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

25
BlueCare Tennessee and BlueCare, Independent Licensees of BlueCross BlueShield Association CLS & CLS-FM Provider Policy & Procedure Checklist

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

Page 1: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

BlueCare Tennessee and BlueCare, Independent Licensees of BlueCross BlueShield Association

CLS & CLS-FM Provider Policy & Procedure

Checklist

Page 2: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 3: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 4: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 5: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 6: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 7: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 8: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 9: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 10: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 11: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 12: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 13: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 14: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 15: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 16: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 17: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 18: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 19: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 20: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 21: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 22: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 23: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 24: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

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

Page 25: CLS & CLS-FM Provider Policy & Procedure ChecklistCommunity Living Supports (CLS) A community-based residential alternative service for seniors and adults with disabilities encompassing

25 ©2016 BlueCare Tennessee Proprietary and Confidential