Changes to the 90 Day Review Checklist

June 23, 2105

Amy Rapp

Steve Bordenkecher

Background of the “90 Day Review Checklist”

The original purpose of the 90 Day Review was to provide a checklist…..

• To aid the case manager in meeting and documenting the many required elements of the Case Management Service

• To identify health and safety issues and address them proactively

• To identify quality issues with services and address them proactively

Background of the 90 Day Review

Questions address whether the consumer has experienced….• Efficiency, effectiveness, quality, and timeliness in receiving services

• Effective team communications

• Their right to be treated with respect, dignity and integrity

• Person-centered planning, informed choice, and personal empowerment

• Community-based services

• Fiscal stewardship

• Quality customer services

Why Changes Things Now?

• There have been plans to replace the State’s Case Management Database – INsite for several years. In preparation for this conversion, the Division of Aging was told to update it’s tools to take advantage of the increased functionality of a new web-based tool (CaMSS) which is under development. That system was delayed but it was decided to move ahead with the upgrade to the 90 Day Review tool in order to “pilot” the modified tool.

The Case Manager’s Responsibilities

• Implementation of service plan• Quarterly assessment of individual’s needs• Monitoring of the quality of services• Coordination of formal and informal supports• Monitoring the effectiveness of services (cost effective and

effective in meeting needs of the individual)• Demonstrate that the safety and welfare of the individual are

being monitored on a regular basis

Functions of the 90 Day Checklist

• The Checklist functions both as a documentation tool and as a controlling mechanism – Case Managers cannot update service plans unless both their 90 Day Review and level of care determinations are up-to-date.

Preview of Changes

• Eliminating individual/guardian response column• Incorporating the Nutrition Risk Assessment and the

Consumer Directed Care Checklist as applicable• Adding questions related to the CMS Final Rule on HCBS

Settings• Adding or modifying questions to be more focused on health

and safety issues• Adding or modify questions to be more person centered• Dividing questions among 90 Day Reviews to keep the

question count down per review

Type of Review and Other Triggers

Questions will vary based on the type of Review (Initial, Annual, Mid-Year or 90 Day). Additional questions will be asked if an individual lives in an Assisted Living or Adult Family Care Setting, experiences seizures, self-directs care, or received Behavioral Supports.

Nutrition Risk Assessment Tab

This had been a separate assessment but will not be incorporated into the 90 Day Review

Consumer Directed Care Checklist

Displays Answer from Previous Review

Corrective Action Plans (CAP)

• Old: Any NO response required a CAP

• New: A negative response to certain questions will require the Case Manager to formulate and follow-up on a Corrective Action Plan While fulfilling the CAP will be the responsibility of the CM, it will

frequently require participation from the provider.

Risk Profiles

• While we suspect that most providers and Case Managers will already be able to identify an individual’s risks, new Risk Profile Scores will help to document these risks and provide data for analysis.

• These scores are somewhat experimental but we hope to develop the concept and use more fully as time goes on and our analytical tools improve.

• We have not yet developed “risk threshold” criteria to clearly identify what score constitutes an individual “at risk”.

Risk Scores