Independent Care Waiver Program (ICWP)

Presentation to: Georgia Association of Community Care Providers (GACCP)

Presented by: Marcia Stanford, Human Services Program Auditor, OIG/Program Integrity Section

Date: July 14, 2011

Important

• Read Your Manuals• The Information in

the Manuals is Essential

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PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES.

Current DMA-6 • All Waiver applicants must have

DMA-6 prior to admission. • A copy of an approved DMA-6

that covers all periods of service must be maintained in the member’s record. (See Sections 702.3B-2 and 906.1 of the ICWP Manual)

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DMA-80 as noted in the PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES

Current DMA-80 • All requests for prior approval must

be made in writing on the Prior Authorization Form (DMA-80). (See Sections 801 and 906.1)

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PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES.

Freedom of Choice form, Client Rights and Responsibilities form, and Memorandum of Understanding form

• These forms must be signed and dated by the member or representative prior to initiation of services with MOU signed annually, then forwarded to GMCF and copies maintained in the providers’ files (See Sections 604.1A; 703H; I; J 906.1E-4/7 and Appendix C of the ICWP Manual)

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PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES.

Individual Care Plan/Care Path • All member records must contain an

Individual Plan of Care completed, signed, and dated by the case manager, the member and planning team every twelve (12) months.

• Lists all providers, services, frequency, goals and cost. (See Sections 703-F, 902.1(4) 1-26 and 906 and Appendix H of the ICWP Manual)

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PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES.

Case Manager Quarterly Review • Case Manager must review the

Individual Plan of Care every ninety (90) days with the member to determine and document compliance, progress and continues appropriateness.

• This quarterly review must also include assessment and documentation of member satisfaction. (See Sections 902.1 (10) and 907 (B)1) of the ICWP Manual)

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PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES.

Discharge Plan • Providers must maintain a

coordinated program of discharge planning.

• The Case Manager coordinates in consultation with the client, GMCF, providers, physician and others. (See Sections 703, 706, 902.1 (4) 16 and 906.1E-13 of the ICWP Manual)

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PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES, Section 902.2

Monitoring – Personal Support• RN must monitor & supervise

care of members whose health status and situation involve complex observation

• RN must review and sign all documentation of the LPN within 10 days of each visit and follow up immediately on concerns raised by the LPN

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PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES, Section 902.2

Monitoring – Personal Support• LPN must monitor vital signs

as needed and report abnormal readings and concerns to the RN immediately

• Monitoring must be by the personal support supervisor every 90 days.

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PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES.

Documentation of Services • The member’s record must

include documentation for case management must include time spent for telephone calls related to the member’s care.

• The Case Manager face to face monthly visit must be dated and signed with the ICWP member.

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PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES

Documentation of Services, continued• To be reimbursed for services, the

case manager must provide detailed documentation that identifies dates of services, duties performed and actual hours rendered providing service to a member. (See Section 906.1 of the ICWP Manual)

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PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES.

Monitoring of Services• The Provider must monitor

individuals providing Personal Support and Respite services every ninety (90) days.

• Documentation of this visit must be recorded in the provider’s files and a copy forwarded to the Case Manager. (See Sections 902.1.4; 902.2G; 906.1E-12 of the ICWP Manual)

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PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES.

Services performed according the Plan of Care and the DMA-80

• There must be sufficient documentation in the record to indicate that services have been provided as approved on the Plan of Care and DMA-80. (See Sections 906.1E of the ICWP Manual)

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PART I POLICIES AND PROCEDURES FOR MEDICAID/PEACHCARE FOR KIDS MANUAL.

Billing Discrepancies • There is documentation in the

record to support every unit for which the provider billed.

• Payment is reimbursed for services rendered (see Section 402.2 of the Part I Manual)

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Important

• Read Your Manuals• The Information in

the Manuals is Essential

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