m~riiioramaum - Office for the Aging · 2019-10-04 · EISEP Field Liaison (518) 474-8147 I m~riiioramaum - For YOE Infonration mqxmse me Date: rn supxsaled by this dCarment: NEW

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EISEP Field Liaison (518) 474-8147 I

m~riiioramaum -

For YOE Infonration

mqxmse m e Date: rn supxsaled by this dCarment:

NEW YORK STATE OFFICE FOP THE AGING Bldg. 2, Empire State Plaza, Albany, NY 12223

This Technical Assistance Memorandum (TAM) transmits to AAA Directors the EISEP Program Monitoring Guide.

The Guide follows-up on three regional training activities in Albany, Westchester and Rochester that presented the Monitoring Guide to local staff and solicited input for review of the final draft of the Guide.

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We thank each of the participants for their comments and believe that the Monitoring Guide is a more useful document because of your insight and recommendations.

- [ 1111-B [ 1III-c-1 [ 1III-c-2 [ ]RPE TO: [XIAREA AGENCY ON DIRECTORS [ ISNAP [XlCSE [XIEIm [ 1-

[ I C 1 Contact Person(s) - Fhone w ( s )

No: 9 1-TAM-1

This Guide does not tell an Area Agency on Aging how to manage its EISEP program. It offers guidance in a format designed to provide a comprehensive, useable framework around which AAA's may design and implement monitdring processes to meet local needs. Each AAA has a responsibility to ensure that subcontractors adhere to EISEP standards and that s e ~ c e s directly provided by AAA's are consistent, effective and efficient

Date: 02/20/91

Essentially, the Guide is designed to clarify monitoring responsibilities in the local EISEP program, assist AAA staff in monitoring in-home and case management services and provide guidance in carrying out AAA monitoring responsibilities.

Prcgrams Affect&:

Your continuing input on monitoring experience is necessary for future Guide revision. If you would like to make any comments on the Guide, or suggest changes for future editions, please call or write the EISEP Unit, New York State Office for the Aging, 2 Empire State Plaza, Albany, N.Y. 12223-0001, Phone: (518) 474-8147.

SEP Progra M Guide For the Effective Monitoring of in-Home and Case Management Services

This Monitoring Guide was developed by the EISEP Unit of the New York State Office for the Aging. It was written by Andrea Hoffman, Peter Fisher and Marcus Harazin. Special thanks to Dick Wendover for editing and layout and Ron James and Polly Windels for production.

i

CONTENTS

I. Introduction

II. Executive Overview

Ill. Monitoring In-Home Services 4

IV. Monitoring Case Management Services 15

V. Corrective Action 25

VI. Quality Assurance ,26

Glossary 28

I. Introduction

A. Background The State Office for the Aging (SOFA) and Area Agendes on

Adng (AAA) are continually striving to attain the highest level of qualib in the services they And or fiovide directly & functionally impaired elderly under the Expanded In-Home Services for the Elderly Program (EISEP). Good monitoring techniques are one important ingredient for developing and sustaining such quality. Yet, monitoring this complex program is a tremendous challenge. To assist AAAs in this endeavor, SOFA has developed a Monitoring Guide.

This Guide is just that - a Guide. It does not tell an Area Agency on Aging how to manage its EISEP program. It offers guidance. If you have found and are using effective methods to monitor your EISEP program, please inform SOFA staff of other methods you've found effective for potential use in future editions of the Guide.

EISEP is administered by SOFA and operated by participating local AAAs. When the program started, SOFA created regulations, poliaes and program standards to promote the availability and uniformity of services across New YorkState. EISEP is coordinated and integrated with other home care programs and services, such as those provided through Medicaid, Medicare and other social services programs, without duplication.

EISEP, as partof the Community Services for the Elderly (CSE) program, is New York State's response to one of the elderlfs greatest unmet needs: Home Care Services for those elderly who are not Medicaid eligible, but need help in order to remain at home safely. EISEP is now a major factor in enabling and encouraging frail elderly New Yorkers to stay at home and live as independently as possible. While SOFA administers EISEP statewide, AAAs operate EISEP and are responsible for monitoring compliance with requirements. Every AAA is required to have monitoring procedures in - - place.

B. Need for This Guide EISEP needs a com~rehensive. easilv usable Guide for AAAs to

design and implement monitoring locally. Progmm Monitors must check their subcontractors' adherence to EISEP standards, and check if all services directly provided by AAAs are consistent and efficient.

C. This Guide: clarifies monitoring responsibilities within the local AAA's

EISEP program assists AAA staff responsible for monitoring in-home and

case management services subcontractors provides guidance on how to carry out AAA m o n i t o ~ g r e -

sponsibilities. Please Note: This Guide covers case management and in-home

services only. We believe that Area Agencies can use this guide to help design their own tools for monitoring ancillary and non-institutional respite services.

I1 EXECUTIVE OVERVIEW

I r This Guide will help you monitor EISEP on a program level. EISEP regula-

tions require that the program be effectively implemented and monitored by the participating AAAs.

Who should monitor? The Program Monitor must be someone who is experienced in managing

others and in managing a large budget. Often, an experienced case manager makes the best Program Monitor because of hii/her experience and knowledge of the program. However, this is a local decision.

Goals Evaluation of subcontractors to determine that they understand and are com-

plying with EISEP Program Standards. Also, to evaluate your own AAA's direct delivery of services for efficiency, consistency and compliance with EISEP program standards. Your program monitoring should assess:

EISEP program's and personnel compliance with all applicable statutes, regulations, policies and standards EISEPsubcontmctors'compliance with all applicable statutes, regulations,

policies and standards consistent and efficient delivery of service service quality.

Getting Started To implement a monitoring system, your Area Agency on Aging must:

,.. designate staff to carry out the monitoringfunctions I develop procedures to assess compliance with Program requirements

develop methods to communicate and follow up on outcomes of monitoring visits to appropriate parties. To monitor whether EISEP subcontractors fulfii all EISEP requirements for

licensing, staff qualifications, record keeping, compliance with policies and regulations, cost and expenditures and follow-up activities, the Program Monitor must review all agencies which provide EISEP services by subcontract with the AAA, including:

Non-MedicalIn-HmeSemices Case Management Services Ancillary Services Non-Institutional Respite Care Services.

Subcontractors should be provided with a copy of applicable standards, regulations, policies and this Monitoring Guide. Local performance standards, legal requirements, goals and requirements should be incorporated in the subcontractor's contract for service.

Monitoring subcontractors To monitor subcontractors, the Program Monitor must travel to each subcon-

tractor's place of business during each contract year to review a sample of each subcontractor's files, including: personnel, financial and client files. While comprehensive fiscal monitoring is not included, the Guide does indude information on monitoring EISEP expenditures, service rates, and billing and collection procedures.

We recommend that a random sampling of 10% of all files be reviewed during each monitoring visit to document compliance with all EISEP regulations and standards.

2

Closely monitor the fmancial aspects of service contracts. This is critical in order to operate at planned service levels and avoid unanticipated budgetary pitfalls. Monitoring the financial aspects of contracts also plays an important role in helping to comply with the 50% In-Home Service Requirement, the Maintenance of Effort Requirement, the In-Home Services Rate Cap, and the 10% Ancillary Services Requirement.

Monitoring home care services agencies Many AAAs contract with licensed home care services agencies and/or certi-

fied home health agencies for the provision of in-home services. These agencies are under the jurisdiction of the State Department of Health (SDoH) and are surveyed on a regular basis by the Regional Office of Health Systems Management (OHSM). Area Agencies may choose to implement a modified monitoring process for these agencies. However, please remember that only some services provided by these agencies are regulated by the State Department of Health and thus included in the survey. Regulated services include homemaker/personal care but not housekeeper/chore. To make decisions in this area, we suggest you contact your Re- gional Office of Health Systems Management.

Monitoring fairly - The techniques for monitoring direct service provision are the same as the tech-

niques for monitoring subcontracted services. Be careful to monitor directly provided services objectkely, neither more nor less critically than subcontrackh services. The required level of compliance with program requirements is the same whether the service is provided directly or under subcontract.

Sometimes it may be more difficult to conduct unbiased internal monitoring of directly provided services than to monitor subcontracted services. Therefore, you should strongly consider obtaining an independent, third party review of directly provided services.

corrective Action The Guide reviews the methods for ascertaining non-compliance, the severity

of the problems and the process for resolution. This last step of the process, corrective action, will vary depending on the seriousness of the noncompliance. Correc- tive action leading to full compliance may be taken in steps by the subcontractor. The AAA may also take action in progressive steps as the subcontractor does or does not successfully take necessary corrective actions. Always notify subconhac- tors in writing of the results of any compliance monitoring.

Quality Assurance Area Agencies on Aging, which are providing EISEP services, must always

shive to attain the highest possible level of program effectiveness, as well as client and worker satisfaction. The Guide suggests several quality assurance strategies to . assist Area Agencies in this endeavor.

I l l . MONITORING IN-HOME SERVICES

r A. Introduction (NOTE: This Guide's checklists do not differentiate monitoring of in-home seruices provided

directly fra, thme provided under subcontmct.) 1. Subcontracted In-Home Services

This section specifically discusses monitoring subcontractors who provide in- home services to EISEP clients. To enable compliance with all program requirements, the following areas are examined:

Administration Personnel Records Financial Aspects.

Many AAAs contract with licensed home care services agencies and/or certified home health agencies for the provision of in-home services. These agencies and certain services they provide are regulated by the State Department of Health (SDoH). Among the services covered are homemaker/personal care services. Housekeeper/chore services, on the other hand, are not covered by SDoH regulations.

One of the responsibilities of the SDoH is to survey those agencies on a regular basis to assure compliance with the State Health regulations. Area Agencies need not duplicate this process. Many of the EISEP requirements for in-home services are identical or very similar to SDoH regulations. The monitoring process used by AAAs to monitor in-home subcontractors, who are also licensed or certified agen- aes, may be modified to eliminate duplication of effort and make the best use of limited staff resources.

In order to get a complete understanding of the survey process and outcomes, the AAA should contact the Regional Office of Health Systems Management, which actually completes the survey. This will allow the AAA to determine how the survey activities may best be used as part of the AAA monitoring process.

2. Directly Provided In-Home Services The Promam Monitor must survev direct services to maintain the same level of

quality a ~ s u ~ a n c e and program comp<ance as subcontracted services. Direct sewices staff must be familiar and comvliant with all relevant standards, remlations, policies, guidelines and requiremeAts for service administ~ation. ~ o m e k r e workers employed directly by the AAA must be appropriately selected, trained, supervised and evaluated. Client files must be comprehensive and well maintained.

The techniques that are used to monitor directly provided services are the same as those used for subcontracted services. The Program Monitor must be careful to monitor directly provided services objectively, using the same criteria as used to monitor subcontracted services.

In some respects, it may be more difficult to conduct unbiased monitoring of direct services. For this reason, an AAA may prefer to use an independent, third party review process for the monitoring of directly provided in-home services. This could consist of one or more individuals who have no vested interest in the program. Such an individual(s) may be drawn from an existing AAA advisory group or one in which the AAA is a member, from another county agency, or the private sector.

B. Administration

Desaiption To monitor non-medical in-home services, the Program Monitor must examine

each subcontractor's records and files regarding: General administrative procedures Interaction with case management and AAA staff Written procedures for client and other emergencies Certificate of Insurance A valid certificate or license from the New York State Department of Health

(for providers of homemakerlpersonal care services); or A valid or operating permit from the New York State Department of Labor

(for providers or housekeeperlchore services only) The subcontract between the AAA and the in-home services provider.

(A suxxested checklist is located on paxe 6)

C. Personnel Records Desaiption

The AAA must monitor subcontractor personnel records to assure that the subcontractor complies with EISEP standards.

The EISEP in-home services worker requirements are identical to those required by other State agencies. They are designed to meet minimum requirements in the areas of:

basic employment skills health status training and performance.

These areas help to assure that services are given safely by qualified individuals.

(A suggested checklist is louted on page 7)

D. Client Files Desaiption

The EISEP Program Monitor must check the subcontractors' records every twelve months to be sure the client files comply with EISEP standards for completeness. The Program Monitor must look for documentation of all required items.

The client files are maintained to assure the proper provision of services in accordance with program requirements. The files provide an up-to-date history of service delivery which is of an acceptable quality and in accordance with client needs. A well-maintained file documents the continuity of care despite changes in staff and client situations.

Client files are confidential. They may be reviewed by: the client or authorized representative the case manager the case managefs supervisor the AAA the State Office for the Aging EISEP unit other authorized program or fiscal monitoring agents.

These documents must be maintained for six years after the end of the State F i a l Year in which client services were terminated. For example, if a client receives EISEP services from June, 1988 through August, 1990, records of that client must be maintained through March 31,1997.

(A suggested checklist is located on page 9)

5

Home Care Agency Date Program Monitor

B. Administration Checklist

Methods And Procedures For Monitoring Goal: To monitor each subcontractor according to EISEP program requirements. Reauirements: 6654.17 (a), (c), (m), (r).

a. Procedure: 7%e Program Monitor must review evidence that the subcontractor maintains proper administrative records and meets minimum standnrds for EISEP subcontractors.

1. Interview agency management Yes No

la. Management understands contractual responsibilities. lb. Describes internal procedures to maintain compliance.

2. Review the following documents; were they available and complete?

0 2.3. The subcontractor's general procedures book 2b. The subcontractor's written emergency procedures. 2c. Evidence of ongoing contact with AAA and case management staff. 2d. The subcontractor's operating certificate, license or permit from the applicable New York State Department (Health for providers of homemaker/personal care services; Labor for providers of only housekeeper/chore services). 2e. The subcontractor's Certificate of Insurance. 2f. Procedures for screening for history of adult abuse.

b. Procedure: The Program Monitor must discuss with subcontractor management the organizational strudure and level of in-home seruices staff turn- wer.

3. Interview subcontractor managemeni:

3a. Ask subcontractor management to describe the organizational structure of its agency and it is capable of providing in-home services according to EISEP standards.

0 3b. Subcontractor management must describe the in-home senrices staff turnover rate and any identified problems which are being addressed.

NOTES:


C. Personnel Records Checklist

2. Methods And Procedures For Monitoring The Program Monitor may devise a tool to help monitor personnel records.

The tool may resemble the procedure noted below. Goal: To help the subcontractor keep up-to-date personnel records on the overall status of emolovees with EISEP client contact These records shall cover the employee's b;ckground regarding health status, employment history, certification, training and performance evaluation. - ~eauir-ements: 6654.17.(,)-(0)

Procedure: The Program Monitor must revim evidence that the subcontractor keeps required records and that employees meet the minimum standards for employment and trnining. The Program Monitor should eramine a random sample of the In-Home Services subcontrnctor's personnel records, keeping the sample size valid for that particula~agency. The Program Monitor should review at &st one randomly selected personnel record or may wish to review a 10% sample of the agency's records for personnel providing EISEP In-Home Services.

1. Be sure all records contain evidence of each home worker's employment background and skills:

Yes No El la. The application for employment

lb. Evidence that references were checked and the results are in the record lc. Evidence that the worker has no history of client abuse or any criminal conviction for a felony relevant to his or her duties Id. Documentation that the worker can read, write and speak in English le. If the worker will work with a non-English-speaking client, documentation that the worker can communicate in the client's native language

2. Be sure the record shows the home care worker's health status: 2a. Evidence that each new home care worker had a physical examination prior to contact with EISEP clients and has had subsequent annual exams >b. Documentation that each home care worker has received these tests and immunizations prior to EISEP client contact

immunization for kbella (required of all but pregnant workers) ppd (Mantoux) tuberculosis ( l l3 ) skin test before employment and repeated at least once every two years thereafter for negative findings and, if test was positive, appropriate medical follow-up occurred any test the local board of health requires

C. Personnel Records - Continued

3. For homemakerlpersonal services, be sure the record shows evidence of the worker's training and job performance:

.Yes No C] 3a. Documentation that the worker has successfully completed an a p

proved training program or competency examination prior to contact with EISEP clients

(7 3b. Documentation that the worker has successfully completed three hours of in-service training every six months 3c. The presence of an annual assessment or evaluation of each worker's performance and effectiveness

4. For housekeeperlchore services, be sure the record shows evidence of the worker's training and job performance:

C] C] 4a. Documentation that the worker has been instructed, prior to delivering services, on how to work with the elderly

C] 4b. Documentation that the worker has received an orientation covering the tasks which may be performed, the agency's policies and procedures, and client rights

C] 4c. The presence of an annual assessment or evaluation of the workefs performance and effectiveness

NOTES:

Home (;are Agency Date Program Monitor

D. Client Files Checklist

Methods and Procedures for Monitoring Goal: To assure proper maintenance of subcontractor's client files as re-

quired by EISEP standards. Reauirements: 6654.17.(~)(2),(q),(r)(l)-(3)

Procedure: The Program Monitor may wish to follow a checklist approac'l which is shown below. In many aspects, the monitoring of the subcotttrndor's client files is similar to the monitoring of case management records.

1. The file shows Yes No 0- the home care worker performs only those tasks as described in the client's

services plan

2. The file contains ongoing, up-to-date narrative notes, including but not limited to: 2a. observations 2b. problems

13 2c. plans of action 2d. records of telephone contacts 2e. records of in-home supervisory visits

3. The file contains: 13 3a. all current and past services plan summaries

3b. a copy of all current and past authorizations for service 3c. lists of names of workers who provided in-home service and the dates each worker provided service (Note: this information may be located else- where and identified as a time log to be used for billing purposes.) 3d. dated verifications of services pro'vided, signed by the client or authorized representative

. 4. The file contains: 13 4a. all accident or incident reports

4b. notes on any follow-up from the accident or incident reports 4c. the file contains all worker's activity reports

NOTES:

E. Financial Aspects of In-Home Services 1. Description

The Program Monitor must be concerned and knowledgeable about the financial compliance issues discussed in this section of the Guide, since noncompliance may result in disallowances of State reimbursement.

One of the most valuable tools available to the Program Monitor for checking on financial compliance is the Consolidated Area Agency Reporting System (CAARS) reports. The quarterly CAARS reports contain special sections devoted to these important AAA requirements. These reports also provide an analysis of the AAA's EISEP performance measured against goals established in the Annual Implementation Plan and any modifications thereof. Program Monitors should make certain that the information feeding into the CAARS report is as accurate as possible and updated whenever necessary. Only in this way can the CAARS reports be truly useful.

Although the Program Monitor is not a financial auditor, systems and proce dures must be established to assure that several important EISEP expenditure and unit cost requirements are met. These include:

in-home services rate cap, operation within budgetary limitations, . collection of cost sharing and contributions, and maintenance of effort requirements (for in-home services and other EISEP-

like services). Also of importance are monitoring services ordered vs. services delivered and

measuring the extent to which program objectives are achieved. Non-compliance with these requirements may result in the AAA prematurely

running out of funds or in disallowances of State reimbursement. Such problems may then cause curtailments in service delivery. No AAA wishes to cease or curtail program operations due to unforseen overexpenditures or cost disallowances. Therefore, the development of monitoring systems for the financial requirements of EISEP is critical.

Maintaining compliance with the In-Home Services Rate Cap and the 50% In- Home Services Expenditure Requirement can be difficult, especially if the AAA uses multiple subcontractors. Program Monitors should have accurate information regarding the status of applicable Medicaid rates at all times. It is very important to have a good line of communication with appropriate staff from the local social services district in order to track the status of rates.

Effective monitoring of the 50% In-Home Services Expendihres Requirement demands timely submission of contractor bills and related materials to the AAA, and tirnelv review of this material bv AAA staff. This is an ongoing AAA monitoring respo&ibilitity, and a regular rdutine should be developedVby & AAA to conduct this activitv. Conseauentlv, good internal communication between the Program Monitor i n d any A h staff responsible for collecting and analyzing subcontractor's billing statements is necessary.

Noncompliance with the In-Home Services Rate Cap may affect the AAA's ability to meet the 50% In-Home Services Expenditure Requirement. As noted earlier, CAARS reports may aid the Program Monitor in detecting and correcting potential problems.

E. Financial Aspects of In-Home Services -continued

2. Methods and Procedures for Monitoring Goal: To effectively monitor comgliance w i th the following in-home services

expenditure requirements: a. In-Home Services Unit Rate Cap

b. Setvices Delivered Were Services AutJrorized

c. Collection of Cost Sharing and Contributions

d. 50% In-Home Semices Erpenditure Requirement

e. Operation Within Budgetary Limitations

f. Maintenance of Effort Requirements

Reuuirements: In-Home Services Unit Rate Cap - 90-PI-21; Question and Answer Transmittals #2,I.H.15 and #3,P.A.32; Instrudions to the County Home Care Plan for Functionally Impaired Elderly and subsequent updates Consolidated Guide for Completion of the 1990-91 and 1991-92 AIP. Services Delivered Were Services Authorized - 6654.17fa) Colledion of Cost Sharing and Contributions - 6654.6fb); 66455(a),(e),(f). 50% In-Home Smennce Expenditure Requirement - 6655.7(c) Operation within Budgefay Limitations - 6655.7(c) Maintenance of Effort Requirements - 6655.9(6)

(NOTE: The items in the following suggested checklist covering the first 3 requirements noted above in-home seruices unit rate m, services delivered were services dutho~ized and collection of cost sharing and mtn'b&i&s are provider specific. That is, a separate checklist is com~leted for each in-home service subcontractor. There- m a k g items in the c h e c h t are completed combining information fromall of the in-home service subcontractors.)

continued on p. 12


-- ,- E. Financial Aspects of In-Home Services Suggested Checklist a. Procedure - In-Home Semices Unit Rate Cap: The Program Monitor must gather information and review documentation to determine that the in-home services unit cost cap requirement is being met.

1. Determine whether the subcontractor provides EISEP-like services under Medi- caid.

Yes No la. If yes, indicate unit cost and status of rates:

Housekeeper/chore Approved (effective date) Pending Homemaker/personal care Approved (effective date) Pending Supervision of in-home worker Approved (effective date) Pending Mileage Approved (effective date) Pending

lb. If the subcontractor does not provide Medicaid services, do all com- parisons this procedure calls for between the subcontractor's EISEP rate and the highest Medicaid rate in the county for similar service.

Housekeepe?/chore Approved (effective date) Pending Homemaker/personal care Approved (effective date) Pending Supervision of in-home worker Approved (effective date) Pending Mileage Approved (effective date) Pending

2. If the subcontractor has an established Medicaid rate, compare it to the EISEP /- service rate.

2a. Is the EISEP unit rate greater than theMedicaid rate? 2b. If the subcontractor's rate exceeds the Medicaid rate there are several factors that may be the cause. The AAA must identify the reason(s) and seek SOFA'S approval to provide services under such circumstances. 2bl. The EISEP rates include the cost of supervision but the MA rate does not. (MA pays separately.) 2b2. The EISEP rate includes the cost of mileage but the MA rate does not. (MA pays separately.) 2b3. Other (Spec*)


,,-. E. Financial Aspects of In-Home Services - Checklist continued I

b. Procedure - Services Delivered Were Services Autlrorired: The Program Monitor must review documentation to determine t h t the services billed were authorized and delivered.

1. Compare billing records to the client file, where the services plan and the senrice authorizations are located. Verify that:

Yes No la. The services billed were authorized in the services plan. lb. The services billed were actually provided to the client.

c. Procedure - Collection of Cos t Sharingnnd Contributions: The Pro- gram Monitor must gather information and review documentation to determine thnt the w l l ~ t i o n of cost shr ing and contributions complies with program requirements.

1. Contributions Cl la. Is the subcontractor responsible for informing non-cost sharing clients -

of the opportunity to contribute? lb. If the subcontractor is responsible for informing these clients of the o p portunity to contribute, there is evidence that clients not required to costshare are informed of the opportunity to contribute. lc. Is the subcontractor responsible for collecting contributions? Id. There is evidence that contributions received are appropriately accounted for?

2. Cost Sharing 2a. Does the subcontractor bill the client directly? 2b. If the subcontractor is responsible for billing:

17 17 2bl. The EISEP Program was billed correctly? 2b2. The client was billed correctly? 2b3. Does the bill indicate the dates services were provided? 2b4. The date the bill was generated (which should not exceed 60 days from the date services were provided) is indicated? 2c. If the subcontractor receives payments directly kom cost sharing client, there is evidence of the following:

17 2cl. The date payment was received for the bill. 17 C] 2c2. The amount of each payment received.

2c3. Follow u p procedures and notifications to the AAA were imple mented in instances where 60 days elapsed between billing and payment.

Home Care Agency Date Prcgram Monitor

E. Financial Aspects of In-Home Services - checklist continued .-

d. Procedure - 50% In-Home Services Expenditure Requirement: The Pro- gram Monitor must gather informntion and review documentation to determine thnt the 50% in-home services expenditure requirement is being met.

1. Compare total allowable in-home services expenditures against all services expendi tures.

Yes No l a The in-home services expenditures are greater than or equal to 50% of State and local funds expended on services for the time period covered.

0 lb. The in-home services expenditures are less than 50% of State and local funds expended on services for the time period covered.

e. Procedure - Operation Within Budgetary Limitations: The Program Monitor must gather information and raimu documentation to determine that the Program is operating within its budget.

1. Compare total allowable in-home services expenditures against planned expenditures for the covered time period.

la. Expenditures are less than anticipated. C] Ib. Expenditures are greater than anticipated.

13 1c. Identify in-home services subcontractor(s) which appear to be contribu- ting to the problem.

/- f. Procedure - Maintenance of Effort Requirements: The Program Monitor must gather infomtion and review documentation to determine that the AAA is meeting its Maintenance of Effort requirements.

1. Maintenance of Effort Requirements la. Based on expenditures through the current time period, does it appear that the Maintenance of Effort for Total CSE Project Expenditures will be met? Ib. Based on expenditures through the current time period, does it appear that the Maintenance of Effort for CSE Funded EISEP-Like Services will be met?

NOTES:

I

IV. Monitoring Case Management Services A. Introduction

This section of the Monitoring Guide reviews the monitoring of the case management services. This includes monitoring both the programmatic and financial aspects of service.

1. Monitoring Subcontracted Case Management This section specifically discusses monitoring subcontractors who provide case

management services to EISEP clients. To monitor compliance with all program requirements, the following areas are examined:

Administration Personnel Records Client Records and Service Provision Financial Aspects.

Case managers are responsible for: social assessmenWreassessment services planning financial assessmenWreassessment arranging and authorizing service delivery services follow-up client monitoring client discharge from the program.

Case management is the service that lays the groundwork for the provision of all of the other services under EISEP. It is the service that helps to assure that many other program requirements are met. For example, the requirement that EISEP not provide services to clients who are eligible to receive similar services from another program is met through the assessment process and on-going case management. Case management has a far-reaching impact on the entire local EISEP program. Therefore, it must be closely monitored.

2. Monitoring Directly Provided Case Management Case management is often provided directly by the AAA. Although this

Guide contains no section specifically addressing directly provided services, the monitoring techniques are generally the same as those for subcontracted services. The Program Monitor must survey direct services to ascertain that the same level of quality assurance and compliance with program requirements is maintained as with subcontracted services.

In some respects, it is more difficult to conduct unbiased internal monitoring of direct agency services than to externally monitor subcontracted services. It is strongly recommended that, where AAA staff is directly providing some or aU of the case management, an independent, third-party monitoring process be developed. Some approaches that may be used include using a member or members of an existing AAA advisory committee or one existing for another agency or program, or using staff from another county agency involved in the provision of long term care services. It may even be possible to secure the use of an EISEP case management monitor from another county or agency through a reciprocal agree ment. The involvement of such staff benefits not only EISEP, but other agencies and programs as well.

As is true for staff of subcontracted agencies, direct services staff must be familiar and comply with aU EISEP standards, regulations, policies, and guidelines, as well as the monitoring process that has been implemented.

Case Managers delivering services on behalf of the AAA must be appropriately qualified, selected, trained, supervised, and evaluated.

15

B. Administration Description

The Program Monitor must review the subcontractor's administration of case management services. This includes reviewing procedures for implementing case management according to contractual requirements and in accordance with program requirements. Important areas needing review include:

interaction with providers of in-home, ancillary, non-instilutional respite services and AAA staff,

interaction with the local Department of Social Services as required to avoid duplication of services and facilitate coordination between EISEP and services available under Titles XD( and XX,.

subcontract requirements between the AAA and case management services provider,

policies and procedures on how the components of case management are to be performed, and.

policies and procedures for maintaining client confidentiality.

C. Personnel Records Description

The AAA must monitor subcontractor personnel records to assure that the subcontractor complies with EISEF standards.

Case management staff are required to: meet minimum qualifications, receive an orientation, attend in-service training, and receive supervision.

These areas assure that services are provided safely by qualified individuals.

Case Management Agency Date Program Monitor

B - Administration suggested checklist

Methods and Procedures for Monitoring Goal: To monitor each subcontractor according to EISEP program requirements. Reauirements: Comply with 6654.16.(q),(t),(gg),(hh)

a. Procedure: The Program Monitor must review evidence that the subcontractor maintains proper administrative records and meets minimum standards for EISEP subcontractors.

1. Interview subcontractor agency management: Yes No

la. Management can access their subcontract and understands their contractual responsibilities. lb. Staff are able to describe the process for coordinating with the local De- partment of Social Services (LDSS). They are aware of how the agreement with LDSS is working and how problems, if any, are being addressed. Ic. Staff indicate that there is ongoing communication between the case managers and the providers of other EISEP services.

2. Review 2a. The policies and procedures for performing the components of case manaeement

0~ ~

2b. The policies and procedures for maintaining client confidentiality 2c Evidence of client referrals to and coordination with LDSS 2d. Evidence of ongoing contact with AAA staff and providers of in-home, non-institutional respite and ancillary services

b. Procedure: The Program Monitor must discuss with subcontractor management the organizational structure and level of case management staff turnover.

3. Interview subcontractor management: 3a. Ask subcontractor management to describe the organizational structure of its agency and if management appears to be capable of providing case manaeement services accordine to EISEP standards. 3b. subcorkactor management mu; describe the case management staff turnover rate and any identified problems which are being addressed.

NOTES:

Case Management Agency Date Program Monitor

C - Personnel Records suggested checklist

2. Methods and Procedures for Monitoring The Program Monitor may devise a tool to help monitor personnel records.

The tool may resemble the procedure noted below. Goal: To assure that competent, efficient and effective case management is

being proaided Reauirements: Comply with 6654.16(~)(1) through (4).

Procedure: The Program Monitor must revieu, evidence that the subcontractor keeps required records and that each record rm'med indicntes the employee meets the minimum standnrds for hislher position. The Program Monitor should examine a random samnle of the case management agency's personnel records, keeping the sample size valid for that particular agency. The Program Monitor should review at last one randomly selected personnel record or may wish to review a 10% sample of the agency's records for personnel promding EISEP Case Manage- ment and supervision.

1. For case managers, be sure all records contain: Yes No

la. An application for employment Ib. Evidence that references were checked and the results are in the record. lc. Documentation that the case manager meets one of these credentials:

Graduated from a regionally accr2ited college or university, or a New York State registered college or university, with a bachelofs degree.

IJ Is a professional registered nurse who is licensed and currently registered in New York State.

Has the full-time equivalent of four years of satisfactory experience in one or any combination of:

Sodal casework Social work in a community or social action program Teaching in an accredited school Working as a community services worker or case aide in

a local social services agency. Possesses a satisfactory equivalent combination of the foregoing

training and experience. Has been employed by the case management agency for at least two

years before the effective date of the first EISEP regulations issued (7/31/87) and have a demonstrated ability to perform case management activities.

Id. Documentation that the case manager participates in any training required by SOFA. le. Documentation that the case manager receives an orientation about the local program's: administration, management, policies, procedures, description of services areas, and client rights. If. Documentation that the case manager participates iri at least 16 hours per program year of locally arranged in-service training. (This may include continuing education credits.) lg. Documentation that the case manager has a designated case management supervisor.

'S

C - Personnel Records -checklist cotltirtued)

J- 2. For case management supervisors, be sure all records contain:

Yes No 2a. An application for employment.

IJ O 2b. Evidence that references were checked and the results are in the record. 2c. Documentation that the case management supervisor meets one of these credentials:

Graduated from a regionally accredited college or university, or a New York State registered four-year college or university, with a bachelor's degree. Is a professional registered nurse who is licensed and currently registered in New York State. Has the full-time equivalent of six years of satisfactory experience in one or any combination of:

Social casework Social work in a community or social action program Teaching in an accredited school Working as a community services worker or case aide in a local

social services district. Possesses a satisfactory equivalent combination of the foregoing training and experience. Has been employed by the case management agency for at least four years before the effective date of the first EISEP regulations issued (7/ 31/87) and have a demonstrated ability to perform case management activities. -

[ZI [ZI 2d. Documentation that the case management supervisor participates in any training required by SOFA. 2e. Documentation that the case management supervisor receives an orientation about the local program's: administration, management, policies, procedures, descriptions of services areas, and client rights. 2f. Documentation that the case management supervisor participates in at least 16 hours per program year of locally arranged in- service training. (This may include continuing education credits.)

NOTES:

"

D. Client Records

,.-- 1. Description

The EISEP Program Monitor must monitor a random sample of client records. It is recommended that the Prog~am Monitor begin by reviewine 10% of the client records for the current caseload and adjust as needed. The adjustment may be based on such things as the caseload size and monitoring results. The subcontractors' client records should be reviewed at least every twelve months to be sure that they comply with EISEP standards for completeness, although monitoring for quality assurance would suggest a more frequent review. The Program Monitor must look for documentation of all required items.

In addition to client record reviews, the Program Monitor should randomly select clients to visit in their homes to determine if the client is satisfied with the quality of the service. (An interview of at least one client and UD to 10% of the client caseload is suggested.)

The client records are maintained to ascertain that services are provided in accordance with program requirements. The records provide an up-to-date history of service delivery which is of an acceptable quality and in accordance with client needs. A well-maintained record documents the continuity of care despite changes in staff and client situations.

The Program Monitor must review records of services provided to clients who are potentially Medicaid-eligible, as well as to clients who were discharged voluntarily or involuntarily. Such a review assures that the proper procedures were followed. In all cases, the record must reflect the case managefs efforts to help the individual locate and make use of other appropriate services. -

/- Client records are confidential. In addition to the case manager and his/her

supervisor, they may be reviewed by: the client or authorized representative the AAA staff the SOFA staff other authorized program or fiscal monitoring agents.

These documents must be maintained for six years after the end of the State Fiscal Year in which services to the client stopped. For example, if a client received EISEP sewices from June, 1988, through August, 1990, records of that client must be maintained through March 31,1997.

Case Management Agency - Date Program Monitor

D Client Records suggested d~ecklist 2. Methods and Procedures for Monitoring

Goal: T o ascertain that proper recordkeeping is maintained by the subcontractor, as required by EISEP standards.

Requirements: Comply with 6654.16 (aa)(l) through (bb)(3) Procedure: The Program Monitor may wish to follow a checklist approach which is shown below. In many aspects, the monitoring of the subcontractor's cnse mnnage- ment records is similar to the monitoring of in-home services client files (see Section 11 of this Guide: Monitoring Non-Medical In-Home Seroices).

1. The record for each EISEP client contains:

Yes No la. A completed screening instrument Ib. The completed inital assessment PATH or approved substitute) Ic. A copy of the completed instrument used to determine the client's cost- sharing amount Id. All subsequent reassessments, dated no more than six months apart le. The initial services plans If. All subsequent services plans Ig. Copies of all services requests and authorization forms lh. Documentation of any emergency services provided

Ci l i . Copies of any consent forms signed by the client authorizing the sharing of confidential information lj. An uptodate case narrative, including all ongoing activities and their dates

Ci lk A form signed by the client or authorized representative indicating that they were informed of, understand and received a copy of their client's rights

2. The record contains ongoing, up-to-date narrative notes, including, but not limited to: Ci 2a. Observations

2b. Problems 2c. Plans of action 2d. Records of telephone contacts 2e. Records of in-home client visits 2f. Follow-up activities 2g. Start-up for homemaker/penonal care or housekeeper/chore 2h. Client confirmation that service has begun

IJ 2i. Initial in-home visit by case manager 2j. Case manager's personal contact with client or authorized representative, including dates and showing at least one personal contact every 60 days

3. Be sure the file contains all case manager's activity reports. 4. Be sure all forms are completed correctly and on time:

4a. The PATH or auuroved substitute: * .

Initial Reassessment(s)

4b. The Services Plan Summary: Initial

Ci Reassessment(s) 4c. Financial Information and Client Agreement*


*Note: This form is required from September, 1990 on to replace the: Financial Assessment F o m Medicaid &-Screen Fonn Cost Share Worksheet Cost Share Agreement.

D Client Records - checklist continued Yes No

4d. The financial related forms used from April 1987 to May 1990 (and may have been used through August 31,1940) must also be reviewed in the monitoring process. They are: 4dl. The Financial Assessment Form:


4d2. The Medicaid PreScreening Checklist: Initial

[7 Reassessment(s) 4d3. The Cost Share Worksheet:


4d4. The Cost Share Agreement Initial Reassessment(s)

5. If the client appears to be potentially eligible for Medicaid, the record shows: [7 [7 5a. The case manager provided appropriate referral to LDSS.

[7 5b. Appropriate reimbursement was received from LDSS. -

5c. The process seemed to work

6. If the client was discharged from EISEP voluntarily, the record shows the client or authorized representative requested the discharge.

7. If a client is discharged from EISEP, and it was not requested by the client or authorized representative, the record shows:

7a. Acceptable reason for discharge 7b. Appropriate assistance in seeking needed services, if applicable 7c. If involuntary discharge, client or authorized representative was notified in writing at least five days before discharge 7d. Client or authorized representative was notified in writing of h i /he r right to a Settlement Conference, Hearing and appeal on the discharge 7e. Client or authorized representative was notified in writing of procedures to follow to obtain a Settlement Conference, Hearing and appeal on the discharge

8. Records for discharged clients are stored and accessible until the end of the sixth fiscal year following the date of the client discharge. For example, if a client was discharged from the program in May 1990, that client's records are available until March 31,1997.

E. Financial Aspects of Case Management Provision 1. Description

The Program Monitor does not function as a financial auditor in this phase of review of the subcontractofs finances. The emphasis remains compliance with /'~- program standards. Nonetheless, there must be adequate record and documentation to support the funding oi a subcontract for the provision of case management services.

Key financial aspects that require the attention of the Program Monitor include:

determining if services requested under the subcontract are being provided,

determining that services billed are being provided, and reviewing compliance with requirements related to the billing for, col-

lection of, and accounting of cost sharing, and collection and accounting of contributions. (This is relevant only if these are functions of the case management subcontractor.)

(A suggested checklist is located on page 2 4 )

Case Management Agency ' Date

Program Mon'tor

E Financial Aspects suggested checklist 2. Methods and Procedures for Monitoring

Goal: To effectively monitor the subcontractor's use of EISEP funds: a. Determine services billed were delivered b. Determine cost sharing and contribution collections comply with

program requirements c. Determine services are provided in accordance with the subcontract

Reauirements: Comply with 6652.2(e), AIP Standard Assurances 7,8a-h a. Procedure - Determine Services Billed Were Delivered: The Program Monitor

must gather information and review documentation to determine that the services billed were delivered.

1. Client records indicate that services billed were provided. Yes No

b. Procedure Determine Cost Sharing and Contribution Collections Comply With Program Requirements: The Program Monitor must gather information and review documentation-to determine that the collection of cost sharing and contributions complies with program requirements.

1. Contributions IJ la. Is the subcontractor responsible for informing non-cost sharing clients of

the opportunity to contribute? C] lb. If the subcontractor is responsible for informing these clients of the oppor-

tunity to contribute, is there evidence that clients not required to cost share are informed of the opportunity to contribute?

C] lc. Is the subcontractor responsible for collecting contributions? 0 Id. There is evidence that contributions received are appropriately accounted

for. 2. Cost Sharing

C] 2a. Does the subcontractor bill the client directly? 2b. If the subcontractor is responsible for biing: 2bl. The ELSEP Program was billed correctly. 2b2. The client was billed correctly. 2b3. Does the bill indicate the dates services were provided? 2b4. The date the bill was generated (which should not exceed 60 days from the date services were provided). 2c. If the subcontractor receives payments directly from cost sharing clients are there records and documentation of the following:

C] 2cl. The date payment was received for the bill. C] 2c2. The amount of each payment received.

2c3. Follow-up procedures and notifications to the AAA were implemented in instances where 60 days elapsed between billing and payment.

c. Procedure - Detennine Seroices are Provided in Accordance With Thesubcon- tract: The Program Monitor must gnther informtion and revim documentation to determine that seroices under contract are being pruwided.

3. Case Management services data and services reports indicate that services are being provided in accordance with the subcontract

V. CORRECTIVE ACTION A. Description

Discussions with subcontractors often occur only once a year and center solely around contract renewal. However, program monitoring must occur in advance of annual contract discussions so that the Program Monitor can provide appropriate AAA staff with compliance findings for use during negotiations with subcontractors.

Corrective action is essential in order to maintain a dependable delivery system and services of a high quality for EISEP clients. Although there is a shortage of case managers and home care workers to meet the demand for services, the quality of the services should not be sacrificed for maintaining provider participation in the program. In the long run, such oversights will damage the quality of the program and the services provided.

Follow-up with thesubcontractor may begin as part of the visit itself, during an exit interview. There should always be written follow-up with the subcontractor shortly after the visit. The follow-up letter should summarize the outcomes of the visit and clearly indicate any areas in which the contractor is out of compliance with program requirements. If there are no compliance issues or problems requir- ing follow-up, the letter should indicate the subcontractor's compliance. The Program Monitor should require that the subcontractor address any compliance problems through a plan of corrective action developed by the subcontractor and agreed to by the AAA.

The Program Monitor may play a technical assistance role to help a subcontractor achieve compliance.

Follow-up by the Program Monitor is then necessary to determine improve- ,-- ments, and to assure movement toward full compliance. Thus, corrective action

must be progressive in nature. For the subcontractor this means taking steps, as outlined in a corrective action plan, that if successfully completed, lead to full compliance of all program requirements. Progressive action on the part of the AAA ranges from the provision of technical assistance over a period of time to contract t&mination extreme situations.

The time frame for addressing the compliance problemb) must be considered when the corrective action plan is being developed. The amount of time that the provider has to correct a compliance problem must be decided on by taking into account the seriousness of the problem. It is especially important to consider the relationship of compliance to the health, safety and care being received by clients and the seriousness of the problem in assuring that program funds are being appropriately spent. The Program Monitor, with input from the subcontractor and other AAA staff as appropriate, must make these decisions.

8. Methods and Procedures for Corrective Action Follow-Up Goal : To assure that subcontractor operations are in compliance w i t h EISEP

program requirements. k u i r e m e n t s : 66533(4); Standard Assurance 8.6 1990-1991 Annual Implementation

Plan Procedure: This procedure documents what should be done when the subcon- trador is not in compliance with all ElSEP program requirements. Follao-up with non-compliant contructors should always consist ofan exif

.-- conference and written notification. This is done to establish a track record and determine if additional on site monitoring or contractual changes are needed during the program pen'od.

25

VI. Quality Assurance A. Introduction

ElSEP program requirements are intended to help assure a high level of qual- .r ity services. Quality assurance in EISEP, as in any program, is of great importance

and plays a major role in determining: Client Satisfaction Program Effectiveness Worker Satisfaction

The clients served under EISEP, because of their functional impairments and limitations, are often unable to strongly advocate on their own behalf. Therefore, AAAs play an important advocacy role through quality assurance and must be vigilant in their efforts to assure that a high level of quality service is provided. The Program Monitor's activity alone cannot assure quality. A commitment to quality is needed by all AAA staff involved in theadministration, payment for, and delivery of EISEP services. Good communication between the Program Moni- tor and the fiscal and program staff is absolutely critical. Equally important is the process by which the AAA communicates with clients and their infonnal care givers.

The preceding sections in this Guide provide ideas on how to implement monitoring procedures. The process of monitoring is one part of an overall strat- egy an AAA can develop to assure quality. The State Office is currently testing several additional approaches to quality assurance, and will develop additional technical assistance materials for AAAs in the future. Such material will be added to this Guide over the next two years.

In the meantime, we suggest these activities that help to assure a program of acceptable quality:

Visiting clients in their homes, as well as informal caregivers, whenever possible. Such visits are useful in ascertaining client and informal care giver satisfaction with the program and the services received.

Reviewing client records (maintained by the case management agency) and client files (maintained bv the in-home service provider agencv) to get - , a complete picture of the clieit's circumstance and ihe services providG. Review of both services provides important information. This includes a sense of the communication between providers, the timing of their r e sponses and reactions to changing circumstances, and client and worker perspectives on service quality.

Client satisfaction surveys/questionnaires permit clients and informal caregivers to express opinions, feelings and observations about the EISEP Program, while being non-threatening.

Interviewing staff from an agency providing one type of service (e.g., case manager) to discuss the services of another agency (e.g., in- home). The Program Monitor may learn about the impact of services on the client from such discussions with subcontractor agency staff.

Peer Review/Advisory Committees where professionals in similar areas of expertise review records/iiles for appropriateness of care and follow- UP.

The importance of documenting compliance with program requirements was noted earlier in the section on corrective action. This is equally important in the area of quality. Poor performance on the part of service contractors and/or their

/ staff needs to be tracked and ascertained on a regular basis. The methods noted above can each provide a different level of detail and at varying intervals. All are useful in tracking and using the information to help maintain and, if necessary, reach a level of acceptable service quality for the progTam.

B. In-Home Services For in-home services, there are some specific areas that quality assurance

activities should cover. These include the following: Dependability of the workers Did the workers amve on time and stay

for the scheduled period? Quality of the work Did the workers perform the required tasks and

was the quality acceptable? Follow-up Were problems identified by clients, informal caregivers, case

managers and others? If not, why? If so, was follow-up timely and the results documented?

In the case of in-home services, it is critical that the Program Monitor seek feedback from case managers. Problems with performance of service providers should be documented in client records, and ascertained in random client record reviews, as well as in contact with clients. Regular reviews help the Program Monitor obtain documentation of problems and determine whether or not they are chronic, as they relate to a particular subcontractor. This information is valuable in determining the avenue of corrective action that is pursued.

r i C. Case Management Services

Case management plays a very unique role in quality assurance. It brings together services from all available community resources to address identified client needs and includes ongoing client follow-up on a regular basis.

Peer review can be a very valuable tool for assessing quality. Peer Review can be conducted by individuals or committee with the skills and expertise to evaluate client-level decisions.

The following are specific questions that should be answered to measure quality assurance activities for case management:

Were the assessment and care plan complete and internally consistent? Were the identified needs addressed? If not, is there an acceptable

reason for this? Were problems identified during on-going client contact addressed ap-

propriately and in a timely fashion?

. . . I

GLOSSARY Adjusted income: client's monthly income after subtracting the Housing Adjust- ment (if any) and the IncomeThresholds. Available income: the amount of the client's income after necessary adjustments. This is the same as adjusted income. CAARS: Consolidated Area Agency Reporting System: periodic statistical reports each AAA is required to send to SOFA, covering all major programs supported by State funds or Federal Older American Act funds. EISEP sections of the report include monthly units of service; quarterly client characteristics, clients served in each service, cost sharing, and expenditures by service and semi-annual information'on assessments and care plans. Case management: a process which coordinates and helps individual older citizens gain access to appropriate services, benefits and entitlements through using a standardized process of assessment, reassessment, planning, arranging for and monitoring services. Components are:

Standard Assessment used to collect information about a person's situation and functioning and that of his or her caregivers which allows the case manager to identify the person's specific needs and problems in major functional areas.

Services Plan: a formal agreement between the client and worker and, if a p propriate, the clienl's caregivers covering client problems identified, goals to be achieved and services to be pursued to support achieving those goals.

Implementation of Services Plan: done by the case manager, is achieved by contacting service providers, conducting case conferences and negotiating with providers for delivery of needed services to the client as prescribed in the senices plan.

Follow-up and Monitoring: done to ensure that service delivery started or is continuing at the appropriate quality level.

Reassessment: the scheduled reexamination of the clienl's situation and functioning and that of his or her caregivers, allowing the case manager to identrfy changes which occurred since the previous assessment and to measure progress toward goals stated in the Services Plan; in the reassessment, the case manager determines whether the services plans must beupdated and/or the pattern of service delivery changed.

Termination or Discharge: ceasing case management because the client at- tained the goals listed in the services plan, or the client needs service other than case management or the client is ineligible for the service (also, i f the client does not meet appropriate program standards and requirements, (s)he may be discharged).

Client Case file (client file): the auditable, written history of the client's contact with staff of the home care provider agency, the contact between staff of the home - . care provider and the case knagement agency and a log of internal actions and d i i s i o n s of staff in the home care provider agency. Client contribution: money voluntarily given by a client to the program. Client case record (Client record): the auditable, written history of the client's contact with the case manager and the contact between the case manager and other parties in relation to the client. It contains all of the required forms and the case notes. Cost sharing: the portion of the cost of care required to be paid by a client. Clients whose adjusted income is less than 150% of the 1986 poverty level, adjusted annu-

* , ally thereafter based on changes in the consumer price index (CP:),pay none of the cost of their care; between 150% and 250%, clients pay according to a sliding-scale; 250+% clients pay the total cost of service up to their available income. EISEP establishes a maximum monthly fee a client is required to pay. CSE: Community Services for the Elderly Direct service delivery: services provided directly to the client by the AAA. EISEP: Expanded In-Home Services for the Elderly Program established under Chapter 894 of the laws of 1986 and amended by chapter 545 of the laws of 1989 and chapters 384 and 851 of the laws of 1990. Homemaker/personal care service: personal care Level II services as defined by NYS Department of Social Services regulations for Medicaid. Level II includes all tasks under housekeeper/chore. Level I1 includes assistance with:

Bathing Dressing Grooming

Someassistance with: Toileting Walking Eating Transferring Preparing meals in accordance with modified diets Self administration of medication at the request of the client and acting as ex-

tention of the client Routineskincare Following the directions of a qualified professional for use of medical supplies

and equipment such as walkers and wheelchairs Changing simple dressings.

Housekeeperlchore: personal care: Level I service as defined by NYS Department of Social Services regulations for Medicaid. Level I includes assistance with:

making and changing beds dusting and vacuuming light cleaning washing dishes listing needed supplies shopping laundering preparing meals paying bills and running essential errands escorting.

Housing adjustment additional protected client income if a client's average monthly housing expenses are more than the Housing Adjustment Threshold. The Maximum Housing Adjustment allowed is 20% of the income threshold. Housing Adjustment Threshold and Maximum Housing Adjustment are updated and issued with Income Thresholds at the beginning of each calendar year. Housing adjustment thresholds: 40% of income threshold, updated when income threshold is updated. Income thresholds: equivalent to 150% of the 1986 poverty levels for one- and two- person families, updated annually thereafter for cost-of-living changes. The income

29

thresholds are issued by thestate Office for the Aging at the beginning of each calendar year. Local match: the amount of funding that must be provided locally to match State funds. Under EISEP, State Aid is available to reimburse 75% of the allowable costs of services up to the countfs allocation. The remaining 25% must be provided locally and thus is called the local match. Maintenance of effort: consists of three parts, all of which must be met to maintain EISEP funding:

base-year expenditures, the level of expenditures in the year prior to the first year for which a county plan for CSE was submitted or thecounty's 1979 fiscal year, whichever is later.

CSE projects, the level of project spending during the year from 1 April 1985 through 31 March 1986 (SFY 1985-86).

EISEP-like service, the total expenditures for non-medical in-home services, case management and non-institutional respite services under CSE for the year from 1 April 1985 through 31 March 1986 (SFY 1985-86).

Maximum housing adjustment: 20% of income thresholds, updated annually when income thresholds are updated. Maximum monthly fee: the maximum dollar amount the client is required to pay, regardless of cost-sharing level. Monitoring a process for measuring performance levels and compliance with the legislation, regulations, standards, policies and guidelines goveming a program. Non-medical: EISEP is not designed to directly address, through the provision of EISEP-funded services. clients' medical needs. Therefore. a medical assessment is not a required component of the program to determine need, nor does the program h n d the health-related twes of home care (home health aide services or Personal . - Care Level III). PATH: Patient Assessment Tool for Home care, the standaid (re)assessment instrument approved for use in EISEP. Personal contact: any spoken contact between the case manager and the client. Program Monitor: the person who carries out the process of measuring performance and compliance with legislation, regulations, standards, policies and guidelines goveming a program. Program requirements: standards, guidelines and laws that apply to the E'ISEP program. Quality assurance: process for checking to see if the services delivered conform with the related program standards and requirements. This includes reviewing structure, process and client outcomes. Reassessment: reevaluation of the client's situation and functioning, to determine what changes if any have occurred since the client was last evaluated and what changes are needed in services. This must be done at a minimum of once every six months. Services plan: plan drawn up by the case manager in cooperation with the client or authorized respresentative and informal caregivers outlining the services that the client needs and the amount, scope and costs. This includes EISEP-funded services and services provided by informal caregivers and through other funding sources. Subcontractor: a vendor service agency which contracts with a local AAA to provide EISEP s e ~ c e s . Unit: 1 hour of service provided to the client (except ancillary services).

Documents

m~riiioramaum - Office for the Aging · 2019-10-04 · EISEP Field Liaison (518) 474-8147 I m~riiioramaum - For YOE Infonration mqxmse me Date: rn supxsaled by this dCarment: NEW