cls & cls-fm provider policy & procedure checklistcommunity living supports (cls) a...
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BlueCare Tennessee and BlueCare, Independent Licensees of BlueCross BlueShield Association
CLS & CLS-FM Provider Policy & Procedure
Checklist
Agenda
Purpose of Checklist Policy & Procedure Requirements for the Provider Definitions Safety Person-Centered Planning Staff Qualifications Community Representation Residential Providers Liability and Insurance Blended Facilities
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Purpose of Checklist
To ensure that BlueCare providers have included required elements in their organization’s Community Living Supports (CLS) and Community Living Supports-Family Model (CLS-FM) Policy & Procedures (P&P)
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Community Living Supports (CLS)
A community-based residential alternative service for seniors and adults with disabilities encompassing a continuum of support option for up to four individuals living in a home that supports each resident’s independence and full integration into the community, ensures each resident’s choice and rights, and comports fully with standards applicable to HCBS settings delivered under Section 1915(c), including those requirements applicable to provider-owned or controlled homes, as applicable, except as supported by the individual’s specific assessed need and set forth in the person-centered plan of care.
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Community Living Supports-Family Model (CLS-FM) A community-based residential alternative service for seniors and adults with disabilities encompassing a continuum of support option for up to three individuals living in the home of trained family caregivers (other than the individual’s own family) in an adult foster care arrangement. In this type of shared living arrangement, the provider allows the individual(s) to move into his or her existing home in order to integrate the individual into the shared experiences of a home and a family, provides the individualized services that support each resident’s independence and full integration into the community, ensures each resident’s choice and rights, and supports each resident in a manner that comports fully with standards applicable to HCBS settings delivered under Section 1915(c), including those requirements applicable to provider-owned or controlled homes, except as supported by the individual’s specific assessed need and set forth in the person-centered plan of care.
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Provider Safety Requirements
Fire and Evacuation: Develop and maintain policies for fire
evacuations and natural disasters Includes ensuring staff know: Evacuation procedures How to use safety equipment
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Provider Safety Requirements
Maintenance and Sanitation: Routinely monitor maintenance and
sanitation Ensure living environment is comfortable Develop and maintain policies for staff to: Identify and report any individual or
systemic problems
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Provider Safety Requirements
Family Model Pre-Placement Requirements: CLS-FM providers must: Complete DIDD-compliant home study Current DIDD Family Model Residential
Supports Initial Site Survey Both required prior to member placement
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Provider Safety Requirements
Vehicles and Equipment: Develop and maintain policies to routinely
inspect: Provider-owned vehicles Includes employee-owned vehicles used
to transport members Any adaptive equipment used in such
vehicles Deficiencies must be reported and resolved
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Provider Safety Requirements
Critical Incidents: Designate a staff member as an Incident
Management Coordinator: Will be the lead for critical incidents
Ensure critical incident process training occurs
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Provider Safety Requirements
Crisis Intervention: Develop and maintain a crisis intervention
policy Must be approved by the contractor As applicable, must include
instructions on use of: Psychotropic medications Behavioral safety interventions
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Provider Safety Requirements
Complaint Resolution: Develop and maintain a complaint resolution
process, which includes: A designated staff member as complaint
contact person Maintenance of a complaint log Documentation and trending of complaint
activity
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Provider Safety Requirements
Medication Administration: Develop and maintain medication policies to
ensure: Medications are administered according
to MD orders Administration done by trained and
qualified staff Medication administration records are
properly maintained All medication is properly stored and
accessible when needed
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Provider Safety Requirements
Medication Errors Develop and maintain policies to track and
trend medication variance and omission incidents to: Analyze trends Implement prevention strategies
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Provider Person-Centered Planning Requirements
Develop and maintain policies to ensure members are treated with dignity and respect by ensuring: Members/representatives and family have
opportunity to participate in selection and evaluation of direct support staff Solicitation of members/representatives
and families feedback on provider services occurs
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Develop and maintain policies to ensure members are treated with dignity and respect by ensuring: Member/representative has information to
make informed choices about available services Members are allowed to exercise personal
control and choice related to their possessions
Provider Person-Centered Planning Requirements
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Provider Person-Centered Planning Requirements
Develop and maintain policies to ensure members are treated with dignity and respect by ensuring: Members are supported in exercising their
rights Periodic review of members’ day services
and promoting occurrence of meaningful day activities
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Provider Person-Centered Planning Requirements
Develop and maintain policies to ensure members are treated with dignity and respect by ensuring: Members are supported in the pursuit of
employment goals Member’s rights are restricted only as
provided in the person-centered support plan All staff is trained on person-centered
practices
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Provider Staff Qualification Requirements
Provider will ensure all staff have: Appropriate, job-specific qualifications All required licensure and certification prior to
employment and routinely thereafter Ongoing supervision consistent with the job
functions
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Provider Community Representation Requirements
Provider will ensure: Composition of provider board of directors (or
community advisory group, as applicable): Board reflects diversity of community being
served Board is representative of people being served
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Provider Liability and Insurance Requirements
Worker’s Compensation/Employer Liability will include: All States’ coverage Limit not less than $750,000 per occurrence for
employer’s liability
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Provider Liability and Insurance Requirements
Comprehensive Commercial General Liability will include: Personal injury and property damage Premises/operations Independent provider Contractual liability Completed operations/products coverage Bodily injury/property damage combined:
Single limit not less than $750,000 per occurrence $1,500,000 aggregate
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Provider Liability and Insurance Requirements
Automobile Coverage will include: Owned, leased, hired and non-owned vehicles Bodily injury/property damage Combined single limit not less than $1,500,000
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Blended Facilities Critical Incident Requirements
Provider will allow: DIDD staff access to pertinent CHOICES member
information Only during critical incident investigations
in blended facilities Provider to comply with DIDD
investigations If a DIDD investigation indicates a substantiated
finding, TennCare will notify BlueCare BlueCare will take necessary actions to
ensure members’ health and welfare
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