Transcript CAP/DA Program Management and Documentation

CAP/DA
Local Agency Reviews and
Documentation Guidelines
Tracy Colvard, CAP/DA and PCS Manager
May 2006
General CAP/DA Program
Operations
□ Organizational structure and staffing
□ Service provider resources
□ Referral and pre-screening procedures
□ Assessment and case management
practices
□ Billing procedures
□ Exit conference
□ Written report
CAP/DA Program Review
□ Lead agency information
□ Lead agency agreement
□ Case manager information
□ Years experience, FT/PT
□ CAP/DA recipients served (slots)
□ Client termination information
□ Reasons for termination/numbers
CAP/DA Program Review
□ FL-2 issues
□ Who does assessments?
□ Written procedures for POC approval
□ Written guidelines for caseload limits
□ CAP/DA Advisory Committee
□ Membership, meeting frequency,
activities
CAP/DA Program Review
□ Referrals
□ Numbers, sources, written procedures for
referral and pre-screening
□ Waiting list written policies
□ CAP/DA waiver service providers
□ Adult Day Health, In-Home Aide, Meals,
Respite, Telephone Alert
□ Client freedom of choice procedures
CAP/DA Program Review
□ Written Transfer Policy
□ Proof of case manager signing claims
□ Coordination methods with DSS
□ Eligibility, deductibles, CAP/DA
applications
□ Lead agency organizational chart
□ Medicaid provider enrollment
agreement
Record Review
□ Clients selected on day of local review
□ Usually 3-4 months prior to review visit for claims
purposes
□ Review
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FL-2
Assessment
POC
Service Authorization and Participation Notices
Case Management notes
Claims data
Record Review
Minimum Monitoring Requirements
□ Adult Day Health, In-Home Aide,
Respite
□ Monthly review of service provision with
client/provider
□ Hands-on observation at least every 90
days
□ Review supporting documentation for
claims at least every 90 days
□ Review provider claims prior to billing
Medicaid
Record Review
Minimum Monitoring Requirements
□ Meals and Telephone Alert
□ Monthly review of service provision with
client/provider
□ Review provider claims prior to billing
Medicaid
Record Review
Minimum Monitoring Requirements
□ Waiver Supplies & Lead Agency
Provided Medical Supplies
□ Confirm after initial delivery and at least
quarterly if supplies meet client’s needs
□ Home Mobility Aids
□ Confirm after initial delivery and at least
quarterly if supplies meet client’s needs
Record Review
Minimum Monitoring Requirements
□ Nurse Visits
□ Review HHA nurse visits with nurse once a
month (by phone or nursing notes).
□ Home Visits
□ Visit client at least every 90 days
□ Case Notes
□ All activities documented (dated, time in
minutes, signed, multiple daily entries
totaled)
Documentation
Entries should include:
Who, What, When, Where, Why
If it’s not documented,
it didn’t happen !!
Examples of Billable and Nonbillable Case Management
□ Handout
Case Management Exercise
□ Joe Blow
Service Authorization vs.
Participation Notice
□ Handout
Questions and Possible Answers