Supervisory Visits in Beneficiary Primary Private Residences
During the period of the State of Emergency, supervisory visits must be conducted, but may be conducted utilizing eligible technologies that allow the supervising registered nurse (RN) to remotely communicate and evaluate services rendered. Supervisory visits can be delivered via any HIPAA-compliant, secure technology with audio and video capabilities including (but not limited to) smart phones, tablets and computers.
If remote technology is used, it must be real-time communications and the platform is a type consistent with one described in the HHS Office for Civil Rights. The use of remote technology and patient consent should be properly documented in the participant’s medical record.
If the provider is unable to conduct supervisory visits via the above method, the provider must develop and implement a procedure that details the method in which the RN will monitor the beneficiary’s care in accordance with section 7.10(b) of Clinical Coverage Policy 3L.
Requirement for Physician Referral
Clinical Coverage Policy 3L requires that a beneficiary must be under the ongoing direct care of a physician for the medical condition or diagnosis causing the functional limitation. To submit a new referral, the beneficiary must have been seen by his or her practitioner during the preceding 90 calendar days or the PCS referral is not processed. During this period, Medicaid will extend this period to the proceeding 120 calendar days of the date the referral is received by the Independent Assessment Entity. Referrals based on telehealth visits with the beneficiary’s PCP or referring practitioner within the temporary time frame of 120 calendar days are acceptable. Electronic signatures are accepted during this period.
PCS conducted outside of beneficiaries’ primary private residence
Beneficiaries who receive services in their primary private residence may receive their authorized PCS services in an alternate primary private location during this period. Providers should document the new location and the period that the beneficiary will reside temporarily as well as the reason for the temporary location.
Documentation requests to determine PCS authorization
Beneficiaries and providers may be asked by the IAE or the PCS Nurse Consultant to submit documentation that is typically shown and reviewed during the face to face assessment. Providers and beneficiaries may submit requested documents to the requestor via fax. If the beneficiary received the request for documentation from Liberty Healthcare of NC, please fax documents to 919-322-5942 (local) or 855-740-0200 (toll-free). If the beneficiary received the request for documentation from the Medicaid PCS Nurse Consultant, documents may be faxed to 919-715-0102.
Service Plan Requirement
During this period, beneficiaries who submit an initial request will receive a telephonic mini assessment. Once a provider accepts a beneficiary who has had an initial mini assessment completed, the provider shall create a manual service plan and obtain written consent in the form of the signature of the beneficiary or their legally responsible person. The written consent of the service plan must be printed out and uploaded into the provider interface within 21 business days of accepting the referral. There is no specific template for a manual service plan. You may use any format you wish, as long as it covers tasks, frequency, hours awarded, etc.
If a written consent cannot be attained, a “verbal signature” or “verbal concurrence” from the beneficiary or legally responsible person may be obtained.
The provider organization should maintain a record of the verbal signature or concurrence that clearly documents who took part in the verbal agreement, both at the provider organization and the beneficiary/legally responsible person.
Beneficiaries who submit an initial request with a signed attestation currently receive a mini telephonic assessment followed by a full telephonic assessment. Providers who accept beneficiaries who have a signed attestation do not have to complete a manual service plan for the mini assessment hours. Once the full telephonic assessment is completed and hours are authorized and accepted, the provider will follow the typical process described in Clinical Coverage Policy 3L:
- complete the service plan within 7 business days of accepting the beneficiary
- obtain the written or verbal consent as identified
- upload a signed copy of the service plan into the provider interface within 14 business days of the validated service plan
During this period, for initial requests without attestations, if the Independent Assessment Entity (IAE) is unable to contact the beneficiary or legally responsible person to complete the mini assessment, these may move to the full assessment queue. In those cases, the IAE will make one additional attempt to contact the beneficiary or legally responsible party before issuing a technical denial. If the last contact is successful, the IAE will conduct a full telephonic assessment and not the mini assessment. When a full telephonic assessment is conducted, the system follows typical workflow and issues a system generated service plan once the provider accepts. In these instances, providers will complete the service plan in accordance with current PCS policy 3L.
If the mini assessment moves to the full assessment queue and the IAE is unable to make contact to complete a telephonic assessment, the IAE will issue a Technical Denial. If the beneficiary or legally responsible party contacts the IAE within 10 business days of the Technical Denial issuance and has not filed an appeal, a full telephonic assessment may then be conducted. Once the assessment is conducted and a provider accepts a system generated service plan is issued. The provider will complete the service plan in accordance with current PCS policy 3L.
CONTACT: GDIT, (800) 688-6696