Case Management Refresher Training

1. Case ManagementRefresher Training January 31, 2012 Presented by: West Central Florida Area Agency on Aging (WCFAAA)

2. Agenda • Introductions • Program Updates • Enrollment Management • Medicaid Benefit Counselor Role in your community • Adult Protective Service Referrals • SGR Case Narratives • Medicaid Waiver Concerns and Great CM Documentation • Performance Outcome Measure Overview • Client Satisfaction • Q & A • Kudos

3. ARC Enrollment Management • Martha Caron is the ARC Enrollment Manager This is her office - NOT!

4. ARC Enrollment Management • Martha’s responsibilities : • Evaluates the availability of State funds • Determines how many clients to serve • Releases highest priority clients for service • Tracks start date of service delivery • Reviews Care Plans submitted for approval

5. SGR Care Plan Review Procedures • Case Managers can start services for released clients up to Risk Level/Cost Threshold. • Does NOT apply to MedWaiver clients; advance approval is still required.

6. Risk Level / Cost Thresholds Risk Score Range --- Annual Est. Care Plan Cost: > 0 to 7 = Risk Level 1 --- $3,493.92 >8 to 15 = Risk Level 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

7. SGR Care Plan Review Procedures • Services implemented must be offered in the program for which the client is released. EXAMPLE: 1. Client is waitlisted for: CCE & HCE 2. AAA releases client for CCE only 3. CCE services can be started but not HCE subsidy 4. HCE can only be started when released by AAA

8. SGR Care Plan Review Procedurescont … • 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.

9. The Case Manager’s role in the ARC enrollment process • Complete the 701B Assessment • If the 701B Priority Score is 1 or 2: • return to ARC • terminate APPL line in CIRTS • restore APCL status • If the client is not to be served for any other reason, terminate APPL and notify ARC.

10. The Case Manager’s role in the ARC enrollment process – cont … • If priority score is 5, 4 or 3, submit Care Plan for services needed by the authorized program(s). • 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.

11. Common Problems with Care Plan Reviews • Risk and/or Priority Score not provided • Program that services are requested under not indicated • Services requested that are not available under the authorized program • Inadequate justification provided for services requested • Justification states declining condition but no indication of updated assessment • Incorrect/Illegible completion of form

12. Nursing Home Transition Case Management Procedures cont … • 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 • 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

13. Nursing Home Transition Case Management Procedures cont … • 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, 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

14. Nursing Home Transition Case Management Procedures cont … 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 • 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

15. Nursing Home Transition Case Management Procedures cont … • 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 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.

16. Medicaid Benefits Counselors Working Together with Case Managers

17. IntroductionMedicaid Benefits Counselors • Kristen ‘Dani’ Gray - serves Hillsborough and Manatee Counties • Carol Keen – serves Polk, Highlands and Hardee Counties

18. How does using the MBC help you? • 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

19. Ex parte in 6A • 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, Hospice, MMS). • What forms are needed for ex parte? ARC Referral Form, LOC, both pages of the 2515 and sometimes bank statements.

20. Ex parte in 6B • 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? ARC Referral Form, LOC, both pages of the 2515, and sometimes bank statements.

21. Documents Needed for RFA: • NewARC Referral Form-faxed to I&S Fax (see form in appendix) • Please complete all sections on this form, including the date 3008 was received. • The MBC Documentation List can be given directly to the client or care giver (This form is in appendix).

22. Documentation Needed cont…: • Level of Care (LOC) and 2515 indicating Case Manager start date and include the Room and Board rate; • Send any income and asset based information that is available; • Any monthly income that is direct deposited can be excluded from the balance of their bank account for the application month. • Subtract income to get the value of the bank account. • Assets can be excluded as burial contract up to $2,500 (see form in appendix).

23. Qualified Income Trust Accounts • What is a QIT? An account that helps you become eligible when you are over the income limit ($2,094). • How do I set up a QIT? Please see Irrevocable Income Cap Trust form in appendix. An elder law attorney can also assist. • How does it work? Basically, any amount over the gross income limit gets deposited into this account each month.

24. MBC Referral Process • Receive referral from ARC fax line • #888-401-4606 • Research client on DCF Florida, CIRTS and FLMMIS databases; • Call client/caregiver, or facility to discuss income, assets and expenses; • Mail out checklist of verification needed to submit application • checklist includes contact info & instructions to call MBC once all verification is together.

25. MBC Referral Process cont… • Client can mail or fax verification if they are able and have a current DCF Medicaid case in process. • If not, MBC will conduct a home visit to gather all verification. • Application is submitted and all verification is faxed to DCF.

26. Commonly Asked Questions: • Direct enroll clients-SSI is active, need LOC and verification that the client receives SSI. DCF does not process these clients and you WILL NOT get a NOCA. • Income must be verified from the source. Bank statements may not be used. • When whole life policies have face values that exceed $2500, the cash value must be verified from the source.

27. Reports • Provider Log: CM’s can use this tool to check the current status of referrals made to MBC’s. • APPL Report: A tool used to track clients that have been released for waiver, but have not yet had eligibility established.

28. MBC Contact Information 6A Kristen ‘Dani’ Gray 813-676-5601 or 1-866-827-6095 Option 1 Referral Fax 888-401-4606 Fax verification to: 813-600-1997

29. MBC Contact Information 6B Carol Keen 863-413-3473 or 1-866-827-6095 Option 2 Referral Fax 1-888-401-4606 Fax verification to 863-413-3475

30. Adult Protective Service Referrals

31. Have you completed this training online?

32. APS Referral ProcessTraining Tutorial • Required of all Case Managers • Online on the ARTT System • If you are a new Case Manager and have not taken this training module, please arrange to do so with your supervisor.

33. The ARTT Web site is pictured to the left. The ARTT website address is: https://199.250.26.79/reports/artt/artt.html

34. In 2011 - • Services routinely provided within 72 hours ! • Improved Documentation with better detail • No findings by DOEA monitors on APS files!

35. Opportunities for More Improvement • Care Plan ALL services for 31 days, then revise for remaining 11 months if CM & API agree to continue services. • Problem continues: Many instances of only CM care planned for 1 month and all other services care planned for 12 months!

36. Remember to . . . • Update ARTT within 72 hours and include actual dates of services. • Include Assessment Summary page with all assessments and updates. • Call API within 24 hours if client refused or delayed services. • Call API if all recommended services were not ordered.

37. APS File Notes Should Contain: • Specific dates individual was contacted by CM during the 31 days following referral. • Specific dates the individual was assessed • Individual’s abilities, needs and deficiencies observed during all assessments

38. APS File Notes Should Contain: • specific services and service dates for services provided during 72 hours following referral (include NDP– non-DOEA) • services provided and frequency at which they were provided during 31 days following referral • all contact and discussions with APS staff

39. APS File Notes Should Contain: • If services could not be provided for reasons beyond control of provider, document all actions taken in an attempt to provide services and/or contact the referred individual • If services were delayed, document why, when services began, and which services were provided. • CM must staff service delay issues with API immediately. • If the API and CM disagree on need for services requested by API, the CM Sup and API Sup jointly review and resolve.

40. APS File Notes Should Contain: • all contacts and discussions with Nursing Home Diversion providers (if applicable) • when follow-ups are performed • AT A MINIMUM: • before 14 calendar days to ensure services started ( call to client) • By 31st day to determine if services are still needed (call to API)

41. APS Referrals for Existing Clients • Update the current 701B by making hand-written changes on the actual 701B hard copy. • Update Assessment Date (#4d) to current date. (this does not change the initial referral date) • Update Assessment Type (#4f) to ‘U’ for update. • Update Referral Source (#11) to ‘A’ for APS • Update CIRTS with changes noted during re-assessment. • Print out new turnaround report and put into file.

42. 14 Days Call to Client • Made sometime before 14th day to ensure that services have started. • If CM has already received confirmation of service delivery prior to day 14, no need to make additional call on the 14th day. • Calls should be documented and include date that services started.

43. APS Decision Point: 31 Days • Continue or terminate services? “Need” vs. “Abuse, Neglect, Exploitation” ? ? ? ?

44. 31 Day Call with API • Before or on 31st day, CM must speak to API to determine service continuance. Remember to document call attempts and messages left. • If the call is delayed after the 31st day, an explanation as to why must be included in the notes.

45. Items to consider when determining continuation of services for an APS client • Is the client likely to be a victim of Abuse, Neglect or Exploitation if services ended ? • Risk score –likelihood of nursing home placement without services • Caregiver in the home? • Income/assets – could they privately pay for services?

46. Termination of APS Client Services • Termination letters doNOTneed to be sent to client if it is determined that services should not continue after the 31 day period. • CM should speak with Supervisor, then API, then advise client of termination. • Document case notes regarding decisions and all discussions • Update assessment • Re-write care plan • Put client on APCL list if they would like future services.

47. SGR Documentation • Similar to MW requirements. • DOEA is closely examining files for: • Client eligibility • Use of current forms • Excessive billing • Repetitive or duplicative documentation • Billable vs. non-billable actions • Reasons for Face to face contact

48. Case Narratives OBSERVATIONS! • Case narratives must contain the case manager’s observations of the client: • What did you see in and around the home? • What did the client or caregiver say? • How did the client appear?

49. Case Narratives Note review: At the end of your note, ask yourself the following: Does the note justify the time billed? • If not, why not? • What should be included or left out? • Did you record the appropriate time spent and units of services?

50. Case Narratives Tips to keep in mind… • Case notes should not be repetitive or contradict previously stated documentation. They should provide a fresh picture of the client’s current condition. • Keep in mind that what your write down can potentially be seen by the client, caregiver or other providers. • Case Narratives must justify units billed