MB-AASA-AAA-HCS-DDD-RCS-01-32
MANAGEMENT
BULLETIN
Division
of Developmental Disabilities Regional Administrators
Effective 9-1-01, payment for Nurse Delegation (ND) which
was previously billed through MMIS by the delegating nurse will be authorized
by the Social Worker/Case Manager through SSPS. Responsibilities for contract management, resource management and
quality assurance of the program will remain with the Program Manager at the
state level. Social workers and case
managers are responsible for making or facilitating referrals for Nurse
Delegation, and continuing authorization of services via the SSPS system. Roles and responsibilities are outlined
below:
Social
Worker/Case Manager
1.
Identify need for ND and refer for evaluation.
2.
Forward recent copy of CA and Service Plan to nurse to
complete referral process.
3.
Authorize Nurse Delegation services via SSPS 14-154/159.
4.
Re-authorize continuation of ND services after consultation
with delegating nurse as needed.
5.
Report to Nurse Delegation Program Manager concerns about
contractor performance, lack of sufficient providers in a specific area.
Program
Manager
1.
Train/technically assist contracted providers in program
requirements.
2.
Establish /maintain provider contracts for Nurse Delegation
with qualified providers.
3.
Monitor payment history for extraordinary expenses.
4.
Quality assurance monitoring for program integrity.
5.
Respond to/investigate concerns about contractor
performance or availability.
6.
Authorize additional units of Nurse Delegation above and
beyond the maximum of 13 hours (52 units) per calendar year per client upon
request from delegating nurse.
This change is being implemented in order to facilitate
reimbursement and enrich communication coordination among case managers and
delegating nurses and health care providers caring for state clients.
Initial
creation of authorizations for clients currently receiving Nurse Delegation:
Authorizations for all residents of Adult Family Homes who
are currently receiving Nurse Delegation services have been created and
forwarded to the appropriate field office by August 31, 2001. These
authorizations have been created for those clients who have had Nurse
Delegation services billed under the old billing system (MMIS) between 1-1-01
and 6-30-01. The authorizations used
SSPS data current as of 6-30-01. Field staff need to review
these authorizations to see that they are current and accurate, especially the
eligibility end date, and the ACES number.
All clients have been assigned a reason code of A (administration of
oral/topical medications) and this may need to be revised after consultation
with the delegating nurse. Not all
of these clients will continue to receive Nurse Delegation after 9-1-01, when
the SSPS payment system becomes effective.
The authorizations will be opened to the maximum number of units and
usage will be monitored at the state level by the Program Manager.
Residents
requiring Nurse Delegation after 9-1-01 for the first time in 2001:
Follow the referral process as outlined in roles and
responsibilities of social worker/case manager on previous page. Consult the Service Code Data Sheet attached
to this memo.
We will be forwarding the list of Nurse Delegation
authorizations to the regional SSPS coordinators as requested by the Regional
Administrators, but this information will not be available until after
September 5, 2001.
Please
direct any further questions to: Kay
Kramer, Program Manager Nurse Delegation, 360/725-2563, or kramek@dshs.wa.gov.
Penny Black, Director
Home and Community Services Division