2014 Care Coordinator’s Conference. The rules, policies, and procedures in this Power Point presentation are highlights and summaries of those rules,

CCP Programmatic Updates & Discussion Topics

2014 Care Coordinator’s Conference

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.

Disclaimer/Reminder

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

Choices for Care/Universal Screening Update

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

Mission of IL Department on Aging

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.

Intention of Pre-Screening

Part of the Care Coordinator’s role is to educate an individual on what services are available and appropriate to meet their specific needs.

Care Coordinator’s Role

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

Changes to Choices for Care

Removal of Illinois Department on Aging Nursing Facility Parolee Screen Notification Form (IL-402-1321)

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; orPre-existing condition of need for a caregiver

and caregiver is no longer able to provide care

Facilities are not required to first contact BEAM

Clarifications to Post-Screenings

Facilities are not required to first contact BEAMThe CCU shall first check eCCPIS for previous

assessment within past 90 calendar days

If none, the CCU shall complete the post-screen 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.


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

Clarifications

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

Clarifications

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

Clarifications

mailto:[email protected]

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

Cellular Emergency Home Response

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

CCU is required to inform EHRS provider that participant needs cellular service

Currently all but one EHRS provider offers cellular service

Cellular Emergency Home Response

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

Electronic Visit Verification

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

Electronic Visit Verification

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

CCU Reviews

Through September 2014, 31 CCU contracts have been reviewed

813 files have been reviewed, this number includes prescreen files

CCU Reviews (cont)

Service Authorization Guidelines: files not compliant = 17%

Determination of Need: files not compliant = 23%

CCU Review Findings

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%

CCU Review Findings (cont)

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

CCU Review Corrective Actions

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

Next Steps

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

Service Authorization Guidelines: Suggestions to Improve Compliance

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 number of times per week for service can be indicated on the notes section of the POCNF

The participant can direct the homecare aide regarding which day a task is completed


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

Service Authorization Guidelines: Authorizing Transport or Escort

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.

Service Authorization Guidelines: Authorizing Transport or Escort

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


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

Determination of Need Scoring

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


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


Dressing◦ Bathing, grooming, dressing A side scores should

be similar

◦ Encourage clothing with Velcro, elastic, etc. so participant can remain as independent as possible


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


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


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


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.


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


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


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


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


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


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


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


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


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


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

CCP Paperwork—Requirements for Timeframes

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


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.


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

CCP Paperwork—Eligibility Determination Date & POCNF Reminders

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

CCP Paperwork—Eligibility Determination Date & POCNF Reminders

Implementation of Goals of Care

◦ CCU has 15 calendar days to make referrals to non-CCP 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.


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


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.


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


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

Verification of Tasks

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

Verification of Tasks

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

State-wide CCP averages

Section 240.350 of CCP rules outlines instances of and responses to non-cooperation

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

CCP Participant Cooperation

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


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


240.350 a) 1) through 4):

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


240.350 a) 1) through 4):

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


240.350 a) 1) through 4):

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


240.350 a) 1) through 4):

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.


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


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


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


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.


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


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

Options to MOU

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)

Violation of MOU

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)

Violation of MOU

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

Receiving CCP Services after MOU Violation

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


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


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

Physical Injury

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

Physical Injury

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]

Friendly Reminders



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

Friendly Reminders

Looking to the future

Have a safe trip home

Thanks for all you do

Questions??

Documents

2014 Care Coordinator’s Conference. The rules, policies, and procedures in this Power Point presentation are highlights and summaries of those rules,