Nurses Clocking In At Home & Saving Medically Fragile Foster Care Infants & Children

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 Services Offered By AIW:

Road Blocks & Questions...

The nurses at AIW walked the walk. We are happy to help point out potential hazards, pitfalls and any pot-holes along the way.  The best way is to contact us through our our website. Please provide us a detailed e-mail into what your needs may-be, or the difficulties you are facing.  We will return your e-mail or give you a call within a day or two. 


POT, E-TARS, CMS BILLING SERVICES: 

We are so excited to announce our brand new billing consultant to our Angels in Waiting family, Jessica D. She comes to us with multiple different backgrounds in executive management, medical billing, medical administration, emergency medicine, holistic health, and nutrition. As a single mother, she intuitively gravitates towards the needs of AIW. With an innate love of children and a deep understanding of what motivates and drives AIW’s mission, she is the perfect addition to our team. 

 Contact AIW For Your POT, E-Tar, And All Of Your Medi-Cal Billing Needs.

 

Need Help With Plan Of Treatments (POT), Nursing Notes, Medication Records (MAR).  EPSDT Contact Personnel... 





 Forms and Sample:

 (check your download folder after clicking on link)

Need A POT Form ? Click Here!

Need To View A Sample POT? Click Here!

Need Sample Nursing Notes? Click Here!

Need Medication MAR ? Click Here!

Need Initial Bates Intake Form? Click Here!

Need Initial Nursing Head-To-Toe Assessment Form? Click Here !

CONTACTS:

Numbers for EPSDT Private Duty Nursing;

EPSDT direct line: 855 347-9227

Supervisor :      213 897-2720

Nurse Of The Day:    213 620-2115

  • EPSDT: 916 552-9105
  • E-TAR Help: To check status on a claim; 800 786-4346
  • Paper TAR (not recommend) call 800 541-5555 to order TAR 50-1 forms.
  • Claims Submission Help:  ACS/Small Billing Unit 916-636-1275 Options:11-15-15-11
  • Moving, Change of Address? You will need to complete Medi-Cal Provider Packet Form 6204, the Medi-Cal Disclosure Statement Form 6207 & Medi-Cal Provider Agreement Form 6208. You can get these forms by calling the Nurse Evaluator at 916 552-9105 
  •  OTHER IMPORTANT NUMBERS:  
    E-TAR Help: To check status on a claim; 800 786-4346
    Paper TAR (not recommend) call 800 541-5555 to order TAR 50-1 forms
    Claims Submission Help:  ACS/Small Billing Unit 916-636-1275 Options:11-15-15-11
    Moving Change of Address; You will need to complete the Medi-Cal Provider Packet Form 6204, the Medi-Cal Disclosure Statement, Form 6207 & Medi-Cal Provider Agreement Form 6208, You can get these forms by calling the Nurse Evaluator at 916 552-9105 as well.

    Join our closed Facebook Group for INP's, go to your  Facebook page and ask to join:  CA Nurses: "Clocking in at home" with medically fragile foster kids.  Click this link: CA Nurses: "Clocking in at home" with medically fragile foster kids

    Get the best outcome for your little ones by acquiring knowledge, and performing early intervention therapies. Pathways.org  is an invaluable website please visit it frequently, to make sure your little ones are meeting or surpassing their milestones. 


    https://pathways.org/growth-development/0-3-months/

    IMPORTANT STUFF FOR INP's ...

    Numbers for EPSDT Private Duty Nursing;

    EPSDT direct line:     855 347-9227

    Supervisor :               213-897-1368

    Nurse Of The Day:    213 620-2115

    >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>




    Tar Billing Codes  For Nurse-Foster Providers:

    Bill Under These Codes: 

    Z5804-RN’s

    Z5806-LVN’s

    e-Tar & Tar Units = Hours / 100 units = 100 hours.


    **** Add a " " (zero) to the end of your Tar / Pre Authorization Code when billing. 


    EPSDT/ Medi-Cal Supplement Care Private Duty Nursing Support People... 

    INP's Use your Small Provider Billing Unit Person:

    * * You have their help for billing & e-Tar, etc. For a one year period of time USE THEM ! For more information, call (916) 636-1275 or 1-800-541-5555, ext. 1275. Representatives are available from 8 a.m. to 5 p.m., Monday through Friday, except holidays.


    Regional Representatives:

    
The 22 Regional Representatives live and work in cities throughout California and are ready to visit providers at their office to assist with billing needs or provide training to office staff at no cost. To schedule a Regional Representative on-site visit please call the Telephone Service Center (TSC) at 1-800-541-5555   


     

     INP's are paid for Skilled Nursing Hours ~ Not foster parent hours! 

    ~~~~~~~~

    What Level of Care is your child?

    www.oal.ca.gov/ccr.htm

     

    KNOW YOUR REGULATORY RIGHTS – HOURS ARE DETERMINED ON MEDICAL NECESSITY THAT YOU HAVE DETAILED IN YOUR POT –

    Nurses... if you don’t detail "MEDICAL NECESSITY"  for RN and LVN  skilled nursing care, your nursing hours may be denied if there is too little information in your POT.

     

    CALIFORNIA CODE OF REGULATIONS:

                                ~ Title 22 ~ 

    Division 3 Health Care Services

    Subdivision 1 California Medical Assistance Program

    Chapter 3 Health Care Services

    Article 2 Definitions:

    CURRENT MAXIMUM NUMBER OF HOURS BASED ON COST NEUTRALITY:

     

    Section 51124.6  Pediatric Subacute:

    Peds Subacute:  Daily rate $613 Hours per week 145 (20/day)

                               Hours per month= 623hr

    Peds Subacute: Vent Daily rate $673 Hours per week= 159 hr (22/day)

                               Hours per month= 683hr

    Peds Subacute Requirements: Trach/Vent >6 hr or Trach with suctioning and room air mist or 02 needs. TPN Dependence other IV Nutritional support and one of the following:

    1. Continuous IV Therapy or Administration of more than one IV medication.
    2. Peritoneal Dialysis
    3. Tube Feedings
    4. Other Medical Technologies required continuously which requires the service of a licensed nurse.

    Peds Subacute Requirements (cont): Dependence on Skilled Nursing Care In The administration of 3 of these 5 procedures:

    1. Intermittent suctioning every 8 hours and room air  or 02 needs.
    2. Continual IV therapy or the administration of more than 1 IV medication.
    3. Peritoneal Dialysis
    4. Tube Feedings
    5. Other Medical Technologies required continuously which requires the service of a licensed nurse.
    Peds-NF-B; usually is what level INP nurses will bill under... Nurses, if you ask for too many hours you will be deferred, do the math correctly:


    Section 51124 & 51335 Pediatric Nursing Facility Level of

                                                  Care (Peds NF-B): 

     

     Peds NF-B:  Daily rate $245, Hours per week= 57hr

                               Daily rate $247

               

    Requirements: Continuous Availability Of Skilled Nursing Care By A Licensed Nurse To Provide But Not Limited To:

    1. Tracheostomy Care
    2. Administration of Medication on routine and as needed basis.
    3. Tube Feeding
    4. Suctioning
    5. Insertion of Catheters
    6. Application of dressing with prescribed medication.
    7. Extensive Decubiti Care
    8. Intake & Output


    Section 51343.2  Intermediate Care Facility – Dev. Disabled

                                Nursing (ICF-DDN)

    ICF/DDN (Developmental Disabled Nursing)

                               Daily rate $181   Hours per week= 42                          

                               Hours per month= 182hr

    Requirements: A Regional Center has diagnosed the individual as developmentally disabled.  The Individual shall have two or more developmental deficits and need intermittent scheduled skilled nursing services as example:

    1. Tube Feedings
    2. Suctioning
    3. Medication Administration
    4. Tracheostomy Care
    5. Respiratory Treatments 


    Section 51343.1  Intermediate Care Facility – Developmental

                                Disabled Habilitative (ICF-DDH)

    ICF/DDH (Developmental Disabled Habilitative)

                              Daily rate $149 Hours per week= 34 

                               Hours per month= 149hr

    Requirements: A Regional Center has diagnosed the individual as developmentally disabled.  Shall have two or more developmental deficits and skilled nursing needs are predictable and scheduled.

    ~~~~~~~

     Resources and Directions:

    If you are a Nurse-Foster Provider, you may not pay taxes on the medically fragile foster care children assigned to you as a nurse-foster provider/ parent. 

     For more tax clarification in IRS issues contact Tax AccountantWade Cheney 909 882-3323.  

    Bookkeeper: Colleen Kerns 909 883-5500. 

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    HELPFUL HINTS: 

    Many INP's open their POT with this statement: As Per California’s State Law: Chapter 490 ~ "Preferential Consideration" is now given to Nurses-Foster Providers under the EPSDT Private Nursing Non-Wavier programs.

    See the Attached State Law Chapter 490 requirements  pertain into the care of Medically Fragile Fosters Care Population. 

    Hint...

    Medi-Cal is reviewing Nursing Documentation and our Plan Of Treatments (POT’s) closely – the Reviewers may not always have detailed understanding of YOUR particular child’s diagnosis (the Reviewers may NOT be nurses)!  Write your POT as if you are explaining what to look for to a group of HIGH SCHOOL kids hoping to become nurses–write it like you are back in Nursing School and your Nursing instructor wants to make sure YOU understand what you are looking for!

    Remember – as RN’s and LVN’s; INP’s, we know the “WHY” and not just the “tasks” of what we are doing – so, explain the “WHY” to the possible non-nurses who may be reviewing your charting and POT.  WHY is an "Air Embolism" going to cause a problem for a 18 month old child with a CVL if the line breaks because they are teething and chewing on the IV lines... etc.


    Write your POT with detailed information about all of the complications your child has or can develop.  Write your POT as if someone WITHOUT a nursing background is reading about your medically fragile foster child.  You have to spell out in layman’s terms the signs and symptoms of a complication, plus what is to be done about the complication should it arise. Moreover, pull on the heartstrings of the reviewer, tell the story of why the child has been placed into the foster care system, the number of foster home placements, etc... this helps provide a broader picture of the physical and psychological complexities of the medically fragile foster care population.  

     THERE IS NO SUCH THING AS "TOO MUCH DOCUMENTATION" WHEN IT COMES TO PRESENTING THE CHILD FOR CONSIDERATION TO EPSDT.   (Review our POTSample)

    As nurses, we consistently and vigilantly monitor for signs of pending complications. Repeat this OVER and OVER in your POT and ALSO ON YOUR NURSING NOTES! 

    Nurse-Foster Providers Please Become De Facto Parents...

    If you have been taking care of a child who has been declared a dependent of the juvenile court, you may want to be more involved in the child’s court case and consider becoming a de facto parent.

    You may be a de facto parent if:


    • The child is a dependent of the juvenile court.
    • You are or have been taking care of the child every day.
    • You have been acting as the child’s parent.
    • You are meeting (or have met) the child’s needs for food, shelter, and clothing. You have also met the child’s needs for care and affection.

    No law says exactly what a “de facto parent” needs to be. Judges make this decision based on other court cases and on rule 5.502(10) of the California Rules of Court.

    Rights of de facto parents

    If the judge finds you are a de facto parent, you have the following rights:

    • To be present at dependency proceedings (note: as a caregiver you can go to all dependency review and permanency hearings even if you are not a de facto parent);
    • To be represented by a lawyer if you hire one, or, in some cases, the court may appoint a lawyer at no cost to you if the judge thinks that is necessary;
    • To present evidence and cross-examine witnesses; and
    • To participate as a party in the disposition hearing and any hearing after that.

    You can learn more about these rights by reading rule 5.534(e) of the California Rules of Court.

    Remember: A de facto parent is not the same as a parent.

    As a de facto parent, you do NOT have the right to:

    • Attorney fees. But, in some cases, the judge may give you an attorney, and the court will pay the fees.
    • Rehearing. You cannot ask for another hearing if you do not agree with the judge’s decision, but you have a right to an appeal.
    Applying for de facto parent status
    1. Fill our your forms
      To apply, fill out the following forms:
      • De Facto Parent Request (Form JV-295):
        • Asks for your name, address, and phone number.
        • On the form, tell the judge that you or someone else wants to be the child’s de facto parent. If you are asking for someone else, you need to write that person’s information on the form.
        • Sign and date the form (or if you are asking for someone else, have that person sign the form). If you have an attorney, he or she will sign the form too.
      • De Facto Parent Statement (Form JV-296):
        • Say why you think the judge should decide that you or the other person named on Form JV-295 is a de facto parent.
        • List important things you did for the child and how often you did them. This is so the judge has all the information he or she needs to make a decision.
        • Give information like:
          • How long you have cared for the child;
          • What you do with the child;
          • What you do for the child;
          • How much you care for the child;
          • What you know about the child’s special needs, desires, hopes;
          • How you can meet the child’s needs.
        You can also attach letters from others who know you and the child. For example, teachers, therapists, pediatricians, spiritual advisors, etc.
    2. The court will make a decision
      Only the juvenile court can decide if you are a de facto parent. The judge will apply case law and rule 5.502(10). He or she will consider the care you gave the child and how long you did it. Also, the judge will decide if you can help the court understand what is best for the child — the child’s best interest. If you have harmed the child or put the child at risk, the judge will likely decide that you are NOT a de facto parent. 
    If the judge decides you are not a de facto parent, you may still tell the judge what you feel or know about the child by filing out Caregiver Information Form (Form JV-290), or if you are not the current caregiver, by sending a letter to the court. If you need help filling out Form JV-290, read the Instruction Sheet for Caregiver Information Form (Form JV-290-INFO).

    Link to Apply: http://www.courts.ca.gov/1207.htm