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Medical Nursing Needs. Melissa A. Fritzman Program Administration Supervisor II Division of Long-Term Care and Quality Assurance Department of Medical Assistance Services Virginia Department of Medical Assistance Services. Medical Nursing Needs.

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Medical Nursing Needs

Melissa A. Fritzman

Program Administration Supervisor II

Division of Long-Term Care and Quality Assurance

Department of Medical Assistance Services

Virginia Department of Medical

Assistance Services


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Medical Nursing Needs

  • You assess the child for what currently is occurring.

  • DMAS is seeing that most children are meeting the functional criteria.

  • Medical Nursing needs with the risk of placement into nursing homes is the area we hear and see people having difficulty with.


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Medical Nursing Needs

  • Different things we have seen when reviewing enrollment packages

    • No documentation of need

    • In good health documented

    • Provider assessment saying no medical nursing needs

    • Stating no risk of nursing facility placement


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Medical Nursing Needs

  • There are times that people are giving such great care to their children that they get caught in catch 22 because they do not have skin breakdown, weight loss, contractures etc.

  • We commend these people for their devotion and hard work.


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Documentation Examples ofMedical Nursing Needs

Seizures

  • Is there medication changes?

  • Is there labs being drawn for medication levels?

  • Any recent seizure activity both grand mal or petite mal?

  • Family noted any blank stares?


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Documentation Examples ofMedical Nursing Needs

Potential Nutritional Problems

  • Documentation of weight loss/gain?

  • Documentation of dehydration?

  • Is person seeing a dietician or other health professional on regular basis?

  • Taking any supplements, Ensure, Boost, Gatorade, Pedialyte, scheduled snacks, etc.?


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Documentation Examples ofMedical Nursing Needs

Potential for skin break down

  • Documentation of red areas?

  • Any open areas currently?

  • Use of restraints or other equipment that has in past caused breakdown?

  • Any special things caregiver may be doing, turning q2hrs, applying ointments, using pressure relieving devices?


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Documentation Examples ofMedical Nursing Needs

Therapies

  • Documentation of all therapies and where occurring.

  • If child is receiving at school these are ok. Please let families who may already have Medicaid know that these therapies can be done when not in school if ordered by doctor.


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Review Process

  • Screenings are reviewed by the DMAS prior authorization contractor.

  • The contractor will enter all preadmission screening packets into the MMIS system allowing for entry into the waiver.

  • Any screenings that the contractor feels did not meet criteria are sent to DMAS.


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Review Process

  • DMAS will review the preadmission screening packet and make the final determination on enrollment into waiver.

  • DMAS may call you, providers or even visit a recipient. The method of doing this is done on a case by case basis.


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Review Process

  • For 2004

    • Reviews completed 27,993

    • Enrollments 12,151

    • Changes 13,293

    • Approvals 20,156

    • Denial 494

    • Overall percentage of denial 2.34

      Rejects not included



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Thank You

As we journey through life we will choose different paths that lead us in different directions. The directions and the paths are not important but how we use our unique abilities to achieve our individual successes,whether they be large and grand or simple is at the heart of the journey.


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