South Carolina Provider Training Review Year 2005-06 First Health Services June 2005

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South Carolina Provider Training Review Year 2005-06 First Health Services June 2005. Provider Manual CD. 01 2005-06 Provider Manual Cover 02 2005-06 Provider Manual TOC 03 2005-06 Provider Manual Overview 04 2005-06 Provider Manual SOW - PowerPoint PPT Presentation

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  • DeletedAdministrativeIndicators

    Discovery Remediation Improvement

    Deleted IndicatorsA2-12For Respite Service funded by individual and Family Support Services, the Board/Provider maintains bi-annual (i.e. June and December) written reports that contain the following information: -Unduplicated count broken into age groups of 0-21 years of age and over 21 years of age for consumers receiving Respite through Family Support Funds. -Cumulative total Respite hours provided.

    Discovery Remediation Improvement

    General AgencyIndicatorChanges

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG1-01 (reworded) *SANCTIONABLE * THE PLAN IS DEVELOPED AND SIGNED BY THE SERVICE COORDINATOR EVERY 365 DAYS. (removed by a facilitator or under the direction of a facilitator-or a Single Plan is developed by a DSN Board Plan Manager)G1 The Plan

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG1-02 (new) The Record/Plan shows that facilitation was explained and choice was offered.G1 The Plan

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG1-03 (reworded) Needs/goals reflected in the Plan must be justified by formal or informal assessment information in the record. G1 The Plan

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG1-04 (reworded) Record must reflect that the consumer or his/her legal guardian was offered the opportunity to participate in planning.G1 The Plan

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG1-05 (reworded) The Plan reflects the service needs/personal goals, priorities and concerns of the consumer or his/her guardian.G1 The Plan

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG1-06 (reworded) The Plan identifies Actions/interventions that address the Need.G1 The Plan

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG1-07 (reworded) The Plan identifies the name of the provider and the person responsible by name or title (i.e. CTH Coordinator, Service Coordinator, etc.) for implementing Actions/Interventions.G1 The Plan

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG1-09 (new Sanctionable & reworded) *SANCTIONABLE* THE PLAN IS AMENDED/UPDATED AS NEEDED.G1 The Plan

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG1-11 (reworded) Needs/personal goals are written to reflect the consumers needs rather than the service to be provided.G1 The Plan

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG1-12 (reworded) *SANCTIONABLE* THE PLAN IS MONITORED AT LEAST QUARTERLY (QUARTERLY PLAN REVIEW).G1 The Plan

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG2-01 (combination) *SANCTIONABLE* SERVICE COORDINATION ACTIVITY REFLECTS ONGOING NEEDS ASSESSMENT, PLANNING, AND MONITORING TO ADDRESS IDENTIFIED NEEDS AND PERSONAL GOALS.G2 Service Coordination

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG2-02 (reworded) Face-to-face contacts occur as required.G2 Service Coordination

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG2-03 (new) Contacts for Level II Service Coordination are provided at least every 365 days or as determined by the consumer.G2 Service Coordination

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG2-09 (reworded) An index is maintained and followed for Service Coordination records.G2 Service Coordination

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG2-12 (change) The STS is current. (no longer sanctionable)G2 Service Coordination

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG3-01 (reworded) *SANCTIONABLE* THE CONSUMER HAS A CURRENT DAY PLAN THAT INCORPORATES 1. CARE: SUPPORTS TO MAINTAIN OR IMPROVE THE HEALTH AND PERSONAL RESPONSIBILITY OF THE CONSUMER; 2. SUPERVISION: SUPPORTS TO PROTECT THE CONSUMER FROM HARM AND/OR INJURY IN COMPLIANCE WITH DDSN POLICY 510-01-DD; 3. SKILLS TRAINING INTERVENTION: GOALS AND OBJECTIVES TO ASSIST THE CONSUMER IN ACQUIRING, RETAINING, OR IMPROVING SKILLS FOR OPTIMAL FUNCTIONING.G3 Facility-Based Day Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG3-02 (new) The Day Plan must reflect the authorized service.G3 Facility-Based Day Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG3-03 (new) Supports within the Plan correspond to the service definition.G3 Facility-Based Day Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG3-04 (reworded) Each support, goal, and objective identified within the Plan corresponds to an assessed need.G3 Facility-Based Day Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG3-05 (new) The record must clearly reflect the consumers approval of the Day Plan. If the consumer is under 18 or over 18 and deemed unable to consent, the approval come from the consumers legal representative.G3 Facility-Based Day Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG3-06 (reworded) The consumers Day Plan is monitored by the Day Coordinator or Lead Clinical Coordinator (or designee) to insure plans are implemented as specified.G3 Facility-Based Day Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG3-07 (new) For consumers who receive rehabilitation supports, a six-month review must be completed and address the following issues: Are current goals and objectives appropriate and effective in meeting the needs and goals of the consumer? Are there any other issues pertinent to the functioning of the consumer? Do the needs of the consumer support the continuation of rehabilitation support services?G3 Facility-Based Day Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG3-08 (new) For consumers who receive Rehabilitation Supports, a Medical Necessity Statement has been obtained.G3 Facility-Based Day Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG3-09 (reworded) The consumers Day Plan is monitored by the Day Coordinator or Lead Clinical Coordinator (or designee) to insure timely amendments are made to supports identified within the Plan when the consumer: Meets a goal or objective;Is not benefiting from a specific intervention, service or support; Requests a changeNew support needs are identifiedG3 Facility-Based Day Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG3-10 (reworded) If earning sub-minimum wage for work performed, the consumer is paid in accordance with Department of Labor Regulations.G3 Facility-Based Day Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG3-11 (reworded) Documentation is available to show services were provided on the day that services were reported.G3 Facility-Based Day Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG4-01 (new) The Individual Rehabilitation Support Record contains a Medical Necessity Statement.G4 Individual Rehabilitation Supports

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG4-03 (new) Supports within the Plan correspond to the service definition. G4 Individual Rehabilitation Supports

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG4-04 (reworded) *SANCTIONABLE* INDIVIDUAL REHABILITATION SUPPORTS RECORD CONTAINS A TREATMENT PLAN THAT IS REVIEWED EVERY 6 MONTHS AND REFORMULATED ANNUALLY BY THE LEAD CLINICAL STAFF (LCS) OR LIFE SKILLS SPECIALIST (LSS).G4 Individual Rehabilitation Supports

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG4-05 (separated) Individual Rehabilitation Supports records contain Progress Summary Notes.G4 Individual Rehabilitation Supports

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG4-06 (separated) Individual Rehabilitation Supports Progress Summary Notes contain documentation of delivery of service(s).G4 Individual Rehabilitation Supports

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG5-03 (change) *SANCTIONABLE* INDIVIDUAL PLAN OF SUPPORTED EMPLOYMENT (IPSE) IS LOCATED IN THE SUPPORTED EMPLOYMENT RECORD.G5 Supported Employment

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG5-11 (new) Documentation is available to show Supported Employment was provided on date service was reported.G5 Supported Employment

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG6-01 (separated) *SANCTIONABLE* THE CONSUMER HAS A CURRENT RESIDENTIAL PLAN THAT INCLUDES INTERVENTIONS TO ADDRESS NEEDS IN THE FOLLOWING AREAS:1. CARE: SUPPORTS TO MAINTAIN OR IMPROVE THE HEALTH AND PERSONAL RESPONSIBILITY OF THE CONSUMER;2. SUPERVISION: SUPPORTS TO PROTECT THE CONSUMER FROM HARM AND/OR INJURY IN COMPLIANCE WITH DDSN POLICY 510-01-DD; AND3. SKILLS TRAINING TO ASSIST THE CONSUMER WITH THE ACQUISITION, RETENTION OR IMPROVEMENT IN SKILLS RELATED TO ACTIVITIES-OF-DAILY-LIVING, SOCIAL AND ADAPTIVE BEHAVIOR THAT ARE NECESSARY TO ENABLE THE CONSUMER TO RESIDE IN A NON-INSTITUTIONAL SETTING.G6 Residential Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG6-02 (reworded) Each intervention identified within Plan corresponds to an assessed need. G6 Residential Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG6-03 (reworded) Once developed, the Plan is implemented.G6 Residential Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG6-04 (reworded) The consumers Residential Plan is monitored at least monthly by the Residential Coordinator to insure services are effective.G6 Residential Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG6-05 (new) Timely amendments are made to supports identified within the Plan when the consumer: Meets a goal or objective;Is not benefiting from a specific service or support; Requests a change; or heath care professional requests a change.New interventions are neededG6 Residential Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG6-06 (new) Documentation is available to show services were provided on every Day Services were reported.G6 Residential Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG6-07 (new) Rights of the consumer are protected.G6 Residential Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG7-01 (new) For respite funded through the DDSN Family Support Contract or Wavier, documentation is available to show respite was provided on the date reported.G7 Respite Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG8-02 (new) A consumer's behavior(s) that pose a risk to the consumer, others, or the environment has a BSP consultation and plan (without consumer consent).G8 Behavior Support Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG8-03 (new) A BSP is developed by an approved provider on the MR/RD Medicaid Waiver List for Psychological Services.G8 Behavior Support Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG8-05 (new) A consumer who is receiving psychotropic medication and Residential or Day Program services, may not have a BSP under specific conditions.G8 Behavior Support Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG8-09 (reworded) The Behavior Support Plan is reviewed at least quarterly and modified to revise behavioral objectives and/or procedures when needed, and discontinued after the person has met all objectives.G8 Behavior Support Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG8-10 (reworded) All consumer records contain the Behavior Support Plan, if applicable in those settings.G8 Behavior Support Services

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG9-01 (separated) For MR/RD Waiver funded services provided by the board (also called board-based services), documentation is available to show the service was provided on date service was reported.G9 MR/RD Waiver

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG9-07 (reworded) The current Level of Care is supported by the assessments and documents indicated on the Level of Care determination. (Single Plan removed)G9 MR/RD Waiver

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG9-08 (reworded) When the consumer refused a MR/RD Waiver service(s), the risks associated with refusing the service(s) were discussed. (Single Plan removed)G9 MR/RD Waiver

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG9-12 (reworded) The Acknowledgement of Choice Confirmation (MR/RD Form 29) or Acknowledgment of Rights and Responsibilities (MR/RD Form 60) is completed annually.G9 MR/RD Waiver

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG9-17 (reworded) MR/RD Waiver services are received at least every 30 days.G9 MR/RD Waiver

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG10-12 (new) The Acknowledgement of Choice and Appeal Rights is completed prior to Waiver enrollment and annually thereafter.G10 HASCI Waiver

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG10-13 (new) The Acknowledgement of Rights and Responsibilities is present.G10 HASCI Waiver

    Discovery Remediation Improvement

    2005 - 2006 General Agency Indicator ChangesG10-25 (new) Service Notes reflect an on-site visit for Private Vehicle Modifications within two (2) weeks of completion.G10 HASCI Waiver

  • DeletedGeneral AgencyIndicators

    Discovery Remediation Improvement

    Deleted Indicators G1-08 Service needs and personal goals identified subsequent to the Single Plan meeting are documented on the Single Plan and addressed annually.

    Discovery Remediation Improvement

    Deleted IndicatorsG1-09*SANCTIONABLE* A SINGLE PLAN IS REFORMULATED OR COMPLETED ANNUALLY.

    Discovery Remediation Improvement

    Deleted IndicatorsG1-12aThe Single Plan contains current and accurate information.

    Discovery Remediation Improvement

    Deleted IndicatorsG1-15Ineffective services, supports, or actions are terminated or modified and replaced by services, supports, or actions that are anticipated to be more effective.

    Discovery Remediation...

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