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.
SAR, TAR, E-TAR, CMS BILLING Bill Can nurses bill CCS and Medi-Cal for the same client? "Yes" we can!
Service Authorization Requests: (SARs)
- Are the equivalent of Medi-Cal TARS
- Are used in place of a TAR by the provider when billing CCS
- Available for the CCS eligible condition only. use only the CCS's ICD10 Codes on your SAR Form (all other conditions "ICD 10 codes should be billed to Medi-Cal"!
If you are unable to find an answer to your question, please call Provider Relations at
*** For Medi-Cal Not to reject your TAR and/or SAR show seperate ICD 10 codes, CCS has their ICD 10 Codes for you child, call the CCS nurse caseworker and get the correct ICD 10 codes for your SAR use other ICD 10 codes for Medi-Cal.
INP's if you need help with any issue, request "Your Area Representative" Call Medi-Cal #: 800 541-5555 and get a personal representative assigned to you. They will help you with billling, address any billing issues you have regarding our program.
Forms and Sample:
(check your download folder after clicking on link)
CERTIFICATE OF MEDICAL NECESSITY FORMS:
(Click the embedded links below).
MORE CONTACT INFO:
- Sign Up For The Small Billing Unit #: 916-636-1275
Join our closed Facebook Group for INP's, go to your Facebook page and ask to join: AIW Nurses & Angels Closed Facebook Page For Information and Foster Care Placements.
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.
IMPORTANT STUFF FOR INP's ...
Numbers for EPSDT Private Duty Nursing;
Tar Billing Codes For Nurse-Foster Providers:
Bill Under These Codes:
Z5805 RN (Shared Nursing)
* E-Tar & Tar Units = Hours / 100 units = 100 hours do not bill for more than 999 units.
**** Add a " 0 " (zero) to the end of your Tar / Pre Authorization Code when billing.
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 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.
INP's are paid for Skilled Nursing Hours ~ Not foster parent hours!
What Level of Care is your child?
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 CHANGES...
Private duty nursing (PDN) for children and adolescents under 21 years of age is available under the Medi-Cal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. To be covered under EPSDT, PDN must be medically necessary to correct or make more tolerable the child’s or adolescent’s physical or mental condition. The determination of medical necessity is made case by case, taking into account the needs of the individual child or adolescent.
The child’s treating physician is responsible for determining or recommending that PDN services are medically necessary. If the state’s expert disagrees with the treating physician as to whether a particular child’s service is medically necessary, the state is responsible for the decision based on the medical documentation provided. The child or the child’s family may appeal the state’s decision under the Medi-Cal fair hearing procedures.
In the past, a “level of care analysis” and “cost limit” were used to decide requests for PDN services under EPSDT, but that is no longer the case. Coverage of EPSDT PDN services is determined based on medical necessity for each case.
Requesting EPSDT PDN if enrolled only in a managed care plan
For EPSDT to cover PDN services for a child or adolescent enrolled in a Medi-Cal managed care plan, the provider must request PDN by submitting a request to the managed care plan. Each managed care plan has its own procedures for requesting services. Providers should contact the child’s managed care plan for that specific information.
Requesting EPSDT PDN through fee-for-service Medi-Cal
If a child or adolescent receives Medi-Cal services through fee-for-service Medi-Cal, the provider can request PDN services directly through the electronic Treatment Authorization Request (eTAR) system, and submit the necessary documentation by selecting “Submit Freeform Attachments.”
Requesting EPSDT PDN if related to a California Children’s Services eligible condition
If the requested PDN services relate to a California Children’s Services (CCS) eligible medical condition, the request must be directed to the EPSDT Unit. Eligibility is decided by CCS. If CCS denies the request on the grounds that the PDN services are not related to a CCS condition, the request can then be submitted to either the child’s managed care plan or through fee-for-service to determine if the services are covered under EPSDT.
Each Treatment Authorization Request (TAR) for PDN services must include the following documents:
- PDN plan of treatment signed by a physician (within 30 days)
- Nursing assessment (within 30 days of the requested date of service), and
- Medical information supporting the nursing services requested, (that is, medication administration record, discharge summary notes, ventilator log, suction log and treatment notes)
For general information about EPSDT services, providers can visit the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Web page of the Department of Health Care Services (DHCS) website. The PDF document EPSDT– A Guide for States contains further information regarding EPSDT services, including but not limited to PDN.
Questions about coverage of PDN services under EPSDT can be directed to the DHCS Systems of Care Division, EPSDT Unit by phone at 1-855-347-9227 or by email at [email protected].
The OLD Title 22 Regulations No Longer Apply!!!
HOURS BASED ON COST NEUTRALITY: No LONGER applies to our program! Use the below forms, to help document of your child's medical necessity. Please have the physician signed, the certificates of medical necessity, as well as your POT. The more documentation to show medical necessity the better!
CERTIFICATE OF MEDICAL NECESSITY:
(Click the embedded links below).
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 Accountant: Wade Cheney 909 882-3323.
Bookkeeper: Colleen Kerns 909 883-5500.
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.
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!
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.
- 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.
- De Facto Parent Request (Form JV-295):
- 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