STATE OF WASHINGTON



354330037401500STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESAging and Long-Term Support AdministrationHome and Community Services Division1492250238760HCS MANAGEMENT BULLETIN00HCS MANAGEMENT BULLETINPO Box 45600, Olympia, WA 98504-5600H17- 005 – ProcedureJanuary 23, 2017 TO:Area Agency on Aging (AAA) Directors Home and Community Services (HCS) Division Regional AdministratorsDevelopmental Disabilities Administration (DDA) Regional AdministratorsFROM:Bea Rector, Director, Home and Community Services DivisionDon Clintsman, Deputy Assistant Secretary, Developmental Disabilities AdministrationSUBJECT:Advanced Home Care Aide Specialist (AHCAS) PilotPURPOSE:To inform staff about the AHCAS pilot and provide direction on how to authorize services for clients and training for Individual Providers (IP) who are enrolled in the pilot.BACKGROUND:Individuals with a Predictive Risk Intelligence system (PRISM) score of 1.5, or higher or Behavior Point Score of 12 or higher, are at greater risk of emergency room use, avoidable hospitalizations, nursing home placement, and adverse impacts due to provider turnover than individuals without these levels of risk. Currently, IPs are trained to assist clients with personal care tasks and skills acquisition assistance. These tasks are essential to maintaining basic health and safety and to help individuals remain in their own homes. IPs are not trained to support clients with Health Action Plans (HAP) and Positive Behavior Support Plans designed to improve health and maintain individuals in their setting of choice. The AHCAS Pilot focuses on increasing the clients' ability to manage care, recognize risk factors, and live safely in the community; and shifts from the use of reactive care and treatment to proactive health promotion and self-management. With additional training, IPs will learn to encourage individual empowerment, help to build resilience and assist clients to meet their healthcare needs. WHAT’S NEW, CHANGED, OR CLARIFIED:The AHCAS Pilot will support approximately 1,051 client/IP pairs. IPs will receive 70 hours of advanced specialized training. Clients with a Behavior Point Score of 12 or greater will receive behavioral support services, and clients with a PRISM score of 1.5 or higher will receive a Health Action Plan.Training for IPs began in early fall of 2016 in Region 3. Statewide training will begin in March 2017.AHCAS program staff at headquarters will be responsible for enrolling interested pilot participants and directing IPs to the Training Partnership to register for training.Identification:To be eligible to participate in the pilot, a client must:Receive personal care from an IP through DDA or HCS/AAA who meets the AHCAS IP eligibility criteria:Either have a current HCA certification or equivalent, or have completed their required basic training Has worked six hundred (600) cumulative career hoursWork for an eligible client who has agreed to participate in the AHCAS pilotNot reside in a hospital or residential facility more than 30 days during the pilot periodHave a PRISM risk score of 1.5 or higher, or CARE Behavior Point Score of 12 or higher at the time of enrollment Be enrolled in Health Home Service and have a current Health Action Plan, or have a Behavior Support Plan within 60 days of AHCAS training completionComplete an Agreement to Participate form as well as a Release of Information formEnrollment:AHCAS Program Managers at HQ will send AHCAS enrollment packets to all individuals who meet eligibility requirements. Program Managers will also conduct outreach to clients, providers, and staff in order to provide technical support for proper enrollment. Both the client and the IP must agree to participate in the pilot. Once the enrollment agreement surveys and consents are received by the AHCAS program managers, IPs will be enrolled and their information will be sent to the Training Partnership. IPs will receive directions from the Training Partnership via e-mail or mail directing them to their SEIU 775 NW portal where they will register for training and receive information regarding the location and times to attend training. Field staff will be sent the enrollment documents for the client file. HQ Program Managers will notify field staff when to open the authorization for AHCAS training. HQ Program Managers will notify field staff when training has been completed and behavioral services are to be authorized. Behavioral Support services must be in place within 60 days of training completion.For HCS/AAA only:HCS/AAA clients who are currently CFC-only and want to participate in the pilot will need to enroll in COPES and have both a CFC and a COPES RAC prior to creating any authorizations for the pilot. Clients currently enrolled in Roads to Community Living will have services paid through the RCL RAC. The service code SA543 has been mapped to all appropriate program RACS.Individuals who are on MPC or MAGI-based CFC clients will have behavior support services paid through the WA Roads RAC. For DDA only:DDA clients who are on a waiver should access Behavior Support through their waiver funds. DDA clients who are CFC only will have access to funding for Behavior Support using state only AHCAS pilot funds. Clients currently enrolled in Roads to Community Living will have services paid through the RCL RAC. The service code SA543 has been mapped to all appropriate program RACS. ACTION:For Training Authorization:HCS/AAA and DDA case managers will:File the enrollment agreement mailed from HQ in client’s file (HCS/AAA use DMS)Add “Advanced Home Care Aide Pilot” in the treatment screen in CARE with provider type of “IP/Agency”Add COPES RAC if participating client is enrolled in COPES (HCS/AAA staff only)Authorize 70 hours of IP training using service code SA 543Note: The Service code SA543 has been mapped to all appropriate program RACsFor Behavior Support Services Authorization: AAA/HCSCase managers will: Receive notification that the IP has completed the 70 hours of AHCAS training from HQ Assign the Treatment of AHCAS Pilot to the specific provider in the HCS/AAA Supports Screen or the DDA Support Needs ScreenHCS/AAA Case Managers will authorize Behavior Support services using service code H2019 for 10 hours over a six-month periodFor Behavior Support Services Authorization: DDACase managers will: Select Behavior Support as a service and add to ISP Clients receiving waiver services will utilize waiver funds for behavior support. For non-waiver client receiving CFC services, AHCAS Pilot funds are accessed through state-only funding. For clients receiving waiver services, DDA case managers will authorize behavior support using service code H2019. For clients receiving CFC services, DDA case managers will authorize behavior support using service code H2019 with the modifier U9.To access funds for Behavior Support a Prior Approval is required for both waiver and non-waiver clients DDA case managers will complete ISP amendment and PAN to add the service of Behavior Support. DDA case managers will authorize the hours approved in the Prior Approval. The begin date of the authorization is the date the referral was accepted by the behavior support providerAdditional training will be provided to individual offices during the pilot roll out. ATTACHMENT(S):AHCAS fact sheet and Field staff cheat sheets \s\s\s\sCONTACT(S):Dawn Okrasinski, HCS AHCAS Program Manager 360.725.2503 okrasdm@dshs. Will Nichol, DDA AHCAS Program Manager 360.407.1510 William.Nichol@dshs. ................
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