1. Time Frames:

A Comprehensive Assessment, including face-to-face contact with the client and development of the service plan, must be completed for each individual who is assigned for assessment for Adult Emergency Shelter Care services. This assessment must be completed within thirty (30) calendar days following the date the case is assigned for assessment. Since placement in Adult Emergency Shelter is limited to thirty (30) days, it is essential that the Comprehensive Assessment be completed as soon as possible following placement in the ESC home to allow time to arrange alternate placement upon discharge from the ESC.

2. Information to Be Collected:

a. Identifying Information Demographic information about the client, their family and their unique circumstances is to be documented. This includes information such as (not an all inclusive list):

C	name;
C	address (mailing and residence);
C	telephone number;
C	date of birth/age;
C	household members;
C	other significant individuals;
C	legal representatives/substitute decision-makers (if applicable);
C	identification numbers (SSN, Medicaid, Medicare, SSA Claim, etc.);
C	gender/ethnicity;
C	marital status; and,
C	directions to the home.
b.	Referent Information

Information about the person(s) making the referral is to be documented. With requests to receive Adult Emergency Shelter Care services the client frequently will make the request on their own behalf. If this is the case, the social worker must indicate that this is a self-referral and documentation of additional referent information is not necessary. When the referent is someone other than the client, the information to be gathered must include but is not limited to the following: C referent name; C referent address; C referent telephone number C relationship to the client C how they know of the client’s needs; and, C other relevant information.

c. Services Requested

Document the specific services being requested. This should include information such as the
following:
C the specific type(s) of assistance being requested;
C why assistance is being requested;
C how needs are currently being met; and,
C other relevant information.

d. Living Arrangements

Document information about the client’s current living arrangements. This should include information about where the client currently resides such as the following: C client’s current location (own home, relative’s home, hospital, etc.);

C	is the current setting considered permanent or temporary;
C	type of setting (private home/residential facility, etc.);
C	household/family composition;
C	physical description of the current residence (single family dwelling, duplex, townhouse,
	apartment, retirement community, foster home, group home, nursing facility, etc.);
C	interior condition of the residence;
C	exterior condition of the residence;
C	type of geographic location (rural, urban, suburban, etc.);
C	access to resources such as family/friends, transportation, shopping, medical
	care/services, social/recreational activities, religious affiliations, etc.
e.	Client Functioning

Document information about the client’s current physical and medical conditions. This should
include information about the physical condition and description of the client during the face-to-
face contact as well as information about their diagnosed health status. Included are areas such
as:
C observed/reported physical conditions of the client;
C primary care physician;
C diagnosed health conditions;
C current medications;
C durable medical equipment/supplies used; and,
C nutritional status including special dietary needs, if applicable.

f. Mental/Emotional Health

Document information about the client’s current and past mental health conditions. This should
include information about how the client is currently functioning , their current needs and
supports, and his/her past history of mental health treatment, if applicable. Included are areas
such as:
C current treatment status;
C current mental health provider;
C mental health services currently receiving;
C medication prescribed for treatment of a mental health condition;
C prescribing/treating professional;
C observed/reported mental health/behavioral conditions; and,
C mental health treatment history.

g. Financial Information

Document information about the client’s current financial status. This should include information about the client’s resources and his/her ability to manage these independently or with assistance. The thoroughness and accuracy of financial information is especially critical for clients who will receive other adult residential services that will be paid in part by the department. Included are areas such as:

C	financial resources - type, amount and frequency;
C	other resources available to the client: non-financial;
C	assets available to the client (can not exceed a maximum of $2,000 to be eligible for other
	adult residential services);
C	outstanding debt(s) owed by the client;
C	extraordinary expenses;
C	health insurance coverage; and,
C	information about the client’s ability to manage their own finances.
h.	Educational/Vocational Information

Document information about the educational/vocational training the client has received or is
currently receiving. This should include information such as:
C last grade completed;
C field of study;
C history of college attendance/graduation; and,
C history of special licensure/training.

i. Employment Information

Document information about the client’s past and present employment, including but not limited
to sheltered employment. Information should include:
C current employment status;
C current employer;
C type of employment; and,
C prior employment history.

j. Military Information

Document information about the client’s military history, if applicable. This should include
information such as:
C branch of service;
C type of discharge received;
C date of discharge; and,
C service related disability, if applicable.

k. Legal Information

Document information about the client’s current legal status. This should include information about all known legal representatives, and the specific nature/scope of that relationship. This should include information such as: C assessment of the client’s decision-making capacity by the social worker;

C information about legal determination of competence, if applicable; C information about efforts to have the client’s decision-making capacity formally evaluated; and, C identification of specific individuals who assist the client with decision-making.

3. Conclusion of Comprehensive Assessment:

When the Comprehensive Assessment is completed, all the information and findings are to be documented in FACTS. This, along with the service plan that was developed as a result of the assessment findings, is then to be submitted by the social worker to the supervisor for approval.

1. Selection of the Provider:

The successful placement of a client in an Adult Emergency Shelter Care home will depend largely on assuring a good “match” between the client being placed and the provider. In order to ensure as good a match as possible, the social worker must evaluate the client in the following areas: C current physical health status and medical history; Whenever possible, the client must have a medical evaluation completed by their regular physician prior to placement in an Adult Emergency Shelter Care home. If completion prior to placement is not possible, the social worker must arrange for this evaluation to be completed within two (2) working days following placement. Completion of this form serves two purposes. It documents the current health status of the client and it indicates that he/she is free of communicable diseases to the best of the physician’s knowledge.

C	current mental/emotional/cognitive status and history;
C	current medications and ability to self-administer medication;
C	individual or special needs as viewed by the client, the physician, and the social worker;
C	the client’s expressed wishes regarding his/her living arrangements;
C	family, friends and community ties, who and where these are located and assistance they
	are willing to provide to the client;
C	family experiences of the client such as the kind of home life he/she had and attitude
	toward any remaining family;
C	educational and employment history;
C	religious preferences, interests, hobbies, likes and dislikes, and personal habits;
C	household possessions or pets and plans for what will be done with these;
C	physical appearance and personal characteristics (e.g. neat/untidy, withdrawn/outgoing);
C	behavior problems that are currently present or that have been present in the past;
C	problems with any prior placement;
C	unusual habits that could be problematic for a provider; and,
C	financial resources such as income, medical insurance and assets.
2.	Client Medical Evaluation:

The first section contains identifying information about the client and is to be completed by the social worker. The remaining portions of the form relate to the client’s current condition(s), diagnosis, and special needs he/she may have. These portions are to be completed by the client’s physician. The completed form is to be returned to the department. The social worker must enter all relevant medical information about the client and his/her physician in the appropriate areas of FACTS. Finally, the completed report must be filed in the client’s case record (paper) and the location of this evaluation noted in FACTS.

Note: The Client Medical Evaluation is available as a DDE and may be accessed through the reports area of FACTS.

3. Ongoing Medical Care for ESC Clients:

All clients placed in an Adult Emergency Shelter Care home are to receive ongoing medical care throughout their placement. If the client does not have an attending physician at the time of placement, he/she will be assisted in the selection of one of his/her choice. The physician is to be consulted as needed regarding any medication, special diet, or other routine health supervision.

4. Required Notification of Placement:

At the time placement of the adult in the Adult Emergency Shelter Care home is completed, the social worker must send/ensure notification of the placement to certain parties. Specifically, if the adult is receiving any services through Office of Family Support (e.g. Food Stamps, Medicaid, Emergency Assistance, etc.), written notification is to be provided advising them of the placement. This notification is to be done using the Interdepartmental Referral Form (DHS1) and must include the type of placement the client resides in, the date placement became effective, the client’s new address and telephone number, client identifying numbers such as SSN, SSA Claim number, Medicaid number, etc., the name of the provider, and the monthly amount paid by the client to the provider for his/her care.

Also, notification of the client’s change of address and living arrangements must be sent to all of the client’s sources of income. This notification may be done by the client, the provider, or another responsible party. The social worker, however, should follow up with the individual designated to provide this notification to ensure that this is done promptly. If not handled promptly, problems may result in the provider receiving payment from the client in a timely manner. In the event the social worker sends this notification, the Interagency Referral Form is to be used.

5. Contact by the Social Worker:

During the first week following placement, the client and provider will need regular guidance and support from the social worker to ensure a smooth adjustment. The social worker is to maintain regular contact with the client and provider during this adjustment period to monitor the client’s and the provider’s adaptation to the new placement and to assess the client’s functioning in the home. The social worker must conduct a visit to the home when the client first arrives, and a follow-up visit within one (1) week following placement. The social worker must maintain frequent contact throughout placement in order to facilitate appropriate discharge.

6. If the ESC Placement Fails:

It is essential that the social worker carefully consider the characteristics and needs of the client and the characteristics and resources of the provider in order to ensure as good a match as possible. If, after placement, problems arise, the social worker will work with the provider to arrange the assistance and/or training necessary to aid the provider in furnishing appropriate care to the client. If, after the social worker has provided or arranged for all appropriate assistance,

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the arrangement remains unworkable, the social worker shall arrange for placement of the client with another provider who is better able to address the client’s needs.

After a successful match is found and the client is placed with a new provider, the social worker must monitor the new placement carefully. While it is important to maintain regular contact with both the provider and client during the week immediately following any placement, this is especially important when the placement has occurred as a result of a failed placement in another setting. Frequent contact with the client and provider will ensure the support and opportunity necessary to promptly identify problems, should these occur, and seek appropriate resolution.

B. Payment by the Office of Social Services

Providers of Adult Emergency Shelter Care services may receive reimbursement from the department in one of two ways, automatic payment and demand payment. Reimbursement to the provider for the care and supervision furnished to the client will be done by automatic payment. Demand payments are available for a very limited and specific set of expenses that may occur in an Adult Emergency Shelter Care setting.

1. Automatic Payments:

Payment due to an Adult Emergency Shelter Care provider is done automatically by FACTS. The provider receives a monthly payment for each approved bed. The stipend rate is established by the department (current stipend rate is $84/bed/month). In addition, the provider receives a payment for each individual placed in their home at the maximum monthly/daily Adult Family Care (AFC) rate in effect during the period of placement. The monthly stipend payment is generated by FACTS based on selection of the Emergency Shelter Care provider type. In addition, payment to the provider for the care of each individual placed in their home is automatically created by FACTS, based on the enter/exit dates entered.

In order to assure that payments to the provider are accurate and received by the provider without delay, it is essential that the social worker enter the required information in a timely manner. Payment information and supervisory approval must be completed by noon on the fourth working day of the month following the month in which placement was made in order to prevent inaccurate or delayed automatic payment. Payment information that is not entered and approved by noon on the fourth working day will require the social worker to request a demand payment for the purpose of doing a payment adjustment/correction.

Finally, prior to the end of business on the fourth working day the social worker must review the monthly payment approvals screens in FACTS in order to verify that the payment information in the system and due for release during the next payment cycle is accurate. If there are errors detected, the social worker must make the necessary changes prior to the fourth working day of the month. If no errors are detected, the social worker must verify the payment shown.

2. Payment Agreement

This agreement, which is completed during the case management phase of the case work process, is the document which sets forth the terms of payment for placement. This form also is a placement agreement that the social worker completes with the client and the provider. This agreement specifies: 1) the terms of payment, 2) a statement by the client that he/she agrees to temporary placement in the ESC and, 3) a statement by the provider that they are willing to accept the client in placement.

This payment agreement is created by FACTS based on information entered by the social worker. After all required documentation is completed, the Payment Agreement may be printed and all required signatures obtained. Finally, a copy of the signed agreement is to be furnished to the provider and the client, the original signed document filed in the client case record (paper record), and record in document tracking where the original signed document is located.

This form is available in the FORMS section of this policy for informational purposes. In addition it is available as a DDE in FACTS and may be accessed through the report area. It may be opened as a WordPerfect document, populated with information that has been entered in FACTS.

The completed document must then be saved to the FACTS file cabinet for the case. Creation of this form must be documented in the document tracking area of FACTS. Finally, after printing the Payment Agreement, the worker must secure all required signatures, provide the client and all signatories with a copy, file the original signed document in the client case record (paper record), retain a copy in the provider record, and record in document tracking where the original signed document is located.

3. Demand Payments:

Most costs associated with the care of an adult placed in an Adult Emergency Shelter Care home will be included in the monthly reimbursement paid to the provider by automatic payment. There are, however, certain specific costs that may be incurred that are not included in that monthly reimbursement. The demand payment process may be used to request reimbursement for certain costs incurred for/on behalf of clients placed in an Adult Emergency Shelter Care home by the department or for specific expenses incurred by the Adult Emergency Shelter Care home provider that are not client specific. The need for a demand payment of any type must be determined jointly by the social worker and the provider prior to any cost being incurred and must be reflected in the client’s service plan.

Some demand payment types require a two-tiered approval meaning they must first be approved by the supervisor and then must also be approved by the Office of Social Services. Those payment types that require a two-tiered approval are marked with an (*) in the list below. The demand payment will not be generated by FACTS and sent to the provider until the required approval(s) is done. Only the following demand payment types are permitted:

Payments requiring supervisory approval C payment adjustment (to correct underpayment to provider); C client medical evaluation; C co-payment on prescription medications; C provider training incentive payment (not client specific); C annual provider medical report (not client specific);

Payments requiring both supervisory and Office of Social Services approval
C *durable medical equipment and supplies;
C *food supplements;
C *over-the-counter drugs/DESI drugs or prescriptions not covered by insurance/Medicaid;
C *non-Medicaid covered services; and,
C *other demand payments.

Demand payments are done on a weekly basis, based on information entered in FACTS by the
social worker. Information that is required in order for FACTS to generate demand payments
include:
C information identifying the provider to be paid;
C client for whom request is being made, if applicable;
C invoice date;
C service month;
C amount to be paid;
C payment type; and,
C explanation of why the payment is necessary.

When a demand payment is needed, the social worker must enter the required information in
FACTS. The payment information must then be forwarded to the supervisor for approval.
Demand payments require supervisory approval. For certain demand payment types, approval by
the Office of Social Services is also required in addition to the supervisory approval.

Finally, after the required approval(s) is granted, the social worker must review the payment on the demand payment verification screen to ensure that the amount to be paid to the provider is accurate. If the payment is accurate, verify the payment. If not, identify and resolve the problem(s).

Note: In order for any provider or vendor to receive payment through FACTS, the provider/vendor must be set up as a provider in FACTS.

a. Payment Adjustment

This demand payment type is to be used for the purpose of correcting an under payment to an Adult Emergency Shelter Care provider. An under payment may occur when the social worker is unable to complete the placement process, including all applicable documentation in FACTS, prior to the deadline for entering payment/placement information. A payment adjustment may be requested to reimburse the provider for any unpaid portion due.

b. Client Medical Evaluation

Each client placed in an Adult Emergency Shelter Care home (ESC) should have a current medical evaluation (within three months prior to placement in the ESC). If the client has not had a medical evaluation completed within the three months prior to placement in the ESC OR if the worker believes there is need for a more current evaluation due to changes in the client’s functioning/circumstances, the social worker is to arrange for a medical examination within two

(2)

working days following placement in an Adult Emergency Shelter Care home. If the ESC provider arranges for payment for the evaluation, the provider may submit the receipt to the department to request reimbursement. If the ESC provider does not pay for the evaluation, the doctor must submit a invoice to the local Department of Health and Human Resources (DHHR) to request reimbursement. The social worker must then prepare a request for reimbursement for the client medical evaluation. Upon completion of the demand payment request, the social worker must forward the request to the supervisor for approval.

c.

Co-Payment on Prescription Medications

The cost incurred for co-payments for medications may be reimbursed for adults who have been placed in an Adult Emergency Shelter Care home by the department. Reimbursement by the department may only be considered after it has been determined by the social worker that there is no other personal or community resource that can meet this need. In addition, the medications to which the co-payment applies and for which payment is requested must: C be prescribed by the adult’s physician; C meet an identified need on the adult’s service plan; and, C be necessary to prevent the need for a higher level of care; In order to request reimbursement for this type of expense, the provider must submit documentation of the medical necessity of the medications and the receipt for the required medications after they have been purchased. The social worker must then prepare a request for a

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demand payment in order to reimburse the provider for the cost incurred. The request must address each of the identified areas. Upon completion of the demand payment request, the social worker must forward the request to the supervisor for approval.

d. Provider Training Incentive Payment

Approved Adult Emergency Shelter Care providers are entitled to receive reimbursement for approved training they receive. This reimbursement is offered as an incentive to encourage providers to participate in relevant training opportunities to enhance their skills and knowledge as Adult Emergency Shelter Care providers. Training that would be acceptable in order to qualify for this payment would include training provided by the department or training that is furnished by another agency/entity that has been approved in advance by the department.

In order to be eligible to receive this training allowance, the provider must attend a minimum of six (6) hours of approved training during the quarter for which reimbursement is being requested. The quarters to be used for determining this allowance are based on the calendar year. Specifically, the quarters to be used are January - March; April - June; July - September; and October - December. Upon completion of the required hours of approved training, the provider may request payment of the training allowance by the department. Verification of attendance of the approved training must be submitted at the time reimbursement is being requested. Without verification that training was attended, payment shall not be made.

Upon receipt of the required verification of attendance of at least six (6) hours of approved training during the quarter, the social worker may then prepare a request for a demand payment in the amount of $25.00. Upon completion of the demand payment request, the social worker must forward the request to the supervisor for approval.

Note: The training allowance can not be prorated. If a full six (6) hours of training is not completed within the quarter, the provider is not eligible for this payment. Additionally, homes that are approved as a combination home (AFC/ESC) may only receive one training incentive payment per quarter - not one incentive payment as an AFC AND another incentive payment as an ESC provider.)

e. Annual Provider Medical Report

After an Adult Emergency Shelter Care home becomes an approved provider, the person(s) in the household who is primarily responsible for furnishing care to the clients placed in the home is required to have a medical evaluation completed annually. The purpose of this evaluation is to ensure that the provider remains in good health and able to provide the necessary care and support to adults placed in their home.

The provider is to arrange for completion of the annual medical report with their physician. When arranging for completion of this evaluation, providers are to be encouraged to request that

Effective July 2001 Page 16 of 56

their physician complete this evaluation during a regularly scheduled medical appointment whenever possible.

If the provider has no other resources or insurance coverage to pay for this annual report, they may request reimbursement by the department for this expense. To request reimbursement, the provider must submit a receipt, along with the completed medical report, to the department and indicate that reimbursement is being requested. If the report is paid in part by insurance, the provider may request reimbursement by the department for their out-of-pocket co-pay, if applicable. Reimbursement for completion of the medical report by the physician may not exceed the current Medicaid rate for a medical report. Reimbursement for out-of-pocket co-pay may not exceed the actual expense incurred.

f. Durable Medical

In certain situations the cost of obtaining durable medical equipment or supplies may be reimbursed for adults who have been placed in an Adult Emergency Shelter Care home by the department. Reimbursement by the department may only be considered after it has been determined by the social worker that there is no other personal or community resource that can meet this need. In addition, the durable medical equipment/supplies for which payment is requested must: C be prescribed by the adult’s physician; C meet an identified need on the adult’s service plan; C be necessary to prevent the need for a higher level of care; C be a one (1) time only expense rather than a reoccurring cost; and, C not exceed the current Medicaid rate. In order to request reimbursement for this type of expense, the provider must submit the receipt for the equipment/supplies after they have been purchased. The social worker must then prepare a request for a demand payment in order to reimburse the provider for the cost incurred. The request must address each of the identified areas. Upon completion of the demand payment request, the social worker must forward the request to the supervisor for approval. This demand payment type requires approval by the Office of Social Services in addition to the supervisory approval (two-tiered approval). The demand payment will not be generated by FACTS and sent to the provider until the required approval(s) is done.

g. Food Supplements

In unique situations, food supplements may be required by an adult placed by the department in an Adult Emergency Shelter Care home in order to maintain sound nutritional status. In certain situations the cost of obtaining these food supplements may be reimbursed by the department. Reimbursement by the department may only be considered after it has been determined by the social worker that there is no other personal or community resource that can meet this need. In addition, the food supplements for which payment is requested must: C be prescribed by the adult’s physician; C meet an identified need on the adult’s service plan; and, C be necessary to prevent the need for a higher level of care. In order to request reimbursement for this type of expense, the provider must submit documentation of the medical necessity and the receipt for the food supplements after they have been purchased. The social worker may then prepare a request for a demand payment in order to reimburse the provider for the cost incurred. The request must address each of the identified areas. Upon completion of the demand payment request, the social worker must forward the request to the supervisor for approval. This demand payment type requires approval by the Office of Social Services in addition to the supervisory approval (two-tiered approval). The demand payment will not be generated by FACTS and sent to the provider until the required approval(s) is done.

h. Over-the-Counter Drugs/DESI Drugs or Rx Not Covered

In certain situations medications may be required by an adult placed by the department in an Adult Emergency Shelter Care home that are not covered by Medicaid or other insurance. These include items such as over-the-counter medications, DESI drugs, or other prescription medications that are medically necessary but not covered by insurance. The cost of these medications may be reimbursed by the department. Reimbursement by the department may only be considered after it has been determined by the social worker that there is no other personal or community resource that can meet this need. In addition, the medications for which payment is requested must: C be prescribed/ordered by the adult’s physician; C meet an identified need on the adult’s service plan; and, C be necessary to prevent the need for a higher level of care. In order to request reimbursement for this type of expense, the provider must submit the receipt for the after they have been purchased. The social worker must then prepare a request for a demand payment in order to reimburse the provider for the cost incurred. The request must address each of the identified areas. Upon completion of the demand payment request, the social worker must forward the request to the supervisor for approval. This demand payment type requires approval by the Office of Social Services in addition to the supervisory approval (twotiered approval). The demand payment will not be generated by FACTS an