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OPS-8 Process Guide

Every couple of weeks PHW sends a report to us about missed visits/sessions from PAS providers to participants, along with the reason. It is our duty to follow up with the participant to determine if the report is correct, why the missed visit occurred, and how the participant was cared for in that time. 

OPS-8 Report

PHW sends a report to management and they put that information in a spreadsheet for supervisors. It includes:

  • Name of the participant
  • PAS agency authorized or reporting missed visit
  • The dates of missed visits 
  • “Reason code” for  missed visit

Supervisors should be notifying SCs about the report, particularly the dates and reason codes, as they MUST be stated in the OPS 8 FP Session. 

Reason Codes
  • AR – Participant/Family refused or were unavailable
  • HU – Hospitalization unplanned
  • UN – Agency was unable to staff the case
  • CV – All other cases where the agency could not staff due to COVID-19
  • FA – Participant is in the hospital or nursing facility due to COVID-19
  • IS – Participant refused due to COVID-19, receiving service through informal supports
  • SI – Participant refused, self-isolating due to COVID-19, not receiving service
  • TX – Worker switched to cover another case due to staffing limitations as a result of COVID-19. 

The FP Session

SCs then must call the participant and obtain details about the missed visit from them directly. 

  • If the call to ptp is Unsuccessful, then the standard unsuccessful outreach procedure MUST be followed 
  • If the call to ptp is Successful, then SC must ask appropriate questions relating to the reason for missed visit and complete “OPS 8 Outbound Call” FP session
    • You only need 1 session for all reasons and dates for the participant listed in the spreadsheet
    • The dates and reason codes stated in the report MUST be mentioned in the FP session. 

Important Notes

  • All dates mentioned in the report MUST be stated in the “Missed Dates” section and properly correspond to each reason code stated in the report
  • Each Reason code in the report MUST be answered positively in the FP session and every other reason code must be answered negatively.
    • In the FP session, the first question of the Reason code has a Positive and Negative answer. SC needs to select the appropriate answer, based on what was listed in the report.
      • The first answer is the Positive answer, the second is the Negative answer.

DO NOT select the positive answers for a Reason code UNLESS it is stated in the spreadsheet.
If the participant states that reason code is inaccurate, SC still must select the Positive answer for the reason code, and explain the participant’s correction within that section.  


OPS 8 Outbound Call

Used to document calls made to confirm missed PAS visits from PHW’s OPS 8 report. 

  • Session Requires:
    • Appropriate answers to all required fields
      • Including “positive” answers to the reason codes from the PHW report
      • “Negative” answers to the reason codes not mentioned in the PHW report
      • Sufficient details in Resolution about:
        • The health and safety concerns addressed
        • Comments about the participant’s backup plan 

Process

1. Call Conditions
  • Visit Type – How are you contacting the participant?
    • Answer should always be Telephone
  • Was the Legal Representative invited to participate? – Did you or the participant try to involve the participant’s Legally Authorized Representative, if there is one at all?
    • Answer is based on if your participant has a rep and invited them or not
    • Based on you answer you may need to answer the following:
      1. Did the Legal Representative participate in the contact?
      2. Did the member request that the legal representative not participate?
  • Where did the visit take place? – Better known as “where did the contact take place?
    • Answer should always be Other
      1. Then in Other visit location you should put Telephone
  • Where does the participant currently reside? – Coordinator should be confirming the client’s address and type of residence, then choose the appropriate answer. 
    • If the answer was “Home (with a caregiver)” then the coordinator needs the following information about the caregiver. 
      1. Caregiver name
      2. Caregiver relationship 
      3. Does the caregiver live with member? Answer should be – Yes
      4. Does the caregiver provide natural support? – meaning does the caregiver provide informal/unpaid support?
      5. Is the caregiver paid?– meaning does the caregiver provide formal/paid support?
    • If the answer was “Other” then the coordinator needs to state what the Other residential location is
    • If the answer was: “AFCH, ALF, Hospice, or Nursing Home” the the caregiver must state what the Residential location facility name
  • Information provided by** – Meaning who did the coordinator speak with during the call.
  • Has the participant expressed the desire to move from an institutional setting to the community? – participants have to be currently residing in an institution, which most of our clients do not.
    • Answer is most likely – Participant has NOT expressed desire…
    • If the answer was “Participant has expressed desire …” the coordinator needs to state the current transition status
  • Did the participant’s demographics change?  – Has any of the information about the participant changed?
    • If there was a change, then the coordinator must state what the changes are.
2. Missed Dates
  • PAS Provider – name of the PAS provider on OPS 8 report
  • Missed dates – all of the dates/date range provided on the OPS 8 report

Reason codes for Missed Visits

  • You must select the “positive” answer for each code mentioned in the OPS 8 report
    • Even if it was not the appropriate reason for missed visit per the participant
  • Select the “negative” answer for all other codes that were NOT mentioned in the OPS 8 report
    • Even if they are the appropriate reason for missed visit per the participant

3. AR
  • Participant/Family refused HHA or was unavailable
    • Did the participant refuse or was unavailable?
      1. Participant refused or was unavailable – positive answer
      2. Participant did NOT refuse or was unavailable – negative answer
        • If selecting the Positive answer, the SC must answer the following:
          • Dates for when the participant refused or was unavailable – All dates mentioned in the OPS 8 report that coincide with the AR reason code
          • Is this a recurring problem for the participant? 
            • If this is the first time choosing this reason code, then you should select “This has NOT been a recurring problem”
            • If this is not the first time choosing this reason code, then you should select “This has been a recurring problem” then provide details in the comment
          • Reason for participant being unable to keep scheduled visits?
          • Follow-up actions being taken
4. HU
  • Hospitalization unplanned
    • Did the participant have an unplanned hospitalization?
      1. Participant had an unplanned hospitalization – positive answer
      2. Participant did NOT have an unplanned hospitalization – negative answer
        • If selecting the Positive answer, the SC must answer the following:
          • Dates for unplanned hospitalizations – All dates mentioned in the OPS 8 report that coincide with the HU reason code
          • Were there HHA/PAS services missed due to an unplanned hospitalization? – If so answer the following:
            • Comment about hospitalization
            • First date of Hospitalization
            • Hospital Name
          • Was the SC made aware of the Hospitalization – If so, leave a comment about how they were made aware and when
          • Was the PCSP adjusted due to the Hospitalization? – If so, leave a comment about what was adjusted and when
          • Has the CHC-MCO/SCE observed a trend of unplanned hospitalizations? 
            • If this is the first time choosing this reason code, then you should select “has  NOT observed a trend of unplanned hospitalizations”
            • If this is not the first time choosing this reason code, then you should select “This has been a recurring problem” then provide details in the comment
5. UN
  • Agency was unable to staff the case
    • Was the agency unable to staff the case?
      1. The agency was unable to staff the case – positive answer
      2. The agency was ABLE to staff the case – negative answer
        • If selecting the Positive answer, the SC must answer the following:
          • Dates for when the agency was unable to staff – All dates mentioned in the OPS 8 report that coincide with the UN reason code
          • Why weren’t the services received? – Reason why the agency was unable to provide staff
            • If selected Other describe the reason provided
          • What did the agency do to address the missed service to ensure the participant wasn’t at risk?If selected Other describe the reason provided
          • Has the issue that caused the gap… been resolved? If NOT then provide comment
          • Was the backup plan initiated? – Describe the backup plan
6. CV
  • All other cases where the agency could not staff due to COVID-19
    • Were there cases when the agency could not staff due to COVID-19?
      1. There were cases when the agency could not staff – positive answer
      2. There were NO cases when the agency could not staff – negative answer
        • If selecting the positive answer, the SC must answer the following:
          • Dates for when the agency could not staff – All dates mentioned in the OPS 8 report that coincide with the CV reason code
          • Did the provider contact the CHC-MCO to report a change? – Provide comment describing the answer
          • Did the CHC/MCO contact the participant? – Provide comment describing the answer
          • Did the missed service cause any health and safety concerns? – If so, describe the health and safety concerns
          • What follow up actions were taken? – describe follow-up actions
7. FA
  • Participant is in the hospital or nursing facility due to COVID-19
    • Was the participant in the hospital or nursing facility due to COVID-19?
      1. The participant was in the hospital or nursing facility due to COVID-19 – positive answer
      2. The participant was NOT in the hospital or nursing facility due to COVID-19 – negative answer
        • If selecting the positive answer, the SC must answer the following:
          • Dates for when the agency could not staff – All dates mentioned in the OPS 8 report that coincide with the FA reason code. 
          • Follow-up call completed date?
          • Discharge planning – describe what plans were made regarding ptp’s discharge from the hospital or facility
          • Is the visit scheduled? – If the visit is scheduled then put in the visit scheduled date
          • Comments –  comment describing the situation
8. IS
  • Participant refused due to COVID-19, receiving service through informal supports
    • Did the participant refuse due to COVID-19, receiving service through informal supports?
      1. The participant refused due to COVID-19 – positive answer
      2. The participant did NOT refused due to COVID-19 – negative answer 
        • If selecting the positive answer, the SC must answer the following:
          • Dates for the participant refusing due to COVID-19 – All dates mentioned in the OPS 8 report that coincide with the IS reason code
          • Is the participant’s informal support able to maintain assistance? – If UNABLE make a comment describing why
          • Are the participant’s needs being met? If NOT describe what needs are not being met
          • Is the reassessment needed? If NOT describe why
9. SI
  • Participant refused, self-isolating due to COVID-19, not receiving service
    • Did the participant refuse while self-isolating due to COVID-19?
      1. The participant refused while self-isolating -positive answer 
      2. The participant did NOT refuse while self isolating – negative answer
        • If selecting the positive answer, the SC must answer the following:
          • Dates for the participant refusing while self-isolating due to COVID-19 – All dates mentioned in the OPS 8 report that coincide with the SI reason code. 
          • How are needs being met without formal services – Describe how participant’s needs are being met
10. TX
  • Worker switched to cover another case due to staffing limitations as a result of COVID-19. 
    • Did the worker switch to cover another case due to staffing limitations as a result of COVID-19?
      1. The worker switched to cover another case – positive answer
      2. The worker did NOT switch to cover another case – negative answer
        • If selecting the positive answer, the SC must answer the following: 
          • Dates for the worker switching to cover another case – All dates mentioned in the OPS 8 report that coincide with the TX reason code
          • Are the participant’s needs being met? – if NOT describe what needs are not being met
          • Was the backup plan initiated? – Describe what was initiated or why it wasn’t
          • Additional Information 
11. Resolution
  • How were the health and safety concerns addressed?
    • Describe in detail what major health and safety concerns the participant has and what was done to manage them
  • Was the participant’s backup plan able to be implemented?
    • Describe in detail what the participant’s backup plan is and how it was implemented, or why a backup plan was not implemented
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