Case Study/Random
In what situation would a PERs device NOT be indicated for a member?
Member is not at risk for falls, member is never left alone (24/7 care or SNF), member unable to operate device d/t cognitive deficit.
What is considered "moderate activity" in regards to the UAS dyspnea question?
Climbing 2 full flights of stairs, gardening, walking long distances
What must be completed prior to starting a UAS Community Based Assessment on a member?
Mini Mental Exam- MMSE
Will also accept: verify patient identity
What is the name of the form that is required to be filled out by a licensed physician every 6 months(or 1 year) for member's receiving consumer directed home aid service?
DOH-4359
M11Q- some NYC counties
How long is the M11Q Valid for from date of signing?
1 year
You are performing an assessment on a member who has no short term or procedural memory problem. The member reports that her medications are organized into a 7-day planner for her by her daughter due to limited hand dexterity and inability to read the labels on the bottles, but she is able to physically take the medication and remembers to take them at the required times. How should medication management be coded in Section F: Functional? (independent, set up, supervision, limited extensive, maximal, total)
Extensive assistance- even though member can take remember to take her medications and physically swallow them, member still requires they be organized into the 7-day planner for her, so she is extensive assist for medication management.
Name at least two Priority Level I Lenavi suggestions that cannot be resolved due to having a fixed answer?
POA Present, At Risk for Falls, whether or not the person received in the listed time frame Influenza or Pneumococcal vaccine, Hearing/Eye/Dental/Colonoscopy Exam, BP checked, HCP Present, Advanced Directives in place,
When giving a member their proposed service hours at an Intake assessment, any hours over ____ per week total require manager approval before proceeding.
hours over 20/ per week require manager approval
Which Assessments are tasked to the NCM with a due date of 1 day?
Intake assessments and Priority Reassessments
Who is not able to be the Designated Representative on the Memorandum of Understanding for a member receiving CDPAS services?
The caregiver working as the member's aid.
You notice during your assessment of Mr. Blue that he frequently uses the Emergency Room to seek care often and would be considered a "frequent flyer". What education can you provide to Mr. Blue regarding ER visits?
Education Mr. Blue to:
-Reach out to his primary care provider for assistance with issues that are not emergencies and can wait 24-72 hours to be resolved.
-Utilize urgent care facilities in his area during their operating hours for situations where he is unable to wait until his PCP is available
-Educate member on what is considered an emergency where an ER visit is warranted, and what can wait until his PCP is available.
A member with a Dx of Schizophrenia has to have at least one of these symptoms coded for in Section D: Mood and Behavior?
Behavior Symptoms
(Wandering, verbal abuse, physical abuse, socially inappropriate behavior, inappropriate sexual behavior, Resists Care)
What is the difference between Short Term Memory and Procedural Memory
Short term- recall of recent events (words or information given, current president, what ate for breakfast, etc
Procedural- ability to perform tasks that require multiple steps in a specific order (Making a sandwich, getting dressed, etc)
Which plan does NOT include Home Delivered Meals?
MMC.
What must be done to the subject line when tasking a NCM for a member that is requesting an increase in hours?
On the subject line of the tasks, you must write "REQUEST" in the front of the title of the task, followed by entering in the Task comments the details of the request.
Mrs. Smith's last UAS assessment was done 6 months ago and today you are performing a routine reassessment. Mrs. Smith reports going to the ER 45 days ago for chest pain and was admitted that same day, being admitted in the Hospital for 3 days before discharge. Member also reports going to the ER 15 days ago for a UTI and was kept overnight for observation, being sent home the following day. When coding for Inpatient Hospital Admissions and ER visits, what number will you input for each of these sections?
1 inpatient hospital stay
1 ER visit
When selecting "Severely Impaired" in Section B. Cognition of UAS, what also need to be selected as "severe" in section C: Communication and Vision?
Vision must also be coded as "Severe Difficulty". Because of their severe cognitive impairment, the RN is unable to verify their level of vision and must select "Severe", testing the member by their ability to track objects/people with their eyes during the assessment.
Name at least 4 IADL's that are coded for in Section F: Functional of UAS
Meal Prep, Housework, Finance and Medication management, phone use, stair use, shopping, transportation, Equipment Management
What are the 4 Quality Incentive Measures?
Shortness of Breath (Dyspnea)
Continence
NFLOC Score
Pain
What specific paperwork is required at each reassessment for a member receiving CDPAS services (excluding mandatory paperwork for all other assessments)
Memorandum of Understanding
CDPAS Plan of Care
What are the numerical ranges out of 10 for the following pain ratings:
No pain, mild, moderate, severe
No pain- 0
Mild- 1-3
Moderate 4-6
Severe 7-10
-Per Lenavi QIM 1&2 training
Name at least 4 Disease Diagnoses that are associated with Potentially Avoidable Hospitalizations
Heart failure, respiratory infection, electrolyte imbalance, sepsis, anemia, and urinary tract infection
Which items in the TBT when selected will decrease the total amount of hours given regardless of functional status or NFLOC score?
Attendance in Social or Medical Day Program, Meal Delivery
There are several measures that affect an MLTC's star rating, broken up into 4 categories. Name at least 2 of these categories.
1) Preventative Care- prevention, patient safety, advanced directives
2) Quality of Life
3) Satisfaction with care- member survey that rates level of satisfaction with health plan, regular visiting nurses, care manager, timeliness of aids
4) Stability or Improvement- ADL, pain intensity, SOB, Urinary Continence
What unique member identifier is required on PHI release form that is not required for any other Assessment paperwork?
Fidelis ID, located on member's Fidelis ID card.