SCL2 Questions and Answers

Questions Related to Carewise Health
Q.
Why is it Carewise has not returned any SCL2 authorizations? Are there sufficient staff reviewing these documents and how many?
A.
A review of 200 SCL2 cases was conducted. Of these 200, 25 were submitted with complete documentation, met criteria, and were approved with the initial submission. The remainder of the submissions were placed in Lack of Information (LOI) status. Since 1/28/13, 39 LOIs have been approved with the submission of additional information. This brings the total approved cases of the sample to 64 of the 200.

The reasons for LOI were reviewed. The top five reasons for LOI are:
  • 1. Missing forms
  • 2. SIS-specific questions related to goals incomplete
  • 3. ICD-9 missing
  • 4. Signatures missing
  • 5. Incomplete forms
Haley Hammond (haley.hammond@ky.gov) and Mary Mann (mary.mann@ky.gov) are available for on-site technical assistance. Please contact them for help.
Q.
Case Management providers are still not receiving authorization from Carewise for all requested supports. Instead we are continuing to receive duplicate PA's for case management services. This has been a pervasive issue and will lead to increased difficulties in ensuring adequate service provision for waiver recipients.
A.
Please provide specific examples. The PAs reviewed for approved services have all been copied to the Case Management agency.

Please submit specific questions or member issues to Pam Smith (pamela.smith6@hp.com) for resolution.
Q.
For both SCL and SCL2, Case Managers are coming across instances where services are remaining unapproved for a glitch within the Carewise approval system where they are being flagged for review and no one has been able to adequately explain why or when they will be corrected. Specific examples can be provided but this is not an isolated occurrence and has been evident for a number of months.
A.
The root cause of this issue is when providers request a modification for a service but continue to bill the service. Since modifications are backdated 14 days unless a start date is specified, this results in claims continuing to be paid. The system will not allow a service to be end-dated to create the new approved service line with increased units. Carewise Health will review each of these on a case-by-case basis and adjust the dates based on paid claims data.

There are two simple ways to prevent this issue:
  • 1. If a modification is submitted, do not continue to bill the service until the updated PA is received; or

  • 2. Specify a start date for the new service or increased units and do not bill until the PA is received for the modification.
Please submit specific questions or member issues to Pam Smith (pamela.smith6@hp.com) for resolution.
Q.
RE: New to SCL2 Clients. When the client enters SCL2, the effective date is not near or around their date of birth. How do we get back on track for the LOC to be the date of birth?
A.
People receiving allocations and entering SCL for the first time after 1-1-14, will not have level of care (LOC) dates that match their birth dates. Their LOC will begin on the date of the initial submission of the documentation to Carewise Health. LOC birth dates are only for people transitioning from SCL1 to SCL2.
Q.
I submitted a MAP-95 for my client who is now under the SCL2 waiver. How do I resubmit his request for classes using Carewise Health?
A.
The MAP-95 is no longer used in SCL2. Requests for medically related items are requested through the MAP-530 service of Specialized Medical Equipment. Items that are not medical in nature are requested through the service of Goods and Services.

If the SCL2 plan has already been submitted, you would send in a modification to add the appropriate service.
Questions Related to Case Management Supervisory Training
Q.
Do old Case Management Supervisors who have been with the agency for an extended period of time have to watch these modules and take the tests?
A.
Yes, all existing Case Management Supervisors, regardless of years of experience, are required to complete this DDID approved curriculum; new CM Supervisors within six months of taking the position; existing CM Supervisors within six months of the training being made available, which was 2/11/14.
Q.
Does the new SCL2 CM Supervisor's Training module replace the CFSM Your First Few Weeks module, or would supervisors need to complete both?
A.
The Case Management Supervisors Training is the approved DDID curriculum that is required specifically for Case Management Supervisors per new regulation. It must be completed regardless of other management modules the person may have previously completed or is currently assigned.
Q.
We do not provide Case Management at our agency. Do I need to take the Case Management Supervisor's training?
A.
No, if you do not provide Case Management at your agency, you do not have to ensure someone at your agency takes Case Management Supervisor's training.
Questions Related to Credentialing and Continuing Education
Q.
Pertaining to the continuing education required for professional staff that is in new regulations/policy manual, can the hours include training like crisis prevention, focus tool, CM, Big Day training, PDS training, or does it have to be something above and beyond those trainings offered by DDID and/or from an outside company or business?
A.
The six hours of ongoing professional development must be training or professional development opportunities other than those required in regulation or required by DDID. Therefore, the DDID Crisis Prevention and Intervention training, Case Management training, Phase I and II College of Direct Support (CDS) modules, DDID Medication Administration training are not eligible to count as ongoing professional development.

In addition, training such as First Aid and CPR which require annual updates are not eligible, nor is training required by the agency such as policies/procedures, orientation, and PDS training required by the individual or any required training necessary to support an individual. Training required for PDS services that are designated in the regulation are not eligible to count for ongoing development.

However, things that would count for ongoing professional development are:
  • CDS modules not required in Phase I or II training.
  • Training offered by the agency, either from internal or external resources, on topics that assist in provision of supports to multiple individuals supported by the agency.
  • Training offered by DDID either through webinars, modules, or face-to-face methods on a variety of topics, including DSP Credentialing, which are not required in regulation; conferences such as APSE, TASH, AAIDD, NADD, or SPEAK
  • Seminars or other educational opportunities offered by associations, agencies, etc. which are applicable to a staff member's role and responsibilities.

Professional staff such as case managers or positive behavior support specialists who have specific topics designated in the regulation may attend professional conferences, training, or events related to those topical areas.

Several Web-based training events are available from outside sources, as well as agencies who offer ongoing professional development, which may carry a cost to the individual or agency. Please contact Barb Locker (barb.locker@ky.gov).
Q.
What is "documentation of completion of the expanded requirements for the direct support professional credentialed in the area of positive behavior supports?" Says we need that in our cover letter for exceptional supports.

Should that be considered "as applicable"? I have not heard this defined further so any clarification would be awesome!
A.
As noted in the Exceptional Supports Protocol (ESP), if an individual's needs are such that staff (specifically Direct Support Professionals) implementing exceptional behavioral health or behavioral supports require specialized training in the area of positive behavior supports, it is expected the DSP is appropriately trained to provide the specialized services for that individual.

The expanded requirements for DSPs credentialed in the area of positive behavior support may be met by completing the Kentucky Direct Support Professional Specialty in Positive Behavior Support (DSP-SPBS) Credential available through DDID or an equivalent national credential as referenced in the KY DSP-SPBS Application Packet.

Documentation that a DSP has met those requirements would be the actual copy of the current credential issued to the DSP by the appropriate credentialing agency (DDID, NADD, or NADSP). This is an "as applicable" component of the ESP.

You may download a copy of the Application Packet for the KY DSP Specialty in PBS from the SCL Training page (see Related Links).

The Application for DSP-SPBS contains the qualifications necessary for a DSP to attain a DDID issued credential through education, experience, or having attained an equivalent national credential. If the DSP seeks to attain a DDID-issued credential based upon experience, the competencies and skills the DSP must demonstrate in a portfolio are outlined.
Q.
Are there any changes in staff credentialing due to a lack of providers being able to provide such services as Community Access? If not, what is the direction if there are not enough providers offering the service to cover the demand?

Not a lot of providers, if any, are offering Community Access in central Kentucky or rural areas. Does the Department have a list of providers authorized/approved or currently providing those supports?
A.
Thus far, there has not been clear evidence of a shortage of providers for Community Access (CA). The DDID online provider directory lists agencies that plan to offer the service. Current CLS staff employed prior to 1/1/14 are able to provide Community Access Services if they pursue and complete a credential within one year.
Q.
Can a provider, without a degree or five years' experience, who is hired after 1/1/14, pursue credentialing prior to providing CA?
A.
An individual hired on or after 1/1/14 who does not meet the educational or five years' experience requirement may seek a credential at any point for CA. The individual will not be held to a time frame such as those employed prior to 1/1/14.

The individual must have a minimum of one year of I/DD experience to be eligible to seek a credential, and must demonstrate proficiency in the competencies and skills for the CA Specialty Credential. The credential replaces the degree. Until the individual receives the credential, he or she will not be eligible to provide CA Specialist functions.
Q.
After 1/1/14, what are the qualifications to provide CA?
A.
On or after 1/1/14, the qualifications to provide Community Access are stipulated in the regulation 907 KAR 12:010 Section 1 (see Related Links or visit https://apps.legislature.ky.gov/law/kar/907/012/010.pdf).
Q.
This is what is on the streets per regulatory representation: 3) After 1/1/14 the qualifications to provide CA is that you have to have a bachelor's degree. Years’ experience and credentialing no longer apply. Is this true?
A.
This is false. You must have a bachelor's degree in Human Services or a bachelor's degree in any program of study plus one year of experience in I/DD, or relevant experience or credentialing will substitute for the education requirement on a year-for-year basis. Below are a couple of brief examples which may help.

Example 1: An individual may have completed an associate degree in the Human Services program at Jefferson Community College and then worked at Agency A providing relevant CA-type supports for three years. Therefore, the individual would be qualified for the CA Specialist position.

Example 2: A potential candidate for a position as CA Specialist at Agency A has two years of relevant, full-time experience in I/DD. You want to employ the candidate and the candidate is ambitious. You may employ the candidate as a DSP and the candidate begins completing the credential program.

It takes the candidate less than a year to develop and submit a portfolio and receive the credential as a DSP-SCA. The effective date of the candidate's credential is the date the candidate is eligible to provide CA services as a CA Specialist. At that point, you may transition the candidate to that position within the agency.
Questions Related to Documentation
Q.
According to the regulation, the Day Training monthly summary must include “an analysis of the efficacy of the service provided including recommendations and identification of additional support needs.”

Since most Day Training staff who write monthly summaries have a high school diploma or GED or neither, can you please give specifics on what reviewers will be looking for regarding this requirement.
A.
This is a basic description of how the person has benefited from Day Training Services during the month and identifies any changes or support needs that should occur. The person who works with the participant the most should have valuable input to document and share with the team about whether the Day Training piece of the person-centered POC is working.

The Direct Support Professional most involved will have the clearest insight about why or why not a particular approach, teaching mechanism or opportunity is helping a person achieve the person's outcome. That same person is also in the best position to notice when something needs to be changed, to recommend changes, or to celebrate accomplishments.

907 KAR 12:010, Section 1, (22) Direct support professional… (e) has the ability to 1. Communicate effectively with a participant and the participant’s family; 2. Read, understand, and implement written and oral instructions; 3. Perform required documentation; 4. Participate as a member of the participant's person centered team if requested by the participant.
Q.
We have encountered a lot of problems with getting doctors to write out prescriptions. Almost all have moved to e-scripts (which allows a lower liability on their part by not having their signature floating around), which has caused us a lot of problems of obtaining written-out and signed prescriptions.

Furthermore, pharmacies have been unwilling to allow us to have copies of the prescriptions as well. How is DDID moving forward with this? We are already VERY limited in the number of doctors that will see our individuals due to their insurance. We have also encountered doctors stating that this is our problem and that we should consider ourselves lucky that we see them.
A.
E-Scripts printed out and signed by the doctor is acceptable. Carewise Health will accept a pharmacy printout of E-Scripts with the electronic signature of the physician.

The Board of Pharmacy considers the E-Script as the original and that no other script should be printed. So, DDID staff will not be looking for a handwritten prescription if an E-Script exists.

Please contact your agency DDID Nurse if you have further questions.
Q.
Can we get a specific response on this as to what the division expects to see in a record on an annual dental exam and/or what you would consider best practice?
A.
The SCL Regulation requires that providers maintain a record for each participant served that contains the results of an annual dental exam. With or without teeth, oral health is an important component of a person’s overall well-being.

Even if a person is edentulous, the person should have his or her mouth and gums checked by a professional in that field, not only for gum care and hygiene reasons, but for specific oral health and disease prevention. Dentists are frequently the first to identify mouth cancers. Early diagnosis of mouth and throat cancer is crucial because these cancers caused by HPV and tobacco are so frequently fatal if diagnosed at late stage.

The regulation does not specify that the requirement for dental exams only applies to people who have teeth. Also, dentists do recommend that people who are edentulous still have routine exams. If a general practitioner checks the person's gums during the physical exam, this should be documented by the physician.
Q.
Could the Department please clarify what is the Summary Sheet and what elements should be present within that document?

Please discuss and clarify the expectations for the participant summary.
A.
The Participant Summary is intended to be a quick-reference document that captures the most critical need-to know information from the participant’s plan of care. It should combine the critical elements previously included in Crisis Prevention Plans (ALL health/safety/welfare issues) with more general information about the individual’s preferences and needs.

The Participant Summary should include all the information a direct support staff person needs to know to provide quality supports for the participant, including items that are important to and for the person.

This should be person centered and may include items like:
  • I prefer to take a shower in the morning. I do not like to take a bath.
  • Don't expect me to talk to you before I've had my morning coffee. I like it to be quiet and peaceful in the morning, so please don't turn on the TV until at least after breakfast.
  • It is important to me to watch XXX on TV every Monday night. If you, as a staff person, really want to watch football, then you should ask to take Mondays off during football season.
  • I do not like to eat green vegetables, but will agree to have a small portion if you remind me that the doctor said it is important to eat a balanced diet.
  • I attend YYY church every Sunday. It's important to me to arrive early so I can have coffee with my friends there. That means we need to leave the house no later than 9:15.

Under the Crisis Prevention Plan system, people who don't display disruptive behavior when their preferences are not honored did not consistently have their preferences written down or communicated to staff. The broader Participant Summary is intended to ensure that direct support staff know each person's preferences and interests, which will improve quality of life.
  • Each agency should have a policy addressing the participant summary.
  • The participant summary must be current and updated as changes occur.
Q.
Can DDID clarify if this document will include aspects of what would formerly be known as the crisis plan and can it also incorporate other documents currently utilized, such as the Face Sheet and Picture requirements?

And to build on this question, wouldn't preferred items and communication and some of those items you are describing be on the new narrative form?
A.
Yes, the Participant Summary Sheet should include the health/safety/welfare items that would previously have been included in a Crisis Prevention Plan. If an agency elects to also incorporate the participant's picture and information it would previously have included in a Face Sheet (date of birth, MAID number, etc.), that is an acceptable practice. The Participant Summary is intended to serve as a quick reference sheet that includes all the information a direct support staff person needs to know to provide quality support for the participant, which includes information about what is important to the person in addition to health/safety/welfare issues.

It is true that the new Narrative form also includes information about the individual's preferences. The Participant Summary Sheet should include information that can be found in other documents in the participant's record, including but not limited to a Positive Behavior Support Plan, Physician's Orders and/or Protocol, Rights Restrictions, the Life Story, clinical assessments such as a Physical Therapy Assessment, and the Narrative. The Participant Summary is intended to be a summary of the critical information each direct support staff person needs to know to be effective in providing supports for that person, collected into one document.
Q.
Our agency has been told that CM is required to sign the CPP/participant summary sheets. I thought it was up to each agency to develop their own participant summary sheet. If this is required, where is this requirement in regulations?
A.
The Participant Summary Sheet is required to be maintained in the participant’s record. The regulation does not specify that each agency must develop its own. Since it is part of the person centered planning process, the full support team should be involved in the development of the participant summary, and that summary should be maintained in the record of each agency supporting that person.

Each document in the participant's record should be dated and signed by the person who generated the document.
Q.
What paperwork do other providers need for their notebooks and charts?
A.
The following items are required to be in the primary record for all SCL providers.From 907 KAR 12:010, Section 3:

  • (3) An SCL provider shall:
    • ...
    • (p) Maintain a record for each participant served that shall:
      • ...
      • 10. Contain the following:
        • a. The participant summary sheet;
        • b. The participant’s name, Social Security number, and Medicaid identification number;
        • c. The Supports Intensity Scale Assessment Form;
        • d. The results of a health risk screening performed using a Health Risk Screening Tool which shall:
          • (i) Be administered by trained personnel at least annually and updated as needed;
          • (ii) Assist in determining a participant’s areas of vulnerability for a potential health risk; and
          • (iii) Be provided in accordance with the health risk screening tool requirements established in the Supports for Community Living Policy Manual;
        • e. The current person centered plan of care;
        • f. The goals and objectives identified by the participant and the participant’s person centered team which facilitates achievement of the participant’s chosen outcomes as identified in the participant’s POC;
        • g. A list containing emergency contact telephone numbers;
        • h. The participant’s history of allergies with appropriate allergy alerts;
        • i. The participant’s medication record, including a copy of the signed or authorized current prescription or medical orders and the medication administration record (MAR) if medication is administered at the service site;
        • j. A recognizable photograph of the participant;
        • k. Legally adequate consent, updated annually, and a copy of which is located at each service site for the provision of services or other treatment requiring emergency attention;
        • l. The participant’s individual educational plan or individual family service plan, if applicable;
        • m. The participant’s life history updated at least annually;
        • n. The results of an annual physical exam;
        • o. The results of an annual dental exam;
        • p. The Long Term Care Facilities and Home and Community Based Program Certification Form, MAP-350 updated annually;
        • q. A psychological evaluation;
        • r. A current level of care certification;
        • s. The prior authorization notifications; and
        • t. Incident reports, if any exist;


Additionally, in Section 4 specific documents are required as documentation for each service.

If a separate program book is maintained (such as at a Residential or Day Training site), the following information is required:
  • Participant Summary.
  • Plan of Care .
  • Photo (recognizable).
  • Consent for Emergency Treatment.
  • Allergy Alerts.
  • Behavior Support Plan, if applicable.
  • Rights Restrictions, if applicable.
  • Prescription or physician's order for any medication administered at the site.
  • Medication Administration Record .
  • Current documentation for the service provided, such as in and out times for Day Training, daily notes, and implementation of outcomes.
Q.
Do SCL2/PDS clients have to have the same documentation as SCL2 clients? I have been told by many Case Managers that SCL2/PDS clients are not required to have physicals and dental exams. Is this true?
A.
This is not true. People in SCL who chose to participant-direct (PDS) some or all of their SCL services should have dental and physical exams provided by the appropriate professional entity that specializes in that service.
Q.
I understand if a participant has transferred to SCL2 with no Residential Goals, that we are only to do daily notes as outlined in the new regs. However, it asks that we document in the monthly summary how the participant is working toward outcomes, analysis of progress toward outcomes, and a projected plan to achieve the next step in achievement of an outcome. If a participant doesn't have outcomes in the POC, how do we document this correctly?
A.
The monthly summary should have information that indicates that the case manager is monitoring the service, identifying barriers, and taking action as needed. Even without formal outcomes the regulation lists what residential services might include based on the individual’s needs which are:
  • 1. Adaptive skill development.
  • 2. Assistance with activities of daily living, including personal assistance.
  • 3. Community Inclusion.
  • 4. Social and Leisure development.
  • 5. Adult educational supports.
  • 6. Protection and oversight.
  • 7. Transportation. The agency providing residential supports is responsible to arrange for or provide transportation between the participant’s place of residence and other service sites and community locations.
  • 8. Medical and Health Care Services that are integral to meeting the person’s daily needs.
The monthly summary would discuss the provision of the residential service based on the above expectations. It would include any problems noted and steps taken to remedy the situation.

This also includes the individual’s satisfaction with his or her service, the location of the home, staffing, housemates, transportation, opportunities for socialization and participation in the broader community.
Q.
After many different free iPad apps and signing up for a trial of Microsoft 365 to utilize their Excel app, I and my colleagues have not been able to find an app that allows for full functionality of the new Focus Tool. What app is the tablet-friendly version able to be opened in?
A.
For full functionality you must have the complete Microsoft Office. The trial version does not allow for use of the Focus Tool.
Questions Related to Exceptional Supports
Q.
What specific forms do CMs need to submit for Exceptional Supports Requests to DDID for approval?
A.
Please refer to the Exceptional Supports Protocol (see Related Links or visit http://chfs.ky.gov/dms/incorporated.htm#12).

The SCL Exceptional Supports Request Fax Form is located on the SCL2 Home Page (see Related Links or visit http://dbhdid.ky.gov/ddid/scl2.aspx).

Supporting Documentation should include:
  • 1. A cover letter stating:
    • The participant is currently in institutional setting and transitioning to the community; or
    • The participant is at risk of not maintaining their life, friends, home and work in the community; and
    • The assessed needs of the participant based upon the SIS and/or HRST indicate an intense level of supports is required to promote health, wellness and stability.
  • 2. Team-approved Plan of Care documenting:
    • The enhanced service delivery needed (e.g., specific enhanced training requirements or credentialed employee, time of day enhanced staffing ratio required, number of hours of professional staffing, or oversight required), including any support needs for which enhanced professional treatment and oversight are warranted (to include dietary, psychological or positive behavior support services).
    • The frequency of the data review by the team and consideration of criteria for reduction of these, and information about alternative measures attempted.Cost analysis or projected budget for the supports provided for participant.
  • 3. Request for additional supports needed in the area of skilled nursing shall include the following additional documentation:
    • Specification of hours of necessary RN direct support required for delivery of identified nursing care not delegable per 201 KAR 20:400.
    • Plan to obtain and monitor clinical outcome data with criteria for reduction as relevant to medical condition.
    • Specification of additional direct support staffing requirements in amount and time of day with criteria for reduction of these supports, including completion of the expanded requirements for credentialed DSP in the areas of Health Support if appropriate; and
    • Assessed exceptional needs documented by the SIS and the HRST with a copy of the physician’s orders when applicable.
  • 4. Request for exceptional supports based on the exceptional behavioral health or behavioral supports needs of the participant must also include the following (as applicable):
    • Documentation of completion of the expanded requirements for the direct support professional (DSP) credentialed in the area of positive behavior supports.
    • Documentation of the providers' ability to support people with exceptional behavioral health or behavioral support needs which may include implementation of specialized programs, established arrangements with network of community supports. This documentation pertains to a provider’s overall or system wide capacity to provide these types of supports.
    • A functional assessment and any supports developed based on that assessment, to include a Positive Behavioral Support Plan.
    • Any notes from HRC and BIC for plans reviewed.
    • The form of communication utilized and, as appropriate, specified communication techniques/use of technology. Include a description of efforts toward functional communication.
    • Quantitative data in the form of frequency, rate or duration should be provided for each target behavior identified in the Positive Behavior Support Plan. This data must include the most recent three-month period of the continuous data collection for each targeted behavior or behavioral health symptom. Data should be in an objective, numerical and graphical form.
    • Documentation which may include clinical notes, to indicate that ongoing behavioral health services are necessary to achieve the desired outcomes specified in the POC.
    • Behavioral Health Plan, Crisis Prevention Plan and notes from debriefing sessions of the CMHC and ICF/IID Mobile Crisis Services.
Q.
There has been conflicting information about waiver recipients who are at extreme need having to wait until their DOB to access the Enhanced Support Protocol. If a person is in crisis and in need of the ESP funding, why can't extreme situations be reviewed prior to DOB? It was mentioned on numerous occasions by Department staff this would be an option but it appears this has changed.
A.
People will transition from SCL1 into SCL2 services during their birth months. There are no exceptions. The person-centered team should work closely together, and meet as frequently as needed, to develop and revise the POC as needed in order to support the person’s needs.
Questions Related to Human Rights Committee (HRC)/Behavior Intervention Committee (BIC)
Q.
If a person-centered team determines that one or more current rights restrictions may be reduced or rescinded, does the Human Rights Committee need to review prior to discontinuing the rights restriction?
A.
Since rights restrictions originate with the person-centered team, the team may reduce or rescind a rights restriction. Discussion and the team decision should be reflected in the person centered service plan by the case manager as a part of ongoing documentation.
Q.
What must be included in the plan presented with a proposed rights restriction to reduce or rescind the restriction?
A.
The plan may include research to try another way to achieve the outcome without a rights restriction, training or coaching for the participant/family/friends, consideration of changes to the environment where the person lives or works, education or training about responses for the staff supporting the person, and/or a change or addition of supports.

This plan is in addition to a positive behavior support plan if the participant has one which includes a rights restriction. A positive behavior support plan is not necessary to reduce or rescind a rights restriction, but a rights restriction may be a part of a positive behavior support plan. All new or revised positive behavior support plans must be annually reviewed and approved by the Behavior Intervention Committee, and by the Human Rights Committee if the plan contains restrictive measures or a rights restriction.
Q.
Do all positive behavior support plans have to be reviewed by the Human Rights Committee (HRC)?
A.
No. New or revised positive behavior support plans are to be reviewed by the Behavior Intervention Committee prior to implementation. HRC review should occur only if the plan includes restrictive measures or a rights restriction.
Q.
Does an agency which participates in many areas of the state seek HRC/BIC review with each area committee or can the agency have Plans of Care containing rights restrictions or positive behavior supports reviewed by the area committees where the agency is located?
A.
The Division believes it is more person-centered and best practice for area Human Rights Committees and Behavior Intervention Committees to review the rights restrictions and behavior intervention plans for all the individuals living in their area.

That said, agencies may choose to take rights restrictions and positive behavior support plans to the committees located in the area where they are located, as long as the appropriate information (approval forms, BIC rubric, etc.) is provided to the case manager supporting the person in a timely manner.
Q.
If the HRC approves a rights restriction and later a consumer gets hurt because of that restriction, who is liable?
A.
The Human Rights Committee approves a rights restriction and the plan to reduce or rescind that rights restriction based on the information in the person centered service plan, medical information, etc., and from the answers to questions to the participant’s case manager. The Committee has no role in implementing the rights restriction. The agency whose staff is supporting the person at the time of an injury must follow its own policy and SCL regulatory requirements as to the injury and follow-up.
Q.
Does the HRC have to unanimously approve a restriction?
A.
How the Human Rights Committees decide to approve or refuse to approve a rights restriction is not specified in the regulation. The committee may decide to vote and record each vote or to agree to come to consensus and approve or refuse to approve a rights restriction.
Q.
Where does the liability fall when recommendations aren't followed-up on? Does it fall on the agency that is not following up, on the committee members, or DDID?
A.
The requirement to respond to recommendations falls to the person-centered team. DDID staff are not HRC or BIC members.
Q.
We are having more in-depth conversations about the restrictions being presented, but when some of these serious issues are presented and the committee can't get guidance or help from the police, fire department, or other community resources and they won’t give us their written recommendations, where are we to go?

If a Guardian institutes a restriction does the HRC have the authority to veto it, and where again is the liability? Does the agency have to put the restriction in place?
A.
The Committee may give information to the case manager bringing the rights restriction before it but the responsibility for the information required as a part of the plan to reduce or rescind a restriction is that of the participant's person-centered team, not the Committee, which acts in an advisory capacity.

The Committee may choose not to approve a rights restriction requested by a guardian, the person-centered team or an agency. The guardian may request that the rights restriction be reviewed by another area Human Rights Committee through the case manager.

If the area Committee does not approve a rights restriction, the restriction cannot be implemented. Only committee members, as identified in regulation, may vote or discuss to achieve consensus on restrictions. The case manager presenting the rights restriction is not a voting member of the Committee.
Questions Related to Other
Q.
Person Centered Coach. In discussions concerning the Person Centered Coach service, some Analysts are concerned about supervising a high-school level individual who may put the analyst's license in jeopardy, even stating that they would have to withdraw supports if the team pursued a PCC. What is the state doing to remedy this concern?
A.
The Person Centered Coach (PCC) will work under the direction of a positive behavior support specialist or other licensed professional in the settings where the plan of care is implemented.

The PCC, through the direction of the certified or licensed professional, would look at the array of factors influencing the functioning of an individual, which include environment, situations, interest and medical issues. This holistic approach is necessary for implementation of a POC which assist in improving quality of life.

This service is designed to supplement Consultative, Clinical, and Therapeutic (CCT) Services and to free up those CCT units that could then be used for monitoring by the certified or licensed professional.

The person centered team should work together to determine how to approach the appropriate and fair usage of CCT units and may need to consider alternative services or look for a provider that can meet the needs of the individual.
Q.
SCL2 Brochure. Has an SCL2 Brochure been developed? If so, where is it located?
A.
Yes. View the brochure by clicking on the "SCL Brochure" item in Related Links.
Questions Related to Participant Directed Services (PDS)
Q.
Can a consumer use Skype or a similar face-to-face communication mode through the Internet and this be considered allowable through a direct waiver service, like CLS and attendant care through Michelle P? We have denied this possibility in CDO under three CLS service.
A.
A required face-to-face visit by the case manager must be conducted in person. Skype or other programs could be used for non-billable contacts.

This question also pertains to the employee-participant contact. Employees, guardians and parents have considered it possible that using this technology may serve as an aid to participants in meeting their outcomes and objectives.

After conversations with DBHDID, the Department for Medicaid Services, and the Office of Legal Services in recent years, the Department for Aging and Independent Living has stated that this is not an acceptable means of providing a service to a participant.
Q.
Who is responsible for serving as the Financial Management Agency? Please clarify.

Also, further clarification is needed we feel on what the Case Management responsibility is for PDS. It remains unclear to many how PDS and Case Management should be integrated and who has what specific responsibilities, despite recent emails.
A.
The corresponding AAA/CMHC in the area is the Financial Management Agency (FMA). A list of contacts has been sent to case manager supervisors' agencies. If you have not received this, please email Evan Charles (evan.charles@ky.gov) and you will receive a copy.
  • Once the case manager is aware that the participant wishes to choose a PDS service, the participant should have an employee set up for the employment process, ideally through recruiting and interviewing, but this could also be done through acquaintances of family members, friends, or neighbors.

    Please note that immediate family members must qualify through the MAP-532 Exemption process. The case manager may assist in this, through providing ideas about possible advertising or through team discussions about who could be available.
  • The case manager then informs the participant/team about employee requirements, such as drug screen, TB screen, CPR/First Aid, College of Direct Support (CDS), any additional training, possible educational requirements, and background check requirements (employer is responsible for payment for processing these requirements).

    Please note that the funding for these requirements is the responsibility of the employer; having these requirements paid for the first five employees by Medicaid is not an option.
  • Once an employee is qualified, the employer should direct the employee on what duties to be performed as related to the POC.
  • As timesheets are completed, the timesheets are to be reviewed by the employer to ensure accuracy. The case manager then reviews the timesheet to ensure that the plan of care is being followed in terms of outcomes and objectives, unit maximums, and regulation maximums.
Q.
How do we complete the Time Sheets for PDS?
A.
  • The employee writes in the hours, dates, and attaches supporting documentation.
  • The employee/employer is responsible for the identifying information at the top of the timesheet, but the case manager may pre fill this information in order to reduce chances of error.
  • Each party responsible for the timesheet shall provide a signature at the bottom; calculations at the bottom are optional.
  • The case manager reviews the timesheet and ensures it complies with PA limits, and POC guidelines.
  • The case manager submits the original page 1 to the FMA for payment processing, retaining a copy of page 1, and the service documentation, page 2.
Q.
Is there a difference in PDS respite service and traditional respite services?
A.
PDS respite can look a little different. PDS respite is directed by the person and the person's family. They can choose non-SCL staff to provide this service. However, there are outlined training requirements for PDS staff. You can find more information on the SCL Regulations page (see Related Links).

Participant Directed Services (PDS)

907 KAR 12:010 5(1)(a)

The following services may be participant directed and shall be provided in accordance with the specifications and requirements established in Section 4 of this administrative regulation, the Supports for Community Living Policy Manual, and the training requirements specified in paragraph (b) of this subsection:
  • 1. Community access services;
  • 2. Community guide services;
  • 3. Day training;
  • 4. Personal assistance services;
  • 5. Respite;
  • 6. Shared living; or
  • 7. Supported employment.
Q.
When will the PDS manual for case managers be available?
A.
The manual is in its final draft stages.
Q.
Who will it fall back on for recoupment of payment under PDS?
A.
This would depend on the situation and contributing factors. Some billing infractions may be FMA, CM or both. They are looked at on a case-by-case basis.
Q.
What about the consumer handbook f or PDS?
A.
The manual is in its final draft stages.
Q.
For PDS under SCL2 do we complete the MAP-2000?
A.
No, the designation for a representative is on the Rights, Risks, and Responsibilities form.
Q.
Could a Community Guide assist the consumer with an appeal regarding the waiver and/or services?
A.
It has been confirmed that this function would be considered out of the scope of the community guide service and this would be the responsibility of the participant, appointed representative or legal guardian.
Q.
What is the turnaround time for exemptions? And can family members seeking approval work until determination and/or through the appeal process?
A.
DAIL has a turnaround time of 14 days; we request that with each submission, the most recent Plan of Care and Assessment be submitted along with the request (the MAP-351 can substitute for the SIS). A requesting family member cannot be prior authorized to provide services without approval from DAIL and therefore shall be considered an invalid employee, both during the determination process and the denial process.

DAIL pointed out that case managers should not be completing the MAP-532 for the potential employee. DAIL submitted an email to the field that was a "helpful hints" that case managers can use to assist potential employees complete the questions. It was noted that not all AAAs/CMHCs received this email, so it will be resent. If you still have not received the information, please let us know.
Q.
What is the expected time frame for receiving Prior Authorizations?
A.
DAIL will consult with Carewise oversight agency HP to clarify the Prior Authorization procedure and examine any scenarios that are making approval of Prior Authorizations more complex. A couple of agencies footnote that a participant may have an LOI issued, and the agency responded accordingly, only to experience a further delay. Agencies were asked to provide participants with MAID fitting this issue.
Q.
When transitioning from SCL1 to SCL2, what is it necessary for an employee to complete?
A.
All employees will need to complete all background checks and screenings before beginning work after the transition date (Central Registry Check has a 30-day window from beginning work date). All training must be completed for transitioning employees within one year of the transition date.

DAIL added that case managers need to keep in mind that when it comes to drug-related convictions, the five-year window of exclusion ends at the date of conviction for a drug related crime, not a sentencing date, nor a charged date. Quoting from SCL2 regulation Section 3 (3)(aa)3: "Has a drug related conviction within the past five (5) years…"
Q.
Are employees responsible for paying for these background checks?
A.
This is the employer's responsibility according to federal law, the Fair Labor Standards Act.
Q.
How soon could transitioning employees complete background checks before the transition date?
A.
DAIL stated that up to 30 days before the transition date would be acceptable.
Q.
What is the purpose of the additional training form?
A.
This is provided to show documentation that, should a participant require that an employee complete additional training – such as any element of routine treatment or physical restraining courses, medication administration, etc. – an employee would have proof that this training was completed and that the participant verified its completion. Some participants may not require any additional training of their employees.

It was also confirmed that medication administration is not a standard requirement of an employee unless the participant requests so, or if the employee works for three or more participants.
Q.
What is the responsibility of the Case Manager Supervisor regarding undersigning documents?
A.
Please review Page 30 and 31 in the SCL Policy Manual. The CM Supervisor is required to sign the monthly summaries for all Case Managers. The CM Supervisor is to monitor other responsibilities.
Q.
How do PDS Day Training and/or Supported Employment look for a participant?
A.
An employee would be working specifically on objectives designed towards interests of vocation/employment, or towards activities/interests that may later develop into prevocational activities. The participant's team would need to discuss possibilities and/or opportunities that can parallel a participant's interests and/or hobbies with vocation, and what steps could be laid out to get there.
Q.
There is confusion when requesting PDS services on the MAP-530 related to the number of units requested. Please clarify.
A.
In the past, when requesting PDS (CDO) services, this was requested as hours. With the change to PDS in SCL2, you must now request the service in units of 15 minutes. If you are using the hourly rate you must divide by 4 to get the unit rate. If you are requesting 4 hours of service at $16.00 per hour, then on the MAP-350 you will need to request 16 units at $4.00 per unit.
Q.
If a client is going to be SCL (PDS) does it start like SCL2 on the day after the client's birthdate or, if the PA ends in the same month as the birthdate, on the date the PA ends? I am just not sure if it works the same. If you could help me with this I would appreciate it very much. Also, is CLS the same as the Community Access? Thank you for any input you can give me on this.
A.
Yes, the LOC and PA dates will be the same based on the birth date. All services, whether traditional or PDS, are SCL services; participant-directed services are just simply a different way to manage certain SCL services.

No, CLS is not the same service as Community Access; SCL2 does not have a service called CLS. If a person received CLS in SCL1, the person-centered team might consider utilizing Personal Assistance if the service provided meets the service definition of Personal Assistance.

Community Access is a very specific service to help people make connections with groups, clubs and organizations in the broader community. It is used to help a person in SCL become a member of an established community group. It is short-term and requires a plan for reducing services, which would be the criteria for fading the CA service and transitioning ongoing supports, if needed, to another service such as residential, ADT, natural supports, etc.

Additional information about services and supports may be found here.
Q.
On the MAP-530, what should we enter under "Provider Name" and "Provider Number" for a service listed under PDS? Is "Provider Name" the participant/employer's name, the PDS representative's name, or the Financial Management Agency? Is "Provider Number" the participant's EIN? If so, what do we enter if the SS-4 (Application for EIN) has yet to be returned?
A.
The provider for a PDS service is the Financial Management Agency and the provider number is the provider number for the Financial Management Agency.
Q.
I need instruction about listing PDS service FMA T2040 on the MAP-530. I do not see a dropdown box or how to enter this information. I believed it was incurred, but Carewise sent an LOI. Please give guidance.
A.
When requesting a PDS service, enter the Financial Management Agency/Service and its provider number as the provider of the PDS service. This automatically triggers the payment for Financial Management Services. It is not necessary to request the FMA-T2040 as a separate service. The MAP-530 has been revised for this change.
Questions Related to Plan of Care
Q.
How would I find SCL2 forms and additional information?
A.
Click on "SCL2 Home Page" in Related Links to visit the SCL2 Web page, or visit http://dbhdid.ky.gov/ddid/scl2.aspx. Remember to always go to the website for the most updated form every time you need one.

Please do not create your own forms. If you are utilizing a business application that creates forms, they must retain their original format.

Please refer to the CDS Module "Case Management Documentation" found at: the College of Direct Support website (see Related Links or visit http://www.collegeofdirectsupport.com/ky). This link contains several recorded modules that provide information from Big Day training.
Q.
Are the SCL2 forms (LOC Recerts and initials, Life Story, MAP-530, MAP-531, and Narrative) going to be iPad friendly? Our agency is having issues of not being able to open them on iPads. Is there certain software that will open these forms?
A.
Currently these forms are not available for any tablet use. If you are having trouble using these forms on laptop computers please make sure you have the most recent update to Adobe.
Q.
Please explain and define the "Periodic" frequency. If Periodic is chosen, does this mean that the units can be used whenever the clinician deems appropriate?
A.
Periodic is the equivalent of “one time only.”

Services may be requested with the below frequency intervals:
  • One time only: This should be used for services such as evaluations or the Positive Behavior Support Plan (PBSP).
  • Weekly: The number of units you are able to bill will be limited to the number of units authorized during the week (Sunday to Saturday).
  • Monthly: The number of units you are able to bill will be limited to the number of units authorized during the month. Different amounts can be billed from week to week as long as the total monthly authorized amount is not exceeded.

Periodic is not a frequency that is available through SCL2. With SCL2, all requests for services would need to be documented in the weekly or monthly format, unless the request was for a one-time-only service.

The person’s team should create a plan that will work for the participant. The units could be requested monthly, which would allow for some flexibility of the use of the units within the month.
Q.
How do you request respite on an as-needed basis? The individual does not use respite every week or every month, just when needed due to an emergency or when the parents go on vacation. This was submitted to Carewise as periodic and I was told it has to be monthly or weekly.
A.
Respite must be requested with a weekly or monthly frequency. There is no longer an option to request respite without a time frame defined. Respite should be requested with the maximum amount of monthly units in mind.

If a situation arises and more units will be needed, a modification can be submitted.
Q.
If respite is no longer allocated annually, if a provider agency exceeds its weekly or monthly allocation as outlined on the POC are we to assume that won't be billable?
A.
If the provider exceeds the approved amount on a weekly or monthly basis, it will be necessary to submit a modification to the Plan of Care. These can be backdated 14 days from the receipt of the modification by Carewise Health. If a modification is not submitted, then the units over the amount approved would not billable.
Q.
When will the SCL2 forms allow CMs to type more information into the MAP-530, LOC, Life Story, POC Narrative (on the communication section and where we are to add the CPP and BSP)? As of right now there is limited space.
A.
The life story form has been revised to allow for unlimited narrative.
Q.
Life story is just a small part of their life. Would a Psycho-social work best here since it really is their life story?
A.
The PBSP and crisis prevention information is included in the section of the plan of care narrative titled "What others need to know or do to support me and help me to stay healthy and safe."

The Life Story, which is updated at least annually, should contain pertinent historical information about the person as well as current information noting events, activities, overall health and well-being. The "Life Story" form to use is located on the "SCL Forms, Case Management" Web page (see Related Links).
Q.
On the POC Narrative, what if a goal has been achieved and new goals added? How does CM track this?
A.
The form is set up for the CM to put in the completion date for outcomes. Once completed a new outcome can be added by the team and the completed outcome will be maintained in the POC and with the new outcome added. This results in the POC containing all outcomes/action steps worked on and completed for the POC year.
Q.
On the SCL2 Level of Care Recertification Form and Plan of Care Demographic and Billing Information, the Axis diagnoses sections will not print beyond one line, therefore not all information will be submitted. How do we get the rest of the information (for example, Axis III diagnoses) to print so that we can submit all information?
A.
Please include the diagnosis codes only. There is not enough space for diagnoses’ descriptions. Carewise Health will send an LOI if just the diagnosis description is documented.
Q.
On the Freedom of Choice and Case Management Conflict Exemption form, it states on the bottom "by electronically signing and dating this document, the case manager verifies that the participant/ guardian agrees with the information contained on both pages of this form and has electronically signed this document or if not, has signed a paper copy which is kept with the participant's service records."

My questions are:

1. There are not two pages of this form.

2. Does the service record NEED a signed copy along with the electronically signed document? I had another case manager bring to my attention that someone at DDID stated a hand-signed copy will be in each chart. If that is the case, the MAP-531 does not indicate this. It only indicates a signed copy will be in the service record IF AN ELECTRONICALLY SIGNED DOCUMENT IS NOT. Please clarify.
A.
The form is only one page. Carewise Health requires a signed copy be submitted this may be an electronic signature.

907 KAR 12:010, Section 8, allows for the use of electronic signatures. The creation, transmission, storage, or other use of electronic signatures and documents shall comply with:
  • (a) The requirements established in KRS 369.101 to 369.120; and
  • (b) All applicable state and federal statutes and regulations.
Agencies should consult with their legal advisors to determine if their Electronic Signatures policy adheres to other applicable state and federal statutes and regulations beyond the identified KRS.

See "907 KAR 12:010" in Related Links, or "SCL Regulations" to view all SCL Regulations on this website at http://dbhdid.ky.gov/ddid/scl-regulations.aspx).
Q.
What is the time frame to get a response on MAP-531 exemption forms? I have been getting my approval/denial letter after the plan has been submitted to Carewise and then I have to respond to a LOI asking for the approval/denial letter.
A.
The MAP-531 for an exemption should be sent to DDID prior to submitting information to Carewise Health. They cannot process the request without the approval letter. The turnaround time for receiving a response from DDID is seven business days.
Q.
A provider is under the impression that participants coming into SCL2 will not be allowed the Group Home option. I do not believe this is true and don’t recall this being discussed, but wanted to be sure. This is especially important because a gentleman has just received emergency allocation and he currently resides in a group home.
A.
Residential Level 1 Service is provided in either a certified and licensed group home with no more than eight people living in it, or in a staffed residence with no more than three people living in it. Please refer to 907 KAR 12:010, Section 4.

Click on "907 KAR 12:010" in Related Links to view the SCL regulation.
Q.
We have a question regarding the code/rate changes for SCL2 plans effective now. From the SCL2 POC’s we have seen, the codes for services are the same as old codes, so how will this affect agencies trying to submit plans under SCL2?
A.
Many of the codes are different when changing from SCL1 to SCL2. The ones that have the same billing codes have had no change in the rate. These services are OT, PT, Speech, and Specialized Medical Equipment Services.

For CLS services in SCL1, you will use SCL1 codes until the person transitions into SCL2. As SCL2 does not include CLS services, the codes for Personal Assistance, Community Access Individual, and Community Access Group will not overlap with CLS.

For other services with similar codes there are modifiers attached that differentiates these from SCL1 codes.
Q.
Where can we find the new codes?
A.
To view the most current charts with the SCL2 codes, click on "College of Direct Support" in Related Links or visit http://www.collegeofdirectsupport.com/ky.
Q.
"What Works for Me" section: Some individuals communicate via other means than verbally, so do we leave that blank? (Since the next section is "what others think works for me") or do we go by what the person shows through behaviors?
A.
In the POC narrative section titled “What Works for Me,” you should complete it from the perspective of the person based on the person's method of communication. Behaviors and other actions may be the way a person communicates.
Q.
The communication section of the POC is confusing, needs to be changed a little bit.

"What Happens" and "What I am Doing" sections seem to be the same and are repeated.
A.
Please see the table below for examples of this section as found in the POC narrative:

Communication
What is HappeningWhat I DoWhat I Think it MeansWhat Others Should Do
I am in my room alone at home.I begin to yell and hit my head.I am in pain.Discern the source of the pain and take the appropriate action.
I am with a group of people.I begin to yell and hit my head.It is too loud and confusing.Help me find a quieter area.
Q.
"Things I am Figuring Out": Many do not know of anything they feel they are figuring out. Does the team give their input here?
A.
Yes, the team should assist in all areas of the POC. An example for this section might be that the person and the person's team would determine the best method of communication when the person and the person's team have trouble communicating and understanding each other.
Q.
On the POC Narrative section, who do we put as responsible (staff person, agency, title)?
A.
The agency that is providing the service should be noted in the “Who is Responsible” column.
Q.
We feel we need more instruction/information regarding the modifications or making corrections to documents.

For Modifications that do not require a team meeting, like durable medical equipment, is it okay for the CM to document having spoken to the guardian, or does the guardian have to actually sign off on the signature sheet?

The process by which Case Managers submit modifications for services has not been clearly defined or what signature documents are requested. Participant signature has been mentioned as being required, however, not every participant can make his or her mark or sign the necessary documents which leads to prolonging the process for changes and service implementation. Could this please be discussed in more detail?
A.
Please refer to the CDS Module "Case Management Documentation" found at the College of Direct Support website (see Related Links or visit http://www.collegeofdirectsupport.com/ky).

As a person's needs change, the POC may be need to be modified. The case manager should facilitate communication between appropriate members of the person-centered team to modify the POC. A full team meeting may not be required.

The case manager can speak with the guardian and then type the guardian's name and note that they spoke on a particular date and the outcome of the discussion. The person's record should contain a signed copy. This can also be electronically signed.

For individual signatures, the case manager can document that the person cannot physically sign but that the modifications were discussed with them and then the case manager would indicate how this occurred with the individual and/or guardian's input.
Q.
Are Behavior Support Plans/code 96152 to be updated annually? Some Behavior Support agencies are insisting the BSP be requested annually, other providers are saying no.
A.
The PBSP should function similarly to the person-centered POC. There should be continuous review and a system for determining effectiveness. The PBSP should be revised and updated as indicated through review and team consensus. Revisions to the PBSP may be covered through Consultative Clinical and Therapeutic Services.

The need for a PBSP shall be evaluated and revisions made as needed at any time, and at least annually.

If a new PBSP is needed, the team should determine if Consultative, Clinical and Therapeutic Services are needed for a new Functional Assessment, prior to revising the PBSP. The functional assessment must support the PBSP.
Q.
Since monitoring positive behavior support plans could only be authorized for three months, does that mean Positive Behavior Support Plans are only approved for three months?
A.
No. Positive Behavior Support Plan Service is used to develop the PBSP. The prior authorization of this service does not indicate PBSP approval. It is only for the development of the PBSP. Monitoring of the PBSP is through Consultative, Clinical and Therapeutic Services.
Q.
What needs to be sent in for the three-month recertification for positive behavior supports?
A.
Prior to the end date of the three-month PA, the case manager will submit a modification to add the units being requested to the POC. These will be approved again for a three-month period, if the annual limit of Consultative, Clinical and Therapeutic Services has not been reached.
Q.
Paperwork: What paperwork is sent to other providers that makes for a complete POC, etc.?
A.
The POC includes:
  • MAP-530
  • Plan of Care Narrative
  • Team Signature Sheet

The following is as applicable:
  • Person Centered Employment Plan
  • Long Term Supported Employment Plan
  • Positive Behavior Support Plan
Q.
Just to clarify, are residential provider agencies required to have all optional POC packet documents (for example, person-centered supported employment plan) on file even if we don't provide that specific service?
A.
Yes, if any of the "as applicable" plans exist for a person, the POC must contain all.
Q.
For durable medical equipment put on the SCL2 forms, are the time frames for things like Ensure, adult briefs, etc., still three months and are three estimates still required?
A.
Specialized Medical Equipment and Supplies services no longer require the MAP-95. There is no requirement for estimates. The case manager requests these items on the MAP-530. Case managers should refer to the DME Fee Schedule (see Related Links or visit http://chfs.ky.gov/dms/fee.htm) to determine the purchasing route.
Q.
I've requested Specialized Medical Equipment, formerly through MAP-95-ing the items. Today, Carewise confirmed that it's reflected correctly on the POC along with the MD's signature on the order. However, they're asking that DDID send me a letter of some kind stating that DDID (or whomever in Frankfort), who has been processing the MAP-95. no longer pays for this (in this case, briefs and Boost). Who do I need to get a letter from to prove to Carewise that DMS/Division of Comm. Alternatives/DDID, etc., no longer pays for these supplies? This is confusing because isn't it all Medicaid anyway? This letter also needs to come with a letterhead, per Carewise. So, my next question: How long is it going to take to get this letter?

Clarification needs to be given on the change in the MAP-95 process and what the requirements/process is for that submission.
A.
The Case Manager does not need a letter but just needs to document that the requested supply or equipment is not available through DME or any other State Plan program.
Q.
Does there need to be an outcome for CM services, as Carewise has stated needs to occur? Does there need to be an outcome/objectives for case management, respite, and residential services?
A.
Case management, respite and residential do not require outcomes and objectives on the POC; therefore, there is no need to identify SIS supporting questions. However, should a person identify a particular outcome and objective the person wishes to achieve in the residential setting, that outcome and objective would be included on the POC.
Q.
For Case Management, Respite and Residential services, are SIS items necessary to justify these services?

Case Managers have recently informed residential providers (per information distributed by the QAs) that there is no longer a requirement for outcomes and objectives; however, the regulations state that the monthly summary is to be an "analysis of progress toward a participant's outcome or outcomes." How are residential providers to ensure that there are not recoupment issues if/when a participant does not have outcomes and objectives?
A.
The following service components for residential services should be included in the residential notes as applicable to the services provided for that person. This will address the supports provided to an individual who does not have formal outcomes and objectives for residential services:
  • Adaptive skill development.
  • Assistance with activities of daily living, including bathing, dressing, toileting, transferring, or maintaining continence.
  • Community inclusion.
  • Adult education supports.
  • Social and leisure development.
    • Protective oversight or supervision.
  • Transportation.
  • Personal assistance.
  • The provision of medical or health care services that are integral to meeting the participant’s daily needs.
Q.
According to the Big Day training PowerPoint, it states, "For each service requested on the POC, the CM should identify 3-5 SIS quested that justify the need for the service."

So from my interpretation I would understand that to mean if I requested Residential Level 1 services, I would need to justify it. However, the FAQ provided to providers who did not attend Big Day training number 11 asks if outcomes and objectives are needed for residential.

The answer provided states, "If the person has identified they wish to improve, attain, or retain particular skills related to living in the community while at their residential setting, person-centered goals and objectives should then be developed. Otherwise, there is no requirement for residential goals and objectives."

From reading this, I feel the information appears to be conflicting unless the person wants to live on their own in the community and wishes to work towards those independent skills. While recently having a SCL2 POC, a RES level 1 provider stated since the individual was never going to live on their own, needed great supports (per information on the SIS), then goals and objectives did not need to be discussed. Therefore, I was wondering exactly what is correct. Does the CM need to justify each service? Or is residential services an exception?
A.
SIS items can be identified by the sections and item number such as: A3, D1, etc. It is not necessary to write out the complete question or item.

Remember to use the Family Friendly version of the SIS which is titled "My Support Profile."
Q.
In SCL1 the MAP-109 allowed for more autonomy for folks to switch up their days as they saw fit from one week to the next by listing multiple ADT providers on the plan and then requesting up to 160 units per week to be shared by those providers. Now Carewise says that for this to happen in SCL2, the case manager must submit a modification essentially weekly to move the units around. There is absolutely no way a case manager can be expected to submit that much paperwork to accomplish this. Please advise.
A.
Yes. Carewise Health reviews the requested amount and as long as the combination of all providers together does not exceed the weekly limit of 160, it is being approved.

It is suggested that providers ask for monthly units rather than weekly to allow more flexibility during the month. The team of providers that is providing "in combination" services should work together to determine how many units each will be providing.

With monthly units, the person could use more or less in a particular week, but not exceed the monthly total. However, there will be times that a modification is needed, but it most likely would not be every week. If it is happening weekly, then the team probably needs to take another look at the units requested and make any changes to better reflect what is actually happening.

The providers have to abide by the limits listed for each service.
Q.
Has there been a change in the regulations and guidelines regarding family home providers and the provision or "respite services"?
A.
Family Home Provider falls into the Level II Residential Service definition. Respite is not available for people who have residential services.
Q.
If an individual is currently receiving respite services under SCL1 and transitions to SCL2 after six months of this year when respite will no longer be an option, will they be eligible to receive the yearly maximum amount of respite as was available under SCL1? Or will it be prorated?
A.
No, SCL1 respite will not be prorated when a person transitions into SCL2. When the person transitions into SCL2, the Respite limit of 830 hours per calendar year will begin.
Q.
Are AFC/FHPs responsible for arranging coverage for their own time off (i.e., payment and setting it up) once a participant has transitioned into SCL2 services?
A.
The contractual arrangement between the SCL provider and the AFC or FHP should include time off. Respite services are not substituted for the AFC or FHP’s time off. The agency is expected to continue to provide residential supports for a person in SCL while the AFC or FHP provider is off.
Q.
Are the personnel who provide residential coverage to participants receiving Residential Level II supports during the primary AFC or FHP’s time off to have any specific type of training?
A.
Yes. All training and personnel requirements as set forth in 907 KAR 12:010 must be met. An agency prior authorized to provide Level II Residential Services must be available to do so every day of the year.
Q.
Clarify the requirement that CM’s respond to crisis situations within 45 minutes if necessary.
A.
The CM or designee must be able to respond to a call regarding a crisis event within 15 minutes and be able to respond or send a designee within 45 minutes if necessary.
Q.
Part of the problem is that the forms as they exist are not conducive to electronic fax. Not sure how to correct this but it is a problem.
A.
Please print the forms and then fax them to Carewise Health.
Q.
I am wondering why the ADT services were changed and that you can no longer put 160 units per week in combination of both ADTs. We have multiple individuals that go to more than one ADT, and breaking it down into specific units is not helpful, especially with transportation being how it is in this region.

Also, there are times that one ADT is closed and they will go to their other ADT. This is no longer possible due to how the units have to be specifically set numbers.

I have a client who goes to one ADT during the day and then a second ADT in the afternoon. This client wants to spend her whole day at one ADT because of an outing they are going on soon, and now she is no longer able to do this or have the flexibility with her services.

It seems that changes are made with the best intentions, but seem to limit the freedom of choice our clients have and make it much more difficult to live their lives how they want.
A.
The ability to request Day Training services as in-combination, not to exceed 160 units per week, was changed due to billing issues when there was not clear communication about unit use between providers of day training services. This resulted in some providers not being paid for the services provided and possibly other providers billing for more than was planned.

Clear communication between providers about the use of units should enhance a person’s opportunity to choose how his or her day services should occur. Teams must talk with each other; communication is key! The case manager may need to submit more modifications as changes like the one noted in the question occur.

We suggest that providers ask for monthly units rather than weekly, to allow more flexibility during the month. With monthly units, the person could use more or less in a particular week but not exceed the monthly total. In the situation described, if the limits do not exceed the approved units for the month, there will be no issue.

If this cannot be accomplished by communication between the providers, then a modification is needed to increase the units for the provider for that day and decreases the units for the other provider for just that day. Please refer to the “Plan of Care Section” Q&A for more on this topic.
Q.
Did I understand someone to say that residential outcomes are no longer necessary under the SCL2 guideline? If so, that is awesome, finally our ladies and gentlemen have a "normal" home life! Thanks for all your help.
A.
Residential outcomes are not required. It is the decision of the individual, guardian and team if needed or wanted. If the individual wants to work toward an outcome, then that should be included in the person centered plan of care.
Q.
When an individual changes to a new case management agency, this is now done through a modification. Should the transferring case manager to the receiving case manager complete the modification?
A.
The new case management agency should complete the modification to add them as the case management service and submit to Carewise Health. Both agencies should complete a MAP-24C.
Q.
Could we have some guidance on outcomes/action steps for therapies?
A.
Therapy goals on the MAP-530 Narrative should mirror therapist goals/action steps as stated on progress notes or treatment plans. These action steps may be appropriate under another outcome or service. Carewise Health will issue an LOI if the outcomes/goals/action steps differ from what the therapist has identified on the treatment plan.
Qualifications Scenarios: Community Access Specialist
Q.
What is the scenario for a Community Access Specialist?
A.
  • Staff A has been employed in the field of I/DD for five or more years, providing relevant community access-type services. Staff A meets requirements to fulfill the role of Community Access Specialist on or after 1/1/14.
  • Staff B has an associate's degree from a KCTCS institution in Human Services and has been employed in the field of I/DD for three or more years, providing relevant community access-type services. Staff B meets requirements to fulfill the role of Community Access Specialist on or after 1/1/14.
  • Staff C has an associate's degree from a KCTCS institution in Human Services and has been employed in the field of I/DD for one year, providing relevantcommunity access type services. Staff C has been employed with ABC Agency since 11/1/13. Staff C must obtain either a Kentucky DSP Specialty in Community Access or a national equivalent credential by December 31, 2014, to continue in the role of Community Access Specialist.
  • Staff D has one year of experience in the field of I/DD and has been providing relevant community access services at ABC Agency since July 1, 2013. Staff D must obtain either a Kentucky DSP Specialty in Community Access or a national equivalent credential by December 31, 2014, to continue in the role of Community Access Specialist.
  • Staff E was employed by ABC Agency on 1/2/14 and has one year of experience in the field of I/DD. Staff E must obtain a Kentucky DSP Specialty in Community Access or a national equivalent credential before being placed in the role of Community Access Specialist. Until the credential is attained, Staff E must be employed as a DSP whose role and responsibilities do not require a degree or five years' relevant experience.
Qualifications Scenarios: Supported Employment Specialist
Q.
What is the scenario for a Supported Employment Specialist?
A.
  • Staff A has been employed as a Job Coach in the field of I/DD for five or more years, providing relevant supported employment services. Staff A meets the requirements to fulfill the role of Supported Employment Specialist on or after 1/1/14.
  • Staff B has been employed in the field of I/DD for six or more years, providing relevant supported employment services. Staff B meets the qualifications to fulfill the role of Supported Employment Specialist on or after 1/1/14, but must complete the HDI Supported Employment Training Project training within six months of the date Staff B begins providing Supported Employment services.
  • Staff C has an associate's degree from a KCTCS institution in Business Administration and has been employed in the field of I/DD for three or more years providing Job Coach responsibilities. Staff C meets the requirements to fulfill the role of Supported Employment Specialist on or after 1/1/14.
  • Staff D has an associate's degree from a KCTCS institution in Business Administration, has been employed at ABC Agency since June 1, 2013, providing Job Coach related duties, and has attended the HDI Supported Employment Training Project training. Staff D must obtain either a Kentucky DSP Specialty in Employment Services or a national equivalent credential in Supported Employment by December 31, 2014, to continue in the role of Supported Employment Specialist.
  • Staff E has one year of experience in the field of I/DD providing relevant supported employment services at ABC Agency since February 1, 2013, and has completed the HDI Supported Employment Training Project training. Staff E must obtain either a Kentucky DSP Specialty in Employment Services or a national equivalent credential in Supported Employment by December 31, 2014, to continue in the role of Supported Employment Specialist.
  • Staff F was employed by ABC Agency on 1/15/14, has 1 year of experience in the field of I/DD and has completed 12 hours of college coursework. Staff F must obtain a Kentucky DSP Specialty in Employment Services or a national equivalent credential before being placed in the role of Employment Support Specialist. Until the credential is attained, Staff F must be employed as a DSP whose role and responsibilities do not require a degree or five years of relevant experience.
Q.
Can a syllabus be used as a work sample, for example, if the class someone took required the person to complete work that was relevant to the credential the person was trying to obtain?
A.
No, a syllabus alone is not an acceptable work sample. If the individual is completing course work, then the work product submitted for a grade would be an acceptable work sample with the appropriate reflective summary.
Q.
Under Option B that requires you to have 18 months of experience, can that be volunteer experience or does it need to be from a paid position? Does it need to be at one employer?
A.
We have revised some of the qualifications under all the requirements. Relevant experience (paid or volunteer) attained from the age of 18 may be appropriate. It would not have to be from the same employer or volunteer agency.
Q.
Since official transcripts come in a sealed envelope, people were asking if they will still be considered official once they open the envelope and scan them into the computer.
A.
Requirements are that we have a copy of an official transcript. So, once they are scanned into the file, then they will be considered official for our purposes.
Q.
Where are the checks and balances regarding work samples that are submitted? How will you know at DDID that someone actually did what he or she said he or she did and wrote about in the work sample and reflective summary versus just making something up and submitting it?
A.
First, we place high value on the honor system. If the DSP did not do the work, then the DSP should not "make up" something just to get a credential. The résumé should demonstrate that the individual worked in a setting that would be conducive and expected for the work sample provided. We will be asking Quality Administrators for input, especially if the work sample does not appear reasonable or realistic. In addition to our QA staff, we will spot check with employers/supervisors as we review documents.
Q.
If someone completed a credential and then it no longer existed, such as the Person-Centered one, would it still be recognized that the individual had the credential?
A.
If we issue a credential that is discontinued in the future, it will be recognized while it is in effect. At renewal time, the DSP will need to determine what other credential offered by DDID or a national organization is applicable for which the DSP should apply.
Questions Related to Staff/Personnel
Q.
How is it that all of a sudden on a Personnel Checklist it states now that providers have to do the SAM and LEIE exclusion checks. This is not in regulation, so how can something like this occur without even notifying providers, and most providers still are not even aware of this?

If this is a new requirement, although not in regulation, when is it effective? If not in regulation, how and when will providers be held responsible for something that has just appeared in a personnel checklist?

Updated personnel checklist forms indicate two additional personnel screenings not designated in regulation or the policy manual, namely the SAM and LEIE exclusion checks. Providers have not been informed how to review these nor that were they to be initiated at any time over the previous year.

The SAM exclusion check is a check for business entities and does not appear to be a check of potential staff members. What is the purpose of this and why would it need to be done for each new hire?

How do we prove that we did a SAM check since there is no printout?

Medicaid states that LEIE and SAM be checked every month for every employee and provider. Rather onerous. Is there a way to require those checks initially and 25 percent yearly like other checks?
A.
The newly revised version of the personnel checklist no longer includes the SAM and LEIE requirements. These are required by Medicaid but are separate from the SCL regulations.

Questions pertaining to this should be addressed to Medicaid. The Medicaid requirements can be found at the "Kentucky Medicaid Provider Terminated and Excluded Provider List" link in Related Links.
Q.
We have had recent questions about whether applicants for employment or employees may be required to bear the cost of pre-employment background checks.
A.
The Kentucky Labor Cabinet is quite adamant that this is not permitted. The Labor Cabinet has consistently interpreted KRS 336.220 to prohibit an employer/potential employer from passing to the employee/applicant the cost of furnishing any records required by the employer as a condition of employment. This includes background checks, drug screening, etc.
Q.
For an Ohio employee, we must obtain a Central Registry check from the state. However, state law requires that those checks only be provided to third-party agencies for adoption, foster care or for child care agencies. I have sent two requests, and the second one with a self-addressed stamped envelope, to the employee’s home and have not received it back yet.

What are our options when we have obtained an Ohio criminal check and Ohio OIG check and Ohio Nurse Aid Registry check? Do I not hire staff from Ohio and must I terminate my two Ohio employees?
A.
If the agency can show that the state in question will not provide the information, then the agency will not be penalized.

A number of states will not provide a CAN check and/or a Central Registry Check. Each state must follow its own policies, procedures and statues. When this situation arises, we have asked the SCL provider to document its attempt to obtain the background check in the employee's personnel record in lieu of the out-of-state check.

Documentation may include but is not limited to: email or snail mail correspondence with governmental officials of the other state; information printed from the other state's website, or a screenshot of the other state's website. As long as a provider can produce documentation that it has unsuccessfully attempted to obtain the out-of-state check, DDID will accept the documentation in place of the out-of-state check.
Q.
Is there a time frame for new hire out-of-state background checks (case managers and employees)?
A.
Out-of-state background checks must be completed within the same time frames as in-state (Kentucky) background checks. This can be found in regulation 907 KAR 12:010 3(3) (x) 1-3 (see "907 KAR 12:010" in Related Links). Please also reference the question in this section regarding required documentation when another state's policy prevents the completion of out-of-state background checks.
Q.
Is the training for employees under SCL2 applicable for natural supports as well?
A.
Personnel and training requirements listed in Section 3 of the SCL regulation 907 KAR 12:010 (see Related Links) apply to agency employees and volunteers, not natural supports. If a person-centered team determines that training for friends, acquaintances or co-workers who are providing natural supports is needed, the person-centered team should develop Natural Support Training in accordance with the SCL regulation, 907 KAR 12:010 Section 4(12)(a)1-9 (see Related Links).

This is a billable service; specific details of the payment limit can be found in the SCL Payment Regulation, 907 KAR 12:020 Section 3(11) (see Related Links).
Q.
People have had many counselors who fit into the LPCA certification and are no longer able to receive services from those clinicians not having their LPCC certification. Is there a possibility to grandfather some of those providers in?
A.
No, a Licensed Professional Counselor Associate (LPCA) cannot provide Consultative Clinical and Therapeutic Services other than as a Positive Behavior Support Specialist. The SCL2 regulation includes a specific listing of acceptable credentials; LPCA is not included. In fact, an LPCA may be operating outside his or her scope of practice in providing Psychological Services under SCL1. An LPCA must work under clinical supervision and cannot administer psychological testing, evaluation, diagnosis or treatment.

Related Regulations

SCL1: See "907 KAR 1:145" in Related Links.

Section 4. Non-CDO Covered Services
  • Psychological services which shall:
    1. 1. Be provided to an SCL recipient who is dually diagnosed to coordinate treatment for mental illness and a psychological condition;
    2. 2. Be utilized if the needs of the SCL recipient cannot be met by behavior support or another covered service;
    3. 3. Include:
      • a. The administration of psychological testing;
      • b. Evaluation;
      • c. Diagnosis; and
      • d. Treatment;
SCL2: See "907 KAR 12:010" in Related Links

Section 4(8) A consultative clinical and therapeutic service shall:
  • Be provided by a person who meets the personnel and training   requirements established in Section 3 of this administrative reg; and
  • Is a:
    1. 1. Certified nutritionist;
    2. 2. Licensed dietitian;
    3. 3. Licensed marriage and family therapist;
    4. 4. Licensed professional clinical counselor;
    5. 5. Licensed psychological associate;
    6. 6. Licensed psychologist;
    7. 7. Licensed psychological practitioner;
    8. 8. Licensed clinical social worker; or
    9. 9. Positive behavior support specialist;
Q.
Under SCL2, what degrees are considered to fall under Behavioral Science for hiring? Many applicants have a master's in Social Work, Special Education, and mental counseling, and a ton of experience. Are these acceptable? What other degrees qualify?
A.
There is not a specific listing of degrees that would fall under Behavioral Science. Please contact your DDID QA for assistance in determining if the degree is appropriate for a particular job/position.
Questions Related to Supported Employment
Q.
We are being told conflicting information about SE. We are getting LOIs stating that we need to send a VR exhausting letter. However, we have been told by DDID that we no longer need this letter just the SE plan. Please clarify and clarify with Carewise.
A.
Supported Employment planning and activity forms are now available on our Web page. See "Supported Employment" under "SCL Forms" in Related Links.

The long-term employment support plan is created at the end of the Job Acquisition and Training Phase of Supported Employment, immediately before OVR pays the outcome fee to the provider. It is literally the last thing that is done before long term-supports begin. For this reason, it is always proof that OVR funding has been exhausted when presented in conjunction with a request for Long-Term Employment Supports and should, in fact, provide justification for additional supports when more than 24 units per month of long-term supports are requested.

If Person-Centered Job Selection, Job Development and Analysis, or Job Acquisition with Training is to be requested after a participant has received long term supports, the person-centered team should contact Jeff White (see Contact Information box) immediately. Jeff will work with OVR staff to determine the appropriate stream of funding and communicate that information to CareWise Health.

An individual may have a Long-Term Supported Employment Plan and a Person-Centered Employment Plan.

Should an individual working in the community and receiving long-term supports decide that he or she would like to have a different or better job, the individual can continue to receive long-term supports while working with an employment specialist to find a new job. It is much easier for someone to find a new job when the person already has a job.

Type of Supported EmploymentAdditional Documentation to be Sent to Carewise Health
Long-Term Employment Supports24 units per month or less: Written Identification of the participant’s workplace and normal hours of work.

More than 24 units per month: Updated copy of the Long-Term Employment Support Plan justifying the quantity of long-term supports requested, written identification of the participant's workplace, and normal hours of work.
Person-Centered Job Selection No additional documentation required beyond the information referenced below.

  • An official letter from DDID, OVR, or Office for the Blind confirming that all alternative streams of funding have been exhausted and the Medicaid Waiver is the appropriate funder of last resort.
  • Please contact Jeff White at DDID (see Contact Information box) to begin the process for receipt of the letter very early in the person-centered planning process.

    The identification of the proper funding stream often requires several weeks.
Q.
Can you tell us about the APSE pre-conference sessions for case managers in February?
A.
On February 12 from 10:00 a.m. until 4:00 p.m.. Case Managers and Employment Specialists from all around Kentucky have the opportunity to meet together with Rehabilitation Counselors in an effort to help these very important parties learn exactly what should be expected from each other. In addition, opportunities will exist to have questions addressed by applicable DDID, OVR, or UK-HDI staff. The day will end with locally-oriented facilitated breakout sessions geared to help each group develop a well-informed plan to work together into the future.

On February 13 conference attendees and program participants will have the opportunity to enjoy a keynote address by America’s Leading Sit-down- Standup Comedian, Brett Leake. Mr. Leake, a frequent guest on the Tonight Show, refuses to let the fact that he has a significant disability get in the way of making people laugh. Mr. Leake’s critically acclaimed, "A Funny Thing Happened on the Way to the 'Tonight Show'" accomplishes this with a bit of motivation thrown in for good measure.

As an extra treat, Mr. Leake will be holding a workshop for everyone (providers and those seeking employment). It will include take-aways from his keynote address. The stories will focus on how to communicate your needs, of which other people without disabilities may not be at first aware. It will be a deeper exploration, with plenty of humor, of communicating on the job and in different parts of life.

Brett is now able to assist other people with disabilities on the job and will share how his humor has allowed him to help others and create successful situations for all. (Note: Be prepared to learn and to laugh throughout.) A special half-day rate of $15 has been established to enable program participants to take advantage of this opportunity. (The conference favor is likely to cost nearly $15 by itself!)

The conference continues on February 13 with concurrent sessions dealing with theme tracks covering Quality Services How-To, Transition Services and Employment, Mental Illness and Employment, Criminal Justice and Re-entry Services, and Waiver Services and Supported Employment. There should be ample opportunity to meet the SCL continuing education requirement during this single conference. CRC credits are also available.

On February 14, help move employment forward in Kentucky by taking advantage of the special First-Time Introductory APSE membership offer of $75 and get immediately involved in our membership breakfast and meeting. The conference concludes with Kentucky Supported Employment Visionary Carol Estes returning to the podium for the closing session. One can always expect Carol to congratulate us for things we have done well, inform us of thing we should have done better, and challenge us to set our sights higher.

Following the Conference, your employment services staff could take advantage of the opportunity to sit for the CESP exam and establish their credentials as Employment Specialists.
Q.
If someone already has SE and has been getting it for years, does a plan need to be submitted by an OVR/SE Specialist with SCL1 or SCL2 recertifications?
A.
Yes. To request supported employment you must also submit the appropriate plan(s) for the requested service(s) – the Person Centered Support Plan and/or the Long Term Supported Employment Plan. These are found on the SCL Forms - Supported Employment page (see Related Links). Refer to the first question in this section for further clarification.
Questions Related to Supports Intensity Scale (SIS)
Q.
If there is a change in the client’s behavioral status, can a new SIS Assessment be recommended by the team and completed ASAP?
A.
Yes, if there is a significant change in a person's support needs, the case manager would need to make the request to the SIS trainer and the DDID staff person who is listed as "Contact" in the Contact Information box at the right of this page.
Q.
Are there any time constraints on the SIS (i.e., can only have an assessment every years, etc.)?
A.
The SIS is completed once every other year; however, the case manager can request that an SIS be completed as referenced above. Send requests to the person who is listed as "Contact" in the Contact Information box at the right of this page.
Q.
If the information or scoring on the SIS appears to be inaccurate, may a new SIS assessment be requested? If so, who can request a new assessment?
A.
Yes, the case manager would need to make the request to the SIS trainer and send it to the person who is listed as "Contact" in the Contact Information box at the right of this page.
Q.
What is a Respondent?
A.
The DDID SIS assessor contacts the case manager to schedule. The case manager is responsible for inviting the family/guardian as applicable, and work with the individual and family/guardian to identify the best respondents. To be a respondent, the only criteria is that you must have known the person for at least three months, have spent significant time with the individual recently, and also be able to answer questions in a group interview format. There must be at least two qualified respondents. However, if there is a large group of attendees, the SIS may take longer, which may frustrate some. Research with the assessment has not shown that the results are any more accurate.

DDID encourages case managers to look for respondents from different areas of the person's life, if possible, as that helps to get the most complete picture. A clinician could certainly be one of the respondents, as long as the clinician really knows the person well enough to be able to answer detailed questions about the person's support needs (what does it take for the person to be successful in home living, community living, lifelong learning, etc.).
Questions Related to Transitioning
Q.
Clarify the date of submission to Carewise Health for people whose DOB and LOC end date are in the same month.
A.
If the person’s level of care (LOC) end date and date of birth (DOB) are in the same month, the SCL2 request will be reviewed without penalty. However, providers are serving at risk without an authorization, so it would be best practice in these scenarios to submit prior to the LOC end date. Please note that the LOC dates will flow with the original LOC dates and not adjusted to DOB.
Q.
Can you please talk about the process of transitioning folks into SCL2 that currently receive the SCL enhanced rate from an ICF/IID transition (those whose funding expires in 2014 and 2015 respectively)?
A.
If a person has transitioned from an ICF through Money Follows the Person (MFP), the person will receive an SCL allocation at the end of the MFP period. At that time the person will enter into SCL2 as a new allocation.

New Allocations – Individuals entering SCL waiver for the first time

Within 60 days from the allocation date, the case manager submits via fax to Carewise Health for the initial LOC and 120-day POC prior authorization (PA):
  • Copy of Allocation Letter.
  • A complete psychological evaluation that includes an IQ test and current adaptive behavior assessment.
  • Physical examination conducted within the last twelve (12) months.
  • MAP-24C as applicable (if receiving existing waiver services).
  • SCL Initial Level of Care form.
  • Life Story less than one year old.
  • MAP-530 pages 1 and 2; no Person Centered Plan required at this time.
  • MAP-531
  • MAP-350.

The case manager has 120 days based on the PA dates to submit the full plan to Carewise Health for review and continuation of services.

Within the 120 days, submit to Carewise Health for a PA:
  • My Life Story*.
  • Supports Intensity Scale – My Support Profile.
  • MAP-530.
  • Person Centered Plan of Care Document – (Narrative) and Team Signature.
  • Updated MAP-350.
  • Physical examination conducted within the last 12 months*.
  • MAP-531.
  • Other MAPs, plans, and supportive documentation as applicable (MAP-532, PBSP, Supported Employment Plans, etc.)
*It is not necessary to send items already sent in the initial packet unless there has been some type of change or update.
Q.
Is there still a period of T2033 at enhanced rate after MFP ends?

Individuals in MFP transitioned into the Enhanced SCL rate for 1 year and then on day 366 it went to the regular rate. Will this continue with SCL2 or no longer occur?
A.
Once the individual transitions into SCL2, the individual will receive the rates for services as defined in the SCL2 regulations. There are no enhanced rates for people transitioning from MFP.
Q.
If a client's current LOC ends 2/13/14 but the client's birthday isn't until 10/18/14, is the client's LOC extended to 10/18/14 or do we send in SCL1 information? Please advise.
A.
If the person’s birth month occurs after the LOC end date the LOC period and PA will remain unchanged.

The case manager will submit a recertification packet including (SCL1 forms):
  • MAP-350
  • MAP 350
  • MAP-109

Carewise Health will issue a Confirmation Notice of LOC and PA ending on the individual’s 2014 birthdate. Up to 30 days prior to the LOC end date, the CM shall submit to Carewise Health:
  • SCL LOC Recertification Form.
  • My Life Story.
  • Supports Intensity Scale – My Support Profile.
  • MAP-530.
  • Person Centered Plan of Care Document – (Narrative) and Team Signature.
  • Updated MAP-350.
  • Physical examination conducted within the last 12 months.
  • MAP-531.
  • Other MAPs, plans, and supportive documentation as applicable (MAP-532, PBSP, Supported Employment Plans, etc.).
Q.
If LOC date ends 2/28/14 and birthday is 3/6/14, do we have to complete SCL1 for five days, or can we submit SCL2 prior to 2/28/2014?
A.
Yes, you must submit the SCL1 forms and then submit SCL2 forms on the birthdate.
Q.
If a person changes case management agency and the person receives a new LOC, how does that fit into the transitioning to SCL2?
A.
Participants will not transition into SCL2 until 2014 DOB. Updated MAP-109 and admitting/discharging MAP-24C required for case management transfer. If it is time for reassessment then new case manager can complete the MAP-351.
Q.
If an individual within his or her SCL2 plan is transitioning to a new case management company, does the case manager do the plan as initial or re-certification?
A.
In SCL2, a change in case management is requested as a modification to the Plan of Care. It is not an initial plan, just a change in service providers. The case manager should also send the appropriate 24C. The plan and LOC time frame will remain the same. If other changes are needed, then the new case manager will send in modifications for those additional services that need to be changed.
Questions Related to Units/Limits
SCL2 Questions and Answers
Q.
CMs are very confused about the amount of time that CCT PAs are good for.
A.
Prior Authorization (PA) for up to 90 days may be issued for Consultative Clinical and Therapeutic Services per request.
Q.
Under Clinical, Consultative and Therapeutic Services for Behavior Supports, what if someone is getting other services? Do all services have to stay within the 160 units a year, or 160 units for each service (code)?
A.
For Clinical, Consultative and Therapeutic Services, it is a total of 160 units per year. All services are included in the 160 units per year.
Q.
If all of the CCT units that have been approved are used prior to the end of the three-month PA, can the team request additional units before the three months are up?
A.
Yes, this is just a modification. The total amount of units requested, however, may not exceed the 160-unit limit for the LOC year.
Q.
Is the annual cap on units based upon the units that have been approved or the units that have been billed? That is, if a clinician is approved for 12 monthly units and one month only uses 4 units, can the 8 units be approved again later in the year or are they lost?
A.
The cap is monitored through the MMIS via audits on claims. The case manager should note when requesting units that appear to be over the annual cap that previously authorized monthly units were not used.
Q.
In regard to billing for Community Access Group: CA pays $8 per unit and CA Group pays $4 per unit. In the instance that two participants want to receive their CA together, would the first be billed as CA ($8) and second as CA Group ($4)? This is what we assume, but we don't see it clearly stated anywhere in the regulation.
A.
The service for this event would be Community Access Group for both individuals at $4.00 per unit.
Q.
What is the cap on allowable units for Community Access? I believe it’s only authorized for six months, but I can’t find the cap allowances.
A.
Community Access will be prior-authorized for up to six months. Community Access, in combination with Day Training, Supported Employment (including employment hours), and Personal Assistance cannot exceed 16 hours daily. If Community Access services are needed beyond the PA’d six months, the case manager should submit a modification with justification for continuing use.

Community Access services are designed to result in an increased ability by the participant to access community resources by natural or unpaid supports. Community Access services shall have an emphasis on the development of personal social networks for the person. A person may have Community Access services for more than one outcome, or have Community Access in and out of their POC as needed to make the community connections.

There is no cap as to the number of units a person may need during the POC year. The focus is more on how it is used rather than how much is used.
Q.
Is there a limit of outcomes that day training has to have for approval of services?
A.
There is no specified limit of outcomes for day training. However, the outcomes should be individualized to the person’s needs and interests and reasonable for the amount of units requested.
Q.
If approved for 40 one-time units for a Functional Assessment, could the provider complete the FA as quickly as possible, say over two days working on it five hours each day (total of 40 units)?

If so, when the provider bills it, would we submit the billing for the day the FA was completed?

Since there was only one billing date of service (for the 40 units), would we only complete one progress note detailing what was accomplished during those 40 units?
A.
The PA will be issued for a three-month period for a specific number of units. The provider will have the entire three-month period to utilize all authorized units. So using the example below, a PA would be issued for the FA and the provider could complete it in however many days were necessary, documenting and billing for the correct amount of units used on each date of service.

The provider would bill each date of service independently for the corresponding number of units used that day.

A progress note should be done documenting all activities completed on the corresponding date of service. If units are billed on separate dates, each day the behavior specialist works on the FA we would expect to see a separate staff note for each date, including start and end times and a summary of what was done.
Q.
What are the maximum units for SE on a weekly and/or monthly basis?
A.
Person-Centered Job Selection: Up to 120 (15-minute) units per LOC.
Job Development and Analysis: Up to 90 (15-minute) units per LOC.
Job Acquisition with Support: Up to 800 (15-minute) units per LOC.
Long–Term Support and Follow-Up: up to 24 (15-minute) units per month.