It has come to HOPE’s attention that the Division of Aging’s contractor is or has been conducting audits of several assisted living waiver providers. This would be a good time to become reacquainted with the Provider Reference Manual.
Documents referenced in this document:
NOA= Notice of Action (FSSA Notification to Facility of Level of Service to be Billed)
E-Screen=Eligibility Screen (state form 45528)- multi-page document which includes on page 4 a preliminary care plan that includes the brokered services. This is completed by the care manager/case manager at the AAA.
Level of Service Assessment/Evaluation (assessment via point system)- This is also called the Person-Centered Assessment (PCA). This is completed by the care manager/case manager at the AAA.
Provider Responsibilities Specific to the Waiver Program (pages 10-11)
Waiver providers must understand the service definitions and parameters for each service authorized on a participant’s NOA. All waiver providers are subject to audit and potential recoupment if the services provided are not in agreement with the services authorized as indicated on the approved NOA. If the needs of a member change, the provider must contact the care manager to discuss revising the service plan.
Providers are required to furnish at least 30 calendar days’ written notice before terminating waiver services to a member. This notice must be made to the member, the legal representative (if applicable), the member’s care manager and the DA.
HOPE recommends that you review the waiver resident’s file to be certain that you have the following:
NOA
E-Screen
Level of Service Assessment/Evaluation
The care manager must give the completed NOA, E-Screen and Level of Service Assessment (PCA) to the AL waiver provider and if any of these forms are missing, it is recommended that you contact, in writing, the resident’s care manager and request a copy be sent to you, as these documents list the brokered services that the facility is to be providing and documenting.
The AL waiver provider must follow these documentations standards:
Complete and accurate documentation to support daily services rendered by the AL service to address needs identified in the Person-Centered Care Plan:
Participant’s status, including health, mental health, medication, diet, and sleep patterns, social activity.
Updates, including health, mental health, medication, diet, sleep patterns, and social activity
Participation in consumer-focused activities
Medication management records, if applicable
Quarterly updated service plans provided to the participant’s care manager from the AL service
Notification to the participant’s care manager, within 48 hours of any change in participant’s care plan
Services outlined in the service plan
Documentation to support service rendered
The issue of importance is to ensure that the services that were identified when the resident was placed at the facility (and listed on the E-Screen and Level of Care Assessment) are being provided and the facility has documentation of those services continuing to be provided. Should at any time, the facility observe the resident is independent in services or no longer in need of the original services identified, the facility must alert the case manager. This will warrant a new assessment be conducted by the case manager.
Contact HOPE (317-472-0677) if you have questions or other concerns.