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This document outlines essential guidelines for the CAP/DA program, detailing organizational structure, staffing, service provider resources, and referral processes. Key components include assessment procedures, billing practices, and case management methodologies. It emphasizes the importance of written policies, client freedom of choice, and the role of lead agencies in coordinating services. Additionally, monitoring requirements and record review processes are discussed to ensure compliance and effective service provision. This guide serves as a vital resource for CAP/DA program administrators and case managers.
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CAP/DA Local Agency Reviews and Documentation Guidelines Tracy Colvard, CAP/DA and PCS Manager May 2006
General CAP/DA Program Operations • Organizational structure and staffing • Service provider resources • Referral and pre-screening procedures • Assessment and case management practices • Billing procedures • Exit conference • Written report
CAP/DA Program Review • Lead agency information • Lead agency agreement • Case manager information • Years experience, FT/PT • CAP/DA recipients served (slots) • Client termination information • Reasons for termination/numbers
CAP/DA Program Review • FL-2 issues • Who does assessments? • Written procedures for POC approval • Written guidelines for caseload limits • CAP/DA Advisory Committee • Membership, meeting frequency, activities
CAP/DA Program Review • Referrals • Numbers, sources, written procedures for referral and pre-screening • Waiting list written policies • CAP/DA waiver service providers • Adult Day Health, In-Home Aide, Meals, Respite, Telephone Alert • Client freedom of choice procedures
CAP/DA Program Review • Written Transfer Policy • Proof of case manager signing claims • Coordination methods with DSS • Eligibility, deductibles, CAP/DA applications • Lead agency organizational chart • Medicaid provider enrollment agreement
Record Review • Clients selected on day of local review • Usually 3-4 months prior to review visit for claims purposes • Review • FL-2 • Assessment • POC • Service Authorization and Participation Notices • Case Management notes • Claims data
Record ReviewMinimum Monitoring Requirements • Adult Day Health, In-Home Aide, Respite • Monthly review of service provision with client/provider • Hands-on observation at least every 90 days • Review supporting documentation for claims at least every 90 days • Review provider claims prior to billing Medicaid
Record ReviewMinimum Monitoring Requirements • Meals and Telephone Alert • Monthly review of service provision with client/provider • Review provider claims prior to billing Medicaid
Record ReviewMinimum Monitoring Requirements • Waiver Supplies & Lead Agency Provided Medical Supplies • Confirm after initial delivery and at least quarterly if supplies meet client’s needs • Home Mobility Aids • Confirm after initial delivery and at least quarterly if supplies meet client’s needs
Record ReviewMinimum Monitoring Requirements • Nurse Visits • Review HHA nurse visits with nurse once a month (by phone or nursing notes). • Home Visits • Visit client at least every 90 days • Case Notes • All activities documented (dated, time in minutes, signed, multiple daily entries totaled)
Documentation Entries should include: Who, What, When, Where, Why If it’s not documented, it didn’t happen !!
Examples of Billable and Non-billable Case Management • Handout
Case Management Exercise • Joe Blow
