Welcome To Case Manager CDAC Documentation Training

1. Welcome ToCase Manager CDAC Documentation Training 2008

2. Agenda • instruction on how you will confirm that you have viewed this training for DHS tracking purposes and also how you will ask questions. • Learn about the purpose of this training. • Learn results of CDAC documentation reviews • Learn the definition of Case Management as defined in the Iowa Administrative Code • Learn the responsibility of Case Managers

3. Agenda Continued • CDAC will then be defined as well as your responsibilities as Case Managers under this service. • You will be trained on the CDAC Agreement, since this is one of the things that you as CMs are responsible for. • You will be trained briefly on the Daily Service Record. • You will be trained briefly on the Claim for Targeted Case Management • You will be given information about any ongoing support that may be needed.

4. Acknowledgement of Training and Questions • In order for DHS to track who has viewed this training, you will need to send an email to providertraining@dhs.state.ia.usto report that this training was viewed. • You will use the same email address to send any questions that you have after you have viewed this training.

5. Additional Training • We at the IME believe that this training and email forum for answering questions should be adequate in providing answers. However, if you feel that you need additional training, Please work through your supervisor to set up a conference call with IME. You will request a conference call through providertraining@dhs.state.ia.us.

6. Purpose for Today’s Training Session • Define Case Management as stated in the IAC • Emphasize the Case Manager’s responsibility to ensure clear individual agreements… • …Including the appropriate use of discretion when approving & denying CDAC services. • Briefly cover the CDAC Agreement and the CDAC Daily Service Record

7. What is Case Management?

8. What is Case Management? • Case Management is defined in IAC, Chapter 24.4(9) at the web address below: http://www.dhs.iowa.gov/policyanalysis/PolicyManualPages/Manual_Documents/Rules/441-24.pdf • It is also defined in chapters 78 and 90, depending on the type of Case Manager

9. What is Case Management? • As stated in the IAC, Case Managers link individuals to service agencies and support systems responsible for providing necessary direct service activities Case Managers coordinate and monitor those services.

10. Case Manager Responsibilities According to the IAC

11. Case Manager Responsibilities Must clearly define need for case management and document it annually. The CM must also work with the interdisciplinary team to establish the service plan This team is composed of the consumer, case manager, provider, and/or other natural supports such as family and friends.

12. Case Manager Responsibilities • Case Managers are expected to advocate for the consumer. • Case Managers must hold face-to-face meetings with the consumer at least quarterly. • Must communicate in a quarterly review of the progress toward achieving goals with the interdisciplinary team. • Must document the quarterly review of the progress in the Case Manager’s consumer file.

13. Iowa Administrative Code 79.3(2)d(35) • Please see the next slide for a more detailed explanation of the information below. • Lists those items required in a DHS review: • Notice of decision for service authorization • Service plan • Service logs, notes, or narratives • Mileage and transportation logs • Logs of meal delivery • Invoices or receipts • Forms 470-3372 HCBS CDAC Agreement, and 470-4389 CDAC Service Record

14. Iowa Administrative Code Chapter 79.3 Chapter 79.3 is where the legal verbiage is for what is required in a DHS review for all waiver providers. The CDAC Program is just one of the programs that fall under the waiver “umbrella”. Therefore, some of the things listed in the this piece of the code may not apply to CDAC providers. The Notice of Decision is the document that shows the approval for the consumer to receive Medicaid services and for the provider to give these services to the consumer. The Case Manager, provider, and consumer should all have copies of this document. The Service Plan shows all services that the consumer has been approved to receive through the Medicaid program. The Case Manager, provider, and consumer should all have copies of this document.

15. Iowa Administrative Code Chapter 79.3 • All providers, including Case Managers, are required to keep service logs, notes, and narratives. Individual and Agency CDAC Providers will do this by using the Daily Service Record. • Numbers 4, 5, and 6 in the list will most likely not apply to CDAC providers. Mileage and transportation logs need to be kept by transportation companies who are reimbursed by Medicaid. Logs of meal delivery need to be kept by meal delivery companies such as Meals on Wheels. Invoices and receipts are usually kept by Home and Vehicle Modification Providers. • Number 7 on the list, the CDAC Agreement and the Daily Service Record, are required for all CDAC Providers. They should have a copy of the CDAC Agreement, and CMs are responsible for the CDAC Agreement itself. Case Managers should make sure that the CDAC provider has a copy of their CDAC Agreement.

16. Iowa Administrative CodeCase Managers It is also important as Case Managers to keep in mind that your own documentation can be reviewed and audited in the same way as other providers so you want to make sure that you are documenting according to what is required. This can be found in the Iowa Administrative Code, Chapter 24.

17. What is the CDAC program?

18. What is the CDAC program? CDAC stands for Consumer Directed Attendant Care. It is defined in IAC Chapter 78 and in the CDAC Agreement. Both documents list and define Non-Skilled and Skilled Services.

19. CDAC Program • The CDAC Program provides some self-care tasks that the consumer would do themselves if otherwise capable. • This means that the services approved must be for tasks that the consumer absolutely cannot do.

20. CDAC Program Allows for some of the services needed to keep consumers in their homes.

21. CDAC Program There are services that the consumer may need but aren’t payable under the CDAC program.

22. CDAC Program If a necessary service does not fall under the parameters of CDAC, Case Managers should attempt to access coverage of those needs through natural supports in the consumer’s family, friends, & community resources. For example, if a consumer likes to play cards to keep their memory sharp, there may be a church program that would send someone to spend time with the consumer for this purpose.

23. Examples of services not payable under the CDAC Program • Playing Cards • Watching an educational program with the consumer • Providing companionship • Supervision (watching or monitoring) • Time spent waiting “in between” defined services

24. Examples of potentially payable services under the CDAC Program* • Transporting consumer to get a haircut • Transporting consumer to a yoga class or some other non-prescribed exercise class • Transporting consumer to visit a relative *These services are only potentially payable if the consumer NEEDS these services to maintain their health, welfare and safety. It is for these kinds of services that as Case Managers, discretion should be used when approving services.

25. The CDAC Agreement

26. The New CDAC Agreement • The CDAC Agreement was in place before, but a new Agreement was implemented beginning on 12/1/08 for Individual CDAC Providers and 1/1/09 for Agency CDAC Providers. • Consumers should be transitioned onto the new agreement at their annual plan review, or • When there are changes in the needs of the consumer • Providers may also request a new agreement.

27. The CDAC Agreement- what to consider When approving or denying services in the CDAC Agreement, you want to think about whether the needed service fits into one of the categories in the CDAC Agreement. Does the service meet the definition under the Iowa Administrative Code?

28. CDAC Agreement Page 1 • The first page of the HCBS CDAC Agreement is shown on the following slide. • Notice that the name of the consumer and the CDAC provider are required on this first page.

30. CDAC Agreement Page 5 • Page 5 of the CDAC Agreement is shown on the next slide. • Notice that the categories aren’t different from the categories on the previous agreement, but a service code has been assigned to each category. This is important because CDAC providers will use these service codes on their Daily Service Records. • When services on the agreement are approved or denied, you as Case Managers must work within the parameters of the CDAC Program – does the service fit into one of the categories in the CDAC Agreement and does it fill the consumer’s NEED? If the answer to these questions is yes, you will then need to specifically describe the service. For example, if the interdisciplinary team decides that the consumer needs the provider to bathe, groom, and provider personal hygiene services to the consumer, what specific services are needed? Daily shaving? Brushing teeth? These services need to be described in the third column labeled “Specific CDAC Provider Activity”.

31. CDAC Agreement Page 5 • In the fourth column of the CDAC Agreement on page 5, the amount of time required each day for each approved activity must be noted. There is no need to define it down to the minute as the average amount of time will suffice. • In the fifth column, the number of days the service will be provided per month needs to be noted. You as a Case manager will need to use discretion in these areas as to how much time and how many days per month is appropriate.

33. CDAC Agreement Page 12 • Page 12 of the CDAC Agreement is shown in the following slide. • This is where the total number of units approved per month are determined. • To arrive at this number, each category that has been completed must be looked at from pages 5 through 12. • On EACH line, multiply the time by the number of days per month and note this number in the margin beside the line. For example, if, under “Essential Transportation” you have approved a provider to transport the consumer to the doctor and it would take 30 minutes each time and you have approved for this to be done twice per month, you would multiply .5 hours time 2 days, equaling 1 hour per month. Continue to do this for each completed category. • You will then total all of these numbers to arrive at the total units approved per month.

35. CDAC Agreement Page 13 • Page 13 is shown on the following slide. • This page of the CDAC Agreement is where the waiver type of the consumer is marked, and the reimbursement rate and procedure code are determined.

37. Case Management Responsibilities under CDAC

38. Case Management Responsibilities under CDAC To work with the interdisciplinary team to assess the consumer’s needs. • The interdisciplinary team may be composed of the consumer, case manager, and providers and/or natural supports.

39. Case Management Responsibilities for CDAC To ensure decisions are made according to the individual needs of each consumer.

40. Case Management Responsibilities for CDAC Case Managers must specify what services the consumer will receive in relation to their health, welfare, and safety.

41. Case Manager Discretion under the CDAC Program

42. The importance of Case Manager discretion on the CDAC Agreement • As a Case Manager, you approve or deny services on the Agreement. This affects the audit risk of CDAC Providers because all provided services must fall under the program descriptions as noted in the IAC and the CDAC Agreement. This is why it is important that you exercise discretion using the parameters of the CDAC program descriptions. Keep in mind the consumer’s health, welfare and safety while allowing them to stay in their own homes.

43. Case Manager Discretion The CDAC program is designed to meet individual consumer’s needs, which vary significantly. It is part of the Case Manager’s responsibility to assess those needs.

44. Case Manager Discretion As a result, the rules surrounding the program allow for some flexibility to handle unique circumstances of a consumer’s life.

45. Case Manager Discretion The Case Manager is responsible for making sure that services are consistent with program descriptions and are simultaneously responsible for ensuring that services described under the categories on the agreement are clear and specific.

46. Case Manager Discretion In ensuring clear and specific agreements, the Case Manager exercises discretion as to what precise services ultimately fit under the more general service descriptions.

47. Daily Service Record

48. CDAC Documentation Reviews 20% of all CDAC providers who have been reviewed have been found to have NO documentation. This means they have provided services, but have no way to ‘prove’ that they did. In the case of an audit, money could be recouped from the provider. It is important for you as Case Managers to help make sure the provider is aware of the requirement to document their daily services.

49. CDAC Documentation Reviews Continued Another 25% of those reviewed have inadequate documentation. An example of inadequate documentation would be a monthly calendar with the number of hours worked each day. This is inadequate because it does not show what was done during those hours and there is no consumer response.

50. CDAC Documentation Reviews Continued When these numbers are taken into consideration, it shows that 45%, almost half of all CDAC Providers who have been reviewed or audited are at risk of having their payments recouped. This is why a standardized form and training were implemented.