STATE OF WASHINGTON



center31912900STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESAging and Long-Term Support AdministrationHome and Community Services Division18503241959750HCS MANAGEMENT BULLETIN00HCS MANAGEMENT BULLETINPO Box 45600, Olympia, WA 98504-5600H18-080 – Policy & ProcedureDecember 31, 2018TO:Home and Community Services (HCS) Division Regional Administrators Developmental Disabilities Administration (DDA) Regional AdministratorsFROM:Bea Rector, Director, Home and Community Services DivisionDebbie Roberts, Deputy Assistant Secretary, Developmental Disabilities AdministrationSUBJECT:Revision to Long-Term CARE (LTC) Manual Chapter 23B – Financial Services Monitoring to include required supervisory reviews AndFinancial Quality Assurance (QA) Activities and Schedule for 2019PURPOSE:To provide information to Financial Supervisors of the requirement to complete Financial Supervisory QA Reviews using the QA Monitoring toolTo provide the QA monitoring schedule for calendar year 2019, explain updates to the QA Procedures for the 2019 audit cycle, and inform staff of changes to the QA Monitor Tool effective with the release scheduled for use on January 10, 2019BACKGROUND:ALTSA Financial Quality Assurance staff at HQ acquired responsibility of completing QA audits for Financial Service Specialists in March of 2014.WHAT’S NEW, CHANGED, OR CLARIFIED:Long Term CARE Manual Chapter 23B – Financial Services monitoring has been updated to include required supervisory reviews for all financial staff members.The Financial QA monitoring schedule (attached) begins January 18, 2019. ACTION:For Financial Service supervisor staff: EFFECTIVE January 1, 2019Supervisory Monitoring of New and Experienced staffNew Financial Service Specialists (FSS) staff and experienced FSS new to long-term care (LTC) eligibility:After an initial mentoring period when the FSS is assisted with case actions as they occur, 25%-100% of all case actions will be audited based on their learning level until the new worker demonstrates the ability to accurately determine financial eligibility. Experienced staff (processed Applications and/or Reviews):Experienced staff is defined as staff that are authorized to process applications and/or eligibility reviews issuing a Medicaid benefit.Three (3) full case audits per worker(s) per year when the worker(s) have completed at least 3 full case actions in a calendar year. Use of the QA Monitor tool is required and audits completed in the QA Monitor Tool will count toward the annual Supervisory reviews of three per year, per worker.What are the 2019 HQ QA procedures for financial reviews?The QA Unit will select a statistically valid sample to review. Before the start of the scheduled audit cycle, the QA Unit will email each area a list of cases to be audited by QA staff. The QA Unit will conduct all audits at headquarters using the standardized 2019 QA Monitoring Tool.The QA Unit will notify the field of any remediation needed and the date by which they are due.At the end of the Initial Review, the QA Unit will email the preliminary Initial Proficiency Report and the Cases Requiring Action Report.In-person Exit Conferences will be held at designated field offices. After 30 Day Reviews are completed, an updated Initial Proficiency Report will be emailed to the field.After 60 Day Reviews are completed, a Final Report will be emailed.Any questions that did not meet or exceed the proficiency standard at the Initial Review will require a Proficiency Improvement Plan (PIP) to be completed. E-mail PIPs, based on Initial Review findings, to headquarters within 30 calendar days of receiving the Final Report.Send progress reports based on the timelines established in your PIPs.RELATED REFERENCES:LTC Manual, Chapter 23B – Financial Monitoring ServicesATTACHMENT(S):\s \s \s CONTACT(S):Catherine Kinnaman, Office Chief, LTC Financial(360) 725-2318FisheCL@dshs.Marcell Birdsall, DDA Long Term Care Unit Manager(360) 725-3248BirdsMM@dshs.William McBride, Quality Assurance Unit Manager(360) 725-2604mcbriwj@dshs. ................
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