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Providers must demonstrate proficiency in delivery of the services in the consumer's plan of care. Proficiency must be demonstrated through documentation of prior training or experience or a certificate of formal training. All training or experience will be detailed on Form 470-3372, HCBS Consumer-Directed Attendant Care Agreement, which must be reviewed and approved by the service worker for appropriateness of training or experience prior to the provision of services. Form 470-3372 becomes an attachment to and part of the case plan. Consumers shall give direction and training for activities which are not medical in nature to maintain independence. Licensed registered nurses and therapists must provide on-the-job training and supervision to the provider for skilled activities listed below and described on Form 470-3372. The training and experience must be sufficient to protect the health, welfare and safety of the consumer. a. Nonskilled service activities covered are: 1 ; Help with dressing. 2 ; Help with bath, shampoo, hygiene, and grooming. 3 ; Help with access to and from bed or a wheelchair, transferring, ambulation, and mobility in general. Certification for this is available through the area community colleges. 4 ; Toilet assistance, including bowel, bladder, and catheter assistance which includes emptying the catheter bag, collecting a specimen and cleaning the external area around the catheter. Certification of training which includes demonstration of competence for catheter assistance is available through the area community colleges. 5 ; Meal preparation, cooking, eating and feeding assistance but not the cost of meals themselves. 6 ; Housekeeping services which are essential to the consumer's health care at home. 7 ; Help with medications ordinarily self-administered including those ordered by a physician or other qualified health care provider. Certification of training in a medication aide course is available through the area community colleges. 8 ; Minor wound care which does not require skilled nursing care. 9 ; Assistance needed to go to return from a place of employment and assistance with jobrelated tasks while the consumer is on the job site. The cost of transportation for the consumer and assistance with understanding or performing the essential job functions are not included in consumerdirected attendant care services. 10 ; Cognitive assistance with tasks such as handling money and scheduling. 11 ; Fostering communication through interpreting and reading services as well as assistance in use of assistive devices for communication. 12 ; Assisting and accompanying a consumer in using transportation essential to the health and welfare of the consumer, but not the cost of the transportation. b. Skilled service activities covered are the following performed under the supervision of a licensed nurse or licensed therapist working under the direction of a licensed physician. The licensed nurse or therapist shall retain accountability for actions that are delegated. The licensed nurse or therapist shall ensure appropriate assessment, planning, implementation, and evaluation. The licensed nurse or therapist shall make on-site supervisory visits every two weeks with the provider present. The cost of the supervision provided by the licensed nurse or therapist shall not be included in the reimbursement for consumer-directed attendant care services. 1 ; Tube feedings of consumers unable to eat solid foods. 2 ; Assistance with intravenous therapy which is administered by a registered nurse. 3 ; Parenteral injections required more than once a week. 4 ; Catheterizations, continuing care of indwelling catheters with supervision of irrigations, and changing of Foley catheters when required. 5 ; Respiratory care including inhalation therapy and tracheotomy care or tracheotomy care and ventilator. 6 ; Care of decubiti and other ulcerated areas, noting and reporting to the nurse or therapist. DIABETIC BENEFIT and or DME BENEFIT APPLIES. Please refer to member contract for copayment amount. Preferred Meters: Accu-check Active, Accu-check Advantage, Accu-check Compact, Accu-check Complete, One Touch Sure Step, One Touch Ultra All meters are paid through DME Benefit ; DIABETIC BENEFIT APPLIES FOR ALL INSULINS. Please refer to member contract for copayment amount. If Diabetic benefit DOES NOT apply please refer to the following tier classifications: No drugs listed at this time Humalog, Humulin, Lantus, Byetta, Symlin Levemir, Novolin, Novolog DIABETIC BENEFIT APPLIES FOR ALL ORAL HYPOGYLCEMICS. If Diabetic benefit DOES NOT apply, please refer to the following tier classifications: glimepiride, glipizide, glipizide ER, glyburide, Actos, Avandia, Glyset, Prandin, ACTOplus Met, Amaryl, Avandamet, Avandaryl, glyburide metformin, metformin, metformin Precose, Starlix Diabeta, Glucophage, Glucophage XR, Glucotrol, XR Glucotrol XL, Glucovance, Glynase, Metaglip, Micgonase Numerous generics Ciprodex, Floxin Otic Aurulgan, Cerumenex, Cortisporin, Pediotic, Vosol, Vosol HC No drugs listed at this time cromolyn sodium bacitracin, bac poly neo, ciprofloxacin, neosporin, ofloxacin, polysporin, erythro, gent, sodium sulfacetamide, TMP pol, tobra dexameth, dexa neo, fluorometholone, flurbiprofen, prednisolone No drugs listed at this time neomycin, neomycin polymixin, dexamethasone sodium phosphate solution carbachol, carteolol, dipivefrin, levobunolol, pilocarpine, timolol, timolol XE PKU Formulas Acular, Acular PF, Optivar, Zaditor No drugs listed at this time All branded enteral products Alamast, Alocril, Alomide, Alrex, Emadine, Livostin, Opticrom, Patanol Ciloxan, Ocuflox, Quixin, Vigamox , Zymar.
GUIDANCE TO SURVEYORS Guidelines: 483.10 b ; 11 ; For purposes of 483.10 b ; 11 ; i ; life-threatening conditions are such things as a heart attack or stroke. Clinical complications are such things as development of a stage II pressure sore, onset or recurrent periods of delirium, recurrent urinary tract infection, or onset of depression. A need to alter treatment "significantly" means a need to stop a form of treatment because of adverse consequences e.g., an adverse drug reaction ; , or commence a new form of treatment to deal with a problem e.g., the use of any medical procedure, or therapy that has not been used on that resident before ; . In the case of a competent individual, the facility must still contact the resident's physician and notify interested family members, if known. That is, a family that wishes to be informed would designate a member to receive calls. Even when a resident is mentally competent, such a designated family member should be notified of significant changes in the resident's health status because the resident may not be able to notify them personally, especially in the case of sudden illness or accident. The requirements at 483.10 b ; 1 ; require the facility to inform the resident of his her rights upon admission and during the resident's stay. This includes the resident's right to privacy 483.10 e ; , F164 ; . If, after being informed of the right to privacy, a resident specifies that he she wishes to exercise this right and not notify family members in the event of a significant change as specified at this requirement, the facility should respect this request, which would obviate the need to notify the resident's interested family member or legal representative, if known. If a resident specifies that he she does not wish to exercise the right to privacy, then the facility is required to comply with the notice of change requirements. In the case of a resident who is incapable of making decisions, the representative would make any decisions that have to be made, but the resident should still be told what is happening to him or her. In the case of the death of a resident, the resident's physician is to be notified immediately in accordance with State law. The failure to provide notice of room changes could result in an avoidable decline in physical, mental, or psychosocial well-being!

For more information, please contact us at lusciniahealth or on our customer support line at 1-866-368-9807 and imodium. But drug companies continue to find other ways to use their labels to forestall competition. Practices see, e.g., [34], [35], [36] ; but profits from our architecture design and the use of secure triggers. Furthermore, the secure triggers technique turns this difficult-to-defeat fingerprinting system into a robust scheme. The fingerprint module in our system is probabilistic: Every protected program is customized from a different ID used as a seed ; . Static fingerprints are embedded by random modifications on the syntactic structure or layout of the source code that do not modify its functionality. After compilation, this random changes remain in the build. A suspected copy can be identified with the aid of our traitor tracing tool see Section 4.2 ; by different statistic correlation analyses between the suspected copy and those copies stored by the software license owner. The cornerstone of our fingerprinting method comes from the realization that programmers take arbitrary decisions during development, that this variations are present in the binaries, and that this slack can be harnessed for embedding fingerprints. Our approach is to have the developer manually identify the places in the source code open to arbitrary decisions, and then have the fingerprinting module to automatically randomize decisions on compilation. For example, developers arbitrarily decide the order in which a function accepts its arguments; with our method the developer will identify the arguments that can be arbitrarily reordered, then on each build the protection system will randomly reorder these arguments maintaining the code's logic. Other "permutables" include: local and global variable definitions, function definitions, struct members, class data members, class methods, enumerated types, constant arrays, object code link order, if then else statements, independent statements. As a result, a single permutation will introduce multiple changes on several parts of the binary code. For example, permuting the order of global variables definitions will produce a one byte difference in the binary code on each reference to these variables. Random generated implementations for common-use functions e.g., manipulation of constants, multiplication of large integers, etcetera ; provide yet another fingerprinting channel. Say, for example, numeric constants can be replaced, automatically in each build, by functions evaluating to those same constants --with a minor performance penalty. Software byproducts, such as intermediate or temporary files, can also be fingerprinted by methods similar to those used above aiding forensic practices see [37] ; . Candidates for byproduct fingerprinting include intermediate or temporary files, saved documents, configuration or state and loperamide. Synopsis The CSM has reviewed allergic reactions associated with medicinal products containing peanut oil and advised that there is currently insufficient evidence to conclude that exposure leads to sensitisation to peanut protein. Howwever, as a precaution, the CSM has advised that: Patients known to be allergic to peanuts should not use medicinal products known to contain peanut oil. As there is a possible relationship between peanut allergy and soya allergy, patients allergic to soya should also avoid medicinal products known to contain peanut oil. All medicines containing peanut oil are required to include appropriate labelling.
BlueCard Medicare crossover reminder Approximately 28 percent of rejected BlueCard claims are duplicate claim submissions. Many of these duplicate claims are Medicare Crossover claims. If you accept Medicare assignment and render services to members from other Blue Plans, please note the following important information to prevent your claims from being delayed. When Medicare is the primary payer for an out-ofarea Blue Plan member e.g., Medigap plans ; : 1. Submit claims to your local Medicare contractor first. Do not file with Medicare and the supplemental insurer simultaneously. Be sure to include the: Complete Health Insurance Claim Number HICN ; , The patient's complete ID number and name as they appear on the card, and Other carrier's name and address OCNA ; number. If you include this information, make sure it is the correct OCNA for the member's Blue Plan. 2. After you receive the Remittance Advice RA ; , determine if the claim was automatically crossed over to the supplemental insurer: Crossed over: If the indicator on the RA shows that the claim was crossed-over claim status code 19: "Medicare paid primary and the Intermediary sent the claim to another insurer" ; , Medicare has forwarded the claim on your behalf to the appropriate Blue Plan and the claim is in process. You do not need to file for the Medicare supplemental benefits. The Medicare supplemental insurer will automatically pay you, if you accepted Medicare assignment. Otherwise, the member will be paid and you will need to bill the member. Not crossed over: If the indicator on the RA does not indicate the claim was crossed over may show claim status code 1: "Paid as primary, " claim status 19 will not appear ; , file the claim as you do today to Regence BCBSO along with the RA. Regence BCBSO or the member's Blue Plan will pay you the Medicare supplemental benefits. If you did not accept Medicare assignment, the member will be paid and you will need to bill the member. continued on page 10 ; 9 and indomethacin!

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