Providers and Independent Clinicians

1. Providers and Independent Clinicians May 17, 2012

2. Purpose • Improve Service Delivery • Review Documentation Requirements • Set Expectations • Discuss Concerns and Solutions • Explain the role of the DDA’s Consults

3. DDA initiatives • Exit Evans Compliance Plan • CMS Review

4. Concerns • Clinicians are not attending the ISP meetings • The clinicians reports are not available for review during the ISP meeting. • Services are not renders timely. • Staff training (Day Programs) • The clinicians are not providing services as indicated on the reports. • Late reports • Clinicians are not responsive

5. Continuation • Apprehensive to accept the teams recommendation to change the report. • Providers are requesting all of the Medicaid Waiver Service. • Providers/Clinicians are not reviewing the reports prior to submitting the reports to the team.

6. Documentation requirements for Speech and Language • Initial assessment • Comprehensive assessment to determine absence of swallowing disorder; • Communication disorder; • Background review and current functional review of communication capabilities in different environments; • Needs assessments for the use of augmentative and alternate speech devices, methods, or strategies; • Needs assessment for the use of adaptive eating equipment; • Assisting persons with voice disorders; • Teaching and training the person and team on communication program; • Aural rehabilitation by teaching sign language and/or lip reading; • treatment goals that are appropriate for the authorized service; • Number of hours for follow along services;

7. Continuation • Quarterly reports/written documentation • Visitation notes • Progress notes • Pertinent documentation of the person’s progress or lack of progress • Progress on treatment goals • Documentation must include evidence that services did not exceed the authorized frequency and duration.

8. Documentation requirements for Occupational Therapist and Physical Therapist • Initial assessment • Summarizes the physician’s order • Measures the person’s strength • Range of motion • Balance and coordination • Posture • Muscle performance • Respiration • Motor functions, developing, and describing treatment plans strategies including : • Direct therapy, training caregivers, monitoring requirements, monitoring instruments, monitoring instructions, and anticipated outcome. • treatment goals that are appropriate for the authorized service; • Number of hours for follow along services;

9. Continuation • Quarterly reports/written documentation • Visitation notes • Progress notes • Pertinent documentation of the person’s progress or lack of progress • Progress on treatment goals • Documentation must include evidence that services did not exceed the authorized frequency and duration.

10. Documentation requirements for Nutrition • Initial assessment • Biochemical, clinical dietary appraisals; • Food-drug interaction potential; • Health and safety environmental review of food preparation and storage area; • Need assessments for adaptive equipment and dysphagia management; • Improve and increase person’s ability to manage their diet; menu development; shopping; and food preparation. • treatment goals that are appropriate for the authorized service; and • Number of hours for follow along services

11. Continuation • Quarterly reports/written documentation • Visitation notes • Progress notes • Pertinent documentation of the person’s progress or lack of progress • Progress on treatment goals • Documentation must include evidence that services did not exceed the authorized frequency and duration.

12. Documentation requirements for BSP • Diagnostic Assessment • BSP • A description of the techniques for gather information; • The goals of the BSP; • Strategies of positive behavior support; • Etc. • Future meeting for BSP providers.

13. Continuation • Quarterly reports/written documentation • Visitation notes • Progress notes • Pertinent documentation of the person’s progress or lack of progress • Progress on treatment goals • Documentation must include evidence that services did not exceed the authorized frequency and duration.

14. Change in clinicians • Providers that are substituting practitioners for more that two weeks period or four visits due to emergency or availability events need to request a case conference with the Service Coordinator and individual. • The team may opt to select another providers.

15. Expectations • Mandatory Pre-ISP meeting effective March 1, 2012 • Utilization Management effective May 1, 2012 ( no back dating Service Authorizations) • Service Authorization vs. Prior Authorization • Day Treatment vs. Medicaid Waiver Services • Billing and TA (hand out) • Next billing training June 1, 2012 from 9:30 am to 3:00 pm. • New Waiver- November 2012

16. The role of DDA’s consultants • DDS/DDA Clinical Staff are available to provide: • Technical assistance or training to the provider agency or others as needed; • Provide consultation with other health professionals; and • Provider reports and/or recommendations in the specialty area.

17. The following Clinical specialties are available: • Behavioral Health • Occupational Therapy • Physical Therapy • Speech Therapy • Clinical Nutrition

18. Accountability • Independent Clinicians vs. Providers • Ensure Clinicians are licensed in the jurisdiction where services are render. • Issue Resolution System • Provider Performance Review • Provider Certification Review

19. Questions