Agenda. CDCS FOR CAC, CADI, TBI and MR/RC WAIVERS. LTC Screening Document New fields - ALT4 screen

Transcription

1 Agenda CDCS FOR CAC, CADI, TBI and MR/RC WAIVERS May 12, 2005 Screening Document changes for CDCS Service Agreement changes for authorizing CDCS services. Billing CDCS services on the CMS 1500 LTC Screening Document New fields - ALT4 screen A person opening to a CAC, CADI, or TBI waiver and choosing CDCS NEXT: ALT5 09/09/04 06:59:01 MMIS LTC SCREENING - ALT4 PWXXXXX 09/09/04 PWMW938 DOCUMENT NBR: DOC STAT: AGE/LA: ASSESSMENT RESULTS/EXIT RSNS: ASSESSMENT DT: INFORMED CHOICE: CLIENT CHOICE: FAMILY CHOICE: PAS/IDT RECMND: LVL OF CARE: NF TRACK: CASE MIX/DRG: CASE MIX APP (Y/N): MNDC: REASONS FOR INSTITUTIONAL STAY: ADL COND: IADL COND: COMP COND: COGNITION: BEHAVIOR: HYG/SAFETY: NEG/ABUSE: FRAILITY: SENSORIAL: REST/REHAB: UNSTABLE: SPEC TREAT: CMPLX CARE: REQUIRES AC/WVR SVC: SAFE/COST EFFECTIVE: NO OTHER PAYOR IS RESP: PROGRAM TYPE: MNDHO RCC: CDCS: Y CDCS AMOUNT: -use activity type 02, 04 or 07 (if within 60 days of a face to face assessment) -use assessment result 01, 10, 11, 28 -enter a Y in the CDCS field Note: this will create a waiver span for the person. 1

2 A person already on a CAC, CADI, or TBI waiver at reassessment, who chooses CDCS -use activity type 06 -use assessment result 13 -enter a Y in the CDCS field Note: this will extend the waiver span for the person. A person already on a CAC, CADI, or TBI waiver and chooses CDCS -use activity type 07 -use assessment result 98 -enter a Y in the CDCS field Note: this will not extend the waiver span for the person. A person chooses to discontinue CDCS at the time of their reassessment -use activity type 06 -use assessment result 13 -enter an N in the CDCS field Note: this will extend the waiver span for the person. A person chooses to discontinue CDCS at any time other than reassessment -use activity type 07 -use assessment result 98 -enter an N in the CDCS field Note: this will not extend the waiver span for the person 2

3 DD SCREENING DOCUMENT NEXT: ADD4 03/03/05 07:53:23 MMIS DD SCREENING - ADD3 PWCWM37 01/10/05 PWMW942 DOCUMENT NBR: 5062 XXX X 001 DOC STAT: A APPROVED CM NBR: RECIP NAME/ID: PERSON SOME W SEX: M AGE/LA: XX 55 INFORMED CHOICE(Y/N): Y CODE CURRENT SERVICES CODE PLANNED SERVICES CASE MANAGEMENT 19 CASE MANAGEMENT RESIDENCE-OTHER 33 OTHER SERVICES CONSUMER DIRECTED COMM SUPPORT LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID Screening Document Edits Edit 441- CDCS FIELD IS BLANK OR INVALID LTC Screening Document If the Program Type is CAC, CADI or TBI then the CDCS field must be populated. Edit 442 CDCS NOT ALLOWED FOR PCUR If the DD screening document has current service 48 (CDCS) or LTC SD has CDCS field Y then Recipient cannot have a current or past PCUR Begin Date. To Authorize CDCS on a Service Agreement LTC screening document CDCS field is Y or DD screening document Current Service Code is 48 3

4 SERVICE AGREEMENTS CDCS is authorized as one service agreement line item for CAC, CADI, TBI and MR/RC waivers Enter the dates of the service span Use CDCS code T2028 (no modifier) Enter the individual s budget amount as the requested total amount. (no unit or rate) This amount can not exceed the County Approved Resource Amount in the Community Support Plan. This information is on the Waiver Management System Others Services allowed as separate line items on the service agreement T2040- background checks X5476- case management X5491- case management aide X5609- PPHP services X4037- supervision of PCA Other services (con t) S modifications T PCA T skilled nurse visit T home health aide T PDN-RN T PDN-LPN Extended home care is included in the CDCS budget. Service Agreement New Field ASA2 screen NEXT: MMIS SERVICE AGMT - ASA2 PWMW926 AUTHORIZATION NBR: AGMT TYPE/STAT: PROV NBR/TYPE: RECIP NAME/ID: SEX: AGE/LA: STAT RSN: ATTACH(Y/N): SACTAD NBR: OVR LOC: SEND RECIP LTR(Y/N): SEND PROV LTR(Y/N): AC PREMIUM AMOUNT: PREMIUM EFFECTIVE DATE (MM/YY): CLAIMS UPDT DT: PROV COMMENTS: INPUT MEDIA: RECIP COMMENTS: RESP PARTY(Y/N): DHS COMMENTS: FISCAL INT(Y/N): LIVES WITH RESP PARTY(Y/N): EXCLUDED TIME: Y LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID 4

5 EXCLUDED TIME When applicants live in an excluded time facility or receive excluded time services, the county they lived in immediately before entering or receiving excluded time service is financially responsible. Financial responsibility continues until the person lives outside of excluded time facility/service in another county for 2 full calendar months. Service Agreement Edits Edit EXCLUDED TIME FIELD IS BLANK OR INVALID. If procedure code T2028 is entered the Excluded Time field must be populated. Edit 865- PROCEDURE CODE/CURRENT SERVICE MISMATCH For procedure code T2028 The DD screening document must include Current Service Code - 48 (CDCS) Edit 443 CDCS NOT ALLOWED For procedure code T2028 or T2040. The LTC screening document CDCS field must be Y. 5

6 Edit PROCEDURE/MODIFIER CONFLICT Procedure code T2028 cannot be entered on an SA with a modifier Edit 444 CDCS/OTHER SERVICE CONFLICT Procedure code T2028 conflicts with another service on the SA. BILLING CDCS SERVICES CDCS is authorized on the SA using procedure code T2028 (with no modifier) CDCS is billed on the CMS 1500 using an appropriate modifier CDCS is billed using a modifier T2028 U1 CDCS- Personal Assistance T2028 U2 CDCS- Treatment and Training T2028 U3 CDCS- Environmental Modifications and Provisions T2028 U4 CDCS- Self Direction Support Activities T2028 U8 Flexible Case Management Use of these codes for billing will decrement the SA line item T2028 6

7 For assistance call Resource Center County Help Desk or Fax: For Billing questions: Customer Service Help Desk or