DCH Updates –
SOURCE
st
July 1 Release
August 6, 2010
Presented by
Jean Carpenter, RN
Director of Quality Assurance and Education - SCM
Welcome
 Roll Call
 Webinar/Conference Call Format
 Housekeeping
Objectives
 At the end of this presentation, participants
will be able to:


Identify updates to DCH regulations for
SOURCE.
Understand how revisions impact the role
of the Medical Director within SOURCE
Care Management.
Chapter 600 – SOURCE Overview
 601. Introduction to SOURCE
 SOURCE



Operates under Elderly and Disabled 1915-c
Home and Community Based Services
Medicaid Waiver
Eligible members receive Supplemental
Security Income (SSI)
Members meet Intermediate Level of Care for
Nursing Home placement
Chapter 600 – SOURCE Overview
(cont’d)
 601. Introduction to Source
 SOURCE
 Individuals must be



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physically, functionally impaired
in need of services to assist with the performance
of ADLs
Targets individuals who are elderly and
physically disabled
Incorporates PCPs to address medical needs
and need for community based long-term care
services
Chapter 600 – SOURCE Overview
(cont’d)
 601. Introduction to SOURCE
 SOURCE Case Management Provider is
contracted with DCH to provide Enhanced
Primary Care Case Management services for
eligible older and physically disabled Medicaid
recipients.
Chapter 700 – Eligibility
 701. Eligible Members (New)
 SOURCE

Provides Home and Community Based
Services to elderly and physically disabled
members who are functionally impaired and
require assistance to perform the ADLs and
who meet the Intermediate Nursing Home
Level of care for placement in a nursing
facility.
Chapter 800 – Scope of Services
 801.2 Level of Care Criteria

a) The SOURCE RN/LPN, through the use of
the MDS-HC(v-9), Level of Care justification
criteria (Appendix I), and professional
judgment, determines the Level of Care (LOC)
for members during the assessment process.
Chapter 800 – Scope of Services
(cont’d)
 801.3 Procedures
 Terminology changed


#3 Placement form (new) vs. Appendix F
#5 SOURCE Level of Care Placement Form
vs. Appendix F
Chapter 800 – Scope of Services
(cont’d)
 804 Case Management (Added)
 SOURCE case managers

Consist of nurses, RN and LPN, currently
licensed in Georgia and social services
workers
Chapter 800 – Scope of Services
(cont’d)


Section 804 (cont’d)
Program policy does not mandate specific
education and experience requirements for
CM staff; however, best practice suggests the
following guidelines:


Bachelor’s degree in a healthcare or human
service field such as nursing, social work,
sociology, psychology, etc.
Two years experience in the field of case
management
Chapter 800 – Scope of Services
(cont’d)
 807 Community Services (Added)
 Triggers for referral to SOURCE
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Cognitive loss
Physical impairment
Acute illness
Exacerbation of a chronic illness
An unmet need for assistance with ADLs and
IADLs due to the lack of an adequate and/or
reliable informal support network.
Chapter 900 – SOURCE Member
Enrollment (cont’d)
 903 Program Admission

Step#2. Approval of the nursing home level of
care as determined by the assessment nurse
using the information gathered from the MDSHC (v9) and compared to the Level of Care
Justification
Chapter 900- SOURCE Member
Enrollment (cont’d)
 Section 903 (cont’d)
 Procedures


b) Following discussion of information
presented, the multidisciplinary team reviews
the Level of Care, MDS-HC and other
SOURCE approved assessment tools, with
the RN/LPN presenting justification as
needed.
c) The team recommends confirmation of the
Level of Care
Chapter 900 – SOURCE Member
Enrollment (cont’d)
 Section 903 (cont’d)

Procedures

f) Following team meeting, the SOURCE level of
Care Placement form should be faxed to DCH at:
404-463-2889 for enrollment
Chapter 900- SOURCE Member
Enrollment (cont’d)
 Section 903 (cont’d)
 Procedures

k) The supervising RN reviews the MDS-HC,
completes and signs the MDS-HC
Participants Form… RN reviews the
findings of the MDS-HC and determines
level of care based on the clinical
assessment.
Chapter 1000 – SOURCE Carepaths
(cont’d)
 1002 Carepath Development and
Completion (new)


Note: When a new service is required as the
result of a change in member support or
functional capacity; the physician signature
and date on the Carepath will confirm his or
her review and approval of the new plan of
care.
Example:

7/30/10 PSS initiated Dr. Doctor 8/4/10 (team
meeting date)
Chapter 1000 – SOURCE Carepaths
(cont’d)
 1003 Completed Carepaths (Added)

During the initial review of the individualized
member carepath with the PCP or designee
(PA, NP or RN), the following exchange of
information will occur:

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PCP role in patient education and treatment
monitoring of chronic conditions at home
Self care and informal support
Reimbursed services ordered
Chapter 1400 - Provider Performance
Monitoring (cont’d)
 1406. Right to Appeal
 B. Failure to Meet Nursing Home Level of Care
 Members who fail to meet the Nursing Home Level of
Care Criteria will be:
 Reviewed by the Interdisciplinary team
 Receive review of the team prior to issuance of the
Appendix Z

The assessment nurse will present, or, at a minimum,
be available to answer questions about the
member’s MDS-HC assessment, additional
assessments and any other documents used in the
LOC determination…
REVISION TO
FORMS
Appendix U – SOURCE Contact Sheet
 April 2010 updates
 PCP Conference
 PCP signature
 Date
 Case Manager
Signature
 Date
 July 2010 updates
 PCP Conference
 PA Signature
 Date
 PCP signature
 Date
 Case Manager
Signature
 Date
QUESTIONS
References
 www.dch.georgia.gov
 Policies and Procedures for Service Options
Using Resources in Community
Environments (SOURCE), July 1, 2010