1. CAP/DA Local Agency Reviews and Documentation Guidelines Tracy Colvard, CAP/DA and PCS Manager May 2006

2. General CAP/DA Program Operations □Organizational structure and staffing □Service provider resources □Referral and pre-screening procedures □Assessment and case management practices □Billing procedures □Exit conference □Written report

3. CAP/DA Program Review □Lead agency information □Lead agency agreement □Case manager information □Years experience, FT/PT □CAP/DA recipients served (slots) □Client termination information □Reasons for termination/numbers

4. CAP/DA Program Review □FL-2 issues □Who does assessments? □Written procedures for POC approval □Written guidelines for caseload limits □CAP/DA Advisory Committee □Membership, meeting frequency, activities

5. CAP/DA Program Review □Referrals □Numbers, sources, written procedures for referral and pre-screening □Waiting list written policies □CAP/DA waiver service providers □Adult Day Health, In-Home Aide, Meals, Respite, Telephone Alert □Client freedom of choice procedures

6. CAP/DA Program Review □Written Transfer Policy □Proof of case manager signing claims □Coordination methods with DSS □Eligibility, deductibles, CAP/DA applications □Lead agency organizational chart □Medicaid provider enrollment agreement

7. Record Review □Clients selected on day of local review □Usually 3-4 months prior to review visit for claims purposes □Review □FL-2 □Assessment □POC □Service Authorization and Participation Notices □Case Management notes □Claims data

8. Record Review Minimum Monitoring Requirements □Adult Day Health, In-Home Aide, Respite □Monthly review of service provision with client/provider □Hands-on observation at least every 90 days □Review supporting documentation for claims at least every 90 days □Review provider claims prior to billing Medicaid

9. Record Review Minimum Monitoring Requirements □Meals and Telephone Alert □Monthly review of service provision with client/provider □Review provider claims prior to billing Medicaid

10. Record Review Minimum Monitoring Requirements □Waiver Supplies & Lead Agency Provided Medical Supplies □Confirm after initial delivery and at least quarterly if supplies meet client’s needs □Home Mobility Aids □Confirm after initial delivery and at least quarterly if supplies meet client’s needs

11. Record Review Minimum Monitoring Requirements □Nurse Visits □Review HHA nurse visits with nurse once a month (by phone or nursing notes). □Home Visits □Visit client at least every 90 days □Case Notes □All activities documented (dated, time in minutes, signed, multiple daily entries totaled)

12. Documentation Entries should include: Who, What, When, Where, Why If it’s not documented, it didn’t happen !!

13. Examples of Billable and Non- billable Case Management □Handout

14. Case Management Exercise □Joe Blow

15. Service Authorization vs. Participation Notice □Handout

16. Questions and Possible Answers