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Providers and Independent Clinicians Slide Presentation

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