3/21/2019 1 Consumer Directed Services Monthly Case Management (MCM) Activity Best Practices Presented by Tonya Potter The Whole Person, Independent Living Advocate II [email protected]A little bit about me: • My passion comes from my family • My sister in‐law was shot when she was 14 at the time, very little was known about CDS. • My experience started as an in home aide over My experience started as an in home aide over 10 years ago • I began my career in 2006 Presentation Objectives • What are the Vendor Requirements? • Best Practices that will comply with the State h b fi that benefits your company that can benefit your participants • Face to Face Visit safety • How to maximize return on investment
Transcript
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Consumer Directed ServicesMonthly Case Management (MCM)
Activity Best Practices
Presented by Tonya PotterThe Whole Person, Independent Living Advocate II
htt // l d / l / l 189 200http://manuals.momed.com/manuals/ ‐personal care, pages 189‐200
• Section 208.900‐ 208.930 RSMo
• 19 CSR 15‐8
• VM 07‐18
Personal Care Manual pg. 189‐200
VM‐07‐18:
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What is the Vendor Memo 07‐18?
• MEMO FOR VENDORS OF CONSUMER‐DIRECTED SERVICES
• Issued May 15th 2007
• For the clarification of vendor responsibilities
A i t d i i i li t• Assists vendors in remaining compliant
“In accordance with statutory requirements, vendors are responsible for monitoring the performance of the personal care assistance services. The minimum standard in regulation requires at least monthly MCM”
VM‐07‐18 HighlightsDocumentation should include at a minimum:
• Documentation MUST include the date/time of contact
• The type of contact (telephone, face to face or home visit)home visit)
• Specific details of the discussion • That services being provided are in accordance with the care plan
• Action is being taken regarding changes in health/circumstances/unmet needs
Example
• Spoke to Consumer via 816‐123‐4567 on 3/19/19 @ 3:43 pm her attendant was not on the clock when we spoke. I reviewed the care plan with her and let her know that her attendant did not follow the care plan in February. She advised me that the attendant was moving and was unable to work a few days so there were some long shifts to prepare the consumer for the dates the attendant would not be there. The consumer has not been in the hospital however she is being monitored for ongoing issues with her heart. EVV is at 97%
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MCM Best Practices prior to contact• Review the hours delivered vs. authorized for prior month.
• Ex: when completing April’s contact review March’s hours delivered.
• Review the attendants EVV usage• Review the attendants EVV usage
• Review EVV for open shifts that need documentation
• Review task codes documented for compliance
MCM Best Practices prior to contact• Consumer training that may be needed to:
• Attendant supervision • Ensuring the units submitted do not exceed the plan of careN tif i DHSS f h• Notifying DHSS of any changes
• Pull the Emergency back up plan (EBP) for review
MCM Best Practices • MCM should be done by phone or in person. No text, email or social media messenger.
• Document rather or not if the PCA is working.• Refer back to this when reviewing EVV or ti h ttimesheets
• Develop a MCM form to ensure no questions are missed.
• Document reasons for over/under delivery of units
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Example
• Attendant EVV report shows 22% EVV usage• Talk to the consumer about training needed
• Attendant worked 149 hours in February and consumer is only authorized for 98 hoursconsumer is only authorized for 98 hours
• Review the authorized hours vs. delivered hours with the consumer
• Ask consumer why there is an over delivery of hours
• Provide another copy of the care plan
• Consumer moved to a new residence • Complete new EBP and send DHSS communication
VM‐07‐18 HighlightsVendors must Determine when a face‐to‐face visit is necessary to ensure program compliance and preform appropriate case management activities.
Examples include but not limited to:Examples include but not limited to:• Under or over utilization of care plan• Consumer training required • Care plan compliance • Paperwork review• Advocacy • Information and referral
Documentation
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What you should be looking for
• Ability/ wiliness to self direct • Ensure
• the attendant is not a legally responsible individual such as a spouse or guardian.h CDS i b i d b fi h• the CDS services are not being used to benefit the household or being used for someone other than the participant.
• no time is being used for stand‐by assistance, respite care or medical appointments
• No time is used for task that must be performed/ trained by a licensed professional (i.e., skilled nursing, therapies ordered by a physician, etc.).
What you should be looking for• Consumers needs are being met
• Any unmet needs or concerns that need addressed
• Any hospital stay or changes to health to report • Changes to circumstances to report
• Problems between the attendant and the consumer that are being handled
• Are they properly using EVV • Care plan compliance
• Any plans to hire or recruit a new attendant • Any other discussion pertinent to care oversight
Face‐to‐Face Best Practice's• Complete Home visits twice a year• Complete a new or review current Emergency back up plan (EBP)
• Renew consumer training paperwork• Call as a reminder to the consumer prior to visitCall as a reminder to the consumer prior to visit• Verify the address with the consumer prior to the visit.
• Make sure a co‐worker/supervisor knows who you are visiting and the location of the visit.
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Face‐to‐Face Best Practice'sSafety • Keep valuables out of sight• Dress professionally and functionally• Carry/wear items with your company’s logo on them. Walk with confidence and purpose, display friendliness and assertiondisplay friendliness and assertion.
• After consumer answers the door, ask for permission to enter & exchange polite greetings (“Hello I am Tonya with The Whole Person, May I come in?” As you walk in, “Thank you for meeting with me today.”)
Face‐to‐Face Best Practice'sSafety
• Make it clear that you have other appointments. This gives you a way out if you feel uncomfortable.
• Refrain from telling consumers too much (i.e. where you live, your religious or political views, etc.)
• Do not “Friend” consumers on social media, and be sure to monitor your privacy setting.
• Make sure your vehicle is in good running condition/has enough gas.
“Just in case” Tips!• Keep a flashlight/first aid kit in your vehicle.
• Take dog biscuits along to calm excited/aggressive dogs.
• Use a Lone Worker Smartphone app.
• Keep a barrier between you and the aggressor.
A l d lf d L k fid t Y• Appear calm and self‐assured. Look confident. Your anxiety could make the aggressor feel more anxious and unsafe.
• Be empathetic of their feelings, but not their behavior.
• Do not argue with them. Never tell an aggressor to “calm down.”
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Documentation
Regardless of the type of unsuccessful attempts to contact the consumer they must also be documented.
• Repeated inability to contact a consumerRepeated inability to contact a consumer could indicate program noncompliance or inability to self‐direct.
• This could result in program closure.
Ideas for monitoring utilization of units• EVV (electronic visit verification) or timesheets
• Medicaid billing
• Monthly contact with participants
• Spreadsheets• Spreadsheets
• Case notes
• Service Delivery Monitoring Forms
MCM can be used to provide information and referrals • Discussion of needs or resources that could assist consumer’s independence
• Documentation of providing referrals or sources the consumer can contact to obtain resources
• Create a database of referral sources in the community
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No contact best practices
Unsuccessful attempts to contact the consumer.
• Document every attempt rather it be via phone, pop in visit, letter or contacting an ER contact.
• If you are unable to reach the consumer for the required MCM h l d i i h f hMCM sent them a letter, advising them of the requirements and that closure could result from non‐compliance.
• Try to reach out to the PCA or an ER contact.• Review local obituaries or case net • Review Cyber access or eMOMED for hospital stay or reported death
No contact best practices
Sometimes it’s not so easy…
• The resistance
• The hunt
• The fraud
• The repetitiveness• The repetitiveness
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By completing the properprogram oversight and utilizingthe VM 07‐18 during MCM,
will actually help you check offmany of the requirements
of 19 CSR 15‐8.400
Don’t forget you must …
Have a philosophy that promotes the consumer’s ability to live independently…..
• Advocacy
• Independent Living Skills TrainingIndependent Living Skills Training
• Peer Counseling
• Information and referral
• Providers must demonstrate a positive impact on participant outcomes.
What if fraud, abuse, neglect, or financial exploitation is suspected?• Complying with applicable statutes and regulations reports of abuse and neglect
• Complying with applicable statutes and regulations regarding reports of misappropriation of a consumer’s property or funds or the falsification of documents …
• After notice to DHSS suspend services pending investigation or provide consumer with 21 day notice.
……Document and Report!
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Once the Case Managementactivity is complete,activity is complete,what do you do withthe information?
Is there a need to…..
• Refer for additional resources?
• Suspending services to consumers?
• Provide additional training?
• Need for a face to face visit?• Need for a face to face visit?
• Refer for additional services?
• Report to MMAC?
• Need for Advocacy?
• Hot Line
Is there a need to…..
• To Provide Consumer Training or assistance with attendant training
• Timesheets and or EVV protocols
• Issues that would be considered fraud of the program
