Yes or No: Is an IR Needed?
Member, Ron, fell while transferring to the shower. Afterward, Ron complained of pain in his side. CBRF staff called EMS and Ron was taken to ER via ambulance. An X-Ray was completed and no fractures were noted. Ron was discharged back to CBRF with diagnosis of some bruising on his side and was encouraged to take PRN pain medication - ibuprofen - as needed. No follow-up appointment was recommended.
No IR Needed.
Bonus Question: Why?
This document is designed to help IDT staff determine if approving Ensure is appropriate for a member and the process to follow to authorize if/when approved.
What is The Nutritional Supplement RAD Companion
This is the residential daily rate for a Tier 2 member at a 3-4 bed Adult Family Home
What is $220.79/day
This tab of the Wellness Assessment includes the assessment of whether or not a member is resistive to cares
What is ADLs/IADLs/DME
This rule requires that all provider-owned community residential settings are physically accessible to all residents and that residents can have visitors at any time, among other things
What is HCBS (Home and Community Based Settings) Rule
FYI - the other requirements of residential providers are that residents have a lease that offer legal protections, privacy in their units including lockable doors, choice of roommates, ability to furnish their living space, and control of their own daily schedule and activities, including mealtimes.
Donna calls and reports that her grandson took her debit card to the store to buy her some groceries and made unauthorized purchases for himself while there. Donna has allowed her grandson to use her debit card many times in the past and he always makes unauthorized purchases. You and APS have both educated Donna to the risk of giving her card to others and believe she understands the risk.
Yes, an IR is needed.
Bonus Question: Why?
Bonus Bonus Question: What category?
This is the document you would review if you have a member who is in the hospital past the last day of the month who is interested in paying a bed hold to keep their room at their residential facility.
What is the Residential Absence Policy and Procedure
This is a designation given to individuals with an intellectual/developmental disability who, for either health reasons or because of advanced age, no longer require treatment related to their intellectual/developmental disability
What is NAT, or No Active Treatment
Bonus Question - where can you find out if a member is NAT?
Bonus Bonus Question - why is this important?
This tab of the Person Assessment includes the 3-question Loneliness Assessment
What is Community and Connections
This category of restrictive measure is the only restrictive measure that DHS does not permit the unapproved or emergency use of
What is Seclusion
FYI - Seclusion as defined in this context is "When the individual is physically apart from others inside a room using locked doors equipped with a pressure-locking mechanism."
Jesse calls to report that, when driving to work yesterday, his car was struck from the side while parked at a red light. He was wearing his seat belt. He was medically assessed and cleared with no injury, though he has some pain in his neck that he is monitoring. Jesse's car is totaled and cannot be driven. He has filed an insurance claim and plans to purchase another used vehicle.
Yes, an IR is needed.
Bonus Question: Why?
Bonus Bonus Question: What category?
This is the document you would review if you are wondering whether gloves are included in the Care and Supervision rate for a member at an Adult Family Home
What is the Scope of Service for Adult Family Home
This is the section of the handbook that you would review your care management partner is sick and you must complete separate MCP review visits
What is Module 18.2 "Separate CC and FCMN MCP Visits"
This tab of the Health Assessment includes the member's height and weight to calculate BMI
What is Vitals/Labs
Transportation up to this many miles is included in the Care and Supervision rate that Inclusa pays to Adult Family Home providers
What is 100 miles
John has a BSP and 1:1 supervision at his AFH to support his tendency to become physically aggressive toward others. It is reported to you that John hit staff in the face when angered yesterday. The staff had a black eye as a result. In your follow up to the report, you learn that the staff had not followed the interventions on the BSP when supporting John.
Yes, an IR is needed.
Bonus Question: Why?
Bonus Bonus Question: What category?
This is the document you review when you have a member transferring from another MCO who will not enroll with Inclusa until services are coordinated and ready.
What is the PreEnrollment Care Planning Procedure
This is the only time that IDT staff can/should select "No NOA Needed" for their RAD Decision on Member's request in the Decision/Final Outcome tab
What is when IDT staff started a RAD for an item and later learn that the request was out of benefit.
Bonus Question: What would staff do after finalizing the RAD?
This tab appears in every section of the "My Plan" and includes a full list of a member's DME, among other things
What is Assessment Tools
What is daily
FYI - Contact can be phone call or email. If IDT and discharge planner agree to have contact less than daily, this is acceptable. The adjusted contact plan must be case noted.
Renee has a significant history of trauma and experiences persecutory delusions. She regularly reports that her AFH staff sexually assaults her and has a BSP to support her. Every report has been unsubstantiated. Today, she calls you to report that staff fondled her in the car on the way to the store. In your follow up, you identify that staff followed her BSP when supporting her.
Yes, an IR is needed.
Bonus Question: Why?
Bonus Bonus Question: What category?
This is the document you would review if you have approved a ramp for a member and want to know how to coordinate them receiving it
What is the Home Modification Procedure
This is the payment model Inclusa uses for Job Coaching which is based on member's hours worked and years of employment
What is SEOB, or Supported Employment Outcome- Based, payment model
Bonus question: within this model, how much would a provider be paid per member hours worked for a Tier 4 member?
This tab of the MCP is where the Member Specific Contact Plan is documented
What is the Plan Meeting tab
This policy indicates that Inclusa is responsible for items and services in the benefit package necessary to support the member’s individual long-term care outcomes and is strictly prohibited from billing members for approved services.
What is the Use of Personal Resources Policy