Care Coordination - Tennessee Access to Recovery Review Guide

							Access to Recovery-Iowa
Provider Manual: January 2009
                                           Iowa -Access to Recovery Audit Tool
Agency Name:                                                           Date of Intake:

Client ID#:                                                            Date of Discharge / Follow Up:

Care Coordination
Documentation                                                      Yes No   N/A                    Comments
1. Documentation that SSI-AOD was completed and filed in
    client record at time of admission into ATR
2. Documentation of client’s name, address telephone number,
    and Client ID number
3. Documentation of signed and dated ATR Assessment
4. Documentation of choice offered to client
5. Documentation that GPRA Intake was completed and
    documented in the voucher management system (VMS)
6. Documentation of signed and dated ATR Voluntary Consent
7. Documentation of signed releases of information
8. Documentation of distribution of client satisfaction survey
9. Dated service notes documenting client’s participation and
    matching dates of each reported encounter
10. Documentation of care coordination facilitation and
    collaboration with other recovery providers, taken on behalf
    of ATR client
11. Documentation of encounters in the VMS matching VMS
12. Documentation of GPRA follow-up is completed between
    five and eight months post admission date
13. Documentation that $20 gift card was given to ATR client
14. Documentation of Client Satisfaction Survey
15. Documentation of GPRA Discharge Interview

                                                               -1-
Iowa Department of Public Health, Division of Behavioral Health
Go to www.idph.state.ia.us/atr
Access to Recovery-Iowa
Provider Manual: January 2009
Documentation                                                         Yes No   N/A   Comments
16. Documentation of Administrative Discharge
17. Documentation credentials match the required ATR
    qualifications
18. Documentation of receipts documenting payment for the
    activity, documentation of encounter in the VMS
19. Documentation of actions taken for inappropriate use of ATR
    funds
20. Documentation of distribution of items to client
21. Cost of item(s) (rounded) matches reported billable units
22. Documentation of service notes for all ATR services which
    includes:
        a. Date of each service
        b. Type of service
        c. Duration of service
        d. Brief note indicating service provided
23. Documentation of personnel records for all staff providing
    ATR services including:
        a. Job descriptions and employee credentials
        b. Documentation that staff providing care coordination
            is 18 years of age or older
        c. Documentation of employee or agency current
            liability coverage
*This requirement may be met through the application process
and not reviewed at the site visit.
24. Documentation of financial status (pay stubs, work-force
    development, tax returns, etc) eligibility or a statement
    regarding any absence of income verification: documentation
    of application of the sliding fee scale and statement regarding
    collection of any co-pays or treatment fees from client prior
    to Intake GPRA
                                                               -2-
Iowa Department of Public Health, Division of Behavioral Health
Go to www.idph.state.ia.us/atr
Access to Recovery-Iowa
Provider Manual: January 2009
Documentation                                                      Yes No   N/A   Comments
25. Documentation of Collateral Contacts Form in client record
    or VMS
26. Documentation of continued client participation in chosen
    ATR covered services
27. If referral made for dental services, copy of pre-estimate
    of dental services in client record
28. If referral made for dental services, notification of client
    and coordination of care with dental provider
    documented
29. If referral made for dental services, client enrolled in
    ATR 3 months prior to referral.
Sober Living Activities
1. Documentation of Sober Living Activities matches services
    documented in the voucher management system and does not
    exceed $100 limit
2. Documentation in clinical record or VMS of need related to
    recovery goals, documentation of receipts documenting
    payment for the activity, documentation of encounter in the
    VMS
3. Documentation that client has been involved in ATR for 30
    days prior to receiving Sober Living Activities




                                                               -3-
Iowa Department of Public Health, Division of Behavioral Health
Go to www.idph.state.ia.us/atr
Access to Recovery-Iowa
Provider Manual: January 2009

Documentation                                                     Yes No   N/A   Comments
Supplemental Needs
1. Documentation of Supplemental Needs matches definitions
   and requirements in the ATR Provider Manual
2. Documentation that services documented in the voucher
   management system and does not exceed the category limits
3. Documentation in VMS of need related to recovery goals,
   documentation of itemized, readable receipts documenting
   payment for the activity, documentation of encounter in the
   VMS
4. All receipts for gas cards match the encounter vouchered
   and does not go over the authorized amount, company
   name printed on receipt by vendor of goods
5. All receipts represent only approved goods or services
   according to service descriptions
6. If client is receiving Supplemental Needs – Independent
   Living, documentation should be kept in client file regarding
   where and length of funding used and that client is not
   receiving ATR Housing Assistance
7. Documentation that client has been involved in ATR for 30
   days and be involved in substance abuse treatment through
   any payor and receiving at least one of the following recovery
   support services:
   - Employment Counseling, Financial Counseling, or
        Spiritual Counseling
   - Family Education
   - Client Family Therapy, Integrated Therapy, or Multiple
        Family Group Therapy
   - Life Skills Coaching or Recovery Peer Coaching
   - Native American Healing

                                                               -4-
Iowa Department of Public Health, Division of Behavioral Health
Go to www.idph.state.ia.us/atr
Access to Recovery-Iowa
Provider Manual: January 2009
Documentation                                                   Yes No     N/A   Comments
   - 12 step support groups
   - Spiritual Recovery related activities
   - Family Drug Court
8. Documentation that clients coming from a correctional
   institution cannot exceed up to $100 of Supplemental Needs –
   Clothing within the first 30 days of admission into ATR


Recovery Support Services
Documentation                                                     Yes No   N/A   Comments
Childcare
1. Documentation reflects definition and qualifications as
   defined in the ATR Provider Manual
2. Documentation of childcare services for each child on behalf
   of the ATR client
3. Dates and hours of childcare match dates and hours of each
   reported encounter entered in the VMS
4. Documentation of childcare registration or state childcare
   license
Co-Pays
1. Documentation of out-of –pocket fees assigned to clients
   receiving substance abuse treatment
2. Documentation of co-pays match encounters entered in the
   VMS
3. Documentation/verification that agency is a block grant
   funded provider
Dental Services



                                                               -5-
Iowa Department of Public Health, Division of Behavioral Health
Go to www.idph.state.ia.us/atr
Access to Recovery-Iowa
Provider Manual: January 2009
Documentation                                                       Yes No   N/A   Comments
1. Documentation of need for dental services related to
   substance use and procedures completed
2. Documentation of service match ATR qualifications and
   requirements
4. Documentation of co-pays match voucher management
   system encounters
Drug Testing
1. Documentation of drug testing results in client file or in VMS
       *Documentation of CLIA regulations will be reviewed
       during the application process
2. Documentation of incentive gift cards based on consecutive
   negative drug screens and distribution to client
3. Documentation in VMS matches unit reimbursement(s)
4. Documentation if a positive drug screen occurs during the
   drug testing cycle, discontinuation of incentives are
   documented
Employment Counseling
1. Documentation of session content meets ATR
   definitions and qualifications
2. Documentation that services provided matches the encounter
   entered in the VMS
Family Education
1. Documentation of session content meets ATR definitions and
   qualifications
2. Documentation group size has minimum of 2 families
3. Documentation that services provided matches the encounter
   entered in the VMS
Financial Counseling



                                                               -6-
Iowa Department of Public Health, Division of Behavioral Health
Go to www.idph.state.ia.us/atr
Access to Recovery-Iowa
Provider Manual: January 2009
Documentation                                                     Yes No   N/A   Comments
1. Documentation of session content meets ATR definitions and
    qualifications
2. Documentation that services provided matches the encounter
    entered in the VMS
Housing Assistance
1. Documentation of client residence for each bed day reported,
    evidence of log indicating client signature for each night
    billed
2. Documentation of services match ATR qualifications and
    requirements
3. Documentation that services provided matches the encounter
    entered in the VMS
4. Documentation of billing at end of monthly cycle
5. Documentation of maximum of $1000 per client
Individual Family Therapy
1. Documentation of session content meets ATR definitions and
    qualifications
2. Documentation that services provided matches the encounter
    entered in the VMS
Integrated Therapy
1. Documentation of service in client record
2. Documentation that services provided matches the encounter
    entered in the VMS
3. Documentation of staff qualifications meets ATR definitions
Life Skills Coaching
1. Documentation of session content meets ATR definitions and
    qualifications
2. Documentation that services provided matches the encounter
    entered in the VMS
3. Documentation of majority of billed monthly sessions
                                                               -7-
Iowa Department of Public Health, Division of Behavioral Health
Go to www.idph.state.ia.us/atr
Access to Recovery-Iowa
Provider Manual: January 2009
Documentation                                                    Yes No   N/A   Comments
   occur in the community and not in the office setting.
Multiple Family Group Therapy
1. Documentation of session content meets ATR definitions and
   qualifications
2. Documentation that services provided matches the encounter
   entered in the VMS
3. Documentation group size has minimum of two families
Native American Healing
1. Documentation of service content meets ATR definitions and
   qualifications
2. Documentation that services provided matches the encounter
   entered in the VMS
3. Documentation group activities has a minimum of two clients
Pharmacological Interventions
1. Documentation of prescription and pharmacy receipt
2. Documentation that client received medication
3. Documentation that amount of pharmacy receipt matches
   voucher management system encounter
Recovery Calls
1. Documentation of service content meets ATR definitions and
   qualifications
2. Documentation that services provided matches the encounter
   entered in the VMS
3. Documentation of a maximum of 1 completed call per week
4. Documentation that Substance Abuse Treatment, Recovery
   Peer Coaching and Life Skills Coaching are not provided for
   the client
5. Documentation of client contacts
6. Documentation of client outcomes
7. Individual providing service is 18 or older
                                                               -8-
Iowa Department of Public Health, Division of Behavioral Health
Go to www.idph.state.ia.us/atr
Access to Recovery-Iowa
Provider Manual: January 2009
Documentation                                                        Yes No   N/A   Comments
8. Volunteer policies covered in policy manual
9. Documentation of each completed call of the ATR Recovery
    Call form
10. Documentation that IDPH has been sent quarterly copies
    of recovery call forms
Recovery Peer Coaching
1. Documentation of service content meets ATR definitions and
    qualifications
2. Documentation that services provided matches the encounter
    entered in the VMS
3. Documentation of a minimum of 4 face-to-face contacts each
    month(group, individual) with a minimum of one individual
    session each month
4. Documentation that recovery calls are not provided for
    client
5. Individual providing service is 18 or older
6. Volunteer policies covered in policy manual
7. Evidence of Programming/training related to submitted or
    purchased/right to use curriculum including peer coach
    training, orientation, schedules, ethics, cultural competence,
    diagnosis education, etc
8. Documentation of initial and continuing education
    training.
9. Documentation of policies and procedures related to
    supervision, trainings, responsibilities, job descriptions,




                                                               -9-
Iowa Department of Public Health, Division of Behavioral Health
Go to www.idph.state.ia.us/atr
Access to Recovery-Iowa
Provider Manual: January 2009
Documentation                                                     Yes No   N/A   Comments
Documentation                                                     Yes No   N/A   Comments
Spiritual Counseling
1. Documentation of service content meets ATR definitions and
   qualifications
2. Documentation that services provided matches the encounter
   entered in the VMS
3. Documentation group size has minimum of two clients
4. Documentation of summary of progress for each ATR
   client for each billed date of service
Transportation
1. Documentation of service content meets ATR definitions and
   qualifications
2. Documentation that services provided matches the encounter
   entered in the VMS
3. If client is receiving Transportation – Bus / Cab,
   documentation in the client file that they have not received
   over $10 of gas cards per week
4. If client is receiving Transportation – Gas Cards,
   documentation of itemized, readable receipts, printed on
   company letterhead, and all expenditures of gas cards prior
   to distributing additional gas cards
5. Evidence that gas cards are given to client on weekly basis
   not exceeding funding limits
6. Documentation related to distribution of gas cards does
   not include transportation to work
7. If client is receiving Transportation – Mileage, documentation
   in the client file the number of miles and destination

Substance Abuse Treatment Services
Treatment – Assessment
                                                              - 10 -
Iowa Department of Public Health, Division of Behavioral Health
Go to www.idph.state.ia.us/atr
Access to Recovery-Iowa
Provider Manual: January 2009
Documentation                                                      Yes No   N/A   Comments
1. Documentation of session content meets ATR definitions and
   qualifications
2. Documentation that services provided matches the encounter
   entered in the VMS
3. Documentation of standardized placement screening and
   comprehensive assessment and treatment plan


Documentation                                                      Yes No   N/A   Comments
Treatment-Continuing Care (Level I)
1. Documentation of session content meets ATR definitions and
   qualifications
2. Documentation that services provided matches the encounter
   entered in the VMS
3. Documentation of services for clients does not include Life
   Skills Coaching and / or Recovery Peer Coaching
4. Documentation of an organized service delivered by addiction
   professionals which provides for individualized counseling
   for clients who have completed substance abuse treatment
Treatment – Extended Outpatient (Level 1)
1. Documentation of session content meets ATR definitions and
   qualifications
2. Documentation that services provided matches the encounter
   entered in the VMS
3. Documentation of standardized placement screening
   consistent with level of care
4. Documentation of an organized service delivered by addiction
   professionals which provides for professionally directed
   evaluation, treatment and recovery services
Treatment – Halfway House (Level 111.1)
                                                               - 11 -
Iowa Department of Public Health, Division of Behavioral Health
Go to www.idph.state.ia.us/atr
Access to Recovery-Iowa
Provider Manual: January 2009
Documentation                                                  Yes No   N/A   Comments
 1. Documentation of session content meets ATR definitions and
     qualifications
 2. Documentation that services provided matches the encounter
     entered in the VMS
 3. Documentation of an organized service delivered by
     addiction professions which provides addiction treatment
     services at least 5 hours per week in a 24 hour setting
 4. Documentation of standardized placement screening
     consistent with level of care
 5. Documentation of bed days for each day in which an
     encounter was entered in the VMS
Treatment-Intensive Outpatient Treatment (Level 11.1)
1. Documentation of session content meets ATR definitions and
    qualifications
2. Documentation that services provided matches the encounter
    entered in the VMS
3. Documentation of an organized service which delivers
    treatment services during the day, before or after work or
    school, in the evening or weekends
4. Program meets the required number of weekly hours: 9 hours
    per week for adults, 6 hours per week for adolescents
5. Documentation of placement criteria
Treatment- Residential (III.3 and III.5)
1. Documentation of session content meets ATR definitions and
    qualifications
2. Documentation that services provided matches the encounter
    entered in the VMS
3. Documentation of an organized service which provides a 24-
    hour live-in, seven-day-a-week substance abuse treatment
    program providing a structured recovery environment

                                                              - 12 -
Iowa Department of Public Health, Division of Behavioral Health
Go to www.idph.state.ia.us/atr
Access to Recovery-Iowa
Provider Manual: January 2009
Documentation                                                     Yes No   N/A   Comments
4. Documentation of bed days for each day in which an
   encounter was entered in the VMS




                                                              - 13 -
Iowa Department of Public Health, Division of Behavioral Health
Go to www.idph.state.ia.us/atr