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5392.01 How To Get The Extra Help You Need To |
There are two home and community based waivers under Medi-Cal that can help you avoid being placed in a nursing home or can help you get out of a nursing home. The waivers are called 1) the Nursing Facility (NF) A/B Waiver and 2) the Nursing Facility (NF) Sub Acute Waiver. Through these waivers, you can receive among other things, extra attendant care hours (IHSS/Medi-Cal personal care services), nursing, and home modifications (ramps, widen a door frame).
If you are married and ineligible for Medi-Cal because of too many resources and/or too much income, the waivers may help you qualify for Medi-Cal and for extra services.
See Attachment A for more information about these waivers.
Simply fill out the two forms found in Attachment B and send them to In-Home Operations. We have provided an additional copy of each form for your convenience.
Yes, a long waiting list. It can take more than a year to
get the waiver services you need! Why? Because there are only 1,135 slots or
spaces under the waivers. Other waivers have more slots. One example of a
waiver with more slots is the Medi-Cal waiver for persons eligible for regional
center services, which has 45,000 slots! Although Medi-Cal pays for
approximately 80,000 nursing facility beds, Medi-Cal has only set aside 685
slots for people who would otherwise require care in a sub acute nursing
facility (mostly people with ventilators) and
only 450 slots for people who would otherwise require care in other kinds of
nursing facilities!
If you are on the waiting list and want to know where you are on the list, how many there are ahead of you and how long you will have to wait, call (916) 552-9105.
The State has the authority to increase the number of
slots in the nursing facility waivers by simply asking the federal government
to approve an increase in the number of slots. You need to ask the State to
increase the number of slots or spaces under the nursing facility waivers. If
you want to qualify for services sooner, call, write or e-mail your state
representatives: the governor, your state senator, your state assembly member.
Attachment C tells you how to contact the governor and how to use the internet
to get the name, phone number and address of your state senator and assembly
member. If you do not have access to the internet, you can call Carlos Garcia
at (213) 427-8757 ext. 3020 who will give you the name, phone number and
address of your state senator and assembly member.
If you are 65 or older, you may be eligible for home and community based waiver services through the Multipurpose Senior Services Program (MSSP). Call the State Department of Aging at (800) 510-2020. There are a total of 11,700 slots under the MSSP waiver.
If you are HIV positive, you may qualify for the home and community based waiver services through the AIDS waiver. Call (916) 327-6784. There are a total of 3,100 slots under the AIDS waiver.
Protection
& Advocacy, Inc.
3580 Wilshire Blvd., Suite. 902
Los Angeles, CA 90010-2512
Tel: (213)
427-8747 – Fax: (213) 427-8767
Toll Free/TTY/TDD:
1-800-776-5746
Ø Subject to prior authorization.
Ø Designed for persons who are physically disabled and
in the absence of the waiver would be expected to require at least 365 days of
nursing facility care.
Ø Beneficiary must be Medi-Cal eligible. This can be
established in one of two ways:
·
community deeming rules/requirements, i.e., the regular financial rules for Medi-Cal
eligibility;
·
institutional deeming rules/requirements, i.e., the individual is assessed
to be Medi-Cal eligible “as if” he/she were in a long-term care facility.
Ø Authorized services must be cost-effective to the Medi-Cal program. This means that the total
cost of providing NF A/B waiver services and all other medically necessary
Medi-Cal services to the beneficiary must be less than the total cost incurred
by the Medi-Cal program for providing care to the beneficiary at the otherwise
appropriate nursing facility. The NF A and B levels of care are defined in CCR,
Title 22, Division 3, Sections 51120, 51124, 51134 and 51135.
Ø NF A/B waiver services include: case management, RN or
LVN private duty nursing services, home health aide services, shared nursing
services, waiver service coordination, minor home modifications such as
grab-bar placement or ramps, utility coverage for life-sustaining equipment,
personal emergency response systems, family training, personal care services,
and respite.
Ø Implementation of NF A/B waiver services also involves
the active participation of the family and/or primary caregiver in the home
care program. A family member and/or a primary caregiver should be proficient
in the tasks necessary to care for the beneficiary at home to ensure care is
not interrupted due to the inability of the provider to render services on a
given day or for a certain period of time. This proficiency requirement may be
satisfied by training as necessary to safely carry out the plan of treatment
and/or by providing direct care to the beneficiary on an ongoing basis. The
involvement of the family and/or the primary caregiver helps to ensure a safe
home program for the beneficiary.
Ø Services are authorized through appropriate licensed
and certified Medi-Cal providers or waiver specific providers. The provider type
may include licensed and certified home health agencies, private duty nursing
agencies, individual licensed registered nurses or licensed vocational nurses,
and unlicensed caregivers.
Ø Prescribed by the beneficiary’s primary care physician
in accordance with regulations outlined in CCR, Title 22, Division 3.
Ø Provided in the beneficiary’s home that has been
assessed to be a safe environment. Home may include congregate living health
facilities, Type A.
Ø Subject to prior authorization.
Ø Designed for persons who are physically disabled and
in the absence of the waiver would be expected to require at least 180 days or
more of nursing facility care. The levels of service under the NF Subacute are
the adult subacute and pediatric subacute.
Ø Beneficiary must be Medi-Cal eligible. This can be
established in one of two ways:
·
community deeming rules/requirements, i.e., the regular financial rules for Medi-Cal
eligibility;
·
institutional deeming rules/requirements, i.e., the individual is assessed
to be Medi-Cal eligible “as if” he/she were in a long-term care facility.
Ø
Authorized services must be cost-effective to the Medi-Cal program. This means that the total
cost of providing NF Subacute waiver services and all other medically necessary
Medi-Cal
services to the beneficiary must be less than the total cost incurred by the
Medi-Cal program for providing care to the beneficiary at the otherwise
appropriate nursing facility. The subacute nursing facility levels of care are
defined in CCR, Title 22, Division 3, Sections 51124.5, 51124.6, and the
Medi-Cal Manual of Criteria.
Ø NF Subacute waiver services include: case management,
RN or LVN private duty nursing services, home health aide services, shared
nursing services, waiver service coordination, minor home modifications such as
grab-bar placement or ramps, utility coverage for life-sustaining equipment,
personal emergency response systems, family training, personal care services,
and respite.
Ø Implementation of NF Subacute waiver services also
involves the active participation of the family and/or primary caregiver in the
home care program. A family member and/or a primary caregiver should be
proficient in the tasks necessary to care for the beneficiary at home to ensure
care is not interrupted due to the inability of the provider to render services
on a given day or for a certain period of time. This proficiency requirement
may be satisfied by training as necessary to safely carry out the plan of
treatment and/or by providing direct care to the beneficiary on an ongoing
basis. The involvement of the family and/or the primary caregiver helps to
ensure a safe home program for the beneficiary.
Ø Services are authorized through appropriate licensed
and certified Medi-Cal providers or waiver specific providers. The provider
type may include licensed and certified home health agencies, private duty
nursing agencies, individual licensed registered nurses or licensed vocational
nurses, and unlicensed caregivers.
Ø Prescribed by the beneficiary’s primary care physician
in accordance with regulations outlined in CCR, Title 22, Division 3.
Provided
in the beneficiary’s home that has been assessed to be a safe environment. Home
may include congregate living health facilities, Type A.
* All
Waiver Services require prior authorization *
The
following are the definitions of the services offered under the NF A/B and NF
Subacute Waivers:
Ø Services which will assist individuals who receive
waiver services in gaining access to needed waiver and other State Plan
services, as well as needed medical, social, educational and other services,
regardless of the funding source for the services to which access is gained.
These services are provided in cooperation with the Department of Health
Services (DHS), Medi-Cal Operations Division (MCOD), In-Home Operations (IHO).
Ø The following persons may provide case management
services:
1.
A Registered Nurse (RN) employed by a home health
agency (HHA) or a Private Duty Nursing Agency (PDNA);
2.
A RN, also known as an Individual Nurse Provider
(INP), under the direction of a licensed physician;
3.
An individual who is licensed and certified by the
State of California such as Marriage, Family, Child Counselor (MCFF), Clinical
Psychologist, or Licensed Clinical Social Worker (LCSW); or
4.
An entity or organization that is licensed and
certified by the State of
Ø Case managers shall be responsible for ongoing
monitoring of the provision of services included in the individual's plan of
care/plan of treatment (POT) and Menu of Home and Community-Based Services
Waiver Service (MOHS) Form.
Ø The waiver service providers for case management will
have responsibility for the ongoing, routine aspects of waiver services being
provided in the home. They will have the direct contact with the beneficiary
and, as applicable, the assigned nursing staff and the physician; will oversee
the implementation and evaluation of all services identified in the POT and
offered in the MOHS. Case management responsibilities include assessing, care
planning, authorizing, locating, coordinating and monitoring a package of long-
term care services for community-based clients.
Ø Case management services may begin up to 180 days
prior to discharge from an institution. All services provided will be billed
against the waiver on the date of discharge. If the beneficiary should decease
before discharge, all services provided may be charged to the waiver on the
date of death.
NOTE: The
beneficiary must be enrolled in the State Plan Personal Care Services Program
in order to access waiver personal care services.
Ø Services which provide assistance with eating,
bathing, dressing, personal hygiene, and activities of daily living; includes
hands-on care, of both a supportive and health-related nature, specific to the
needs of a medically stable, physically handicapped individual and may include
skilled or nursing care to the extent permitted by law. This service may
include assistance with preparation of meals, but does not include the cost of
the meals themselves. When specified in the plan of care/plan of treatment,
this service may also include such housekeeping chores as bedmaking, dusting
and vacuuming, which are incidental to the care furnished, or which are
essential to the health and welfare of the individual, rather than the
individual's family. Personal care providers must meet State standards for this
service.
Ø Personal care companions to provide non-medical care,
supervision and socialization provided to a functionally impaired adult.
Personal care companions may assist or supervise the individual with such tasks
as meal preparation, laundry and shopping, but do not perform these activities
as discrete services. The personal care companion may also perform light
housekeeping tasks which are incidental to the care and supervision of the
individual. This service is provided in accordance with a therapeutic goal in
the plan of care, and is not purely diversional in nature.
Ø To the extent that the waiver participant is willing
and able, they will be allowed to manage their personal care services to the
extent of their capability.
Ø Personal care providers may be members of the
individual's family. Payment may be made for services furnished to a minor by
the child's parent (or stepparent), or to the individual's spouse. Legally
responsible individuals (parents of minors, spouse) may be used in the event
there are no other available providers, the individual lives in a rural area or
the cost neutrality for waiver services can be established and/or maintained.
MCOD-IHO may require additional documentation to support requests of this
nature.
Ø Personal Care services may also be provided by Home
Health Agency staff or Service Agencies employing personal care providers.
Ø Supervision of personal care providers may include:
1.
Case managers as described under the Case Management
Services, if applicable
2.
The beneficiary or the service agency/applicable
county agency employing the unlicensed caregiver
Ø If a HHA/PDNA participates in the home care plan for
the beneficiary, but does not employ the personal care services provider, then
the HHA/PDNA nurse is not responsible for the monitoring or supervision of the
personal care services provider when the beneficiary is receiving State Plan or
Waiver Personal Care Services. However, the HHA/PDNA nurse is responsible for
monitoring the health, safety, and welfare of the waiver beneficiary. In this
regard, the HHA/PDNA nurse discusses with the beneficiary their health and the
care being provided. The HHA/PDNA nurse is required, depending on the
circumstances, to report to Adult Protective Services, Child Protective
Services or to the beneficiary's physician, any areas of concern regarding a
beneficiary's health, safety and welfare, including any sign or symptom
requiring professional evaluation or care.
Ø If an INP participates in the home care plan for the
beneficiary, then the INP is not responsible for the monitoring or supervision
of the personal care services provider when the beneficiary is receiving State
Plan or Waiver Personal Care Services. However, the INP is responsible for
monitoring the health, safety, and welfare of the waiver beneficiary. In this
regard, the INP discusses with the beneficiary their health and the care being
provided. The INP is required, depending on the circumstances, to report to
Adult Protective Services, Child Protective Services or to the beneficiary's
physician, any areas of concern regarding a beneficiary's health, safety and welfare,
including any sign or symptom requiring professional evaluation or care.
Ø Waiver personal care services shall be rendered by a
provider subject to the informed consent of the beneficiary or the authorized
representative, and shall be obtained as a part of the order for service,
pursuant to W&I Code sections 12300, et seq. and 14132.95. Training
requirements for unlicensed caregivers will be the primary responsibility of
the beneficiary with support from the primary care physician and/or medical team,
any identified nursing support and appropriate MCOD-IHO staff. As requested,
MCOD-IHO staff will work with the beneficiary in assisting them with
questions/concerns that may arise regarding hiring, training and supervision of
unlicensed caregivers. Referrals will also be made back to the county of
residence or other local programs for assistance in this area.
Ø As part of the eligibility criteria for waiver
personal care services only, the beneficiary shall receive periodic case
management visits from an identified waiver case management service provider,
at prescribed intervals to be determined by the physician to ensure health and
safety. As warranted, intermittent nursing services may be authorized through
the State Plan benefit.
Ø Personal care service providers may be paid while the
beneficiary is hospitalized up to 7 days per each hospitalization. This payment
is necessary to retain the care provider for services when the beneficiary
returns home. During these time periods, the personal care services provider
will provide written documentation to MCOD/IHO as to the activities performed.
Appropriate activities may include care and maintenance of the home
environment, running errands for the beneficiary which will facilitate the
return home and checking mail.
Ø Intermittent or regularly scheduled temporary medical
care and supervision provided in the beneficiary's own home or in an approved
out-of-home location to do all of the following:
1.
Assist family members in maintaining the beneficiary
at home;
2.
Provide appropriate care and supervision to protect
the beneficiary's safety in the absence of family members;
3.
Relieve family members from the constantly demanding
responsibility of caring for a beneficiary; and
4.
Attend to the consumer's medical needs and other
activities of daily living, which would ordinarily be performed by the service
provider or family member.
Ø Respite care may be provided in the following
location(s):
1.
Individual's home or place of residence
2.
Medicaid certified NF A or B facility or Subacute
(Adult or Pediatric} Facility
Ø Those physical adaptations to the home, required by
the individual's plan of care/plan of treatment and selected in the MOHS, which
are necessary to ensure the health, welfare and safety of the individual; or
which enables the individual to function with greater independence in the home,
and without which, the individual would require institutionalization. Such
adaptations may include the installation of ramps and grab-bars, widening of
doorways, modification of bathroom facilities, or installation of specialized
electric and plumbing systems which are necessary to accommodate the medical
equipment arid supplies which are necessary for the welfare of the individual.
Excluded are those adaptations or improvements to the home which are of general
utility, and are not of direct medical or remedial benefit to the individual,
such as carpeting, roof repair, central air conditioning, etc. Adaptations that
add to the total square footage of the home are excluded from this benefit. All
services shall be provided in accordance with applicable State or local
building codes.
Ø Requests for any and all modifications to a residence
which is not the property of the waiver recipient, shall be accompanied by
written consent from the property owner for the requested modifications.
Environmental modification services are payable one time only to a
maximum amount of $5,000.
Ø The only exceptions to the one time, $5,000 maximum
are if:
1.
The recipient's place of residence changes; or
2.
In the opinion of the DHS-MCOD nurse case manager, and
based upon review of appropriate documentation, the waiver beneficiary's
condition has changed so significantly that additional modifications are
necessary to ensure the health, welfare and safety of the beneficiary; or are
necessary to enable the beneficiary to function with greater independence in
the home and without which, the recipient would require institutionalization.
Ø Absent written authorization from the owner,
environmental accessibility modifications will not be authorized or be subject
to compensation for residential care providers or rental units. To the extent
possible, modifications will be made to the residence prior to occupation by
the beneficiary. Upon commencement of the modification, all parties will
receive written documentation that the modifications are permanent, and that
the State is not responsible for removal of any modification if the beneficiary
cease to reside at a residence which is rental property.
Ø All requests for environmental accessibility
modifications submitted by a provider should include the following information:
1.
Physician's order specifying the requested equipment
or service;
2.
Physical Therapy evaluation and report to assess the
medical necessity of the requested equipment or service. This should typically
come from an entity with no connection to the provider of the requested
equipment or service. The Physical Therapy evaluation and report should contain
at least the following information:
a.
An assessment of the beneficiary and the current
equipment needs specific to the individual, describing how/why the current
equipment does or does not meet the needs of the beneficiary.
b.
An assessment of the requested equipment or service
and description how/why it is necessary for the beneficiary. This should
include the ability of the beneficiary and/or the primary caregiver to learn
about and appropriately use any requested item.
c.
Description of similar equipment used either currently
or in the past that has demonstrated to be inadequate for the beneficiary and a
description of the inadequacy.
3.
Medical Social Worker evaluation and report to assess
for other community resources available to provide the requested equipment or
service, the availability of the other resources, and any other pertinent
recommendations related to the requested equipment or service. This should
include the description of the availability of Other Health Care (OHC) coverage
to provide for the requested equipment or service.
4.
Depending on the type of adaptation or modification
requested, documentation from the provider of the equipment or service
describing how the equipment or service meets the medical needs of the
beneficiary, including any supporting documentation describing the efficacy of
the equipment. Brochures will suffice in showing the purpose and efficacy of
the equipment; however, a brief written evaluation specific to the beneficiary
will still be necessary describing how and why the equipment or service meets
the needs of the individual.
5.
If possible, include a minimum of two bids from
appropriate providers of the requested service, which itemize the services,
cost, labor and applicable warranties. Providers may include Durable Medical
Equipment companies; licensed contractor's or professional organizations
6.
The MCOD nurse case manager will take the appropriate
action on the TAR after all requested documentation has been received,
reviewed, and a home visit has been conducted by appropriate program staff to
determine the suitability of any requested equipment or service.
Ø Because of the maximum allowed cost of $5,000 for an
adaptation, the use of this service may result in a reduction in the amount of
other services the beneficiary may receive in the year the adaptation is
authorized. Since the waiver must remain cost neutral, it is very important
that the fiscal impact of this service be clearly understood by the beneficiary
at the time of request for the accessibility adaptation and before the
authorization of the modification service.
Ø PERS is an electronic device which enables certain
individuals at high risk of institutionalization to secure help in an
emergency. The individual may also wear a portable "help" button to
allow for mobility. The system is connected to the person's phone and
programmed to signal a response center once a "help" button is
activated. The response center is staffed by trained professionals. PERS
services are limited to those individuals who live alone, or who are alone for
significant parts of the day, and have no regular caregiver for extended
periods of time, and who would otherwise require extensive routine supervision.
PERS services will only be provided as a waiver service to a beneficiary
residing in a non-licensed environment. All types of PERS, described below, shall
meet applicable standards of manufacture, design, and installation. Repairs to
and maintenance of such equipment shall be performed by the manufacturer's
authorized dealers whenever possible.
1.
24-hour
answering/paging;
2.
Beepers;
3.
Med-alert
bracelets;
4.
Intercoms;
5.
Life-lines;
6.
Fire/safety
devices, such as fire extinguishers and rope ladders
7.
Monitoring
services
8.
Light fixture
adaptations (blinking lights, etc.);
9.
Telephone
adaptive devices not available from the telephone company;
10.
Other electronic devices/services designed for
emergency assistance.
Ø Individual and continuous care (in contrast to part
time or intermittent care) provided by a licensed and certified home health
agency (HHA), a private duty nursing agency (PDNA), a Congregate Living Health
Facility-Type "A" (CLHF-A), a certified home health aide (CHHA) under
a HHA, or individual licensed nurses within the scope of State law. These
services are provided to an individual at home.
Shared Private Duty Nursing
Services
1.
"Shared Private Duty Nursing Services” under the
waiver are provided by a licensed RN, LVN or CHHA under a HHA, PDNA, an INP or
a CLHF-A in accordance with the attending physician's orders, the written plan
of care/plan of treatment and the MOHS. Shared nursing is the provision of
nursing services for two beneficiaries who live in the same residence and share
a nurse amongst themselves, i.e., one nurse for two beneficiaries. This service
will only be provided upon request by the beneficiary or his/her authorized
representative.
Ø Training and counseling services for the families of
individuals served under the waiver. For purposes of this service
"family" is defined as:
1.
The persons who live with or provide care to a person
served on the waiver, and may include a parent, spouse, children, relatives,
foster family, or in-Iaws, and
2.
May include other responsible persons who agree to act
as an uncompensated caregiver in the absence of a waiver service provider.
Ø “Family" does not include individuals who are
employed to care for the consumer. Training includes instruction about
treatment regimens and use of equipment specified in the plan of care, and
shall include updates as necessary to safely maintain the individual at home.
All family training must be included in the individual's written plan of
care/plan of treatment.
Ø Family training services shall be rendered by a
Registered Nurse. The MCOD/IHO staff will review training and its
appropriateness on a case by case basis and will include follow-up on training
for all beneficiaries and their families during scheduled on-site visits to the
home.
Ø Electric services necessary to prevent
reinstitutionalization for waiver beneficiaries who are dependent upon medical
technology. Utility coverage must be included in the POT and the MOHS.
Ø There is a minimum monthly amount of $20.00 that must
be reached before this service will be authorized. When the minimum amount has
been reached, the waiver will reimburse the beneficiary all charges up to a
monthly maximum amount of $75.00.
Ø Utility coverage is limited to that portion of the
utility bills directly attributable to operation of life-sustaining medical
equipment in the beneficiary's place of residence. For purposes of the waiver,
"life sustaining medical equipment" is defined as: mechanical
ventilation equipment and other respiratory therapy equipment, suction
machines, cardiorespiratory monitors, feeding pumps, and infusion equipment.
Notwithstanding this definition, in the event a specific medical need is
identified in the POT, a consultation between the IHO Nurse Case Manager and
the IHO program consultants (medical or nursing) will evaluate requests for and
may grant exceptions to this definition.
Ø
Utility coverage
is provided through the local utility company. The waiver service provider will
submit a request for the authorization of this service. Upon receipt of
payment for any claim for this service, the waiver service provider will then
give the monies to the beneficiary.
Ø In order to calculate the cost per unit of time, the
authorization for waiver utility services includes consideration of the type of
equipment and frequency of use. Cost factors to operate electrical equipment
are supplied by utility companies and are based on a consideration of the
equipment's size, voltage requirement and amperage requirement. Upon
identifying the power requirements of the equipment and the utility rates per
kilowatt-hour, MCOD/IHO can estimate the cost of operation of the equipment to
within a few cents per unit of time.
Ø The waiver service provider is responsible for
assuring notification to utility providers that services are being provided to
an individual dependent upon life sustaining medical equipment. Documentation
indicating this notification has been made and, as appropriate, revised shall
be kept in the beneficiary's medical record in the provider's files.
Ø This service will include educating the beneficiary
and/or caregivers about the different funding sources which could include
Medi-Cal related services, California Children's Services for individuals under
the age of 21, Regional Center, Department of Rehabilitation, county funded
services, Medicare, private insurance; and helping to assist the beneficiary
and/or caregivers in understanding the various services he/she is receiving or
may receive and the impact, if any, of the services received/requested, based
on the source of funding. Waiver Service Coordination will supplement the case
management activities authorized under this waiver or through other entities
including the state plan benefit of targeted case management.
Service Providers Include:
1.
Individuals who meet the same standards as those who
provide waiver case management services.
2.
Members of the individual's family.
Ø This may be the parents of a minor or the spouse of
the individual. Legally responsible individuals may be used in the event there
are no other available providers, the individual lives in a rural area or the
cost neutrality for waiver services can be established and/or maintained by
using this individual. MCOD-IHO may require additional documentation to support
requests of this nature.
Justification:
Ø Criteria for service provider(s) will include written
documentation of experience in coordinating such services and how they will
coordinate the waiver services with other services received by the beneficiary.
This documentation will be included on the plan of treatment and updated as
needed. Must include service coordination beyond the use of Medi-Cal linked
services and
1.
"Individual nurse provider" means a
Registered Nurse or a Licensed Vocational Nurse, who provides individual nurse
provider services, as defined in subsection I-III below, and, in this capacity,
is not employed by or otherwise affiliated with a home health agency or any
other licensed health care provider, agency, or organization. An individual
nurse provider may be a parent, stepparent, foster parent of a minor, a spouse,
or legal guardian of the individual. Legally responsible individuals may be
used for this service in the event there are no other available providers, the
individual lives in a rural area or the cost neutrality for waiver services can
be established and/or maintained by using this individual. MCOD-IHO may require
additional documentation to support requests of this nature.
2.
"Private duty nursing services" means
services provided by a Registered Nurse or a Licensed Vocational Nurse, which
are more individual and continuous than those routinely available through a
home health agency as in part-time or intermittent care on a limited basis.
3.
“Education and/or training requirements" means
any type of formal instruction related to the care needs of the individual for
whom services are being requested. Examples of this could include
certifications in a particular field, appropriate to the licensure status of
the nurse; or continuing education units in the needs of the beneficiary such
as wound or pain management.
4.
"Evaluation of theoretical knowledge and manual skills" means
an assessment conducted by the registered nurse (RN) of the licensed vocational
nurse (LVN) in which the LVN is able to demonstrate competency in the provision
of skilled nursing services. Examples of this could include having the LVN
verbalize requirements for a certain procedure/process; having the RN review a
certain task, demonstrate the task and then observing the LVN perform the tasks
as prescribed on the plan of treatment. This evaluation would need to be
documented and provided to MCOD-IHO as indicated.
Requirements of the individual Nurse
Provider:
I.
Registered Nurse
(RN) acting as the direct care provider:
The initial
Treatment Authorization Request (TAR) shall be accompanied by all of the
following documentation:
Current license
to practice as an RN in the State of
Current Basic
Life Support (BLS) certification.
Written evidence,
in a format acceptable to the Department, of training or experience, which shall
include at least one of the following:
A minimum of 1000
hours of experience in the previous two years, in an acute care hospital caring
for individuals with the care need(s) specified on the TAR and plan of
treatment. At least 500 of the 1000 hours shall be in a hospital
medical-surgical unit; for subacute cases, the 500 hours shall be in an
intensive care unit.
A minimum of 2000
hours of experience in the previous three years, in an acute care hospital
caring for individuals with the care need(s) specified on the TAR and
plan of treatment.
A minimum of 2000
hours of experience in the previous five years, working for a licensed and
certified home health agency caring for individuals with the care need(s)
specified on the TAR and plan of treatment.
A minimum of 2000
hours of experience in the previous five years in an area not listed above,
that in the opinion of the Department, would demonstrate appropriate knowledge,
skill and ability in caring for individuals with the care needs specified on
the TAR and Plan of Treatment.