UCare Connect Care Coordination Requirement Grid Updated effective
|
|
- Jeremy Newman
- 5 years ago
- Views:
Transcription
1 UCare Connect Care Coordination Requirement Grid Updated effective The assigned Care Coordinator (CC) must meet the required definition of a qualified professional. Care coordination services incorporate complex case management and consist of a comprehensive assessment of the member s condition, the determination of available benefits and resources, the development and implementation of an individualized care plan with performance goals, and monitoring and follow-up, as described in the grid below. Community Non-Waiver Members Community Waiver Members Institutionalized Members Initial Assignment Initial Contact with Member Assessment Review and Development of the Plan of Care Upon receiving the enrollment roster, the CC is required to: Look each member up in MN-ITS to determine waiver status. Return members to UCare via the Monthly Activity Log if MN-ITS indicates the member is open to a waiver, TCM, or the member is institutionalized. **Do not continue care coordination for these members.** Provide the member with the name and phone number of the CC assigned within 10 calendar days of initial assignment. Initial assignment is the first day the delegate organization receives the enrollment roster. Notification may be done by phone or letter and the contact must be documented. If contact is by letter, the CC must use UCare s approved Care Coordinator Welcome Letter found on UCare s website. Contact the member, either Return members to UCare via the Monthly Activity Log if MN-ITS indicates telephonically or face-to-face, the member is open to a waiver. **Do not continue care coordination for these within the month of assignment to members.** review information in the comprehensive assessment. Develop a Person Centered Plan of Care (POC) using the UCare Connect Plan of Care form, or other UCare approved form within 30 days of completion of
2 Initial Contact with Member/ Unable to Reach or Refusal the assessment review. (Delegates may opt to do a faceto-face visit but it is not required). Maintain a record of the assessment and POC in the member s case file. Share the assessment and POC information with UCare upon request. Make a minimum of 4 attempts to contact the member within the month of enrollment. Contacts may be by phone, face-to-face, on different days, and at different times, and/or by using the Unable to Contact Letter on UCare s website. At least 3 of these attempts must be made by phone. A good faith effort should be made to obtain a working phone number for the member. (Sending the Care Coordinator Welcome Letter is not considered an attempt to contact the member). If the CC is unable to contact the member after six consecutive months of attempts, the CC is required to: Add the member to the Monthly Activity Log as a refusal and Return the member to UCare via the Monthly Activity Log if MN-ITS indicates the member is open to a waiver. **Do not continue care coordination on these members.**
3 return to UCare by the 20 th day of the following month. Product Change- this is when a member moves from Connect Regular or Expansion to Connect + Medicare and vice versa. Entry of Assessments on Monthly Activity Log Admission to a Nursing Facility from the Community If there is a change in CC due to a product change, the existing (sending) CC is required to: Send a copy of the current HRA and POC, and relevant case notes to the new (receiving) CC. The new (receiving) CC is required to: Provide the member with the name and telephone number of the new CC within 10 days of the assignment. This may be done by phone or letter (using the approved letter on UCare s website), and must be documented in the case record. Obtain and review the current HRA and POC from the previous (sending) CC. Review the POC and update as necessary. If unable to obtain a completed HRA and POC that was completed within the last 365 days, or if there has been a change in condition, the CC is required to complete a new HRA (DHS-3428H form) and POC face-to-face. Enter the assessment into MMIS. Document all product change assessments on the Monthly Activity Log. Enter all assessments and refusals on the Monthly Activity Log. Submit the Monthly Activity Log to connectintake@ucare.org by the 20 th calendar day of the following month. If a member is admitted to a Nursing Facility and their stay is expected to be less than 90 days, keep the member open to care coordination. If it is expected that the member will be admitted for greater than 90 days, the CC is required to return the member to UCare via the Monthly Activity N/A
4 Comprehensiv e Plan of Care (POC) Log. UCare Responsibilities: Complete all Preadmission Screening and Resident Review (PASRR) activities. Notify the delegate when a PASRR is received. CC Responsibilities: Monitor the daily authorization report for admissions. Assist with transitions and complete a TOC log. Develop and implement a personcentered comprehensive POC within 30 days of the assessment review. This takes into account input from the member and/or family members, the member s authorized health care decision maker, Primary Care Physician (PCP), and other interdisciplinary care team members as applicable. The CC develops the personcentered POC using the Care Plan document found on UCare s website. The POC is based on the information collected through N/A
5 telephonic or face-to-face review of the comprehensive assessment with the member or legal guardian, and includes: o Member problem list/needs. o Discussion of service back-up plan. o Prioritized member goals. o Member driven interventions to address medical, social, behavioral, educational, and other service needs of the member. o Member s strengths and services in place. o Measurable outcomes (must be monitored and POC revised as necessary) with a target achievement date identified by month/year. Fax a copy of the POC or a POC summary to the member s PCP and specialist (as applicable) on an annual basis. Communicate updates and
6 Plan of Care Signature Page Ongoing Contact with Member and Plan of Care Updates changes in the member s condition to the PCC as appropriate. Complete the Personal Risk Management Plan (PRMP) section of the POC when the member refuses services, and document PRMP discussion with the member. Obtain a signature from the member or authorized representative on the POC on an annual basis to document that they have discussed their care plan with their CC. The POC is not considered valid unless signed by the member or authorized representative. Maintain ongoing contact or check-in with the member at a minimum of every 90 days (quarterly) to update the POC which includes documenting the monitoring of progress or goal revisions (with date). Contact may be by phone or face-to-face (refer to contact attempt N/A N/A
7 Reassessment requirements in the unable to reach or refusal section). Return the member to UCare via the Monthly Activity Log if any of the following occur: The CC is unable to reach the member after attempting for six consecutive months. The member opens to a waiver or TCM/ACT services. The member becomes a longterm resident of a skilled nursing facility. Complete a face-to-face HRA using the DHS-3428H-HRA form within 365 days of the previous assessment or upon a change in condition. When completing the HRA, all questions and sections must be completed or marked as not applicable. Enter the DHS-3437H form in MMIS. Enter the reassessment on the Monthly Activity Log and return to UCare by the 20 th of the following month. N/A
8 Medicaid Eligibility Renewals Reassessments When Member is in the 90 Day Grace Period After MA Terminates Advance Directives Update the Date Goal Achieved/Not Achieved column from the previous year s POC with a month and year documented and retain in member s file. Develop a new POC with ongoing and new goals within 30 days of the HRA. Send the POC or POC summary to the PCP and member/rep within 30 calendar days of the HRA date. Review the UCare Connect eligibility renewal report, provided by UCare, on a monthly basis and remind members when they are at risk of losing Medicaid eligibility due to incomplete or unprocessed Medical Assistance paperwork. The UCare Retention Specialist reaches out to members to see if they need additional assistance with maintaining eligibility. If a member s Medical Assistance (MA) terms, the CC is required to discontinue providing care coordination services but monitor the member for up to 90 days. If their annual reassessment is due during the 90 day term window, the CC is required to: Complete the annual reassessment and maintain in the member s file. Enter the DHS-3427H form into MMIS if and when the member s MA is reinstated. o If there is a assessment completed within 365 days of the previous assessment it can be reviewed with the member via telephonically or face-to-face and entered in MMIS. Enter the assessment on the Monthly Activity Log. Document on an annual basis that they addressed or discussed advance directives with the member, or;
9 Document the reason why advance directives were not discussed. Transition of Care (TOC) Coordination with Local Agencies Assist with the member s planned and unplanned movement from one care setting (e.g., member s home, hospital, and skilled nursing facility) to another care setting. Each movement, when due to a change in the member s health status, is considered a separate transition. Conduct Transition of Care activities and document these activities on the Transitions of Care Log on UCare s website, according to the TOC Log instructions.. Conduct a reassessment in the event of a care transition that may involve significant health changes, repeated or multiple falls, recurring hospital readmissions or emergency room visits. If the CC finds out about the transition(s) 15 days or more after the member has returned to their usual care setting, the CC is not required to complete a TOC log, however, the CC is required to: Follow-up with the member to discuss the care transition process, and any changes to their health status and POC. Provide education about how to prevent readmission, and document this discussion in case notes. Refer to the TOC log instructions on the UCare website for additional instruction. The CC is required to make referrals and/or coordinate care with county social services and other community resources when a member is in need of: Pre-petition screening. Home and Community Based Services (HCBS). County case management for HCBS. Child protection. Court ordered treatment. Case management and service providers for people with DD. Mental Health Targeted Case Management (MH-TCM). Behavioral Health Home. Adult protection services. Assessment of medical barriers to employment. Relocation services
10 DTR Requirements- Medically Necessary Services Transfer of Member Between Delegates Member Death Nursing home, residential, or home care providers. State Medical Review Team or Social Security disability determination. Work with local agency staff or county attorney staff for members who are victims or perpetrators in criminal cases. Assessment and evaluation related to judicial proceedings. Assertive Community Treatment (ACT), Intensive Residential Therapy Services (IRTS), or Adult Rehabilitative Mental Health Services (ARMHS). UCare or one of its utilization review (UR) delegates must review all services that require a medical necessity review. UCare sends a denial, termination, or reduction (DTR) letter to the member any time services that require prior authorization and review of medical necessity according to UCare s prior authorization grid are denied, terminated, or reduced. A DTR of these services requires review and determination by a UCare Medical Director. The current (sending) CC is required to: Complete the DHS-6037 form and send or fax the form to the new CC delegate (receiver) as soon as the enrollment with the new delegate is indicated on the enrollment roster, but no later than the 15 th calendar day of the month. Include the following supporting case documentation with the DHS-6037 form: o Current assessment(s). o POC. o Relevant case notes. The receiving CC is required to: Contact the transferred member within 10 calendar days of assignment, by letter or phone, to introduce the new CC. Review the DHS-6037 form, assessments, and current POC with the member and document this review in the member s record. Identify when the next assessment is due. Reassessments should be kept on schedule, based on the previous assessment date per MMIS. Complete a new assessment and POC if unable to obtain a copy of the most recent assessment and POC from the previous CC. Notify UCare by completing the Death Notification form found on UCare s website
11 Documentation Requirements Policies and Procedures Complete the DHS-5181form and send it to the county financial worker. If any of the care coordination requirements were attempted but not completed, the CC is required to document all attempts in the plan of care and/or progress notes. All UCare delegates are required to have policies and /or procedures that support all the above stated requirements
UCare Connect + Medicare Care Coordination Requirement Grid Updated
UCare Connect + Medicare Care Coordination Requirement Grid Updated 1.1.18 The assigned Care Coordinator (CC) must meet the required definition of a qualified professional. Care coordination services incorporate
More informationAll related UCare forms can be found, HERE, all DHS forms can be found HERE, all DHS Bulletins can be found HERE.
Minnesota Senior Health Options (MSHO) Care Coordination (CC) and Minnesota Senior Care Plus (MSC+) Community Case Management (CM) Requirements Updated 1.1.18 All Minnesota Senior Health Options (MSHO)
More informationINSTRUCTIONS FOR INSPIRE (SNBC) CARE PLAN
INSTRUCTIONS FOR INSPIRE (SNBC) CARE PLAN INFORMATION ABOUT ME 1. Name: Enter member s name. 2. My DOB: Enter member s date of birth. 3. Health Plan ID Number: Enter member s HealthPartners Member ID number.
More information3 rd Quarter MSHO/MSC+ Care Coordination Training
3 rd Quarter MSHO/MSC+ Care Coordination Training Care Systems & UCare Care Coordinators: September 13 th, 2017 Recorded WebEx: September 14 th, 2017 Agenda STARS Cindy Radke Bus Pass Transportation Jeremy
More informationPURPOSE CONTACT. DHS Financial Operations Division (651) or or fax (651) SIGNED
Bulletin NUMBER #17-32-08 DATE March 20, 2017 OF INTEREST TO County Directors SSTS Coordinators Social Services Supervisors and Staff Fiscal Supervisors ACTION/DUE DATE Please read information and prepare
More informationSpecial Needs BasicCare
Minnesota Disability Health Options (MnDHO) Special Needs BasicCare (SNBC) Special Needs Purchasing Deb Maruska Program Coordinator Susan Kennedy Project Coordinator Managed Care Programs for People with
More informationMedicare: 2017 Model of Care Training 12/14/201 7
Medicare: 2017 Model of Care Training 12/14/201 7 What is the Model of Care? The Model of Care (MOC) is Allwell s plan for delivering our integrated care management program for members with special needs.
More information1 st Quarter MSHO/MSC+ Care Coordination Training March 13 th -Care Systems and Internal Care Coordinators March 14 th -Recorded WebEx
1 st Quarter MSHO/MSC+ Care Coordination Training 2018 March 13 th -Care Systems and Internal Care Coordinators March 14 th -Recorded WebEx Agenda CAHPS Survey Emily Eckhoff Behavioral Health Malanie Blanchard
More informationMedicaid RAC Audit Results
Medicaid RAC Audit Results Clinical Audits: The RAC Clinical audit goal was to review supporting documentation for necessity of admission and continued stay in long term care for Medicaid residents. There
More informationHealthPartners Inspire (SNBC) Overview
Draft HealthPartners Inspire (SNBC) Overview July 1, 2016 1 What is SNBC? Special Needs Basic Care (SNBC) began in 2008 Voluntary health plan option for enrollees with disabilities ages 18 through 64 who
More information# December 29, 2000
#00-53-3 December 29, 2000 Minnesota Department of Human Services 444 Lafayette Rd. St. Paul, MN 55155 OF INTEREST TO! County Social Service Directors/Supervisors! County Designated LMHA for PASRR! County
More information(Referred to as the Care Plan Data Collection Guide in the DHS Triennial Compliance Assessment (TCA) conducted by the Minnesota Department of Health)
Minnesota Department of Human Services Managed Care (MSHO MSC+) Elderly Waiver Care Planning Audit (as required under 7.1.4.D., 7.8.3, 9.3.7 of the 2016 MSHO/MSC+ contract) 2017 Audit Protocol (Final 7.17.2017)
More informationLOUISIANA MEDICAID PROGRAM ISSUED: 10/18/13 REPLACED: CHAPTER 9: ADULT DAY HEALTH CARE WAIVER SECTION 9.10: SUPPORT COORDINATION PAGE(S) 13
SUPPORT COORDINATION Support coordination, also referred to as case management, is an organized system by which a support coordinator assists a recipient to prioritize and define his/her personal outcomes
More informationA SUMMARY OF MEDICAID REQUIREMENTS AND RELATED COA STANDARDS
A SUMMARY OF MEDICAID REQUIREMENTS AND RELATED COA STANDARDS This tool is intended to provide a broad overview of common Medicaid (MA) requirements in relation to COA s Standards. While there are specific
More informationWORK PROCESS DOCUMENT NAME: Medical Necessity Review for Behavioral Health and Substance Use Disorder REPLACES DOCUMENT: RETIRED:
PAGE: 1 of 7 SCOPE: Coordinated Care Departments for Behavioral Health and Substance Use Disorder (SUD) Reviews for members enrolled in Integrated Managed Care and Behavioral Health Services Only PURPOSE:
More informationThe Power and Possibility of PASRR Webinar Series Webinar Assistance
The Power and Possibility of PASRR Webinar Series Webinar Assistance http://www.pasrrassist.org/resources/webinar-assistance-and-faqs Call-in through one of two ways listed below: Telephone: 1. Locate
More informationGreenwood Connections Notice of Privacy Practice
Note: This notice describes how healthcare information about you may be used and disclosed and how you can get access to this information. Please read it carefully. This Notice is effective April 1, 2003
More informationFinal Report. UCare Minnesota 2005
Minnesota Department of Health Compliance Monitoring Division Managed Care Systems Section Final Report UCare Minnesota 2005 Quality Assurance Examination For the period May 1, 2002 through February 28,
More informationEnrolling Participants into the PACE Program
Program of All-inclusive Care for the Elderly Enrolling Participants into the PACE Program Cindy Susee, APD PACE Policy Analyst February 2017 PACE Model PACE is a Medicare and Medicaid national program,
More informationSteps for Success. Personal Care Assistance
Steps for Success Personal Care Assistance Why are you here? An overview of: PCA Program guidelines Eligibility Covered services How a person gets services 2 Why are you here? Program policy requirements
More informationLead Agency Quality Assurance Plan Survey for Medical Assistance Waiver Home and Community-Based Services
Lead Agency Quality Assurance Plan Survey for Medical Assistance Waiver Home and Community-Based Services Introduction: The Minnesota Department of Human Services (DHS) has, in years past, required counties,
More informationHOME HEALTH CARE TABLE OF CONTENTS. OVERVIEW TRANSITIONAL... CARE... SERVICES . MEMBERS... MANAGED... BY... EVICORE
TABLE OF CONTENTS. OVERVIEW............................................................................................. 452..... TRANSITIONAL................. CARE...... SERVICES......................................................................
More informationMedicaid-Enrolled Hospice and Nursing Facility Providers
M E D I C A I D B U L L E T I N B T 1 9 9 9 2 4 J U L Y 3 0, 1 9 9 9 To: Subject: Medicaid-Enrolled Hospice and Nursing Facility Providers Treatment for Non-Terminal Conditions for Hospice Recipients Admitted
More informationHOSPICE POLICY UPDATE
#02-56-13 Bulletin June 24, 2002 Minnesota Department of Human Services # 444 Lafayette Rd. # St. Paul, MN 55155 OF INTEREST TO County Directors Administrative contacts AC, EW, CAC, CADI, TBI DD Waiver
More informationCMS HCBS Settings Final Rule (Final Rule) and the Role of the Waiver Support Coordinator Frequently Asked Questions
CMS HCBS Final Rule CMS HCBS Settings Final Rule (Final Rule) and the Role of the Waiver Support Coordinator Frequently Asked Questions 1. Does the Final Rule apply to large group homes that are located
More informationSpecial Needs Plan (SNP) Model of Care Training 2018
Special Needs Plan (SNP) Model of Care Training 2018 Table of Contents Training Overview Pg. 1 Denver Health Medical Plan s (HMO SNP) MOC Annual Training Pg. 2 Special Needs Plans (SNPs) Pg. 2 Special
More informationMedicaid Home- and Community-Based Waiver Programs
INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Danyell Punelli, Legislative Analyst 651-296-5058 Updated: October 2016 Medicaid Home-
More informationUCARE MODEL OF CARE SUMMARY FOR MH-TCM (February 2009)
UCARE MODEL OF CARE SUMMARY FOR MH-TCM (February 2009) The UCare Model of Care for Mental Health Targeted Case Management is designed to provide care for the child member and their families and adult members,
More informationDIVISION CIRCULAR #8 (N.J.A.C. 10:46C) DEPARTMENT OF HUMAN SERVICES DIVISION OF DEVELOPMENTAL DISABILITIES
DIVISION CIRCULAR #8 (N.J.A.C. 10:46C) DEPARTMENT OF HUMAN SERVICES DIVISION OF DEVELOPMENTAL DISABILITIES EFFECTIVE DATE: September 17, 2012 DATE ISSUED: September 17, 2012 (Rescinds DC #8 Waiting List
More informationRyan White Part A. Quality Management
Quality Management Medical Case Management 2014 Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White CARE Act Part
More informationNotice of Privacy Practices
Notice of Privacy Practices, pg. 1 of 5 Notice of Privacy Practices CATHOLIC CHARITIES OF THE ROMAN CATHOLIC DIOCESE OF SYRACUSE, NY This notice describes the privacy practices of Catholic Charities of
More informationModel of Care Heritage Provider Network & Arizona Priority Care Model of Care 2018
Model of Care Model of Care 2018 Learning Objectives Program participants will be able to: List two differences between the Complex Care Management (CCM), and Special Needs Program (SNP) programs. Identify
More informationA GUIDE TO HOSPICE SERVICES
A GUIDE TO HOSPICE SERVICES PURPOSE: Minnesota Rules 4664.0140, subpart 1 states: "Every individual applicant for a license, and every person who provides direct care, supervision of direct care, or management
More informationCoordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012
Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012 Table of Contents CARE COORDINATION GENERAL REQUIREMENTS...4 RISK STRATIFICATION AND HEALTH ASSESSMENT PROCESS...6
More informationKANSAS MEDICAL ASSISTANCE PROGRAM. Fee-for-Service Provider Manual. HCBS Frail Elderly
Fee-for-Service Provider Manual HCBS Frail Elderly Updated 02.2016 PART II Section BILLING INSTRUCTIONS Page 7000 HCBS FE Billing Instructions................. 7-1 7010 HCBS FE Specific Billing Information.............
More informationPAGE R1 REVISOR S FULL-TEXT SIDE-BY-SIDE
69.11 ARTICLE 4 69.12 CONTINUING CARE 50.15 ARTICLE 4 50.16 CONTINUING CARE 69.13 Section 1. Minnesota Statutes 2010, section 62J.496, subdivision 2, is amended to read: 50.17 Section 1. Minnesota Statutes
More informationThe Power and Possibility of PASRR Webinar Series Webinar Assistance
The Power and Possibility of PASRR Webinar Series Webinar Assistance http://www.pasrrassist.org/resources/webinar-assistance-and-faqs Call-in through one of two ways listed below: Telephone: 1. Locate
More informationTexas Administrative Code
TITLE 40 PART 1 CHAPTER 19 SUBCHAPTER I RULE 19.802 SOCIAL SERVICES AND ASSISTANCE DEPARTMENT OF AGING AND DISABILITY SERVICES NURSING FACILITY REQUIREMENTS
More informationPerson-Centered Treatment Plan and Managing Outpatient & Home- and Community-Based Services
Person-Centered Treatment Plan and Managing Outpatient & Home- and Community-Based Services Agenda Person-Centered Treatment Plan Overview Eligibility Process Person-Centered Treatment Plan Process Descriptions
More informationWYOMING MEDICAID PROGRAM RULES Chapter 12 and Chapter 22. Statement of Reasons
WYOMING MEDICAID PROGRAM RULES Chapter 12 and Chapter 22 Statement of Reasons The Wyoming Department of Health proposes to adopt the following Amended Rules to reflect current process, policy, and procedure
More informationLutheran Brethren Homes, Inc. NOTICE OF PRIVACY PRACTICES
Lutheran Brethren Homes, Inc. [dba LB Homes] and Affiliates: Lutheran Brethren Retirement Services, Inc. [dba LB Alcott Manor / dba Lutheran Brethren Home Care / dba LB Broen Home / dba LB Short Stay];
More informationModel Of Care: Care Coordination Interdisciplinary Care Team (ICT)
Cal MediConnect 2017 Model Of Care: Care Coordination Interdisciplinary Care Team (ICT) 2017 CMC Annual Training Learning Objectives Define the L.A. Care Cal MediConnect (CMC) Model of Care Describe the
More informationS.E. Wisconsin Hearing Center Inc.
NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Effective Date:
More informationSpecial Needs Plans (SNP) Model of Care (MOC) Initial and Annual Training
Special Needs Plans (SNP) Model of Care (MOC) Initial and Annual Training 2018 Learning Objectives Program participants will be able to: List the three overall goals of the SNP Model of Care Describe the
More informationFMLA LEAVE REQUEST FORM
FMLA LEAVE REQUEST FORM NAME: EMPLOYEE ID #.: TITLE: DEPARTMENT: _ LEAVE DATES REQUESTED: BEGINNING DATE: ENDING DATE: REASON FOR LEAVE REQUEST: (CHECK ONE AND ANSWER FOLLOW-UP QUESTIONS) (1) the birth
More informationHIPAA Notice of Privacy Practices
HIPAA Notice of Privacy Practices Georgia Mountains Hospice understands that your health information is highly personal and we are committed to safeguarding your privacy. Please read this Notice of Privacy
More informationNotice of Privacy Practices for Protected Health Information (PHI)
Notice of Privacy Practices for Protected Health Information (PHI) Dermatology Associates of Colorado, PC THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
More informationHospital Appeals. December 6, Adrienne Mims, MD MPH Medical Director, Medicare Quality Improvement
Hospital Appeals December 6, 2012 Adrienne Mims, MD MPH Medical Director, Medicare Quality Improvement Objectives Review process for appeals for termination of Medicare services in the hospital setting
More informationNew York Children s Health and Behavioral Health Benefits
New York Children s Health and Behavioral Health Benefits DRAFT Transition Plan for the Children s Medicaid System Transformation August 15, 2017 DRAFT Transition Plan for the Children s Medicaid System
More informationTennessee Health Link Guidelines: Adults Medical Necessity Criteria
Tennessee Health Link Guidelines: Adults Medical Necessity Criteria https://providers.amerigroup.com Program description The Health Link service model is a program created to address the diverse needs
More informationNotice of Adverse Benefit Determination Training
Notice of Adverse Benefit Determination Training Santa Cruz County Behavioral Health Quality Improvement Mental Health Plan / Drug Medi-Cal Plan From here-out to be referred to as Plans 05/1/18 Goal Training
More informationMental Health Certified Family Peer Specialist (CFPS)
Mental Health Certified Family Peer Specialist (CFPS) Policy Number: SC170065A1 Effective Date: May 1, 2018 Last Updated: PAYMENT POLICY HISTORY VERSION DATE ACTION / DESCRIPTION Version 1 5/1/2018 The
More informationChapter 14: Long Term Care
I N D I A N A H E A L T H C O V E R A G E P R O G R A M S P R O V I D E R M A N U A L Chapter 14: Long Term Care Library Reference Number: PRPR10004 14-1 Chapter 14 Indiana Health Coverage Programs Provider
More informationMODEL OF CARE TRAINING 2018
MDEL F CARE TRAINING 2018 Content Introduction to SNP SNP Model of Care CHMP SNP population and vulnerable population SNP Benefit Roles and Responsibility HRA ICT Team Care Transition process Provider
More informationBT JUNE 15, 2001
Indiana Health Coverage Programs P R O V I D E R B U L L E T I N BT200123 JUNE 15, 2001 To: Subject: All Indiana Health Coverage Programs Waiver Case Managers, BDDS District Managers, BDDS D&E Teams, Nursing
More informationPCA Provider Quality Today
PCA Provider Quality Today Home Care Association 42 nd Annual Meeting May 16, 2010 Presented by Audrey Fischer MN Department of Human Services Disability Services Division 1 Objectives 1. To gain knowledge
More informationResource Management Policy and Procedure Guidelines for Disability Waivers
Resource Management Policy and Procedure Guidelines for Disability Waivers Disability waivers Brain Injury (BI) Community Alternative Care (CAC) Community Alternatives for Disabled Individuals (CADI) Developmental
More informationCDDO HANDBOOK MISSION STATEMENT
Adopted 6-19-09 Revised 11-1-10 Revised 4-30-13 Revised 2-27-17 CDDO HANDBOOK MISSION STATEMENT Arrowhead West, Inc. is the Community Developmental Disabilities Organization (CDDO) for initial contact
More informationSpecial Needs Program Training. Quality Management Department
10/26/2017 1 Special Needs Program Training Quality Management Department 10/26/2017 2 Special Needs Plan (SNP) Overview 3 SNP Overview Medicare Advantage (MA) plans were created by the Medicare Modernization
More informationReview/Guidance for RN QA Review form: Reminder that the Review is of locations/sites not of people. The Review tool looks at agency
Review/Guidance for RN QA Review form: Reminder that the Review is of locations/sites not of people. The Review tool looks at agency processes/procedures to determine if they are effective in making sure
More informationNursing Home Model Policy for West Virginia Physician Orders for Scope of Treatment (POST)
Nursing Home Model Policy for West Virginia Physician Orders for Scope of Treatment (POST) POLICY STATEMENT: It is the policy of [Name of Facility] to support the rights of residents to make decisions
More informationNorth Carolina Department of Health and Human Services NC Division of Medical Assistance - Program Integrity
02072011 North Carolina Department of Health and Human Services NC Division of Medical Assistance - Program Integrity BEHAVIORAL HEALTH: INDEPENDENT MH SA PROVIDER TOOL REVIEW GUIDELINES ADMINISTRATIVE
More informationInpatient Rehabilitation Facilities. Navigating the Sea of Requirements
Inpatient Rehabilitation Facilities Navigating the Sea of Requirements Purpose of Presentation Review the purpose of the Inpatient Rehabilitation Facility (IRF) Benefit. Review the Required Elements of
More informationHome & Community Based Services Waiver Member Handbook
Home & Community Based Services Waiver Member Handbook For Members Enrolled in the MyCare Ohio Home and Community Based Services Waiver H2531_160714_124129 Approved 1 WELCOME Welcome! This handbook was
More informationCHILD HEALTH SERVICES TARGETED CASE MANAGEMENT COVERAGE AND LIMITATIONS HANDBOOK
Florida Medicaid CHILD HEALTH SERVICES TARGETED CASE MANAGEMENT COVERAGE AND LIMITATIONS HANDBOOK Agency for Health Care Administration June 2012 UPDATE LOG CHILD HEALTH SERVICES TARGETED CASE MANAGEMENT
More informationOverview: Mental Health Case Management and 1915(i) Chapter I
Overview: Mental Health Case Management and 1915(i) Chapter I 1 Home And Community-Based Services: Intensive Behavioral Health Services For Children, Youth and Families Beacon Health Options Maryland began
More informationCredentialing Standards
Credentialing Standards Presenters: Mei Ling Christopher Veronica Harris Royal Agenda Definitions vs. 2017 Regulatory Updates Understanding the Standards SB 137 Provider Directories Reminders Questions
More informationPreadmission Screening for Medicaid Certified Nursing Facilities. Department of Human Services Med-QUEST Division 2016
Preadmission Screening for Medicaid Certified Nursing Facilities Department of Human Services Med-QUEST Division 2016 1 Agenda History Specialized Services Hawaii s Revised Level I Screening Tool Level
More informationSETTLEMENT AGREEMENT I. FRAMEWORK OF THE AGREEMENT
SETTLEMENT AGREEMENT BETWEEN THE UNITED STATES DEPARTMENT OF JUSTICE AND THE CITY AND COUNTY OF SAN FRANCISCO REGARDING THE LAGUNA HONDA HOSPITAL AND REHABILITATION CENTER SETTLEMENT AGREEMENT The United
More informationAdult Protective Services Referrals Operations Manual. Developed by the Department of Elder Affairs And The Department of Children and Families
Adult Protective Services Referrals Operations Manual Developed by the Department of Elder Affairs And The Department of Children and Families December 11, 2007 Table of Contents Appropriate Referrals...
More informationProvider Manual Supplement
Provider Manual Supplement Tennessee CHOICES Amerigroup Community Care 1-866-840-4991 providers.amerigroup.com/tn 02.16 TABLE OF CONTENTS Introduction... - 4 - TennCare CHOICES Long-Term Services & Supports...
More informationNew Level of Care (LOC) Rule Webinar Frequently Asked Questions (FAQ)
During the month of March, 2012, ODJFS conducted a series of training Webinars called "New Medicaid Level of Care Rule Changes." Because hundreds of individuals participated in each Webinar session, taking
More informationDisenrollment. Participants and Plan s Rights and Responsibilities upon. Disenrollment. Department:
Department: Policy Purpose: Policy Sponsor: Review Cycle: Approval: Participants and Plan s Rights and Responsibilities upon Disenrollment Intake and Enrollment To ensure timely identification and resolution
More informationAssociates in ear, nose, throat/ Head & Neck surgery, pllc
Associates in ear, nose, throat/ Head & Neck surgery, pllc Notice of Privacy Practices for Protected Health Information Associates in Ear, Nose & Throat (ENT) is providing this Notice to comply with the
More informationNF PTAC Dec 12, 2017 PASRR. Specialized Services
NF PTAC Dec 12, 2017 PASRR Specialized Services 2 Session Topics Hot Topics: Certification Revised Chapter 19 BB Rules Taking charge of your PASRR knowledge Reminders: IDT membership Preadmission Referring
More informationThe Moving Target of Successful Long Term Care Therapy Reimbursement: Audits, Denials, and Appeals 8/13/2018 OBJECTIVES
The Moving Target of Successful Long Term Care Therapy Reimbursement: Audits, Denials, and Appeals Becky Finni, DHS, OTR/L Kim Karr, BS, OTR/L Senior Appeal Specialists for RehabCare OBJECTIVES Understand
More informationCHAPTER 35. MEDICAL ASSISTANCE FOR ADULTS AND CHILDREN-ELIGIBILITY SUBCHAPTER 15. PERSONAL CARE SERVICES
CHAPTER 35. MEDICAL ASSISTANCE FOR ADULTS AND CHILDREN-ELIGIBILITY SUBCHAPTER 15. PERSONAL CARE SERVICES 317:35-15-8.1. Agency Personal Care services; billing, and issue resolution (4-1-2009) The ADvantage
More informationDEVELOPMENTAL PROGRAMS BULLETIN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
DEVELOPMENTAL PROGRAMS BULLETIN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE DATE OF ISSUE January 30, 2008 EFFECTIVE DATE January 1, 2008 NUMBER 00-08-03 SUBJECT: Procedures for Service Delivery
More informationAction Request Transmittal
Aging and People with Disabilities Action Request Transmittal Mike McCormick Number: APD-AR-17-041 Authorized signature Issue date: 7/12/2017 Topic: Long Term Care Due date: Subject: Identifying Client
More informationAppendix 2 Corporate Adult Family Homes
Appendix 2 Corporate Adult Family Homes SCOPE OF SERVICE The service is a non-owner occupied Adult Family Home in which 1 4 adults, not related to the licensee reside. Care, treatment or services above
More informationNew Federal Regulations for Home and Community-Based Services Program: Offers Greater Autonomy, Choice, and Independence
New Federal Regulations for Home and Community-Based Services Program: Offers Greater Autonomy, Choice, and Independence The Centers for Medicare and Medicaid Services (CMS) has published a Final Rule
More informationCHILDREN S RECORD AUDIT TOOL
Date of Audit: Netsmart ID #: Date of enrollment: Agency: Auditor: Score: STANDARD Yes No NA Located In: Recommendations Additional Comments ELIGIBILITY Chart EHR Recent claims and clinical data document
More informationIowa PASRR for Providers. A brief introduction to
Iowa PASRR for Providers A brief introduction to Iowa s PASRR process 1 Why are PASRR Level I screens and Level II evaluations important? Mental health services in nursing facilities make a difference
More informationNursing facility-based level of care assessment and determination process for children.
ACTION: Original DATE: 10/27/2017 9:30 AM 5160-3-10 Nursing facility-based level of care assessment and determination process for children. (A) This rule describes the processes and timeframes for a child's
More informationSECTION 672- STANDARDS OF PROMPTNESS. Coordination. Respond to telephone
SECTION 672- STANDARDS OF PROMPTNESS SUMMARY STATEMENT: BASIC CONSIDERATIONS PROCEDURES Care coordinators complete CCSP activities within the standards of promptness guidelines determined by the Division
More informationHome Health Care Provider Training
Home Health Care Provider Training Presented by New Mexico Medicaid Utilization Review Blue Cross Blue Shield of New Mexico 2009 Medicaid Utilization Review Blue Cross Blue Shield of New Mexico (BCBSNM)
More informationMDS 3.0 Section Q Implementation Questions and Answers from Informing LTC Choice conference and s September 22, 2010
MDS 3.0 Section Q Implementation Questions and Answers from Informing LTC Choice conference and emails September 22, 2010 DATA USE AGREEMENTS (DUA) 1. Do state agencies need a Data Use Agreement to implement
More informationAppeals Policy. Approved by: Tina Lee Approval Date: 3/30/15. Approval Date: 4/6/15
Appeals Policy Department: Compliance Policy Number: C205 Attachments: Attachment A- Attachment B- Effective Date: 1/1/14 Revision Date: 5/19/14, 3/17/15, 3/30/15 Title of Policy: Reference(s): NCQA UM
More informationDD WAIVER. New Mexico Medicaid Utilization Review. Presented by. Blue Cross Blue Shield of New Mexico
2009 DD WAIVER Presented by New Mexico Medicaid Utilization Review Blue Cross Blue Shield of New Mexico Prior Authorization Requests US Mail P.O. Box 27950 Albuquerque NM 87125-7950 Delivery services (e.g.,
More informationWhat is a retrospective Level of Care and what is the process for submitting a retrospective Level of Care?
Last updated 9/14/2011 The following are Frequently Asked Questions (FAQs) associated with Connecticut Level of Care and PASRR Level I/II processes. To read to the corresponding response to the questions
More informationLTC User Guide for Nursing Facility Forms 3618/3619 and Minimum Data Set/ Long Term Care Medicaid Information (MDS/LTCMI)
LTC User Guide for Nursing Facility Forms 3618/3619 and Minimum Data Set/ Long Term Care Medicaid Information (MDS/LTCMI) v 2018 0614 Contents Learning Objectives...1 Sequencing of Documents...2 Admission
More informationMoving Home Minnesota Demonstration and Supplemental Services Table
Demonstration and Supplemental s Table Supplemental (S) D - Transition Planning and Transition Coordination s Identifying and engaging program participants; Developing a transition plan; Implementing the
More informationHealth Management Policy
Health Management Policy Policy Number: 0101 Effective Date: 4/1/18 Policy Title: Circumvention of PPS/Readmission Review Applies To: Generations Advantage Purpose: The Martin s Point Health Care Medicare
More informationAdult Protective Services Referrals Operations Manual
Adult Protective Services Referrals Operations Manual Developed by the Department of Elder Affairs and The Department of Children and Families and The Area Agencies on Aging November 2012 Table of Contents
More informationNursing Home and Hospice Billing Training Presented by Field Representatives Kinzie Baker & Liz Lovell-Poynor
Nursing Home and Hospice Billing Training 2018 Presented by Field Representatives Kinzie Baker & Liz Lovell-Poynor Wyoming Medicaid General Manual Chapter 1- General Information Chapter 2-Getting Help
More informationNF PTAC March 13, 2018 PASRR. Specialized Services
NF PTAC March 13, 2018 PASRR Specialized Services Session Topics Hot Topics: Certification Form 1013 Issues Errors on PL1s NFSS Status Technical Support 2 3 Certification NFs must indicate they can meet
More informationSUBJECT Supported Living Cost Containment Measures YEAR PROCEDURE NUMBER APD
SUBJECT Supported Living Cost Containment Measures YEAR 1-8-08 PROCEDURE NUMBER APD 17-001 PROCEDURE MAINTENANCE ADMINISTRATOR: Home and Community-Based Services PURPOSE: This operating procedure describes
More informationPolicy Number: Title: Abstract Purpose: Policy Detail:
- 1 Policy Number: N03402 Title: NHIC-Grievance Resolution Policy and Procedure for Medicare Advantage Plans Abstract Purpose: To define the Network Health Insurance Corporation s grievance process for
More informationDepartment of Vermont Health Access Department of Mental Health. dvha.vermont.gov/ vtmedicaid.com/#/home
Department of Vermont Health Access Department of Mental Health dvha.vermont.gov/ vtmedicaid.com/#/home ... 2 INTRODUCTION... 3 CHILDREN AND ADOLESCENT PSYCHIATRIC ADMISSIONS... 7 VOLUNTARY ADULTS (NON-CRT)
More informationProvider Alert April, 2010 Common Audit Findings
Provider Alert April, 2010 Common Audit Findings OMHC Audit Item#/Description 2. If the consumer is a child for whom courts have adjudicated their legal status or an adult with a legal guardian, are there
More information