CCP Programmatic Updates & Discussion Topics

Report
2014 Supervisor’s Conference
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IDOA/DHS Medicaid Application Collaboration
◦ Granting CCUs access to PACIS
◦ Establish liaisons in each FCRC
◦ Streamline application submission
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IDOA/DHS Medicaid Application Collaboration
◦ Move toward online submission (ABE)
◦ Cross Training
◦ Develop plan for centralization
◦ Stakeholder’s Group
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CCU reviews being completed to:
◦ Verify compliance with Service Authorization
Guidelines (Public Act 098-0008)
◦ Verify Determination of Need (DON) scoring
compliance
◦ Verify compliance with CCP timeframes
◦ Verify compliance with CCP forms
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Through March 2014, 6 CCU reviews have
been conducted with 2 additional in April
2014
224 files have been reviewed, this number
includes prescreen files
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Service Authorization Guidelines: 39 of 194
files not compliant, 20%
Determination of Need: 35 of 194 files not
compliant, 18%
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Timeframes: 33 of 174 files not compliant,
19% (late annual redeterminations or late
Temporary Service Increase follow-up
assessments with no documentation of
participant delay)
Completion of Forms: 35 of 174 files not
compliant, 20%
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The CCU was provided technical assistance
regarding findings, with individual participant
files reviewed as needed
The CCU was sent the Quality Improvement
Review report with findings and corrective
actions outlined
Training to Care Coordinators is the primary
corrective action
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Consider IDoA revising CCP Forms
instructions to include need for frequency of
tasks
Continue IDoA CCU reviews
Continue and enhance collaboration between
IDoA & IL Council of CCU for trainings
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Since homecare aides are required to document tasks completed during each
provision of service, CCUs are encouraged to specify frequencies in this
column of the DON; without frequencies indicated the amount of service
authorized may not comply with the Service Authorization Guidelines
Care Coordinators should consider the number of days per week service is to
be provided when specifying frequencies
For example, the frequency of “five times per week” should be utilized if a
participant receives service five times per week, is incontinent and requires
assistance with bathing each time the homecare aide is present. A
participant who attends Adult Day Service three times a week and needs
assistance with taking medication at the ADS, should have the frequency
“three times per week” indicated under “routine health.”
“As needed” may be an appropriate task for some tasks such as telephoning
A participant’s service can be flexible for which days the service is provided,
however, the In-Home Service provider needs to know how many times per
week service is to be provided
The participant can direct the homecare aide regarding which day a task is
completed
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For “outside home” Care Coordinators should encourage
participants to utilize other transportation services besides the
homecare aide
Care Coordinators should authorize transport or escort for InHome Service no more than 1-2 times a week; exceptions should
be documented, including attempts to find other resources
Participants who are actively on Medicaid should utilize this
resource for transportation to medical appointments
Remember that In-Home Service agencies are not required to
provide transportation via the homecare aide’s personal vehicle.
Care Coordinators should refer to the In-Home Service agency’s
Service Specific Application for information indicated by the
agency for transportation/escort.
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Care Coordinators should document
exceptions to Service Authorization
Guidelines in case notes
Service Authorization Guidelines must be
utilized for all In-Home Service authorization,
including Family Homecare Aides
Service Authorization Guidelines do not apply
to Adult Day Service
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Eating
◦ Seek adaptive utensils that can assist
◦ Recommend preparation of foods that do not
require cutting
◦ If the participant cannot feed themselves, there has
to be back up support as CCP cannot be there for
all 21 meals a week
◦ HDM is not a service by other for eating
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Bathing
◦ Bathing, grooming, dressing A side scores should
be similar
◦ Encourage use of assistive devices, such as bath
seats, grab bars, etc.
◦ Daily personal care is not essential unless
incontinence is an issue
◦ Do not impose your hygiene standards onto the
participant
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Grooming
◦ Bathing, grooming, dressing A side scores should
be similar
◦ Encourage use of assistive devices, such as
weighted or large grip brushes—can use foam or
duct tape to modify
◦ Homecare aides can only file and clean nails—no
cutting of nails
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Dressing
◦ Bathing, grooming, dressing A side scores should
be similar
◦ Encourage clothing with Velcro, elastic, etc. so
participant can remain as independent as possible
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Transferring
◦ Consider the use of assistive devices, such as a
walker, lift chair, etc.
◦ A back up support is needed as CCP cannot be
there 24 hours/day—how is the participant
completing this task when CCP not present?
◦ For a participant who scores 3-3 & lives alone a
safe care plan may not be able to be developed
◦ Homecare aides cannot do total lifting; the
participant must be able to assist with the transfer
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Continence
◦ Encourage use of assistive devices, such as bed side
commodes, continence products, etc.
◦ A back up support is needed as CCP cannot be
there 24 hours/day—how is the participant
completing this task when CCP not present?
◦ Homecare aides cannot do catheter or ostomy care
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Managing Money
◦ Getting out to pay bills should be scored under
outside home instead of managing money
◦ Utilize IL Volunteer Money Management Program
(IVMMP) if available in your area
◦ In-Home Service providers must have a policy on
receipt handling; receipts must be returned to
participant & documented
◦ Homecare aides cannot be responsible for money
management
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Telephoning
◦ If the participant has no phone that is not
considered an impairment
◦ Encourage use of assistive devices, such as a
magnifying glass, large number phone, etc.
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Preparing Meals
◦ Encourage meals that can be prepared ahead or
extras made
◦ A participant who lives alone should not have a 3-3
score on the DON—3 on the A side of the DON
means the participant cannot even warm a meal &
no one is there to prepare
◦ If Home Delivered Meals in service by others is
indicated, B side score should be lowered
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Laundry
◦ Laundry & housework A side scores should be
similar
◦ A participant who can do part of the task such as
folding should not be scored a 3 on the A side
◦ Consider location of laundry facilities when
authorizing time to complete the task
◦ A participant with continence problems may need
laundry completed more frequently
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Housework
◦ Housework & laundry A side scores should be similar
◦ Basic housekeeping tasks, not heavy seasonal cleaning,
are to be completed by the homecare aide
◦ The homecare aide is to complete tasks for the
participant, not the entire family
◦ Unless there is documentation in the CCU case notes of
a medical necessity, housework should not be
authorized more than 1 x a week
◦ The participant can direct the homecare aide regarding
which day a task is completed
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Outside Home
◦ Distinction should be made between transport &
escort; escort is needed when the participant is
either physically or cognitively unable to leave the
residence alone
◦ See slide under Service Authorization Guidelines
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Routine Health
◦ Homecare Aides cannot set up or administer
medication; Adult Day Service can
◦ Consider how many days service provided: if
participant needs reminded to take medications
what happens when CCP not there? Back up support
will be needed for those times
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Special Health
◦ Is something a licensed professional needs to
perform
◦ B side should be 0 unless participant going to a
facility (Choices screen) or ADS will perform;
homecare aides cannot perform special health
functions
◦ Watch over-scoring of this function: when scoring
A side consider frequency of professional visits
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Being Alone
◦ For a participant who scores 3-3 & lives alone a
safe care plan may not be able to be developed
◦ Can the participant recognize danger & alert others?
◦ For a participant who cannot be left alone, a back
up support should be in place in case CCP service
unavailable—e.g., homecare aide late, ADS closed
due to weather
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Friendly Reminders
◦ If B side is 0, there should be no CCP services or
frequency indicated
◦ If B side is lowered from A side, notation should be
made in service by other column, including “self” or
“manages”
◦ Side A DON score of 3 should be reserved for
participant who cannot do any part of the task at all
or requires constant supervision
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Friendly Reminders
◦ Side B DON score should be adjusted for both
formal & informal supports
◦ Empower the participant to continue to do as much
for themselves as possible to maintain their
independence
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Referral is made (request for services)
◦ CCU has 5 calendar days from the referral date to
respond to the referral by contacting the participant
(preferably a phone call)
◦ The CCU should document the date the referral was
received by the CCU, including if the referral was a
fax from another agency
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Initial Assessment
◦ CCU has 30 calendar days to complete an Initial
Assessment from the date of the request for
services.
◦ If participant delay occurs, the CCU should
document this in the case notes, e.g., awaiting
financial verification, participant not wanting to
choose provider at time of assessment
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Initial Assessment (continued)
◦ If a supervisor’s signature is required to approve an
assessment, the supervisor must sign and date
page 20 of the Comprehensive Needs Assessment.
The date of the supervisor’s signature is the
Eligibility Determination Date (EDD). Unless
participant delay occurs, this must be within 30
calendar days from the date of request for services.
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The date the Care Coordinator signs the
Client Agreement is the EDD; it may be
different than the date the
participant/authorized representative signed
If eligibility not determined at the
assessment, the participant can sign & date
the CA but the Care Coordinator should not
do so until the EDD
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The EDD is the date shown on section D of
the Plan of Care Notification Form (POCNF)
“Eligibility Finding” which is entered on the
POCNF Input screen
The EDD on the Client Agreement & POCNF
must match
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Implementation of Goals of Care
◦ CCU has 15 calendar days to make referrals &
implement goals of care from the date the
participant signed the Goals of Care on page 20 of
the CCC tool. This includes all referrals to CCP
providers and to non-CCP providers.
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Implementation of Goals of Care
◦ The Eligibility Notification date which is entered on the POCNF
Input screen is the date the CCU provides copies of the POCNF to
the participant and all CCP providers.
◦ The CCU can leave the POCNF with the participant if eligibility is
determined the date of the visit and all providers were notified
◦ The eligibility notification date must be within 15 calendar days of
the EDD.
◦ If there was an adverse action and the CCU leaves the POCNF, the
CCU can obtain a signed receipt from the participant/authorized
representative rather than send the POCNF certified mail
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Service Start Date
◦ CCP Providers have 15 calendar days from the date of
notification to begin providing services to a participant.
◦ CCP providers have 5 calendar days to return the signed
Client Agreement to the CCU after the initiation of
services. Both CCUs and providers should monitor
assure this is completed.
◦ Service start date is the date services initially began or
were increased. If service remains the same the provider
should utilize the same date the Care Coordinator
signed the Client Agreement.
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Client delay
◦ Participant has 60 calendar days from the signature
on the Goals of Care to provide documentation
verifying eligibility. Client Delay only pertains to
CCP cases.
◦ The CCU must document participant delay in case
notes
◦ Providers must also document participant delay,
especially when initiating or increasing services &
should report this to the CCU
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Review your agency’s policies at least
annually to be certain all required policies are
in place & up to date
Review your agency’s pre-service curriculum
to assure it covers all required topics & hours
in CCP 240 rule
Plan your agency’s in-service in advance to
assure all required topics & hours in CCP 240
rule are covered for the year
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HCA verification of tasks—policy “CCP
Participant Verification of Services—update
January 2014”—effective 4/1/2014
◦ All In-Home Service agencies required to have
electronic or paper format to verify tasks performed
by Homecare Aide at each provision of service
◦ If utilizing a paper form for verification of tasks do
not include in/out times as is difficult to match EVV
times
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The homecare supervisor should contact the
CCU if tasks are consistently not completed in
accordance with the CCU POC
Deviations from CCU’s Plan of Care can be
documented in same format/form as
verification of tasks
When requested, electronic documentation,
including EVV & verification of tasks must be
able to be printed by the provider
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Determination of Need Analysis (from October 2013
In-Home Service participant data)
◦ State-wide average DON score=48
◦ State-wide average monthly authorized units=59
◦ State-wide average monthly provided units=49
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Determination of Need Analysis (from October 2013 In-
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Action Steps:
Home Service participant data)
◦ CCUs should review your agency’s data with your Care
Coordinators & supervisors
◦ CCUs should utilize CMIS to periodically run “Active CCP
Averages” report by Care Coordinator
◦ CCUs should consider training and/or monitoring for
Care Coordinators who have excessively high averages
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CCU Medicaid Analysis Report
from October 2013 data
◦ For each CCU contract number, the report shows number
& percentage of participant with 0 & less than $2,000
assets on Case Authorization Transactions (CATs)
◦ Report also shows ratio of CCP participants with
Medicaid ID to those with less than $2,000 assets;
greater percentage equates to increased opportunity to
generate FFP (federal match)
◦ CCUs are required to document actual assets—do not
assume someone has 0 assets if they are on Medicaid
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CCU Medicaid Analysis Report
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Action Steps:
from October 2013 data
◦ IDoA may complete another Root Cause Analysis
◦ CCUs encouraged to utilize PACIS to obtain
Medicaid status about participants
◦ CCUs encouraged to continue to communicate
concerns with local FCRC to IDoA
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Active Caseload & Redetermination List
(generated 4/10/14)
◦ For each CCU contract number, the report shows number
of authorized participants, redeterminations due, &
analysis of time rede is past due
◦ State-wide 31.2% of authorized participants have a rede
past due per eCCPIS data
◦ State-wide average days late is 378
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Active Caseload & Redetermination List
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Action Steps:
(generated 4/10/14)
◦ CCP participants are required to have annual
redetermination of need completed; Eligibility
Determination Date of rede must be within 365 days
of previous EDD
◦ CCUs should utilize CMIS to frequently run the “Next
Assessment Report” to assure redeterminations
being completed timely
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CCUs: please do not put other information in
name & address lines in CMIS; this info is
utilized for mailings & other data analysis; the
notes section in CMIS can be utilized
CCUS & providers: for any changes in contact
information, please send email to
[email protected] and notify IDoA’s
Office of Service Development & Procurement
[email protected]
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CCUs: please thoroughly explain the reason a
participant’s services are denied, decreased,
or terminated & document the reason in the
case notes
CCP Providers: please inform the CCU of
changes in the participant’s condition or
demographics or if the participant is
hospitalized; this communication should be
documented in the case notes
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IDoA will advise CCUs & providers of the date by
which FY 14 billings must be submitted, this date
is usually in August
Billings past that date will need to be submitted
through Court of Claims
CCUs: if your agency requires a supervisor review
& approve the file prior to the file being
processed, please factor this in to assure
person(s) entering CATs has time prior to cut off
date
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CCUs: assessments not entered into CMIS &
transmitted to IDoA cannot be billed by you
or your provider(s)
Providers: delete any rejected payments for
which you have already been paid, i.e.
duplicate billing accidentally submitted
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MMAI Rollout
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CCP & MCO Differences
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Billing
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Communication
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Trainings
 Have
a safe trip home
 Thanks
for all you do

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