SYSTEMS CORPORATION
Entry Level Work HE-04 6.742 Full Performance Work HE-06 6.743 Function and Location This position works in a hospital, clinic or long term care facility and is responsible for providing direct patient/resident
More informationLong Term Care Hospital Clinical Coverage Policy No: 2A-2 Services (LTCH) Amended Date: October 1, Table of Contents
Long Term Care Hospital Clinical Coverage Policy No: 2A-2 Services (LTCH) Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements...
More informationDEMONSTRATED NEED FOR SKILLED CARE FOR MEDICARE PATIENTS: SKILLED NURSING SERVICES
DEMONSTRATED NEED FOR SKILLED CARE FOR MEDICARE PATIENTS: SCOPE: All Ascension At Home, LLC colleagues. For purposes of this policy, all references to colleague or colleagues include temporary, part-time
More informationSCOPE OF SERVICES. Services Allowed by Home Instead Senior Care. CAREGivers cannot. Charlotte County, Collier County, and Lee County areas.
Services Allowed by Home Instead Senior Care Givers in Charlotte County, Collier County, and Lee County areas. TYPE OF SERVICE BATHING -SKIN - -HAIR - -AL ARE- Givers can Assist with bathing when the client
More informationThe CDASS program offers three categories of support services as outlined below: Consumer/ Client. Attendant/ Employee. Directed
Consumer/ Client Directed Attendant/ Employee Support Services Section 3: Available Services For the elderly and many people with disabilities, the key to living independently is having a personal attendant.
More informationGeorgia Department of Behavioral Health & Developmental Disabilities FOR. Effective Date: January 1, 2018 (Posted: December 1, 2017)
Georgia Department of Behavioral Health & Developmental Disabilities PROVIDER MANUAL FOR COMMUNITY DEVELOPMENTAL DISABILITY PROVIDERS OF STATE-FUNDED DEVELOPMENTAL DISABILITY SERVICES FISCAL YEAR 2018
More informationTransition to Community Living Initiative Diversion Process PASRR Manual for Adult Care Homes Licensed Under GS 131D 2.4
Transition to Community Living Initiative Diversion Process PASRR Manual for Adult Care Homes Licensed Under GS 131D 2.4 Presenters : Johnnie McManus, PASRR Coordinator 1 Introduction Pre-Admission Screening
More informationProvider Training Matrix Standards for Direct Care Staff and Allowable Tasks/Activities
PROVIDER TRAINING MATRI Provider Training Matrix Standards for Direct Care and Allowable Tasks/Activities Effective training is the foundation of a Personal Care Program. It is imperative that training
More information2018 Conditions of Participation. OASIS-D in 2019
The IMPACAT Act of 2014 & Progressing from the 2018 Conditions of Participation to the Next Big Change: OASIS-D in 2019 Sharon Hamilton MS, RN, NLCP-C, CFDS OBJECTIVES Briefly explain the requirements
More informationREHABILITATION AND RESTORATIVE CARE UPDATE APRIL 2013
REHABILITATION AND RESTORATIVE CARE UPDATE APRIL 2013 Rehabilitation Helping patients attain the highest possible level of functional ability Focusing on physical ability Restorative care Helping attain
More informationOverview of the Prior Authorization Process for Home Health Aide Services. June 27, 2018
Overview of the Prior Authorization Process for Home Health Aide Services June 27, 2018 Objectives Understand the HUSKY Health program s Prior Authorization (PA) process for home health aide (HHA) services
More informationGeneral Orientation to Personal Assistance Program
General Orientation to Personal Assistance Program What is a Personal Care Attendant? Personal Care Attendants (also known as a PCA) provide personal care and related paraprofessional services in accordance
More informationDEPARTMENT OF HUMAN SERVICES SENIORS AND PEOPLE WITH DISABILITIES DIVISION OREGON ADMINISTRATIVE RULES CHAPTER 411 DIVISION 34 PERSONAL CARE SERVICES
DEPARTMENT OF HUMAN SERVICES SENIORS AND PEOPLE WITH DISABILITIES DIVISION OREGON ADMINISTRATIVE RULES 411-034-0000 Purpose (Amended 10/5/2007) CHAPTER 411 DIVISION 34 PERSONAL CARE SERVICES (1) These
More informationG0110: Activities of Daily Living (ADL) Assistance
SECTION G: FUNCTIONAL STATUS Intent: Items in this section assess the need for assistance with activities of daily living (ADLs), altered gait and balance, and decreased range of motion. In addition, on
More informationSubject to change. Summary only; does not supersede manuals and formal notices and publications. Consult and appropriate Partners
Subject to change. Summary only; does not supersede manuals and formal notices and publications. Consult www.partnersbhm.org and appropriate Partners for most recent information or with questions. Gain
More informationRevised Section GG 8/28/2018. Why does it matter now? Importance of Section GG. Started in Revisions effective Oct. 1, 2018
Revised Section GG Arbor Rehabilitation Approach Fall 2018 Why does it matter now? Started in 2016 Revisions effective Oct. 1, 2018 Increased areas for data collection Significantly increased importance!
More informationBased on the comprehensive assessment of a resident, the facility must ensure that:
13.A. Quality of Care Each resident must receive, and the facility must provide, the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being,
More informationListed below are additional coding tips: you think the patient can do or what the patient s potential is. your shift, even if it only occurs once.
1 It is important to always accurately code how much assistance your patients require to perform their activities of daily living and provide assistance in the safest manner possible for you and the patient.
More informationFlorida Medicaid. Private Duty Nursing Services Coverage Policy
Florida Medicaid Agency for Health Care Administration November 2016 Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions... 1 2.0 Eligible
More informationInitial Pool Process: Resident Interview
Initial Pool Process: Resident Interview Care Area Probes Response Options Choices Are you able to make choices about your daily life that are important to you? I d like to talk to you about your choices.
More informationActivities of Daily Living
About this domain ADLs Activities of Daily Living Identify the need for support in completing basic daily activities including eating, bathing, dressing, personal hygiene/grooming, toileting, mobility,
More informationMississippi Medicaid Hospice Services Provider Manual
Mississippi Medicaid Hospice Services Provider Manual Effective: January 2011 Revised: January 2017 Table of Contents I. Introduction II. Frequently Used Terms III. Getting Started Helpful Tips A. Before
More informationAttachment C: Itemized List of OASIS Data Elements
Attachment C: Itemized List of OASIS Data Item Description Number of Data SOC ROC FU TOC DTH DIS M0010 CMS Certification Number 1 1 M0014 Branch State 1 1 M0016 Branch ID Number 1 1 M0018 National Provider
More informationLONG TERM CARE SETTINGS
LONG TERM CARE SETTINGS Long term care facilities assist aged, ill or disabled persons who can no longer live independently. In this section, we will briefly examine the history of long term care facilities
More informationACTIVITIES OF DAILY LIVING (ADL) DECLINE Facility Assessment Checklists
ACTIVITIES OF DAILY LIVING (ADL) DECLINE Facility Assessment Checklists This is a series of self-assessment checklists for nursing home staff to use to assess processes related to activities of daily living
More informationDiabetes Outpatient Clinical Coverage Policy No: 1A-24 Self-Management Education Amended Date: October 1, Table of Contents
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements... 1 2.1 Provisions... 1 2.1.1 General... 1 2.1.2 Specific... 2 2.2 Special
More informationOccupational Therapy Plans of Care Affecting Chronic Condition Outcomes
Occupational Therapy Plans of Care Affecting Chronic Condition Outcomes (Not Just Upper Extremity Strengthening) Karen Vance, OTR kvance@bkd.com The most important things for you to understand today: Daily
More informationProceed with the interview questions below if you are comfortable that the resident is
Resident Interview Interviewer Interview Date Resident Room Preparation Resident interviews should be conducted in a private setting so the resident feels comfortable providing honest answers without fear
More informationNOVA SCOTIA DEPARTMENT OF HEALTH AND WELLNESS RISK MITIGATION - CONTINUING CARE BRANCH. Caregiver Benefit Program Policy
NOVA SCOTIA DEPARTMENT OF HEALTH AND WELLNESS RISK MITIGATION - CONTINUING CARE BRANCH Subject: Caregiver Benefit Program Policy Original Approved Date; July 27, 2009 Revised Dates: December 7. 2010/ 0ctober
More informationHOSPICE POLICY UPDATE
#02-56-13 Bulletin June 24, 2002 Minnesota Department of Human Services # 444 Lafayette Rd. # St. Paul, MN 55155 OF INTEREST TO County Directors Administrative contacts AC, EW, CAC, CADI, TBI DD Waiver
More informationPOSITION SUMMARY. 2. Communicates: Reads, writes and speaks in English as required for taking direction and performing job-related activities.
Department/s: Nursing Approved By: Senior Management Committee Date Approved: Mar 20 1992 Date Revised: Feb 16 2010 Page 1 of 6 POSITION SUMMARY The Personal Support Worker (PSW) at Fairhaven is responsible
More informationBEFORE THE ALASKA OFFICE OF ADMINISTRATIVE HEARINGS ON REFERRAL BY THE COMMISSIONER OF HEALTH AND SOCIAL SERVICES
BEFORE THE ALASKA OFFICE OF ADMINISTRATIVE HEARINGS ON REFERRAL BY THE COMMISSIONER OF HEALTH AND SOCIAL SERVICES In the Matter of ) ) Consolidated Cases M H ) OAH No. 13-1683-MDS and ) OAH No. 14-0212-MDS
More informationSECTION 3: THE FIM INSTRUMENT
UNDERLYING PRINCIPLES FOR USE OF THE FIM By design, the FIM instrument includes only a minimum number of items. It is not intended to incorporate all the activities that could possibly be measured, or
More informationIndividuals with Intellectual Amended Date: October 1, 2015 Disabilities (ICF/IID) Table of Contents
Individuals with Intellectual Amended Date: October 1, 2015 Disabilities (ICF/IID) Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements...
More informationNursing Assistant
Western Technical College 30543300 Nursing Assistant Course Outcome Summary Course Information Description Career Cluster Instructional Level Total Credits 3.00 The course prepares individuals for employment
More informationALLOWED VS. AUTHORIZED HOURS CASE MANAGEMENT IN-SERVICE POWER HOUR JULY 14, 2016 MEDICAID APD LTC SYSTEMS
ALLOWED VS. AUTHORIZED HOURS CASE MANAGEMENT IN-SERVICE POWER HOUR JULY 14, 2016 MEDICAID APD LTC SYSTEMS 1 AGENDA PURPOSE PLANS BELOW PLANS ABOVE - EXCEPTIONS EXCEPTIONS FOR STATE PLAN PERSONAL CARE 2
More informationCommunity Alternatives Program 1915(c) HCBS Waiver April 26, Department of Health and Human Services Biannual Listening Session
Community Alternatives Program 1915(c) HCBS Waiver April 26, 2017 Department of Health and Human Services Biannual Listening Session Semiannual Listening Session 2 Statement from CAP/C beneficiary My experience
More informationWhat are MCOs? (b)/(c) refers to the type of waiver approved by CMS to allow this type of managed care program. The
Advocating in Medicaid Managed Care-Behavioral Health Services What is Medicaid managed care? How does receiving services through managed care affect me or my family member? How do I complain if I disagree
More informationPersonal Care Assistant (PCA) Nursing Assessment Tool
Per N.J.A.C. 1:6-3.5(a) 3: following the initial PCA nursing assessment, the PCA nursing reassessment visit shall be provided at least once every six months, or more frequently if the member's condition
More information60 Memorial Medical Parkway Palm Coast, Florida 32164
POLICY & PROCEDURES TITLE: Privileges of Student Nurses and Student Nursing Assistants POLICY # EDU 001 POLICY CATEGORY: Administrative / Education Origination Date: 12/2008 Last Review/Revision Date:
More informationJune OLTL Updates PANAC June Agenda. RAI Spotlight PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES OFFICE OF LONG-TERM LIVING
PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES OFFICE OF LONG-TERM LIVING OLTL Updates PANAC Ruth Anne Barnard, BSN, RN MDS/OBRA Coordinator for Nursing Facility Field Operations Catharine B. Petko, BSN, RN
More informationRNSG Pre-Class Activities REQUIRED Ticket to Lab*
Week 1 January 19-24 Online course ientation in Blackboard (Bb) course site (No Lab until next week) Week 2 January 25 January 28 1: Infection Control Medical & Surgical Asepsis 28 Module 2 Basic Skills/Basic
More informationService Plan for: Carine Schmitt Richmond - North 1. This Service has been reviewed by the following: Resident: Responsible Party: Administrator:
Service Plan for: Printed: 6/28/2010 Carine Schmitt This Service has been reviewed by the following: Resident: Responsible Party: Administrator: Health Services Director: Program Director: Other: Date:
More information