Independent Care Waiver Program (ICWP) Presentation to: Georgia Association of Community Care Providers (GACCP) Presented by: Marcia Stanford, Human Services Program Auditor, OIG/Program Integrity Section Date: July 14, 2011

Important Read Your Manuals The Information in the Manuals is Essential ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________

PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES. Current DMA-6 All Waiver applicants must have DMA-6 prior to admission. A copy of an approved DMA-6 that covers all periods of service must be maintained in the member’s record. (See Sections 702.3B-2 and of the ICWP Manual) ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________

DMA-80 as noted in the PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES Current DMA-80 All requests for prior approval must be made in writing on the Prior Authorization Form (DMA-80). (See Sections 801 and 906.1) ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________

PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES. Freedom of Choice form, Client Rights and Responsibilities form, and Memorandum of Understanding form These forms must be signed and dated by the member or representative prior to initiation of services with MOU signed annually, then forwarded to GMCF and copies maintained in the providers’ files (See Sections 604.1A; 703H; I; J 906.1E-4/7 and Appendix C of the ICWP Manual ) __________________________________________________________ ____________________________ _______________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________

PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES. Individual Care Plan/Care Path All member records must contain an Individual Plan of Care completed, signed, and dated by the case manager, the member and planning team every twelve (12) months. Lists all providers, services, frequency, goals and cost. (See Sections 703-F, 902.1(4) 1-26 and 906 and Appendix H of the ICWP Manual) __________________________________________________ __________________________________________________ __________________________________________________ ______________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________

PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES. Case Manager Quarterly Review Case Manager must review the Individual Plan of Care every ninety (90) days with the member to determine and document compliance, progress and continues appropriateness. This quarterly review must also include assessment and documentation of member satisfaction. (See Sections (10) and 907 (B)1) of the ICWP Manual) ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES. Discharge Plan Providers must maintain a coordinated program of discharge planning. The Case Manager coordinates in consultation with the client, GMCF, providers, physician and others. (See Sections 703, 706, (4) 16 and 906.1E-13 of the ICWP Manual) ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES, Section Monitoring – Personal Support RN must monitor & supervise care of members whose health status and situation involve complex observation RN must review and sign all documentation of the LPN within 10 days of each visit and follow up immediately on concerns raised by the LPN ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES, Section Monitoring – Personal Support LPN must monitor vital signs as needed and report abnormal readings and concerns to the RN immediately Monitoring must be by the personal support supervisor every 90 days. ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES. Documentation of Services The member’s record must include documentation for case management must include time spent for telephone calls related to the member’s care. The Case Manager face to face monthly visit must be dated and signed with the ICWP member. ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES Documentation of Services, continued To be reimbursed for services, the case manager must provide detailed documentation that identifies dates of services, duties performed and actual hours rendered providing service to a member. (See Section of the ICWP Manual) ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES. Monitoring of Services The Provider must monitor individuals providing Personal Support and Respite services every ninety (90) days. Documentation of this visit must be recorded in the provider’s files and a copy forwarded to the Case Manager. (See Sections ; 902.2G; 906.1E-12 of the ICWP Manual) ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

PART I I POLICIES AND PROCEDURES FOR INDEPENDENT CARE WAIVER SERVICES. Services performed according the Plan of Care and the DMA-80 There must be sufficient documentation in the record to indicate that services have been provided as approved on the Plan of Care and DMA-80. (See Sections 906.1E of the ICWP Manual) ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

PART I POLICIES AND PROCEDURES FOR MEDICAID/PEACHCARE FOR KIDS MANUAL. Billing Discrepancies There is documentation in the record to support every unit for which the provider billed. Payment is reimbursed for services rendered (see Section of the Part I Manual) ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

Important Read Your Manuals The Information in the Manuals is Essential ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________