FAQ from the November 2013 Special Need Contract Webinar

Transcription

1 FAQ from the November 2013 Special Need Contract Webinar Q: Currently, we can only do exceptions for hours when assistance is being physically provided. A 2-person transfer would not qualify an AFH for an exception to pay a 2 nd staff member to be on site for 24 hours. Would the 2 nd staff member need, 5, be held to a different standard? A: The Specific Need contracts were developed to provide services that are not in our regular community based AFH. Because the residents will be moving out of nursing facilities, the services developed are keeping in mind the barriers of transitioning out of a nursing home. Having awake staff and if needed, two care givers, helps mitigate this barrier. Comparing the two scenario s becomes challenging because in the Specific Need contract facility, all 4 or 5 residents may have the need for awake staff at night, while the regular exception process is just considering one resident s service needs. At this time, there is no changes to the regular (non Specific Need) AFH exception process. Q: Would we want an advanced dementia client (bed) in with an otherwise vulnerable population? A: In a slot model, a Specific Need contractor may be an RCF, ALF or AFH. If the services are provided in an RCF or ALF, the contract would be awarded for so many slots (beds) and the location of the actual rooms could be dispersed throughout facility, or more commonly, grouped near each other. In either situation, the provider must demonstrate that they will be able to meet the service needs of both populations while providing a safe and home like environment. This can be achieved in many different styles. This presentation focused on AFH Specific Needs contracts and in this setting, the provider would be contracted, most typically for four or five beds. The staffing, as outlined in the Statement of Work, indicates the round-the-clock services and addition staff are designed to assist individual with complex service needs, including aggressive or intrusive behaviors. Through a care planning process, providers will develop plans that mitigate the risk to other residents. Q: If during a reassessment someone appears to have improved, and no longer meets criteria for the special needs contract placement and the client wants to remain in the AFH, then the AFH payment would just follow normal AFH rate, even though they continue to take up one of the special needs slots in that home? A: The clients have the right to stay in the community based setting, their home, without being asked to move, even if they improve from needing all the services that they needed when the admitted in to the Specific Need contract home. If a resident chooses to stay living in the Specific Need contract home, and they were admitted in under the Specific Need contract, the provider would continue to receive the Specific Need contract service payment. The payment would not be reduced to regular AFH payments. 1

2 Q: Will there be a link to CM Tools for the power point and flow sheet? It would be helpful. A: The flow sheet is currently on the CM tools. Look for Transition/Diversion, found under the heading Program and Services. The Power Point will be added soon. Q: Regarding CAPS, does it need to be within the past 6 months, or is there a specific requirement? A: In order to ensure the information is updated to meet the admission criteria, the CAPS will need to be completed within the last 3 months, prior to admission. Q: Does the individual need to meet all these criteria listed for each type of specific needs statement of work? A: Yes, the individual will need to meet all of the criteria. Some of the criteria have options, and are listed as language such as, needs to have one of the three, for example. The purpose of these contracts is to have some community options for those unable to live in regular community based living. Q: If a client progresses from basic to advanced dementia, would they need to move? A: No, they would not have to move. Not all communities would have both a basic and an advanced dementia facility. The provider should contact the case manager if they have concerns regarding the service needs of the residents. Q: I have heard that the criteria in the RFP s make it likely most of the new development will be RCF s or ALF s. When you get a moment can you respond? A: The current RFP s are open for AFH, RCF or ALF s to submit a proposal. Each proposer will include information that is requested in the RFP, this includes how they will provide services. Q: Do the providers know that they will be getting two 512 s when these are set up? Once with the standard rate, and again when it is touched after adjustment, it not, maybe we could let them know ahead of time? A: Since all of the existing providers have been getting the 512 s for as long as they have been receiving the Specific Need contracts, they are accustomed to our payment system. We will send information out to the field, via the PT coming soon about the admission process that will outline how to stop the first 512 (the 512 before the Specific Need service payment is added on) from printing and auto-mailing to the provider. Individual TC s or CM s completing the admission process for the individual should review how the payment system works. 2

3 Q: Do you all anticipate any contracts that specialize in folks who have a physical issue that drives their needs, but also severe mental health issues? If this is covered later then we can wait. A: We do anticipate the residents will have both physical and mental health service needs. We have behavioral supports as well as nursing services, either built in to the contract or available. The pre-admission screening process should allow for the providers to review the records and have a full understanding of what services are needed. Q: This specific need contract system will it impact current special contracts (i.e. Windsor Place in Salem for TBI or Jefferson Manor in Dallas for Dementia) or are these contracts sun setting for the facilities to work into the RFP process? A: The five Specific Need contracts discussed today will not apply to a few facilities throughout the state that does include the above mentioned Windsor Place. They will have a payment change. There will be an IM coming out soon that outlines which facilities have chosen what contract. The other AFH with Specific Need contracts will also be discussed in the IM. The memory endorsed facilities, will not be affected by these changes. Q: Do the Dementia or Advanced Dementia homes require that the individual have a Guardian or at least a POA for healthcare decisions? A: The need for a guardian or POA for healthcare will be reviewed on a case by case basis. There is no language in the contract requiring this. It may be appropriate in some cases to have one of these in place. Q: What about a copy of their service plan for the consumer? Would a copy of the service plan document that the provider completed a thorough assessment? A: The consumer is always welcome to any of the service plan documents. The provider will do an assessment to determine that they can meet the service needs; this includes their nurse assessing the person as well. The assessment will include insuring that the consumer meets the targeting population. The service plan will be developed with the individual, once they move in to the facility. Before the TC or CM submits the SDS494 admission request, they will make sure that the provider has completed this part of the pre-admission requirement. The SOW outlines the additional requirements for Care Plan updates: it includes quarterly updates to care plan and a monthly review with all care givers. The individual has an active role in the care planning process. Q: Does the provider need to do a face to face assessment? Sometimes when out of area placement happening, difficult for provider to accomplish face to face. 3

4 A: A face to face assessment is recommended and in most cases. The providers will travel out of the area to assess a potential resident, usually after reviewing records that have been sent to them by the current provider. A provider may thoroughly assess the individual without a face to face, but the TC or CM helping with the admission should have a clear understanding of how thorough the assessment has been. If there is a concern that the assessment was not thorough enough to determine the service needs, please contact central offices contract administrators. Q: Does the TC need to actually see and review provider screening prior to agreeing to admit? A: Part of the transition process usually includes many conversations and communications with the admitting provider. Often times, the TC is involved in helping arrange these records to go to the provider. The TC will need to ensure that a thorough assessment has been completed by the provider. Additionally, the role of the Specific Need RN is to be part of the pre-admission process. The TC may inquire to the provider asking about the review process and what steps took place. Because the TC has to sign off on the SDS494 stating that they have verified that the provider has completed the screening, it may, in some cases, be appropriate to review the screening process, if there is some concern the process was not as thorough as it should be. Additionally, the TC may contact the contract administrator if there is a concern that the provider is not meeting the contractual agreement. Q: Will providers be given guidance or criteria on doing adequate screenings/assessments prior to accepting clients? We ve had some problems with poorly done screenings then problems once client is placed. A: The criteria for admission are outlined in the SOW. The providers are required to adhere to all that is outlined in the contract, as well as any licensing rules that apply. The TC should be aware of the target population and also will make sure that the person, according to the CAPS and narration, meets the criteria as well. The screening determines if they qualify for the targeted population, the Care Plan is then developed. The SOW discusses a Care Planning team and the function of the team. The care plan should reflect the service needs and how the needs will be met. An appropriate developed Care Plan should address anticipated needs, including behaviors, medical and ADL. As problems arise, the Care Plan should be adjusted and appropriate staff should be involved. For example, if the problem involved medical needs, the RN should be involved. Q: If I have a client who has dementia in a regular in home or CBC setting, there are no enhanced memory care beds, but there is no TC worker on the case, just a CM looking to find a dementia placement, these homes would not be an option even it might result in an ICF placement if no other regular AFH or setting will take them? 4

5 A: If someone is not able to continue to live in home and they would be admitted to ICF because there is not other option in the community that will meet this person s needs, then yes, that meets the criteria under diversion from a NF. This case would need to be data entered in to the D/T data base and followed for 90 days and then, the data base would need to be updated as to the outcome on the 90 th day. In some offices, the case manager does this function, in others, they TC would. In either case, the client would meet the criteria for admission. Q: When you say in a NF or diverted from, does that mean they can be any setting but placing in one of this specific need AFH would prevent NF placement? A: The purpose of the Specific Need contracts is to provide an alternative to NF placement. For example, a person is going to be admitted in to a NF and as an alternative; they are able to admit to Specific Need contract facility. This person may have to move out of the current community placement due to involuntary move out notice. If a person is able to live in the traditional community facilities (those without a Specific Need contract), they would not qualify to admit in to a Specific Need contract facility. Q: If they fail in a memory endorsed unit can they go to basic dementia or direct to Advanced? A: It could be either one, it depends on the reason why they failed in the memory endorsed unit. You would want to go back to the Target group for each contract and see which one fits. The Advanced contracts have additional admission criteria listed in the SWO. Q: In the sample SOW there is a section saying Staff Training: talking about a prior 4 hours of orientation to the clients care needs and service planning, and 8 hrs on site after placement. Who ensures this gets done? A: The Contract Administrators will ensure that the provider has met all the SOW requirements. We are aware that some providers like to submit all the training hours to the licensor. This is fine too, if that is the current practice. Q: Do they have to pay for the licensed therapist out of their contract money or can they access home health therapist and have the insurance may pay for it? A: The individuals insurance can be billed. Q: To qualify for an Advanced Neurological must they have failed in the Basic Neurological home? A: It may be that in your community, you have an Advanced Neurological facility but not a Basic Neurological facility. No, they do not have to but they may have. 5

6 Q: Are ventilator-assisted care AFH s in the specific needs contracts? A: No, the ventilator-assisted care AFH will not be part of the Specific Need contracts. There currently is a process for admission in to these facilities, that process will not be affected by the Specific Need contract process. 6