7300, Provider Monitoring of Service Delivery

Revision 21-2; Effective November 8, 2021

The program provider is responsible for ensuring that services are provided according to the IP. Ongoing communication between the program provider’s staff and the individual and LAR is necessary to ensure that the IP reflects services and implementation strategies that meet the needs and desires of the individual and LAR.

The program provider must document services provided as specified in the implementation plan and verify the requirements for reimbursement, as defined in the HCS Program Billing Requirements, have been met. The IP and documentation related to service delivery may also be used by HHSC utilization review staff when determining whether to authorize the Individual Plan of Care (IPC).

 

7310 Example of Documenting Observable Strategies

Revision 21-2; Effective November 8, 2021

Observable: Staff use one or more of the five senses (sight, hearing, touch, smell or taste) to evaluate performance on implementation strategy.

Example: Johnny will independently select and purchase items using the correct amount at the local convenience store. (Based on the PDP, which reflects that it is important to Johnny to be able to go independently to the store and purchase items of his choice.)

Staff Documentation: Staff observed Johnny at the 7-11. He selected three items to purchase and approached the register, greeted the cashier and received the total for his purchase. The purchase price was $3.42. Johnny presented the cashier with $3.00. Staff prompted Johnny to give the cashier an additional dollar. The purchase was then complete.

This example indicates that Johnny appropriately performed many of the steps associated with making a purchase, but he continues to require assistance with determining the total dollar amount to complete the purchase. The program provider is responsible for reviewing staff documentation to determine Johnny’s progress or lack of progress in reaching the desired outcome.

 

7320 Example of Measurable Strategies

Revision 21-2; Effective November 8, 2021

Measurable: Calculations are made to determine progress on implementation strategy.

Example: Johnny will use a walker. (Based on the PDP, which reflects that it is important to Johnny to be able to go from place to place without assistance.)

Staff Documentation: Johnny used his walker to go a total of 25 feet this afternoon.

Note: When using data sheets for measuring progress, be sure that the criteria does not “lock” the individual into a perpetual loop. The individual should be provided with the adequate support to reach their desired outcomes and strategies should be adjusted to assist the individual to do so. When success is not occurring, staff should note their observations on the data sheet and the program provider should assess whether the strategies remain effective.

Example: Staff documented that Johnny does not appear to be motivated to use his walker inside the house. However, Johnny expressed to staff that he enjoys checking the mailbox at the end of the driveway. Staff observed that he consistently uses his walker when he is provided the opportunity to complete this task.

 

7330 Example of Documenting Outcome Oriented Strategies

Revision 21-2; Effective November 8, 2021

Outcome Oriented: Progress is defined by occurrence of an event identified in the implementation strategy.

Example: Johnny wants to participate in the annual cancer research walk/run. (Based on the PDP, which indicated that Johnny’s sister died from cancer, he wants to help raise money for the cause.)

Staff Documentation: Staff took Johnny to the American Cancer Society today so that he could sign up to participate in the annual cancer research walk/run.