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 of Aging Services and DMA. Care coordination, intake and screening, are required to perform all case management activities within the designated time frame according to waiver and policy requirements. The Division of Aging/CCSP and the AAA monitor these activities through the Aging Information System and individual case monitoring. The following Chart 672.1 gives the program standards of promptness: Chart 672.1 Standards of Promptness for Care IF Respond to telephone inquiry regarding CCSP service Screen a referral Re-screen waitlisted clients Notify client referral source of client denial/ineligibility after telephone screening RN completes initial assessments RN completes MDS HC- 9 documentation Advise applicant of denial during screening Written notification to the applicant of non-entry into CCSP due to ineligibility, i.e. financial ineligibility or ineligible for services Determine initial level of care Coordination THEN Standard of Promptness is within: 24 hours after telephone inquiry receiving referral Within 120 days Immediately receiving referral from AAA/intake and screening unit face to face assessment visit NOTE: three additional business days for upload to GMCF Immediate verbal notice 3 business days after screening completed Upon return of the loc from the Physician. NOTE: LOC PA is valid for CCSP Care Coordination Manual MT 2016-01 Page 672-1
(con t) Send level of care denial (first notice) Applicant sends additional medical information Send level of care denial (second notice) Begin level of care redetermination process Assign LOC at reassessment Complete reassessments when client situations change for the following reasons: Emergency Significant change in client condition or situation Adding another skilled service Terminating a skilled service Adding non-skilled service up to 365 days. Remind physician offices that services can t start until the return of the signed 5588. NOTE: RN assigns the LOC within 24 hours of receipt of the LOC page signed by the physician. 10 working days after LOC denial 10 calendar days after receipt of LOC denial notice 10 working days after the second LOC denial 2 months before expiration of the level of care NOTE: May begin as early as 3 months prior to expiration of LOC. Upon return of the loc from the Physician. NOTE: LOC PA is valid for up to 365 days. Remind physician offices that services may be interrupted until the return of the signed 5588. 2 business days after 10 business days after As needed CCSP Care Coordination Manual MT 2016-01 Page 672-2
(con t) Move to another PSA 5 business days (if client needs a change in service) Complete reassessments when requested by: CCSP service provider Utilization Review analyst Legal Services Office Administrative Law Judge Admit an emergency client Broker services for an emergency client Broker services for a new client Telephone follow-up with a client after service brokered to assess service compliance, client satisfaction Send client a Participation Form Send referral packet to provider NOTE: Packets can be faxed or sent by secure electronic mail. The provider s SOP begins the day they receive. Complete and return Community Care Notification Form (CCNF), From 6500, to provider Send CCSP Communicator (CCC) and LOC to DFCS Initial review of Comprehensive Care Plan 10 business days after 2 business days after referral received 24 hours after LOC assigned 3 business days after LOC assigned Within 10 business days after service brokered Applies to initial brokering and subsequent changes in services brokering-use Resource and Tracking screen in AIMS to track date and add to CC Tickler 3 business days after brokering services 24 hours of brokering services 3 business days after receipt from provider 3 business days from receipt of first CCNF 30 days of admission (LOC certification date) CCSP Care Coordination Manual MT 2016-01 Page 672-3
(con t) MFP admissions require monthly face to face contact for the first three months following discharge from the facility. NOTE: The initial visit equals the 30 day care plan review and the third visit will equal the 90 day care plan review Provide signed copy of the initial Comprehensive Care Plan to client NOTE: Copies of reassessment care plans and care plan changes without a reassessment are provided to client Subsequent Comprehensive Care Plan reviews Complete a new care plan that includes exact service orders using only standardized abbreviations ( No change notation may not be used) Send completed care plan to the service provider(s) Notify Adult Protective Services (APS), local law enforcement and Division of Aging Services (DAS) Section Manager (or designee) suspected abuse, neglect or exploitation NOTE: If the client is in an ALS, notify HFR and LTCO instead of APS Documentation of transfer in client electronic record when client moves to another PSA Within 30 days of client admission Within 10 business days of the LOC recertification or change in services Quarterly (within 90 days of the initial care plan review) At care plan review time and when client services change 3 days prior to the expiration date of the current care plan Immediately 2 business days after notification of transfer CCSP Care Coordination Manual MT 2016-01 Page 672-4
Transfer of hard copy client record when client moves to another PSA address Change documentation has been entered into AIMS REFERENCES Chapter 300, Section 348; Chapter 600, Care Coordination; Chapter 700, Case Management; Chapter 800, Reassessment CCSP Care Coordination Manual MT 2016-01 Page 672-5