Exception to the Rule (ETR) Support
If the resident’s care needs are exceptional due to behaviors, discuss a referral with your Case Manager to the Community Behavioral Health Support (CBHS) or Intensive Behavior Supportive Supervision (IBSS) Programs through the Managed Care Organization (MCO).
When Should an ETR be Requested?
If a resident’s personal care needs are truly exceptional (differ from the majority in his/her classification)
AND
If you have attempted alternative options but the resident’s care needs remain beyond the level of care scored in his/her assessment.
Ensure your request does not contradict your Disclosure of Services (i.e. if you disclose that you have awake at night staff, then you may not have grounds for an ETR requesting an increased daily rate for awake at night staff)
Make sure the resident’s assessment is accurate and reflects the care needs
What Information Needs to be Included in an ETR Request?
- Details of resident’s diagnoses and personal care tasks that support the request
- List the frequency and duration of the tasks (and the caregiver costs associated with the tasks)
- Details of resident’s behaviors and extent of interventions required to ensure the resident’s safety
- List the frequency and duration of the interventions (and the caregiver costs associated with the interventions)
- The alternatives explored prior to requesting the ETR and why they did not work
- Potential negative outcomes (i.e. risks to resident’s health and safety or risk of institutionalization) for the resident if the ETR is not approved
- List if you are requesting a custom/temporary ETR or a plan period/ongoing ETR
If you believe your resident’s care needs are exceptional and would like assistance with an ETR, please have the resident or resident representative sign this release of information form to share their assessment (service summary and assessment details) with the AFH Council: Release of Information Form and complete the following form: