personal care assistant services
Download
Skip this Video
Download Presentation
Personal Care Assistant Services

Loading in 2 Seconds...

play fullscreen
1 / 54

Personal Care Assistant Services - PowerPoint PPT Presentation


  • 716 Views
  • Uploaded on

Personal Care Assistant Services. Local Education Agency Medicaid Provider Manual. Purpose. Common Acronyms Provider Participation Requirements Covered Services Documentation Requirements. Commonly Used Acronyms. VDOE - Virginia Department of Education

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Personal Care Assistant Services' - victoria


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
personal care assistant services

Personal Care Assistant Services

Local Education Agency Medicaid Provider Manual

purpose
Purpose
  • Common Acronyms
  • Provider Participation Requirements
  • Covered Services
  • Documentation Requirements
commonly used acronyms
Commonly Used Acronyms
  • VDOE - Virginia Department of Education
  • DMAS - Department of Medical Assistance Services
  • CMS - Centers for Medicare & Medicaid Services
commonly used acronyms cont
Commonly Used Acronyms cont.
  • EPSDT - Early & Periodic Screening, Diagnosis, and Treatment
  • CHIP – Federal Child Health Insurance Program
  • FAMIS – Family Access to Medical Insurance Security Program – Virginia’s CHIP program
  • FAMIS Plus – Children’s Medicaid in Virginia
commonly used acronyms cont5
Commonly Used Acronyms cont.
  • IEP - Individualized Educational Program
  • GAF - Global Assessment of Functioning
  • LEA - Local Education Agency
  • POC - Plan of Treatment/Plan of Care
  • PCP - Primary Care Physician
  • PCA – Personal Care Assistant
  • QMR - Quality Management Review
categories of services
Categories of Services
  • Nursing
  • Occupational Therapy
  • Physical Therapy
  • Speech Language Pathology
  • Psychology (Behavioral)
nursing pcas
Nursing PCAs
  • Must meet minimum qualifications for unlicensed assistive personnel as required by the Department of Education, Virginia School Health Guidelines, VDH and VDOE, 1999 (page 63)

www.doe.virginia.gov/support/health_medical/virginia_school_health_guidelines/developing_program_infrastructure.pdf

nursing pcas cont
Nursing PCAs cont.
  • Must receive training for assisting with meeting the specific health needs of the student as outlined in the following:
    • Virginia School Health Guidelines Manual,
    • Specialized Health Care Procedures Manual,
    • Manual for the Training of Public School Employees in the administration of Medication, and
nursing pcas cont10
Nursing PCAs cont.
    • Manual for training of Public School Employees in the Administration of Insulin and Glucagon.
  • VDOE training publications may be found on the VDOE website at

www.doe.virginia.gov/support/health_medical/index.shtml

nursing pcas cont11
Nursing PCAs cont.
  • Must be identified in the student’s IEP.
  • Must be included in the Plan of Care (POC) prepared by the licensed registered nurse (RN).
  • Personal care assistants for nursing services must be supervised by a RN.
  • ADL and IADL services do not require physician order.
pcas for practitioners of the healing arts
PCAs for Practitioners of the Healing Arts
  • Specific services must be ordered by a Department of Medical Assistance Services (DMAS) qualified practitioner of the healing arts acting within the scope of their licensure
pcas for practitioners of the healing arts cont
PCAs for Practitioners of the Healing Arts cont.
  • Personal care assistants for the healing arts must be trainined and supervised by a DMAS qualified practitioner of the healing arts (OT, PT, SLP, Psychiatrist, Psychologist).
pcas for practitioners of the healing arts cont14
PCAs for Practitioners of the Healing Arts cont.
  • Board of Physical Therapy (18 VAC 112-20-10 et seq.)
    • Licensed PT can supervise support personnel who are designated routine tasks related to physical therapy; however…supervision must be direct.
pcas for practitioners of the healing arts cont15
PCAs for Practitioners of the Healing Arts cont.
  • OT - Board of Medicine (18VAC85-80-110-111 )
    • Unlicensed occupational therapy personnel may be supervised by an OT or a COTA.
    • An occupational therapist may provide clinical supervision for up to six occupational therapy personnel…
pcas for practitioners of the healing arts cont16
PCAs for Practitioners of the Healing Arts cont.
  • Board of Audiology & Speech Language Pathology
    • 18VAC30-20-240 Supervision of unlicensed assistants
      • A SLP…shall ensure that ‘PCA’ perform only those activities …which are appropriate with their level of training.
      • The identity of the ‘PCA’ shall be disclosed… prior to treatment and…made a part of…the file.
pcas for practitioners of the healing arts cont17
PCAs for Practitioners of the Healing Arts cont.
  • Board of Psychology (18VAC125-20-10 )
    • …monitors the performance of the person supervised and provides regular, documented individual consultation, guidance and instruction with respect to the skills and competencies of the person supervised.
provider requirements cont
Provider Requirements cont.
  • The DOE training manuals may be found on the DOE website at under the ‘Board of Education Guidance Documents’

www.doe.virginia.gov/boe/guidance/index.shtml

covered services chapter iv

Covered ServicesChapter IV

Services to assist the child with disabilities in self-sufficiency, communications, and mobility skills.

nursing pcas20
Nursing PCAs
  • Must be identified in the student’s IEP.
  • Must be included in the Plan of Care (POC) prepared by the licensed registered nurse (RN).
  • Personal care assistants for nursing services must be supervised by a RN.
  • ADL and IADL services do not require physician order.
covered services
Covered Services
  • Services provided by the assistant are related to the child’s physical and behavioral health requirements, including:
    • assistance with eating, dressing, hygiene, activities of daily living, bladder and bowel needs;
    • use of adaptive equipment;
    • ambulation and exercise;
covered services cont
Covered Services cont.
  • behavioral issues; and
  • other remedial services to promote reduction of a child’s disabilities.
  • monitoring of a health related service
    • i.e.: bus driver aide or monitoring the need for suctioning
authorization for services
Authorization for Services
  • Services must be authorized by the current Individualized Education Program (IEP)
    • The student shall have a current order from a physician, physician assistant or nurse practitioner for specialized nursing procedures (i.e. tube feedings, catheterizations, and seizure monitoring)
    • The service cannot be provided by a parent or a step-parent
documentation requirements
Documentation Requirements
  • Documentation must be in accordance with requirements of individual licensing board within DHP, VDOE and DMAS.
  • Quality management reviews follow requirements noted in Chapter VI of the DMAS LEA Provider manual.
documentation requirements26
Documentation Requirements
  • DMAS forms are recommended and available online http://dmasva.dmas.virginia.gov under Search Forms / Local Education Agency.
    • May be completed electronically and printed out to place in record.
documentation requirements27
Documentation Requirements
  • Records must be made available to authorized state and federal personnel and include:
    • Current IEP pages which document actual services;
    • Need for assessment must be documented when it does not result in determination that services are indicated in the IEP (such as on Present Level of Performance or Considerations Page)
pca plan of care dmas 46
PCA Plan of Care DMAS 46
  • Developed by a licensed practitioner of the healing arts within the scope of their license.
  • A separate plan of care should be developed per discipline based on the services needed.
pca plan of care cont
PCA Plan of Care cont.
  • If percentages are used for measuring goals, percentages should change based on student’s progression, not a set time frame.
  • IEP may serve as POC only if it includes all elements of the POC.
pca plan of care cont30
PCA Plan of Care cont.
  • The plan of care developed by the qualified provider should be consistent with the health conditions and functional limitations documented on the individual’s IEP.
pca plan of care cont31
PCA Plan of Care cont.
  • Medical condition and diagnosis being address
    • Specific to needs identified in assessment
  • Goals and objectives
  • Treatment intervention and which goal addressed
pca plan of care cont32
PCA Plan of Care cont.
  • Type, amount and frequency of service
  • Anticipated duration of service
  • Signed and dated by individual performing service
  • Reviewed at least annually
pca service log dmas 37
PCA Service Log – DMAS 37
  • Progress notes/Student Log - DMAS
    • DMAS qualified provider must initial, sign and date each form. Entries must be initialed and dated by responsible provider of service each time service is provided.
    • Providers requiring supervision require documentation of supervision per requirements of licensing board, VDOE and DMAS.
pca service log cont
PCA Service Log cont.

The personal care assistant shall document:

  • On a daily basis for non-nursing services
  • For nursing assistants the documentation is per occurrence
  • Date and amount of time
pca service log cont35
PCA Service Log cont.
  • Procedure
  • Comments
    • N = Normal
    • V = variance from normal or standard. Include written explanation in ‘Comment’ section
  • Initials of the assistant
  • Documentation of supervisory visit signed by applicable supervisor
supervision
Supervision
  • Supervision provided by the appropriate qualified provider.
  • Supervisory visits are required as often as needed to ensure both quality and appropriateness of services.
  • Review the child’s progress and make any adjustment to goals or treatment modalities.
supervision cont
Supervision cont.
  • Supervising licensed provider must document supervisory visits with student and PCA at a minimum of every 30 to 90 calendar days, or as often as needed.
  • Purpose is to ensure quality and appropriateness of services being provided.
supervision cont38
Supervision cont.
  • Condition of the child as well as qualified provider’s license requirements determines whether the supervision is direct versus indirect and the frequency of supervision visits.
supervision cont39
Supervision cont.
  • An on-site visit must be conducted at least every 90 calendar days.
  • Supervisor shall identify any gaps in aide’s ability to function competently and shall provide training as indicated.
billing
Billing
  • A unit of services equals 15 minutes for no more than 8.5 hours a day
  • The number of units billed is not to exceed the number of units in a day that the student is in the care of the school
billing cont
Billing cont.
  • While more than one assistant may attend the student during a school day, the unit for a particular period of the day shall not be billed for the services of more than one assistant.
billing cont42
Billing cont.
  • If the total number of units billed ends up with a fraction of a unit, round to the nearest unit
    • 50 minutes of care / 15 = 3.33 = 3 units
    • 100 minutes of care / 15 = 6.66 = 7 units
  • Regular school year is 180 days
    • May vary among school divisions
  • Services during the summer school sessions are billable as well.
resources
Resources
  • Amy Edwards

Medicaid in Schools Specialist, DOE

804-692-0150

[email protected]

  • Ashley Barton, LCSW

Maternal & Child Health Specialist, DMAS

804-371-7824

[email protected]

school health medical evaluations

School Health Medical Evaluations

Local Education Agency Medicaid Provider Manual

child focused iep
Child Focused IEP
  • Medical Evaluations should determine:
    • If the child’s IEP is appropriate to meet the health needs of the child; or
    • If there are medical services required for the student to receive a free and appropriate education
providers of medical evaluations
Providers of Medical Evaluations
  • Medical evaluation services are covered as physicians’ services
  • Persons performing these services must be licensed practitioners (physicians, physician assistants, and nurse practitioners) acting within the scope of practice
providers requirements cont
Providers Requirements, cont.
  • Schools must enroll as a health services provider
    • Have a school provider agreement completed and on file with DMAS
    • Provide DOE Medicaid Specialist (Amy Edwards) with copy of practitioner’s license requesting to provide medical evaluation services
    • Practitioner may be either employed or contracted with the school
covered services48
Covered Services
  • Identifying the nature or extent of a recipient’s medical or other health related condition;
  • May be face-to-face, chart review or telephonic consultation;
  • Review of a recipient’s initial IEP as necessary to determine the medical necessity for the medical/mental health related services designated by the IEP team;
covered services cont49
Covered Services, cont.
  • Annual review of a recipient’s IEP as necessary to determine continuing medical necessity for the medical/mental health related services designated by the IEP team;
  • Review of additional documents related to at recipient’s medical/mental health status either for consultative purposes or to determine medical necessity for services;
covered services cont50
Covered Services, cont.
  • Participating in meetings with IEP providers or families to provide medical input concerning a recipient’s disability and medical/mental health-related services needed;
covered services cont51
Covered Services, cont.
  • Coordinating medical/mental health related services rendered outside the school setting. For example, talking to a recipient’s primary care physician about medication needs; and
  • Completion of referral reports and documentation relative to the IEP.
medical evaluation billing
Medical Evaluation Billing
  • Code: T1024
  • Maximum Interim Rate: $96.51
  • Unit: Per encounter
documentation requirements53
Documentation Requirements
  • Positive and negative examination findings;
  • Diagnostic tests ordered and the results of the tests;
  • Diagnoses;
documentation requirements cont
Documentation Requirements cont.
  • An indication of whether further treatment is needed;
  • Referrals, including the name of the referring physician; and
  • Any recommended IEP changes.
ad