Melissa A. Fritzman

1

Medical Nursing Needs

• Melissa A. Fritzman
• Program Administration Supervisor II
• Division of Long-Term Care and Quality Assurance
• Department of Medical Assistance Services
• Virginia Department of Medical
• Assistance Services

2
Medical Nursing Needs

• You assess the child for what currently is
  occurring.
• DMAS is seeing that most children are meeting the
  functional criteria.
• Medical Nursing needs with the risk of placement
  into nursing homes is the area we hear and see
  people having difficulty with.

3
Medical Nursing Needs

• Different things we have seen when reviewing
  enrollment packages
• No documentation of need
• In good health documented
• Provider assessment saying no medical nursing
  needs
• Stating no risk of nursing facility placement

4
Medical Nursing Needs

• There are times that people are giving such great
  care to their children that they get caught in
  catch 22 because they do not have skin breakdown,
  weight loss, contractures etc.
• We commend these people for their devotion and
  hard work.

5
Documentation Examples ofMedical Nursing Needs

• Seizures
• Is there medication changes?
• Is there labs being drawn for medication levels?
• Any recent seizure activity both grand mal or
  petite mal?
• Family noted any blank stares?

6
Documentation Examples ofMedical Nursing Needs

• Potential Nutritional Problems
• Documentation of weight loss/gain?
• Documentation of dehydration?
• Is person seeing a dietician or other health
  professional on regular basis?
• Taking any supplements, Ensure, Boost, Gatorade,
  Pedialyte, scheduled snacks, etc.?

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Documentation Examples ofMedical Nursing Needs

• Potential for skin break down
• Documentation of red areas?
• Any open areas currently?
• Use of restraints or other equipment that has in
  past caused breakdown?
• Any special things caregiver may be doing,
  turning q2hrs, applying ointments, using pressure
  relieving devices?

8
Documentation Examples ofMedical Nursing Needs

• Therapies
• Documentation of all therapies and where
  occurring.
• If child is receiving at school these are ok.
  Please let families who may already have Medicaid
  know that these therapies can be done when not in
  school if ordered by doctor.

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Review Process

• Screenings are reviewed by the DMAS prior
  authorization contractor.
• The contractor will enter all preadmission
  screening packets into the MMIS system allowing
  for entry into the waiver.
• Any screenings that the contractor feels did not
  meet criteria are sent to DMAS.

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Review Process

• DMAS will review the preadmission screening
  packet and make the final determination on
  enrollment into waiver.
• DMAS may call you, providers or even visit a
  recipient. The method of doing this is done on a
  case by case basis.

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Review Process

• For 2004
• Reviews completed 27,993
• Enrollments 12,151
• Changes 13,293
• Approvals 20,156
• Denial 494
• Overall percentage of denial 2.34
• Rejects not included

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Questions
13
Thank You
As we journey through life we will choose
different paths that lead us in different
directions. The directions and the paths are not
important but how we use our unique abilities to
achieve our individual successes,whether they be
large and grand or simple is at the heart of the
journey.