CCP Programmatic Updates & Discussion Topics

1. CCP Programmatic Updates & Discussion Topics 2014 Care Coordinator’s Conference

2. Disclaimer/Reminder • 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.

3. Choices for Care/Universal Screening Update • 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

4. Mission of IL Department on Aging 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

5. Intention of Pre-Screening • 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.

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

7. Changes to Choices for Care 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

8. 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)

9. Changes to Choices for Care 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

10. Changes to Choices for Care 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

11. Clarifications to Post-Screenings For post-screenings that occur for one of the following reasons: Admission from out-of-state; Admission from a Hospital Emergency/Outpatient Services; or Pre-existing condition of need for a caregiver and caregiver is no longer able to provide care Facilities are not required to first contact BEAM

12. Clarifications to Post-Screenings Facilities are not required to first contact BEAM The CCU shall first check eCCPIS for previous assessment within past 90 calendar days If none, the CCU shall complete the 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

13. Clarifications to Post-Screenings 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.

14. Clarifications • 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

15. 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

16. Clarifications • IDoA will continue to work with Illinois Hospital Association on specific concerns from CCUs; CCUs can send to aging.occs@illinois.gov • IDoA will work with HFS on possibility of revising 2536 and OBRA forms as well as hospitals having electronic version of forms

17. Cellular Emergency Home Response • 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

18. 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

19. Electronic Visit Verification • 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

20. 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

21. CCU Reviews • 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

22. CCU Reviews (cont) • Through September 2014, 31 CCU contracts have been reviewed • 813 files have been reviewed, this number includes prescreen files

23. CCU Review Findings • Service Authorization Guidelines: files not compliant = 17% • Determination of Need: files not compliant = 23%

24. CCU Review Findings (cont) • 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%

25. CCU Review Corrective Actions • 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

26. Next Steps • 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

27. Service Authorization Guidelines: Suggestions to Improve Compliance • 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

28. 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.”

29. Service Authorization Guidelines: Suggestions to Improve Compliance • “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

30. Service Authorization Guidelines: Authorizing Transport or Escort • 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

31. 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.

32. Service Authorization Guidelines: Suggestions to Improve Compliance • 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

33. Determination of Need Scoring • 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

34. 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

35. Determination of Need Scoring • 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

36. Determination of Need Scoring • Dressing • Bathing, grooming, dressing A side scores should be similar • Encourage clothing with Velcro, elastic, etc. so participant can remain as independent as possible

37. Determination of Need Scoring • 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

38. Determination of Need Scoring • 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

39. Determination of Need Scoring • 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

40. Determination of Need Scoring • 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.

41. Determination of Need Scoring • 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

42. Determination of Need Scoring • 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

43. Determination of Need Scoring • 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

44. Determination of Need Scoring • 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

45. Determination of Need Scoring • 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

46. Determination of Need Scoring • 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

47. Determination of Need Scoring • 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

48. Determination of Need Scoring • 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

49. Determination of Need Scoring • 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

50. CCP Paperwork—Requirements for Timeframes • 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