Services
This service allows staff to clock in and out electronically using approved sites and is required for billing.
CLS-EVV
Which services require monthly monitoring by QPs, and which require quarterly monitoring?
Monthly: AFL, Residential, RDSE
Quarterly: CLS, CN, SE, Respite, Day Supports
Who does Allan provide respite to?
Tyler Gates
Short-range goals must be updated every ______ months based on the member's birth month.
6 months
A child receives CLS during school hours to meet 28 hours/week schedule. What rule is being broken?
Services cannot be provided during school hours, the hours must be outside school time.
This services allows relatives to work up to 56 hours (with Alliance), and 56–84 hours requires an application during the member’s birthday month.
RAP/RDSE
Total # of members for Thrive Initiative strategic Goal
100
You receive an authorization that does not match the members ISP. What do you do?
Contact the care manager to make corrections
How many extra hours can you get on non school days
Plus six additional
This daily service requires the member to be physically present ("head in the bed").
AFL or Residential
How long should staff/member records be kept after discharge?
11 years
What document should you always reference first should you have service questions
Clinical Coverage Policy 8P
A guardian insists on 40 hours CLS + 20 hours SE under 1915i. Whats the issue?
CLS + SE combined may not exceed 40 hours per week.
This program was launched on 7/1/2023 to expand services for IDD, TBI, and SPMI individuals waiting for waiver services.
1915i
What service did Luis provide to his member Ryan?
AFL
What report needs to be completed if there is reported abuse, neglect, or exploitation?
IRIS
A member receives ABA therapy at 2 PM. Staff also want to bill CLS from 1 PM–4 PM. What's the issue?
Services cannot overlap with therapies (ABA, OT, PT, Speech) — this is Medicaid fraud.
The number of units for 28 hours of CLS for an entire annual plan.
5,824
What month and year did Ryan’s place open
January 2020
H what to do to assist with guardianship
Reach out to lawyer or court system to get forms
A 1915i RDSE wants their child to have respite on on any given day. What's the issue?
1915i RAP cannot have respite