NEVADA MEDICAID-DIVISION OF HEALTH CARE FINANCING & POLICY, DIVISION OF AGING, FIRST HEALTH SERVICES CORPORATION WRONGFUL DENIAL REDUCTION TERMINATION BY NEVADA MEDICAID-DHCFP, DIVISION FOR AGING SERVICES, FIRST HEALTH SERVICES CORPORATION REGARDING HOME & COMMUNITY BASED SERVICES, WAIVER/PCS SERVICES STATE PLAN, DEVIATION FROM WRITTEN POLICY CORRUPTION/UNETHICAL BEHAVIOR Carson City Nevada
Nevada Medicaid aka "Division Of Financing Health Care & Policy", the Division Of Aging and the contracted Fiscal Agent "First Health Services Corporation" are a corrupted an unethical instituions who wrongfully deny medically necessitated an indigent individuals social service programs such as personal care services and various waiver services (home maker, chore, respite, nutrition, respite, case management etc).
The State Of Nevada has on file with the Centers For Medicaire & Medicaid Services an Approved "State Plan" and various "Waivers" such as the Frail & Elderly Waiver Chapter 2200 ("CHIPS") and Physicailly Disabled Waiver 2300 ("WIN"), Home And Community Based Waiver Chapter 2100 (Waiver For The Persons With Mental Retardation and Related Conditions) to name a few.
Despite the fact that CMS is meticulously detailed in their instructions to the States to stipulate the types of services they will provide including determinations of eligibility, parameters for programs to be implemented and administered, parameters on types of coverages, purposes of the service and exactly how they meet their goals, and grievance process to be followed in case of a disagreement between the applicant seeking social services/medical assistance.
They are all in COLLUSION MALICIOUSLY perpetuating a cycle of disinformation, lack of training, false assertions, fabrications of policy out of thin air (meaning that they are NO WHERE WRITTEN in Nevada Medicaid Policy, Nevada Revised Statutes, Nevada Administrative Code, Code Of Federal Regulations, TITLE 42 Public Health, and Social Security Acts) by directing their employees who are charged with seeking out, evaluating and ENSURING that medically needy and qualified individuals obtain of all available medical and social services available to meet the needs of such individuals of which those programs were originally created bythe edict of the United States Congress who appropriates the majority of the funds that the States use to pay for such services.
It is very appaling and disgraceful that although the State Of Nevada is recognized as the State with a large and rapidly escalating elderly/disabled population our Governor and State Legislators have NOT appropriated sufficient funds for the administration of much needed social services relief programs like the Personal Care Services program through which a PCA is afforded and various other Waiver services as noted above.
It is one thing that this State Of Nevada FAILS to appropriate enough funds to help those Elderly/Disabled people who need those types of assistance, BUT TO TAKE AWAY FROM WHAT MEAGER SERVICES THEY DO HAVE TO OFFER IS MORALLY REPREHENSIBLE, APALLING & DISGRACEFUL!
At the current time the State Of Nevada is expericning Economic issues to a Budgetary Problem that was caused by Fiscal Mis Management in the first place. Our Governor has issued secret memos to various Departments to do all they can to CUT OUT SERVICES and MAX OUT COST SAVINGS TO THE STATE.
Nevada Medicaid has been targeted as potential way of CLEARING the BUDGETARY PROBLEMS utilizing moneys designated for the Elderly, Poor and Disabled! They are also attacking medical assistance and lunch assistance programs for school kids!
This state has maintained for many years a conspiratorial strategy to keep people in the dark by employing unqualified, untrained, non compassionate airhead imbecils, or willfully evil withholders of information pertaining to social services program in an attempt to reduce the amount of dollars spent on such programs while at same time reporting to the Federal Government via CMS that the need for such services is VERY LOW and they have no idea why (this offcourse is there intent all along).
The State Of Nevada DOESNOT advertise the existence of social service relief programs MOST people DOONT even know that they exist and much less one iota of how to begin pursuing the services. The staff employed at the Nevada Medicaid District Office are little more than simple minded boot lickers who themselves don't understand the service or operation manuals of Nevada Medicaid and are only there to collect a paycheck.
If you happen to be like me who researches extensively the information to empower yourself to seek said services essentially doing the job which is in actuality the responsbility of a case manager or social worker you run into clueless people who cause more delays and trouble than their worth because you sound to them as your speaking rocket science and they have to check with their equally ineffective and incompetent Supervisor and GET BACK TO YOU.
I have for several years been dealing with various State agencies in attempt to obtain social service program for various loved ones and have seen first hand there modus operandi. What you find that is consistent is that employees of these State Departments or Divisions bank on the fact that they will be dealing with ignorant individuals or people who are not capable to challenge them based on established policy to obtain the level of assistance they need.
These social worker and in the case of First Health Services Corporation "Nurses" come with their prmary directive which is to "SAVE THE STATE MAXIMUM AMOUNT OF DOLLARS IF UNABLE TO DENY SERVICES OUTRIGHT." The BIG PROBLEM is that if you spend the time, research and obtain the State Plan or Waiver Applications on file with CMS specific to the services you are seeking you will find that the Social Workers/Bureaucrat Nurses and Supervisors involved will DEVIATE from WRITTEN POLICY if they are UNABLE to find GROUNDS on which to DENY services or to provide meager assistance like they have been trained to do (for example the awarding of a PCA for only 9 hours in a week for an extensively needy individual regardless if they live alone).
These individuals are trained to come in to your home and act like Deceptive Spies probing for as mcuh information as they can obtain to DENY or REDUCE to as little as possible what services can be provided. They will document your family members if your have friends and then will enter their own creative writing sessions in creating a care plan as to how your LEVEL OF CARE NEEDS can be met by these others individuals COMPLETELY or in GREAT MAJORITY.
They will refer to this as a "SUPPORT SYSTEM." Nevada Medicaid wants to be the "PAYER OF LAST RESORT AT ALL COSTS." They are especially Harsh at identifying individuals related to you (family members) and throwing around such terms as "Legally Responsible Adults/Relatives" (which these people have no idea of the true meaning thereof or are again testing to see how much the recipient knows and what they can get away with pulling) and will Notate that on their Functional Assessment and Service Plan conveniently taking Nevada Medicaid OFF THE HOOK and Reducing or Denying Home & Comunity Based Services!
If you are well prepared you will find that the Staff of these Nevada Divisions are not at all brilliant and utterly fail at defending their outrageous assertions and the Determinations they make to Deny services or to provide too little services. The Service and Operation Manuals and the State Plan and Waiver Chapters are written using simple words of the English Language it is child's play and EXTREMELY EASY TO UNDERSTAND.
However Nevada Medicaid (Division Of Health Care Financing & Policy) is NOTORIOUS for making mistakes in their Service and Operations Manual Policy, Medicaid Approved Documents are flawed (meaning they may not ask for all required pieces of information that the chapter may require to authorize a service such as Self Directed Skilled Services), references that are ambigous clearly designed to give them flexibility to get away with administering social service programs at will to their liking and if someone happens to get upset and invokes the Fair Hearing process of the state they conveniently have some corrupted unethical forked tongued individuals from the Attorney Generals office there to defend there morally rephensible, unethical, malicious and spectacularly incompetent staff on the grounds that they are ENTITLED TO "GREAT DEFERENCE IN THE INTERPRETATION OF THEIR OWN POLICY!"
What they essentially are stating with the commentary of "Great Deference" is that they can RUN these programs HOWEVER THEY SO CHOOSE and NO ONE NOT EVEN A LEGISLATOR, JUDGE OR CONGRESSMAN CAN TELL THEM OTHERWISE. Nevada Medicaid also has written in there policy that they DONOT ISSUE "RETROACTIVE PAYMENT AUTHORIZATIONS." This means that if you Challenge them on a decision to Fair Hearing and an action they took was INFACT WRONG they will ONLY FIX IT FROM THAT DAY FORWARD!
The State Of Nevada has even gone so far as to create Fancy but IDIOTIC and Generic "Catch All Denial Reasons" for use by their incompetently malicious staff to justify actions to DENY, TERMINATE or REDUCE SERVICES. Essentially what they do is they state that "YOU or YOUR Representative Fail to Show a Need for Home And Community Based Services, YOU or YOUR Representative Fail to COOPERATE in the establishing of the Care Plan, Recipient Is NOT in DANGER of Nursing Facility Replacement if Community & Home Based Services were Not Provided within 30 Days."
Those are not the exact phrases but relay the actuals extremely well. These people will have the audacity to use such Frivolous Grounds for Denial of Services despite the fact that you may have presented your circumstances establishing that substantial assistance is not only necessary but would be beneficial considering supporting information and documentation from your physician clearly establishing disability!
Speaking of the Fair Hearings process through the Department Of Administration of State Of Nevada you will find the most partial and unethical individuals as the Hearing Coordinators and Officers who have clear affilition and "buddy buddy relationships" with the people whose Decisions you are challenging LOL.
Your best bet is to take your grievances to any Public Hearings (if you are so able and most people are NOT) and blasting those evil doers even during the 5 minutes you are given to speak, and maintain all email and mailed correspondence with the management of the Departments/Divisions who administer the services you were seeking plus the various Notice Of Decisions that were issued and presenting them to the FEDS via the Centers For Medicare & Medicaid Services who will have a field day with them.
For anyone interested the State Of Nevada has one of the WORST RECORDS in the administration of Medical Assistance/Social Service program they are at the moments under the barrel of an AK47 by the FEDS who are THREATENING to take back MILLIONS of DOLLARS because they have DEVIATED and FAILED TO ADMINISTER SAID PROGRAMS in the manner that they had presented to the FEDS that they would do in exchange for Federal Financial Participation and those juicy dollars!
My experiences with these people are extensive and I encourage anyone who think they may be able to help me in my battle against the State Of Nevada, or that believe I may be able to help them in a similar battle against the State or who are seeking to learn more to maybe file a Legal Action including but not limited to Class Action Lawsuit against these various Divisions under the banner of the Nevada Department Of Health & Human Services, PLEASE PLEASE CONTACT ME.
There are still a couple of issues that I am taking through the so called Fair Hearings Process and all attempts to obtain legal assistance from such organizations like the Nevada Disability Law & Advocacy Center and Nevada Legal Services have Failed. It is an outrage that these Legal organization that are supossed to champion the rights of the elderly, disabled, indigent CONSISTENTLY FAIL TO PROVIDE ASSISTANCE.
These organization are pathetic they DONOT want cases of great importance that they perceive as highly complex, requiring alot of time, resources and litigation to handle and are themselves on more than friendly terms with the managers of those other state departments and dvisions!
Zealouswhistleblower
Las Vegas, Nevada
U.S.A.
9 Updates & Rebuttals
anonymous
las vegas,Nevada,
United States of America
Medicaid and FHS are not out to corrupt people
#10UPDATE Employee
Wed, December 01, 2010
Although I agree on one or two things in this report, I must say as an employee of First Health (formerly) Now Megallan Medicaid Administration (MMA) that NO ONE has EVER told us clinical reviewers ("nurses") to cut hours from somebody. I as well as the other reviwers I work with are ethical people. We try very hard to give client's what they need. That said, this is NOT a medical program so we do not take orders from doctors. Heck, even my own doctor will write anything I ask him to and we all know that. When I see a client, I am a visitor. I don't tell people what to do, how to do it or anything else. I have a brain and a degree and can think on my own. If I ever worked for a company such as what this person is stating (corruption and harming people) I would be the first one to quit. That was not how I was raised and I have compassion for my fellow human beings who are hurting and need help. I am PROUD to be able to visit my clients on a daily basis and bring some joy to their lives. Without this program some would end up in a nursing home. Family members are being paid to take care of their loved ones. If this program did not exist, the family would still be taking care of their loved ones for free. We do not consitently fail to provide assistance. In fact, we do provide a lot of assistance. I have had client's tell me when I see them a year later that because of what I said, did, etc. I have changed their lives. We are not evil. We did not get an education to F people. The only one I have to prove myself to is my higher power and I know when I die, I will be proud of who I am and what I have done my whole life to help people, not only through this job but volunteering as well. Meager services? 20 years ago, even 15, nobody had services. We do the best with what we have, but I will in no way harm any of my clients, ever! My clients want to see me again and again and tell me how much they appreciate me. So I guess you may have a few problems yourself and I am sorry if someone treated you bad. But for the most part the employess of this program take DO NO HARM seriously. As for the lady who said a reviewer told her she would have her kid taken away...I seriously doubt that anyone said that to her and if they did, they were not only wrong to say it but they were wrong all together. We are not protective services and her daughter was 20 at that time, an adult. Adults are not removed from their homes by force unless they are an immenent threat to themselves or others, just like anyone else. We as Nevada taxpayers along with the federal government and the tobacco monies pay for these programs. There are also plenty of people who are out there that lie to us stating they need bathing, dressing and grooming and don't. They just want a maid to clean and cook for them. We have to play detective. We use our expertise as "nurses" and social workers to provide as much of what we can to the people who need it. The system is abused by the people (not all) not by the employees. Then again we have had some bad employees as well, but what company doesn't? I am the first one to report a bad apple because I do not want my client's harmed. We do not falsify policies and procedures. What would the use of lying to people prove? Nothing. We need to work together to make this program stronger. Not listen to assholes who have NO Idea what they are talking about. I invite you to do my job for a week and then you'll see what the truth is.
Marina
LV,Nevada,
U.S.A.
CONTACT INFO
#10Consumer Comment
Sun, November 02, 2008
ZEALOUSWHISTLEBLOWER,
THIS IS MARINA AGAIN AND I NOTICED THAT ON MY POSTING, MY EMAIL AND ADDRESS WERE NOT ON MY COMMENTS SO PLEASE LOOK ME UP IN THE LAS VEGAS PHONEBOOK. YOU ARE VERY KNOWLEDGEABLE AND I THINK BETWEEN THE 2 OF US WE COULD HELP EVERYONE WHO NEEDS THESE SERVICES.
THANKS, MARINA
Marina
LV,Nevada,
U.S.A.
MARINA, MOTHER TO HANDICAPPED 20 YR OLD
#10Consumer Suggestion
Sat, November 01, 2008
I WAS AT THE 8/26/08 MEETING REGARDING PCA CARE CUTBACKS. I AM THE ONE WHO CONTACTED THE MEDIA (CHANNEL 8 AND THE REVIEW JOURNAL). I ALSO VOICED MY COMMENTS AT THE MEETING, EMAILED DHCFP, THE LEGISLATURE, THE SENATORS, THE GOVERNOR, AND THE PRESIDENT. I HAVE BEEN CONTACTED BY THE CMS REGIONAL OFFICE IN SAN FRANCISCO AND THEY ARE INVESTIGATING OUR STATE'S USAGE OF FEDERAL MONIES FOR PCA SERVICES. I ALSO RECEIVED A LETTER FROM MICHAEL WILLDEN STATING THAT THERE IS NO STATUE REGARDING SERVICES BASED ON MY UNAVAILABILITY AS A CAREGIVER!!!!! HE IS ABSOLUTELY CORRECT BUT WHAT HE FAILS TO POINT OUT IS THAT IT IS IN THE MSM MANUEL AND IS PART OF THE CRITERIA FOR SERVICES!!!!
WE NEED TO GET TOGETHER AS A WHOLE AND APPEAR IN CARSON CITY IN FEBRUARY WHEN THE LEGISLATURE MEETS!!! I HAVE RESEARCHED THE MSM, THE NRS, THE CFR'S, ETC AND WE NEED TO REPLACE OUR CURRENT MEDICAID ADMINISTRATION!!!! I HAVE MADE NUMEROUS SUGGESTIONS TO THE STATE AND EVEN OFFERED TO PAY MORE TAXES (PERSONALLY), GIVE UP MY FUTURE SOCIAL SECURITY BENEFITS, ETC. FOR MY DAUGHTER'S CARE SO SHE CAN REMAIN HOME VS INSTITIONALIZATION. IT WOULD COST THE STATE IN EXCESS OF $200 A DAY FOR MY DAUGHTER'S CARE!!!
TODAY THE STATE CAME AND DID MY DAUGHTER'S RECERT AND FUNCTIONAL ASSESSMENT AND LO AND BEHOLD THEY CUT HER HOURS FROM 3.5 A DAY (M-F)TO 2.5 A DAY!! THAT LEAVES AN HOUR SHORTAGE UNTIL I GET HOME FROM WORK SO I HAD THE ASSESSOR PUT HER AS AN AT RISK RECIPIENT AND SHE INFORMED ME THAT THE STATE WOULD COME AND REMOVE MY DAUGHTER RIGHT AWAY!! IT IS NOW 6:15 PM AND NO ONE HAS COME TO REMOVE MY DAUGHTER, BECAUSE THE STATE HAS NO PLACEMENT OPTIONS!!!!!!!!!!
THANK YOU, MARINA
Marina
LV,Nevada,
U.S.A.
MARINA, MOTHER TO HANDICAPPED 20 YR OLD
#10Consumer Suggestion
Sat, November 01, 2008
I WAS AT THE 8/26/08 MEETING REGARDING PCA CARE CUTBACKS. I AM THE ONE WHO CONTACTED THE MEDIA (CHANNEL 8 AND THE REVIEW JOURNAL). I ALSO VOICED MY COMMENTS AT THE MEETING, EMAILED DHCFP, THE LEGISLATURE, THE SENATORS, THE GOVERNOR, AND THE PRESIDENT. I HAVE BEEN CONTACTED BY THE CMS REGIONAL OFFICE IN SAN FRANCISCO AND THEY ARE INVESTIGATING OUR STATE'S USAGE OF FEDERAL MONIES FOR PCA SERVICES. I ALSO RECEIVED A LETTER FROM MICHAEL WILLDEN STATING THAT THERE IS NO STATUE REGARDING SERVICES BASED ON MY UNAVAILABILITY AS A CAREGIVER!!!!! HE IS ABSOLUTELY CORRECT BUT WHAT HE FAILS TO POINT OUT IS THAT IT IS IN THE MSM MANUEL AND IS PART OF THE CRITERIA FOR SERVICES!!!!
WE NEED TO GET TOGETHER AS A WHOLE AND APPEAR IN CARSON CITY IN FEBRUARY WHEN THE LEGISLATURE MEETS!!! I HAVE RESEARCHED THE MSM, THE NRS, THE CFR'S, ETC AND WE NEED TO REPLACE OUR CURRENT MEDICAID ADMINISTRATION!!!! I HAVE MADE NUMEROUS SUGGESTIONS TO THE STATE AND EVEN OFFERED TO PAY MORE TAXES (PERSONALLY), GIVE UP MY FUTURE SOCIAL SECURITY BENEFITS, ETC. FOR MY DAUGHTER'S CARE SO SHE CAN REMAIN HOME VS INSTITIONALIZATION. IT WOULD COST THE STATE IN EXCESS OF $200 A DAY FOR MY DAUGHTER'S CARE!!!
TODAY THE STATE CAME AND DID MY DAUGHTER'S RECERT AND FUNCTIONAL ASSESSMENT AND LO AND BEHOLD THEY CUT HER HOURS FROM 3.5 A DAY (M-F)TO 2.5 A DAY!! THAT LEAVES AN HOUR SHORTAGE UNTIL I GET HOME FROM WORK SO I HAD THE ASSESSOR PUT HER AS AN AT RISK RECIPIENT AND SHE INFORMED ME THAT THE STATE WOULD COME AND REMOVE MY DAUGHTER RIGHT AWAY!! IT IS NOW 6:15 PM AND NO ONE HAS COME TO REMOVE MY DAUGHTER, BECAUSE THE STATE HAS NO PLACEMENT OPTIONS!!!!!!!!!!
THANK YOU, MARINA
Marina
LV,Nevada,
U.S.A.
MARINA, MOTHER TO HANDICAPPED 20 YR OLD
#10Consumer Suggestion
Sat, November 01, 2008
I WAS AT THE 8/26/08 MEETING REGARDING PCA CARE CUTBACKS. I AM THE ONE WHO CONTACTED THE MEDIA (CHANNEL 8 AND THE REVIEW JOURNAL). I ALSO VOICED MY COMMENTS AT THE MEETING, EMAILED DHCFP, THE LEGISLATURE, THE SENATORS, THE GOVERNOR, AND THE PRESIDENT. I HAVE BEEN CONTACTED BY THE CMS REGIONAL OFFICE IN SAN FRANCISCO AND THEY ARE INVESTIGATING OUR STATE'S USAGE OF FEDERAL MONIES FOR PCA SERVICES. I ALSO RECEIVED A LETTER FROM MICHAEL WILLDEN STATING THAT THERE IS NO STATUE REGARDING SERVICES BASED ON MY UNAVAILABILITY AS A CAREGIVER!!!!! HE IS ABSOLUTELY CORRECT BUT WHAT HE FAILS TO POINT OUT IS THAT IT IS IN THE MSM MANUEL AND IS PART OF THE CRITERIA FOR SERVICES!!!!
WE NEED TO GET TOGETHER AS A WHOLE AND APPEAR IN CARSON CITY IN FEBRUARY WHEN THE LEGISLATURE MEETS!!! I HAVE RESEARCHED THE MSM, THE NRS, THE CFR'S, ETC AND WE NEED TO REPLACE OUR CURRENT MEDICAID ADMINISTRATION!!!! I HAVE MADE NUMEROUS SUGGESTIONS TO THE STATE AND EVEN OFFERED TO PAY MORE TAXES (PERSONALLY), GIVE UP MY FUTURE SOCIAL SECURITY BENEFITS, ETC. FOR MY DAUGHTER'S CARE SO SHE CAN REMAIN HOME VS INSTITIONALIZATION. IT WOULD COST THE STATE IN EXCESS OF $200 A DAY FOR MY DAUGHTER'S CARE!!!
TODAY THE STATE CAME AND DID MY DAUGHTER'S RECERT AND FUNCTIONAL ASSESSMENT AND LO AND BEHOLD THEY CUT HER HOURS FROM 3.5 A DAY (M-F)TO 2.5 A DAY!! THAT LEAVES AN HOUR SHORTAGE UNTIL I GET HOME FROM WORK SO I HAD THE ASSESSOR PUT HER AS AN AT RISK RECIPIENT AND SHE INFORMED ME THAT THE STATE WOULD COME AND REMOVE MY DAUGHTER RIGHT AWAY!! IT IS NOW 6:15 PM AND NO ONE HAS COME TO REMOVE MY DAUGHTER, BECAUSE THE STATE HAS NO PLACEMENT OPTIONS!!!!!!!!!!
THANK YOU, MARINA
Marina
LV,Nevada,
U.S.A.
MARINA, MOTHER TO HANDICAPPED 20 YR OLD
#10Consumer Suggestion
Sat, November 01, 2008
I WAS AT THE 8/26/08 MEETING REGARDING PCA CARE CUTBACKS. I AM THE ONE WHO CONTACTED THE MEDIA (CHANNEL 8 AND THE REVIEW JOURNAL). I ALSO VOICED MY COMMENTS AT THE MEETING, EMAILED DHCFP, THE LEGISLATURE, THE SENATORS, THE GOVERNOR, AND THE PRESIDENT. I HAVE BEEN CONTACTED BY THE CMS REGIONAL OFFICE IN SAN FRANCISCO AND THEY ARE INVESTIGATING OUR STATE'S USAGE OF FEDERAL MONIES FOR PCA SERVICES. I ALSO RECEIVED A LETTER FROM MICHAEL WILLDEN STATING THAT THERE IS NO STATUE REGARDING SERVICES BASED ON MY UNAVAILABILITY AS A CAREGIVER!!!!! HE IS ABSOLUTELY CORRECT BUT WHAT HE FAILS TO POINT OUT IS THAT IT IS IN THE MSM MANUEL AND IS PART OF THE CRITERIA FOR SERVICES!!!!
WE NEED TO GET TOGETHER AS A WHOLE AND APPEAR IN CARSON CITY IN FEBRUARY WHEN THE LEGISLATURE MEETS!!! I HAVE RESEARCHED THE MSM, THE NRS, THE CFR'S, ETC AND WE NEED TO REPLACE OUR CURRENT MEDICAID ADMINISTRATION!!!! I HAVE MADE NUMEROUS SUGGESTIONS TO THE STATE AND EVEN OFFERED TO PAY MORE TAXES (PERSONALLY), GIVE UP MY FUTURE SOCIAL SECURITY BENEFITS, ETC. FOR MY DAUGHTER'S CARE SO SHE CAN REMAIN HOME VS INSTITIONALIZATION. IT WOULD COST THE STATE IN EXCESS OF $200 A DAY FOR MY DAUGHTER'S CARE!!!
TODAY THE STATE CAME AND DID MY DAUGHTER'S RECERT AND FUNCTIONAL ASSESSMENT AND LO AND BEHOLD THEY CUT HER HOURS FROM 3.5 A DAY (M-F)TO 2.5 A DAY!! THAT LEAVES AN HOUR SHORTAGE UNTIL I GET HOME FROM WORK SO I HAD THE ASSESSOR PUT HER AS AN AT RISK RECIPIENT AND SHE INFORMED ME THAT THE STATE WOULD COME AND REMOVE MY DAUGHTER RIGHT AWAY!! IT IS NOW 6:15 PM AND NO ONE HAS COME TO REMOVE MY DAUGHTER, BECAUSE THE STATE HAS NO PLACEMENT OPTIONS!!!!!!!!!!
THANK YOU, MARINA
Zealouswhistleblower
Las Vegas,Nevada,
U.S.A.
NEVADA MEDICAID MOVES FORWARD AND HARMS ELDERLY/DISABLED/HANDICAPED&INDIGENT
#10Author of original report
Thu, August 28, 2008
Here is an update post the Public Hearing mentioned above. The Division Of Health Care Financing & Policy recently held a Public Hearing in Carson City & Las Vegas via Video Conferencing on August 26, 2008 at 9:00A.M.
If you were to go to the Nevada Medicaid's website at http://www.dhcfp.nv.gov and click on "Public Notices" under DHCFP Index you will find the list of Public Notices complete with Agendas & Attachments.
Please take note that Nevada Medicaid has utterly failed to complete the studies necessary to determine how many people would be adversely affected or harmed and the level of care those affected peoples would require as was raised a few times by participants of the public hearing.
The Administrator from DHCFP and the Chief of Compliance John Liveratti seemed to flip flop or change answers during the course of the public hearing such as from what areas of Nevada Medicaid's charter and list of programs have they considered and actually implemented funding cuts to attempt to meet the funding cut quota assigned to them by the Office of the Governor.
As was brought out during the Public Hearing no statistical monetary accounting information was posted or included as part of any supporting attachments nor where there studies on just exactly how many recipients of these "medical assistance" services would be affected, by how much, and again the level of care the affected people possess.
There was an individual representing AARP (was it a Paul Gowan?) and Bill Heavilin (Nevada Disability Law Advocacy Center Las Vegas, Nevada) who suggested that the State Of Nevada would be opening themselves up to legal repercussions for the actions they are undertaking and pleaded with them NOT to take these actions, instead to issue some type of delay, to re-evaluate other tactics to meet the budget cut quotas. The Division Of Health Care Financing & Policy was advised by these people that there will be major problems with Federal Mandates they would be violating due to seemingly discriminatory actions that place the budgetary problems above the needs of the medically needy, elderly, disabled, handicapped, low income etc.
I also wish to point out that it is despicable that the Division Of Financing & Policy in what I could only refer to as an "underhanded move" went to the Interim Finance Committee" of the Legislative Counsel Bureau (in session when main legislature is not in session) and simply asked to blindly sign off as approving their proposed Budgetary Cuts out of much needed Medicaid Services!!
What is the point for these people who are charged to administer these types of social services/medical assistance relief/support programs if they are little more than bureaucrats and "yes men" not loyal to the people they are supposed to protect and serve?
What is the point of a Public Hearing if they went to the Interim Finance Committee FIRST and obtained an approval and then solicit Public Commentary that they know they will simply DISCARD them with 2 statements, the Chief Of Compliance "John Liverrati" saying "I recommend the chapter be adopted as is and referred to xxx for grammar and spell check" followed by a "For the Record Charles Duarte "Nevada Medicaid Administrator" I accept the Chapter as written and will refer for grammar and spellcheck!"
I should mention that there was some really sad stories mentioned by the public at this public hearing. Some very real and greatly dependent people will be greatly harmed because of these service cuts that have been proposed and approved. Several real life scenarios were shared with the members of the Division Of Health Care Financing & Policy and their Fiscal Agent "First Health Services Corporation" that explained in detail how current service times allowed under Bathing, Dressing, Grooming were already inadequate thus cutting service times further in these areas would deprive the level of care that the dependent individuals medical state requires.
Regarding the "Exercise" Activity Of Daily Living categroy many caregivers and recipients commented that this action would dramatically affect in the negative recipients who have suffered strokes, who have physical limb problems or diabilities, quadraplegics, paraplegics, and bed bound who must on a MANDATORY basis receive Range Of Motion Exercises in order to be able to be transfered or moved for any purpose and for pain mangement reduction. They also commented regarding elderly who still possess the ability to walk but with deficits that if not kept exercising would deteriorate!
It appears that due to public feedback and offcourse the big one, meaning the potential for legal liability against the State, the DHCFP Administrator Charles Duarte began commenting that he agreed that they "NEDD TO TAKE ANOTHER LOOK AT THESE SERVICE CUTS FOR THOSE AFFECTED RECIPIENTS WITH HIGH LEVEL OF CARE NEEDS WHO ARE GREATLY DEPENDENT OR REQUIRE MUCH ASSISTANCE AND COME UP WITH SOME ADDITIONAL "EXCEPTION TO THE POLICY" TO AUTHORIZE THEM TO MAINTAIN EXISTING SERVICE HOURS OR TO ALLOW THE MEANS TO EXCEED THE NEW LIMITS IF UNFEASIBLE TO THEIR CIRCUMSTANCES."
I am referring to Personal Care Services (through which a Personal Care Attendant is assigned) at this point. The Chief Of Continuum Of Care "Connie Anderson" stated that she is "sorry this must happen but these changes are necessary to maintain the program primarily intact and attempts to keep it 100% intact were unsucessfull."
Both Connie Anderson and Charles Duarte assured everyone that the changes to Personal Care Services "WOULD NOT go into effect until everyone that will be affected is Properly Notified and provided their rights to Appeal the Action."
Please consider that Mr. Duarte was slammed on this idiotic statement when the AARP representative stated "Fair Hearing for what, if you approve this Policy Change and the Interim Finance Committee has approved setting these service Limits on Bathing, Grooming, Dressing and doing away with "Exercise" category THEN WHAT EXACTLY CAN BE APPEALED IF THAT POLICY HAS BEEN SET IN STONE!"
Mr. Duarte had no answer but stated the "Recipients of Personal Care Services can request ANOTHER ASSESSMENT to be possibly provided further assistance in other categories of the Functional Assessment (ADL'S & IADL'S) that remain whose limits are NOT YET FULL."
In addition the "Chief Of Continuum Of Care" Connie Anderson stated "PLEASE TAKE INTO CONSIDERATION WE WILL REVIEW EACH SERVICE PLAN FOR ALL RECIPIENT'S RECEIVING PERSONAL CARE SERVICES AND NOT ALL WHO WOULD BE AFFECTED WILL BE."
This however appears to contradict a statement by Charles Duarte (DHCFP Administrator) who earlier on in the process and after initially receiving the first counter strikes of the reality of what these proposed cuts will due to the elderly, disabled, handicap medically needy & indigent had stated when asked how extensive their research and review was on identifying how many people would be harmed, how harmed would they be as a result and level of care needs those people possessed, stated "WE HAVE REVIEWED EVERY SERVICE PLAN FOR ALL PERSONAL CARE SERVICES RECIPIENT!"
The fact that Mr. Charles Duarte had moved to implement such a proposal at the expense of the most needy CLEARLY ESTABLISHES that they DIDNOT review every single service plan because had they discovered the reality of just who they would harm with this action they would have included some SPECIAL PROTECTIONS or EXCEPTIONS in the policy for those individuals with SUBSTANTIAL LEVEL OF CARE NEEDS!
Mr. Charles Duarte also commented when asked what are people to do if they are affected by this change and are left with INADEQUATE AMOUNTS OF PCS ASSISTANCE, replied "You can then look at receiving EXPANDED ASSISTANCE through the use of a WAIVER PROGRAM which can provide assistance OVER AND ABOVE the Personal Care Services program of the State Plan!"
What Mr. Duarte failed to NOTE there, was that ALL WAIVER PROGRAMS whether they be for Mental Retardation and Related Conditions Chapter 2100 or Waiver For frail Elderly (CHIPS) Chapter 2200 or Waiver For Physically Disabled (WIN) Chapter 2300 have HUMONGOUS WAITING LISTS!!!
This individual didnot address that particular issue (oh how convenient). As you will note in the Agenda section the DHCFP makes the remarks that they will make "SPECIAL ARRANGEMENTS FOR ALL THOSE WHO WISH TO ATTEND THE PUBLIC HEARING" however what you find is that they only MAKE ROOM at locations at which the Public Hearings will be conducted they will NOT make special arrangements to ensure all those capable and interested in attending are TRANSPORTED TO THE LOCATIONS!
The Division Of Health Care Financing & Policy utterly fails to NOTIFY all Medicaid Recipients who would be the subject of a proposed change keeping it under wraps posted on their Division Website and at times in a tiny area (rarely reviewed by most) in a newspaper.
As was raised at the Public Hearing these people lack common sense (or they are evil and everything they do is strategic and adverse) because "MOST ELDERLY, DISABLED, HANDICAP, INDIGENT INDIVIDUALS DO NOT OWN A COMPUTER MUCH LESS HAVE INTERNET ACCESS OR KNOW HOW TO SEND AN EMAIL OR CAN AFFORD TO PAY FOR THE NEWSPAPER."
According to Rita Mackey Public Hearings Coordinator for DHCFP the "MINUTES WILL NOT BE POSTED ANY SOONER THAN THE END OF NEXT WEEK DUE TO THE PUBLIC HEARING BEING SO LARGE." Readers please obtain those minutes and intervene as much as you are able in light of this community resource problem. I have loved ones who are elderly, disabled and have very high level of care needs are receiving inadequate assistance through these Home & Community Based Services, Personal Care Services and who would the be affected by these service cuts. If you are able to reach this website and ripoff report please add commentary to it and then lets talk about uniting in Class action against these despots.
Please also take Note that Mr. Charles Duarte has "ACCEPTED AS IS" the proposal (which again they went behind the Public's back to the Interim finance Committee) which REMOVES Medicaid coverage for OCULAR (GLASSES, LENSES, SPECTACLES) for people over 21 years of age (as was raised how are low income, disabled, elderly people going to be able to afford glasses if there will be no community resources out there to assist), REDUCTION of DENTAL COVERAGE to $600.00 PER YEAR (there was much attempts to awaken some sense of reality in those people by a couple of Dentists who stated that $600.00 is completely inadequate and unrealistic to provide the level of dental care they are required to do so by the American Dental Association which happens to be the reality of the majority of patient situations) and REMOVAL of ORTHODONTIA SERVICES for Children under Nevada Checkup (there excuse is offcourse they have parents that work and have higher incomes, but enough to pay those Dental/Orthodontists Bills and other bills they must NOT!).
Another area of outrage that would be of great importance to the community to have exposed is their ADOPTION of the ELIMINATION of MEDICAID REIMBURSEMENT FOR SCHOOL KID TRANSPORTATION FROM THEIR HOMES TO THE SCHOOL AND BACK (BUSING). The "Chief Of Program Services" Coleen Lawrence and another Program Specialist from the Division Of Health Care Financing & Policy stated "THIS WILL CAUSE NO FINANCIAL LOSSES TO THE SCHOOL DISTRICTS THEREFORE THEY ARE NOT SERVICE CUTS." However thereafter came up an Administrator from the Clark County School District and Carson City School District who totally exposed the deceit behind those statements. They both stated that the "SCHOOL DISTRICTS HAVE FOR MANY YEARS ATTEMPTED TO BILL FOR TRANSPORTATION COST REIMBURSEMENT ON BEHALF OF SCHOOL KIDS TO NEVADA MEDICAID BUT HAVE BEEN UNABLE TO DO SO BECAUSE A RATE METHODOLOGY AND A BILLING CODE SYSTEM WAS NOT IMPLEMENTED FOR THEM TO DO SO! In other words Nevada Medicaid was presenting to the public of the State Of Nevada and the Feds via the Center For Medicare & Medicaid Services that they offer such a Benefit but was it a FLAWED INACESSIBLE NON USABLE SERVICE!! I'm sure that families everywhere would be Outraged!!
Zealouswhistleblower
Las Vegas,Nevada,
U.S.A.
NEVADA MEDICAID TO STRIP OFF HOURS FOR BATHING, GROOMING, DRESSING & ELIMINATE EXERCISE UNDER FUNCTIONAL ASSESSMENT
#10Author of original report
Sat, August 23, 2008
In an attempt to SHORT CHANGE the medically needy (elderly, disabled, indigent) the State Of Nevada Department Of Health & Human Services has coordinated an action via the Division Of Health Care Financing & Policy (AKA "NEVADA MEDICAID") to REDUCE and REMOVE TIMES awarded under their "FUNCTIONAL ASSESSMENT" form that is utilized for the determination of Personal Care Services (through which a PCA would come).
Nevada Medicaid in an underhanded move submitted to the Nevada Legislature Committe for such services in a NON PUBLIC HEARING earlier this month a request to CONSOLIDATE 3 particular areas of the "FUNCTIONAL ASSESSMENT" form namely the CONSOLIDATION of "GROOMING" "DRESSING" and "BATHING" into 1 COMBINED CATEGORY and the ELIMINATION of the "EXERCISE" category from the assessment tool alltogether.
Due to certain feedback in regards to this Hostile Action NEVADA MEDICAID seemingly REMEMBERED that they are to HOLD a PUBLIC HEARING BEFORE ADOPTION OF ANY MAJOR POLICY CHANGES THAT WILL IMPACT THE COMMUNITY.
As it stands the current "Functional Assessment Tool" AUTHORIZES up to a MAXIMUM of 45 MINUTES PER DAY for EACH CATEGORY "BATHING, DRESSING & GROOMING" whose determination as to the allotment is supossed to be based on a "Person Centered Approach" and "MEDICAL NECESSITY" concerning the recipients Functional Deficits but is LEFT completely to the Discretion of Nevada Medicaid, Nevada Division Of Aging Services, First Health Services Corporation (Fiscal Agent) Social Worker and Bureaucrat Nurse staff who are dispatched to perform the assessment under the hidden agenda and motto dictating "Cost Savings First, Recipients Needs Last If We Can Help It."
The EXERCISE category of the "Functional Assessment" currently Authorizes a MAX of 45 Minutes PER DAY and allots for such things as taking the recipient for a Walk, or based on their medical necessity the providing of hands on medically appropriate Exercise which includes Range Of Motion or techniques as would be taught by a Physical Therapist or Occupational Therapist to the caregivers to perform on their behalf.
Now keep in mind that these Particular Categories happen to be of the MOST IMPORTANT to people who have Functional Deficits that interfere with their abilities to complete Activities of Daily Living (ADL'S) and Independent Activities Of Daily Living (IADLS).
Examples of ADL'S are Bathing, Dressing, Grooming, Toileting, Transfers & Positioning (Changing position in bed , transferring to Bed, chair etc), Exercise (this can include hands on exercise and range of motion to recipient), Mobility & Ambulation (providing assistance from sitting to rising position, puttiing on leg braces or prostheses, assisting them use a walking apparatus etc), and Eating (cutting up or pureeing food, assisting them to eat,cleanup etc).
Examples of Independent Activities Of Daily Living are Light Housekeeping, Laundry, Essential Shopping (for food, medication, DME supplies and other items needed for care) and Meal Preparation (planning and preparing the meals).
Please take note that as I have stated above these individuals are trained to deprive service times to needy individuals especially if they find out you get visitors or have family around even if for insignificant periods of times.
They are trained to throw out the excuse that they "cannot authorize maximum amount of times because they have to allow room to work within should the recipients condition worsen, because if maximum times under the Functional Assessment are reached it would require placement into a Nursing Facility."
This comment is just a bully tactic and is Legally absurd. But what happens to those Elderly and Disabled who cannto speak up or defend themselves due to their medical or psychosocial conditions? These people are run over and deprived of services they are rightfully entitled too and that is the game the State Of Nevada has been playing for years when it comes to such services.
Be aware that not only would that type of a situation (if it were attempted) be a violation of the freedoms and rights of these people to live independently and in their communities, two major acts that would be violated are the "Olmstead ACT" and the "American Disabilities Act."
I must again state these bureaucratic Nurses and Social Workers employed by Nevada Medicaid, Division Of Aging and the Fiscal Agent "First Health Services Corporation" are UNDULY UNREASONABLE when it comes to loved ones needing assistance (who if they happen to be in the home of other family members), will be Denied or awarded anywhere between 5-9 hours per week.
If anyone challenges or presses these individual as to their Unreasonable Deprivations of much needed services they will talk down to you saying "you have to be realistic we have to look out that these services are not improperly used on those less needy when there are others who have no help "such as the people who live alone."
I would encourage anyone who knows elderly and disabled individuals who are receiving Home & Community Based Services via a Waiver Plan (CHIPS (Division Of Aging-Waiver For The Frail Elderly, Chapter 2200), WIN (Physically Disabled-"Waiver For Independent Nevadans" Chapter 2300 and those that are victims of Personal Care Services via the State Plan Option (administered by First Health Services Corporation) through which a PCA is awarded you will ultimately learn that the TRUTH is that MOST PEOPLE DONOT EVEN KNOW SUCH SERVICES EXIST AND THOSE THAT ARE PROVIDED SERVICES RECEIVE AN UNBELIEVABLY LOW & INADEQUATE NUMBER OF SERVICES AND SERVICE HOURS.
There are countless people out there with sick and disabled loved ones who know the reality of the situation as it pertains to "medical assistance" to the elderly, disabled and indigent individuals in the State Of Nevada who in their GREAT MAJORITY are found WITH NO SUCH SERVICES and those that are lucky enough to be awarded have INADEQUATE SERVICE PLANS(Home and Community Based Servives are considered medical assistance per the Social Security Acts and Code Of Federal Regulations).
One good source of information is from people in the Medical Community particularly Nurses, Therapists, and those very few compassionate Social Workers who work in the Medical Fields as they can tell you about TONS and TONS of cases where patients are SORELY NEEDING of HOME & COMMUNITY BASED SERVICES but are RECEIVING ABSOLUTELY NOTHING DESPITE their Medical Necessity and Financial Indigence.
The biggest disgrace is that some times a situation will be reported to the Division Of Aging Services--Elderly Protection Unit and they will UTTERLY FAIL IN COORDINATING & OBTAINING THE MUCH NEEDED LEVEL OF ASSISTANCE THE CLIENT REQUIRES EVEN WHEN SOCIAL/MEDICAL ASSISTANCE PROGRAMS like HCBS (Home And Community Based Services) and PCS (Personal Care Services), WAIVER SERVICES (Home Maker, Chore, Respite, Home Delivered Meals, Nutrition Therapy, PERS (Personal Emergency Response System), Transportation, Senior Companion, and Adult Day Care) Exist!
Social Workers of the County, City and State as it poertains to the Medically Disabled, Indigent and Elderly are charged with "Assisting individuals who are in need of medical assistance due to disability, indigence and age in gaining access to needed waiver and other State plan services, as well as needed medical, social, educational and other services, regardless of the funding source for the services to which access is gained. Case managers shall be responsible for ongoing monitoring of the provision of services included in the individual's plan of care. Case Management services can be provided by the Division for Aging Services, Agencies or Independent Private Providers."
You may also find information on metrics and results of audit quality assurance investigations performed by the "Centers For Medicare & Medicaid Services "CMS" where it establishes that the State Of Nevada is rated next to last on number of violations as to the administration of social service/medical assistance programs that they participate in to receive FEDERAL FINANCIAL PARTICIPATION DOLLARS from the Federal Government.
There is just so much to write about in regards to this slent corruption and coverup pertaining to Home and Community Based Services in the State Of Nevada but I will share one major pont of Nevada Medicaid Policy that many of you NEVER KNEW EXISTED!
Many you have loved ones who could benefit from such services. Contained within Chapter 3500 of the Nevada Medicaid Service Manual starting at about 3503.2 references the "SELF DIRECTED SKILLED SERVICES MODEL." [http://dhcfp.state.nv.us/MSM%20Table%20of%20Contents.htm]. This model in actuality was taken from the Physically Disabled Chapter "WIN" Chapter 2300 of the Medicaid Service Manuals which contained something called the "Attendant Care Model" which would Authorize a Qualified PCA to perform Skilled Tasks on behalf of a medically necessitated recipient, and was in the Chapter FOR MANY YEARS!
Due to CMS intervention the State has opted to MIRROR the Model pretending it's something NEW they call the "Self Directed Skilled Services Model" into the STATE PLAN OPTION, Medicaid Service Manual Chapter 3500 so that ALL MEDICAID RECIPIENTS CAN OBTAIN SUCH SERVICES IF QUALIFIED.
Prior to this it was buried in the Physically Disabled Waiver Chapter who serviced Insignificant Number of medically deserving peoples and utilized HUMONGOUS WAITING LISTS. To those few people that were Awarded Skilled Times under the "Attendant Care Model" most received but a FEW HOURS for the extra skilled tasks!
Information on the statistics as to the utilization of this Model can be requested from the Centers For Medicare & Medicaid Service "REGIONAL OPERATIONS OFFICE" in San Francisco, Calfornia. When you look at the numbers you will find it is ILLOGICAL & INCONCEIVABLE to believe that SUCH LITTLE DEMAND FOR THIS TYPE OF WAIVER PROGRAM (PHYSICALLY DISABLED--WIN Chapter 2300) with all of the services it COULD PROVIDE, not considering the special provision for "ATTENDANT CARE MODEL" which would empower a PCA to perform skilled tasks on behalf of a client.
The actual Truth is that the State Of Nevada knew exactly what it was doing it engaged in a conspiracy to REDUCE THE NUMBER OF WAIVER SLOTS, AMASS A LARGE WAITING LIST, MAXIMIZE DURATION OF THE WAITING PERIOD EACH QUALIFIED INDIVIDUAL WOULD BE FORCED TO WAIT IN ORDER TO RECEIVE SERVICES, AND ENGAGED IN "DAMAGE CONTROL" that is to KEEP THE EXISTENCE OF SUCH PROGRAM A SECRET (this being the OPPOSITE of a Community Outreach Campaign to Educate the Populace of the existence of programs that may be beneficial to the Elderly, Disabled, Categorically and Medically Needy!
Under the SELF DIRECTED SKILLED SERVICES MODEL (Medicaid Service Manual Chapter 3500 of the STATE PLAN OPTION) those of you who have found that Nursing Facilities, Convalescent Hospitals and Long Term Care facilities just provide outright terrible care to their patients and are the playgrounds for miscreants, medical imbecils and abusers of the elderly and disabled and who are WILLING TO LEARN HOW TO TAKE CARE OF YOUR LOVES ONES AT HOMES CAN BE AUTHORIZED TO DO SO.
Under Nevada Revised Statutes 629.091 a Physician may Authorize an UNSKILLED INDIVIDUAL (meaning someone who is NOT a LICENSED Therapist, Nurse or Physician) to perform what the Chapter Refers to as "SKILLED TASKS/INTERVENTIONS" upon the DOCTOR stipulating on the "Physician Authorization for Self-directed Skilled care (NMO-3428A)." that the "Skilled Interventions" (meaning those tasks that would ordinarily be done by a Nurse or Therapist) are SIMPLE ENOUGH THAT AN UNSKILLED INDIVIDUAL CAN BE TRAINED TO PERFORM SAFELY & EFFECTIVELY."
Many of you out there are already taking care of a loved one h*o is dependent on you for their care, WITH NO ASSISTANCE FROM THE STATE! Many of you as is the case in my family have been with your loved ones during Hospital Stays and have interacted with many Medical Professionals of various types and have learned much in regards to taking care of them, medical diagnosis, purposes of medications, medical procedures and have received "training" many times at various medical facilities including via Home Health Services who dispatch Certified Nursing Assistants and Registered Nurses and Therapists to the home.
Many of you have been diligent and are compassionate enough to take care of your loved one yourself because there is no better care than that and you have spent ample time researching on Medical Information related websites like WEBMD to become more and more educated and a Competent Caregiver.
There are others of you out there who DUE TO THE LACK OF SUPPORT from COMMUNITY RESOURCES like "Home & Community Based Services," Personal Care Services (which would provide a PCA) and due to inadequate assistance from BAD "Home Health Companies" not to mention the fact that you have BILLS TO PAY and therefore cannot leave your Jobs and Careers to devote to FULL TIME CARE of a Loved One HAVE BEEN UNABLE TO DO SO.
Consider this if you have the capability, the skills, or the drive to be trained to perform "Skilled Interventions" on behalf of a Medically Necessitated patient YOU CAN BE AUTHORIZED AS A "QUALIFIED SKILLED BY UNSKILLED PERSONAL CARE AIDE(PCA)!"
This means you can seek out what is referred to in Chapter 3500 as an "Intermediary Service Organization" ISO and fulfill the Medicaid requirements to be hired as a PCA which requires a Background Check, Tuberculosis Testing, CPR Training and 16 Hours of Basic Training concerning elements that an UNSKILLED PCA would perform.
You can negotiate with the ISO regarding a starting Wage since you are BRINGING YOUR OWN CLIENT (you are bringing income to their agency wtihout you and the client they would NOT be receiving any moneys). The CURRENT RATE the State Of Nevada REIMBURSES PER HOUR of Care for BOTH "PERSONAL CARE SERVICES "UNKSILLED" and "SELF DIRECTED SKILLED SERVICES" is $18.52 HOUR. The ISO takes a cut from that amount and the DECENT prevailing wages to the PCA from the ISO averages $11.50 to $12.00 Hour but you can competitively shop the various ISO's (the list is on file with any Nevada Medicaid District Office).
Another REQUIRED FORM is the "Healthcare Provider's Verification of Training and Competency (NMO-3428B)" where a "provider of health care may authorize a person to act as a PERSONAL ASSISTANT to perform specific medical, nursing or home health care services for a person with a disability WITHOUT OBTAINING ANY LICENSE REQUIRED FOR A PROVIDER OF HEALTH CARE.
I have copied and cited NRS 629.091 and NRS 629.031 which Defines what a "Provider of Health Care" is BELOW. As you will note there are alot of possibilities to obtain a signature from that will VERIFY that you are a QUALIFIED PERSONAL ASSISTANT (meaning whatever the skilled tasks the Physician will state the Patient requires, you have already been trained and know how to do them on your own).
Here below I will list the Documents that the Chapter requires to obtain conversion and a Payment Authorization for Self Directed Skilled Care:
a. Recipient Self-directed Skilled Services Agreement (NMO-3426).
b. Physician Authorization for Self-directed Skilled care (NMO-3428A).
c. Healthcare Provider's Verification of Training and Competency (NMO-3428B).
d. ISO provider agreement for the provision of Self-directed Skilled care, signed by the recipient, the ISO and the qualified personal care assistant. (NMO-3427).
In regards to #A that is a simple straightforward form that the RECIPIENT (or if they are unable to do so) his Authorized Representative or Power Of Attorney can sign. They also have a designation for "Personal Care Representative (PCR)" and any adult can be designated as such (other than the individual who will be the Qualified PCA).
In regards to #D this is a form the Intermediary Service Organization "ISO" will have you sign to maintain in their files. Those 4 documents named above are available via the Nevada Medicaid District Office or First Health Services Corporation (Fiscal Agent for Nevada Medicaid) and per current revision of the policy should be provided via the ISO.
In regards to #B the area where the Skilled Tasks are to be listed they can mirror the list established by the Physician on #A. Please make sure that every "Skilled Intervention" that will be done for the Patient/Recipient is listed by the Physician on #A and by the Health Care Training Provider on #B.
Be also aware that #A and #B are currently Flawed as Nevada Medicaid Policy in that same chapter requires that the FREQUENCY OF SKILLED TASKS BE ALSO STATED but those forms DONOT ask any such question (this is yet another ploy Nevada Medicaid utilizes to DENY the Payment Authorization for these Services or DELAY the processing of such request). The Physician or even you yourself can write a simple letter identifying the DOCTOR as the Primary Physician for the client where he DETAILS out ALL the 'SKILLED TASKS/INTERVENTIONS" and there Frequencies and SIGNS OFF.
3503.3A (3)
3. MEDICAL CRITERIA
Services must be based on supporting documentation (Form 3428A) provided by the provider of health care that describes the complexity of the recipient's care and the frequency of skilled interventions. Services must be appropriate, reasonable and necessary for the diagnosis and treatment of the recipient's illness or injury within the context of the
recipient's unique medical condition and the standard of practice within the community.
a. The following criteria are used to establish the appropriate complexity of skilled interventions. The DHCFP or its designee makes the final determination regarding the reasonable amount of time for completion of a task based on supporting documentation, standards of practice, and/or a home health evaluation, as indicated.
1. Limited Skilled Interventions - Interventions that when performed in
combination would not reasonably exceed four hours per week. Limited
skilled interventions include, but are not limited to: obtaining vital signs or weights; nail care; suprapubic catheter care; attaching an ostomy bag on a wafer or other attachment device that already adheres to the skin; weekly bowel care; skin care, or catheter care; application of opsite, duoderm, or similar product to an abrasion or stage I wound; application of oxygen; monitoring of oxygen saturation levels; nebulizer treatments performed no more frequently than once daily; once a day glucose monitoring; medication set up; administration of non-complex oral medications; suppositories; enemas; subcutaneous or intramuscular injections; eye drops, nose drops, and/or ear drops; application of a medicated patch, or application of a prescription ointment or lotion to less than two body parts.
2. Routine Skilled Intervention - Intervention that by its inherent complexity combined with the frequency in the recipient's care routine can reasonably be expected to exceed four hours on a weekly basis. Routine skilled interventions include, but are not limited to: bowel care performed more than once a week; daily pulmonary treatments; nebulizer treatments done more than once a day; catheter changes; stage II to IV wound care; digital stimulation; ostomy care that includes both attaching an ostomy bag on a wafer or other attachment device that already adheres to the skin and changing the wafer or attachment device; multiple straight catheterizations daily; and complex medication administration. Complex medication administration includes, but is not limited to, administration of six or more medications on a different frequency schedule, administration of medications through a feeding tube, and glucose testing and insulin administration occurring more than once a day.
3. Highly Complex Intervention - Intervention that by its inherent complexity combined with the frequency in the recipient's care routine can reasonably be expected to exceed one and one-half or more hours per day to perform. Highly complex interventions may include, but are not limited to: tube feedings; special swallow techniques; peritoneal dialysis; stage III or IV wound care; or care of stage II to stage IV wounds in multiple locations. A physician must provide a written rationale for the time requested to perform this intervention.
4. Interventions performed on a monthly frequency are not included in
calculating the total number of interventions being performed unless the
performance of this task requires 2 or more hours and a physician has
provided a written rationale to explain this request. If authorized, this
intervention will equal one routine intervention.
5. Additional major procedures not listed here may be considered in
determining the complexity of skilled intervention. The DHCFP Central
Office, or their designee, should be contacted with information on what the procedure is and the amount of skilled time needed to perform this
procedure or task.
b. Clinical Decision Support Guide - See Section 3505.5. The clinical decision support guide identifies the benefit limitations for individual recipients based upon supporting documentation provided by the physician that describes the complexity of the recipient's care and the frequency of skilled interventions. Services must be appropriate, reasonable and necessary for the diagnosis and treatment of the
recipient's illness or injury within the context of the recipient's unique medical condition and the standard of practice within the community. The QIO-like vendor reviews the request and supporting documentation utilizing criteria identified in the clinical decision support guide. The QIO-like vendor will use these criteria to review for medical necessity and utilization control procedures.
[http://dhcfp.state.nv.us/MSM/CH3500/Ch%203500%20Final%207-8-08.pdf] Scroll to the End (Last Page #58) to see the Clinical Decision Support Guide.
NRS 629.031 Provider of health care defined. Except as otherwise provided by specific statute:
1. Provider of health care means a physician licensed pursuant to chapter 630, 630A or 633 of NRS, physician assistant, dentist, licensed nurse, dispensing optician, optometrist, practitioner of respiratory care, registered physical therapist, podiatric physician, licensed psychologist, licensed marriage and family therapist, licensed clinical professional counselor, chiropractor, athletic trainer, doctor of Oriental medicine in any form, medical laboratory director or technician, pharmacist or a licensed hospital as the employer of any such person.
2. For the purposes of NRS 629.051, 629.061 and 629.065, the term includes a facility that maintains the health care records of patients.
(Added to NRS by 1977, 1313; A 1983, 1492; 1987, 2123; 1991, 1126; 1993, 2217; 1995, 1792; 1997, 679; 2003, 904; 2005, 69; 2007, 3041, 3050)
NRS 629.091 Personal assistant authorized to perform certain services for person with disability if approved by provider of health care; requirements.
1. Except as otherwise provided in subsection 4, a provider of health care may authorize a person to act as a personal assistant to perform specific medical, nursing or home health care services for a person with a disability without obtaining any license required for a provider of health care or his assistant to perform the service if:
(a) The services to be performed are services that a person without a disability usually and customarily would personally perform without the assistance of a provider of health care;
(b) The provider of health care determines that the personal assistant has the knowledge, skill and ability to perform the services competently;
(c) The provider of health care determines that the procedures involved in providing the services are simple and the performance of such procedures by the personal assistant does not pose a substantial risk to the person with a disability;
(d) The provider of health care determines that the condition of the person with a disability is stable and predictable; and
(e) The personal assistant agrees with the provider of health care to refer the person with a disability to the provider of health care if:
(1) The condition of the person with a disability changes or a new medical condition develops;
(2) The progress or condition of the person with a disability after the provision of the service is different than expected;
(3) An emergency situation develops; or
(4) Any other situation described by the provider of health care develops.
2. A provider of health care that authorizes a personal assistant to perform certain services shall note in the medical records of the person with a disability who receives such services:
(a) The specific services that he has authorized the personal assistant to perform; and
(b) That the requirements of this section have been satisfied.
3. After a provider of health care has authorized a personal assistant to perform specific services for a person with a disability, no further authorization or supervision by the provider is required for the continued provision of those services.
4. A personal assistant shall not:
(a) Perform services pursuant to this section for a person with a disability who resides in a medical facility.
(b) Perform any medical, nursing or home health care service for a person with a disability which is not specifically authorized by a provider of health care pursuant to subsection 1.
(c) Except if the services are provided in an educational setting, perform services for a person with a disability in the absence of the parent or guardian of, or any other person legally responsible for, the person with a disability, if the person with a disability is not able to direct his own services.
5. A provider of health care who determines in good faith that a personal assistant has complied with and meets the requirements of this section is not liable for civil damages as a result of any act or omission, not amounting to gross negligence, committed by him in making such a determination and is not liable for any act or omission of the personal assistant.
6. As used in this section:
(a) Guardian means a person who has qualified as the guardian of a minor or an adult pursuant to testamentary or judicial appointment, but does not include a guardian ad litem.
(b) Parent means a natural or adoptive parent whose parental rights have not been terminated.
(c) Personal assistant means a person who, for compensation and under the direction of:
(1) A person with a disability;
(2) A parent or guardian of, or any other person legally responsible for, a person with a disability who is under the age of 18 years; or
(3) A parent, spouse, guardian or adult child of a person with a disability who suffers from a cognitive impairment,
performs services for the person with a disability to help him maintain his independence, personal hygiene and safety.
(d) Provider of health care means a physician licensed pursuant to chapter 630, 630A or 633 of NRS, a dentist, a registered nurse, a licensed practical nurse, a physical therapist or an occupational therapist.
(Added to NRS by 1995, 749; A 2005, 69)
Please take note that Nevada Medicaid has moved to ELIMINATE "Exercise" from the Functional Assessment tool which is utilized to award the Standard Unskilled Hours to a PCA on behalf of the recipient.
This category would allow times for "Non Prescribed Range Of Motion" which NEVADA MEDICAID would utilize if times were awarded under THAT SECTION to DENY any RANGE OF MOTION INCLUDING if it was PRESCRIBED by the recipients Physician. After this change occurs (which no doubt passes without a hitch because they DONOT care what medically needy individuals require only their Budgetary Problem at the moment) make sure that the Physician stipulates "Physical Therapy, Occupational Therapy, Prescribed Range Of Motion" on any paperwork or statement they submit in the pursuit of the "Self Directed Skilled Services Model" so TIMES can be evaluated an awarded according to it's complexity under the CLINICAL DECISION SUPPORT GUIDE 3505.5.
Keep in mind other tasks the Doctor may require for their patients care can be evaluated and determined to be Limited, Routine or Highly Complex Interventions depending on it's complexities, which will grant times under the Self Directed Skilled Model.
In my case a bed bound loved one receives PRESCRIBED RANGE OF MOTION Excercises that are techniques that were taught to us via Physical and Occupational Therapists. Separate from these is the application of Splints/Braces on Legs, Arms, Feet and Hands 3 times per day for 1 hour at a time. We also have to transfer the patient off the Hospital Bed and onto a Gerri/Roll-About chair twice per day for 1 hour at a time as part of a Therapeutic Regimen.
These extra tasks though NOT specifically stated in the Chapter are for Consideration in the awarding of "Self Directed Skilled Times" because they are prescribed, consistent and skilled.
Also DONOT think that obtaining an additional statement from the Physician to stated Frequency of Skilled Tasks or for ay Rationale on amount of time it takes to complete a "Skilled Intervention" is difficult or Rocket Science. The DOCTOR only needs to merely state the Number of Skilled Tasks Numbered or Bulleted (doesn't matter) and State FREQUENCY per Day it is performed on behalf of the Patient and state a Simple Reason in form of an acronym of a Diagnosis for support according to their preference.
Here are a few examples" Nebulizer Treatment X3 per Day (COPD, Pneumonia), Obtaining Vital Signs X2 Per Day, Skin Care X8 per Day (application of zinc oxide to prevent skin breakdown), Complex Medication Administration 12X Medications Varying Schedules or Conditions. The Physician can start his letter with an opening remark stating he/she is the Physician and a general statement of the current condition of the patient and all of their diagnosis.
These individuals at Nevada Medicaid have NOT the Authority to Disbelieve or Challenge the attending Physician Statement and must award according to terms discussed in their Chapter. The Better the job done by the patients Physician the more you Handcuff the evil doers who are attempting to SHORT CHANGE your Loved ones in this particular program. If anyone wishes to pursue this program and runs into a brick wall and incompentent individuals who provide no support to you or even the Physician and have questions don't hesitate to contact me.
FINALLY NEVADA MEDICAID IS HOLDING A PUBLIC HEARING ON AUGUST 26, 2008 at 9:00AM in Grant Sawyer Building on East Washington Avenue here in Las Vegas to receive feedback on their proposal to CUT OUT SEVERAL SERVICE HOURS from the FUNCTIONAL ASSESSMENT concerning Standard PCS Service Hours (PCA-Unskilled). I have added the link to this area of the Division of Health Care Financing & Policy (AKA "NEVADA MEDICAID") website. Many people are NOT able to attend and the State Of Nevada WILL NOT ACCOMODATE and ENSURE YOU CAN BE IN ATTENDANCE (their mind is already made up) therefore if t be POSSIBLE those of you who can be in ATTENDANCE DO SO REPRESENT THOSE PEOPLE WHOSE VOICES ARE NEVER HEARD!
http://dhcfp.state.nv.us/publicnotices.htm
MAY GOD ALMIGHTY JUDGE AND DESTROY THE CORRUPT CONSPIRACIES OF THOSE WHO CONTINUALLY DEPRIVE THE MEDICALLY NEEDY & INDIGENT OF SERVICES HE HAS INSPIRED FOR THEIR BENEFIT!
Carol Ann
Las Vegas,Nevada,
U.S.A.
Suggestions That Work In Nevada!
#10Consumer Suggestion
Sat, August 23, 2008
Contact the House Ways and Means Committe In Washington D.C. They are also online and Demand an investigation. Elderly, Injured Veterans and Handicapped Persons Deserve Better. After you have Contacted President Bush and Vice President Cheney, John Ensign, Harry Reid, Dina Titus and Shelley Buerkley. Once you make enough Racket in the Right Places, they will give you what You need. Good Luck!