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4. Service Plan

Posted
Updated
ByErin Carlin

All Services that the participant receives (regardless of payor) should be entered into the Service plan.

PA Health and wellness will make the final determination for hours.  Participant will be notified via determination letter from PHW.

Services Staying the same as prior Service Plan

  • If SC has completed an assessment with a participant and services and providers are all staying the same as last assessment, then the Service Plan in the PCSP should reflect the following:
    • Start Date: date of assessment/visit
    • Amount: Current hours approved are listed (this does not have to match the SPG tool)
    • If PHW makes a change to the hours that will be approved moving forward (e.g. increase or decrease), at the next visit with the participant the SC will update the PCSP Service plan to reflect what is currently approved.
    • End date: one year from the date of visit minus 1 day
Assessment done with participant on 8/12/2020

Increase/Decrease Procedure

For PAS
  • If SC has completed an assessment with a participant and the hours for PAS indicated by the new assessment are either an increase or a decrease from what the participant has currently, then the Service Plan in the PCSP should reflect the following:
    • Start Date: date that SC completed assessment with participant
    • Amount: Current hours approved are listed (this does not have to match the SPG tool)
    • If PHW makes a change to the hours that will be approved moving forward (e.g. increase or decrease), at the next visit with the participant the SC will update the PCSP Service plan to reflect what is currently approved.
    • End date: one year from the date of your visit minus 1 day
For non-PAS 

This will result in two separate entries on the PCSP for the same type of service

  • If SC has completed an assessment with a participant and an increase or decrease in a Non-PAS service are being requested, then the Service Plan in the PCSP should reflect the following:
    • 1st Entry
      • Start date: first date in current year that participant began receiving this service (eg. if participant had HDM for this entire year then 1/1/20 is listed, if participant started receiving HDM on 3/2/20 then 3/2/20 is listed).  You will need to look at the authorizations in FP to determine the appropriate start date.
      • Amount: Current amount of service approved
      • End date: Day of current visit with participant
    • 2nd Entry
      • Start date: Day after your current visit with participant
      • Amount: Increase/decrease amount being requested
      • End date: one year from the date of your visit minus 1 day

New service request

For PAS
  • If SC completes an assessment with the participant and a request is made for PAS and the participant does not currently have PAS hours, then the Service plan in the PCSP should reflect the following:
    • Start date: Day of visit with the participant
    • End date: one year from date of visit, minus one day
    • Amount will be left blank, as PA Health and Wellness will make the final determination of hours.
    • At next visit with the participant SC will update assessment to reflect currently authorized PAS hours
For PERS
  • For a PERS installation, you need to also make two separate services. 
    • First service: PERS installation
      • Start Date: Date of Visit
      • End Date: date of visit minus one day 
    • Second Service: PERS Monthly Monitoring
      • Start Date: Date of Visit
      • End Date: Date of visit minus one day
Ex. Participant requesting PERS unit at 8/12/20 assessment
For every other service
  • If SC completes an assessment with the participant and a request is made for a Non-PAS service (e.g. HDM’s, transportation, etc) and the participant does not currently have that service, then the Service plan in the PCSP should reflect the following:
    • Start date: Day of visit with the participant
    • End date: one year from date of visit, minus one day
    • Amount will be filled in for what is being requested (e.g. Amount= 1 for one trail pass, Amount = 7 for seven HDM’s)

Ending a Current Service

DO NOT just leave the service off of the service plan

  • If SC has completed an assessment with a participant and it has resulted in a request to end a service that is already in place.
    • Start date: first date in current year that participant began receiving this service (eg. if participant had HDM for this entire year then 1/1/20 is listed, if participant started receiving HDM on 3/2/20 then 3/2/20 is listed).  You will need to look at the authorizations in FP to determine the appropriate start date.
    • Amount: Current amount of service approved
    • End Date: Date that service is requested to be terminated
    • DO NOT just leave the service off of the service plan
Ex. ptp assessed on 8/12/20 and ending meals on 8/31/20

Change in Provider

This will result in two separate entries on the PCSP for the same type of service

  • If SC has completed an assessment with a participant and a change in any type of provider is being requested, then the Service Plan in the PCSP should reflect the following:
    • 1st Entry
      • Start date: first date in current year that participant began receiving this service (eg. if participant had HDM for this entire year then 1/1/20 is listed, if participant started receiving HDM on 3/2/20 then 3/2/20 is listed).  You will need to look at the authorizations in FP to determine the appropriate start date.
      • Amount: Current amount of service approved
      • End date: Future date that new provider can begin, minus 1 day (SC may need to confirm this with new provider)
    • 2nd Entry
      • Start date: Future day that new provider can begin (SC may need to confirm this with new provider)
      • Amount: Current amount of service approved
      • End date: one year from the date of your visit minus 1 day
Assessment on 8/12/2020 where ptp already requested provider switch via call to PHW prior to assessment

Home Adaptations Request

  • If the SC has completed an assessment with the participant and a modification to the home has been requested it should be documented as follows.
    • Start Date: Date of Visit
    • End Date: 6 months from visit date to allow for evaluation
    • Amount: 1 evaluation
    • Frequency: one time
    • Service Details: Ingress and egress is noted (do NOT list the specific item ie. stair glide)

Ex. Participant requesting stair glide at 8/12/20 assessment

Ptp requesting stair glide at 8/12/2020 assessment

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