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Provider Update: June 23, 2016

ADvantage Service Plan Goal requirement regarding ongoing Member education on Abuse, Neglect, Exploitation (ANE), protections from ANE and how to report.

The goal of the DHS Medicaid Services Unit is for ADvantage Members to live independently, and thrive within their homes, and to provide assurances for their health, safety, and well-being. The ADvantage Waiver Performance Measure specific to Member safety, reported to CMS, includes an assurance that our Case Managers provide prevention and education to Members and their caregivers related to abuse, neglect, and exploitation.

To address this assurance beginning July 1st, 2016 the following information must be addressed in all ADvantage Members Service Plan goals and addressed in monthly monitoring;

All ADvantageMembers new and reassessment Service Plan goals submitted to the Medicaid Services Unit – ADvantage Administration (MSU-AA) must reflect that the Case Manager has provided, and will continue to provide, ongoing education to the Member, and/or their caregiver(s) regarding how to prevent, identify, and report abuse, neglect, and exploitation (ANE). The goal must specifically reflect education and prevention is recurring at minimum monthly during and addressed during the CM monthly monitoring encounter.

All Service Plan goals received on or after July 1st, 2016 that are not in compliance with this requirement will have the Case Management Service Line conditionally authorized for thirty days.

All New and Reassessment Service Plans goals received at the MSU-AA on or after September 1, 2016, that are not in compliance with the requirements above, will have Case Management service lines entered as not authorized until the Service Plan goal(s) are received meeting all compliance requirements.

Please reference the Oklahoma State statue and definitions to ensure that the goals developed support ANE prevention as follows:

Abuse: "Intentional infliction of physical pain, injury, sexual abuse or mental anguish or the deprivation of food, clothing, shelter, or medical care to a vulnerable adult by a caretaker or other person responsible for providing these services" (O.S. 43A § 10-103. A.8).

Neglect: "Failure to provide protection to a vulnerable adult who is unable to protect the person's own interest; or the failure to provide adequate shelter or clothing; or the harming or threatening with harm through action or inaction by either another individual or through the person's own action or inaction because of a lack of awareness, incompetence, or incapacity, which has resulted or may result in physical or mental injury" (O.S. 43A § 10-103. A.10).

Exploitation: "An unjust or improper use of the resources of a vulnerable adult for the profit or advantage, pecuniary or otherwise, of a person other than the vulnerable adult through the use of undue influence, coercion, harassment, duress, deception, false representative or false pretense" (O.S. 43A § 10-103. A.9).

Other definitions listed in the statutes include: self-neglect, verbal abuse, sexual exploitation.

NOTE: In accordance with the State of Oklahoma statute (O.S. 43A § 10-104.A), "any person who has reasonable cause to believe a vulnerable adults is suffering from Abuse, neglect or exploitation shall report the situation to authorities as soon as the person is aware of the situation. Reports can be made to the Department of Human Services APS program, the local district attorney's office, or the local police of sheriff's department. Reporting is the individual responsibility of the person who believes the situation to be one which should be reported."

In addition, the State of Oklahoma statute (O.S. 43A § 10-104.B) states that, "although the reporting requirement applies to everyone, certain professionals are specifically required by law to report situations." These include, but are not limited to, social workers, mental health professionals, and other medical professionals.

If you have any questions regarding the information provided above, please feel free to contact us via Smarter Mail at:

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