q&a presentation - iowa providers · q&a yourquesonsanswered!%...
TRANSCRIPT
Q&A
Your Ques)ons Answered!
This material is designed and intended for general informa)onal purposes only. The user is responsible for determining the applicability and legality of this informa)on and for determining the most recent law, statute or regula)on(s) that may be applicable to the user’s par)cular situa)on. The Iowa Associa)on of Community Providers assumes no responsibility for the accuracy or legality of the informa)on contained herein.
Presenters: Gayla Harken
Edie Bogaczyk
December 2013
Pre-‐Voca-onal Q: Has there been a rule change that now allows both Pre-‐Voca-onal services and Supported Employment Job Development to obtain a job through Voca-onal Rehabilita-on combined with Waiver funding? In the past we were told that Voca-onal Rehabilita-on had to deny services before Pre-‐Voca-onal was an approved service. Last week I was told that: 1) Voca-onal Rehabilita-on is now replacing the denial leNers with a leNer sta-ng they will not fund Pre-‐Voca-onal services; and 2) A person may receive Waiver funding for Pre-‐Voca-onal and funding from Voca-onal Rehabilita-on for employer development along with Supported Employment funding through the waiver for Job development. Is this correct? A: There has not been a rule change as far as we know. The provider can, under certain circumstances, provide both Pre-‐Voca)onal and waiver supported employment.
ID Waiver – SCL Daily
Q: Under the HCBS Intellectual Disability (ID) Waiver -‐ Supported Community Living (SCL) 24-‐Hour, what cons-tutes one billable unit?
A: 441-‐78 indicates a full unit of services is: (1) One full calendar day when a member residing in the living unit receives on-‐site staff supervision for eight or more hours per day as an average over a calendar month and the member’s service plan iden)fies and reflects the need for this amount of supervision.
ID-‐Waiver SCL Daily
Q: When should the provider not bill for a day? A: A provider should not bill for the day of service:
When you provided no service in a day. When the average hours of services provided per day over the month is less than 8. (Average of days billed, not total days in the month.)
Daily Service Sites
Q: I have heard different informa-on on the number of people that can live together in a daily-‐service seYng. What is the real deal?
A: According to IME, daily services in sites up to four people is fine. However, sites with 5 people need prior approval from DHS.
Elderly Waiver and VA Benefits
Q: Where can we get training on VA benefits?
A: For this, we recommend calling the Iowa Department of Veterans Affairs office. Call 800-‐838-‐4692 and ask for a Benefit Specialist. In addi)on, each county has a Veterans Service Office. For more informa)on in your area, use this link: hbps://va.iowa.gov/coun)es/
Elderly Waiver Transporta-on
Q: Why are Elderly Waiver members not allowed to use TMS if they have a registered vehicle? A: It is that way because it is based on rule. If, however, a special circumstance comes up such as the person not being able to drive out of down, ader dark, etc…these situa)ons can be discussed with the program manager. Tim Weltzein is the direct contact and his number is (515) 256-‐4633.
Waiver + Hospice
Q: Can you use hospice services in conjunc-on with waiver services?
Waiver + Hospice
A: Yes. However, hospice is paid a daily rate and includes personal care as well as medical aben)on. The Provider cannot be paid for CDAC services if there is hospice available that should be providing those same services. Waiver is the payer of last resort. If hospice is authorized, waiver payment could not cover anything “duplicated” by hospice. Be aware of this prior to accessing hospice services and make sure hospice is willing and able to do the needed care for the pa)ent/member.
IMPA
Q: My ques-on relates to submiYng Incident Reports in IMPA. I would like to know why it is not more user friendly, as it is nearly impossible to figure it out and I have heard other agencies voice the same concern. If it is not going to work correctly, we need to have a place to e-‐mail or mail it to that will work so we will not be penalized for not geYng these reports in as is required.
IMPA
A: A webinar was recently held on December 6, 2013 on IMPA. Here is what we learned…..
Day Habilita-on
Q: What is the future for Day Habilita-on Services?
A: Our crystal ball says…There have been no official changes to the service defini)on or scope at this )me. Currently, more and more people are relying on this service type as their voca)onal services are cut.
Habilita-on and RCF
Q: What number of beds can a Residen-al Care Facility (RCF) license cover for that agency to be able to provide Home-‐Based Habilita-on services in that licensed facility?
A: The facility must be licensed for 16 or fewer people. ** In order to use a medica)on manager staff instead of a CMA, the license must be for 15 beds or fewer. ***
Children’s Mental Health Waiver
Q: How has the Children's Mental Health Waiver changed with the implementa-on of Integrated Health Homes (IHH)? Specifically, the referral process and documenta-on requirements.
A: Medicaid documenta)on requirements listed in Iowa Administra)ve Code 441 Chapter 79 have not changed at all.
Service Audits and Review
Q: Will you provide us with informa-on about the various reviews completed by HCBS Quality Oversight and their descrip-ons and processes? Example: Desk Reviews, Accredita-on Reviews, On-‐Site Reviews, Targeted Reviews?
A: Self-‐Assessment, Focused Review, Targeted Review, Periodic On-‐Site Review.
Audits and Reviews
Q: What is the deal with HCBS audi-ng for 100% when the rules say 75%?
A: According to HCBS Quality Oversight, “When determining if a standard is met or not met, HCBS considers if the areas demonstrate systemic issues, iden)fy members safety or welfare issues or are areas that if not corrected could cause the provider hardship if audited by another department en)ty.” This has been approached on a case-‐by-‐case basis and we are expec)ng further clarifica)on.
Documenta-on
Q: Can you re-‐share the word list from a documenta-on training you did earlier this year?
A: You bet! It is posted on the IACP website. www.iowaproviders.org Select the “Technical Assistance” bubon at the bobom of the page, from there you will find a link to the page with the resources (including other past trainings!)
Forced to Work?
Q: Why are individuals being asked to work when they are physically limited or not able to work? Is there some way to challenge this? Is this a local or federal rule? A: Many people with physical limita)ons are able to work and maintain successful careers. That being said, there are no waiver or habilita)on rules that require people to work. If a person’s Medicaid edibility is through Medicaid for Employed Persons with Disabili)es (MEPD), the en)re basis of this program is that the person is working or searching for work. Here is the link to the IME website on the program: hbp://www.ime.state.ia.us/HCBS/MEPDIndex.html
MEPD Q: Individuals are being required by case managers to par-cipate in programs such as MEPD in order to access associated benefits. If the person is not interested or able to par-cipate in such programs, is there an appeal process? A: Each region should have in its regional plan a method for the person to appeal decisions that have been made. If that is unsuccessful, contac)ng an organiza)on such as Disability Rights IOWA may be another avenue for resolu)on.
D-‐4s
Q: When I get the approved rate sheets back from Provider Cost Audit, do I really need to forward them to the Case Manager every -me?
A: Yes. The Case Manager is not supposed to enter a new rate into ISIS without first having seen the approved rate sheet.
Magellan
Q: I would like to know what other providers are experiencing with the Magellan process, especially those consumers that are carrying high hours or need 24-‐hour care?
A: What we know:
Magellan
Q: If my claims from Magellan are not paying properly, whom do I contact? Contact Steve Johnson at Magellan at 515-‐273-‐5010 or send him an e-‐mail at: [email protected] He will put you in contact with a customer service representa)ve. Those representa)ves are assigned according to the area of the state where the provider is located.
Magellan
Q: If I need assistance due to an urgent case where someone is geYng out of the hospital and is in need of Habilita-on Services, is it best to e-‐mail or call Magellan?
A: A phone call is beber. Magellan is commibed to geong back to Providers the same day in these circumstances.
Magellan Q: When a No-ce of Decision (NOD) is not approved by Magellan for the same amount as previously agreed upon by the Team, how can this be reconciled? For example, the Team approved 50 units but the Magellan website says 25.
A: There are three possible answers to this: 1) If there is a discrepancy, call back the person who gave you the authoriza)on. 2) If there is a disagreement because Magellan believes fewer units are needed, the Provider is able to appeal that decision. 3) The Excep)on: Magellan’s system can only include 3 digits per authoriza)on leber. The Provider will see one authoriza)on leber that is 999, a second for 999 and a third for 2.
Habilita-on
Q: If someone is on MEPD, will they go into IHHs for care coordina-on?
A: Yes, unless they are also receiving ID or BI Waiver services.
Habilita-on and IHH
Q: How are the new Integrated Health Homes going to affect individuals receiving Habilita-on services? A: There are a number of resources that speak to IHH on the Magellan website: hbp://www.magellanofiowa.com/for-‐providers-‐ia/integrated-‐health-‐home.aspx hbp://www.magellanofiowa.com/for-‐providers-‐ia/addi)onal-‐op)ons/habilita)on.aspx
Habilita-on and IHH Q: What is the referral process for consumers to receive Habilita-on services when the Provider is not an IHH?
A: This referral depends on a number of factors, including income and resources, whether they are currently receiving services, if they have a Targeted Case Manager (TCM), etc. If the person has a TCM, the TCM would assist in the referral. If the person is not sure what they have, both that individual and the Provider could call to Magellan and inquire.
Transporta-on Rate Changes
Q: I heard things are changing with HCBS transporta-on reimbursement rates. What do you know about that? A: Refer to Informa)onal Leber 1311 that came out November 8, 2013.
County Transporta-on Contracts
Q: Are there specifics regarding how and when county transporta-on contracts with a Provider will be ending? Addi-onally, is there any informa-on explaining how these contracts will paid out once moving over to IME?
County Transporta-on Contracts A: IACP is not aware of any changes that are happening with those programs at this point (other than the flat rate discussion that is currently going on with Magellan). Our experience has been that if the Provider had a contract with your county, there was language included that specified how those could be terminated and no involvement from another en)ty like IME was required. Also, it looks like the transi)on )me is by September 30, 2014, when NODs indica)ng the new rate and a change in ISIS needs to be done. This may define the )meframe.
Service Plan Progression
Q: If a person has not met his/her objec-ve by the end date aNached to it, does it make sense to move to the next step? Our Case Manager insists we move forward even if progress has not been made that would logically take the person forward.
Service Plan Progression
A: Service planning, by rule, is to be collabora)ve. While specific service ac)vity )melines are based on best guesses of how a person will progress, the )meline should be reflected accurately (adjusted when necessary). Moving forward with goals prior to comple)on does not really follow a plan that is designed to be incremental. Adjustments must be made to )melines if needed and the person's team needs to insist on this. If you do not get your Case Managers to agree with this, speak to their supervisors. If that does not help, please contact us at IACP and we will try to help problem-‐solve this situa)on.
Training
Q: Do staff need to have separate trainings for Habilita-on and other services (when providing services in both services)?
Training
A: No, as long as the trainings address the content that is required as well as the specific popula)ons being served. While you are required to provide individual-‐specific support needs training, the generalized trainings you provide do not need to be duplicated (separate). Many trainings cross a variety of popula)ons and can be generalized. Providers needs to document that the training was conducted on a par)cular day and addressed the training needs of the specific popula)ons they are serving.
Plan Signatures
Q: Do Waiver/HAB Provider plans have to have signatures on them? If so, who needs to sign them? A: Yes. The Provider, Case Manager, Member and Guardian (if applicable). This is most frequently done as a signature sheet abached to the service plan. An Inter-‐Disciplinary Team (IDT) sign-‐in sheet is the most common way of addressing this requirement.
NOD
Q: What happens if you are issued a new NOD and not all of the informa-on is listed? Can you use both the old NOD in conjunc-on with the new one?
A: No. You should call and get a new and correct NOD as the Provider is responsible for billing from what is on the NOD.
Self-‐Assessment
***Remember the Provider Quality Management Self-‐Assessment was due December 1, 2013.