Kentucky Cabinet for Health and Family Services

SCL Questions and Answers

Questions Related to Plan of Care

How would I find SCL2 forms and additional information?

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.

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?

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.

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?

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.

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.

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.

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?

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.

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.

The life story form has been revised to allow for unlimited narrative.

Life story is just a small part of their life. Would a Psycho-social work best here since it really is their life story?

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).

On the POC Narrative, what if a goal has been achieved and new goals added? How does CM track this?

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.

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?

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.

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.

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).

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.

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.

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.

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.

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?

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.

Where can we find the new codes?

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.

"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?

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.

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.

Please see the table below for examples of this section as found in the POC narrative:

Communication
What is Happening	What I Do	What I Think it Means	What 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.

"Things I am Figuring Out": Many do not know of anything they feel they are figuring out. Does the team give their input here?

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.

On the POC Narrative section, who do we put as responsible (staff person, agency, title)?

The agency that is providing the service should be noted in the “Who is Responsible” column.

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?

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.

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.

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.

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?

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.

What needs to be sent in for the three-month recertification for positive behavior supports?

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.

Paperwork: What paperwork is sent to other providers that makes for a complete POC, etc.?

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

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?

Yes, if any of the "as applicable" plans exist for a person, the POC must contain all.

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?

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.

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.

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.

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?

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.

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?

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.

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?

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."

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.

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.

Has there been a change in the regulations and guidelines regarding family home providers and the provision or "respite services"?

Family Home Provider falls into the Level II Residential Service definition. Respite is not available for people who have residential services.

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?

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.

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?

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.

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?

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.

Clarify the requirement that CM’s respond to crisis situations within 45 minutes if necessary.

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.

This requirement has been incorporated into Case Management Training.
This requirement will be included on the Quality Indicator Tools.
See page 26 of 144 of the Amended SCL Waiver document (see Related Links or visit http://dbhdid.ky.gov/ddid/documents/scl/AmendedSCLWaiver.pdf).

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.

Please print the forms and then fax them to Carewise Health.

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.

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.

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.

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.

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?

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.

Could we have some guidance on outcomes/action steps for therapies?

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.