Transcript 2013 MDS 3.0 Section Q Training for Local Contact Agencies Nursing Facilities

Department of Medical Assistance Services
MDS 3.0 Section Q Training for Local
Contact Agencies
Virginia Department of Medical Assistance
Services (DMAS)
Presenter: Amy K. Burkett, DMAS
State Section Q Coordinator
April 2013
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Overview
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MDS 3.0 Section Q Background
Purpose of MDS 3.0 Section Q
Revisions to Section Q Referral Workflow
Roles of Stakeholders
Pre-Screening for MFP Referral
Section Q Resources and State Contacts
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
MDS 3.0 Section Q Background
• Important progress has been made in the
last 20 years so that individuals have
more choices, care options and available
supports to meet care preferences and
needs in the least restrictive setting
possible.
– Americans with Disabilities Act (1990)
– Olmstead Supreme Court Decision (1999)
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
MDS 3.0 Section Q Background
• Gives resident a voice and a choice
• Places resident/family at center of
decisions
• Increases person-centered care and
discharge planning
• Increases communication and
collaboration between providers of
services
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Purpose of MDS 3.0 Section Q
• MDS 3.0 standardizes long-standing
requirements for nursing facilities and
states to ensure individuals are
appropriately assessed and reside in
settings of their choice and appropriate to
their needs
• Promotes linkages and information
exchange between nursing facilities, local
contact agencies, transition coordination
providers, and other community-based
long-term care providers
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Purpose of MDS 3.0 Section Q
• Meaningfully engages residents in their
discharge planning goals
• Directly asks the resident if they want
information about long-term care
community options
• Promotes discharge planning collaboration
between nursing facilities and local contact
agencies for residents who may require
medical and supportive services to return
to the community
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Purpose of MDS 3.0 Section Q
• Nursing facility staff are required to
contact their Local Contact Agency for
those residents who express a desire to
learn about possible transition back to the
community and what care options and
supports are available
• Local Contact Agencies respond to nursing
facility staff referrals by providing
information to residents about available
community-based long-term care supports
and services
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Workflow
(1)
NF administers MDS 3.0 Section Q, which
generates a referral to the designated LCA
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Workflow
(2)
NF completes and faxes the MDS 3.0
Section Q Transmittal Notification and
Tracking Form (DMAS-P261) with
Universal Signed Consent to designated
LCA within eight (8) business days
providing: individual’s basic demographic
info, payer source, date of NF admission,
and individual’s preferred contact
information
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Workflow
(3)
LCA signs, dates, and faxes the DMAS-P261
form back to the NF within two (2)
business days and enter individual’s
information into No Wrong Door Tools
Application or approved manual process
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Workflow
(4)
LCA contacts individual or individual’s
preferred contact by phone or face to face
within two (2) business days to confirm
information and provide general
information on available community
services. The LCA will gather additional
information on the individual’s wishes and
support needs
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Workflow
(5 a)
If individual is interested in MFP, LCA
provides printed materials/MFP fact sheet
within three (3) business days including
list of available resources and list of TCPs
or DD/ID screening entity (CSB or CDC) to
individual or individual’s preferred contact;
or (continued ~ next slide)
DD – Developmental Disability
ID – Intellectual Disability
CSB – Community Services Board
CDC – Child Development Clinic
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Workflow
(5 b)
If not a MFP referral, LCA provides printed
materials within three (3) business days
including list of available resources and
community resource contact information
to individual or individual’s preferred
contact.
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Workflow
(6)
The LCA documents the specific process
(from previous two slides) on the
DMAS-P261 form and faxes to the NF
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Workflow
(7)
NF confirms receipt of materials with the
individual or individual’s preferred contact.
NF Social Worker talks with the individual
about choices.
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Workflow
(8)
Once individual has made decision to either
seek additional information or end the
referral process, the NF completes and
faxes the DMAS-P261 form and updated
Universal Signed Consent with name of
TCP or community resource contact or
DD/ID screening entity, to designated LCA
to inform them of the decision of the
individual
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Workflow
(9)
LCA or community resource contact
documents individual’s decision into No
Wrong Door Tools Application or approved
manual process and if applicable, forwards
the individual’s information and Universal
Signed Consent to the selected TCP or
community resource within two (2)
business days
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Workflow
(10)
TCP or community resource contact
completes and faxes DMAS-P261 to LCA to
confirm acceptance of referral within
three (3) business days
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Workflow
(11)
TCP or community resource contacts NF and
the individual to arrange a face-to-face
meeting with the individual and/or
individual’s preferred contact, and NF, to
discuss community services. Notify LCA
that a visit occurred.
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Workflow
NOTE: The Section Q referral workflow
process does not negate NF discharge
planning responsibilities in accordance
with the Code of Virginia, Section 32.1138.
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q Referral Information
• All discharges from a NF do NOT require a
Section Q referral to an LCA
• MDS 3.0 Section Q does NOT replace the
role of the NF discharge staff to develop
and implement a discharge plan for their
residents
• For more information, refer to the VDH
Section Q Webinar link listed on slide #35
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Role of Stakeholders
• Nursing Facility (NF) - initiate the referral
• Local Contact Agencies (LCA’s)- VA
designated Area Agencies on Aging to
serve as LCA’s
• Transition Coordination Provider (TCP) specific to MFP clients
• Community Resource Contact – Agencies
that may support an individual’s transition
to community that may not otherwise be
indicated
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Roles of Stakeholders
Nursing Facility (NF):
• Administers MDS 3.0 Section Q at the frequency
and manner as directed by CMS (i.e.: on
admission, 14, 30 and 90 day intervals)
• Contacts designated Local Contact Agency (LCA)
as directed by responses to MDS 3.0 Section Q
within eight (8) business days using the MDS 3.0
Section Q Referral Facsimile Transmittal
Notification and Tracking form (DMAS-P261)
• Confirms receipt of materials with the individual
on community services provided by the LCA
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Roles of Stakeholders
Nursing Facility (NF) ~ continued:
• Contacts designated LCA on the decision of the
individual and the Transition Coordination
Provider (TCP), DD/ID screening entity or
community resource chosen by the individual
using the DMAS-P261 form
• Coordinates and assists TCP as needed to
facilitate a transition to the community
• Documents all actions taken by the NF and
subsequent decisions of individual on their
decision to transition to the community
• Adheres to Health Insurance Portability and
Accountability Act (HIPAA) requirements
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Roles of Stakeholders
Local Contact Agency (LCA):
• Responds to fax from NF Section Q referral within
two (2) business days using the DMAS-P261
• Calls or visits with individual, or the individual’s
preferred contact, within two (2) business days of
confirming receipt of referral from nursing facility
• Provides information about community living
options and available supports and services to
the individual/individual’s preferred contact
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Roles of Stakeholders
Local Contact Agency (LCA) ~ continued:
• Provides all relevant printed materials on
community services including a list of
geographically available TCPs or DD/ID screening
entity and resources to the individual, or the
individual’s preferred contact, within three (3)
business days of speaking with the individual
• If applicable, forwards individual’s information to
the chosen TCP or community resource within
two (2) business days of receiving notification of
individual’s decision from NF
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Roles of Stakeholders
Local Contact Agency (LCA) ~ continued:
• Documents all actions taken by LCA in No Wrong
Door Tools Application or approved manual
process
• Adheres to the confidentiality and exchange of
protected health information guidelines as set
forth in the Code of Virginia
* NOTE: LCA’s which are also TCPs should not
promote their TCP services over other
similar TCP organizations *
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Roles of Stakeholders
Transition Coordination Provider (TCP) or
Community Resource Contact :
• Responds to fax notification from the LCA for a
referral of an individual who is interested in
transitioning to the community
• If accepting the referral, contact the individual
interested in transitioning to the community
and/or the individual’s preferred contact within
three (3) business days of receiving fax
notification from LCA for a referral
• Arranges face-to-face meeting with the individual
and/or the individual’s preferred contact, and NF
staff within ten (10) business days of speaking
with the individual
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Roles of Stakeholders
Transition Coordination Provider (TCP) or
Community Resource Contact ~ continued:
• Notifies LCA via fax that a visit occurred with the
individual and/or the individual’s preferred
contact
• Coordinates and assists NF staff as needed to
facilitate a transition to the community
• Documents all actions taken by TCP or
community resource contact and subsequent
decisions by individual to transition to the
community
• Adheres to Health Insurance Portability and
Accountability Act (HIPAA) requirements
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Money Follows the Person
Money Follows the Person is a process to
assist Medicaid individuals living in an
institution who would benefit from
transition services and assistance from
transition coordinators to support their
return to the community.
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Pre-Screening for MFP Referral
• It is not the LCA’s responsibility to
determine if an individual meets MFP
criteria; however, a pre-screening by the
LCA is suggested so as to determine an
appropriate referral.
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Pre-Screening for MFP Referral
Individual must:
• Reside in the institution for at least 90
consecutive days
NOTE: SNF days do not count toward 90
day requirement, and
• Have Medicaid as a payer source
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
MFP Referral Information
• Once it is determined that an individual
meets the pre-screening for MFP, the LCA
will provide a list of TCPs for the
individual to choose their TCP.
• Once the LCA has made the referral to the
chosen TCP, the TCP will assist the
individual with the final determination of
MFP criteria and if met, will assist with the
transition to the community.
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
MFP Referral Information
• If the individual has a diagnosis of
Intellectual Disability, refer to the local
Community Service Board (CSB) to
facilitate MFP services
• If the individual has a diagnosis of
Development Disability, refer to the local
Child Development Clinic (CDC) to request
a screening for the DD waiver
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Section Q and MFP Resources
MDS 3.0 Section Q Website:
http://www.olmsteadva.com/mfp/MDS3SectionQ.htm
VDH MDS 3.0 Section Q Webinar Training:
http://www.vdh.virginia.gov/olc/training.htm
MFP Information on the DMAS Website:
http://www.dmas.virginia.gov/Content_pgs/ltcmfp.aspx
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Agency Contact Roles
• State Section Q Coordinator – handles inquiries
from NFs and LCAs related to Section Q referral
process
• State No Wrong Door Coordinator – serves as the
primary contact for LCA inquiries
• State RAI Coordinator – Oversees the NFs in the
administration of the MDS 3.0 assessments of NF
residents; works with NF MDS Coordinators
throughout Virginia
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Contact Information
• State Section Q Coordinator – Amy Burkett
[email protected]
Phone #: 804-786-0568
• State No Wrong Door Coordinator – Kathleen
Vaughan
[email protected]
Phone #: 804-662-9153
http://dmasva.dmas.virginia.gov/
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Department of Medical Assistance Services
Contact Information
• State RAI Coordinator – Priscilla “Cil” Bullard
[email protected]
Phone #: 804-367-2141
• Ramona Schaeffer, MFP Coordinator
[email protected]
Phone#: 804-225-3007
http://dmasva.dmas.virginia.gov/
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