August 17, 2001

 

 

MB-AASA-AAA/HCS/DDD/RCS-01-30

MANAGEMENT BULLETIN

 

TO:                  Area Agency on Aging Directors

                        Home and Community Services Regional Administrators

                       

SUBJECT:       POLICY ON CLIENT CONSENT AND CLIENT SIGNATURES ON SERVICE PLANS

 

The intent of the MB is to notify HCS Regions and AAA’s of a newly written policy regarding client consent and signatures on service plans.  The policy written below is effective immediately.

 

POLICY:        Client Consent to Service Plan

 

RCW 74.39A.095                   Case management services –

Agency on Aging oversight – Plan of Care

WAC 388-15-205                   Long-term care services-

Service Plan development

HCFA Protocols                      Plan of Care Development

State Medicaid Waiver             Plan of Care Development

LTC Manual, Chapter 4           Service Plan

 

PURPOSE:

The purpose of this policy is to ensure:

 

  1. Documentation of client’s/client’s representative participation in the development of his/her plan of care as outlined on the service plan;
  2. Documentation of client’s/client’s representative consent to services as outlined on the service plan;
  3. Assuring that the client has consented to the plan of care prior to authorization of services;
  4. Clarify when client consent as documented by a signature on the service plan is required.

 

PROCEDURE:

Every effort will be made to obtain the client’s/client’s representatives signature on the service plan prior to the authorization of services.  If there are circumstances where it is not possible to obtain the client’s signature prior to the authorization of services, it is necessary to document in the Service Episode Record (SER) that the client has participated in the development of the plan and consents to the services as outlined on the plan.  The verbal review and documentation of approval must happen prior to the authorization or reauthorization of services.  A service plan must be developed prior to obtaining client consent.  As a result service authorization cannot precede service plan development. 

 

SERVICES CANNOT BE AUTHORIZED WITHOUT A CLIENT SIGNATURE OR DOCUMENTATION OF THE CLIENT’S VERBAL CONSENT TO THE PLAN.

 

Document the steps taken to obtain the client’s signature in the Service Episode Record (narrative) section of the client’s file.  A client file may be returned to the transferring agency if the steps outlined below have not been documented in the SER and the client’s service plan is unsigned.

 

Follow this procedure when a service plan is developed or changed as a result of an initial assessment, annual reassessment or an assessment that results in an increase or decrease in hours or an addition or deletion of a service.  The service plan must also be updated when there is a change in service provider.  However a change in service provider alone does not require a new client signature.  Document the client’s request and consent for a change in provider in the SER.

 

At a minimum the steps listed below are to be taken to obtain the necessary consent to services from the client or client representative:

 

1.      If it is possible to fully develop the client’s service plan in their home, the client’s signature will be obtained at the time of assessment.  If multiple visits are necessary to complete service plan development, the signature can only be obtained once the plan is fully developed.

2.      If it is not possible to obtain the client’s signature prior to authorizing services, the case manager/social worker or designee will call the client to review the contents of the service plan verbally and document this conversation in the SER.  Document the client’s participation in the development of the plan as well as their verbal approval to the services authorized in the plan.

3.      The case manager/social worker documents on the service plan above the client signature box “client signature not available, see SER mm/dd/yy.

4.      Once the client has given verbal approval to the fully developed service plan, a copy of the service plan with an extra signature page will be sent to the client with a cover letter and self-addressed stamped envelope.  Services can be authorized with a start date of when verbal approval was obtained from the client.

5.      Each HCS Region and AAA will develop a system to track the return of the signature page.

6.      If the signature page is not returned, a follow-up call by the HCS Region or AAA to the client will be made requesting return of the signature page.  If after 10 days the signed service plan has not been received, the file can be transferred to the receiving agency.

7.      If verbal approval is the only client consent on record, the service plan must be signed at the next in-person visit.  There will be rare circumstances in which a client is able to give verbal approval of the service plan, but is unable to physically sign the document.  In these cases, document the reason the client is unable to sign in the SER.  Obtain a substitute decision maker’s signature when available.

8.      If a client refuses to sign the service plan, it is the responsibility of the case manager to identify with the client and or client representative the nature of the refusal.  Adjustments to the service plan contents or wording may be necessary.  This does not imply that services are to be included on the service plan that the client is not eligible for or that information that a caregiver must be aware of to provide care will be omitted from the plan.  If agreement on the service plan cannot be reached after negotiation, the case manager/social worker will consult with a supervisor to determine appropriate action.

9.      In rare cases a client may refuse authorized services and therefore will not sign the service plan.  Under this circumstance, services are terminated.   

 

Inquiries to:       Bea Rector, Program Manager             Lorrie Mahar, Program Manager

                        (360) 725-2560                                               (360) 725-2532

                        rectobm@dshs.wa.gov                         maharla@dshs.wa.gov

 

 

 

                                                           

Penny Black, Director

Home and Community Services Division