Current through Reg. 49, No. 38; September 20, 2024
(a) The applicant may be admitted to a day
activity and health services DAHS facility as soon as verbal physician's orders
are obtained if he appears to:
(1) be
Medicaid eligible; and
(2) meet the
medical/functional need criteria based on the information collected on DADS'
Client Health Assessment/Plan of Care form.
(b) When a DAHS facility initiates a
referral:
(1) the DAHS facility interviews
the applicant to determine whether he appears to be Medicaid eligible. The DAHS
facility determines Medicaid eligibility by reviewing the information on the
applicant's Medical Care Identification Card;
(2) the nurse:
(A) conducts a health assessment/plan of care
to determine whether the applicant appears to have a medical need for the
service. The nurse determines medical need by completing DADS' Client Health
Assessment/Plan of Care form; and
(B) obtains verbal or written physician
orders, if the applicant appears to meet the medical/functional need
criteria;
(3) the DAHS
facility verbally notifies the DADS caseworker or intake unit of the placement
the day the applicant contacts the DAHS facility. The DAHS facility follows up
the notification in writing within seven days using DADS' Case Information
form. This verbal notification is a request for community services and
supports.
(c) The DAHS
facility must request written prior approval for the applicant from the
regional nurse within 30 days after the date of the physician orders.
(d) If the DAHS facility fails to submit
prior approval forms or additional documentation within required time frames,
if the additional documentation is not adequate, or if the applicant is
determined ineligible by the DADS caseworker, the regional nurse cancels the
DAHS facility-initiated prior approval and the DAHS facility is not reimbursed
for services.
(e) If DADS' Client
Health Assessment/Plan of Care form or Physician's Order for Day Activity and
Health Services form is missing, or if any of the critical omissions or errors
stated in paragraphs (1) - (9) of this subsection have occurred in the required
documentation, the DAHS facility cannot obtain prior approval.
(1) The nurse fails to sign or date DADS'
Client Health Assessment/Plan of Care form or omits the registered
nurse/licensed vocational nurse credentials that should follow his
signature.
(2) Documentation on
DADS' Client Health Assessment/Plan of Care form does not support the medical
eligibility criteria specified in §
98.201
of this title (relating to Eligibility Requirements for
Participation).
(3) Items A, B, in
Sections II and III of DADS' Client Health Assessment/Plan of Care form are not
completed or completed incorrectly and medical need cannot be
determined.
(4) DADS' Physician's
Order for Day Activity and Health Services form does not include the MD or DO
credential of the physician who signed the form.
(5) DADS' Physician's Order for Day Activity
and Health Services form does not include the license number of the physician
who signed it.
(6) The physician
who signed the order is excluded from participation in Medicare or
Medicaid.
(7) The physician's
signature is not on DADS' Physician's Order for Day Activity and Health
Services form.
(8) The physician's
signature date is missing or illegible and the DAHS facility's stamped date is
missing from DADS' Physician's Order for Day Activity and Health Services
form.
(9) The DAHS facility's
stamped date used instead of the physician's date on DADS' Physician's Order
for Day Activity and Health Services form does not include the provider
agency's name, abbreviated name, or initials.
