A D U LT DAY H E A LT H C A R E

PROVIDER MEETING 2014

AGENDA

• Welcome• Overview of Adult Day Care• Scope Changes• Total Care Participants at Adult Day Care Center• Final Rule

OVERVIEW OF ADULT DAY CARE

• CLTC will continue to stress the importance of Adult Day Care to Participants.• An Adult Day Care Video has recently been shown

to the CLTC area offices to encourage Case managers to look at Day Care when explaining services to Participants.• CLTC can enroll eligible Participants. There is no

waiting list.

OVERVIEW OF ADULT DAY CARE

• CLTC is working with other Divisions of Medicaid to assist in getting participants eligible for Waiver services.

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Community Choices WaiverCensus FY14

Series1

ADULT DAY CARE SCOPE CHANGES

• All criminal background checks must include all data for the individual with no less than a ten (10) year timeframe. • The criminal background check must include

statewide data. The statewide data must include South Carolina and any other state or states the worker has resided in within the prior ten years.

ADULT DAY CARE SCOPE CHANGES

• Providers must obtain approval from CLTC Central Office prior to initiating electronic filing systems. Providers may use paperless filing systems.• Providers will verify nurse licensure at time of

employment and ensure that the licensure remains active and in good standing at all times during employment.

ADULT DAY CARE SCOPE CHANGES

• Based on your compliance review, you may be suspended for receiving new referral for 30, 60, or 90-days. • The provider will also be required to submit a

corrective action plan. • If the corrective action plan is approved, the

suspension is automatically lifted at the end of the suspension period.

ADULT DAY CARE SCOPE CHANGES

• If corrective action plan is not approved, the provider will have 10 days to submit an approved corrective action. • If the next corrective action plan is not approved,

the provider will be terminated.

ADULT DAY CARE SCOPE CHANGES

• Providers who have two (2) consecutive reviews that result in suspension of new referrals, will be terminated if the third review has a score that would result in a suspension of new referrals (100 and above).• The provider is responsible for updating the

Phoenix system with his/her telephone numbers, e-mail address, holidays, physical address, and administrator.

ADULT DAY CARE SCOPE CHANGES

• Providers can be terminated based on the results of a single review.

TOTAL CARE PARTICIPANTS AT DAYCARE

• Regulation D2 Medical Needs, in the SC Regulation Number 61-75 Standards for Licensing Day Care Facilities for Adults. The last sentence of Regulation D2 states "The physical and mental condition of a participant must not confine him/her to a bed.(II)”

• To address this an exception request must be filed with DHEC. The exceptions are granted to individual facilities rather than a provider wide exception (granted to all facilities). A request must be filed for each participant that require an exception.

QUESTIONS

FINAL RULE

• Discussion of Final Rule• It’s impact on your business• Ways it may affect your business.

RESOURCES

• Provider-distribution@scdhhs.gov for policy and billing problems.• Report a Problem button in phoenix for phoenix

related problems.