Aging and People with Disabilities Completing New Decision Notice: Presented by APD Central Office Staff May – August 2018 * Same slide # 1

Agenda Background and key points New Service Notice – Service Plan and Notice or “SPAN” form Case Manager expectations Supervisor and Lead worker expectations * Same slide # 2

Introduction: Background Oregon lost several cases in Circuit Court due to insufficient notices. Legal advocates said the notices for the October changes did not meet legal sufficiency. DOJ advised APD to correct the notices. APD updated notices hoping to reduce the burden on the field. * Same slide # 3

Introduction: Key Points Legal sufficiency demands high level of accuracy for: Assessments and comments; and Notices Legal risk means additional scrutiny and QA. * Same slide # 4

Introduction: Key Points Assessments and comments must be: Accurate; Answer the 3 questions; Why is there a need? How frequent is the need? How is the assistance being received? Document what the CM saw and heard; and What has changed. * Same slide # 5

Benefits of the New Notice Notices will be legally sufficient. Provides transparency on: How eligibility and hours decisions are made. The exception process. Reduce the need for: Re-assessments for hearing requests. Amended notices for hearing requests. * Same slide # 6

SPAN NOTICE The new notice is called “Service Plan and Notice”, or SPAN. SPAN will be used as the notice for consumers requesting or receiving services. SPAN is also used for the consumer’s service plan agreement.

When SPAN is required At the completion of an assessment and one of the following applies: Consumer is initially approved for services Consumer is denied services Consumer that is currently receiving services in a nursing home/CBC setting and their SPL increases in number i.e., goes from 7 to13 Any in-home consumer

General Information Not yet linked to Oregon ACCESS All fields must be manually completed. Each free text section must be written in simple and clear language consumers can understand. 300 character maximum. Translations are in process (mail out the 0097 form) With the use of this form, the 001N, 914, and in most instances, the 541N form, is no longer required. * Same slide 8

SPAN Form: – General Information Sections in red will not print. Review instructions provided Check the appropriate boxes. The notice generates depending on the selections made. * Same slide 9

SPAN Form: – General Information Notices should be printed by using the “Print Notice” button. This will generate only the pages needed by the consumer. When saving to EDMS, use the “Print Notice” button and use a Print to PDF option. Do not save to EDMS in any other way. The notice will not have the consumer’s specific information and will be invalid. * Same slide 9

SPAN Form: Notice Generation

SPAN Form: Demographic Information Branch Prime Program DOB Name Date of notice CM name CM phone # Address City State Zip Page 3 in the workbook * Same slide 7

SPAN Form: CBC or NH case Fill in all of the blanks The free text box needs to explain, in plain language, why the consumer is/is not eligible, and what has changed since last assessment. Critical

SPAN Form: In-home case The circled sections will autofill The hours segments will auto-fill as you complete the notice For the date sections move the mouse pointer over those sections. .

SPAN Form: Information Gathering Enter information on what was used in the assessment decision: Who has at the assessment Other information used care plan, Discussion with natural supports

SPAN Form: EWE Determination Select which box best applies. The page will generate the appropriate information needed.

SPAN Form: EWE Determination If the consumer is not eligible for SPL or EWE, selecting the appropriate box will provide the notice reason why they are not eligible. A free text box will also appear. Explain in plain language why the consumer is EWE ineligible.

SPAN Form: SPPC Eligible Select the correct box. If the second box is checked, you will be prompted to enter consumer’s authorized hours. The 541 is not required. If boxes 3 through 5 are checked, a free text box will display. Explain in plain language why the consumer is not eligible for SPPC.

SPAN Form: Liability/Pay-in Depending on the selection made, either the in-home pay-in information or the CBC/NH liability information needs to be filled out. The 541N is not required for service eligibility.

SPAN Form: Shift Services/Spousal Pay Check the appropriate boxes for the consumer’s eligibility for Shift Services and Spousal Pay. Select all of the appropriate dropdown selections for Shift Services if the consumer is not eligible.

SPAN Form: ADL information 1-2: Select the appropriate need level that was assessed in the previous assessment (if applicable: this section will not display for consumers not currently receiving services) and the current assessment. This information should be from the assessment itself. Select the most appropriate reason (most options include why the need level has changed). In the free text box, in plain language, explain the reason why the person is assessed at the need level they are at, as well discussing any changes that have occurred since the last assessment. They should not be left blank. 1. 2. 3. 4.

Oregon ACCESS Selections - SPL Determining appropriate need levels in the CA/PS assessment: A – C selections: A = Ind./ B = Assist / C = Full Assist A – D selections: A = Ind. / B = Min. Assist / C = Sub. Assist / D = Full Assist EXCEPT Eating: A = Ind. / B = Assist / C and D = Full Assist

SPAN Form: Free Text Examples for ADL/IADL Needs Your physical therapy allowed you gain enough strength to help you walk again without any help. Your bathroom was modified allowing you to get up from the toilet without any help. You have since recovered from your X medical condition and no longer need any help. You let us know that due to your medical needs, you are now needing help with dressing and undressing each time. Although you prefer to have someone in your home while you take a shower, that is not a need that we cover. You are still able to feed yourself. * Same slide # 22

SPAN Form: Hours Information This section will not generate if the consumer is/will be receiving services in NF/CBC or will be closed/denied. Date will autofill. Select the appropriate need level that was assessed in the previous service plan. Select the appropriate need level for this most recent service plan. 1. 2.

SPAN Form: Hours Information Enter in the appropriate number of hours the consumer was authorized including any exception hours. If the previous plan is under the monthly format, it will need to be converted to the two week format Enter the same information for the current assessment. Select the most appropriate reason. Pick the appropriate drop down selection. If less than the maximum hours are being assigned: Check the box provided, and in the free text box that is provided, explain in plain language why the hours were not fully assigned. The free text box is not used if the max hours are assigned. 3. 4. 5. 6.

SPAN Form: Free Text Examples When Authorizing Less than the Maximum Hours Rules have changed which has resulted in you receiving fewer hours in this task. You do not need as much help in this area. You have a natural support who is assisting with this task. This task is not occurring as often or is not taking as long as it did last year. You indicated that you do not wish to have this task completed by a paid caregiver. * Same slide # 41

Cases Reassessed After 10/1/17 During the monthly to 14-day conversion project, additional hours were authorized in the mainframe, which sometimes resulted in needing to add “exception” hours to the service plan in Oregon Access. These will need to be documented on the notice in the Hours field with the total amount authorized. Check the box and explain why there is a change in hours. * Same slide # 42 For cases reassessed after 10/1/17 that resulted in a reduction and were part of the Restoration. Central Office had added exceptional hours as needed to restore benefits based on the previously allowed hours. In order to complete the reduction, and the form (IHS Hours Redetermination Decision Notice). To communicate this to consumers when populating the Decision Notice in the Hours fields enter the allowed hours, a plus sign and the number of exceptional hours that were temporarily added.

SPAN Form: Please note… For any assessment created prior to 10/1/17, select the appropriate dropdowns that includes the word “former”. For Cognition: “Not Previously Assessed” is a dropdown option. Use if: The previous assessment was prior to 10/1/17. The previous assessment was a 4 ADL assessment/ Starting on page 23 in the workbook * Previous slide 18 (as numbered in printed PPT material)

SPAN Form: Exception Decisions This includes weekly cap and hourly exceptions. For in-home cases, complete as appropriate. If the consumer’s request is not fully approved, an explanation in the free text box is needed.

SPAN Form: Exception Decisions Continued… For hourly exceptions, only the sections where the consumer requested an exception need to be completed. The hours will auto fill in the Total Hours Approved. If a new exception decision is made after a service plan has been provided, you may use the “Print Exception Decision Only” button to provide the exception decision without the entire notice.

Note on Exceptions Exceptions and Transparency: The new notice provides more transparency on the exceptions process. It provides individuals the right to appeal if we deny or partially deny an exception. Decisions include: Whether or not exception was requested. Exception decision. Who the decision was made by. The date the decision was made. Reason for the decision. * Previous slide 28 (as numbered in printed PPT material)

SPAN Form: Service Plan Agreement The Service Plan Agreement replaces the use of forms 001N and 914. Select the services the consumer has agreed to receive. Select “Case Management Services” unless the consumer is on MAGI or in a NH. Leave this form blank if the consumer is ineligible. Consumer is in a CBC setting: in the field below it, enter in the type of placement (i.e. Assisted Living, Adult Foster Home, etc.)

SPAN Form: Service Plan Agreement The consumer or representative, the provider if CBC or NF and case manager must sign the form. A new signed agreement needs to be on file after the completion of each assessment the consumer is determined eligible. The consumer may check the below box if they disagree with the assessment or service plan, however they still need to sign. The “Print Service Plan Only” button may be used to print an extra copy of just this page (i.e. for the consumer’s record).

CM RECEIVING APPROVAL TO MOVE FORWARD WITH SENDING OUT THE SPAN FORM * Same slide # 44

Receiving Approval to Move Forward with Decision Notices CM completes a SPAN form. CM submits the SPAN form to the supervisor or lead worker for review. Once reviewed and approved by supervisor or lead worker, the supervisor or lead worker should submit the SPAN form to CO via email to APD.DecisionNotices@dhsoha.state.or.us One case per email. * Same slide # 45 FLAG!

Receiving Approval to Move Forward with Decision Notices CO will review and will email the CM and manager if approved. Notices approved by CO: LO will mail the final approved notice with additional required documentation. LO must save all files to EDMS. * Same slide # 47

Receiving Approval to Move Forward with Decision Notices Notices NOT approved by CO: CO will email CM and manager of required changes. CM will update Decision Notice. CM will re-submit to manager or lead work to re-review the notice. Once approved by LO, CM will resubmit to CO. * Same slide # 48

Receiving Approval to Move Forward with Decision Notices In order to be released you must correctly complete decision notices for 2 cases. After completing the required number of correct notices, the CM will no longer be required to submit the draft notices through the CO review process. The CM will be notified when this occurs. * Same slide # 49 Approval means 2 cases (up to 4 notices) FIRST ATTEMPT notices approved. So if one is returned that one does not count in the 8. Released means you no longer need to submit notices for review.

Supervisor and lead work expectations * Same slide # 50

Supervisor and Lead Worker Expectations Over time, the review expectation will lessen slightly, but supervisors and lead workers will continue reviewing notices. During the roll-out supervisors and lead workers will be expected to review all notices before being submitted to CO. * Same slide # 51

Supervisor and Lead Worker Expectations QA reviews include ensuring that: The assessed level of need in each ADL/IADL meets rule. Assessment comments are appropriate and accurate. Demographic information on page one is complete and accurate. * Same slide # 52

Supervisor and Lead Worker Expectations QA reviews include ensuring that: All applicable drop-down fields are completed, including selections of independent or N/A. The individual’s assessed SPL and hours in Oregon ACCESS match the form. Free text fields have been updated with plain language statements. * Same slide # 53

Supervisor and Lead Worker Expectations The expectations and review process for exceptions has not changed. Supervisors should be reviewing both of the following: The exception request in detail; and Exception information on the notices. * Same slide # 54 Once manager or lead worker have reviewed and approved the notices, they should notify the CM so they can submit to CO for review.

Questions? Lisa Bouchell (503) 269-4771 Darwin Frankenhoff (503) 947-5162 Christine Maciel (541) 471-3830 Mat Rapoza (503) 945-6985 Ben Sherman (503) 602-3471 Scott Spencer (503) 509-7418 Bob Weir (971) 600-7876 * Same slide # 55