Health information management 8,9,10
A means to collect uniform data from states that is client specific, but not client identifiable, including demographic and substance abuse characterisitics
Treatment Episode Data set
DSM-5 recognizes four degrees of severity of intellectual disabilities: mild, moderate, severe, and profound.
True
Substantial noncompliance and substandard quality of care findings at a long term care facility can result in fines up to $10,000 per day
True
T/F A care area may be triggered by data entered on the minimum data set (MDS) and if so, the interdisciplinary team must document the outcome of their assessment process for that care area
True
T/F All substance abuse treatment is voluntary; no one can be forced into a substance abuse treatment program
True
T/F Clients with acute problems may be seen in a medically managed intensive impatient treatment program, such as that found in an acute care general hospital.
True
T/F Contracted providers, such as physical therapists bill Medicare directly for their services to residents in a skilled nursing facility
True
T/F Contracted providers, such as physical therapists, bill Medicare directly for their services to residents in a skilled nursing facility.
True
T/F DSM-F recognizes four degrees of severity of intellectual disabilities: mild, moderate, severe, and profound
True
T/F Federal law mandates strict confidentiality guidlines for substance abuse facilities.
True
T/F Habilitation is a process by which a person is assisted to acquire and maintain life skills that enable him or her to cope more effectively with personal and environmental demands and to raise the level of physical, mental, and social efficiency
True
T/F ICF/IID client records are often divided into three sections- administrative, health and debilitation/training sections
True
T/F Intensive outpatient treatment requires a minimum of nine treatment hours per week with in a structured program.
True
T/F It is important to prevent the individual recieving services from participating in interdisciplinary team meeting
True
T/F Long term care patients are commonly called residents
True
T/F Long term patients are commonly called residents
True
T/F Many substance abuse agencies and treatment facilities have established employee assistance programs to serve working adults and their employers
True
T/F Medicaid (title xix) provides most funding for ICF/IIDs
True
T/F Standard surveys of long term care facilities are unannounced and conducted at least every 15 months
True
T/F The U.S. supreme court has ruled that the American with Disabilities act may require states to provide community based services rather than institutional placements for individuals with disabilities
True
T/F The council on Quality and Leadership publishes its accreditation standards for facilities for individuals with intellectual disabilities in a document called Personal Outcome Measures.
True
T/F The individualized treatment plan must be based on the clients comprehensive clinical assessment.
True
T/F When federal and state laws conflict the facility is required to follow federal law.
True
T/F When the state agency receives notification of a complaint about a long term care facility the result is an investigation of the facility
True
The inventory for client and agency planning (ICAP) is an assessment instrument used by some states that provides service scores that can be used to adjust payments to providers
True
quality of life
a broad category of the long term care federal regulations that requires a facility to care for its residents in a manner and in an environment that promotes maintaining
quality of care
a broad category of the long-term care federal regulations that requires a facility to provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care; substantial noncompliance with quality of care requirements subjects a facility to potential civil money penalties and other punitive measures in the federal enforcement regulations
Resource Utilization Groups (RUGs)
a case-mix methodology based on data submitted on the MDS; RUGs are used to adjust per diem payments to SNFs under the Medicare PPS and to NFs under some stat Medicaid programs
Diagnostic and Statistical Manual of Mental disorders, fifth edition (DSM-5)
a classification system and nomenclature of mental disorders developed by the American Psychiatric Association
care area assessment (CAA)
a component that helps the assessor and clinician interpret and utilize MDS data by focusing on key issues
individual program plan (IPP)
a comprehensive written document that states the specific objectives necessary to meet the individual's needs, as identified by a comprehensive individualized assessment; the IPP is the major tool in planning and implementing the care and services rendered to the individual
active treatment
a continuous program for each recipient, which includes aggressive, consistent implementation of specialized and generic training, treatment, health services
Minimum Data Set (MDS)
a core set of screening and assessment elements, including common definitions an coding categories, that forms the foundation of the comprehensive resident assessment for all residents of long-term care facilities certified to participate in Medicare or Medicaid
Drug and Alcohol Services Information System (DASIS)
a data system managed by SAMHSA that provides national and state-level data on substance abuse clents and on the facilities that receive federal grants or contracts to provide substance abuse treatment. DASIS includes 3 components: the Treatment Episode Data Set (TEDs), the National Survey of Substance Abuse Treatment Services (N-SSATS), and the Inventory of Substance Abuse Treatment Services (I-SATS)
developmental disability
a disability attributable to a mental or physical impairment that begins before age 18 and is likely to continue indefinitely
Special care unit
a distinct service within a long term care facility such as an Alzheimer SCU
intermediate care facility for individuals with intellectual disabilities (ICF/IID)
a facility that provides care and training for persons with intellectual disabilities to increase their adaptive skills self-care skills, language skills, social skills, vocational skills and so on
Home and Community Based Services (HCBS)
a federal program that allows states to use Medicaid funding to serve persons in their own homes and communities not just in institutional settings
interdisciplinary (ID) team
a group that develops an integrated habilitation or program plan that provides individualized services to the individual
involuntary commitment
a legal process by which individuals who are deemed to be a danger to themselves or to others may be admitted to a substance abuse (or mental health) treatment program even though they refuse or cannot consent to the treatment
CAA resources
a list of resources that may be helpful in performing the assessment of a triggered care area
Inventory of Substance Treatment Services (I-SATS)
a listing of all known public and private substance abuse treatment facilities in the United states and it's territories
Quality Indicator Survey (QIS)
a long term care survey process developed by CMS to standardize resident centered outcome oriented quality review processes
case-mix reimbursement
a long-term care reimbursement methodology designed to provide a mechanism for facilities to be paid in a manner that reflects the types of residents served and the types of services provided; the system is also designed to provide greater access to nursing facility beds for heavier care residents and to improve the quality of care for all nursing facility residents; payment is based on a specific methodology that considers direct care costs, care-related costs, administrative and operative costs, and property
standard survey
a periodic, resident-centered inspection that gathers information about the quality of service furnished in a facility to determine compliance with the requirements of participation in the federal Medicare and Medicaid programs (CMS, 2011)
A qualified developmental disabilities professional (QDDP)
a person assigned to monitor and coordinate all activities related to the development and implementation of the individual program plan
culture change movement
a person-centered philosophy that creates a more homelike environment for residents of a nursing facility; culture change involves providing individuals with privacy and the ability to make choices similar to what they would experience were they living in their own homes
clinical assessment
a procedure conducted by a clinician for every client who enters a substance abuse treatment program; used as a basis for the clients diagnosis and individual treatment plan
person-centered planning
a process that focuses on the preferences of the individual receiving services in planning the type of future life the individual wishes to live
residential/inpatient treatment
a program directed at clients with sub-acute medical, behavioral, or emotional problems; provides a live-in facility with 24-hour supervision
Addiction Severity Index (ASI)
a rating scale that was developed to be used by clinicians to measure the severity of a client's substance abuse problems; the ASI measures 7 substance abuse-related problem areas: medical condition, drug use, alcohol use, employment, illegal activity, social relations, and psychological findings
National Outcome Measures (NOMS)
a reporting system developed by SAMHSA to collect and distribute outcome measures from substance abuse and mental health services
intensive outpatient or partial hospitalization treatment
a required minimum of 9 hours of weekly attendance, usually in increments of 3 to 8 hours a day for 5 to 7 days a week.
person-centered thinking
a set of values, skills, and tools used in person centered planning
inventory for client and Agency Planning (ICAP)
a standardized assessment instrument that can be used for program planning and is also used in several states as a data collection tool for case-mix reimbursement to ICF/MR organizations
federal survey
a survey based on the federal long-term care requirements and using the federal long-term care survey procedures required for long-term care facility participation in the Medicare and/or Medicaid programs
licensure survey
a survey conducted by the state agency to determine long-term care facility compliance with state licensure laws
sub-acute care
a transitional type of care representing a level of service that is less intensive than traditional acute care but is more goal-oriented and resource-intensive than what generally is regarded as skilled nursing care
CARF International (Commission on Accreditation on Rehabilitation Facilities)
a voluntary accreditation agency that sets standards that promote "the delivery of quality services to people with disabilities " CARF 1994.
Alcoholics Anonymous (AA)
a worldwide organization of self-help groups based on alcoholics helping each other achieve and maintain sobriety
individualized treatment plan (ITP)
a written plan developed by the client's treatment team that is used to identify the type and frequency of services needed by the client; it includes measurable goals and objectives that address the problems identified in the clinical assessment and should be updated periodically usually every 6 months) as the client's treatment needs change
care plan
a written plan for each resident created by a nurse; outlines the steps taken by the staff to help the resident reach his or her goals
Aggressive and consistent implementation of specialized and generic training, treatment, health and related services received by each ICF/IID client
active treatment
Individual records at an ICF/IID facility are often divided into sections as follows
administrative, health, and habilitation /training
Center for Substance Abuse Treatment (CSAT)
an agency of SAMHSA that "promotes the quality and availability of community-based substance abuse treatment services for individual and families... (working) with States and community-based groups to improve and expand existing substance abuse treatment services under the Substance Abuse Prevention and Treatment Block Grant Program" (CSAT, n.d., para. 1).
Center for Substance Abuse Prevention (CSAP)
an agency of SAMHSA that provides national leadership for community-based substance abuse prevention programs; among other activities, CSAP administers a number of grant programs aimed at reducing the incidence of substance abuse
National Survey of Substance Abuse Treatment Services (N-SSATS)
an annual survey of all substance abuse treatment facilities known to SAMHSA; N-SSATS collects facility-specific information on location, characteristics, services offered, and utilization
qualified service organization agreement (QSOA)
an exception to the 42 CFR, part 2 Confidentiality of alcohol and drug abuse patient records that permits disclosure of patient record information to an organization providing services to the substance abuse program, such as laboratory, data processing, bill collecting, dosage preparation, legal, medical, or accounting services; the qualified service organization (QSO) has a written agreement to provide professional services to the substance abuse program, and that agreement requires the QSO to follow the 42 CFR regulations
skilled nursing facility (SNF)
an institution or a distinct part of an institution that provides skilled nursing care or rehab services
What is Alcoholics Anonymous?
an organization of self-help recovery groups that utilizes a 12 step program
What is the role of a case manager in substance abuse treatment settings?
assists the client with non-treatment activities
activities of daily living (ADLs)
basic self-care tasks such as eating, bathing, toileting, walking, and dressing
May assist the client with non treatment activities, such as obtaining adequate housing securing financial assistance keeping medical and counseling appointments or organizing plans for follow up care
case managers
Which of the following is NOT recommended by the American Academy of Pediatrics in an adolescent substance abuse treatment program?
combining adolescents and adults in the same treatment unit
Resident Assessment Instrument (RAI)
composed of MDS, core assessment process (CAA) and RAI utilization guidelines
Specially trained professionals such as social workers and psychologists who provide therapy to substance abuse clients and their families according to the treatment plan
counselors
A term used almost interchangeably with the term intellectual disability
developmental disability
Nursing Facility (NF)
facility that provides skilled nursing care
Confidentiality of Drug and Alcohol Abuse Records, 42 C.F.R. Part 2
federal regulations that mandate strict confidentiality of drug and alcohol patient information in federally assisted substance abuse treatment programs
Which of the following provides structure for assessing social, medical, and psychological problems by providing a systemized method of reviewing key components of the minimum data set and directing caregivers to evaluate causes, interrelationships, and particular stregths that affect development of the care plan?
federal survey requirements
Civil Money Penalties
fines levied by the federal government against providers who are found to be in substantial noncompliance with federal regulations
The most common form of outpatient treatment for substance abuse disorders is________
group therapy
A summary of the goals and the objectives that the staff will assist the individual to attain during the coming year, this document outlines how the program will guide the individual toward achieving the set goals.
individualized program plan
annual staffing
information term for the annual meeting of the interdisciplinary team during which the individual program plan is reviewed and revised for the coming year; not to exceed 365 days from the previous annual or initial staffing
The Diagnostic and Statistical Manual of Mental Disorders is
is a coding system is based on SNOMED
In long term care, CPT codes are used most commonly to bill for
medicare part B services
In long-term care CPT codes are used most commonly to bill for
medicare part b services
What is a facility in which the majority of patients are regarded as permanent residents?
nursing facility
Which of the following is a faciltiy in which the majority of patients are regarded as permanent residents?
nursing faciltiy
Treatment Episode Data Set (TEDS)
one of the components of DASIS, collects from states uniform data that are client specific, but not client identifiable, including demographic and substance abuse characteristics
substandard quality of care
one or more deficiencies related to participation requirements under 42 CFR 483.13, resident behavior and facility practices; 42 CFR 483.15, quality of life; or 42 CFR 483.25, quality of care; these constitute either immediate jeopardy to resident health or safety; a pattern of widespread actual harm that is not immediate jeopardy; or a widespread potential for more than minimal harm, but less than immediate jeopardy, with no actual harm (CMS, 2011)
OBRA assessments
performed for a nursing facility resident at admission, quarterly, annually, whenever the resident experiences a significant change in status, whenever the facility identifies a significant error in a prior assessment, and when discharged.
Residents who need constant oversight and supervision in activities of daily living
permanent residents receiving non skilled care
Residents receive frequent skilled care from licensed professionals.
permanent residents skilled care
Designed to care for residents diagnosed with conditions such as Alzheimer's
permanent residents special care
A process that focuses on the preferences of the individual receiving services in planning the type of future life that individual wishes to live
person centered planning
direct care staff
personnel whose daily responsibility is to manage, supervise, and provide direct care to individuals in their residential living unit
May treat clients under the supervision of a physician, although in some states they may practice more independently
physician assistants and nurse
Monitor or manage any treatment plan that requires a medical intervention such as prescription medications or detoxification services
physicians
In long term inpatient and residential treatment programs may develop programs for residents such as games, exercise programs, or outdoor actives
recreational therapists
dully diagnosed
refers to clients who have both a substance abuse disorder and a chronic mental illness
outpatient treatment
regularly scheduled sessions with a mental health professional; can include individual therapy, group therapy or family therapy. The sessions address current issues and also educate the clients about relapse prevention.
Substance abuse treatment composed of "services staffed by designated additction treatment and mental health personnel who provide a planned regimen of care in a 24 hour live in a setting ___" is called
residential/inpatient treatment
intellectual disability
significant limitations in both intellectual functioning and in adaptive behavior
training objective
single outcome expected to be achieved by the individual within 1 year as a result of training; measurable outcome, criteria for measuring progress, and projected completion date should be specified relative to strengths, needs, and established goals
National Registry of Evidence-based Programs and Practices (NREPP)
sponsored by SAMHSA, an online searchable database of treatments and interventions that have been demonstrated to be effective for substance abuse and mental health treatment and prevention programs
The major tool in the care and services rendered to the individual, consisteing of a comprehensive individualized assessment, list of goals and objectives, and plans to attain those goals
staffing
Which of the following would initiate a complaint investigation in response to a hotline call concerning alleged abuse or neglect?
state licensing agency
resident assessment protocols (RAPs)
structured, problem-oriented frameworks for organizing MDS information and additional clinically relevant information about an individual that identifies medical problems and forms the basis for individual care planning (CMS, 2011); although RAP terminology is still in common use, CMS now uses the term care area assessment (CAA) process to describe this concept
Employee Assistance Program (EAP)
substance abuse assessment and treatment programs established through a contractual arrangement between an organization and a substance abuse treatment facility to serve the employees within the organization
The phrase private pay in the long term care setting denotes payment by ______
the individual or family
substantial compliance
the level of compliance with the Conditions of Participation such that any identified deficiencies pose no greater risk to resident health or safety than the potential for causing minimal harm
The resource utiliztion group (RUG) that applies to a given resident is based on ______
the minimum data set
habilitation
the process by which a person is assisted to acquire and maintain life skills that enable the person to cope more effectively with personal and environmental demands and to raise the level of his or her physical, mental, and social efficiency
Assessment
the process of identifying an individual's functional level, strengths, needs, causes of disabilities, and conditions that hinder development
When a care area is triggered, the long-term care interdisciplinary team documents the outcome of the assessment process for that particular care area and _____
their decision regarding care planning for a particular problem or need
Consolidated Billing
under Medicare, a skilled nursing facility is responsible for billing the entire package of care that residents receive during a stay, with certain specified exceptions such as physicians' professional services
The duration of skilled nursing facility Medicare Part A coverage is limited to the need for daily skilled care up to a maximum of ___ days per spell of illness
100
Medicare Part A coverage is limited in that a long term care resident must first qualify with a minimum of a ____ hospital stay.
3-day
According to federal regulations, the care plan should be completed within _____ of the comprehensive assessment
7 days
comprehensive resident assessment
A key element in the long term care federal regulations this assessment describes the residents ability to perform daily life functions and significant impairments in functional capacity
Ability to bathe, dress, groom, transfer and ambulate, toilet, eat, use speech, languages, etc.
Activities of daily living
Responsible for assessing the therapeutic recreational needs and preferences of each resident and developing an individualized program
Activities staff
risk contract
Also known as a Medicare risk contract. A contract between an HMO or CMP and the HCFA to provide services to Medicare beneficiaries under which the health plan receives a fixed monthly payment for enrolled Medicare members and then must provide all services on an at-risk basis. This type of contract may be between physicians and an HMO, placing the physician at risk for costs of services provided.
Two voluntary accreditation organizations that set standards for substance abuse treatment facilities are __________________.
CARF and The Joint Commission
utilization review
CMS guidelines that provide instructions for when and how to use the RAI.
Clinically relevant information about an individual that identifies specific problems and forms the basis for individual care planning
Care area triggers
An agency of SAMHSA that provides national leadership for community-based substance abuse prevention programs through grant programs aimed at reducing the incidence of substance abuse
Center for Substance Abuse
In some states, can assume responsibilities to lessen the load of licensed nursing professionals.
Certified medication technician
care area assessment (CAA)
Component of the RAI that is used to make decisions about areas triggered by the MDS.
Susan Smith, Director of Health Information Services, is preparing a presentation for the new employee orientation at the drug and alcohol rehabilitation program where she is employed. She will be presenting information on 42 CFR, Part 2. The topic of her talk will be _______________.
Confidentiality of drug and alcohol abuse records
A person-centered philosophy that creates a more home like environment for residents of a nursing facility
Culture change movement
A data system managed by SAMHSA and comprised of three components providing national and state level data on substance abuse clients and on the facilities that recieve federal grants or contracts to provide substance abuse treatment
Drug and Alcohol Services
T/F A case manager provides therapy to substance abuse clients
False
T/F A case manager provides therapy to substance abuse clients.
False
T/F For security purposes, no part of the individuals record is stored on the person's living unit at any time.
False
T/F In a long term care facilities such as nursing facilities, records are generally audited for completeness only at the resident's death or discharge
False
T/F In the U.S. less than $10 million a year is spent for substance abuse treatment and prevention
False
T/F Reimbursement for intellectual disabilities services is usually a capitation payment which is an easily determined amount based on services received
False
T/F Reimbursement for intellectual disabilities services is usually a capitation payment, which is an easily determined amount based on services received.
False
T/F The Addiction Severity Index calculates a severity rating, or score, that can be used as an outcomes measure in research studies.
False
T/F The American Society of Addiction Medicine identified two levels of outpatient care and two levels of inpatient care in substance abuse treatment settings.
False
T/F The group program plan (GPP) is the sole responsibility of the case manager and is a summary of the goals and objectives that the staff will assist the individual to attain
False
T/F The medical program for the indigent is called Medicare
False
HIPPA
Health Insurance Portability and Accountability Act which protects the privacy of individually identifiable health information
What types of coding may be utilized in an ICF/IID?
ICD
Developed by the substance abuse client's treatment team, this document is used to identify the type and frequency of services needed by the client. It includes measurable goals and objectives that address the problems identified in the clinical assessment and should be updated periodically.
Indivdualized treatment plant (ITP)
Informal term for a meeting of the interdisciplinary team during which the individual program plan is reviewed and revised
Individualized program plan
A listing of all known public and private substance abuse treatment facilities in the U.S. and its territories
Inventory of Substance Abuse
Physical presence in the long term care facility is limited
Licensed physicians
Predominant licensed caregivers in the long term care setting
Licensed practical nurses
An online searchable database of treatments and interventions that have been demonstrated to be effective for substance abuse and mental health treatment and prevention programs
National Registry of Evidence
An annual survey of all substance abuse treatment facilities that collects facility specific information on location, characteristics, services offered and utilization
National Survey of Substance
Provide daily care needs to long term care residents
Nursing assistants
Often independent contractors rather than employees
Occupational therapists
CMS provides free software for entering and transmitting MDS assessment data. This software is called ____
RAVEN
Coordinate long term daily care and hold supervisory positions
Registered nurses
Short stay to provide relief to primary caregivers of the frail elderly
Respite care
Residents length of stay is less than 100 days
Short-term patients
Make arrangements for adaptive equipment,clothing, and financial assistance.
Social Services
A periodic, resident-centered inspection that gathers information about the quality of service furnished in a facility to determine compliance with the requirements of participation in the Medicare and Medicaid programs
Standard survey
How is reimbursement to the ICF/IID handled in most states?
The ICF/IID receives a per diem payment for each day of service to each individual resident.
