This Appendix must be completed when waiver services are furnished to participants who are served in licensed or unlicensed living arrangements where a provider has round-the-clock responsibility for the health and welfare of residents. The Appendix does not need to be completed when waiver participants are served exclusively in their own personal residences or in the home of a family member.
a. Applicability. Select one:
Yes. This Appendix applies (complete the remaining items).
No. This Appendix is not applicable (do not complete the remaining items).
b. Medication Management and Follow-Up
i. Responsibility. Specify the entity (or entities) that has ongoing responsibility for monitoring participant medication regimens, the methods for conducting monitoring, and the frequency of monitoring.
The Support Coordination Agency has the responsibility of monitoring to ensure the participant medication regimens for appropriateness. They review the Medication
Administration Record (MAR) and verify the medication, date given, diagnosis and person giving medication. Every provider as to supports provided has a written procedure for prescribing, ordering or authenticating orders, procuring, dispensing, supervision of
consumer self-administration of medications, recording, and for disposal of discontinued or out-of-date medication. The team developing the individual service plan will determine the frequency of visits by the Support Coordinator for a waiver participant. The team ensures adequate frequency of visits to ensure the health and safety of waiver participants when they have especially complex medication regimens or when they are prescribed
behavior-modifying medications. In these instances, the team specifies any additional review criteria for support coordinator visits. Support coordinators are required to inform providers of inappropriate practices and follow-up to ensure that the provider addresses the problematic, medication management practices.
ii. Methods of State Oversight and Follow-Up. Describe: (a) the method(s) that the State uses to ensure that participant medications are managed appropriately, including: (a) the identification of potentially harmful practices (e.g., the concurrent use of contraindicated medications); (b) the method(s) for following up on potentially harmful practices; and, (c) the State agency (or agencies) that is responsible for follow-up and oversight.
DHR, Division of MHDDAD is responsible for oversight of medication administration by community providers. The Division of MHDDAD requires the Support Coordination Agency to verify the following policies and procedures are in place and followed. The community provider, as applicable to its support service array, has written procedures for prescribing, ordering or authenticating orders, procuring, dispensing, supervision of
consumer self-administration of medications, recording, and for disposal of discontinued or out-of-date medications. The community provider has protocols governing documentation of when the medication was administered and who administered the medication, including documentation of self-administration of medications when applicable. For each medication, the instruction for use, dosage and frequency, must be documented. Medication must be recorded each day and each time that it is given. Missed or refused medications must also be documented in the person’s medication administration record. The organization’s policy and practices for medication management include immediate notification of the prescribing professional regarding drug reactions, medication problems, refusals of medication by the consumer, medication errors, and potentially harmful practices, such as the concurrent use of
State: Georgia
Effective Date October 1, 2007 Appendix G-3: 2
contraindicated medications.
Whenever a medication management issue is identified in the monitoring of a provider, the support coordinator requests a corrective action plan from that provider. Each corrective action plan is submitted to the Division of MHDDAD for a review that results in approval as submitted or a request for revisions and subsequent resubmission. The Division of
MHDDAD is in the process of the development of procedures for the gathering of information on potentially harmful practices and the use of this information to improve quality statewide in medication administration. This process is described further in the Quality Management Strategy specified in Appendix H.
c. Medication Administration by Waiver Providers
i. Provider Administration of Medications. Select one:
Waiver providers are responsible for the administration of medications to waiver participants who cannot self-administer and/or have responsibility to oversee participant self-administration of medications. (complete the remaining items)
Not applicable (do not complete the remaining items)
ii. State Policy. Summarize the State policies that apply to the administration of medications by waiver providers or waiver provider responsibilities when participants self-administer medications, including (if applicable) policies concerning medication administration by non-medical waiver provider personnel. State laws, regulations, and policies referenced in the specification are available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
The community provider organization that administers medication or that supervises the self-administration of medications has policies, procedures, and controls governing proper administration, storage and monitoring as defined by law and best practice. These policies include stipulations that: 1) Only licensed medical personnel can directly administer medication; 2) Only physicians or pharmacists may re-package or dispense medications; 3) There are safeguards utilized for medications known to have substantial risk or undesirable effects; 4) Require the education of persons served and families regarding potential risks and expected benefits of medication; 5) Define protocols and training to support and promote consumer self-administration of medication; 6) Require the education of staff regarding medication use, monitoring, and supervision of consumer self-administration of medications;
7)Practices are in place for handling both illicit and licit drugs brought into the service support setting by persons served; and 8) The storage of medication is in secured areas as according to law.
The community provider organization, which allows verbal orders from physicians, has policies and practices, which determine those who are approved and authorized to give and receive these orders. The prescribing physician within a policy-designated time frame authenticates verbal orders.
The community provider organization assures practices for the regular and ongoing physician review of prescribed medications including the appropriateness of and need for continued use of each medication and monitoring of the presence of side effects. When consumers are on medications likely to cause tardive dyskinesia, an Abnormal
Involuntary Movement Scale is used as a monitoring tool at selected intervals.
State: Georgia
Effective Date October 1, 2007 Appendix G-3: 3
iii. Medication Error Reporting. Select one of the following:
Providers that are responsible for medication administration are required to both record and report medication errors to a State agency (or agencies). Complete the following three items:
(a) Specify State agency (or agencies) to which errors are reported:
Providers and/or Support Coordinator Agencies report Medication errors to the MHDDAD Regional Office and DHR, Investigation Section.
(b) Specify the types of medication errors that providers are required to record:
Medication errors, such as those that do not adversely affect the individual and/or are isolated instances of missed documentation but the individual did receive medication as prescribed, are documented per DHR, Division of MHDDAD policy, and the provider is required to submit a corrective action plan. The following would be cases that would require a correction action plan and tracking by the Support Coordinator and MHDDAD Regional Office. Any violation of the “5 rights” (right person, right dose, right route, right medication, right time) is a medication error and would warrant a corrective action plan by the provider and which is presented to the MHDDAD Regional Office, unless already identified by the provider with documentation of corrections made. Unsecured medication box (does not apply where an individual has a corresponding physician’s note that says the individual can administer his/her own medications); emergency medication and medical information not accessible; medication count does not match prescribed usage; loose pills; medications are received by an individual more than one hour before or after prescribed time; documentation of medications received by individual is prior to individual actually receiving the medications; out of date or discontinued medications are present; and evidence that medication administration records do not accurately reflect current prescribed medications. Documentation will include quality improvement activities for any systemic problems identified.
Medication errors with adverse consequences are those that cause the person discomfort or jeopardize his/her health and safety, not including refusal of medication by the person. Any medication errors with adverse reactions identified by the community provider or the support coordinator are transmitted, by fax or electronically to DHR, Division of MHDDAD Investigation Section on the same day as the incident, or on the next business day if the incident occurred after business hours or on a weekend or holiday. If the support coordinator is unaware of the incident, the provider is to contact the support coordinator by telephone within 24 hours of the incident. When information about a critical incident is received by a community provider from any person other than support coordinators, the staff receiving the information completes the Critical Incident Report form and follows procedures to send to Investigation Section.
Medication errors include: omission and wrong dose time, wrong person, wrong route, and wrong medication. A pattern of medication errors (even though they were
documented and corrected) with no evidence of quality improvement activities by the provider. Adverse consequences are those that cause the person discomfort or
jeopardize his/her health and safety, not including refusal of medication by the person.
(c) Specify the types of medication errors that providers must report to the State:
State: Georgia
Effective Date October 1, 2007 Appendix G-3: 4
Medication errors with adverse consequences are those that cause the person discomfort or jeopardize his/her health and safety, not including refusal of medication by the person. Any medication errors with adverse reactions identified by the community provider or the support coordinator are transmitted, by fax or electronically to DHR, Division of MHDDAD Investigation Section on the same day as the incident, or on the next business day if the incident occurred after business hours or on a weekend or holiday. If the support coordinator is unaware of the incident the provider is to contact the support coordinator by telephone within 24 hours of the incident. When information about a critical incident is received by a community provider from any person other than support coordinators, the staff receiving the information completes the Critical Incident Report form and follows procedures to send to Investigation Section.
Medication errors include: omission and wrong dose time, wrong person, wrong route, wrong medication, and a pattern of medication errors (even though they were
documented and corrected) with no evidence of quality improvement activities by the provider. Adverse consequences are those that cause the person discomfort or
jeopardize his/her health and safety, not including refusal of medication by the person.
Providers responsible for medication administration are required to record medication errors but make information about medication errors available only when requested by the State. Specify the types of medication errors that providers are required to record:
iv. State Oversight Responsibility. Specify the State agency (or agencies) responsible for monitoring the performance of waiver providers in the administration of medications to waiver participants and how monitoring is performed and its frequency.
The DHR, Division of MHDDAD is responsible for monitoring the performance of waiver providers in the administration of medications to waiver participants. The Division of MHDDAD requires the Support Coordination Agency to provide oversight of medication administration to ensure appropriateness. Support Coordinators review the Medication Administration Record (MAR) and verifying the medication, date given, diagnosis and person giving medication. Every provider as to the services and supports provided has a written procedure for prescribing, ordering or authenticating orders, procuring, dispensing, supervision of consumer self-administration of medications, recording, and for disposal of discontinued or out-of-date medication. The team developing the individual service plan will determine the frequency of visits by the Support Coordinator will make to each person.
Medication errors with adverse consequences are reported to the Division of MHDDAD as specified in Appendix G-1-a. Each of these critical incidents is investigated, and the provider must make corrective actions as applicable (see Appendix G-1-c). The Division of MHDDAD is in the process of the development of procedures for identification of trends and patterns in medication errors that support statewide improvement strategies. This process is described further in the Quality Management Strategy specified in Appendix H.