The Providers and Independent Clinicians slide presentation is available as a PDF document:
Purpose
- Improve service delivery
- Review documentation requirements
- Set expectations
- Discuss concerns and solutions
- Explain the role of the DDA consultants
DDA initiatives
- Exit Evans Compliance Plan
- CMS Review
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.
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;
- Quarterly reports/written documentation
- Number of hours for follow along services.
- Treatment goals that are appropriate for the authorized service;
- Aural rehabilitation by teaching sign language and/or lip reading;
- 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.
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.
- 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.
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
-
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.
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.
-
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.
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.
Expectations
- Day Treatment vs. Medicaid Waiver Services
- Service Authorization vs. Prior Authorization
- Utilization Management effective May 1, 2012 ( no back dating Service Authorizations)
- Mandatory Pre-ISP meeting effective March 1, 2012
- Billing and TA (hand out)
- Next billing training June 1, 2012 from 9:30 am to 3:00 pm.
- New Waiver - November 2012
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.
The following Clinical specialties are available:
- Behavioral Health
- Occupational Therapy
- Physical Therapy
- Speech Therapy
- Clinical Nutrition
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