Individual Care Assistant Services Local Education Agency Medicaid Provider ManualSlide 2
Purpose Common Acronyms Provider Participation Requirements Covered Services Documentation RequirementsSlide 3
Commonly Used Acronyms VDOE - Virginia Department of Education DMAS - Department of Medical Assistance Services CMS - Centers for Medicare & Medicaid ServicesSlide 4
Commonly Used Acronyms cont. EPSDT - Early & Periodic Screening, Diagnosis, and Treatment CHIP – Federal Child Health Insurance Program FAMIS – Family Access to Medical Insurance Security Program – Virginia\'s CHIP program FAMIS Plus – Children\'s Medicaid in VirginiaSlide 5
Commonly Used Acronyms cont. IEP - Individualized Educational Program GAF - Global Assessment of Functioning LEA - Local Education Agency POC - Plan of Treatment/Plan of Care PCP - Primary Care Physician PCA – Personal Care Assistant QMR - Quality Management ReviewSlide 6
Provider Participation Requirements Chapter IISlide 7
Categories of Services Nursing Occupational Therapy Physical Therapy Speech Language Pathology Psychology (Behavioral)Slide 8
Nursing PCAs Must meet least capabilities for unlicensed assistive work force as required by the Department of Education, Virginia School Health Guidelines, VDH and VDOE, 1999 (page 63) www.doe.virginia.gov/support/health_medical/virginia_school_health_guidelines/developing_program_infrastructure.pdfSlide 9
Nursing PCAs cont. Must get preparing for helping with meeting the particular wellbeing needs of the understudy as plot in the accompanying: Virginia School Health Guidelines Manual, Specialized Health Care Procedures Manual, Manual for the Training of Public School Employees in the organization of Medication, andSlide 10
Nursing PCAs cont. Manual for preparing of Public School Employees in the Administration of Insulin and Glucagon. VDOE preparing distributions might be found on the VDOE site at www.doe.virginia.gov/support/health_medical/index.shtmlSlide 11
Nursing PCAs cont. Must be recognized in the understudy\'s IEP. Must be incorporated into the Plan of Care (POC) arranged by the authorized enlisted medical caretaker (RN). Individual tend to nursing administrations must be managed by a RN. ADL and IADL administrations don\'t require doctor request.Slide 12
PCAs for Practitioners of the Healing Arts Specific administrations must be requested by a Department of Medical Assistance Services (DMAS) qualified specialist of the mending expressions acting inside the extent of their licensureSlide 13
PCAs for Practitioners of the Healing Arts cont. Individual watch over the recuperating expressions must be trainined and managed by a DMAS qualified specialist of the mending expressions (OT, PT, SLP, Psychiatrist, Psychologist).Slide 14
PCAs for Practitioners of the Healing Arts cont. Leading body of Physical Therapy (18 VAC 112-20-10 et seq.) Licensed PT can manage bolster faculty who are assigned routine errands identified with active recuperation; be that as it may… supervision must be immediate.Slide 15
PCAs for Practitioners of the Healing Arts cont. OT - Board of Medicine (18VAC85-80-110-111 ) Unlicensed word related treatment work force might be managed by an OT or a COTA. A word related advisor may give clinical supervision to up to six word related treatment work force…Slide 16
PCAs for Practitioners of the Healing Arts cont. Leading group of Audiology & Speech Language Pathology 18VAC30-20-240 Supervision of unlicensed partners A SLP… might guarantee that "PCA" perform just those exercises … which are suitable with their level of preparing. The character of the "PCA" might be revealed… preceding treatment and… made a part of… the document.Slide 17
PCAs for Practitioners of the Healing Arts cont. Leading body of Psychology (18VAC125-20-10 ) … screens the execution of the individual administered and gives general, recorded individual interview, direction and guideline concerning the aptitudes and skills of the individual managed.Slide 18
Provider Requirements cont. The DOE instructional pamphlets might be found on the DOE site at under the \'Leading body of Education Guidance Documents\' www.doe.virginia.gov/boe/direction/index.shtmlSlide 19
Covered Services Chapter IV Services to help the tyke with incapacities in independence, interchanges, and portability aptitudes.Slide 20
Nursing PCAs Must be distinguished in the understudy\'s IEP. Must be incorporated into the Plan of Care (POC) arranged by the authorized enrolled medical caretaker (RN). Individual look after nursing administrations must be managed by a RN. ADL and IADL administrations don\'t require doctor request.Slide 21
Covered Services gave by the right hand are identified with the youngster\'s physical and behavioral wellbeing prerequisites, including: help with eating, dressing, cleanliness, exercises of every day living, bladder and gut needs; utilization of versatile hardware; ambulation and activity;Slide 22
Covered Services cont. behavioral issues; and other healing administrations to advance diminishment of a kid\'s inabilities. observing of a wellbeing related administration i.e.: transport driver associate or checking the requirement for suctioningSlide 23
Authorization for Services must be approved by the momentum Individualized Education Program (IEP) The understudy should have an ebb and flow request from a doctor, doctor right hand or medical caretaker expert for particular nursing methods (i.e. tube feedings, catheterizations, and seizure observing) The administration can\'t be given by a guardian or a stage guardianSlide 24
Documentation Requirements Chapter VISlide 25
Documentation Requirements Documentation must be as per necessities of individual permitting board inside DHP, VDOE and DMAS. Quality administration surveys take after prerequisites noted in Chapter VI of the DMAS LEA Provider manual.Slide 26
Documentation Requirements DMAS structures are suggested and accessible online http://dmasva.dmas.virginia.gov under Search Forms/Local Education Agency. May be finished electronically and printed out to put in record.Slide 27
Documentation Requirements Records must be made accessible to approved state and government faculty and include: Current IEP pages which report real administrations; Need for evaluation must be archived when it doesn\'t bring about determination that administrations are shown in the IEP, (for example, on Present Level of Performance or Considerations Page)Slide 28
PCA Plan of Care DMAS 46 Developed by an authorized professional of the recuperating expressions inside the extent of their permit. A different arrangement of consideration ought to be produced per discipline in light of the administrations required.Slide 29
PCA Plan of Care cont. In the event that rates are utilized for measuring objectives, rates ought to change in view of understudy\'s movement, not a set time period. IEP may serve as POC just on the off chance that it incorporates all components of the POC.Slide 30
PCA Plan of Care cont. The arrangement of consideration created by the qualified supplier ought to be reliable with the wellbeing conditions and useful constraints reported on the individual\'s IEP.Slide 31
PCA Plan of Care cont. Therapeutic condition and analysis being location Specific to needs distinguished in evaluation Goals and destinations Treatment intercession and which objective tended toSlide 32
PCA Plan of Care cont. Sort, sum and recurrence of administration Anticipated length of administration Signed and dated by individual performing administration Reviewed at any rate every yearSlide 33
PCA Service Log – DMAS 37 Progress notes/Student Log - DMAS qualified supplier must starting, sign and date every structure. Sections must be initialed and dated by capable supplier of administration every time administration is given. Suppliers requiring supervision require documentation of supervision per prerequisites of authorizing board, VDOE and DMAS.Slide 34
PCA Service Log cont. The individual consideration collaborator might record: once a day for non-nursing administrations For nursing colleagues the documentation is per event Date and measure of timeSlide 35
PCA Service Log cont. Methodology Comments N = Normal V = fluctuation from typical or standard. Incorporate composed clarification in "Remark" segment Initials of the aide Documentation of supervisory visit marked by material bossSlide 36
Supervision gave by the fitting qualified supplier. Supervisory visits are required as frequently as expected to guarantee both quality and suitability of administrations. Survey the youngster\'s advancement and make any conformity to objectives or treatment modalities.Slide 37
Supervision cont. Directing authorized supplier must archive supervisory visits with understudy and PCA at least every 30 to 90 date-book days, or as frequently as required. Intention is to guarantee quality and fittingness of administrations being given.Slide 38
Supervision cont. State of the tyke and also qualified supplier\'s permit necessities figures out if the supervision is immediate versus aberrant and the recurrence of supervision visits.Slide 39
Supervision cont. An on location visit must be directed no less than each 90 logbook days. Administrator should recognize any crevices in associate\'s capacity to work skillfully and might give preparing as showed.Slide 40
Billing A unit of administrations equivalents 15 minutes for close to 8.5 hours a day The quantity of units charged is not to surpass the quantity of units in a day that the understudy is being taken care of by the schoolSlide 41
Billing cont. While more than one aide may go to the understudy amid a school day, the unit for a specific time of the day should not be charged for the administrations of more than one aide.Slide 42
Billing cont. On the off chance that the aggregate number of units charged winds up with a small amount of a unit, round to the closest unit 50 minutes of consideration/15 = 3.33 = 3 uni
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