J J January 30, 2013 January 30, 2013 30 2013 30 2013 Presented by: West Central Florida Area Agency on Aging (WCFAAA) 1 Introductions Program Updates Enrollment Management Medicaid Benefit Counselor Role in your it community Adult Protective Service SGR Case Narratives Performance Outcome Measure Overview Medicaid Waiver Concerns & Changes Client Satisfaction Kudos Q & A 2 ADRC Enrollment Management Martha Caron is no longer the ADRC Enrollment Manager C Can you believe b li she decided to give up the big office? 3 1
Effective December 2012 – The DOEA implemented a new Enrollment Management System (EMS) for the ADA and AL Waiver programs. WCFAAA now receives a list of individuals from the DOEA titled “EMS Release” The individuals on the EMS Release are current Medicaid Waiver APCL and must be tracked/reported 4 St Stat ate ADRC has separated Medica Medi caid id Gener General l the Medicaid Waiver Waiver Waive Rev Revenu nue (MW) and State General Revenue (SGR) Ca e Care Plan a Lauren au e Kristina st a Enrollment Christy Management Authorization and Care Enrollment Lauren** Katie Plan Review Process **MW Program EMS Requires ADRC to contact client prior to case manager referral 5 Complete the Initial Assessment, Care Plan and related documents to enroll consumer Determine if assistance is needed in obtaining Medicaid and Level of Care obtaining Medicaid and Level of Care eligibility. If yes, make proper referrals (i.e. CARES Unit, RFA, MBC, etc.) ◦ Have CIRTS Updated, if enrolling in MW (ADA or AL) program, terminate any other waiting list enrollment lines. 6 2
Lauren Cury will be responsible for providing each lead agency with the Enrollment Management System (EMS) Report. The EMS report is generated by the DOEA and p provides the ADRC with the clients authorized for enrollment into the MW program (ADA or AL). ADRC contacts client prior to referral. Lauren will then disseminate clients to Lead Agencies for enrollment Monthly tracking and reporting on client status is required. 7 Complete the 701B Assessment If the 701B Priority Score is 1 or 2: ◦ return to ADRC ◦ terminate APPL line in CIRTS terminate APPL line in CIRTS ◦ restore APCL status If the client is not to be served for any other reason, terminate APPL and notify ADRC. 8 If services care planned exceed risk level/threshold, submit care plan review to Program Manager. CM can initiate services up to the care plan risk services up to the care plan risk level/threshold. Make client ACTV in CIRTS upon approval of care plan services. ◦ If client is on waiting list for multiple programs and their needs are already being met, close out the other program lines. 9 3
Program Managers, Christy Wright and Kristina Melling will be responsible for reviewing all SGR Care Plan Review Requests Case Managers can start services for released clients up to Risk Level/Cost Threshold. Clients up to Risk Level/Cost Threshold do not need to be approved by ADRC. 10 Medicaid Waiver Specialist, Lauren Cury, will be responsible for reviewing all Medicaid Waiver Care Plan Review Requests Clients up to Risk Level/Cost Threshold do Clients up to Risk Level/Cost Threshold do not need to be approved by ADRC. Clients that exceed the Risk Level/Cost Threshold can have services initiated up to the threshold. MWS is to approve all services once threshold is exceeded. 11 Risk Score Range --- Risk Score Range --- Annual Annual E Est. Care t. Care Pl Plan Co an Cost: > 0 to 7 = Risk Level 1 --- $3,493.92 >8 to 15 = Risk Level 2 --- $5,646.30 8 15 Ri k L l 2 $5 646 30 >16 to 26 = Risk Level 3 --- $7,246.17 >27 to 52 = Risk Level 4 --- $9,673.18 >53 to 100 = Risk Level 5 --- $14,270.86 12 4
Services implemented must must be offered in the program for which the client is released. EXAMPLE: 1. Client is waitlisted for: CCE & HCE Cl l d f CC & C ◦ ADRC releases client for CCE only ◦ CCE services can be started but not HCE subsidy HCE can only be started when released by AAA ◦ 13 Once a level of care planned services has been approved by WCFAAA, further approvals are not required unless the units of service are to be increased. 14 Risk and/or Priority Score not provided Program that services are requested under not indicated Services requested that are not available S i t d th t t il bl under the authorized program Inadequate justification provided for services requested Justification states declining condition but no indication of updated assessment Inc Incorrect/I rrect/Illegib llegible c e comp mpletion letion of of form form 15 5
Transition Case Manager will conduct face to face visit within 10 business days of receiving referral from the ARC TCM will update CARES 701B and complete nursing home transition plan nursing home transition plan TCM will notify CARES via the NHT plan of client’s estimated discharge date and submit updated 701B with request for LOC via the DOEA-CARES form 603 16 NHT plan must be signed by TCM and client or designated representative when determination has been made that client is able to safely return to community Once Notice of Case Action is obtained from DCF, O C C , TCM must submit NOA to the ARC Upon receipt of the LOC, the TCM must submit Form 2515 to DCF and request ex parte Within 14 days of the waiver start date, the TCM must follow up with face to face visit 17 In order to bill, the following requirements must be met per the waiver handbooks: Client resided in nursing home 60 consecutive days by the time they discharged discharged No more than 20 hrs of TCM can be billed within 6 months of waiver start date Client has completed and signed NHT plan Upon nursing home discharge, client is enrolled into ADA or ALW waiver 18 6
If client is unable to transition after TCM services, the TCM will finalize the NHT plan and forward it to CARES for due process notification. Both the TCM and client or designated representative must sign the designated representative must sign the NHT plan. In the case that a client cannot transition out of the nursing home and into ADA or ALE waiver, transition case management cannot be billed. 19 Monthly Provider Network Report DOEA Critical Incident Report Monthly Adverse Incident M hl Ad I id Report Personal Goal Setting (PGS) Tool 20 Identify, address and seek to prevent occurrence of abuse, neglect and exploitation by collecting A.I. reports within 48 hours of occurrence. Report situation to your immediate supervisor Report situation to your immediate supervisor and follow WCFAAA Reporting requirements. Information provided needs to document what occurred and any necessary services that were provided to resolve the health, safety and welfare issues. 21 7
Working Together with Case Managers 22 Terria Cumberbatch - serves Hillsborough and Manatee Counties Carol Keen – serves Polk, Highlands and Hardee Counties 23 The MBC takes care of the Medicaid eligibility portion and can save you time. The MBC expedites these applications- process time after submitting the application is 3-7 days (depending on county) as opposed to 45 days. MBC’s follow up with DCF for Notices of Case Action (NOCA’s) MBC’s are able to research clients in DCF’s FLORIDA system as well as FLMMIS 24 8
What is an ex parte? An ex parte is a switch from one Medicaid type to another. Who can ex parte? Anyone with a “Full Medicaid” (Waiver, ICP, A i h “F ll M di id” (W i ICP Hospice, MMS, Share of Cost). What forms are needed for ex parte? ADRC Referral Form, LOC, both pa both pages of the 2515 and sometimes bank statements. 25 Who can ex parte? Anyone that has Share of Cost, MMS, ICP, Hospice (Community or ICP) or any type of Waiver. What forms are needed for ex parte? Wh f d d f ? ADRC Referral Form, LOC, both pa both pages of the 2515, and sometimes bank statements. 26 New ADRC Referral Form-faxed to I&S Fax (see form in appendix) Please complete all sections on this form, including the date 3008 was received. Th The MBC Documentation List can be given MBC D t ti Li t b i directly to the client or care giver (This form is in appendix). 27 9
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