PERSONAL CARE AND NURSING SERVICES PROVIDER MEETINGS 2014

AGENDA Welcome State of CLTC Scopes Changes Tasks and Observations Slot increases Provider Compliance Mobile Application Reminders SC Prime

STATE OF CLTC The numbers of Participants for the Community Choices Waiver is continuing to increase. CLTC will enroll any participant who meets Program requirements. CLTC does not have a waiting list. CLTC is actively working with other Divisions of Medicaid to get participants eligible and enrolled. CLTC is glad to announce that with your July 1, 2014, there will be an increase of 10% for PCI, PCII and Companion services.

PERSONAL CARE SCOPE CHANGES Providers may use paperless filing systems. Providers must obtain approval from CLTC Central Office prior to initialing an electronic filing systems. Medically Complex Children’s (MCC) Respite Services will be added to PCII Scope Nurse Supervision for Children’s Personal Care must be by a Registered Nurse. The Scopes of service will be removed from your contracts and put in the CLTC provider manual effective 7/1/14.

PERSONAL CARE/NURSING SCOPE CHANGES The provider must ensure that employee’s license is valid while transporting any participants. Highway Department verification must be obtained initially and every two (2) years during employment. Copies of the initial and subsequent driving records must be maintained in the employee’s personnel file.

PERSONAL CARE/NURSING SCOPE CHANGES The Personal Care Aide (PCA) must have a minimum of ten (10) hours relevant in-service training per calendar year. Documentation of training hours shall include topic, name and title of trainer, training objectives, outline of content, length of training, list of trainees, and location. This documentation should be maintained in an annual in-service manual for all employees.

PERSONAL CARE/NURSING SCOPE CHANGES Each staff member’s personnel file must contain a summary of their in-service training for the year. The summary must include the date of the training, the subject or title of the training and the total number of in-service hours earned.

PERSONAL CARE/NURSING SCOPE CHANGES

Criminal background checks must include all data for the individual with no less than a ten (10) year timeframe being searched. The criminal background check must include statewide data. The statewide data must include South Carolina and any other state or states the worker has resided in within the prior ten years.

PERSONAL CARE/NURSING SCOPE CHANGES Providers are required to give the participant written information regarding advanced directives. The participant is required to sign and date a statement that they have received this information. The nurse supervisor is also required to sign and date the statement.

PERSONAL CARE SCOPE CHANGES Providers are require to inform participants of their right to complain about the quality of PC II/HASCI Attendant, HASCI Respite and/or MCC Respite services provided. The participant is required to sign and date a statement that he/she received this information. The nurse supervisor is also required to sign and date the statement.

PERSONAL CARE/NURSING SCOPE CHANGES 30, 60, 90 day suspension - Based on your compliance review score, you may be suspended from receiving new referrals for 30, 60, or 90-days. You will also be required to submit an approved corrective action plan. If the corrective action plan is approved, the suspension is automatically lifted at the end of the suspension period.

PERSONAL CARE/NURSING SCOPE CHANGES If the corrective action plan is not approved, the provider will have 10 days to submit an approved corrective action plan. If the second corrective action plan is not approved, the provider will be terminated. Acceptable corrective action plans must: Address the deficiencies cited in the review Give a detailed plan for correcting the deficiencies Give an effective date when the correction plan will be implemented Include any pertinent documentation such as new forms, etc.

PERSONAL CARE/NURSING SCOPE CHANGES Providers who have two (2) consecutive reviews that result in suspension of new referrals, will be terminated if the third review has a final score that would result in a suspension of new referrals (100 and above). Your goal should be to get this Not this

PERSONAL CARE/NURSING SCOPE CHANGES Providers can be terminated based on the results of a single review.

PERSONAL CARE/NURSING SCOPE CHANGES The provider is responsible for updating the Phoenix system as needed with his/her telephone numbers, address, holidays, physical address, and administrator.

TASKS AND OBSERVATIONS PCA’s can not check out without entering the task performed. Providers can pull reports that indicate activities performed by the PCA or Nurse. Modifications are being made to make the report more user friendly. Providers must monitor activities performed by workers to ensure that they are in line with the Service Plan. A decision will be made soon as to when providers can stop using task sheets for CLTC participants.

PROVIDER COMPLIANCE RESULTS JANUARY 1, 2013 TO MAY 21, 2014 No Action – 53% Corrective Action – 29% 30 Day Suspension – 9% 60 Day Suspension – 6% 90 Day Suspension – 2% Termination – 1% Total providers reviewed - 286

PROVIDER COMPLIANCE CONT... We are looking at ways to enhance the provider choice list. The enhanced choice list will contain items like: last compliance review score review action date of last review years in operation any other information that participants can use to make an informed choice.

MOBILE APPLICATION The mobile application may be used by in-home service providers to check in/out for personal care, nursing and case management services. The application is currently only available for Android mobile devices. The application for iOS (I-Phones) will be available in the near future. When the I-Phone application is ready, providers will be required to use the mobile application.

MOBILE APPLICATION Before an in-home worker can use the mobile application the following must take place: The provider must be set to mobile enabled. This must be done by the provider group at CLTC. If this has been done, you should see a mobile devices tab on your profile screen. Workers must be set to mobile enabled. You may see if a worker is mobile enabled from the main worker tab (mobile column will state yes).

MOBILE APPLICATION

A password must be entered for the worker and the mobile device ID must be entered

MOBILE APPLICATION The mobile application user guide can be found in the Help section of the Phoenix provider portal. The link to download the mobile application and the toll free support number for mobile application issues can also be found in the Help section of the Phoenix provider portal.

REMINDERS All providers have access to reports in Phoenix to monitor activities of their workers. Nurse supervisors should be checking in Care Call when making visits. Only a check in is required for nurse supervisors. Providers must register their workers in Phoenix. Providers should terminate worker’s access to phoenix when they leave the agency. Not terminating the worker’s access to phoenix records is a HIPAA violation.

REMINDERS There is a training environment link under the Help section in Phoenix provider portal for the IVR and Mobile Application. There is a Report A Problem button on each screen in Phoenix for providers who have Phoenix issues. How many of you use this? Providers can use Conversations in Phoenix to communicate electronically with Case Managers. How many of you ever use this?

RESOURCES for policy and billing problems. for Care Call problems Report a Problem button in Phoenix for Phoenix related problems.

QUESTIONS

SC PRIME Discussion of SC Prime Its impact on your business Ways it will impact your business