presented by: apd ltc policy unit on 9/2/15 oregon access 8/31/15 changes
TRANSCRIPT
PRESENTED BY:APD LTC POLICY UNIT ON 9 /2 /15
Oregon ACCESS 8/31/15 Changes
Oregon ACCESS changes
This training covers the changes that have occurred in Oregon Access on 8/31/15.
Related PT’s and IM’s:APD-IM-15-064 (OA changes)APD-IM-15-067 (Mainframe changes)APD-PT-15-023 (Hourly Cap Policy)APD-PT-15-025 (Live-in/Shift Services Policy)APD-PT-05-028 (Exceptions Policy)
When Do the Changes Go Into Effect?
The Hourly Cap is applied to all assessments, regardless of when the assessment was created. Any service plan segment with a start date of 8/31/15 or later will
be impacted.
The Live-in/Shift Services criteria is applied to any assessment that is created on or after 8/31/15. Assessments and service plans prior to 8/31/15 do not have to
meet the new criteria. Existing live-in and shift services plans may continue until the new assessment occurs. A new assessment is needed: At the annual review or at the request of the individual. If the individual has not received live-in/shift services within the last
30 days (days in the hospital or receiving skilled care are not counted).
Live-in Services Folder
Justification for Live-in or Shift Services
Comments should be added to support the need for live-in
or shift services.
Live-in/Shift Services Eligible
Live-in/Shift Care Not Eligible
Live-in/Shift Services eligibility are viewed in the Full Benefit Results Screen.
Full Benefit Results Screen
Please note that the Spousal Pay button has been re-labeled to “SPL Summary”. Also, final approval for Live-in or Shift Services are approved by CO.
The number is a variable.
Formula is 496-ADL
total-IADL total.
Updated 514 Exceptions FormIn-Home Exception Request Type of request 1
Live-in Hourly cap (over 50 hours per week) Service plan hours
Effective date: Most recent CA/PS date: Request: Select one Select one Provider type: Select one Manager name: Manager e-mail: In-Home Provider information 2 Details Hours Provider numbers: Allowed number of hours: Provider names: Requested exceptional hours: Number of providers: Total: Meets VDQ requirements?: Enhanced HCW’s?: Reasons for exceptions (check all that apply): 3 Hourly cap reasons:
Insufficient number of HCW’s to provide
needed care
HCW has quit or been terminated until replacement can be hired (no more than 30 days)
Traveling out of town and needs one HCW to accompany
Emergent or urgent need
Back-up plans that include relief or substitute caregiving when the primary or scheduled caregiver is unavailable
Unique or complex needs requiring continuity of care
Until this is added to the form server, please use the link on APD CM Tools under “Recent Updates”.
Initial Completion of Hours Authorization Segment
Exiting and Re-entering Hours Authorization Segment
Exception Request for Live-in
Hours Authorization for the HCW
Copy and Creating a Plan Prior to 8/31/15
Spousal Pay Plan Change
Live-in Service Approval
Live-in Services must be approved by Central Office, even if there are no exception hours assigned. The plan segment must also have a live-in HCW.
Scenario: Hours Segment approved Live-in Services for 439 hours.
Plan #1: Tier 1 or 2 Approval (Live-in HCW has been assigned all 439 hours).
Plan #1: Tier 3 Approval (due to Live-in HCW not being assigned all hours and is below 496).
50 Hour Cap (220 a Month) Approval
Central Office must also approve a HCW in the plan level if it is above 220 hours.
Scenario: Plan #1 approved HCW Aaron for 250 hours andHCW David for 30 hours.
Plan #2: Tier 2 Approval (Aaron still is above 220, but now is only assigned 240.
Plan #2: Tier 3 Approval (due to increased hours for Aaron)
Scenario: Plan #1 approved HCW Aaron for 250 hours andHCW David for 30 hours.
Plan #2: Tier 1 Approval (Both HCW hours are below 221).
Plan #2: Tier 3 Approval (due to change in HCW, even though hours are the same).
ADL Roll-Up on the 546N
For an Hourly HCW, the staff person entering in the voucher will combine the ADL and Self Management total into one line.
For a live-in HCW, the Self Management and Live-in Services hours are separated out still.
HATH screen prior to implementation
HATH screen after implementation
ADL Service Levels Combined with IADL
This change occurs for all vouchers 9/1/15 and later.
Contact Information
Policy Questions: [email protected] Functionality and Training:
[email protected] Service Desk: [email protected] or 503-945-
5623.Contacts:
Chris Ellis - [email protected] Mat Rapoza - [email protected] Christine Maciel - [email protected] Kelsey Weigel - [email protected] Suzy Quinlan - [email protected] Darwin Frankenhoff - [email protected]