Alzheimers Assisted Living Waiver

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Alzheimers Assisted Living Waiver
Waiver Update Required Documentation May 2009
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Presentation Outline

• Why now for AAL waiver
• AAL in 2009
• Summary of proposed changes
• Paper Processes
• Admission Request
• Admission Summary
• Monthly Summary
• Annual Level of Care Review
• QMR
• Discharge

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Why now for AAL waiver
The Silver Tsunami
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Why now for AAL waiver

• Demographic Imperative
• Baby boomers will be eligible for Social Security
  in 2 years
• Enormous pressure on retirement systems, health
  care facilities, and other services

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Population Age Structure
Dr. Frederic Blow 2009
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Population Age Structure
Dr. Frederic Blow 2009
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Population Age Structure
Dr. Frederic Blow 2009
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Growth of Alzheimers as diagnosis

• An estimated 5.1 million Americans have
  Alzheimers
• Between 2000 and 2010, Virginia will experience a
  30 growth in the number of people 65 with
  Alzheimers
• By 2050 the number of individuals with
  Alzheimers will range from 11.3 to 16 million

Data from Alzheimers Association fact sheet
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Presentation Outline

• v Why now for AAL waiver
• AAL in 2009
• Summary of proposed changes
• Paper Processes
• Admission Request
• Admission Summary
• Monthly Summary
• Annual Level of Care Review
• QMR
• Discharge

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AAL Overview

• Allows participants to
• Remain in a home-like setting for as long as
  possible
• Maximizes their autonomy, privacy, and dignity,
  even if they require a high level of services
• Provide relief for family caregivers 

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Admission criteria

• Meets nursing facility criteria
• Functional criteria
• Medical nursing needs
• Have a diagnosis of
• Alzheimers or
• Related Dementia

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Admission criteria

• Diagnosis Defined by
• a physician or psychologist for Alzheimers
  disease or related dementia (using the clinical
  guidelines) defined in the Diagnostic and
  Statistical Manual of Mental Disorders (DSM IV)
• Must not have a diagnosis of mental
  retardation/intellectual disability as defined
  by the American Association on Intellectual
  Disability or a serious mental illness as
  defined in 42 CFR 483.102(b)

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Qualifying Criteria

• Reside in or be seeking admission to a safe,
  secure unit of a VDSS licensed assisted living
  facility, that has a DMAS provider agreement
• Be eligible / receiving an Auxiliary Grant

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Funding in 2009

• 2009 was a difficult time for maintaining funding
  
• Virginia has funding approval from CMS and
  General Assembly for 200 slots

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Presentation Outline

• v Why now for AAL waiver
• v AAL in 2009
• Summary of proposed changes
• Paper Processes
• Admission Request
• Admission Summary
• Monthly Summary
• Annual Level of Care Review
• QMR
• Discharge

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Summary of Proposed Changes
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Presentation Outline

• v Why now for AAL waiver
• v AAL in 2009
• v Summary of changes
• Paper Processes
• Admission Request
• Admission Summary
• Monthly Summary
• Annual Level of Care Review
• QMR
• Discharge

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Documentation Goals

• Insure the health welfare and safety of
  participants
• Support provider activities
• Simplify documentation
• Coordinate documentation

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AAL Cycle of Documentation
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DOCUMENTAION FORMAT

• AAL waiver documentation is built to blend with
  current DSS licensing documentation
• Forms are very similar in content
• Forms are direct and simple to complete
• If your records are electronic they must be
  available for review

DMAS forms are all available at our web site
http//www.dmas.virginia.gov/ . All forms are in
word format and available to be copied. NOTE
Forms cannot be altered
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Lets follow the paper

• Admission Notice DMAS 783
• Admissions assessment/summary DMAS 483
• ISP 032-05-020/2
• Physicians report history physical diagnosis
  032-05-007/8
• Assessment of serious cognitive impairment
• 032-05-07/2
• Approval of placement in special care unit
• 032-05-0082-02
• Monthly Summaries DMAS 483
• Annual Level of Care DMAS 99
• Discharge Notice NEW

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Admissions Notice

• DMAS 783
• Sent to DMAS before admitting resident
• UAI
• ISP
• Physical
• Be sure there is a diagnosis
• for Alzheimers signed by physician

DMAS typically turns around Admissions documents
within 10 business days
Hint
Admission can occur any time during the month.
Partial months will be paid based on a daily
census. Census is typically determined at
midnight
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Admissions summary

• DMAS 483 (Check Admissions summary box)
• Check the box indicating Admission summary fill
  in date
• Key areas
• Admission date
• Family Executive Directors consent for
  placement
• Physicians diagnosis
• ADLs
• Identifying prohibited conditions
• Nutritional status
• Signed by and RN
• Always sign with 3 elements
• Full name
• Professional Credentials
• Full date signed

Stephen D. Ankiel ACSW 5-5-2009
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Individual Service Plan

• Utilizing DSS licensing form 032-05-020/2
• Critical facts
• Include all needs listed on UAI for ADLs
• Include behavioral plans
• Include family role
• Include activities
• Be sure all signatures and dates are in place
• ( LHCP, family, resident, etc)
• Update anytime there is a change in condition
• This could be monthly (use the monthly summary as
  a guide)

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Monthly Summary

• DMAS 483 (Check monthly summary box)
• Key areas
• Changes in ADL needs
• Changes in Cognitive Status/memory
• Changes in Behavior
• Activities
• Elopements
• Prohibited conditions
• Provides reminder/checks for next Executive
  Director/family consent for placement
• Services received (therapies, hospice, home
  health, etc.)
• Status of ISP (was it updated with change of
  condition or annual review?)
• Signed by and RN
• Always sign with 3 elements
• Full name
• Professional Credentials
• Full date signed

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Annual Level of Care

• Complete DMAS 99
• Key points
• Complete all sections
• List Medical Nursing needs
• Completed by RN
• Complete 225 if discharged / expired
• Mail to DMAS
• DMAS will score and notify agency if additional
  information is needed.

LTC is working on a project to have all of these
forms completed on the web and submitted
electronically. The provider would receive a
copy of the submitted material
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QMR Documentation Sources

• DMAS
• Last years QMR
• Corrective Action Plan (CAP) (If one)
• Monthly summaries
• Claims reports
• Provider enrollment
• Provider documentation
• DSS
• Licensing status
• Data bridge

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Routine Documentationfor annual QMR reviews

• Daily census
• ISP (current and last revision)
• Checking if completed annually and if needs
  changed
• Licensed Health Care Professional Log
• One hour of 11 activity per week per resident
• Activities calendar (documenting all residents
  received correct hours)
• Monthly summaries (submitted by 10th of each
  month)
• Maintain your DSS License in good standing

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Routine Documentationfor annual QMR reviews

• Annual UAI Assessments
• Full 12 page UAI
• To be completed by local Preadmission Screening
  team (Social Worker and RN)

• Collaborate with screeners to insure they get a
  complete picture of the resident
• Insure the screening team knows AAL waiver
  screenings are Nursing facility NOT ALF
  screenings
• If you see error immediately call screening team
  to get it corrected

Hints
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Routine Documentationfor annual QMR reviews

• Staff schedules
• Nursing schedule
• CNA Schedule
• Criminal Records Check for employees
• Must show results
• Training records for all employees
• Must have 12 hours of dementia training within 30
  days of hire.
• All staff must receive at least 8 hours of annual
  training relating to dementia
• Changes to Policy Procedures

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Top Documentation errors

• Staff not fully signing documentation
• Not monitoring annual UAI assessment having LOC
  changed
• Not completing monthly summaries
• Not following up on corrective action plans
• Not fully documenting staff
• Training
• Criminal record checks

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Top Documentation errors continued

• 6. No documentation of 11 activity time
• What was activity?
• Who did it?
• 7. ISP not reviewed quarterly
• 8. ISP not being reviewed by RN

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Discharge Notice

• New form
• Key Areas
• Name of resident
• Medicaid number
• Date of Discharge
• Reason for discharge
• Signature of ALF Employee

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Success formula

Documentation
Security

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A Reminder
Mandated Reporters for Abuse, Neglect, or
Exploitation

• When to report
• Immediately
• How to report
• Call local department of social services
• Or call Hotline 24 hrs a day, 7 days a week
• WHAT do I report?
• The identity, age, and location of the alleged
  abused individual
• Any information about the suspected abuse,
  neglect or exploitation

For Adults 1 [phone])
For Children 1-800-552-7096
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• Insuring
• Success

Success is the best by-product of team work and
cooperation
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Contact Information Division of Long-Term Care
FYI

• Division Director
• Terry Smith
• 804-371-8490
• Alzheimers Waiver Project Lead
• Steve Ankiel
• 804-371-8894
• Lead AAL Waiver Analyst
• Thren Baugh
• 804-785-7955
• Long-Term Care
• Phone [phone] Fax number
  804-371-4986

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Alzheimers Assisted Living Waiver

• Thanks for your time and your interest in the
  Alzheimer's Assisted Living Waiver