The Providers and Independent Clinicians slide presentation is available as a PDF document:

• Presentation to Providers and Independent Clinicians given May 17, 2012

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