Consolidated Personal Care Services Webinar Training for Licensed Home Providers

1
Consolidated Personal Care Services Webinar
Training for Licensed Home Providers

• Program Eligibility, Independent Assessments, and
  Recipient Notifications
• Talbatha Myatt, Division of Medical Assistance
• Robyn Reasor, The Carolinas Center for Medical
  Excellence
• July 26, 2012

2
Presentation Overview

1. Review Recipient eligibility criteria,
   independent assessment (IA) requirements, and IA
   scheduling
2. Walk-through IA tool and process
3. Preview IA notification process

3
Consolidated PCS

• January 1, 2013 program implementation
• Comparable benefit for beneficiaries in private
  residences and licensed homes
• Recipient eligibility criteria
• Service definition
• Reimbursement rate and methodology

4
(No Transcript)
5
Proposed Clinical Coverage Policy 3L
6
Eligible Beneficiaries
Eating

• Have a medical condition, disability, or
  cognitive impairment, and
• Demonstrate unmet need for hands-on assistance
  with qualifying activities of daily living (ADLs).

7
(No Transcript)
8
Covered Services for Adults
9
Additional Services for Children
10
Eligibility Determinations for Current Licensed
Home Residents

1. Medical attestation
2. Independent assessment (IA) conducted in
   recipients home by Carolinas Center for Medical
   Excellence (CCME) RN Assessor

11
Transition Planning Resources
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
Medical Attestation Form
16
(No Transcript)
17
Independent Assessments
18
Preliminary Projected Timeline
19
Preliminary Projected Timeline

• Licensed care facilities with paid Medicaid PCS
  claims for Jan-May 2012 dates of service
• Additional facilities use New Admission
  assessment request
• New Admission request process to be announced and
  implemented this fall

20
Assessment Scheduling

• CCME contacts facility in advance by phone to
  confirm dates and verify Medicaid resident list
• Provider reports discharges and new admissions
• CCME makes return visits this fall to assess new
  admissions since initial visit

21
(No Transcript)
22

• The Independent Assessment

23
(No Transcript)
24
Cognitive/Mental Capacities to Participate in
Assessment

• Fully able Resident is alert and oriented to
  person, place and time can verbalize general
  information about conditions and medications
  appropriately.
• Requires limited assistance Resident alert and
  oriented greater than 50 of time with periods of
  confusion, but can be redirected easily
  questions may need to be repeated, but resident
  verbalizes appropriate answers to basic
  questions.
• Requires extensive assistance Resident alert and
  oriented less than 50 of time may need basic
  questions repeated several times generally not
  able to answer complex questions appropriately.
• Requires full assistance Cognitive impairment
  prevents resident from participating in
  assessment.

25
(No Transcript)
26
Residents Ability to Self-Manage Medications

• Totally able no assistance required
• Can do with set-up assistance only
• Can do with verbal cueing and supervision only
• Can do with set-up assistance and verbal
  cueing/supervision only
• Can do with limited hands-on assistance with
  taking medications
• Can do with extensive hands-on assistance with
  taking medications
• Cannot do at all full staff assistance required

27
(No Transcript)
28
(No Transcript)
29
Assessors Overall Self-Performance Capacity
Rating

• Totally able Recipient able to self-perform 100
  of activity, with or without aids or assistive
  devices and without supervision or set-up
  assistance
• Needs verbal cueing or supervision only
  Recipient able to self-perform 100 of activity,
  with or without aids or assistive devices, and
  requires supervision, monitoring, or set-up
  assistance.
• Can do with limited hands-on assistance
  Recipient able to self-perform more than 50 of
  activity, and requires hands-on assistance to
  complete remainder.
• Can do with extensive hands-on assistance
  Recipient able to self-perform less than 50 of
  activity, and requires hands-on assistance to
  complete remainder.
• Cannot do at all Recipient unable to perform any
  of the activity activity must be completely
  performed for recipient.

30
(No Transcript)
31
(No Transcript)
32
(No Transcript)
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
(No Transcript)
39

• INDEPENDENT ASSESSMENT
• Data Transmission
• Quality Review
• Assessment Processing
• Eligibility Determination
• Service Level Determination
• RECIPIENT NOTIFICATION

40
Recipient Notification

• Recipient notified of assessment results and
  authorized service level in formal Decision
  Notice
• Approval notices sent by U.S. mail
• Adverse decision notices sent by trackable mail
• Current provider receives notice copy
• Notification timelines will be announced when
  finalized

41
Recipient Appeals and MOS

• Adverse decision service reduction or denial
• Recipient may appeal adverse decision
• Decision Notice includes appeal rights, appeal
  request form, and instructions
• Providers may assist beneficiaries who wish to
  appeal
• beneficiaries who appeal timely, within 30 days
  of decision, are entitled to Maintenance of
  Services (MOS) until appeal is resolved

42
Upcoming Provider Trainings
Date Description Topic
Aug 6 17, 2012 Regional Trainings for Licensed Home Providers Policy, Assessments, Recipient Decision Notices
Sept 20, 2012 10001130 a.m. Webinar Training Recipient Appeals
Sept-Oct 2012 Regional Trainings for Licensed Home and Home Care Agency Providers  PCS Policy, Billing and Aide Documentation
Nov 15, 2012 10001130 a.m. Webinar Training To be determined
43
For More Information

• Consolidated Personal Care Services (PCS)
  http//www.ncdhhs.gov/dma/pcs/pas.html
• CCME Independent Assessment Help Line
• 1-800-228-3365
• CCME IA e-mail PCSAssessment_at_thecarolinascenter.o
  rg
• (Do not include PHI.)