Kimberly Noble - Agency for Health Care Administration - MyFlorida ...
Kimberly Noble - Agency for Health Care Administration - MyFlorida ...
Kimberly Noble - Agency for Health Care Administration - MyFlorida ...
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After-Action Report<br />
Tampa ALF/Assistive <strong>Care</strong> Services Initiative<br />
March 12-15, 2013<br />
Initiative: ALF/Assistive <strong>Care</strong> Services Initiative. Twenty-nine (29) facilities were visited.<br />
Contact <strong>for</strong> Initiative: Penny Taylor, Program Administrator, Medicaid Program Integrity, Tampa Field<br />
Office, Phone: 813-350-4847, Penny.Taylor@ahca.myflorida.com<br />
Date: March 12 – 15, 2013<br />
Location: Tampa, Florida<br />
Initiative Participants: The Initiative consisted of five teams which included staff from AHCA’s Office of<br />
Inspector General/Medicaid Program Integrity, AHCA’s Division of <strong>Health</strong><br />
Quality Assurance and representatives from the Centers <strong>for</strong> Medicare and<br />
Medicaid “Medicaid Integrity Group”.<br />
Purpose:<br />
To determine if Assistive <strong>Care</strong> Services providers are rendering, billing and documenting<br />
services in accordance with Medicaid policy;<br />
To ensure that the homes with provider numbers are not “sharing” the number with other<br />
homes who do not have Medicaid provider numbers;<br />
To verify that all enrollment in<strong>for</strong>mation on the FLMMIS system is correct;<br />
To determine if Assistive <strong>Care</strong> Services are being rendered by staff that have been<br />
successfully background screened;<br />
To ensure that the provider, staff, each relief person, and all adult household members<br />
have submitted a statement from a licensed health care provider that he or she is free<br />
from apparent signs and symptoms of communicable diseases, including tuberculosis;<br />
To ensure that annual TB updates have been received by the provider;<br />
To ensure the health and safety of the residents residing in these facilities;<br />
To ensure that the residents with services billed to Medicaid are currently residing in the<br />
licensed facility billing Medicaid; and<br />
To make appropriate referrals to other entities as needed or required.<br />
The pre-initiative training included:<br />
Pertinent in<strong>for</strong>mation from the provider files was compiled <strong>for</strong> each of the teams,<br />
including all known provider numbers, claims billed during the identified timeframe,<br />
number of Medicaid residents in the home, etc.<br />
Identifying the referral process between AHCA MPI and AHCA HQA to avoid duplicative<br />
work by both bureaus, yet enabling the combining and tracking of all findings;<br />
Discuss any questions or concerns about the initiative, including questions related to<br />
statutes or handbooks;<br />
Phone conferences with MPI and CMS/MIG to discuss initiative details;<br />
A contact list enabling teams members to contact the appropriate person with additional<br />
questions.<br />
Tampa ALF/Assistive <strong>Care</strong> Services Initiative<br />
March 12 – 15, 2013 Page 1 of 3
The teams met every morning beginning on March 12, in the designated command center to go over<br />
files, turn in files and reports, and to address any questions or concerns arising during the initiative.<br />
Penny Taylor coordinated the findings that may impact follow-up visits, pending documentation and<br />
possible sanctions. Anne Avery coordinated the findings <strong>for</strong> AHCA’s Bureau of <strong>Health</strong> Quality Assurance.<br />
<strong>Kimberly</strong> <strong>Noble</strong> coordinated the findings <strong>for</strong> specific non-compliance issues and communicating with the<br />
<strong>Agency</strong>’s Management team and the Communications office. Penny Taylor, Anne Avery and <strong>Kimberly</strong><br />
<strong>Noble</strong> managed the command center and were available to assist with confirming documentation,<br />
calling other agencies, checking on background screenings when computer access was needed and any<br />
other situation as needed. The command center had many people from various agencies, including law<br />
en<strong>for</strong>cement, on alert to assist as necessary.<br />
The following compliance issues were documented by Medicaid Program Integrity:<br />
Background<br />
Screening<br />
TB<br />
Current<br />
Communicable<br />
Disease Statement<br />
Service<br />
Plans<br />
Service<br />
Logs<br />
<strong>Health</strong><br />
Assessment<br />
(1823/ 1023)<br />
Certification of Medical<br />
Necessity<br />
13 34 22 107 52 20 113<br />
The following issues were encountered by <strong>Health</strong> Quality Assurance staff:<br />
Provider Name Citations<br />
A 30 smoke detectors, A55 OTC meds unsecured, A77 no core, A79<br />
HYDE PARK ASSISTED LIVING<br />
staffing pattern A93 menus posting, A52 physical plant<br />
TORIA'S SUPPORT CARE SERVICES, INC A 08 1823,A 78TB CD,A 52 insulin syringe<br />
CASA LORETO ASSISTED LIVING FACILITY A 78 Communicable DZ, A 26 activities,<br />
SHARON M BUTLER<br />
A 30 RR <strong>for</strong> staff sleeping in common areas, A 93 Menu, A 79 staffing<br />
schedule, A 161 Communicable DZ, A 162 Resident records<br />
TRACY BURR A 78 TB,CD<br />
MAGALY VALDESPINO, INC A 78 Communicable DZ, A 815 BGS, A 30 bedrails<br />
YETEY ENTERPRISES INC A 008-1823<br />
YETUNDE ADEGBOLA 3 without TB and 1 without Communicable A 78<br />
CASTLE COURT ALF,INC<br />
A 008 falsification of 1823's A 52 improper procedure <strong>for</strong> selfassistance,<br />
A AZ 815 BGS055 storage of meds, A 93 meal pattern off<br />
<strong>for</strong> timing, A 0161 staff records-CD and fraudulent,<br />
ADRIANNE WILSON A 55 storage, A 152 physical plant-door knobs<br />
ROCKY CREEK RETIREMENT PROPERTIES AE<br />
A 30 RR <strong>for</strong> privacy, A 55 unsecured room meds, A 161 lack of CD<br />
SHADY OAKS LIVING CENTER, INC. statement<br />
MICHELINE LYNCEE A 008- incomplete 1823<br />
PHOEBE WILLIAMS F 401 TB, F 609 No background<br />
SONYA WILLIAMS F1101 physical plant<br />
Concerns about LNS services related to oxygen-emailed Sally Leonard<br />
SENIOR HEALTH TLTC LLC<br />
and both recommend an LNS monitoring visit<br />
AZ 815 <strong>for</strong> BGS 3 employees, A 152 Physical plant, A 78<br />
HOME FORCE GROUP, INC<br />
Communicable DZ and TB<br />
EMMA KELLY F 401 TB and CD, F 612 BGS, F 203 <strong>Health</strong> assessments<br />
ELIANNE D JEROME F 203 <strong>Health</strong> Assessment, F 401 TB,F 1101<br />
THE HERTIAGE ALF, INC possible complaint with AHCA unlicensed activity<br />
Tampa ALF/Assistive <strong>Care</strong> Services Initiative<br />
March 12 – 15, 2013 Page 2 of 3
Lessons Learned: No unexpected or emergency findings were encountered during this<br />
initiative. Because the <strong>Agency</strong>’s Inspector General had alerted the trade<br />
associations of pending initiatives, many facilities were expecting the<br />
<strong>Agency</strong> staff. However, the advance notice did not result in 100%<br />
compliance to licensing and Medicaid laws, rules and policy. It was<br />
recommended that the folders be given to the teams earlier than the<br />
morning of the site visit in order <strong>for</strong> them to acquaint themselves with<br />
the files and the facility. This will be done <strong>for</strong> future initiatives.<br />
Tampa ALF/Assistive <strong>Care</strong> Services Initiative<br />
March 12 – 15, 2013 Page 3 of 3