1 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

2 Department of Medical Assistance Services Overview 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

3 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)

4 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

5 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

6 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

7 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

8 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

9 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

10 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

11 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

12 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

13 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.

14 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

15 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.

16 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

17 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

18 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

19 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.

20 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

21 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

22 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

23 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

24 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

25 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

26 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

27 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 *

28 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

29 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

30 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.

31 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.

32 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

33 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.

34 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

35 Department of Medical Assistance Services Section Q and MFP Resources MDS 3.0 Section Q Website: VDH MDS 3.0 Section Q Webinar Training: MFP Information on the DMAS Website: mfp.aspx

36 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

37 Department of Medical Assistance Services Contact Information State Section Q Coordinator – Amy Burkett Phone #: State No Wrong Door Coordinator – Kathleen Vaughan Phone #:

38 Department of Medical Assistance Services Contact Information State RAI Coordinator – Priscilla “Cil” Bullard Phone #: Ramona Schaeffer, MFP Coordinator Phone#: