Aging Waiving: A Case Study

Code §150.2. as of February 1, 2017. Moreover, the Regulations are explicit that “the emergency medical services required to treat an emergency medical condition are only funded by MA until the medical condition is no longer an emergency. MA funded medical services are not available for treatment received after the emergency ends.” 55 Pa. Code § 150.11(emphasis added). In this case, the Appellant’s emergency medical condition ended (February 1, 2017) and she is seeking continuous MA funding for ongoing treatment after that emergency, which is prohibited by the Regulations. Accordingly, the ALJ finds the Department was correct to discontinue the Appellant’s MA benefits because she is a noncitizen who is not in immediate need of emergency medical services and has not provided evidence that a new emergency medical condition

Pt is a 84 year old Cascasion female living with her husband in their home. Husband reported the Pts Alzhemers has be pergresing for the last 8-9 years. Pt had open heart surgery in 2012, which contributed to the memory loss decline and increasing level of Alzhemer symtoms, husband verbalized. Husband reports they have been married for 19 years. Pt has a sister living Florda, two daughters living in Texas and Wyoming and one son in New York. The children stay in contact with them every other day. Pt reports she worked as a RN at the VA Hospital in New Mexico. Pt is not independent in the home without the husbands assistance. Pt does ambulate well in the home, but does have a walker in needed. Husband assists the Pt all her ADL's in the home and drives her to the store and for MD appointments. Husband currently suffers from Hemochromatosis (too much iron in one's body). Husband reports he manages well with his illness while taking care of Pt at the sametime. Husband reports the Pt's Alzehmers level appears to be stable at this time, but is quite forgetful at times and needs his assistance. Husband said they are managing

He reports the patient’s roommate was subsequently evicted from his home after the landlord inquired about the ambulance visiting. He reports he contacted her father concerning the patient residing within the family home, but the father has said no. In addition, he reports he has attempted to contact her uncle but has been unable to make contact with him. He reports he has attempted to make contact with her said friend who is considering allowing her the opportunity to reside with her but she has not answered her phone and he has been unable to leave a voice message. He reports no one wants her in their home, and the patient has “burned her bridges” with family members. He reports her family would benefit from counseling. In addition, he reports her family has high expectations of CPS. He reports her current case was not going to close within 12 days of 06/30/2017. In addition, the case will not

The spouse explained to us that up to two day ago, that patient was able to sit in a wheelchair, ate pureed foods and was awake and alert. What was presented the day in the ER was a patient with multiple fractures, nonverbal and very lethargic. The husband was not aware of any falls, or medical conditions that would cause her symptoms. He also chose not to follow up with exams looking for a reason, such as a stroke. We accepted his wishes and returned his wife back to the nursing home with no treatment. The decision was made as a team effort between the spouse, medical staff, and the patient, with her advance directives.

Kathy has a weight bearing restriction in place, is currently utilizing a wheelchair for mobility, and is a hands on one person assist with transfers. Judy shares that the previous day Kathy and the physical therapist worked with Joe and herself on transfers into and from the car so they can take her to her scheduled appointment with the orthopedic doctor on Friday. Judy shares that it is expected that the doctor will modify the weight restriction at the appointment. Judy and SSA spoke about a time frame for discharge. Judy shares there is no time frame established. Per Judy, Kathy’s private insurance only has twenty days of physical therapy remaining in the plan and does not know what happens at the end of the twenty days if Kathy needs additional therapy. She has plans to contact Humana later this day to discuss Kathy’s insurance benefits. We discussed that Kathy believes she has an UTI and that a sample of her urine was taken before lunch for testing. We discussed that Kathy is satisfied with the Care Springs facility, the food served, and nurses assigned to work with her. During the visit, Kathy asked about Wildey staff and of all who was aware of her injury. We discussed her

CCIB Intake received a call from resident Eugene Kunz DOB 2/8/24 in room #6. Mr. Kunz call to state he wanted to remove his daughter Joyce as his Power of Attorney (POA) and pay his $3000 rent each month. According to the caller he has residing in the facility for approximately 3 1/2 years and wanted to return to his home, however due to his slight dementia he was having difficulty with his memory and therefore could not return to his home. Conversely the caller described how his daughter would have him examined by physician who would give him 3 words at the beginning of his examination and at the end would ask him the 3 words. Unfortunately the caller could never recall the 3 words and thus was unable to return to his home. Recently the caller

A practice change in a non-VA primary care practice led by a Nurse Practitioner (NP) that includes identifying eligible veterans and utilizing the referral process guidelines to peer support services. In the Veterans Choice Program, 2015 the authorization for all non-VA medical care for veterans who resides more than 40 miles from a VA health care clinic or is not able to obtain a medical appointment within 30 days is eligible to receive care from a non-VA entity. The consignment of all medical care appointments are over sought by Health Net, which authorizes all non-service, secured care. PCPs are highly fortified to communicate with veterans with a courtesy memorandum for their medical appointment. PCPs must adhere to the subsequent standards

The medical form was not totally in compliance with the “Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), even though the claimant had a written notice there was no effort put forth in order to secure an approved medical authorization and

The patient is very independent in his home and is able to perform all ADLS within the home without any addtional assistance. MSW asked patient if he was interested in any addtional care giving support in the home, but patient declined addtional support at this time. Patinet stated he gets transportation from his neiabors to the store when needed. MSW offered the patient additional transportation services, but the patient declined needing any addtional transportation services at this time.Patient reported falling back in 2004 off the steps and was air lifted to the hospital. Patient reports having diffculty paying doctors and helicoter bills. Patinet's only income is through SS for $847. Patient reported that was the only time he was fallen in his life. Patinet has only been in the hospital two times during his lifetime. MSW offered life alert services, but the patient was not interested. Patient stated his only concern was being able to afford his doctor and helicotor transportion bills. MSW connected AHCCCS and spoke to represtative regarding getting patient signed up for the medicare savings program. Representative stated the patient has already applied for AHCCCS back in

The patient was placed on HOLD to see the writer to address his non-compliance with treatment. The patient was reminded about his Step 3 of the patient engagement. According to the patient as the writer reviewed the patient case history of his no show for counseling, group attendance, and continuously AWOL, the patient only response was, " I, know." The writer then inquired of the patient efforts to engage in mental health services through ICRC. The patient admits that he haven't done the intake when the deadline was extended for the third time. The writer discussed with the patient about the risk of facing an intent to discharge due to his non-compliance and addressed alternatives such as suboxone and transferring to a clinic in Massachusetts to accommodate the work location. The patient declines the writer's suggestion as he wants to remain with HCRC-Hartford due to the positive treatment and said. " You guys really care....I do not want to be discharge.....I, mean what is the process of the intent of discharge?" The writer explained to the patient about the appeal process as his record will be reviewed by the Practice Manager to determine as to whether or not to forward with the discharge or the discharge to be overturn.

On 8/7/2015, CM met with the client and completed Bi-Weekly ILP Review. Client arrived early for the meeting; she was alert, satisfactorily groomed, and casually dressed. In the meeting she was cooperative and friendly. CM inquires how client is doing since the last Bi-Weekly ILP Review. Client reported she is exhausted from running around obtaining relevant documents to be submitted to Lemle & Wolfe, Inc. by 8/3/2015. She continues to reports she has Straight Medicaid and she is searching for a Managed Cared that cover oxygen tanks.

Intervention: As per member's request days of PCA services changed as Monday, Tuesday, Wednesday and Friday 4D/8H, Thursday, Saturday and Sunday 3D/4H effective 03/12/2017. Spoke with Ms. Irina Simkhovich from HCS home health care, authorization and billing department, CM informed changes of schedule and sent an fax with updated authorization. Also, Ms. Irina Simkhovich reminded CM request of 8 hours for 03/03/2017 and 03/06/2017, CM kindly informed member is only approved 4D/8H, 3D/4H by ABH and by 02/28/2017 Americare( covered by Medicare) informed they would covered M,W,F 4 hours each day. on 03/07/2017 Morrine Fox , Americare, informed as per RN recommendation 2 additional hours each day was approved for M-F, case shown up as active by 03/08/2017. HCS provided from 03/02/2017- 03/06/2017 each day 8 hours for this reason are requesting coverage of 03/03/2017 & 03/06/2017.

The adult-gerontology acute care nurse practitioner (AGACNP) has many responsibilities. In addition to providing excellent patient care, the AGACNP must also know how to code for patient services, bill appropriately and know how much they should expect in reimbursement for specific treatments. Many legal issues arise for the AGACNP, including several forms of negligence; the AGACNP should be educated on the essential elements. Finally, the AGACNP must educate themselves and be prudent to avoid legal issues related to malpractice. In the following paragraphs, each of these issues will be discussed.

SC completed monitoring telephone with Pa’s informal Tressa on 1/28/2016. No new health problem was reported. However Pa’s treatment regimen has change to include radiation therapy due no change in the tumor. No ER visit, hospitalization, or falls were reported by CG. A temporary increase in PAS services was requested due to new medical treatment. Pa's informal, stated Pa is requesting a temporary increase in Pa's aide services so that she can safely remain in her home with assistance. Pa is being treated for cancer and need a more aggressive treatment which includes chemo and radiation 5 days a week. Pa currently gets 6 hours of PAS per week, 4 hours on Wednesday and 3 Saturday agency model PAS via Prestige Home Car. Pa anticipates that

N.A is a 73 year old Caucasian female who presented to the clinic to establish new patient care. She has a former primary care giver in another town, but wanted a physician closer to her home. She does have a health history that includes Diabetes mellitus type II that was