BPA HEALTH RECOVERY SUPPORT SERVICES AUDIT

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Kerry Marsh
6 years ago
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1 Provider: Reviewer: Site ID: CASE MANAGER SUPERVISION IDAPA Supervision. The case management program must provide and document at least one () hour of case management supervision per month for each case manager or as defined by Clinical Supervision if clinician Points # Case Manager Name S P Scoring: point possible per case manager per month (as indicated by competency rating) Supervision Sub-total 0 0 PR-3-0/06/05 Case Management

2 Provider: Reviewer: Site ID: Question # Progress Notes. Notes for each service charting the client's progress must include: * Date of session * Beginning and ending time of session * Description of the session * Signature of person conducting the session Standard. Client ID # Case Management Files - Pull up to 5 client files Case Management Comprehensive Service plan must completed within 30 days after first meeting and must include: * Assessment of the client and client family strength and needs * Service planning * Linkage to other services * Client advocacy and monitoring Scoring point possible for each of the 4 items Points S P 3 Comprehensive Case Management Service Plan Development. The case manager must update the plan every 90 days. per 90 days 4 5 Case Manager Contact and Availability. At least thirty (30) days, case managers must have face-to-face contact with the client, or have contact with the guardian, who can verify the client's well-being and whether services are being provided according to the written plan. The frequency, mode of contact, and person being contacted must be identified in the plan and must meet the needs of the client. Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. [Referral agencies examples: IDOC, other providers] PR-3-0/06/05 Case Management

3 Provider: Reviewer: Site ID:. Client ID # Scoring Earned Possible Progress Notes. Notes for each service charting the client's progress must include: * Date of session * Beginning and ending time of session * Description of the session * Signature of person conducting the session 3 Case Management Comprehensive Service plan must completed within 30 days after first meeting and must include: * Assessment of the client and client family strength and needs * Service planning * Linkage to other services * Client advocacy and monitoring Comprehensive Case Management Service Plan Development. The case manager must update the plan every 90 days. point possible for each of the 4 items per 90 days 4 5 Case Manager Contact and Availability. At least thirty (30) days, case managers must have face-to-face contact with the client, or have contact with the guardian, who can verify the client's well-being and whether services are being provided according to the written plan. The frequency, mode of contact, and person being contacted must be identified in the plan and must meet the needs of the client. Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. [Referral agencies examples: IDOC, other providers] PR-3-0/06/05 Case Management

4 Provider: Reviewer: Site ID: 3. Client ID # Scoring Earned Possible Progress Notes. Notes for each service charting the client's progress must include: * Date of session * Beginning and ending time of session * Description of the session * Signature of person conducting the session Case Management Comprehensive Service plan must completed within 30 days after first meeting and must include: * Assessment of the client and client family strength and needs * Service planning * Linkage to other services * Client advocacy and monitoring point possible for each of the 4 items 3 Comprehensive Case Management Service Plan Development. The case manager must update the plan every 90 days. per 90 days 4 Case Manager Contact and Availability. At least thirty (30) days, case managers must have face-to-face contact with the client, or have contact with the guardian, who can verify the client's well-being and whether services are being provided according to the written plan. The frequency, mode of contact, and person being contacted must be identified in the plan and must meet the needs of the client. 5 Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. [Referral agencies examples: IDOC, other providers] PR-3-0/06/05 Case Management

5 Provider: Reviewer: Site ID: 4. Client ID # Scoring Earned Possible Progress Notes. Notes for each service charting the client's progress must include: * Date of session * Beginning and ending time of session * Description of the session * Signature of person conducting the session Case Management Comprehensive Service plan must completed within 30 days after first meeting and must include: * Assessment of the client and client family strength and needs * Service planning * Linkage to other services * Client advocacy and monitoring point possible for each of the 4 items 3 Comprehensive Case Management Service Plan Development. The case manager must update the plan every 90 days. per 90 days 4 Case Manager Contact and Availability. At least thirty (30) days, case managers must have face-to-face contact with the client, or have contact with the guardian, who can verify the client's well-being and whether services are being provided according to the written plan. The frequency, mode of contact, and person being contacted must be identified in the plan and must meet the needs of the client. 5 Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. [Referral agencies examples: IDOC, other providers] PR-3-0/06/05 Case Management

6 Provider: Reviewer: Site ID: 5. Client ID # Scoring Earned Possible Progress Notes. Notes for each service charting the client's progress must include: * Date of session * Beginning and ending time of session * Description of the session * Signature of person conducting the session Case Management Comprehensive Service plan must completed within 30 days after first meeting and must include: * Assessment of the client and client family strength and needs * Service planning * Linkage to other services * Client advocacy and monitoring point possible for each of the 4 items 3 Comprehensive Case Management Service Plan Development. The case manager must update the plan every 90 days. per 90 days 4 Case Manager Contact and Availability. At least thirty (30) days, case managers must have face-to-face contact with the client, or have contact with the guardian, who can verify the client's well-being and whether services are being provided according to the written plan. The frequency, mode of contact, and person being contacted must be identified in the plan and must meet the needs of the client. 5 Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. [Referral agencies examples: IDOC, other providers] Case Management File Sub-Total: 0 0 Case Management Total: 0 0 PR-3-0/06/05 Case Management

7 Provider: Reviewer: Site ID: PR-3-0/06/05 Case Management

8 Provider: 0 Site ID: 0 Question # Standard. Client ID # DRUG AND ALCOHOL TESTING Scoring Points S P Documentation that results were sent to requesting agency. [If the DT is not a stand-alone agency and is administered within a treatment provider agency, results should be communicated to the PO.] Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. [Referral agencies examples: IDOC, other providers]. Client ID # Documentation that results were sent to requesting agency. [If the DT is not a stand-alone agency and is administered within a treatment provider agency, results should be communicated to the PO.] Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. [Referral agencies examples: IDOC, other providers] 3. Client ID # Documentation that results were sent to requesting agency. [If the DT is not a stand-alone agency and is administered within a treatment provider agency, results should be communicated to the PO.] Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. [Referral agencies examples: IDOC, other providers] PR-3-0/06/05 Drug and Alcohol Testing

9 Provider: 0 Site ID: 0 Documentation that results were sent to requesting agency. [If the DT is not a stand-alone agency and is administered within a treatment provider agency, results should be communicated to the PO.] 4. Client ID # Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. [Referral agencies examples: IDOC, other providers] 5. Client ID # Documentation that results were sent to requesting agency. [If the DT is not a stand-alone agency and is administered within a treatment provider agency, results should be communicated to the PO.] Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. [Referral agencies examples: IDOC, other providers] D & A Testing Total 0 0 PR-3-0/06/05 Drug and Alcohol Testing

10 Provider: 0 Site ID: 0 Question # Standard CHILD CARE Setting Ensures Safety. Provide a setting that promotes and ensures the health, well-being, and safety of the child or children in care. [CORE] [yes=5] Medicines, cleaning products, and other dangerous substances and articles are kept away from children at all times. Scoring No = 0 points No = 0 points Child Care Facility Sub-total 0 0 S Points P Question # CHILD CARE Standard. Client ID # Scoring S Points P 3 Child Care Program Sign In for Billable Service Date. The program must maintain a register of all children receiving services. The register must include each child's full name, gender, date of birth, parents or guardian, the date and time of services, and names of individual(s) providing care. 4. Client ID # Child Care Program Sign In for Billable Service Date. The program must maintain a register of all children receiving services. The register must include each child's full name, gender, date of birth, parents or guardian, the date and time of services, and names of individual(s) providing care. PR-3-0/06/05 Child Care

11 Provider: 0 Site ID: Client ID # Child Care Program Sign In for Billable Service Date. The program must maintain a register of all children receiving services. The register must include each child's full name, gender, date of birth, parents or guardian, the date and time of services, and names of individual(s) providing care Client ID # Child Care Program Sign In for Billable Service Date. The program must maintain a register of all children receiving services. The register must include each child's full name, gender, date of birth, parents or guardian, the date and time of services, and names of individual(s) providing care Client ID # Child Care Program Sign In for Billable Service Date. The program must maintain a register of all children receiving services. The register must include each child's full name, gender, date of birth, parents or guardian, the date and time of services, and names of individual(s) providing care. Child Care Sub-total 0 0 Child Care Total 0 0 PR-3-0/06/05 Child Care

12 Provider: 0 Site ID: 0 Question # Standard. Client ID # LIFE SKILLS Scoring point possible per date audited S Points P Encounter note for dates billed [review note and life skills plan] There is an identified curriculum/lesson for the Life Skills program being billed. PR-3-0/06/05 Life Skills Page 3 of 6

13 Provider: 0 Site ID: 0. Client ID # Encounter note for dates billed [review note and life skills plan] There is an identified curriculum/lesson for the Life Skills program being billed. point possible per date audited 3. Client ID # Encounter note for dates billed [review note and life skills plan] There is an identified curriculum/lesson for the Life Skills program being billed. point possible per date audited 4. Client ID # Encounter note for dates billed [review note and life skills plan] There is an identified curriculum/lesson for the Life Skills program being billed. point possible per date audited 5. Client ID # Encounter note for dates billed [review note and life skills plan] There is an identified curriculum/lesson for the Life Skills program being billed. point possible per date audited Life Skills Total 0 0 PR-3-0/06/05 Life Skills Page 4 of 6

14 Provider: 0 Site ID: 0 Recovery Coach Supervision Recovery Coach is Receiving Supervision Employee Name Scoring: point possible per recovery coach per month Supervision Sub-total 0 0 S Points P Question # Standard. Client ID # RECOVERY COACH Scoring S Points P Recovery Wellness Plan in Place. Client ID # S P Recovery Wellness Plan in Place 3. Client ID # S P Recovery Wellness Plan in Place 4. Client ID # S P Recovery Wellness Plan in Place 5. Client ID # S P Recovery Wellness Plan in Place Wellness Plan Sub-total 0 0 Recovery Coach Total 0 0

15 Provider: 0 Site ID: 0 TRANSPORTATION The minimum insurance required for all programs is professional liability, commerical general liability, and comprehensive liability for all program vehicles. All facilities must maintain professioanl liability insurance in the amount of at least five hundred-thousand to one million dollars ($500,000/$,000,000) and general liability and automobile insurance in the amount of at least one million to three million dollars ($,000,000/$3,000,000). Copies of the declarations face-sheet for all policies must be included with the application. Individual providers must carry at least the minium insurance requried by Idaho law. If an agency permits employees to transport clients in employee's personal vehicles, the agency must ensure that insurance coverage is carried to cover those circumstances. Points Each Vehicle Used Scoring: Per Vehicle No = 0 points Transportation Total 0 0 S P PR-3-0/06/05 Transportation

16 Provider: 0 Site ID: 0 SAFE AND SOBER HOUSING Question # Standard Scoring No facility concerns with regard to bedroom size, bed spacing or safety issues were noted. No = 0 points S Points P A minimum of one () fire drill must be held at last every thirty (30) days at unexpected times and under varying conditions to simulate unusual circumstances encountered in case of a fire. A record of drills must be maintained which includes the date and time of the drill, response of the personnel and clients, problems encountered and recommendations for improvements. No = 0 points 3 Adult Staffed Safe and Sober housing facilities must provide information regarding community resources to persons recovering from alcohol and substance use disorders. Sections 370 and 380 of these rules do not apply to this level of care in this setting. No = 0 points 4 Facility Inspection of an Adult Staffed Safe and Sober Housing Facility. Adult Staffed Safe and Sober Housing facilities must be inspected by staff weekly to determine if hazards or potential safety issues exist. A record of the inspection must be maintained that includes the date and time of the inspection, problems encountered, and recommendation for improvement. No = 0 points 5 Staffing of Safe and Sober Housing Facility. A house manager on-site a minimum of twenty (0) hours a week or a housing coordinator who is off-site but monitors house activities on a daily basis. No = 0 points Facility Sub-total 0 0 Question # Standard. Client ID # Scoring S P Documentation that client was in the facility on billed date. Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards.. Client ID # Documentation that client was in the facility on billed date. Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. PR-3-0/06/05 Safe and Sober Housing

17 Provider: 0 Site ID: 0 3. Client ID # Documentation that client was in the facility on billed date. Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. 4. Client ID # Documentation that client was in the facility on billed date. Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. PR-3-0/06/05 Safe and Sober Housing

18 Provider: 0 Site ID: 0 5. Client ID # Documentation that client was in the facility on billed date. Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. SSH Documentation Sub-total 0 0 SSH Total 0 0 PR-3-0/06/05 Safe and Sober Housing

19 Provider: 0 Site ID: 0 Halfway House Question # Standard Scoring S Points P No facility concerns with regard to bedroom size, bed spacing or safety issues were noted. No = 0 points Supervision for Adults Level III.. A Level III. treatment facility must be supervised by a qualified substance use disorders professional. No = 0 points 3 Staffing for Adults Level III.. A staff person must be available to residents twenty-four (4) hours per day, seven (7) days a week. The staff to client ratio must not exceed twelve () clients to one () staff person. No = 0 points Facility Sub-total 0 0 Question # Standard. Client ID # Scoring S P Documentation that client was in the facility on billed date. Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards.. Client ID # Documentation that client was in the facility on billed date. Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. PR-3-0/06/05 Halfway Housing Page 3 of 6

20 Provider: 0 Site ID: 0 3. Client ID # Documentation that client was in the facility on billed date. Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. 4. Client ID # Documentation that client was in the facility on billed date. Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. PR-3-0/06/05 Halfway Housing Page 4 of 6

21 Provider: 0 Site ID: 0 5. Client ID # Documentation that client was in the facility on billed date. Signed and dated releases with referral agencies. Must meet 4 CFR and HIPPA standards. Halfway House Documentation Sub-total 0 0 Halfway House Total 0 0 PR-3-0/06/05 Halfway Housing Page 5 of 6

22 DATE DUE: DATE CONDUCTED: PROVIDER: PROVIDER SITE ID: AUDIT CONDUCTED BY: BPA HEALTH TOTALS Section Score Earned Score Possible % Case Management: 0 0 0% D&A Testing: 0 0 0% Child Care: 0 0 0% Life Skills & Rec. Coach: 0 0 0% Transportation: 0 0 0% SSH 0 0 0% Halfway House 0 0 0% TOTAL 0 0 0% Recovery Support Services (yes=, no=0) Case Management Drug & Alcohol Test. Child Care Life Skills & Rec. Coach Transp. SSH Halfway House Date Results Sent: Date Next Audit Due: Follow-Up [yes=, no & NA=0] None (passed): Action Plan (failed): Perf. Imp. Plan (passed): # Claims Recouped: Date Plan Due: PR-3-0/06/05 Totals

Level 2.1- Intensive Outpatient Services (IOP)

QUALITY OF DOCUMENTATION Level 2.1- Intensive Outpatient Services (IOP) 1. Has the participant consented for treatment or with the consent of the participant, a parent or guardian has consented for treatment?