Transcription
SCDHHS Self-Directed Attendant andCompanion Care Stakeholder TrainingMay 22, 2017
Agenda Welcome and Speaker Introductions Training Introduction & Learning Objectives Self-Direction Philosophy & Background Delivery of Self-Direction in South Carolina Questions & Answers2
SpeakersTeeshla Curtis, Program ManagerSCDHHS Healthy Connections PrimeSusan Bolt, Program CoordinatorSCDHHS Community and Long Term CareLinda Motley, Attendant Care Program DirectorUniversity of South Carolina School of MedicineDustin Welch, Program CoordinatorSCDHHS Healthy Connections PrimeMaggie Novak, AssociateIkaso Consulting, LLC3
Introduction & Learning Objectives4
Learning Objectives Apply self-directionphilosophy and personcenteredness Describe the unique role ofeach stakeholder in SouthCarolina’s attendant andcompanion care programs Outline South Carolina’sscreening, enrollment, andongoing monitoring processesfor attendant and companioncarePhoto source: www.unsplash.com5
Philosophy & Background6
What Is Self-Direction?A service delivery philosophy:Participant assesses their own needsParticipant determines how and by whom needs are metParticipant monitors the quality of service receivedSelf-Directed Care Participant-Directed Care Consumer-Directed CareSource: Motley, Linda. Center for Disability Resources.7
What Services Qualify for Self-Direction in SC?For the South Carolina Department of Health and HumanServices’ Division of Community Long Term Care (CLTC), selfdirection is provided in a home or community setting and isavailable for:1.Attendant Care - assist with Activities of Daily Living (ADL, such as bathingand dressing) and Instrumental Activities of Daily Living (IADL) such asshopping and using the phone2.Companion Care – provide shortterm relief for caregivers with neededsupervision of participants. Assistswith some IADLs but no ADLs (i.e., nohands-on care). Note: Self-direction isavailable for individuals but not foragency-provided companions.Photo source: www.pridehhc.com/personal-attendant-services8
Defining Self-DirectionParticipantDecides:WhatHowWhoWhen The participant knows his/her needs better than anyone else Attendants and companions are accountable to the participant and/or the participant’srepresentative Self-direction gives the participant freedom to plan his/her own life Key components: Choice, Control, and EmpowermentSource: Integrated Care Resource Center/NationalResource Center for Self-Directed Care.9
Federal and State Requirements States can provide self-directed care under the State Plan andunder home and community based services (HCBS) waivers The Centers for Medicare and Medicaid Services (CMS) requires: Person-centered planningService Plan for each individualIndividualized budgetProvision of information and assistance in support of self-directionSupport broker/consultant/manager to serve as a liaison between theindividual and programFinancial Management Services (FMS)Quality assurance and improvement strategies SCDHHS sets forth its policies and procedures within in thesefederal guidelines and within the framework of its approvedMedicaid waivers. SCDHHS leverages the waiver authority. The structure of SCDHHS’ program will be detailed in thispresentation.Source: Medicaid.gov10
11Practicing Person-Centered PlanningThe backbone of self-direction is person-centered planning.Key considerations for person-center planning: What is important to the person? On-going listening, learning, and reacting todiscussion Influence of program staff is very limited Creative problem-solving Significant reliance on participant input Facilitating not managing Personalized to each participant Conveys to participant the consequences ofresponsibility and decisions Seeks to develop a shared understanding ofthe person and his/her situationSource: Integrated Care Resource Center/NationalResource Center for Self-Directed Care.11
Example of a Self-Direction InterviewDiscussion What are some strengthsand weaknesses of socialworker’s approach? What was personcentered about the carecoordinator interaction? What could be improvedto make it more personcentered?Begin video at 4:15. Double click to start.Also located at: https://www.youtube.com/watch?v WlQJRwiH7s8Note: This video is not tailored to South Carolina’s program and is for illustrative purposes only. However, it givesa flavor of how self-direction is generally administered in the United States. Each state has specific regulations andpolicies that govern their respective programs. We will cover the South Carolina program in the following slides.Source: Integrated Care Resource Center/NationalResource Center for Self-Directed Care.12
Self-Direction in South Carolina13
South Carolina Self-Direction Overview Established in 1996 to promote participant choice &community-living Five Medicaid waivers participating:o Community Choiceso HIV/AIDSo Mechanical Ventilator Dependent Programo Head and Spinal Cord Injury Waivero Intellectual Disability and Related Disabilities Current number of self-directed care participants: 2,000(approximation as of March 2017) Hourly rate for attendants is about 10.5014
Key StakeholdersParticipant/MemberThe individual who receives and directs the services; the employer ofrecord (EOR) for the attendant or companionAttendant/CompanionThe individual who provides the servicesRepresentativeAn individual selected by the participant who may assist the participant todirect their services (e.g. a spouse, adult child, etc.) and be the EORWaiver Case ManagerProvider responsible for managing a client’s servicesCDRCenter for Disability Resources (CDR) at the University of South CarolinaSchool of Medicine; agency contracted by SCDHHS to screen and enrollattendants/companions; CDR Nurses assess the care given by a provider,administer diagnosis-specific training, and facilitate enrollmentNote: CDR may also be referred to as the University Affiliated Program (UAP)Public PartnershipLimited (PPL, alsoFMS)Third-party fiscal employer agent (via First Data) who managesattendant/companion care payments. “Care Call” is the PPL’sattendant/companion time-keeping system15
The Participant/MemberParticipants are responsible for:Learning how to manage their attendant/companionCommunicating their needs to the attendant/companionCommunicating about the quality and appropriateness of servicesreceivedDismissing attendant if not meeting needsFormulating a back-up plan to ensure needs met whenattendant/companion is absentIn some cases, participants may delegate these responsibilities to arepresentative. The representative assumes the role of the employerof record (EOR).16
A Representative’s RoleRepresentatives are:Used by choice or needIdeally nominated by participant or agreed upon by familyKnows participant and what decisions the participantwould makeAcknowledges and accepts the responsibilitiesShows strong commitment to the participantVoluntary – may be changed or removed as necessaryMust reside within a 50-mile radius of the participant’shome or have an approved exemptionSource: Integrated Care Resource Center/NationalResource Center for Self-Directed Care.17
Service Provider ComparisonAttendant and Companion Care is closely related to Personal Care, but Personal Care Attendants arenot available for self-direction.AttendantCompanionPersonal Care 1Personal Care 2Assist with ADLsand IADLsShort-term relieffor caregivers withneeded supervisionof participants.Does not includehands-on care.Preserve a safeand sanitary homeenvironment withhome care dutiesAssist with ADLsand IADLsIndividual orAgency?MedicaidenrolledindividualMedicaid enrolledindividual oragency (onlyindividual isavailable for selfdirection)AgencyAgencyCan be selfdirected?YesYesNoNoSummary ofRole18
Minimum QualificationsAttendantCompanionMust be 18 years of age or olderAble to read, write, and communicate effectively with the participant and/or theparticipant’s representativeCapable of following the Service Plan with the participant or their representativeHave acceptable tuberculosis/PPD skin test resultsCapable of following billing proceduresCapable of assisting with activities ofdaily living & fully ambulatoryNO hands on care may be provided19
Who May Not Be a Paid Attendant or Companion? Has a disqualifying offense identified through a criminalbackground checko Felonyo Crime against another persono Crime of abuse including assault, battery, and domestic violenceo Abuse of federal funds (e.g. food stamp fraud, Medicaid fraud, orunemployment fraud) Has debarment or exclusion from Medicare or Medicaidprogram Legally responsible relative (spouse, parent of minorchild, step-parent) Legal guardian The participant’s chosen representative20
Duties of the Attendant or CompanionRoleAttendant CompanionPreparing and serving meals, assisting with prescribed diet General housekeeping Shopping and errands Attending medical appointments with participant Assistance with communication Assist with ADLsNo Monitor vital signs, skin condition, and appetiteNo Monitor medication (but cannot administer or prepare)No Skilled services with MD approval (e.g. complex dressingNo changes, vent care)Limited assistance with financial mattersNo Strength and balance trainingNo Socialization (e.g. conversation, reading, assisting with mail)No Sitting services focused on participant supervisionNo 21
Attendant/Companion Care Referrals When: During initial enrollment, assessments, andreassessments Who: Waiver Case Manager How:̶ Describe the option to the participant/representative̶ Assess if option may be appropriate̶ Initiates in the Phoenix system if the client is interestedand the situation appears to be appropriate. Request issent to UAPSource: Integrated Care Resource Center/NationalResource Center for Self-Directed Care.22
Attendant/Companion Care Enrollment ProcessMEMBER/EORWants to self-directtheir care with anattendant and knowswho they want to betheir attendant.Receives info packet anda call from the UAP nurseto review serviceCompletes enrollmentpaperwork & SLA,including backgroundcheck, and gets TB test.ATTENDANT/COMPANIONSubmits fiscal agentpaperwork & SLAIf YesWAIVERCASEMANAGERReceives request frommember regardingdesire to self-directIs the Member'sService Planauthorized for SelfDirection?If NoCreates priorauthorization inPhoenix.Reviews UAP's Match Visitcomments, if any. Works withSupport Staff to verifies prospectiveattendant's enrollment in Phoenix.Sends Request toUAP in PhoenixReceivesapprovalWorks with member todetermine if self-direction isappropriate. Sends enrollmentpacket to prospective attendantincluding Service LevelAgreement (SLA) andinformation packet to member.CDR (UAP)Reviews background check, TBtest results, CNA registry, StateID, and SS card. ChecksMedicaid provider exclusionlist.² Enters providerinformation for online Medicaidenrollment.Calls member to setup Match Visitappointment with themember, EOR, andprospectiveattendant.Provides Care Calltraining as needed(after Fiscal Agenthas the EmployerEIN and E-Verify hasbeen done)Conducts Match Visit. Assessesprospective attendant's skills andprovides teaching. Faciliatesenrollment with Fiscal Agent. Informsabout contacting case manager forCare Call training. Helps withmember/EOR paperwork.Receives paperworkand prepares totransmit payments toattendant.PPLEnrolls prospectiveattendant as aMedicaid provider.STATEMMPReviews andapproves the priorauthorizationFunctions depicted as currently envisioned for the fullimplementation of MMP functions in self-directed care.Receives SLA andprepares to issuepayments to PPL.We will review this processin the following slides.23
Enrollment ProcessMEMBER/EORWants to self-directtheir care with anattendant and knowswho they want to betheir attendant.Receives info packet anda call from the UAP nurseto review serviceCompletes enrollmentpaperwork & SLA,including backgroundcheck, and gets TB test.ATTENDANT/COMPANIONSubmits fiscal agentpaperwork & SLAIf YesWAIVERCASEMANAGERReceives request frommember regardingdesire to self-directIs the Member'sService Planauthorized for SelfDirection?If NoCreates priorauthorization inPhoenix.Reviews UAP's Match Visitcomments, if any. Works withSupport Staff to verifies prospectiveattendant's enrollment in Phoenix.Sends Request toUAP in PhoenixReceivesapprovalWorks with member todetermine if self-direction isappropriate. Sends enrollmentpacket to prospective attendantincluding Service LevelAgreement (SLA) andinformation packet to member.CDR (UAP)Reviews background check, TBtest results, CNA registry, StateID, and SS card. ChecksMedicaid provider exclusionlist.² Enters providerinformation for online Medicaidenrollment.Calls member to setup Match Visitappointment with themember, EOR, andprospectiveattendant.Conducts Match Visit. Assessesprospective attendant's skills andprovides teaching. Faciliatesenrollment with Fiscal Agent. Informsabout contacting case manager forCare Call training. Helps withmember/EOR paperwork.Receives paperworkand prepares totransmit payments toattendant.PPLEnrolls prospectiveattendant as aMedicaid provider.STATEMMPProvides Care Calltraining as needed(after Fiscal Agenthas the EmployerEIN and E-Verify hasbeen done)Reviews andapproves the priorauthorizationMEMBER/EORReceives SLA andprepares to issuepayments to PPL.Step One: Membernotifies waiver casemanager they wantto self-direct theircareWants to self-directtheir care with anattendant and knowswho they want to betheir ives request frommember regardingdesire to self-direct24
Enrollment ProcessMEMBER/EORWants to self-directtheir care with anattendant and knowswho they want to betheir attendant.If YesReceives info packet anda call from the UAP nurseto review serviceCompletes enrollmentpaperwork & SLA,including backgroundcheck, and gets TB test.ATTENDANT/COMPANIONWAIVERCASEMANAGERReceives request frommember regardingdesire to self-directIs the Member'sService Planauthorized for SelfDirection?If NoCreates priorauthorization inPhoenix.CDR (UAP)Reviews UAP's Match Visitcomments, if any. Works withSupport Staff to verifies prospectiveattendant's enrollment in Phoenix.Sends Request toUAP in PhoenixReceivesapprovalWorks with member todetermine if self-direction isappropriate. Sends enrollmentpacket to prospective attendantincluding Service LevelAgreement (SLA) andinformation packet to member.Reviews background check, TBtest results, CNA registry, StateID, and SS card. ChecksMedicaid provider exclusionlist.² Enters providerinformation for online Medicaidenrollment.Calls member to setup Match Visitappointment with themember, EOR, andprospectiveattendant.Provides Care Calltraining as needed(after Fiscal Agenthas the EmployerEIN and E-Verify hasbeen done)Conducts Match Visit. Assessesprospective attendant's skills andprovides teaching. Faciliatesenrollment with Fiscal Agent. Informsabout contacting case manager forCare Call training. Helps withmember/EOR paperwork.Is the Member'sService Planapproved for SelfDirection?If NoCreatesapproval inPhoenix.ReceivesapprovalReceives paperworkand prepares totransmit payments toattendant.PPLEnrolls prospectiveattendant as aMedicaid provider.STATEMMPWAIVERCASEMANAGERSubmits fiscal agentpaperwork & SLAIf YesReviews andapproves the priorauthorizationReceives SLA andprepares to issuepayments to PPL.CDR (UAP)Step Two: ServicePlan checked forapproval of selfdirected care; priorapproval created ifself-directed carenot previouslyapproved.PPLSTATEMMPFunctions depicted ascurrently envisionedReviews andapproves therequest25
Enrollment ProcessMEMBER/EORWants to self-directtheir care with anattendant and knowswho they want to betheir attendant.Receives info packet anda call from the UAP nurseto review serviceCompletes enrollmentpaperwork & SLA,including backgroundcheck, and gets TB test.ATTENDANT/COMPANIONSubmits fiscal agentpaperwork & SLAIf YesWAIVERCASEMANAGERReceives request frommember regardingdesire to self-directIs the Member'sService Planauthorized for SelfDirection?If NoCreates priorauthorization inPhoenix.ReceivesapprovalWorks with member todetermine if self-direction isappropriate. Sends enrollmentpacket to prospective attendantincluding Service LevelAgreement (SLA) andinformation packet to member.CDR (UAP)Reviews UAP's Match Visitcomments, if any. Works withSupport Staff to verifies prospectiveattendant's enrollment in Phoenix.Sends Request toUAP in PhoenixReviews background check, TBtest results, CNA registry, StateID, and SS card. ChecksMedicaid provider exclusionlist.² Enters providerinformation for online Medicaidenrollment.Calls member to setup Match Visitappointment with themember, EOR, andprospectiveattendant.MEMBER/EORConducts Match Visit. Assessesprospective attendant's skills andprovides teaching. Faciliatesenrollment with Fiscal Agent. Informsabout contacting case manager forCare Call training. Helps withmember/EOR paperwork.Receives info packet anda call from the UAP nurseto review serviceReceives paperworkand prepares totransmit payments toattendant.PPLEnrolls prospectiveattendant as aMedicaid provider.STATEMMPProvides Care Calltraining as needed(after Fiscal Agenthas the EmployerEIN and E-Verify hasbeen done)Reviews andapproves the priorauthorizationStep Three:CDR/UAP does aninitial screen andsends enrollmentpackets toparticipant andprospectiveattendant orcompanionReceives SLA andprepares to issuepayments to PPL.Completes enrollmentpaperwork & SLA,including backgroundcheck, and gets TB test.ATTENDANT/COMPANIONWAIVERCASEMANAGERCDR (UAP)Sends Request toUAP in PhoenixWorks with member todetermine if self-direction isappropriate. Sends enrollmentpacket to prospective attendantincluding Service LevelAgreement (SLA) andinformation packet to member.26
Enrollment ProcessMEMBER/EORWants to self-directtheir care with anattendant and knowswho they want to betheir attendant.Receives info packet anda call from the UAP nurseto review serviceCompletes enrollmentpaperwork & SLA,including backgroundcheck, and gets TB test.ATTENDANT/COMPANIONSubmits fiscal agentpaperwork & SLAIf YesWAIVERCASEMANAGERReceives request frommember regardingdesire to self-directIs the Member'sService Planauthorized for SelfDirection?If NoCreates priorauthorization inPhoenix.Works with member todetermine if self-direction isappropriate. Sends enrollmentpacket to prospective attendantincluding Service LevelAgreement (SLA) andinformation packet to member.CDR (UAP)Reviews UAP's Match Visitcomments, if any. Works withSupport Staff to verifies prospectiveattendant's enrollment in Phoenix.Sends Request toUAP in PhoenixReceivesapprovalReviews background check, TBtest results, CNA registry, StateID, and SS card. ChecksMedicaid provider exclusionlist.² Enters providerinformation for online Medicaidenrollment.Calls member to setup Match Visitappointment with themember, EOR, andprospectiveattendant.Conducts Match Visit. Assessesprospective attendant's skills andprovides teaching. Faciliatesenrollment with Fiscal Agent. Informsabout contacting case manager forCare Call training. Helps withmember/EOR paperwork.Receives paperworkand prepares totransmit payments toattendant.PPLEnrolls prospectiveattendant as aMedicaid provider.STATEMMPProvides Care Calltraining as needed(after Fiscal Agenthas the EmployerEIN and E-Verify hasbeen done)Reviews andapproves the priorauthorizationReceives SLA andprepares to issuepayments to PPL.CDR (UAP)Step Four:UAP schedules aMatch Visit, andthe prospectiveattendant orcompanion isenrolled in theMedicaid programReviews backgroundcheck, TB test results,CNA registry, State ID, andSS card. Checks Medicaidprovider exclusion list.Enters provider informationfor online MedicaidenrollmentCalls member to setup Match Visitappointment with themember, EOR, andprospectiveattendant.PPLSTATEEnrolls prospectiveattendant as aMedicaid provider.27
Enrollment ProcessMEMBER/EORWants to self-directtheir care with anattendant and knowswho they want to betheir attendant.Receives info packet anda call from the UAP nurseto review serviceCompletes enrollmentpaperwork & SLA,including backgroundcheck, and gets TB test.ATTENDANT/COMPANIONSubmits fiscal agentpaperwork & SLAIf YesWAIVERCASEMANAGERReceives request frommember regardingdesire to self-directIs the Member'sService Planauthorized for SelfDirection?If NoCreates priorauthorization inPhoenix.Reviews UAP's Match Visitcomments, if any. Works withSupport Staff to verifies prospectiveattendant's enrollment in Phoenix.Sends Request toUAP in PhoenixReceivesapprovalWorks with member todetermine if self-direction isappropriate. Sends enrollmentpacket to prospective attendantincluding Service LevelAgreement (SLA) andinformation packet to member.CDR (UAP)Reviews background check, TBtest results, CNA registry, StateID, and SS card. ChecksMedicaid provider exclusionlist.² Enters providerinformation for online Medicaidenrollment.Calls member to setup Match Visitappointment with themember, EOR, andprospectiveattendant.Conducts Match Visit. Assessesprospective attendant's skills andprovides teaching. Faciliatesenrollment with Fiscal Agent. Informsabout contacting case manager forCare Call training. Helps withmember/EOR paperwork.Receives paperworkand prepares totransmit payments toattendant.PPLEnrolls prospectiveattendant as aMedicaid provider.STATEMMPProvides Care Calltraining as needed(after Fiscal Agenthas the EmployerEIN and E-Verify hasbeen done)Reviews andapproves the priorauthorizationATTENDANT/COMPANIONSubmits fiscal agentpaperwork & SLAWAIVERCASEMANAGERProvides Care Calltraining as needed(after Fiscal Agenthas the EmployerEIN and E-Verify hasbeen done)Receives SLA andprepares to issuepayments to PPL.Step Five:UAPcompletes aMatch VisitCDR (UAP)Reviews UAP's Match Visitcomments, if any. Works withSupport Staff to verifies prospectiveattendant's enrollment in Phoenix.Conducts Match Visit. Assessesprospective attendant's skills andprovides teaching. Facilitatesenrollment with Fiscal Agent.Informs about contacting casemanager for Care Call training.Helps with member/EOR paperwork.28
The Match VisitDuring the Match Visit, the CDR/UAP Nurse:Observes the personal care services demonstrated by theattendant or companionProvides individualized directions or training specific to theparticipant’s diagnosis and homeProvides assistance with fiscal agent (PPL) enrollment paperworkto establish the relationship between the participant (employer)and attendant/companion (employee)Reviews participant’s Service Plan and attendant responsibilitiesExplains health care rights, liability, and employer responsibilitiesInstructs how to complete the daily log of activities performedSource: UAP/CDR29
Enrollment ProcessMEMBER/EORWants to self-directtheir care with anattendant and knowswho they want to betheir attendant.Receives info packet anda call from the UAP nurseto review serviceCompletes enrollmentpaperwork & SLA,including backgroundcheck, and gets TB test.ATTENDANT/COMPANIONSubmits fiscal agentpaperwork & SLAIf YesWAIVERCASEMANAGERReceives request frommember regardingdesire to self-directIs the Member'sService Planauthorized for SelfDirection?If NoCreates priorauthorization inPhoenix.Reviews UAP's Match Visitcomments, if any. Works withSupport Staff to verifies prospectiveattendant's enrollment in Phoenix.Sends Request toUAP in PhoenixReceivesapprovalWorks with member todetermine if self-direction isappropriate. Sends enrollmentpacket to prospective attendantincluding Service LevelAgreement (SLA) andinformation packet to member.CDR (UAP)Reviews background check, TBtest results, CNA registry, StateID, and SS card. ChecksMedicaid provider exclusionlist.² Enters providerinformation for online Medicaidenrollment.Calls member to setup Match Visitappointment with themember, EOR, andprospectiveattendant.Provides Care Calltraining as needed(after Fiscal Agenthas the EmployerEIN and E-Verify hasbeen done)Conducts Match Visit. Assessesprospective attendant's skills andprovides teaching. Faciliatesenrollment with Fiscal Agent. Informsabout contacting case manager forCare Call training. Helps withmember/EOR paperwork.Receives paperworkand prepares totransmit payments toattendant.PPLSTATEMMPPPLEnrolls prospectiveattendant as aMedicaid provider.Reviews andapproves the priorauthorizationReceives SLA andprepares to issuepayments to PPL.Step Six:Participant andattendant/companionenrolled. Servicesbegin and paymentsare issuedFunctions depicted as currentlyenvisioned for the fullimplementation of MMP claimsprocessing.Receives paperworkand prepares totransmit payments toattendant.STATEMMPReceives SLA andprepares to issuepayments to PPL.30
Ongoing ActivitiesPartyActivitiesMember/EOR (or Begins receiving services. Supervises des services; documents services via Care Call.EOR signs logs. Attendant sends logs to CLTC.Waiver CaseManagerProvides ongoing oversight of attendant services andmember.CDR (UAP)Provides problem resolution visits by the UAP Nurse, ifrequested.PPLTransmits biweekly payments to attendant andwithholds taxes from paychecks.StateDate stamps and forwards logs to Waiver CaseManager.PlanProvides ongoing oversight of Waiver Case Manager &issues payments for attendant to PPL.Functions depicted ascurrently envisionedfor the fullimplementation ofMMP claimsprocessing.31
Payment Delivery Services are rendered in one hour increments up to a thresholdin the participant’s service plan Attendant records time using Care Call system (via phone ormobile app) every time he/she provides care to the participant Payments are transmitted biweekly̶̶MMIS or MMP releases payment to PPLPPL releases payment to attendant and withholds taxes Impact of the Fair Labor Standards Act (FLSA)̶̶Required to track and pay overtime and travel timeIf attendant provides care to several participants and the attendant’stotal hours are greater than 40 hours in a week, SCDHHS is responsiblefor the overtime32
MMP relationships with CDR & PPL SCDHHS maintains the relationship with bothCDR (UAP) & PPL SCDHHS pays for the administrative servicesof both CDR & PPL NO additional contract is required between CDR and theMMPs. MMPs, along with waiver case managers, may refermembers to CDR A “Service Level Agreement” between PPL and each MMPwill be required, if MMPs fully implement HCBS claimprocessing, in order to exchange the providerreimbursement payments.33
Electronic Visit Verification (EVV) 21st Century Cures Act requiresall states to use EVV forverification of personal careservice by January 1, 2019 orforfeit a portion of the federalmatch rate In South Carolina, the EVV is CareCall (tracks attendant/companionhours worked and locations).South Carolina was the first stateto roll out EVV in 200334
Fraud, Waste, and AbuseThe Federal Office of the Inspector General cited the following vulnerabilitiesin a recent report: Services not provided in compliance withstate requirements Services not supported by documentation Services provided during periods whenthe participant was in a Medicaidreimbursed institution and ongoingpayments to the attendant were notauthorized Services provided by attendants who donot meet state qualification requirements Billing for services not rendered Services furnished to ineligiblebeneficiaries or by eral-policy-guidance/downloads/cib121316.pdf35
Fraud, Waste, and Abuse (continued)CLTC Policy Pertaining to Self-Directed ServicesProgram Integrity SafeguardsProvider Qualifications andBasic Training UAP Nurse verifies during Match Visit that attendant/companion is capable ofproviding services and may also provide diagnosis-specific teachingRegistry of Personal CareService Attendants All attendants are registered in Phoenix once they meet all qualifications. No paymentswill be made unless a claim contains the unique registration information for theauthorized attendantScreening of Providers Background check and check of Medicaid excluded provider listVerification of Need forServices Waiver Case Manager and UAP Nurse verify the individual’s need for attendant careDocumentation of Claims Utilization of Care Call system required by all attendants/companionsDaily Attendant LogPrepayment Edits Each attendant’s claim is compared against the member’s authorization for services. Ifthe units of service are not authorized, no claim is submitted for payment. If the claimis for more units than authorized, the claim is reduced to only include authorized timePost Payment Review CLTC case managers review claims on a monthly basis: is the claim documented fromthe authorized land-line phone number or geo-coded location? Are there anyanomalies in the patterns of behavior or time distribution of work? Are memberspecific needs addressed on the task sheet completed by the uidance/downloads/cib121316.pdf36
Challenges of Self-Direction Family members want greater authorized hours with increasedcompensation Case Managers view their self-direction responsibilities asmore labor intensive Implications for the State related to Workman’s Compensationor unemployment claims Personal Care Aides may decide to leave agency employmentand become an attendant, potentially resulting in issues The State does not have a formal licensure or regulationprocess for attendantsSource: Healthy Connection HCBS Presentation, December 2015.37
Questions & Answers38
Additional Self-Direction Resources: ICRCIntegrated Care Resource Center Module 1: Introduction to Self-Direction Module 2: Implementing Self-Direction Module 3: Implementing Self-Directionin a Managed Care Context: SpecialConsiderations Module 4: Operating and ManagingSelf-Direction in a Managed CareContext All Modules 1-4 sli
to self-direct their care. MEMBER/ EOR ATTENDANT/ COMPANION PPL CDR (UAP) WAIVER CASE MANAGER MMP STATE. Receivesrequest from member regarding desire to self-direct Wants to self -direct their care with an attendant and knows who they want to be their attendant. Sends Requestto UAP in Phoenix Works with member to determine if self-direction is
