Recommandé
Recommandé
Contenu connexe
Similaire à Requirements for all waiver providers
Similaire à Requirements for all waiver providers (20)
Dernier
Dernier (20)
Requirements for all waiver providers
- 1. APD Course Requirements for all Waiver Providers
- 2. Course Sections 1. Medicaid Waiver Information. 2. Key Provider Requirements and Best Practices 3. Compliance with Federal and State Laws 4. Zero Tolerance Overview 5. Incident Reporting 6. Medication Administration and Behavior Emergency Procedures Overview 7. Key Contacts
- 4. Medicaid Medicaid coverage to low income individuals and families State and federal government share the cost the Medicaid program Florida Medicaid administered by the Agency for Health Care Administration (AHCA) Agency for Persons with Disabilities (APD) operates the iBudget Waiver
- 5. What is a Medicaid Waiver? Medicaid Waiver Long term care services are community based Non institutional care Allows state to waive certain Medicaid requirements
- 6. Ensures Community-Based Services Home-like Environment Emphasis on Personal Choice of the Client http://ahca.myflorida.com/Medicaid/hcbs_waivers HCBS Federal Rule
- 7. iBudget iBudget Waiver services approximately 30,000 clients Waiver Support Coordinators help individuals choose services and providers Social, medical, behavioral, residential, and therapeutic services
- 8. iBudget Settings: • Family Home • Own Home • Licensed Residential Facility Service authorized based on: • Client preference • In accordance with state and federal Medicaid requirements
- 9. Eight Service Families in iBudget Service Family 1 Life Skills Development Service Family 2 Supplies and Equipment Service Family 3 Personal Supports Service Family 4 Residential Services Services
- 10. Eight Service Families in IBudget Cont’d Service Family 5 Support Coordination Service Family 6 Therapeutic Supports and Wellness Service Family 7 Transportation Service Family 8 Dental Services Services
- 11. Key Provider Requirements and Best Practices Section 2
- 13. Complete background screening Submit APD Application Complete Medicaid Provider Enrollment Execute Medicaid Waiver Services Agreement Enrollment
- 15. Provider Types Solo Agency Group (WSC Agencies Only)
- 16. Personally renders services Does not employ others to render services Bills at the solo rate Solo Provider
- 17. Agency Providers • Business or organization with two or more employees providing waiver services, including the owner • Provider that hire subcontractors only to perform waiver services cannot bill at the Agency rate • Bills at the Agency rate Agency Providers
- 20. Medical Necessity • Ensures Medicaid service meets the individual’s need • Ensures services are consistent with rules • State and federal Medicaid requirement
- 21. Billing Requirements • Providers cannot bill when clients are not in attendance unless noted in the description of the service • Providers cannot bill for more than one service to the same client at the same time unless authorized by APD • Providers must render service in accordance with their service authorizations
- 22. A Provider must Supervise the provision of, and be responsible for, goods and services that: • Have been provided to the recipient by the provider prior to submitting the claim • Provider is licensed, certified, or enrolled to provide the service • The service is medically necessary • The provider ensures the quality of services Billing Requirements
- 23. Providers must ensure that the claims are: Billing Requirements Not billed in whole or in part to a recipient or their responsible party Provided in accordance to Medicaid rules, regulations, handbooks, and policies Documented in the records
- 24. Billing Requirements Providers submit claims to the Medicaid fiscal agent Only bill using the approved rates Only bill within approved limits The rate table is located on the Medicaid Provider Portal
- 26. Service Authorization •Providers must have a service authorization to bill for iBudget Waiver Services. •Service authorizations identify the provider, amount, duration, scope, frequency, and intensity of service.
- 27. Support Plan Individualized plan of supports and services to meet the client’s needs Identifies services that will be rendered by the provider, along with goals and client preferences about those services Helps achieve defined outcomes in an integrated community setting, ensure delivery of services that reflect client choice, ensures health, safety, and welfare
- 28. Support Plan Person Centered Planning The Provider will: 1. Implement person-centered supports and services 2. Support development of informed choices 3. Enhance service delivery 4. Make improvements in the provider’s service delivery system
- 29. Service Logs Daily Attendance Logs Implementation Plan Quarterly Summary Daily Progress Notes Documentation
- 30. MWSA Contract between APD and providers of waiver services Providers may not bill for waiver services without a signed, current, and executed Medicaid Waiver Services Agreement.
- 31. Self Assessment What is a Provider Self Assessment? • Evaluation completed by the provider reviewing organization capabilities for meeting Client outcomes or goals and the service requirements • Includes review of internal policies and procedures • Provider can ensure quality services
- 32. Section 3 Compliance with Federal and State Laws
- 33. Chapter 393, F.S. Florida Statutes http://www.leg.state.fl.us
- 34. Bill of Rights Right to dignity, privacy and humane care, including freedom from abuse, neglect, exploitation Right to religious freedom and practice Right to receive services within available sources which protect personal liberties The Bill of Rights for Persons with Developmental Disabilities
- 35. • SS Bill of Rights Right to a quality education and training services Right to social interaction and community participation Right to physical exercise and recreational opportunities The Bill of Rights for Persons with Developmental Disabilities
- 36. Bill of Rights Right to be free from harm, including unnecessary restraint, isolation, excessive medication, abuse, or neglect Right to consent to or refuse treatment Shall not be excluded from participation in, or be denied benefits, or subject to discrimination Shall not be denied the right to vote in public elections The Bill of Rights for Persons with Developmental Disabilities
- 37. • Title 42, Code of Federal Regulations • Rehabilitation Act of 1973 • Title VI of the Civil Rights Act of 1964 • The Americans with Disabilities Act (also known as the ADA) • Chapter 760, Florida Statutes is known as the Florida Human Relations Act Other Regulations
- 38. Legal Representative Guardians Power of Attorney Durable Power of Attorney Representative Payees Medical Proxies Client Advocates
- 39. Zero Tolerance Section 4 A statewide initiative to end abuse, neglect & exploitation
- 40. Zero Tolerance • Result in termination review of the Medicaid Waiver Services Agreement Abuse, Neglect, Exploitation • Result in termination review of the Medicaid Waiver Services Agreement Failure to Report
- 41. Zero Tolerance Known or suspected abuse, neglect, or exploitation must also be reported immediately to the Florida Abuse Hotline at: 1-800-96-ABUSE (1-800-962-2873) TDD Access 1-800-453-5145
- 42. Zero Tolerance Sexual activity between a direct service provider or employee and a person with a developmental disability (to whom services are being rendered) is a crime.
- 44. Incident Reporting What is an Incident? An incident is an occurrence which could potentially impact the health, safety and well-being of a client of APD and must be reported to APD.
- 45. • Providers are responsible for reporting incidents involving APD clients to the Region office as they occur, but no later than the next business day. • Providers must report incident reports and follow up reports to the APD Regional office. • Incident Report and Follow up Form: www.apdcares.org/providers/incident-reporting/ • Providers must take immediate action to the resolve the situation. Incident Reporting
- 46. Categories Examples of Critical and Reportable Incidents
- 47. Critical Incidents Unexpected Client Death Unexpected client death that occurs due to an accident, act of abuse, neglect or other unexpected incident. Examples: • Homicides • Motor Vehicle Accidents • Accidental Drug Overdoes • Heart Attack, Stroke, Trauma • Sudden death • Rapid deterioration
- 48. Critical Incidents Life Threatening Injury • Severe Injuries • Substantial Risk of Death • Loss of or substantial impairment of body
- 49. Critical Incident Sexual Misconduct Any sexual activity between a client and provider is sexual misconduct, regardless of whether the client consented. Other incidents of nonconsensual sexual activity between clients or others is also sexual misconduct.
- 50. Critical Incident Missing Child or Adult Who Has Been Adjudicated Incompetent • Missing for more than one hour • Please provide a case number from law enforcement in the Incident Report
- 51. Critical Incident Media Involvement Unusual occurrence with unfavorable media attention Client Arrest Arrest of a client due to a violent crime Verified Abuse, Neglect, or Exploitation Always report any circumstance where the Department of Children and Families verifies Abuse, Neglect, or Exploitation by the provider or staff of a provider.
- 52. Expected Client Death Death a result of long-standing or progressive medical condition May be age-related Altercation Physical confrontation between either: - Client and member of community - Client and provider - Two or more clients while services are rendered Reportable Incidents
- 53. Client Injury Non-life threating injury received during service provision May be due to an accident, act of abuse, neglect, or other incident while receiving services Reportable Incident
- 54. Missing Competent Adult – Absence or unknown whereabouts beyond eight hours of a legally competent adult receiving services from a provider. Suicide Attempt- Physical attempt by a client to cause his or her own death Baker Act – Involuntary admission of a client for involuntary examination or placement for psychiatric care Reportable Incident
- 55. Non-violent Crime Arrest – Arrest of a client for a non-violent crime while under the direct care of a provider. Reportable Incident
- 56. Section 6 Overview of Medication Administration and Behavior Emergency Procedures
- 57. 65G-7 Rule Medication Administration Appropriate training and validation required Document on the Medication Administration Record
- 58. Reactive Strategies Reactive strategies are the procedures or physical crisis management techniques of seclusion or manual, mechanical, or chemical restraint utilized for control of behaviors that create an emergency or crisis situation. Rule 65G-8 of the Florida Administrative Code
- 59. Reactive Strategies • Protects clients from unnecessary restraint and seclusion • Requires training • Prevents the use of reactive strategies when not medically safe and identifies who can authorize them • Limits or prohibits certain procedures • Requires documentation and reporting Rule 65G-8 of the Florida Administrative Code
- 62. Contacts Provider Enrollment (800) 280-7700-Option 4 ( 8 a.m. – 5 p.m. ET) Web Portal Password Reset (800) 289-7700- Option (7:30 a.m.- 6 p.m. ET) http://portal.flmmis.com/flpublic
- 63. Congratulations! You have completed the Requirements for all Waiver Providers Course My signature on this certificate acknowledges that I viewed the “Requirements for all Waiver Providers” course. ______________ ______________ Name Date
Notes de l'éditeur
- This course entitled, “Requirements for All Waiver Providers,” is intended for solo providers and management staff of agencies who render services through the iBudget Waiver. A certificate will be issued upon completion so that providers can document compliance with the iBudget Waiver Handbook. A handout of key websites mentioned throughout this training is available on the APD Website next to this training link.
- During this training, content will be presented in the following Sections: Medicaid Waiver Information Key Provider Requirements and Best Practices Compliance with Federal and State Laws Zero Tolerance Overview Incident Reporting Medication Administration and Behavior Emergency Procedures Overview Key Contacts
- Section 1 provides an overview of Medicaid Waivers and information regarding APD operated waivers.
- Medicaid provides medical coverage to low-income individuals and their families. The state and federal government share the cost of the Medicaid program. Medicaid services in Florida are administered by the Agency for Health Care Administration, also known as AHCA. The Agency for Persons with Disabilities, also known as APD, operates the iBudget Waiver.
- Medicaid Waivers are authorized by the federal Centers for Medicare and Medicaid services. They are an option for states that allows long-term care services to be provided in home and community-based settings rather than in an institutional setting such as a hospital, nursing home, or intermediate care facility. They allow states to waiver certain Medicaid requirements, such as income eligibility for children.
- The Centers for Medicare & Medicaid Services issued a final rule for Home and Community-Based Medicaid programs. The new rule requires that waiver services be provided in a way that facilitates individuals in actively participating in the community, provides for home-like living environments, and better enables individuals to make personal choices. It is important for waiver providers to be aware of this rule. Providers should review information provided by AHCA about this federal rule online at http://ahca.myflorida.com/medicaid/hcbs_waivers.
- APD provides services to about 30,000 clients who are enrolled on the Developmental Disabilities Individual Budgeting Home and Community Based Waiver Program. This waiver is also know as the iBudget Waiver. Clients enrolled on the iBudget Waiver are given a budget to choose medically necessary services with the assistance of their Waiver Support Coordinator. The iBudget Waiver offers a variety of social, medical, behavioral, residential, and therapeutic services. Providers are selected by the client with the assistance of their Waiver Support Coordinator.
- Individuals receiving iBudget Waiver services live in either their family home, own home, or in a licensed residential facility. Services are authorized based on client preference and in accordance with state and federal requirements for the services.
- Waiver Support Coordinators assist individuals in choosing services and providers that are grouped into eight service families. Within each service family there are separate services available based on need, specific conditions of the individual, and medical necessity for the service. The first four families are: Life Skills Development, Personal Supports, Supplies and Equipment, and Residential Services.
- Other services families are: Support Coordination, Therapeutic Supports and Wellness, Transportation, and Dental. A brief description of each service can be found under the Handouts link for this training on the APD website.
- Section 2 covers key provider requirements identified in rule and best practices.
- The iBudget Waiver Handbook identifies the coverage and limitations for each specific waiver service, provider qualifications, documentation and training requirements, and other provider requirements. It is critical for providers to be familiar with this handbook. The iBudget Waiver Handbook is a state rule incorporated by reference to Rule 59G-13, Florida Administrative Code. The handbook can be obtained online through the Florida Medicaid Web Portal at http://portal.flmmis.com/. Click on “Provider Services” and “Handbooks.”
- In order to provide services through the iBudget Waiver, a provider must enroll with Medicaid and have a Medicaid Provider number and a signed Provider Agreement with AHCA. Additionally, the provider must have a signed Medicaid Waiver Services Agreement with APD. APD will not enter into a Medicaid Waiver Services Agreement until the provider has demonstrated that it meets all required educational, training, and background screening requirements for enrollment. There are four major steps for enrolling as an iBudget Waiver provider. These include: 1. Completing background screening; 2. Submitting an APD Application; 3. Completing the Medicaid Provider Enrollment process; and 4. Executing a Medicaid Waiver Services Agreement with APD.
- The steps and applications for enrolling as an APD iBudget Waiver provider can be found online at http://apdcares.org/providers/enrollment/
- Providers may enroll as a solo provider or agency provider. WSC Agencies must enroll as group providers where each Waiver Support Coordinator enrolls as an individual treating provider.
- A solo provider personally renders waiver services directly to clients and does not employ others to provide waiver services. Solo providers must bill at the corresponding rate. If a solo provider incorporates, they are considered a solo provider, unless they hire staff to provide services. If staff are hired, they must request expansion to the Region to be considered as an Agency.
- Agency providers are businesses or organizations enrolled to provide waiver services that have two or more employees to carry out the enrolled services, including the agency owner. An agency or group provider for rate purposes is a provider that employs staff to perform waiver services. A provider that hires only subcontractors to perform waiver services is not considered to be an agency provider for rate purposes.
- Providers must ensure that employees meet the educational, experience, training, and background screening qualifications in order to initiate and continue service provision. These qualifications are specified in the iBudget Handbook.
- The term “coverage” refers to services offered through the waiver program and how they can be utilized. It includes descriptions of services, who can receive them, who can provide them, specific service requirements, and billing requirements. This may include the types of activities performed by the service, intent of the service, and places where services can be provided. “Limitations” relate to how much or how often a service can be provided and whether there are exclusions related to the service. The coverage and limitations for iBudget Waiver Services can be found in the iBudget Waver Handbook.
- A medical necessity determination must be completed before services are authorized. Medical necessity is a state an federal requirement for Medicaid services. It ensures that clients receive services that they need and that they are consistent with the requirements contained in the iBudget Waiver Handbook.
- The iBudget Waiver Handbook identifies billing requirements for services. Providers cannot bill for services when a recipient is not in attendance, except as noted in the description section of that service. A provider must not render a claim or bill for more than one service to the same recipient at the same time and date unless authorized to do so. Providers must render services in accordance with their service authorizations.
- When presenting a claim for payment under the Medicaid program, a provider must supervise the provision of, and be responsible for, goods and services that: Have been provided to the recipient by the provider prior to submitting the claim. Documentation of the service provided should maintained in the provider’s file. When required by law, the provider rendering the service is actively licensed or certified to provide the service. Ensure that iBudget Waiver covered goods or services that are medically necessary. Ensure that the quality of services is comparable to those provided to the general public by the provider’s peers.
- When billing, provider must also ensure that claims: Have not been billed to a client or their responsible party. Claims must be provided in accordance with laws an rules Services billed are documented in records made contemporaneously when goods or services were provided.
- Each provider is required to submit claims for waiver services to the Medicaid fiscal agent. Providers must bill at the approved rates for services. The iBudget Waiver services rates are standardized in Rule 59G-13.081, Florida Administrative Code, and can be found in the Medicaid Provider Portal.
- In addition to the iBudget Waiver Handbook, Medicaid offers handbooks for providers that rules for Medicaid providers to receive reimbursement for covered services. Medicaid handbooks can be located online on the Public Medicaid Provider Portal at http://portal.flmmis.com/. Click Provider Services, and Select Handbooks.
- Providers must have a service authorization to bill for iBudget Waiver Services. A service authorization is an APD document that authorizes the provision of specific waiver services to an individual and includes, at a minimum, the provider’s name and the specific amount, duration, scope, frequency, and intensity of the approved service. The service authorization and any modifications to it must be received by the provider prior to service delivery.
- The service authorization is a result of the person-centered support planning process, which is facilitated by the Waiver Support Coordinator. A person-centered support plan is an individualized plan of supports and services designed to meet the needs of a client. This plan is based on the preferences of the client. The support plan identifies the services that providers will render, along with the client’s goals for those services. The person-centered planning process is to facilitate the achievement of outcomes by ensuring service delivery in a manner that reflects personal preferences and choices, and to assure the health, safety and welfare of the client.
- The provider must participate in the person-centered planning and implementation for each recipient. The provider will also use the recommendations from the person-centered planning to: Implement person-centered supports and services; (2) Support development of informed choices; (3) Enhance service delivery in a manner that supports the achievement of client goals; and (4) Make improvements in the provider’s service delivery system.
- When a provider renders services through the iBudget Waiver, they must document the services provided. The documentation helps ensure that the provider is assisting the client in meeting their individually determined goals. Documentation requirements for services are located in the in the iBudget Waiver Handbook. Depending on the service, some examples include Service Logs, Daily Attendance Logs, Implementation Plans, Quarterly Summaries, or Daily Progress Notes.
- The Medicaid Waiver Services Agreement is a contract between APD and providers of iBudget Waiver services. Providers may not bill for waiver services without a signed, current, and executed Medicaid Waiver Services Agreement. Providers should pay close attention to when their agreements begin and end. Providers should understand all sections of the Agreement and be in compliance accordingly.
- As a best practice, a provider may conduct a Provider Self Assessment. A Provider Self-Assessment is an evaluation completed by the provider to review organizational capabilities for meeting a client’s outcomes and the service requirements identified in iBudget Waiver Handbook. This self-assessment might include review of the provider’s internal policies and procedures by identifying the extent to which they are consistent with rule requirements. A self assessment is a way a provider can ensure that they are providing quality services.
- Section 3 identifies various Federal and State Laws applicable to service provision under the iBudget Waiver.
- Florida Statutes, Chapter 393, describes the system of care for individuals with developmental disabilities within the State of Florida. Florida Statutes are available to view online at http://www.leg.state.fl.us
- Chapter 393.13 of the Florida Statutes describes the treatment of persons with developmental disabilities within Florida. This section is referred to as the Bill of Rights for Persons Who Are Developmentally Disabled and provides for the following rights: The right to dignity, privacy, and humane care, including the right to be free from abuse, neglect, exploitation, and sexual misconduct The right to religious freedom and practice. The right to receive services, within available sources, which protect the personal liberty of the individual
- The right to participate in an appropriate program of quality education and training services, within available resources, regardless of chronological age or degree of disability. The right to social interaction and to participate in community activities. The right to physical exercise and recreational opportunities.
- The right to be free from harm, including unnecessary physical, chemical, or mechanical restraint, isolation, excessive medication, abuse, or neglect The right to consent to or refuse treatment, subject to the powers of an appointed guardian or guardian advocate Additionally, individuals with developmental disabilities shall not due to their disability: Be excluded from participation in, or be denied the benefits of, or be subject to discrimination under, any program or activity which receives public funds Shall not be denied the right to vote in public elections
- There are other federal and state laws that support individuals with disabilities. These laws strive to enhance the freedoms of individuals with disabilities. Some include: Title 42, Code of Federal Regulations Rehabilitation Act of 1973 Title VI of the Civil Rights Act of 1964 The Americans with Disabilities Act (also known as the ADA) Chapter 760, Florida Statutes which is known as the Florida Human Relations Act
- Clients receiving waiver services have legal rights regarding their privacy and healthcare information. It is important for providers to know with whom they can communicate regarding clients and their services. Providers should work with the Waiver Support Coordinator to understand how individuals make decisions about their services. For example, a minor child typically has parents who make decisions on their behalf. An individual over the age of 18 who is an adult, may make their own decisions. Some individuals have legal representatives. These may include guardians, Power of Attorney, Durable Power of Attorney, Representative Payees, Medical Proxies, client advocates, or others who the individual has designated to communicate about their care.
- Section 4 is an overview of Zero Tolerance, which is a statewide initiative to end abuse, neglect, and exploitation. This Section does not satisfy the Required Basic Training course for Zero Tolerance and is only intended as an overview.
- APD takes and aggressive approach in responding to acts of abuse, neglect, or exploitation committed against APD clients. Medicaid waiver providers who abuse, neglect, or exploit APD clients will be reviewed for potential termination from the program. In addition, provider who fail to report abuse, neglect, or exploitation will also be subject to termination review.
- Any person who knows, or has reasonable cause to suspect, that a person with a developmental disability is being abused, neglected, or exploited by a relative, caregiver, or household member is required to report such knowledge or suspicion to the Florida Abuse Hotline by calling 1-800-96-ABUSE (1-800-962-2873), TDD access is gained by dialing 1-800-453-5145. Failure to report known or suspected cases of abuse, neglect, or exploitation is a criminal offense.
- Sexual activity between a direct service provider or employee and a person with a developmental disability (to whom services are being rendered) is not only unethical but is a crime, regardless of whether consent was first obtained from the victim. “Sexual misconduct” refers to any sexual activity between a covered person (such as a direct service provider) and an individual to whom that covered person renders services, care, or support on behalf of the agency or its providers, or between a covered person and another recipient who lives in the same home as the individual to whom a covered person is rendering the services, care, or support, regardless of the consent of the recipient.
- Section 5 covers the incident reporting requirements for providers.
- An incident is an occurrence which could potentially impact the health, safety and well-being of a client of APD. Providers are responsible for reporting incidents regarding APD clients to the APD Region office in accordance with requirements in the iBudget Waiver Handbook.
- Providers are responsible for reporting incidents to the APD regional office as they occur, but no later than the next business day. Providers must submit incident reports and follow-up reports to the APD regional office. An oral report must be followed by submission of the written report. The Incident Report form can be found online at www.apdcares.org/providers/incident-reporting/ . The provider must take immediate action to resolve the situation and ensure the recipient’s health and safety.
- Incident Reports are classified as either “critical” or “reportable.” In the following slides, you will see examples of Critical and Reportable Incidents.
- There are seven types of critical incidents. An unexpected death is the death of a client that occurs due to or allegedly due to an accident, act of abuse, neglect, or other unexpected incident. This may include, but is not limited to homicides, motor vehicle accidents, accidental drug overdose, heart attack, stroke, trauma, sudden death from an undiagnosed condition, or rapid deterioration from medical conditions.
- Life threatening injuries are severe injuries involving a substantial risk of death or the loss of or substantial impairment of the body. This injury or condition may be a result of, or allegedly due to an accident, an act of abuse or neglect, or another unexpected incident.
- Another type of critical incident is Sexual Misconduct. Sexual misconduct is described in Florida Statutes, Chapter 393.135. It occurs between a client and a provider regardless of the consent of the client. It may also include incidents of nonconsensual sexual activity between clients or any other nonconsensual sexual activity involving a client.
- This unknown whereabouts for more than one hour of a minor or an adult who has been adjudicated as incompetent and is receiving services from an APD provider is a critical incident. When reported by the provider, please provide a case number from law enforcement in the Incident Report.
- Media Involvement and Client Arrests are also critical incidents. Media involvement is an unusual occurrence or circumstance that may initiate unfavorable media attention. A Client Arrest is the arrest of a client as a result of a violent crime at any time. The final type of critical incident is Verified Abuse, Neglect, or Exploitation. A Protective Investigation from the Department of Children and Families that verifies that a provider or staff of a provider committed an act of abuse, neglect, or exploitation must be reported.
- Incidents that do not meet the criteria as “critical” incidents are considered “reportable” incidents. There are seven types of reportable incidents. An expected client death is a client that that is considered natural from a long-standing progressive medical condition or age-related conditions. This might include end-stage cancers, end-stage kidney or liver disease, etc. An altercation is a physical confrontation occurring between a client and a member of the community, a client and provider, or two more clients at the time services are being rendered that results in law enforcement contact.
- A client injury is an injury sustained or allegedly sustained by a client due to an accident, act of abuse, neglect, or other incident occurring during the times he or she is receiving services from a provider that requires medical attention in an urgent care center, emergency room, or physician’s office setting. In these cases, the injury is NOT considered life threatening.
- A Missing Competent Adult is defined as the unauthorized absence or unknown whereabouts beyond eight hours of a legally competent adult client receiving services from an APD provider. If the person is known to lack capacity to make safe decisions, it is the sole discretion of the provider to report the person missing prior to eight hours to the Region office and to law enforcement. Providers must also report suicide attempts, which are an act that clearly reflects the physical attempt by a client to cause his or her own death. Baker Acts must also be reported. A Baker Act is the involuntary admission of a client to a receiving facility for involuntary examination or placement for psychiatric care. The criteria for initiating a Baker Act is defined in Chapter 394 of the Florida Statutes.
- When a client is arrested for a non-violent crime, it is a reportable incident. These would include arrests while the individual is under the direct care of a provider and it is a result of a non-violent crime, such as a drug charge or loitering.
- Section 6 is an overview of Rules 65G-7 and 65G-8 of the Florida Administrative Code. Rule 65G-7 contains critical information for providers who will be involved in the administration of medication. Rule 65G-8 contains important information regarding restraints and seclusion for individuals with complex behavioral needs. Please note that there are separate and additional training courses required for direct care staff and providers who will engage in medication administration and emergency behavioral procedures.
- Rule 65G-7 of the Florida Administrative Code sets forth the requirements for medication administration and supervision of the medication administration to APD clients. “Administration of medication” means the obtaining and giving of one or more doses of medicinal drugs by a legally authorized person to an Agency client for his or her consumption. “Supervised self-administered medication,” means a direct, face-to-face observation of a client during the client’s self administration of medication and includes instruction or other assistance necessary to ensure correct self-administration. Only providers who have received appropriate training and validation may administer medications to clients in accordance with physicians orders. All administered medications are documented on the “Medication Administration Record” or “MAR”, The MAR is the chart maintained for each client which records the medication information. Medication Errors must also be reported.
- Rule 65G-8 of the Florida Administrative Code has important requirements to help maintain the health and safety of individuals who exhibit significant behavioral concerns. Some clients require Reactive Strategies as a result of their behavior. Reactive strategies are the procedures or physical crisis management techniques of seclusion or manual, mechanical, or chemical restraint utilized for control of behaviors that create an emergency or crisis situation. However, staff cannot implement Reactive Strategies without completing required training.
- The purpose of Rule 65G-8 is to protect clients from unnecessary restraint and seclusion. This rule requires that those using reactive strategies be trained in an approved curriculum. This rule is intended to prevent the use of reactive strategies when not medically safe. It identifies who can authorize the use of reactive strategies and limits or prohibits the use of certain procedures. The rule also requires that providers document and report reactive strategies.
- Section 7 provides information to help providers locate important contact information for APD Regional offices and AHCA.
- There are six APD Regional offices statewide. Additionally, there are also field offices. Providers needing assistance related to APD clients and services may contact an APD Regional or field office. The contact information for the offices can be found online at http://apdcares.org/region. Region offices have specific contacts posted, depending on the subject matter.
- Florida Medicaid’s fiscal agent is HP Enterprise Services (HP). The Medicaid fiscal agent is responsible for Medicaid provider enrollment; processing claims; and answering provider’s billing, claims status, and recipient eligibility questions. The contacts are also posted online at the Florida Medicaid Public Provider Portal. http://portal.flmmis.com/flpublic.
- You have completed the Requirements for all Waiver Providers Course. You must print and sign an acknowledgement of your completion of this course and maintain for your records.