Department Updates

Report
2014 Care Coordinator’s Conference
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The rules, policies, and procedures in this
Power Point presentation are highlights and
summaries of those rules, policies, and
procedures. This presentation does not
replace the necessity of reading these in their
entirety.
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Policy sent September 2, 2014 with effective
date of October 1, 2014
Email sent September 26 with questions and
answers
IDoA will continue to provide clarification on
questions received
To assist older adults to remain in the
community as long as they safely can
Once a person enters a nursing facility it is
more difficult to transition back to the
community
All options for community-based services are
explained in the pre-screening giving the
individual the opportunity to choose from
available services
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Adults in Illinois have the choice and ability to
remain at home by accessing community
based services.
Education on what is available allows each
adult to make an informed decision on which
methods will meet their needs and maintain
their independence now and in the future.
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Part of the Care Coordinator’s role is to
educate an individual on what services are
available and appropriate to meet their
specific needs.
Public Act 098-0651: Hospital discharge
planner is responsible for forms to facility
The change in the process for CCUs and
hospitals is a small part of this Public Act
which also is meant to address concerns from
facilities. Facilities have to submit 2536 and
other documentation to the Department of
Human Services
Removal of Illinois Department on Aging Nursing
Facility Parolee Screen Notification Form (IL-4021321)
and
Motorized Wheelchair Evaluation Form (previously
eliminated in 2012)
CCUs required to check eCCPIS and CMIS to see
if assessment completed within last 90
calendar days
If the individual has been screened within the
past 90 calendar days, CCU will not complete
a new assessment but will complete HFS
Screening Verification Form
Prescreen CATs required to be transmitted
within 10 calendar days
CAT can be transmitted prior to CCU receiving
paperwork from the hospital
After CAT transmitted, CCU can go into CMIS—
update—Choices for Care and enter
information regarding facility placement so
that follow-up can be completed
For post-screenings that occur for one of the
following reasons:
Admission from out-of-state;
Admission from a Hospital
Emergency/Outpatient Services; or
Pre-existing condition of need for a caregiver
and caregiver is no longer able to provide
care
Facilities are not required to first contact BEAM
Facilities are not required to first contact BEAM
The CCU shall first check eCCPIS for previous
assessment within past 90 calendar days
If none, the CCU shall complete the postscreen assessment within 10 calendar days of
notification from facility
If assessment, the CCU shall complete the HFS
Verification Form and send to facility within 5
calendar days
If a facility contacts the CCU directly, the CCU
can accept the request for a post-screen and
does not need to contact BEAM or refer the
facility back to BEAM.
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Person transferring from SLF to NF does
require a new screening if the DON is more
than 90 days old
Person transferring from NF to SLF does not
require a new screening provided there is no
break in service between NF to SLF
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If a facility does not receive paperwork when
a person is admitted from the hospital the
facility is to contact-◦ 1) the hospital from where the person was admitted
◦ 2) if not received from the hospital within 10
calendar days, then CCU in that area; please check
eCCPIS and complete the Screening Verification
Form if your CCU did not conduct the assessment
◦ 3) contact BEAM who will check eCCPIS and
complete the Screening Verification
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IDoA will continue to work with Illinois
Hospital Association on specific concerns
from CCUs; CCUs can send to
[email protected]
IDoA will work with HFS on possibility of
revising 2536 and OBRA forms as well as
hospitals having electronic version of forms
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Effective December 1, 2013, a participant
may utilize cellular EHRS if no land-line is
available
Cellular EHRS does not use or require a
participant’s personal cell phone
Care Coordinator is to explain limitation of
cellular service
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Care Coordinator is required to review and
explain the “Cellular EHRS Participant
Acknowledgment” form
Participant is required to sign this form, CCU to
keep in the file and send a copy to the EHRS
provider
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CCU is required to inform EHRS provider that
participant needs cellular service
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Currently all but one EHRS provider offers cellular
service
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Effective July 1, 2013, In-Home Service
providers required to utilize EVV system
Providers able to choose their EVV provider
so there are different systems being utilized
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Participant does not have to allow homecare
aide to utilize the phone in their residence
In-Home Service providers were required to
provide participants a copy of the letter from
IDoA which explains EVV
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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 September 2014, 31 CCU contracts
have been reviewed
813 files have been reviewed, this number
includes prescreen files
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Service Authorization Guidelines: files not
compliant = 17%
Determination of Need: files not
compliant = 23%
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Timeframes: files not compliant = 16%
(late annual redeterminations or late
Temporary Service Increase follow-up
assessments with no documentation of
participant delay; late follow-up for initial
assessments, etc.)
Completion of Forms: files not
compliant = 8%
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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
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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.”
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“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
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The number of times per week for service can be
indicated on the notes section of the POCNF
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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 In-Home Service no more than
1-2 times a week; exceptions should be
documented, including attempts to find other
resources
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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 to nonCCP providers & implement goals of care from the
date the participant signed the Goals of Care on
page 20 of the CCC tool.
◦ CCU has 15 calendar days from the EDD to send the
POCNF. This date is the Eligibility Notification Date.
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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 to
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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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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Section 240.350 of CCP rules outlines
instances of and responses to noncooperation
CCP rules should be one of your favorites in
your Internet browser
Refer to Section 240.350 for description of
non-cooperative actions and provider and
CCU responsibilities
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Section 240.350 a) outlines circumstances when
a participant’s services may be suspended after 2
such occurrences within a State Fiscal Year (June
30-July 1)
240.350 a) 1) notify In-Home Service agency of
absence (except for emergency) at least one day
in advance
240.350 a) 2) notify Adult Day Service agency of
absence (except for emergency) at least one day
in advance
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240.350 a) 3) not refuse to allow provider
into home to provide services
240.350 a) 4) not interfere with provision of
services specified in the plan of care, in the
home or in day care site
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240.350 a) 1) through 4):
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Provider shall:
◦ Document incidents
◦ Verbally advise CCU on same day but not later than
next work day
◦ Mail written report to the CCU within 2 work days of
the second occurrence
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240.350 a) 1) through 4):
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CCU shall:
◦ Suspend participant’s service with effective date of
suspension the date of the second occurrence
◦ Immediately but not later than next work day,
verbally advise the participant of the suspension
and date of suspension
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240.350 a) 1) through 4):
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CCU shall:
◦ Send POCNF to participant and provider by regular mail
within 5 calendar days from verbal notification to the
participant
◦ Develop a Memorandum of Understanding (MOU)
between participant, provider, and CCU
◦ Obtain signature on MOU from all parties within 30
calendar days (unless delay from participant) from
effective date of suspension
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240.350 a) 1) through 4):
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CCU shall:
◦ Upon execution of MOU, send POCNF (via regular
mail) to participant and provider(s) to reinstate
services. Services shall be reinstated on or before
15 calendar days from date of signature on the
MOU.
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Section 240.350 a) 5) outlines circumstances
when a participant’s services may be
suspended after 1 occurrence. The
participant/authorized representative or
family member/friend shall:
◦ Not threaten or act abusively (e.g. physical, verbal,
sexual, etc.)
◦ Not display a weapon (e.g. gun, knife, etc.)
◦ Prevent any animal present in the home from
physically harming Department/CCU/provider
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Section 240.350 a) 5):
Provider shall:
◦ Leave the premises immediately or if at ADS advise
family immediately
◦ Verbally advise CCU on same day but not later than
next work day
◦ Mail written report to the CCU within 2 work days of
the occurrence
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Section 240.350 a) 5):
CCU shall:
◦ Send POCNF to participant and provider by regular mail
within 5 calendar days from verbal notification to the
participant
◦ Develop a Memorandum of Understanding (MOU)
between participant, provider, and CCU
◦ Obtain signature on MOU from all parties within 30
calendar days (unless delay from participant) from
effective date of suspension
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Section 240.350 a) 5):
CCU shall:
◦ Upon execution of MOU, send POCNF (via regular
mail) to participant and provider(s) to reinstate
services. Services shall be reinstated on or before
15 calendar days from date of signature on the
MOU.
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Reminders:
◦ Suspension of services may not be appealed
because a suspension is not a final decision
◦ Failure to sign an MOU shall be grounds for
termination of or denial of services
◦ An MOU remains in effect when a participant
changes providers or CCUs; new provider and/or
CCU must sign the MOU
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The Care Coordinator should carefully review the
timeframes outlined in 240.350 and provider
documentation to assure all timeframes met prior
to development of MOU
If timeframes are not met, MOU should not be
developed or executed and provider reminded of
timeframes
IDoA suggests meeting with participant, provider,
and CCU to discuss concerns and explain
consequences of behaviors can lead to
termination of CCP services; there may be other
times meeting with all parties would also be
beneficial
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If, following reinstatement, the requirements of
the MOU have not been adhered to, services are
to be terminated or denied
For 240.350 a) 1) – 5), the CCU shall send the
POCNF certified mail or hand deliver the POCNF
with receipt signed
For 240.350 a) 1) – 5), the effective date of the
POCNF is to be 15 calendar days from the date of
notice (unless mutually agreed upon by all
parties)
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A participant can appeal denial or termination
of services based on an MOU
If appeal received within 10 calendar days of
POCNF notification date, services are to
remain in place unless approval not to do so
received from IDoA (only in cases where
health, safety, and welfare of worker or
others in jeopardy)
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A person can re-apply for CCP services after
their services were terminated for an MOU
violation. The CCU shall:
◦ Conduct an initial assessment following same
guidelines and eligibility criteria
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If the individual qualifies for CCP, review a copy
of the MOU agreement with the participant and
discuss the provisions—e.g. why it occurred
Discuss the incident that caused the termination
Question the individual as to how things have
changed in the situation and why they need CCP
services at this time
Obtain Releases of Information as necessary to
discuss individual’s situation with others involved
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CCU shall document all contacts
If there is a “permanent change” in the
individual’s situation, CCP services can be
provided again
It is ultimately the CCU’s decision whether or not
to approve CCP services, but assistance can be
obtained from IDoA if needed.
If an individual is approved for CCP services after
termination for MOU violation, the MOU is now
null and void
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240.350 b): a participant/authorized
representative or family member/friend shall
not inflict physical injury upon any
representative of Department, CCU, or
provider
Provider shall:
◦ Injured party is to leave premises immediately
◦ Verbally advise CCU same day but not later than
next work day
◦ Mail written report to CCU within 2 work days from
date of injury
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240.350 b):
CCU shall on the same day if possible but no
later than the next work day:
◦ Institute immediate denial or termination of services
with the effective date the date of infliction of physical
injury
◦ Verbally notify the participant/authorized representative
◦ Mail POCNF by certified mail to participant within 5
calendar days of verbal notification
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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
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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Please thoroughly explain the reason a
participant’s services are denied, decreased,
or terminated & document the reason in the
case notes
CCP Providers are required to 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
 Looking
 Have
to the future
a safe trip home
 Thanks
for all you do

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