H06-013 – Information
February 28, 2006
TO: / Home and Community Services (HCS) Regional AdministratorsArea Agency on Aging (AAA) Directors
Division of Developmental Disabilities (DDD) Regional Administrators
FROM: / Bill Moss, Director, Home and Community Services Division
Linda Rolfe, Director, Division of Developmental Disabilities
SUBJECT: /
Nursing Services Implementation for the Division of Developmental Disabilities (DDD)
Purpose: / To update ADSA staff regarding the implementation of Nursing Services for Division of Developmental Disabilities’ clients and case resource managers.Background: / DDD has been providing Nursing Oversight (Nursing Services) as support for social workers in their assessment, services planning, and care monitoring through contracts with the Area Agencies on Aging (AAA), and contracted agencies and individuals, based on a scheduled annual visit to the client for the purpose of nursing assessment and service plan review.
The DDD case resource manager will now determine when a client requires a Nursing Services activity.
Nursing Services and their associated activities include:
1. Nursing Assessment/reassessment;
2. Instruction to client and care providers;
3. Care coordination and referral to other health care providers;
4. File review;
5. Evaluation of health-related care needs affecting service planning and delivery; and/or
6. Skilled treatment (only in the event of an emergency).
Nursing Services are provided to clients receiving services from programs administered through the Aging and Disability Services Administration (ADSA). These programs include:
§ HCS and DDD
o Medicaid Personal Care (MPC)
§ HCS
o Community Options Program Entry System (COPES)
o Medically Needy Residential Waiver (MNRW)
o Medically Needy In-Home Waiver (MNIW)
§ DDD
o Basic and Basic Plus waivers
o Core waivers
Nursing Services offers enhancement of the comprehensive assessment and service planning process for in-home and residential clients by providing health-related consultation to case management staff, clients and caregivers in the development and implementation of community-based long-term care services. This is not the same as the direct nursing care and services that are provided through COPES Waiver skilled nursing, DDD Waiver skilled nursing, or the DDD Family Support nursing services that provide skilled intermittent nursing tasks to clients such as: administration of medications and injections, sterile catheter changes, and bowel programs that cannot be nurse delegated.
Nursing Services responds to referrals from Home and Community Services (HCS), the Division of Developmental Disabilities (DDD), and the Area Agency on Aging (AAA) case management and case resource management staff. The goal of these services is to promote the client’s maximum possible level of independence by contributing nursing expertise.
What’s new, changed, or
Clarified: / The current referral practice for DDD has been to refer clients to a contracted Nursing Services resource for a “nursing oversight” visit within three months of establishing services, and then annually thereafter. The model of service that we are transitioning to will require the DDD case resource manager to determine when a client requires a Nursing Services activity based on the needs of the client and/or their caregiver, Nursing Referral Critical Indicators, or department established protocols, such as the Skin Observation Protocol.
Contracts/Billing Changes
§ AAA billing for the provision of Nursing Services for DDD clients will continue through the ADSA finance and contracts office. Contracting is included in the state and federal contract with each participating AAA.
§ Agency contractor billing for the provision of Nursing Services for DDD will be transferred to the ADSA finance and contracts office. Nursing Services contracting will also be transferred to the ADSA finance and contracts office. This will allow for centralized billing and contracting. The effective date of centralized billing and contracting for the contracted agency will be April 1, 2006.
§ Contract Nurse Consultants billing for the provision of Nursing Services for DDD in Region 3 (Skagit, Whatcom and Island counties) will be authorized for payment by the case resource manager using SSPS authorization payment codes. Contracting is centralized with the ADSA Nurse Delegation program.
Effective Dates and Training Opportunities
The Nursing Services model described in the Nursing Services section of the LTC Manual and applicable RCW and WAC that applies to clients receiving MPC services from the Division of Developmental Disabilities will be effective April 1, 2006.
Prior to May 2006, a series of educational/training sessions will be provided in each DDD region for:
· DDD field and supervisory staff;
· Area Agency on Aging staff providing Nursing Services; and
· Contracted Nursing Services providers (agency and individual contractors).
The focus of this education will be to provide all participants with information related to:
· Selection and referral of clients to Nursing Services resources;
· A review of the Comprehensive Assessment Reporting Evaluation (CARE) Nursing Referral indicators;
· The referral process using a standardized DDD Nursing Services referral form;
· Communication and coordination requirements for clients referred to Nursing Services;
· CARE and paper documentation expectations for nursing service activities;
· Review of the Nursing Services section of the LTC Manual, applicable RCW and WAC.
ACTION: / 1. See the LTC Manual Nursing Services section (link below) for more information. The entire Nursing Services section of the LTC Manual will be out for review shortly. This MB only speaks to the subsections pertaining to Nursing Services implementation for DDD.
2. Attend trainings as required.
Related
REFERENCES: / RCW 74.09.520(3)(b)(c)
WAC 388-106-0200, 0300, 0305 and 0500
LTC Manual Nursing Services Section
ATTACHMENT(S): / DSHS 13-776.Services Referral
CONTACT(S): / Candace Goehring
Program Manager
State Unit on Aging
360-725-2562
Bev Lord
Program Manager
Home and Community Programs
360-725-2536
Debbie Johnson
Division of Developmental Disabilities
Program Manager
306-725-3525
4