DECISIONS ON SERVICE CASES MANDATORY WEBINAR Q & A 5/9/18

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1 Questions? With new intakes that are just having their CAPS done this month, should we also wait to service plan until the hours are adjusted? We still have not received our list of closure cases that I thought that we were going to receive on May 7 th. Is this still in the works? It looks like for all of the exceptions that are reductions, we do not need a new CA/PS but need to do the new 514. Just wanted to make sure that that is correct and we are not missing anything else. Can you talk about the timing of sending out the 001N and 003N on the new assessments that we completed but either have sitting as invalid or complete? We are going through a QA review and they want us to send these all out even though we have not taken action on these cases yet. We have some that were denied EWE due to an SPL of greater than 17. The hearings reps withdrew and we placed them into admin. Now they will close but again will not meet EWE. Can you please talk about these cases? We have someone who will close, they now have a change in condition do we do a closure on the prior assessment and then look at the new one to see if they will qualify or not and take any needed actions on it. Or would we Answers If you can wait, please do so. If the consumer needs their services for the May 21 st date, please go ahead and set up the benefit. We will not have to fix the hours. The hours will recalculate either when a new benefit is created or after a reassessment. We are working on finalizing the list and sending out to all branches. In some instances, we have noted that some on the list may still be eligible for services. If that is the case, we will not send them a closure. Yes, that is accurate. New cases should have been moved to complete and appropriate. If you mean new reassessments: For hours reductions, follow the instructions in the policy transmittals. For closures, Central Office will be sending out the denials and related forms. APD Central Office will send closure notices on these cases. If the consumer has had a change of condition, we should do a new assessment/reassessment. You do not need to send a closure. P a g e 1 10

2 not send a closure on the old assessment, go out and see them now and then make a decision based upon the new assessment that we complete? How long will one have a chance to request a hearing and can they request for APP - Group 1? Do we invalidate all of the plans that are currently in pending status and then recreate after 5/21? Will CMs receive a copy of the notices that CO sends to the consumers by 05/17? What about the other cases we added to the list that we knew of that were pulled from hearings, etc. that should be closed? Once we get the list of those reducing, if they have an end date other than 5/26, do we need to fix them to 5/26 so that the system can auto extend out the cases? Do we make an EWE referral if someone is SPPC eligible, or just go straight to SPPC? Is CO sending out the 4105's and closure of the vouchers by LO or CO? Can you clarify if it is only the clients that will be closing are the clients assessed Oct & Nov or is it anyone that has been assessed through end of April. Who will be extending IHCA POCs for group 2? If the IADL's are not restored based on this new agreement, if consumers ask for a hearing appealing the IADL reduction, is it hearable? Same as normal. Yes, CMs will get the notices but we are not confirming the date. They will be treated the same. We are extending cases with benefit end dates from 5/20 through 7/31 to catch everyone within that date range. Individuals eligible for SPPC are not eligible for EWE. See APD-PT s will be the responsibility of the LO. New vouchers will also be the responsibility of the LO. We will be closing everyone who does not meet SPL or EWE who should have been closed and either had their adverse decision put on hold or who had their services restored. This includes all consumers assessed from October 1 st through April. Central Office. P a g e 2 10

3 With new increase of max hours, will the Tier 2 level approval amount increase as well? For new cases opened up since Oct 1st, it sounds like they will show the reduction hours. If we touch these service plans and the consumer is asking for additional hours and these could be met by us creating a new benefit line, will this trigger showing the restored ADL hours? So October and November service plans need to be recreated, and May assessments need to continue as normal with new service planning, all between May 21st and June 1st; because we cannot update any service plans until after the 21st? So 3 months of service plans in one-week? If we are setting up the service plans, we will need to do it off the current pending CA/PS. Are you stating that we would first place those pending CAPS to complete? What if a nursing home client was in the process of appealing the denial, received notice that they will uphold the placement contingent upon APD decision. Will the state be notifying the hearings rep? This client never had a hearing. What about cases that were done in March and that had to go to exception process because of the ADL reduction but now are not needing to do the exception tier 3 process. Should we just wait for access to update and run the assessment that was conducted in March? For exceptions that were held due to reduction (even with the exceptions request the plan would still be a reduction and have We understand this is a lot work. However, the other option was to have CMs go in manually to update all of the cases that have been extended through May 26 th. CO will issue a new notice with a new effective date. The consumer can appeal that decision. Ideally, if the consumer can wait, wait till the 21 st. If the consumer needs the hours immediately, please proceed with the exception request. It depends on the timing. If you already have the 514 submitted, we will accept what was submitted. If you are just working with the P a g e 3 10

4 not been requested yet) Are CM's to submit using old criteria for request or with the new 514 form completed by consumer/cm? So are the hours for ADLs restored or not? In the assessment comments, what are the "3 questions" you want addressed? What about the cases that were reduced/closed due to hour changes that were between Oct. and Feb. that went to hearing but got hours restored? Will decisions be made off of these hearings? Or will these people fall into group 1? We are part of a AAA and our Outlook is not connected to the states, so our information will not populate correctly. Do you want a list? When will CO be posting the ADL rules to adjust the increased/restored hours? consumer, please use the new 514 and follow the revised process. Please staff these with CO Exceptions staff. We are extending Yes, the ADL hours for Mobility, Eating, Bathing and Personal Hygiene, and Dressing and Grooming. The additional hours that were added to Elimination and Cognition in the October 2017 rule changes are staying at the higher levels. Meal Preparation hours are NOT being increased. Why is there a need? This is not diagnosis driven. Clearly describe the symptoms of the diagnosis, which are the cause of the need for assistance. How frequent is the need? Words like occasionally, at times, or on bad days are not specific enough. How is the assistance being received? Describe what the provider is doing instead of stating the assist type. They fall into group 1 or 2 depending on the adverse action. If this is regarding the CM s phone numbers, we are using what is in OA. Please make sure that information is up to date. When sending in notice requests, sending in the correct worker and their phone number will also be helpful. Prior to May 21 st. P a g e 4 10

5 When will we be getting a comprehensive list of required documents, ie 001/002 etc. needed to send to our consumers at assessment? Is SPPC also being reduced? For new intakes that were done previously what should we do when the ADL hours are increased in Oregon Access? Or will hours be added at review? Do we need to leave cases in pending and send information to CO for notice creation if an individual's SPL increases (eg 7 to 13), but they remain eligible, reside in a CBF, and their level/rate of pay didn't change? What happens to the clients we have created new service plans for in May before this training? Are the notices from Central Office being sent to us by so we can print them and get them out fast enough? What is going to happen to cases with exceptions in place now once the ADL hours increase on 5/21? will exception hours be adjusted? Will new exceptions be needed? The required forms list will be updated shortly. However, all of the required forms are spelled out in transmittals. Not at this time. For new intakes with established benefit plans, do not do anything. The current hours will stay in place until a new benefit is created for whatever reason. For consumers who do not yet have a benefit plan, if the consumer can wait, or has not selected a provider, please wait till 5/21 to set up the new benefit. These individuals will receive new hours when they have a reassessment or a new benefit established. For consumers who meet the criteria we discussed today, please DO NOT set up a new benefit. For new consumers, you do not need to do anything. Their hours will stay at the October 2017 hours until their next reassessment or a new benefit plan is established. Keep in mind that closure actions will be mailed out by CO. The exception will stay in place until a new benefit is created based on the schedule in the PT and presented in the Webinar. When the CM creates a new service plan the P a g e 5 10

6 What about the hours that were reduced in ADLs because a client no longer meets the 10/17 definition in bowel and bladder? Are those hours restored as well? Just to be clear, as of right now, any decision notices should be sent to CO first, including new approvals, denials or recertification, etc. For the new assessments that were not reduced, will the new ADL in OA increases affect their hours at all or will they remain at the hours effective October 2017? Will you be sending a list via PT of the ADLs that have increased or have stayed the same? How soon can you have the slides to this presentation posted for us? I hope soon. For redeterminations for folks in CBC facilities - no change in SPL but add-on drops off. What notices will the provider get? Just to make sure - all redeterminations regardless if change or not, will get new notices each year right? If someone is in a community based care facility is does the LO send a 541 for new assessments and reassessments? How does this affect facilities with rate/level reductions now that the assessment ADL's are changing? exception hours will need to be reduced by the corresponding increase. The hours were restored for the full ADL not specific components within the ADLs. Some consumers will still see a reduction in hours for a variety of reasons, including the changes to the ADL definition changes. This is expected and appropriate. Yes, that is correct. It will not affect these consumers. When their benefit plan is changed for any reason, the new hours will be generated. We have a target date of 5/21 for the transmittal. Case management tools website will also be updated. They have been posted. The SPL Redetermination notice will bot be required in this situation. Just send the 541. The new notice requirements are stated in APD-PT None of the negotiated changes should impact CBC rates or payments. The ADL definition changes that were implemented in October have not changed. Hopefully, the LOs did not delay or pend CBC cases P a g e 6 10

7 How are recipients of Community Housing Services Program services (CHSP) treated? If no longer waivered-eligible what are the best practices to assist customer prevent potential loss of housing due to change in eligibility? So if there is a case that will be closing services and there will be a need to send the 7210 for Magi process, can you please explain that process since the notices are being mailed from CO. Typically we send them out and we leave the services as is until MAGI is determined. When will CO be finished extended benefits to Oct? Are we to understand that if a person was assessed on April 30th and they were determined no longer eligible nor EWE eligible, would they be closing end May 26, 2018? Do we wait to complete the May exceptions until 21st? May 2018 assessments that are put in- will those be lumped in with March/April timeline? 5/21 won't be enough time for reduction notice? where the rate was reduced because of the October changes. Most housing programs do not require that an individual be enrolled in Medicaid Long Term Services and Supports to maintain housing. However, if the individual would be evicted from their housing, they may be eligible for Extended Waiver Eligibility. Please see: APD-PT If the consumer is required to go through due process for MAGI determination, the consumer is still not eligible to receive services after they are closed. However, please have the case coded for continued OSIPM eligibility until a MAGI determination is made. CO will not review the case to determine if the consumer needs a 7210 for due process. The extensions are scheduled to run the weekend of 5/18 through 5/21. To ensure that ONGO vouchers the mainframe will run first and then Oregon Access will be completed so that by Monday the dates will be updated as well. If hourly, yes. If CBC or NF, the end date will be 5/31. Yes, if possible. Yes, if needed. P a g e 7 10

8 Are the dates for taking actions negotiated or if we can complete them earlier, is this allowed? For example, if in June the CM has the ability to work cases for March and April. For new service plans that are waiting in pending status, do we invalidate those? Or will the system update with those plans in pending status? I received a copy of a closure notice from CO this morning. CO is supposed to narrate the action correct? (it has not been done) Where is it pulling phone numbers from for CMs? An old phone number for me appears on the closure notice CO mailed today. If we create a plan after 5/21, can we back date the benefit to start with the pay period- 5/13? For reassessments. CAPS were completed, service plans were created and then it was determined that it was a reduction. Those plans are in pending status. Do we need to invalidate? Is the assessment brochure being mailed out, and if so who mails that out? What about hearing clients service plans ending 05/12/18? For any active cases that receive an increase in hours on the service plans as a result of the ADL changes on 5/21/18 how will the consumers and HCW's be notified of the We set the timeline to give CMs time to get the work done. Cases can be done on an accelerated timeline. If a CM can complete all of their new benefit plans early, they may do so. Those service plans will need to be invalidated in order to utilize the newly available hours on 5/21. Currently, the CO notice team does not have the ability to narrate. The LO should narrate until the OA rights have been updated for the CO staff. Phone numbers are pulled from Oregon ACCESS. If you find that your information is incorrect, your local sub-administrator is able to make those updates. No, the service plan cannot cross the CA/PS versions. Yes, the benefit and service plan must be invalidated and updated after 5/21 when the new benefit version is available in OA. But the assessment can still be used. The new Assessment brochure (form 5139) should be sent by the LO after the CM scheduled the assessment but in enough time for the consumer to receive the brochure prior to the assessment. Hearings will be handled on a case by case basis. In order to avoid confusion will send the notices to LO and then all the material that needs to be mailed can be packaged P a g e 8 10

9 increased hours? are LO's to be sending those out? What about denial notices for when the local office does not approve the exceptional hours? Can we set up benefits and APD CO for all of our reduced consumers at once instead of staggering them? For RI cases that are being processed this month and we are not to set up a Service Plan until 05/21/18 we will not have 10-day notice for those cases so do they have to be Admin'd until 06/09/18? We have very few cases that are still in hearing. If they are due for assessment, and the assessment results in a closure. Do we close? Or do they still get hours based on the hearing that hasn't been resolved? together and staff can take the necessary action. In the near time, the LO will notify CO for a notice to be sent. After the local office has been trained and approved to send notices, the LO can send the exception denial with the hours notice. The Exception portion is located on page 6. New notices names and form # s are: DHS 2780 Service Priority Level (SPL) Determination Decision Notice DHS 2781 Service Priority Level (SPL) Redetermination Decision Notice DHS 2782 In-Home Service Hours Determination Decision Notice DHS 2783 In-Home Service Hours Redetermination Decision Notice We are allowing them to be spread out depending on workload, but the sooner all cases can be touched the better. Reassessments for in-home plans this month already need to be extended through June 9 th. An admin extension is not needed. The 5/21 date will give us enough time for the 10 day notices. All hearings that were based on October Changes should have been withdrawn. So now we can follow up with the new notices and close them. The consumer can then appeal that decision. If for some reason the hearing was not withdrawn, please the notice in box with the name, prime and hearings rep s name. APD.DecisionNotices@dhsoha.state.or.us P a g e 9 10

10 Does CO give LO the SPL notice and we add the 541 for facility clients? What should we be doing with our current CAPS due by the end of this month that will result in a reduction? What is the turnaround time for notices to be sent once the request is received by CO? For closures, we send 540 for SPPC after review if not eligible. Do we also send some sort of denial for EWE to show it's been reviewed and a decision made? On the Transmittal PT it is stated that all newly completed re-assessments must be accompanied by the new notices have to have immediate action eff May 7th, does this also apply to NEW assessments for new consumers? What will the new tier 2 limits be on/after May 21? Complete the process like normal. There is no need to hold off on any adverse actions. Follow the process specified in: APD-PT Right now the plan is for the notices to be returned to the LO no later than 7 days. EWE decisions are included in the new SPL Redetermination Notice. Information regarding EWE determinations are included on the of the SPL notices (DHS 2780 and DHS 2781). New consumers should receive notices as soon as possible. ADLs will be 73 and IADLs will remain 35. P a g e 10 10