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Change Happens

Change Happens . Question: What types of change occur with your consumers that require a change in the way they receive their PAS/SDPAS services?. The Paper Trail . Question: What type of paperwork do you use to document the change in service delivery?. Type of Documentation. Chart notes

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Change Happens

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  1. Change Happens Question: What types of change occur with your consumers that require a change in the way they receive their PAS/SDPAS services?

  2. The Paper Trail Question: What type of paperwork do you use to document the change in service delivery?

  3. Type of Documentation • Chart notes • SDRs/Time Sheets • Temporary Authorization • Amendment Request • Profile

  4. Making the Change a Reality (and a billable unit) Questions to ask yourself? • What is the reason for the change • What is the expected length of the change • What paperwork needs to be filled out • Who needs to know about the change • What type of tracking should be done • What needs to be done to follow-up on the change

  5. Activity • Work with your group to read the “change happens” scenarios For each scenario: • Discuss the questions from slide 8 • Outline what needs to be done

  6. Temporary Authorization- SLTC 161 Form that allows you to document an increase or decrease in needs • Use as the only documentation for a temporary change to the authorization if the change is less than 21 days • Use as a temporary authorization until MPQH can generate an updated profile. • In cases where the change in authorization is greater than 21 days • In High Risk Admission circumstances • In intakes with folks who will be on less than 21 days

  7. ProfileDate Span • A MPQH profile date span is usually annual • A short-term authorization is marked on the profile if the change in services will last less than 90 days • If you have a temporary authorization you must return to the regular (annual) profile at the end of the span date • Make sure you track temporary profile spans and update the service plan accordingly • Services provided in excess of the annual span after the temporary span has ended are recoverable • MPQH will send two profiles with every short-term profile

  8. SLTC 151 or SLTC 164Amendment Request (PAS/ SDPAS 417, 502) When a change (either increase or decrease or change in tasks) occurs that will last over 20 days and you . . . • Determine the request is within the program policy and medically necessary • Support the request for change in authorization • Compare utilization and authorization levels and they support the request

  9. Amendment Request Cont. Then you complete the SLTC-151/165 form and mark the amendment box • Specify whether it is temporary (21-90 days) or long term (over 90 days) • Be specific and detailed about consumer condition, situation, health, living arrangement, etc. since you know the consumer and his/her circumstance best! • Spell out the consumer’s daily routine and the time needed to complete the tasks • Identify the consumer’s priorities • If you think the consumer is limited in his/her ability to report the change let MPQH know on the form so they can prioritize a home visit or contact your agency

  10. Role of MPQH with Amendments (PAS/SDPAS 417) • MPQH receives the amendment • If no onsite visit is necessary, MPQH sends updated profile to agency within 10 working days • If the agency does not receive an updated profile within 10 working days the agency must contact MPQH • Agency proceeds with temporary authorization until they receive the updated profile • If MPQH determines an onsite is necessary • Agency is given notification to continue with temporary authorization until the onsite is made • Once onsite is made MPQH sends the updated profile to Agency

  11. What Happened? • You submit an amendment to MPQH to have Connie’s exercise removed and to decrease her time (see scenario 4). • MPQH returns the overview and profile with no changes in tasks or time • What should an agency do?

  12. Information gathered during review DOES NOT MATCH Information provided by Agency What if? Gather more information, call consumer, family, provider or Health Care Professional GET A CLEAR PICTURE OF SITUATION AND MAKE DETERMINATION, based on Rules

  13. Problem? What do you do if the short-term span has ended but the consumer situation warrants an extension of the short-term authorization? Hint: Think in terms of the length of time the extension is needed

  14. Case Example Discussion Detailed and Not-so-detailed Questions?????

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