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CAP/DA Local Agency Reviews and Documentation Guidelines. Tracy Colvard, CAP/DA and PCS Manager May 2006. General CAP/DA Program Operations. Organizational structure and staffing Service provider resources Referral and pre-screening procedures Assessment and case management practices
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CAP/DA Local Agency Reviews and Documentation Guidelines Tracy Colvard, CAP/DA and PCS Manager May 2006
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
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
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
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
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
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
Record ReviewMinimum 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
Record ReviewMinimum Monitoring Requirements • Meals and Telephone Alert • Monthly review of service provision with client/provider • Review provider claims prior to billing Medicaid
Record ReviewMinimum 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
Record ReviewMinimum 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)
Documentation Entries should include: Who, What, When, Where, Why If it’s not documented, it didn’t happen !!
Examples of Billable and Non-billable Case Management • Handout
Case Management Exercise • Joe Blow
