Preadmin training


Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Preadmin training

  1. 1. Department of MedicalAssistance ServicesPre-Admission Screening Melissa A. Fritzman Program Supervisor Division of Long-Term Care Fall 2008 1
  2. 2. Why Do We Cover Who We Cover?Basic Services, Eligibility, Coverage Groups, and Patient Pay 2
  3. 3. Overview of Today’s Session Why Do We Cover Who We Cover? Why Do We Do What We Do? Assisted Living Pre-Admission Screenings What Do I Need To Get Paid? Criteria for Eligibility Determination Based On Individual’s Abilities/Needs What Do We Look Like? What’s Wrong With My UAI? What Do Services Look Like? 3
  4. 4. Why Do We Cover Who We Cover? Medicaid Services - Mandatory Services - Medicaid State Plan (must be available statewide in the same amount, duration, and scope to all who meet criteria; individuals must be able to choose providers) 4
  5. 5.  Inpatient Hospital Services Emergency Hospital Services Outpatient Hospital Services Nursing Facility Care Rural Health Clinic Services Federally Qualified Health Center Clinic Services 5
  6. 6.  Lab and X-Ray Services Physician Services Home Health Services EPSDT Family Planning Nurse-Midwife Services Transportation Medicare Premiums (Part A) - Hospital; (Part B) - Supplemental Ins. For Categorically Needy 6
  7. 7.  Other Clinic Services Skilled Nursing Facility Services for Individuals under 21 years of age Podiatrist Services Optometrist Services Clinical Psychologist Services Certified Pediatric Nurse and Family Nurse Practitioner Services Home Health: PT, OT, and Speech Therapy ICF/MR 7
  8. 8.  Dental Services for Persons under 21 Physical Therapy & Related Services Prescribed Drugs Case Management Services Prosthetics Mental Health Services Mental Health Clinic Services Hospice Services Medicare Part B Premiums for the Medically Needy PACE 8
  9. 9. Medicaid ServicesMandatory vs. Optional Waivers Can determine Mandatory Optional services to be Services Services provided (State Plan) Can be targeted to (State Plan specific groups: Option) • Aged,Cannot be targeted to specific groups, unless that is part of the service definition • Disabled, • Persons with DevelopmentalProvided to both mandatory and optional disabilities,coverage groups • Persons who are Mentally Ill/Mentally Retarded 9
  10. 10. Long-Term Care Eligibility and Services Coverage Group Financial •Aged, blind, and Eligibility disabled After you are •Families with in a coverage children group, you •Recipients of must meet cash assistance •Pregnant women income and and children asset •Low-income guidelines, as Medicare well as non- beneficiaries financial criteria. 10
  11. 11. Long-Term Care Eligibility and Services To be eligible for Medicaid-funded long-term care services individuals must :  Qualify for Medicaid; and 11
  12. 12. Long-Term Care Eligibility and Services  Meet specified long-term care criteria using the standardized long-term care assessment instrument. They are: •Uniform Assessment Instrument (UAI) for nursing facility level of care •Level of Functioning (LOF) for Intermediate Care Facility/Mentally Retarded (ICF/MR) level of care 12
  13. 13. Long-Term Care Eligibility and ServicesLTC accounts for 70 % of the total Medicaid Budget and 30% of the individualsLong Term Care is provided In institutions:  Intermediate Care Facilities for the Mentally Retarded (ICF/MR) (State Plan Option);  Nursing Facility (Mandatory State Plan service)  Assisted Living Facilities (State Plan Option) 13
  14. 14. Long-Term Care Eligibility and ServicesLong Term Care is provided In the community:  Home and Community Based (1915(c)) Waivers  Program of All-Inclusive Care For the Elderly (PACE) (State Plan Option) 14
  15. 15. Qualify for Medicaid Individuals who are financially Medicaid eligible at the time of application for LTC services are not automatically eligible for LTC services if they meet the functional and/or medical nursing needs assessment. The local DSS must assess the individual’s financial eligibility for Medicaid (LTC) and calculate a patient pay. Everyone must have a calculation, not everyone has a patient pay. 15
  16. 16. Qualify for Medicaid* DMAS -122 The Patient Pay (DMAS-122) is the amount that the individual must contribute each month towards their cost of care. The DMAS-122 is the service provider’s authorization to bill Medicaid for LTC services. DMAS-122 is to be sent by the EW no later than 45 days from date of application, and 30 days from the date of a reported change. If the individual does not receive LTC services for 30 days, he must be referred to the Eligibility Worker for a determination of continued Medicaid
  17. 17. Why Do We Do What We Do?Why Is Pre-AdmissionScreening Important? 17
  18. 18. Why we do Pre-Admission Screenings In order to be eligible for long-term care services, individuals must be screened to determine if they meet the admission criteria. Virginia has one of the most stringent criteria in the country. For Nursing Facilities and Home and Community Based Waivers: The authorized assessors are the local health departments in conjunction with the local departments of social services and acute care hospitals. 18
  19. 19. Preadmission Screening Waiver Assessment Tool Screening AgencyAIDS/HIV UAI Local DSS and HD/HospitalsALZHEIMER’S UAI Local DSS and HD/HospitalsEDCD UAI Local DSS and HD/HospitalsTECH UAI Local DSS and HD/HospitalsIFDDS LOF Local CDCDay Support LOF Local CSBMR LOF Local CSB Some waivers have a wait list. LOF = Level of Functioning Tool 19
  20. 20. Preadmission ScreeningRecipient’s Choice of Placement Criteria for Criteria for Admission to Admission to the Waiver InstitutionThe individual applying for a waiver must meetthe same criteria that is used for admission tothe alternative institutional placement. 42 C.F.R.441.302 (c)(1); 42 C.F.R. 441.303 (c)(2)
  21. 21. Alternate Institutional Placement There must be an alternate institutional placement for which Medicaid pays. Must determine the most appropriate institutional placement for an individual, and must name that placement in the waiver application. This does not mean that the individual must 21
  22. 22. Preadmission Screening The Uniform Assessment Instrument (UAI) is an interagency assessment used by most publicly funded human services agencies in the Commonwealth for long-term care services. The UAI is an assessment tool to gather information to determine care needs, service eligibility, and planning and monitoring a person’s care needs across agencies. 22
  23. 23. Preadmission Screening Read the UAI Manual !!! Use the UAI Manual!!! Knowing the definitions for items on the UAI is critical to determining appropriate level of care and services. Assess the individual for current functional status and/or medical nursing needs.
  24. 24. Assisted Living Pre- Admission ScreeningsWhat’s Different with this Program? 24
  25. 25. Who are the Preadmission Screening Teams?• For Assisted Living Services: The authorized assessors are the local departments of social services, local departments of health, area agencies on aging, centers for independent living, or community service boards.• ALFs may not complete any UAI assessments for public pay individuals. This includes prior to admission, the annual reassessment, and whenever there is a significant change in condition. ALFs may complete these assessments for private pay individuals. 25
  26. 26. Who are the Preadmission Screening Teams? • Emergency placements: Placement must be approved by Adult Protective Services (APS) through the local department of social services and the assessment must be completed within seven working days from the date of placement. 26
  27. 27. Preadmission ScreeningALF Change in Level of CareCompleted by all entities authorized to perform initial assessments.Performed when permanent change (expected to last longer than 30 days) in level of care indicated.Follow same assessment process as initial assessment.Payment to assessor tied to completion of short versus full assessment. 27
  28. 28. Preadmission ScreeningNew Assessment Not Needed When. . .For Assisted Living Services Only• Lapse in financial eligibility; or• Transfer from one ALF to another ALF; or• Respite care resident; or• Discharge back to the same ALF from the hospital (if less than 30 days) with no change in level of care. 28
  29. 29. Preadmission ScreeningALF Prohibited Conditions Ventilator Dependency Dermal Ulcers Stage III and IV IV Therapy or Injections Directly into the Vein Airborne Infectious Diseases in a Communicable State Psychotropic Medications w/o appropriate DX and TX NG Tubes Gastric Tubes 29
  30. 30. Preadmission ScreeningALF Prohibited Conditions Individuals Presenting an Imminent Physical Threat or Danger to Self or Others Individuals requiring continuous Nursing Care (24/7) Individuals whose physician certifies placement is no longer appropriate Individuals who require Maximum Physical Assistance Individuals whose health care needs cannot be met in the ALF setting. 30
  31. 31. What Do I Need To Get Paid?Documentation Requirements 31
  32. 32. Preadmission Screening For NF, Regular Assisted Living, Alzheimer’s Assisted Living, Program for the All-Inclusive Care of the Elderly (PACE), and Waiver placement all 12 pages of the UAI, the DMAS-96 form, the DMAS-95 MI/MR/RC form, and the DMAS-97 forms are required. For Residential Assisted Living a short form is required. This is the first 4 pages of the UAI, plus the questions related to medication administration and behavior pattern. 32
  33. 33. Criteria for Eligibility Determination based on Individual’s Abilities/NeedsFor Nursing Facility, PACE and Homeand Community Based Care Waivers 33
  34. 34. Activities of Daily Living – There are three different waysto meet the criteria for ADL dependencies ….1 Dependent in 2-4 ADLs, plus semi- dependent or dependent in behavior and orientation, plus semi-dependent in joint AND motion or semi-dependent in medication Have administration, OR Medical Nursing2 Dependent in 5-7 ADLs plus dependent in Mobility, OR Needs3 Semi-Dependent in 2-7 ADLs, plus dependent in mobility, plus dependent in behavior and orientation. 34
  35. 35. Required Activities of Daily Living (for purposes of Medicaid eligibility)  Although Mobility is not Bathing considered an activity of Dressing daily living, it is an area Transferring where screeners have Toileting questions. The definition of Bowel Function mobility is – the extent of the individual’s movement Bladder Function outside his/her usual Eating/Feeding living quarters. 35
  36. 36. Behavior and Orientation Behavior and Orientation are considered one item for the purposes of criteria determination. Semi-dependency and dependency are based on the combination of both behavior and orientation. Remember: In order to meet this criteria, the individual must be dependent in both areas. 36
  37. 37. Medical Nursing Needs In addition to meeting functional criteria, in order to receive Medicaid reimbursement, the individual must have medical or nursing supervision or care needs that are not primarily for the care and treatment of mental disease (Alzheimer’s and dementia are not considered mental diseases.) 37
  38. 38. Medical Nursing Needs – There are three different ways to have one… The individual’s medical condition requires observation and assessment to assure evaluation of the person’s needs due to the inability for self observation or evaluation; OR The individual has complex medical conditions which may be unstable or have the potential for instability; OR The individual requires at least one ongoing medical or nursing service. 38
  39. 39. Examples of Medical Nursing Needs(May or may not necessarily indicate on ongoing medicalnursing needs. Except as specified, the risk of theidentified conditions are not a medical nursing need if nota current problem.) Routine care of colostomy or ileostomy or management of neurogenic bowel and bladder Use of physical or chemical restraints Routine skin care to prevent pressure ulcers for individuals who are immobile 39
  40. 40. Examples of Medical Nursing Needs(May or may not necessarily indicate on ongoing medicalnursing needs. Except as specified, the risk of the identifiedconditions are not a medical nursing need if not a currentproblem.) Care of small uncomplicated pressure ulcers and local skin rashes Management of those with sensory, metabolic, or circulatory impairment with demonstrated clinical evidence of medical instability Infusion therapy Oxygen 40
  41. 41. Examples of Medical Nursing Needs(May or may not necessarily indicate on ongoing medicalnursing needs. Except as specified, the risk of the identifiedconditions are not a medical nursing need if not a currentproblem.) Supervision for adequate nutrition and hydration for individuals who show clinical evidence of malnourishment or dehydration or have a recent history of weight loss or inadequate hydration which, if not supervised, would be expected to result in malnourishment or dehydration. 41
  42. 42. Examples of Medical Nursing Needs(May or may not necessarily indicate on ongoing medicalnursing needs. Except as specified, the risk of the identifiedconditions are not a medical nursing need if not a currentproblem.)  Application of aseptic dressings  Routine catheter care;  Respiratory therapy  Therapeutic exercise and positioning  Chemotherapy  Radiation  Dialysis  Suctioning
  43. 43. Medical Nursing Needs Documentation Requirements Examples of Medical Nursing Needs (May or may not necessarily indicate on ongoing medical nursing needs. Except as specified, the risk of the identified conditions are not a medical nursing need if not a current problem.) Seizures Are there medication changes? Are there labs being drawn for medication levels? 43
  44. 44. Medical Nursing Needs Documentation Requirements Seizures Any recent seizure activity? (Either grand mal or petite mal) Family noted any blank stares? 44
  45. 45. Medical Nursing Needs Documentation Requirements Examples of Medical Nursing Needs (May or may not necessarily indicate on ongoing medical nursing needs. Except as specified, the risk of the identified conditions are not a medical nursing need if not a current problem.) Supervision for Adequate Nutrition Documentation of weight loss/gain? Documentation of dehydration? 45
  46. 46. Medical Nursing Needs Documentation Requirements Supervision for Adequate Nutrition Is person seeing a dietician or other health professional on regular bases? Taking any supplements (ensure, boost, Gatorade, Pedialyte, scheduled snacks, etc.)? 46
  47. 47. Medical Nursing Needs Documentation RequirementsExamples of Medical Nursing Needs (May or may not necessarily indicate on ongoing medical nursing needs. Except as specified, the risk of the identified conditions are not a medical nursing need if not a current problem.)Routine Skin Care to Prevent Pressure Ulcers Documentation of red areas? Any open areas currently? 47
  48. 48. Medical Nursing Needs Documentation RequirementsRoutine Skin Care to Prevent Pressure Ulcers Use of restraints or other equipment that has in past caused breakdown? Any special techniques caregiver may be doing (repositioning every 2 hours, applying ointments, using pressure relieving devices)? 48
  49. 49. Medical Nursing Needs Documentation Requirements Examples of Medical Nursing Needs (May or may not necessarily indicate on ongoing medical nursing needs. Except as specified, the risk of the identified conditions are not a medical nursing need if not a current problem.) Therapies Documentation of all PT, OT or Speech therapies and the location where the therapies are received. 49
  50. 50. Medical Nursing Needs Documentation Requirements If a child receives therapy services during the school year at school, this is acceptable. NOTE: Remind families that therapies received outside of the school year can be ordered by doctor through Home Health or Outpatient Rehab. 50
  51. 51. What Do We Look Like? Case Examples 51
  52. 52. 52
  53. 53. Case Examples Mrs. Jones is a 96-year-old female with a diagnosis of congestive heart failure and non-insulin dependent diabetic. She is dependent in bathing, dressing, toileting, and needs assistance eating. Mrs. Jones is oriented to some spheres, some of the time and her behavior is wandering/passive more than weekly. 53
  54. 54. Case Examples Mrs. Jones cont’d: Mrs. Jones’ medications must be administered/monitored by professional nursing staff. Individual #1: Dependent in 2 to 4 ADLs, plus semi-dependent or dependent in behavior and orientation, plus semi- dependent in joint motion or semi- dependent in medication administration. 54
  55. 55. 55
  56. 56. Case Examples Mrs. Smith is a 60-year-old female with a diagnosis of hypertension and non-insulin dependent diabetes who recently suffered a cerebral vascular accident. She has hemi- paresis with right-sided weakness. She is dependent in bathing, dressing, eating, toileting, and transferring. 56
  57. 57. Case Examples Mrs. Smith cont’d: Mrs. Smith requires human help when going outside the home, therefore she is dependent in mobility. She is oriented to all spheres all times and her behavior is appropriate. Individual #2: Dependent in 5 to 7 ADLs and dependent in mobility. 57
  58. 58. 58
  59. 59. Case Examples Mrs. Ford is a 75-year-old female with a diagnosis of leukemia and Alzheimer’s disease. She requires supervision in bathing and requires mechanical help with toileting and transferring. She is continent of both bowel and bladder. Mrs. Ford is disoriented to all spheres all of the time and is abusive/aggressive/disruptive less than weekly, which makes her dependent in this area. 59
  60. 60. Case Examples Mrs. Ford, cont’d: Her medications must be administered/monitored by professional nursing staff and she is currently receiving chemotherapy treatments for her leukemia. Individual #3: Semi-Dependent in 2 to 7 ADLs, Plus dependent in behavior and orientation. 60
  61. 61. What’s Wrong with My UAI? Process & Problems 61
  62. 62. Process & Problems First Health Services, our contractor, data enters all pre-admission screening packages. The contractor will enter all pre-admission screening packets into the VaMMIS system allowing for payment of the screening. Any screenings that the VaMMIS system can not process because they did not meet criteria are sent to DMAS for further review. 62
  63. 63. Process & Problems DMAS will review the preadmission screening packet and make the final determination on the pre-admission screening package. DMAS may call the screening team, providers, or even visit an individual to determine if the individual meets the established criteria for services. The method of doing this is done on a case by case basis. 63
  64. 64. Process & Problems Reasons that packages are returned: No documentation of medical/nursing need Screening documents that the individual is in good health No documented risk of nursing facility placement Not fully completed Missing required attachments Screeners unfamiliarity with criteria 64
  65. 65. What Do Services Look Like? Overview of What Makes PACE and Waivers Special 65
  66. 66. Medicaid ServicesLong –Term Care Program for the All-Inclusive Care of the Elderly (PACE) Community based waivers:  Aids Waiver An  Alzheimer’s Waiver increasing  Developmentally Disabled emphasis  Day Support Waiver  Elderly or Disabled Consumer Direction Waiver  Mental Retardation Waiver  Tech Waiver
  67. 67. Medicaid ServicesLong –Term Care Facility based programs: Assisted Living Home Health A decreasing Hospice emphasis Nursing Facilities Specialized Care ICF/MR Rehabilitation Programs In / Out patient School
  68. 68. Medicaid Services – PACE PACE is a Program of All Inclusive Care for the Elderly  Serves persons 55 and older that meet nursing facility criteria in the community.  Provides all health and long-term care services centered around an adult day health care model.  Combines Medicaid and Medicare funding. 68
  69. 69. Medicaid Services – PACEMap Key FrederickSentara PACE WinchesterMountain PACE Manassas Park LoudounCentra PACE Clarke Falls Church WarrenRiverside PACE Hampton Fauquier Arlington Shenandoah AlexandriaRiverside PACE Richmond Rappahannock Fairfax Fairfax CityAppalachian PACE Prince William Manassas Rockingham Page Harrisonburg  Culpeper Stafford Highland  Madison Augusta King Greene Fredericksburg George Staunton  Orange Spotsylvania Westmoreland Albemarle Bath Waynesboro Essex Louisa Caroline Northumberland Charlottesville Lexington Clifton Forge Fluvanna King & Richmond Buena Vista Queen Accomack Covington Nelson Goochland Hanover Lancaster Alleghany Rockbridge King Middlesex Henrico Amherst William Buckingham Botetourt Powhatan Richmond New Cumberland Kent Matthews Craig Lynchburg Chesterfield James Gloucester Northampton Appomattox Charles City Roanoke Bedford Amelia Giles Col.Heights City Salem Prince  Buchanan Roanoke City Prince York Poquoson Montgomery Bedford Campbell Edward Petersburg George Surry Williamsburg Nottoway Hampton  Dickenson  Tazewell Bland Dinwiddie Hopewell Isle of Newport News  Wise Radford Charlotte Wight Pulaski Franklin Lunenburg Norfolk Sussex  Russell Floyd Portsmouth  Norton Wythe Smyth Pittsylvania Brunswick Virginia Franklin Beach  Lee Henry Suffolk Washington Carroll Emporia Scott Danville Southampton Chesapeake Galax Patrick Halifax Mecklenburg Grayson Martinsville Greensville Bristol
  70. 70. Medicaid Services – PACE Community Model: Program of All Inclusive Care for the Elderly or PACE. Combines Medicaid and Medicare funding to provide all medical, social, and long-term care services through an adult day health care center. 70
  71. 71. Medicaid Services – PACE Seven communities actively pursuing PACE-6 were awarded start up grants* ($250,000 each): - PACE of Riverside at Hampton Roads* - PACE of Riverside at Richmond* - PACE of Centra at Lynchburg * - PACE of Appalachian AAA at Tazewell * - PACE of Mountain Empire AAA at Big Stone Gap * - RFA under development for Northern Virginia * 71
  72. 72. Waivers Social Security Act allows states to “waive” the freedom of choice of provider, statewideness, and amount, duration, and scope of services requirements in order to:  have managed care programs (Section 1915(b);  try new approaches through research and demonstration (Section 1115); and 72
  73. 73. Waivers allow services to be provided in the community rather than in institutions (Section 1915(c) Home and Community Based Care Waivers) . About 30% of long term care spending is provided through HCBS waivers. 73
  74. 74. WaiversRecipient ChoiceThe applicant must be offeredthe choice in all of the following:  Waiver  Alternate institution  Providers  Services 74
  75. 75. Waivers…………..Cost Effective It can be individually cost effective or cost effective in the aggregate.  Aggregate Cost Effectiveness : The average cost to Medicaid for individuals enrolled in a waiver cannot cost more than the average cost to Medicaid for individuals in the comparable institution.  Individual Cost Effectiveness: Cost to Medicaid for the individual in the community can’t exceed the cost in the comparable institution.  DMAS has chosen to use aggregate cost effectiveness.
  76. 76. WaiversCommunity Based Medicaid waiver funds cannot pay for room and board. Services must be based in the communityWaiver Payments are for Services Rendered 76
  77. 77. 7 Medicaid Waivers Alternate Institutional Placement Special Conditions VAC Waiver Regulatory Cite Nursing Facility/ Hospital A diagnosis of AIDS 12 VAC-30-120-140 Be experiencing medical and functionalAIDS/HIV symptoms Nursing Facility Have a functional and medical need & a 12 VAC-30-120-10EDCD Disability Intermediate Care Facility for the 6 years of age or older 12 VAC-30-120-700 Mentally Retarded ICF/MR) If child under 6 years, be developmentally at riskDevelopmentally and meet ICF-Criteria Waiting ListDisabled Cannot have diagnosis of MR Intermediate Care Facility for the Must have diagnosis of MR 12 VAC-30-120-210 Mentally Retarded (ICF/MR) If child under 6 years, be developmentally at riskMental Retardation and meet ICF-Criteria Waiting ListTechnology Specialized Care in Nursing Facility for Must be dependent on ventilator or specialized 12 VAC-30-120-70Assisted adult / Hospital for children equipmentDay Support Intermediate Care Facility for the Must be on the MR wait list 12 VAC-30-120-1500 Mentally Retarded (ICF/MR) Waiting ListAlzheimer’s Nursing Facility Must have diagnosis of Alzheimer’s 12 VAC-30-120 Emergency regulation
  78. 78. Waivers…..Eligibility - All Waivers Cannot be served in more than one waiver at a time (federal requirement). DD Can be on one waiver Waiver EDCD while on a waiting list Waiver John Doe for another waiver if John Doe meet the criteria for admission to both waivers. 78
  79. 79. WaiversConsumer-Directed Services 79
  80. 80. Waivers …….Consumer-Directed Services Services provided by a  The individual enrolled Medicaid consumer or their Agency who hires and representative monitors staff that employs and monitors provide services to a staff providing services variety of individuals. exclusive to them. 80
  81. 81. Waivers …..Consumer-DirectedPersonal Care Services Available in four of Virginia’s waivers:  HIV/AIDS (personal care and respite)  EDCD (personal care and respite)  DD Waiver (personal care and respite)  MR Waiver (personal care, respite, and companion) 81
  82. 82. Waivers …..Consumer-DirectedPersonal Care Services Afford recipients or family caregivers direct control over who, how, and when services are provided. Waiver recipient is the employer of record with the IRS. In Virginia personal assistants are classified as domestic workers and are not subject to worker’s compensation claims. 82
  83. 83. Waivers …...Consumer-Directed Personal Care Services The individual must be over the age of 18, without cognitive impairment, and interested in managing his/her own personal attendant. If a minor child or individual with cognitive impairment, there must be a a responsible family member willing and able to direct and manage the personal attendant. 83
  84. 84. Waivers …..Consumer-DirectedPersonal Care Services Specific steps are required BEFORE consumer directed services can begin. The recipient or Employer of Record (ERO) must: Select and meet with a Medicaid approved Service Facilitator; Establish a service plan with the SF; 84
  85. 85. Waivers ……..Consumer-DirectedPersonal Care Services Complete Employer Tax Forms Packet and mail the tax forms to the fiscal agent (FA) giving the authority to withhold & submit taxes as the recipient’s agent; Receive preauthorization from DMAS’ contractor (KePRO) – this is accomplished by the service facilitator’s prompt submission of the service plan to KePRO. Hiring, training, documenting time worked, and submitting time sheets for the attendant. 85
  86. 86. Waivers …..Consumer-DirectedPersonal Care ServicesRemember – it takes time to accomplish all of the steps before consumer directed services start.Consider – Agency directed services may be used prior to or at the same time as consumer directed services. 86
  87. 87. Waivers …..Consumer-DirectedPersonal Care ServicesExample: A recipient may want consumer directed services. However, the recipient needs services immediately. Agency directed services may be used until all of the requirements for consumer direction are accomplished by the recipient, service facilitator and fiscal agent. 87
  88. 88. Waivers …..Consumer-Directed Personal Care Services At a minimum, personal assistants cannot be a legally responsible relative (a spouse or a parent of a minor child).* Waivers can define differently. Payment is not made to other family members unless there is objective, written documentation as to why there are no other providers available to provide the service.**These are federal requirements. 88
  89. 89. Questions and Answers Long-Term Care IssuesPre-Admission Screeners list serve at questions, please contact the Division of Long-Term Care at 804-225-4222, or by fax at 804-371-4986.Please visit the DMAS website at: 89