Issue:
Vol 3 • Dec. 2011
Welcome
Legislative
Updates (go)
- Protecting Vulnerable Adults
SDS Insights (go)
- Update on new HCBS waiver regs
- Third Party review process
- Community First Choice PCA
- Medicare Info Office moving; Rx plan sign-up over
- New Staff
- Job Openings
Tips & Best
Practices(go)
- When is a service reimbursable?
Training (go)
- Waiver services webinar and more
Partner News & Community Events (go)
- In case you missed it...
- 2012 Full Lives conference dates
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Welcome
2011 has been a productive year for SDS. We completed our Medicaid waiver Corrective Action in June. The team that came up for our final review was so impressed with what we’d put into place, they invited us to showcase our success to a national audience at the National Association of States United for Aging & Disabilities conference in September in Washington, D.C. This fall, we developed a third-party review process for waiver eligibility reassessments that result in denial.
2012 promises to be another year with significant developments for SDS. We’re looking forward to your feedback on our draft HCBS waiver regulations. We’re hoping proposed legislation to better protect vulnerable adults will move out of committee and into law. And we recently signed a contract with Home & Community Based Services Strategies Inc. to help us develop the Community First Choice option.
Read on for details!
As always, if you have a question you’d like to see answered here, or news you’d like to share, please email us at sdsnewsletter@alaska.gov
Thanks for all you do in support of our shared mission of timely, quality care that promotes dignity, choice and independence!
Warm regards, Duane
Duane Mayes, Director
Legislative Overview
2012 Legislative Session: Protecting Vulnerable Adults
This is the second year of the two-year session. These bills made it through the Judiciary committees last year, and will start this session in Finance.
•HB 150 & SB 86 - Protection of Vulnerable Adults/Minors is the official short title. These Governor’s bills add two new protections against financial exploitation, add more mandated reporters and expand the definition of reportable harm. The legislation is a collaborative effort between Office of Elder Fraud & Assistance (Dept. of Administration) and Adult Protective Services (APS).
- The first financial protection is an emergency conservatorship. Vulnerable adults at imminent risk of losing resources will be able to get a hearing within 72 hours to get help with their financial affairs.
“Stolen funds are hard to trace and recover,” said Scott Sterling of Elder Fraud & Assistance. “Prevention, in this area, is much better than cure.” The second protection allows elders or their advocates can apply, without a lawyer, for a 20-day financial protective order (like domestic violence victims can apply for a physical protective order). This is sorely needed, said Brenda Mahlatini of APS. “Currently we’re not able to freeze an account, so by the time we get a court order, all the money’s gone.”
- The law would also add mandated reporters: employees of nursing homes and other health care facilities, and educators and administrative staff of educational institutions. School staff may not think of turning to APS, since they work mostly with children, but there are many students 18 and older, including disabled adults who can stay in the school system until 22.
- “Undue influence” would be added as a reportable harm. APS sees many cases where someone uses their position of trust to exploit a vulnerable adult. There are gray-area situations where a relative moves in and doesn’t quite pull their full weight, which APS assesses on a case-by-case basis to ensure there’s no exploitation. This clause will be most helpful in other situations that are much more clear: when a person repeatedly targets a type of vulnerable adult — widows, for example — gains their trust, and takes their money and property.
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SDS Insights
Draft regulations out for comment
Regulations on SDS’s new Medicaid home and community-based waiver categories are now out for comment.
Once the regulations take effect in the spring, the Medicaid recipient categories will be:
- Children with Complex Medical Conditions: No change.
- Intellectual and Developmental Disabilities: A new name for MRDD.
- Adults with Physical and Developmental Disabilities: A new waiver category.
- Alaskans Living Independently: A new waiver category for both adults with physical disabilities and frail elderly Alaskans.
This change is an administrative one to satisfy federal requirements for program structure, said Angela Salerno, policy and program development manager. “No one’s going to lose eligibility; no one’s going to get their service array changed.”
Other items covered:
- Provider certification and enrollment requirements: For certification, providers must adhere to the new Standards of Practice for Home and Community-Based Services. The regulations also set out the reasons the department will deny a provider certification.
- Recipient safeguards: Providers are responsible for protecting recipient health, safety and welfare. They must have and use systems to manage and report
- critical incidents,
- medication errors, and
- the use of restraints or restrictive intervention.
The regulation specifies which provider types must help administer medication and when, and sets out the safe-medication-administration policies providers must have and use.
- Requirements for screening, assessment, level of care, and plan of care: More entities may conduct a waiver screening; the department or an agency designated by the department will conduct the waiver assessment. The regulation lists criteria and timelines for a plan of care amendment.
- Redesigns environmental modification service processes.
SDS will hold information sessions on the proposed regulations on Tuesday, Dec. 20, with time for questions and answers. Registration is required.
You may submit your comments:
- Be email: angela.salerno@alaska.gov
- By mail: Division of Senior and Disabilities Services,
ATTN: Angela Salerno, P.O. 110680, Juneau, Alaska, 99811
- During a public comment session:
- You may comment at a Legislative Information Office session in person or by phone, 463-5009 for Juneau or 1-855-463-5009 toll-free statewide.
- Juneau/statewide call-in, Jan. 10, 1-4 p.m.; LIO: State Capitol, Terry Miller Building, Suite 104
- Fairbanks/statewide call-in, Jan. 12, 1-4 p.m.; LIO: 1291 Sadler Way, Suite 308
- Anchorage in-person only (you may listen in by phone), Jan. 13, 1-4 p.m.; LIO: 716 W. 4th Ave., Suite 200
If you need an accommodation for a disability, please contact Angela Salerno, 465-4874, by Jan. 5.
Comments must be received by 4:30 p.m. Monday, Jan. 23, 2012.
Third-party review process
SDS has developed a process to have a contractor independently review any re-assessment denials for waivers. Qualis Health is now conducting reviews.
To prevent the need for a review, make sure assessors have complete records for re-assessments. Care coordinators and recipients should supply:
- copies of the previous 12 months of medical & functional information, and
- a current Verification of Diagnosis (VOD).
Records can be emailed to dsdswaiver@alaska.gov or hard copies can be given to the assessor at the assessment. Please submit documents no later than 5 p.m. the next business day following the assessment. Please understand that the assessor has a submission timeline of three days from the date of assessment, so it’s important to get supporting information to SDS as quickly as possible.
For more information, see these FAQs or attend the InfoShare sessions. You may also contact Leanna Hunter, 269-3604; Kathi Potter, 269-2610, or Jan Bragwell, 269-3693.
Community First Choice option
Under the Affordable Care Act, a new section added to the Social Security Act gives states a new option for providing home- and community-based personal care services and supports. The act took effect Oct. 1, and Alaska’s in the forefront of developing a Community First Choice option to better support Alaskans who need assistance with instrumental activities and with daily living activities.
The option, which is not a Medicaid waiver program, is similar to the current Personal Care Assistance (PCA) program but covers more services. The new program includes nursing home transition, emergency response systems (for example, an alert system for a person who has fallen and can’t get up), and personal care services.
One service that the Community First Choice option proposes covering -- that the existing PCA program doesn’t -- is supervision and cueing. When an Alaskan who experiences Alzheimer’s needs to be reminded to take a bath, that cueing would count as a Medicaid-billable part of that person’s direct care. Another benefit to the state: the federal match for this option is 6 percent higher than standard Medicaid.
The requirements for adopting this Community First Choice option mesh well with the person-centered philosophy behind SDS’s Personal Care Assistant program. While the federal regulations haven’t been finalized, states do know they must:
- have a strong quality assurance component, and
- form a Development & Implementation Council to give input on the program’s design before the state seeks federal approval and give ongoing feedback on quality assurance; a majority of the members must experience a disability.
SDS has hired contractor Home & Community Based Services Strategies Inc. to help develop the new program. The program design deadline is June 30, 2012.
The Medicare Information Office is moving!
Early next year, the Medicare Information Office will be moving to the Public Assistance office at the corner of Fourth Avenue and Gambell Street in Anchorage. The contact information will stay the same: 269-3680, 1-800-478-6065 toll-free statewide, and hss.medicare@alaska.gov.
Medicare Part D sign up ended Dec. 7
The enrollment period for Medicare prescription drug plans ended Dec. 7. Keep in mind recipients of both Medicare and Medicaid are exempt from enrollment deadlines – they can sign up anytime.
New SDS staff
- SDS has a new quality assurance nurse: Michelle Moore. She will provide nursing expertise for quality oversight of the Medicaid waiver programs, as well as other duties including assessments and input to Adult Protective Services. Moore started her nursing career as a psychiatric RN (and loved it), then worked in surgical, renal, mother/baby and other medical specialties. She plans to add a master’s degree to the associate’s degree she earned in 2005.
- The IDD unit welcomes Kristin Lee Vandagriff, a new health program associate who will be working with care coordinators, participants and guardians. She previously worked at Hope Community Resources for six years as an individual support specialist. Vandagriff has also volunteered with Special Olympics for 12 years. She can be reached at 334-2536 or kristin.vandagriff@alaska.gov.
- Wendy Freeland, RN starts today as the new PCA assessor supervisor. Originally from Indiana, she has nine years of nursing experience, including working as a public health nurse in Bethel and as a nurse at Alaska Psychiatric Institute and Northstar in Anchorage. Freeland said she’s looking forward to learning her new role with SDS.
Now hiring
SDS is hiring an office assistant II, health program manager IIs and a developmental disability assessor, with positions in Anchorage and Fairbanks. For details, go to this link.
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Tips & Best Practices
When is a service reimbursable?
TIP: A service is Medicaid reimbursable only when:
- Provided by certified and enrolled agency
- Provided to Medicaid participant
- Medicaid participant has met eligibility for the service
- Approved in service plan
- Prior authorized
- Delivered by qualified/trained service staff
- Documented properly by service staff
- Billing created with correct code/processed within 1 yr of delivery
- Service note/billing handled properly (ex: HIPAA)
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Training
Upcoming SDS trainings
Upcoming trainings include advanced care coordination; critical incident reporting and critical incident improvement plans. The “residential HCB waiver services in assisted living homes” training is now being offered as a webinar; the first online class started Dec. 5.
The SDS training schedule can be found on the SDS Training page . The new schedule for January-March is up now.
A few new trainings are planned for 2012, including a one-day Plan of Care Development class for care coordinators about the plan of care document itself (for all waiver types). We are also planning a one-day Care Coordination Administrator Training on what CC administrators need to know and do.
SDS trainings are also included in the Trust Training Cooperative learning management system, www.ttclms.org/catalog.php , which has a full catalogue of classes.
We welcome your suggestions about trainings you’d like to see! Please send your requests and feedback to our training specialist, Kara Thrasher-Livingston, at Kara.Thrasher-Livingston@alaska.gov.
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Partner News & Community Events
In case you missed it in recent SDS e-Alerts…
- Diagnosis code now required on Personal Care Agency and Home- and Community-Based Services (HCBS) claims Starting Jan. 1, 2012, electronic Medicaid claims must conform to new federal HIPAA “5010 standards.” Claims must contain an ICD-9 Diagnosis Code, or they won’t be paid. This affects all PCA and HCBS providers. Because these providers don’t have access to recipients’ medical records, they will use a default diagnosis code. For the codes and other details, select “HIPAA 5010” or “Training” at http://medicaidalaska.com, or contact AKHIPAASupport@acs-inc.com, 644-6831 or 855-226-9391 (toll-free).
Watch for updated SDS Verification of Diagnosis and Qualifying Diagnosis Certification forms. Coming soon!
- Easier background check payment, ROI form filing
Prospective new employees will soon be able to pay for a background check using a credit card, and get online confirmation of the required Release of Information form. Thanks, DHSS Certification & Licensing. Contact: Teresa Narvaez, teresa.narvaez@alaska.gov.
Save the date for the 11th annual Full Lives Conference
The 2012 Full Lives Conference for Direct Service Professionals will be Wednesday and Thursday April 18-19, in the Sheraton Anchorage Hotel. The statewide event will provide motivation, education and networking to direct service frontline staff working in developmental disabilities, behavioral health, Alzheimer's disease and related disorders, traumatic brain injuries, and substance abuse/prevention. Supervisors, administrators, and consumers are also invited.
For details on registration, financial assistance and more: www.fulllivesconference.org. If you are interested in presenting or have other questions, email raelynn@alaskachd.org.
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