PROVIDER MEETINGS 2014
PERSONAL CARE AND NURSING SERVICES
AGENDA
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Welcome
State of CLTC
Scopes Changes
Tasks and Observations
Slot increases
Provider Compliance
Mobile Application
Reminders
SC Prime
STATE OF CLTC
• The numbers of Participants for the Community
Choices Waiver is continuing to increase.
• CLTC will enroll any participant who meets Program
requirements.
• CLTC does not have a waiting list.
• CLTC is actively working with other Divisions of
Medicaid to get participants eligible and enrolled.
• CLTC is glad to announce that with your July 1,
2014, there will be an increase of 10% for PCI, PCII
and Companion services.
Community Choices Waiver
Census FY14
13400
13200
13000
12800
12600
12400
12200
12000
Series3
PERSONAL CARE SCOPE CHANGES
• Providers may use paperless filing systems. Providers
must obtain approval from CLTC Central Office prior
to initialing an electronic filing systems.
• Medically Complex Children’s (MCC) Respite
Services will be added to PCII Scope
• Nurse Supervision for Children’s Personal Care must
be by a Registered Nurse.
• The Scopes of service will be removed from your
contracts and put in the CLTC provider manual
effective 7/1/14.
PERSONAL CARE/NURSING SCOPE
CHANGES
• The provider must ensure that employee’s license is
valid while transporting any participants.
• Highway Department verification must be obtained
initially and every two (2) years during employment.
• Copies of the initial and subsequent driving records
must be maintained in the employee’s personnel
file.
PERSONAL CARE/NURSING SCOPE
CHANGES
• The Personal Care Aide (PCA) must have a
minimum of ten (10) hours relevant in-service
training per calendar year.
• Documentation of training hours shall include topic,
name and title of trainer, training objectives, outline
of content, length of training, list of trainees, and
location.
• This documentation should be maintained in an
annual in-service manual for all employees.
PERSONAL CARE/NURSING SCOPE
CHANGES
• Each staff member’s personnel file must contain a
summary of their in-service training for the year.
• The summary must include the date of the training,
the subject or title of the training and the total
number of in-service hours earned.
PERSONAL CARE/NURSING SCOPE
CHANGES
Employee: Jane Doe
Year: 2013
Title of training
Date taken
# of hours
Hand washing
2/3/13
1
Dealing with a difficult Client
3/16/13
2
Safe Transfers
4/8/13
1
Documentation
2
511/13
CPR
6/21/13
4
Total hours earned: 10
PERSONAL CARE/NURSING SCOPE
CHANGES
• Criminal background checks must include all data
for the individual with no less than a ten (10) year
timeframe being searched.
• The criminal background check must include
statewide data.
• The statewide data must include South Carolina
and any other state or states the worker has resided
in within the prior ten years.
PERSONAL CARE/NURSING SCOPE
CHANGES
• Providers are required to give the participant
written information regarding advanced directives.
• The participant is required to sign and date a
statement that they have received this information.
• The nurse supervisor is also required to sign and date
the statement.
PERSONAL CARE SCOPE CHANGES
• Providers are require to inform participants of their
right to complain about the quality of PC II/HASCI
Attendant, HASCI Respite and/or MCC Respite
services provided.
• The participant is required to sign and date a
statement that he/she received this information.
• The nurse supervisor is also required to sign and date
the statement.
PERSONAL CARE/NURSING SCOPE
CHANGES
• 30, 60, 90 day suspension - Based on your
compliance review score, you may be suspended
from receiving new referrals for 30, 60, or 90-days.
• You will also be required to submit an approved
corrective action plan.
• If the corrective action plan is approved, the
suspension is automatically lifted at the end of the
suspension period.
PERSONAL CARE/NURSING SCOPE
CHANGES
• If the corrective action plan is not approved, the
provider will have 10 days to submit an approved
corrective action plan.
• If the second corrective action plan is not
approved, the provider will be terminated.
• Acceptable corrective action plans must:
• Address the deficiencies cited in the review
• Give a detailed plan for correcting the deficiencies
• Give an effective date when the correction plan will be
implemented
• Include any pertinent documentation such as new forms,
etc.
PERSONAL CARE/NURSING SCOPE
CHANGES
• Providers who have two (2) consecutive reviews
that result in suspension of new referrals, will be
terminated if the third review has a final score that
would result in a suspension of new referrals (100
and above).
• Your goal should be to get this
• Not this
PERSONAL CARE/NURSING SCOPE
CHANGES
• Providers can be terminated based on the results of
a single review.
PERSONAL CARE/NURSING SCOPE
CHANGES
• The provider is responsible for updating the Phoenix
system as needed with his/her telephone numbers,
e-mail address, holidays, physical address, and
administrator.
TASKS AND OBSERVATIONS
• PCA’s can not check out without entering the task
performed.
• Providers can pull reports that indicate activities
performed by the PCA or Nurse.
• Modifications are being made to make the report
more user friendly.
• Providers must monitor activities performed by
workers to ensure that they are in line with the
Service Plan.
• A decision will be made soon as to when providers
can stop using task sheets for CLTC participants.
PROVIDER COMPLIANCE RESULTS
JANUARY 1, 2013 TO MAY 21, 2014
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No Action – 53%
Corrective Action – 29%
30 Day Suspension – 9%
60 Day Suspension – 6%
90 Day Suspension – 2%
Termination – 1%
• Total providers reviewed - 286
PROVIDER COMPLIANCE CONT...
• We are looking at ways to enhance the provider
choice list.
• The enhanced choice list will contain items like:
last compliance review score
review action
date of last review
years in operation
any other information that participants can use to
make an informed choice.
MOBILE APPLICATION
• The mobile application may be used by in-home
service providers to check in/out for personal care,
nursing and case management services.
• The application is currently only available for
Android mobile devices.
• The application for iOS (I-Phones) will be available in
the near future.
• When the I-Phone application is ready, providers will
be required to use the mobile application.
MOBILE APPLICATION
• Before an in-home worker can use the mobile
application the following must take place:
• The provider must be set to mobile enabled. This must be
done by the provider group at CLTC. If this has been done,
you should see a mobile devices tab on your profile screen.
• Workers must be set to mobile enabled. You may see if a
worker is mobile enabled from the main worker tab (mobile
column will state yes).
MOBILE APPLICATION
MOBILE APPLICATION
• A password must be entered for the worker and the mobile
device ID must be entered
MOBILE APPLICATION
• The mobile application user guide can be found in
the Help section of the Phoenix provider portal.
• The link to download the mobile application and
the toll free support number for mobile application
issues can also be found in the Help section of the
Phoenix provider portal.
REMINDERS
• All providers have access to reports in Phoenix to
monitor activities of their workers.
• Nurse supervisors should be checking in Care Call
when making visits. Only a check in is required for
nurse supervisors.
• Providers must register their workers in Phoenix.
• Providers should terminate worker’s access to
phoenix when they leave the agency.
• Not terminating the worker’s access to phoenix
records is a HIPAA violation.
REMINDERS
• There is a training environment link under the Help
section in Phoenix provider portal for the IVR and
Mobile Application.
• There is a Report A Problem button on each screen
in Phoenix for providers who have Phoenix issues.
How many of you use this?
• Providers can use Conversations in Phoenix to
communicate electronically with Case Managers.
How many of you ever use this?
RESOURCES
• Provider-distribution@scdhhs.gov for policy and
billing problems.
• Carecall-distribution@scdhhs.gov for Care Call
problems
• Report a Problem button in Phoenix for Phoenix
related problems.
QUESTIONS
SC PRIME
• Discussion of SC Prime
• Its impact on your business
• Ways it will impact your business