CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based...

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BlueCare Tennessee and BlueCare, Independent Licensees of BlueCross BlueShield Association CLS & CLS-FM Provider Policy & Procedure Checklist
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Transcript of CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based...

  • 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

    2 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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)

    3 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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.

    4

    ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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.

    5 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    6 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    7 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    8 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    9 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    10 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    11 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    12 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    13 ©2016 BlueCare Tennessee Proprietary and Confidential

  • Provider Safety Requirements

    Medication Errors Develop and maintain policies to track and

    trend medication variance and omission incidents to: Analyze trends Implement prevention strategies

    14 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    15 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    16 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    17 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    18 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    19 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    20 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    21 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    22 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    23 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 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

    24 ©2016 BlueCare Tennessee Proprietary and Confidential

  • 25 ©2016 BlueCare Tennessee Proprietary and Confidential

    CLS & CLS-FM Provider Policy & Procedure ChecklistAgendaPurpose of ChecklistCommunity Living Supports (CLS)Community Living Supports-Family Model (CLS-FM)

    Provider Safety RequirementsFire and Evacuation:Maintenance and Sanitation:Family Model Pre-Placement Requirements:Vehicles and Equipment:Critical Incidents:Crisis Intervention:Complaint Resolution:Medication Administration:Medication Errors

    Provider Person-Centered Planning RequirementsDevelop and maintain policies to ensure members are treated with dignity and respect by ensuring:Develop and maintain policies to ensure members are treated with dignity and respect by ensuring:

    Provider Staff Qualification RequirementsProvider will ensure all staff have:

    Provider Community Representation RequirementsProvider will ensure:

    Provider Liability and Insurance RequirementsWorker’s Compensation/Employer Liability will include:Comprehensive Commercial General Liability will include:Automobile Coverage will include:

    Blended Facilities Critical Incident RequirementsProvider will allow: