Documentation on Record Review 1 Ineligibles Report: Client/ - PDF document

10/16/2020 Documentation on Record Review 1 Ineligibles Report: Client/ Miscellaneous/ Communication 2 1

10/16/2020 3 Expiring S hort Certs Report Clinic/ Reports/ Participation/ Expiring S hort Certs  Generate Report  Review record to determine if legitimate reason for short certification (from past 6 months) RR: S ection 2 4 4 2

10/16/2020 Verify Need for Short Cert No Proof of Income… Verify income &  Adjunct history (to view verification)  No income, homeless, migrant or cash income self declared  Adj unct eligibility verified? (Champs or MI-Benefit) RR: S ection 2 5 5 6 3

10/16/2020 S hort Certification Review S hort Cert Not Applicable For Income Due To Adj unct Eligibility Confirmation RR: S ection 2 7 7 Local Agency S tate User Roles Report -Monitors roles assigned to staff to determine if meet credentials for role 8 4

10/16/2020 9 S taff Training 10 5

10/16/2020 11 Formula Approval Record Review Class I, Class II, and Class III Special Formula, Soy Beverage, whole & 2% Milk Approval Guidelines 2017 2017 12 12 6

10/16/2020 Formula Approval Record Review 2018 13 13 Run ‘ Formula Usage’ Report to select clients for chart audit 2017 14 14 7

10/16/2020 S elect Local Agency or Clinic, Month, Y ear, and All Class I, II,& III formulas Run the report going back 1 to 3 months. Do monthly or quarterly. 2017 15 15 2017 16 16 8

10/16/2020 Has the “Medical Documentation” form been scanned? Click on the Images Icon to assure S pecial Formula/ Food Request form has been scanned. 17 Is “Medical Documentation Form” Complete? S ections 1, 2, 3, and 5 are completed? S ection 4 completed if a milk choice with different fat content is specified by the physician with a special formula? Provider signature & 2017 18 date? 18 9

10/16/2020 Qualifying Condition (QC) Meets Requirement? 2017 19 19 Is Condition included in risk assessment if known at the time of certification or eval? Medical S creen/ risk assessment Qualifying Condition 2017 20 20 10

10/16/2020 Fields where qualifying condition should be documented On Medical S creen in MI-WIC On Medical S creen pop up in MI- Record WIC Record- click Details 2017 21 21 Food Package reflects Med. Doc. Rx? 2017 22 22 11

10/16/2020 2017 23 23 Expiration Dates Expiration Dates MUST MATCH Expiration Date on MDF   S ystem will not let you assign past recertification date.  Y ou can use same form when date goes beyond recert date and does not exceed 6 months.  Expiration date should be SAME for each food package line assigned on the food prescription screen to prevent expiration notification postcards from being sent out prematurely . 2017 24 24 12

10/16/2020 Expiration Dates Must match Expiration Date on MDF 2017 25 25 Last three summary questions:  7.3 a -Does the  4.3 a – Were all agency accurately known qualifying approve food conditions included 6.6a -Are all Class III packages/ formula in the risk records designated (Class I, II, III) for assessment at the as High Risk? clients with special last cert, recert, (MI-WIC policy 5.06) dietary needs? (MI- IEVAL or CEVAL or any appt when WIC Policy 7.03) appropriate? (MI- WIC policy 2.13, 7.03) 26 13

10/16/2020 Michigan WIC Formulary Reference Revised when new formulas are added to formulary, formulas are discontinued, or maximum amounts are changed by USDA regulations. 27 High Risk Record Review 28 28 14

10/16/2020 Policy 5.06 Overview  Local agency must provide ADEQUATE RD coverage to meet needs. RD appt available within 30 days.  HIGH RIS K:  1 or more HR codes (+)  Class III Formula  LA designated risks  Multiple conditions/ circumstances 29 Policy 5.06: High Risk Clients 5. Scheduling High Risk Counseling : Any client can request and be scheduled to meet with an RD for a) development of an ICP . All clients identified as high risk must receive explanation of the benefits of b) individual Nutrition Counseling with an RD (NCRD) and be encouraged to use this benefit. All high risk clients must be offered the opportunity for RD services and an c) ICP at each certification/ recertification (CERT/ RECERT), Infant/ Child Evaluation (IEVAL/ CEVAL), when a high risk is identified and/ or when a new Class III formula has been approved. Acceptance or declining the RD services must be documented at each d) CERT/ RECERT or IEVAL/ CEVAL. 30 30 15

10/16/2020 REPORTS Generate a List of High Risk Clients 31 Clinic Module: Reports => Nutrition & Health S ummary  High Risk Report  High Risk Client CP Closed or Not Needed Report  S ummary of High Risk Enrollees 32 16

10/16/2020 33 Run High Risk Report 6 months back 34 17

10/16/2020 High Risk Report 35 High Risk Care Plan Closed or Not Needed Report - monitoring Gives you a snapshot of refusals and whether care plans are being closed. 36 18

10/16/2020 Summary of High Risk Enrollees 37 S ummary of HR Enrollees: 9/ 2018 38 19

10/16/2020 2020 High Risk Individual Care Plan (ICP) Instructions: “ S elect 5 nutrition high risk clients who have recently completed a cert period & who have individual care plans in their records.” 39 Problem List: CP A documents additional information In Notes for client continuity of care 40 40 20

10/16/2020 ICP Includes: Assessment – RD interpretation of client status, client concerns/ nutrition issue, and may include other relevant data: -growth, diet, meds, diagnosis, treatment, diet prescription, lab values, readiness for change 41 Intervention Section  Behavior change/ goals determined by client & RD  Nutrition education documentation  Notes may include desired outcomes, additional goals, handouts provided, etc. 42 42 21

10/16/2020 Plan  Monitoring/Evaluation  Next appt type  Indicator to monitor client’s progress toward goal  Follow-up info related to CP to support continuity of care 43 Freezing the ICP  “Freeze Care Plan” button within 48 hrs of creation  ICP will be “ READ” only  It can no longer be modified  It will remain on the CP screen until a New ICP is created 44 44 22

10/16/2020 Follow Up Tab:  CP As & RDs document relevant info in the Follow Up Tab  At next scheduled appointment  If resolved, confer with RD to Close 45 45 6.6b Closing the ICP RD documents rationale:  Client’s Desired Outcomes have been met  Client’s planned behaviors are obsolete or no longer applicable  RD is only staff who can close the ICP Policy 5.06 46 46 23

10/16/2020 ICP is complete RD documents Rationale on the Follow up Tab. 47 47 ICP/Client Care Plan 48 24

10/16/2020 Client Care Plan S ummary of all of the information written in the Care Plan by RD 49 HR Record Review 50 25

10/16/2020 Where To Look in MI-WIC:  Nutrition Education Screen: NE Pop-Up Grid  NE Plan  Non-WIC RD  RD Declined  Household Summary Screen Past Appts/ missed= NCRD offered Future Appts. S cheduled  Care Plan completed  CPA Notes in Record: “ Follow up planned with RD.” “ NCRD appt. to be scheduled.” 51 Nutrition Education S creen : NE Pop-up Grid 52 26

10/16/2020 Where to Look? Household S ummary S creen: Past Appts. 53 No NCRD S cheduled 54 27

10/16/2020 What are we looking at? Appointments Offered:  EDU (kept)  Recert (kept)  Appt. Cancelled:  NCRD not scheduled => NCRD NOT OFFERED 55 Household S ummary S creen: NCRD Appt. Scheduled 56 28

10/16/2020 Dual Enrollment 57 Dual Enrollment Report MI-WIC: Clinic/ reports/ participation/ WIC dual enrollment RR: S ection 2 58 58 29

10/16/2020 Dual Enrollment Review  Review Dual Participation reports to determine if resolved within 45 days of identifying dual enrollee  If resolved within 45 days-Met  If unresolved after 45 days- Not Met RR: S ection 2 59 59 Certification Timeframes 60 30

10/16/2020 61 Compliance Report 62 62 31

10/16/2020 Compliance Investigation Miscellaneous/ Compliance Investigations Compliance Investigation screen  S ee Investigation notes for follow up steps  S tatus-complete within 31 days? 63 63 Breast Pump Monitoring  Reports  Overdue Breast Pump Report  Client List by Pump Model Issued 64 64 32

10/16/2020 Breast Pump Monitoring Reports Breastpump Monitoring Reports Overdue Breastpump Report: S elect current list-review up to 10 # of records or 50% of listings. Pumps (Clinic/ Reports/ Breastpump/ Overdue Breastpump Report) b/ a=% of pumps monitored a # of Pumps due? b Follow-up documented (monthly follow – ups) Y Cite if No MPR Is the agency monitoring past due pumps? (cite if more than 9.1a 20% with no follow-up) 65 65 Overdue Breast Pump Report 66 66 33

10/16/2020 Overdue Breastpump Report 67 67 Client List by Pump Model Issued Report: 68 68 34

10/16/2020 69 69 Images: 70 70 35

10/16/2020 Questions Questions 2017 71 71 36