Case Management Refresher Training Presented by: Senior Connection - PowerPoint PPT Presentation

Case Management Refresher Training Presented by: Senior Connection Center, Inc. February 18, 2016 1

A GENDA Every ‘star’ has a corresponding handout in back of manual... • Introductions 1 • ADRC Information and Referral Overview • SHINE Overview • SMMC LTC Overview • Break • SGR Case Narratives • APS Referrals • Performance Outcome Measure Overview • Client Satisfaction • Q & A 2

Aging and Disability Resource Center - Information & Referral Overview Zeke Barbosa, Information & Referral Manager 3

ADRC- Information & Referral Department ❏ The Elder Helpline serves 5 Counties in West Central Florida: Hillsborough, Polk, Manatee, Highlands, and Hardee. ❏ Our specialists are certified by AIRS – Alliance of Information and Referrals “AIRS Certification is the System – a professional professional credentialing program for individuals working association of more than within the I&R sector of human 5000 individuals and services” (AIRS.org) 4 organizations (AIRS.ORG)

ADRC- Information & Referral Department ❏ The I&R Department is the “front door” to the S enior C onnection C enter. ❏ O ur I&R S pecialists assist people in finding the services they need while explaining the clients’ options . ❏ Empower them to make good decisions for 5 themselves.

ADRC- Information & Referral Department • I&R includes the following: Assessment, Information G iving, R eferral G iving, Advocacy, Follow ups, esource Database , etc. R • I&R specialists can provide information on community resources such as housing, transportation, food pantries, SNA P, & volunteer associations (when available) etc. • The Information & Referral Department can be reached directly at 1.800.336.2226 6

Community Resource Database at Your Fingertips • The database used by our I&R Department is available online • If you have knowledge on any potential resources please refer to the inclusion and exclusion criteria handout for application criteria and guidelines. 7 2 • Refer to Handouts.

Kyrie-Leigh Chambliss SHINE Liaison/Volunteer Manager 8

฀ What can S S H HINE do for your clients? ◦ Free, unbiased, and confidential Medicare counseling ◦ Help with Medicare questions and plan comparisons ◦ A ssistance with Medicare claims, appeals and billing issues ◦ Prescription A ssistance ◦ L IS and MSP A pplications ◦ Educational presentations 9

฀ Call 1-800-963-5337 ( option 2 for SHINE) ฀ All calls are screened by Data Entry Operators and then assigned to a SHINE Counselor. ฀ SHINE counselors can counsel over the phone or by appointment at designated counseling sites. ฀ For more information or to submit an online request for assistance, please visit: www.floridashine.org ฀ “Your help saved me money every month.. Money I desperately needed to live on.” ฀ “SHINE is the best thing going for seniors. Your staff helped me in an increasingly hostile world.” ฀ “I was greatly relieved after the services. Everyone was very helpful and showed concern. Thank you. I appreciate your help.” ฀ “My counselor was very nice and patient with me. Going over 17 medicines and finding the best one for me is a big job. I am 78 and can no longer do it myself. Thank you very much.” 10

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TOPICS WE WIL L COV ER • SMMC L TC Overview • A DRC SMMC L TC Functions • SMMC L TC Enrollment Process • How Can Y ou Help? • Helpful Tips • SMMC L TC FA Qs • EMS Release Clean Up Tracking • A dditional Topics • SCC Contact Information • A dditional Resources 12

SMMC L TC OV ERV IEW 3 What is it? ● It stands for Statewide Medicaid Managed Care L ong Term Care (SMMC L TC). ● A system through which Medicaid recipients who qualify and become enrolled receive long- term care services through a managed care plan. ● It has two key components: L ong Term Care (implemented A ugust 2013 – March 2014) and Managed Medical A ssistance (implementation in mid 2014) 13

SMMC L TC ENROL L MENT REQUIREMENTS 4 • Recipients residing in a nursing facility must have: • A nursing home level of care from Comprehensive A ssessment and Review for L ong Term Care Services (CA RES) and • Medicaid eligibility approval from DCF • Recipients residing in the home or community must have: • A nursing home level of care from CA RES; • Been released from the waitlist; and • Filed a Medicaid application 14

A DRC SMMC L TC FUNCTIONS • L TC Program Education • Utilization of new HCBS Client Intake and Screening A ssessment • Referral for Nursing Home Placement A ssistance for community • Waiting L ist Release • L TC Program Education and Screening (in home) • Medicaid Eligibility A pplication A ssistance • A ssist Recipients with G rievances/Complaints • A nnual Re- Screening for waiting list individuals • Quality A ssurance 15

SMMC L TC ENROL L MENT PROCESS 5 • A DRC is the gatekeeper for all new consumers needing home and community based services. • A DRC conducts Intake & Screening for eligibility, education on managed care options and other program and service resources. • Consumers are prioritized based on greatest need and placed on waitlist (A ssessed Priority Consumer L ist). • Consumers who receive Rank 5 or higher are sent a Form 5000- 3008. 16

SMMC L TC ENROL L MENT PROCESS • Consumer information is sent to DOEA who maintains statewide waitlist and approves consumers for waitlist removal/ release. • Once consumer is released, A DRC assists consumers (if needed) to file A ccess Medicaid A pplication for financial eligibility with DCF, and obtains Form 5000- 3008 from Doctor. • Concurrently, the A DRC refers cases to CA RES to complete the 701B A ssessment and generate a L evel of Care (L OC). 17

SMMC L TC ENROL L MENT PROCESS • CA RES feeds L OC through Health Track System to Enrollment Broker (EB). • A DRC sends a Form 2515 to DCF to notify them that an L OC determination was made. • DCF electronically feeds eligibility information through Health Track System to the EB. • Once financial eligibility and medical eligibility are approved, the consumer is enrolled by the EB with their voluntary choice or mandatory assignment to a managed care organization for services. 18

S MMC LTC : HO W C AN YO U HE LP? • Refer consumers to the SCC Elder Helpline for general questions related to SMMC L TC. • A ssist consumers with the Medicaid Eligibility process, as needed • Submit technical questions to L TC Coordinators and/or Manager to help resolve consumer eligibility issues. • Includes SMMC L TC lost eligibility (SIXT) issues • Refer consumers to Enrollment Broker/Choice Counselors for assistance with choosing an SMMC L TC plan. • See next slide for helpful tips. 19

HEL PFUL TIPS: SMMC L TC ENROL L MENT BROKER • There are three ways to enroll after Medicaid eligibility is established: ● Enroll Online at www.flmedicaidmanagedcare.com ● Call the choice counseling call center at 1- 877- 711- 3662, and speak to a choice counselor ● Request an in- person meeting: Call the above call center or select “schedule an appointment” on the above website. 20

ADDITIO NAL TO PIC S SMMC L TC: INEL IG IBIL ITY • Ineligibility = failure to meet financial requirements for Medicaid eligibility as determined by DC F and/ or medical LO C eligibility requirements as determined by C AR E S . • What happens to a C C E AC TV consumer who is found ineligible for the S MMC LTC Program? ● They may remain CCE A CTV . TO BE, OR NOT TO BE... 21

ADDITIO NAL TO PIC S FREQUENTL Y A SKED QUESTIONS • C an consumers that were terminated for failure to follow through with S MMC LTC eligibility process be eligible for enrollment in C C E ? ● Consumers can only be enrolled in CCE, or keep their current CCE services, if the individual completed the eligibility process for SMMC L TC, and were determined to be ineligible. • What happens to CCE A CTV consumers who refuse to complete the SMMC L TC eligibility process? • The CCE contract requires that the consumers’ CCE services be terminated. • Exception: Incompletion of eligibility process is not the fault of the consumer , i.e. documented attempts made to obtain Form 5000- 3008. 22

ADDITIO NAL TO PIC S SMMC L TC: RETURNING TO PIPEL INE • C an C C E AC TV consumers who are terminated from C C E for refusal to pursue S MMC LTC eligibility return to the pipeline? ● The consumer may return to the pipeline for SMMC L TC, if they were not previously terminated from the SMMC L TC pipeline for non- compliance. ● If the consumer was previously terminated from the pipeline for non- compliance, they must be placed back on the waitlist for 23 SMMC L TC.