ODJFS Communications Strategy: A New Approach

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Home Care Attendant: An
Overview of Provider
Requirements
Bureau of Long Term Care Services and Supports
1
Home Care Attendant
New Rules
OAC 5101:3-46-04.1 (Ohio Home Care Waiver Program: Home Care
Attendant Services)
OAC 5101:3-46-06.1 (Ohio Home Care Waiver Program: Home Care
Attendant Services Reimbursement Rates and Billing Procedures)
OAC 5101:3-50-04.1 (Transitions Carve-Out Waiver Program: Home Care
Attendant Services)
OAC 5101:3-50-06.1 (Transitions Carve-Out Waiver Program: Home
Care Attendant Services Reimbursement Rates and Billing Procedures)
2
Home Care Attendant
Home Care Attendant Services:
– Permits unlicensed individuals (non-agency
providers) to assist consumers with:
• Self administration of medications
• Performance of certain skilled tasks that would otherwise be
completed by a nurse
• Personal care tasks
3
HCA services are provided to
consumers in lieu of nursing services.
HCA services are not in lieu of
personal care aide services.
4
Home Care Attendant
HCA can assist with certain medications
including:
• Oral medications (includes medication administered through
a metered dose inhaler)
• Topical medications (includes medication applied to outer
skin, including transdermal medications and eye, ear and
nose drops, vaginal or rectal suppositories)
• Subcutaneous injections of routine doses of insulin
5
Home Care Attendant
HCA can assist with certain medications including:
• Programming of a pump to administer routine doses of
insulin
• Medication via stable, labeled gastrostomy or jejunostomy
tubes
• Doses of schedule II, III IV or V drugs only when
administered orally or topically
6
Home Care Attendant
Nursing tasks that Home Care Attendants
can not perform:
•
•
•
•
Intravenous insertion, removal, or discontinuation
Intramuscular injections
IV medication administration
Subcutaneous injections (except for routine doses of insulin)
7
Home Care Attendant
Nursing tasks that Home Care
Attendants can not perform:
• Programming of a pump to deliver medications
(including epidural, subcutaneous and IV), except
routine doses of insulin
• Insertion or initiation of infusion therapies
• Central line dressing changes
8
• HCA’s who provide activities to a
consumer in accordance with the
limitations as set forth in the rules,
including activities in accordance with the
authorizing health care professional’s
authorization shall not be considered to be
engaging in the practice of nursing as an
RN or LPN in violation with the Nurse
Practice Act.
9
HCAs must:
• Not be the consumer’s authorized
representative.
• Not be the consumer’s legally responsible family
member as defined in 5101:3-45-01 of the Ohio
Administrative Code.
• Not be the consumer’s legal guardian or foster
parent.
10
• The HCA will secure the services of a RN, in
agreement with the consumer and/or
authorized representative.
• The HCA must participate in face-to-face visit upon the
initiation of services and every 90 days thereafter with the
consumer, authorized representative, and the RN for the
purpose of monitoring the consumer’s health and welfare.
• The RN will serve as a resource for the purpose of
answering any questions that the HCA, consumer, and/or
authorized representative have about the consumer’s needs,
medications and other issues.
11
• The face-to-face RN consultation visit
activities shall be documented by the HCA
and the RN in the consumer’s clinical
record.
• The HCA will discuss the results of the
face to face consultation visit with the CM
and the consumer and/or authorized
representative.
12
Clinical Records must be maintained by the
HCA for each consumer in a manner that
protects the consumer’s privacy and
confidentiality of these records.
• HCA must maintain the clinical records at their place and
business and also maintain a copy at the consumer’s
residence.
– The HCA’s place of business is considered to be a location
other than the consumer’s residence.
13
The HCA’s clinical record must include
the following information:
– Consumer’s identifying information, including,
but not limited to: name, address, age, date of
birth, race, marital status, significant phone
numbers and health identification numbers.
– Consumer medical history.
14
HCA’s clinical record must include the
following information:
(continued)
• Names and contact information for all of the
consumer’s licensed health care professionals.
• Copy of the initial and subsequent all service
plans.
• Documentation of all allergies and dietary
restrictions.
15
The HCA’s clinical record must include the
following information:
(continued)
– A copy of any advance directives, including but not
limited to a “do not resuscitate order” (DNR) or a
“medical power of attorney” if they exist.
– The ODJFS 2389 and 2390 Forms as appropriate.
16
HCA’s clinical record must include the following
information:
(continued)
– Documentation of HCA services performed or not performed,
arrival times, departure times, and the dated signature of the
provider, and consumer or authorized representative, verifying
service delivery upon completion. Nothing shall prohibit the use
of technology-based systems. The consumer’s or authorized
representative’s signature of choice shall be documented
on the consumer’s all services plan, and shall include, but
not be limited to the following forms: handwritten signature,
initials, a stamp or mark, or electronic signature.
17
HCA’s clinical record must include the
following information:
(continued)
– Copy of the log detailing the count and
reconciliation of schedule II-V drugs for which
the HCA is assisting consumer with selfadministration.
18
HCA’s clinical record must include the
following information:
(continued)
– Progress notes, signed and dated by the HCA
documenting all communications with the CM,
licensed health care professionals, including
the authorizing health care professional, other
members of the multidisciplinary team.
19
HCA’s clinical record must include the following
information:
(continued)
– Documentation of the face-to-face visits at the initiation of
service, and every 90 days with HCA, consumer and the
authorized representative and the RN.
– For the first visit, document that CM was present.
– The documentation should include issues discussed at the visit.
20
HCA’s clinical record must include the
following information:
(continued)
– Discharge summary that is signed and dated
by the departing HCA when services are no
longer provided. The summary should include
documentation regarding progress made
toward achievement of the goals as specified
in the all services plan.
21
HCAs must:
Request reimbursement for the provision
of HCA services in accordance with
5101:3-46-04.1 and 5101:3-50-04.1
22
• To be reimbursed as a HCA, the provider
must be identified and specified on the
consumer’s all services plan that has been
prior-authorized prior authorized by
ODJFS or its designee.
23
• Upon request of the consumer or the
consumer’s authorizing health care
professional, the HCA must perform a
successful return demonstration of the
service to be provided.
• Meaning the consumer or the authorizing health
care professional can ask the HCA to perform in
front of the them a specific task to determine that
the HCA has the ability to correctly perform task.
24
– HCA must complete at least 12 hours of
continuing education regarding HCA services
annually. Evidence of completion must be
submitted to the department no later than the
annual anniversary date of the issuance of the
HCA’s initial Medicaid provider agreement.
25
• Continuing education topics can include but are not
limited to the following:
–
–
–
–
–
–
–
–
–
–
–
Consumer health and welfare
CPR
Patient rights
Emergency preparedness
Communication skills
Aging sensitivity
Developmental stages
Nutrition
Transfer techniques
Disease-specific trainings
Mental health issues
26
• The consumer, authorized representative,
and provider shall report to the case
manager all instances that a HCA appears to
have:
– Provided nursing services, other than assistance with
self-medication or the performance of nursing task
authorized in the rules.
– Provided services not in accordance with the tasks
and assistance with self-medication which had been
approved by the authorizing health professional’s
authorization.
27
• ODJFS may initiate an investigation based
on the report of a HCA providing
inappropriate services and shall report the
findings to the Ohio Board of Nursing.
28
Home Care Attendant
• Provider Enrollment
• New Provider Type 26-Home Care Attendant
• Interested providers will need to complete a new
provider application with HCA provider addendum
» Required for all providers including existing waiver
providers
29
• ODJFS agrees to enter into a provider
agreement with an individual to provide
HCA services to a consumer enrolled on
the following waivers:
– Ohio Home Care Waiver
– Transitions Carve Out Waiver
30
• The HCA must:
Agree to comply with all Medicaid provider
requirements in Division 5101:3 of the
Administrative Code.
Agree to comply with all of the waiver provider
requirements in 5101:3-45, 5101:-46 and 5101:350 of the Administrative Code.
31
The HCA must:
Agree to comply with the requirements in 5111.88 and
5111.8811 of the Revised Code and all requirements
set forth in this rule.
32
• HCA shall not provide services until:
– ODJFS approves the JFS 2389/ 2390 Home Care Attendant
Medication Administration Authorization or Home Care Attendant
Skilled Nursing Task Authorization that contains the following:
• Written consent from the consumer or authorizing representative
allowing the HCA to provide HCA services, and assuming
responsibility for supervising the activities of the HCA.
• When there is authorized representative, who is supervising
activities of the HCA, they will be present and awake during the
delivery of the services.
33
– Written consent from the consumer’s authorizing health care
professional attesting that the consumer and or the authorized
representative have demonstrated the ability to monitor the
consumer-specific HCA service for the consumer. This consent
includes all of the following:
• Consumer’s name and address;
• Description of the specific nursing task or self-administration of
medication that the HCA will assist consumer, including the selfadministration of medication, name of medication, dosage, and
route of administration;
• Times or intervals when HCA is to assist with self-medication of
each dosage of medication or performance of nursing tasks;
34
– This consent includes all of the following:
(continued)
• Dates which HCA is to begin and end providing assistance;
• List of severe adverse reactions that the HCA must report to
the consumer’s health care professional if one should occur;
• At least one telephone number which the HCA can reach the
consumer’s health care professional in an emergency for
consultation after contacting an emergency personnel;
• At least one fax number that the HCA can reach the
authorizing health care professional when the HCA observes
that the scheduled medication's) is missing or can not be
reconciled.
35
This consent includes all of the following:
(continued)
• Instructions the HCA must follow when assisting
the consumer with performance of a nursing task
or self-administration of medications, including, but
not limited to instructions for maintaining sterile
conditions and for storage of task-related
equipment and supplies.
36
HCAs must:
– Be at least 18 years old
– Provide HCA services to consumer enrolled on the
Ohio Home Care Waiver or Transitions Carve Out
Waiver
37
• To make application as a HCA, the
individual must have a valid Social
Security number and one of the following
forms of identification:
– Alien ID
– State of Ohio ID
– Valid Driver’s License
38
HCA applicant must:
– Provide ODJFS evidence to its satisfaction
of all of the following:
– HCA either meets the personnel qualifications as
specified in 42 CFR 484.4 for home health aides, or has
successfully completed at least one of the following:
» Competency evaluation program, or training and
competency program by the Ohio department of
health
39
• A training program approved by the department
that includes training equivalent to a training and
competency evaluation program (CSTO-Consumer
Specific Training Option) which includes:
•
•
•
•
Basic Home Safety
Universal Precautions
Consumer-specific personal care aide services
The labeling, counting, and storage requirements for
schedule II, schedule III, schedule IV and schedule V
medications
40
• HCA must provide ODJFS a certificate of
completion of a first aid course that:
– Is not exclusively internet based
– Includes hands-on skills training provided by a
certified first aid instructor
– Requires the individual to perform a successful
demonstration of what was learned in the course
41
• HCA must show ODJFS evidence of training and
instruction about how to deliver the HCA
services that are authorized by submitting the
ODJFS 2389/2390 with application packet.
– Training is consumer-specific and may be provided by
the authorizing health care professional and/ or the
consumer or the authorized representative in
cooperation with the consumer’s authorizing health
care professional.
42
• The HCA must receive education from the
authorizing health care professional about
health and welfare considerations that are
appropriate for an individual or group
setting.
43
• HCA Services in Group Setting
(Approved on a Case by Case basis only)
– HCA’s can only provide HCA services to 2 or 3 consumers at the
same residence, at the same time within the limitation noted
below.
– Subject to approval by clinical review by ODJFS in consultation
with the consumer, authorizing health care professional, CM and
the multidisciplinary team.
– Clinical review includes the consumers’ needs, and desires, and
the skill level and training needs of the HCA and the ability to
assure health and welfare of the consumers.
44
Home Care Attendant
• HCA service providers are limited to providing a
maximum of 12 hours or forty-eight units of HCA
services during a 24 hour period.
– Exception is made for HCA services that are provided in
a group setting.
45
Home Care Attendant
• Reimbursement
• This means that claims that are submitted for a
single date of service that are in excess of 48 units
will be denied.
46
Home Care Attendant
• Reimbursement
• This does not mean that a consumer can only
receive 12 hours of HCA service a day. If
consumer requires more than 12 hours a day of
HCA service there would need to be at least 2
shifts and 2 different service providers.
47
Home Care Attendant
Provider Requirements
Questions
48
Home Care Attendant
Billing Instructions
49
Home Care Attendant
• Reimbursement
• New Code S5125=Home Care Attendant
Services/Nursing
» Base Rate=$33.36
» Unit Rate=$4.17
50
Home Care Attendant
• Reimbursement
• New Code S5125=Home Care Attendant
Services/Personal Care
» Unit Rate=$3.00
» New modifier U8
51
Home Care Attendant
Codes and U8 Modifier
52
Home Care Attendant
S5125 (HCA/N) – This home care
attendant code is noted on a claim when
authorized nursing tasks and/or
authorized medication assistance are
provided.
53
Home Care Attendant
S5125 with U8 modifier (HCA/PC) – This
home care attendant code (modified with
the U8 modifier) is noted on a claim when
the provider provided personal care
tasks to a consumer during the same visit
authorized nursing tasks and/or authorized
medication assistance were provided.
54
Home Care Attendant
NOTE: Providers cannot bill the S5125 code
modified with the U8 modifier unless
authorized nursing tasks and/or authorized
medication assistance were provided
during the same visit.
55
Home Care Attendant
Modifiers
U2 – This modifier reflects the second
HCA (HCA/N or HCA/PC) visit provided on
the same day, for the same consumer, by
the same provider.
56
Home Care Attendant
Modifiers
U3 – This modifier reflects the third or
more HCA (HCA/N or HCA/PC) visit
provided on the same day, for the same
consumer, by the same provider.
57
Home Care Attendant
Modifiers
U8 – This modifier reflects the HCA/PC tasks performed
during an HCA visit. A provider can only bill the HCA/PC
tasks when the provider provided personal care tasks to
a consumer during the same visit where authorized
nursing tasks and/or authorized medication assistance
were provided.
58
Home Care Attendant
Visits
Each HCA visit must be billed on a separate line, and
there must be a two or more hour lapse between any
previous or subsequent HCA visits. Therefore, all of the
HCA services that aren’t separated by a two hour or
more lapse are provided within one HCA visit. However,
HCA/N and HCA/PC tasks provided during the same
visit are billed on separate lines.
59
Home Care Attendant
Questions
60
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