HC AAA CMTraining

Document Sample
HC AAA CMTraining Powered By Docstoc
					 Training for Case Managers

  Erika Robbins and Kim Donica

       Office of Ohio Health Plans
Ohio Department of Job & Family Services
               Referral Process
   Referrals to Home Choice

       ODJFS 02361

       Can come from a variety of sources including:
             Consumers
             Family Members
             Advocates
             Nursing Facilities
             AAA’s
             CIL’s
             Referral Process
   ODJFS 02361 is submitted to ODJFS Home
    Choice Intake and Care Coordination Unit
    (HCICCU).

        HCICCU reviews and determines which waiver would most
         appropriately meet consumers needs.

        If PASSPORT, then HCICCU sends a copy of ODJFS
         02361 along with a request for HC assessment to ODA.

            ODA sends referral to AAA for PASSPORT and HOME
             Choice Assessment.
              Referral Process
   If during the course of normal business a
    case manger finds a consumer who appears
    eligible and interested in HOME Choice,

          the case manager can assist the consumer in the
           completion of the ODJFS 02361. The case manager can
           wait to submit form to the ODJFS HCICCU until eligibility
           determination is completed and eligibility packet is
           submitted.
HOME Choice Eligibility Requirements
       OAC 5101:3-51-02
                        Eligibility
To participate consumers must:

     Reside in NF, ICF/MR or hospital for at least 6 months
       Stay must be continuous

       Can include a combination of NF, ICF/MR or hospital stay


             If at time of assessment the consumer does not meet this
              requirement, but it is anticipated they will prior to discharge, the
              consumer could still be eligible for program.
                      Eligibility
To participate consumers must:

     Be receiving Medicaid benefits in the institutional
      setting for at least 30 days prior to discharge.

           Consumers may be admitted to facility under a different
            funding source and switch to Medicaid during the course
            of their stay. As long as 30 day requirement met,
            consumer would meet this eligibility requirement.
                     Eligibility
To participate consumers must:

    Be receiving Medicaid benefits in the
     institutional setting for at least 30 days prior
     to discharge.

         If the consumer does not meet this requirement at
          the time of assessment, but it is anticipated that
          they will prior to discharge, the consumer could still
          be eligible for the program.
                       Eligibility
To participate consumers must:

    Meet an Institutional Level of Care (SLOC, ILOC,
     ICF/MR LOC)

        For purposes of HOME Choice only, ODJFS is
         presuming level of care.

              Consumers do not have to be waiver eligible in order to
               participate in program.
                       Eligibility
To participate consumers must:

     Relocate to a qualified residence

             A home owned or leased by the consumer or family member


             An individually leased and lockable apartment rented by the
              consumer or family member


             A community-based residential setting with no more than four
              unrelated persons
                         Eligibility
   Qualified Residence

          A community-based residential setting with no more than
           four unrelated persons.

              Adult Foster Home (AAA’s)
              Adult Family Home (ODH)
              Non-ICF/MR Residential Facilities (ODMR/DD)
              Type 1 Residential Facilities (ODMH)
              Type 2 Residential Facilities (ODMH)
              Supported Living (ODMR/DD)
                         Eligibility
   Qualified Residence

          A community-based residential setting with no more than
           four unrelated persons.

              Group Home for Children
              Family Foster Home (ODJFS)
              Medically Fragile Foster Home (ODJFS)
              Pre-adoptive Infant Foster Home (ODJFS)
              Specialized Foster Home (ODJFS)
              Treatment Foster Home (ODJFS)
              HCBS Adult Foster Care (ODMR/DD)
                Eligibility

   The case manager assess HOME choice eligibility
    at the same time they are assessing waiver
    eligibility.

   HOME Choice eligibility is determined via the
    HOME Choice Eligibility Checklist.
                  Eligibility
   HOME Choice Eligibility Checklist is fillable-can be
    completed electronically and printed.

   HOME Choice Eligibility Checklist has a section for
    each of the eligibility criteria.

   Includes a place to indicate consumers interest in
    employment.
                         Eligibility
   Home Choice is built on Ohio’s existing
    system of services and supports.

       HOME Choice participants will be enrolled on
        either:
                One of Ohio’s existing HCBS programs

            or

                State Plan Services
                     Eligibility
   The case manager recommends a qualified
    program of services and supports (either waiver
    or state plan); or

       recommends denial of HOME Choice program.

            Transitions Carve-Out Waiver opened for HC consumer’s
             over the age of 60 who have on-going nursing needs that
             cannot be met through existing State Plan nursing
             services.
                         Eligibility

   Approval for program cannot occur until consumer
    actually is discharged from facility and moves into
    qualified residence.

   HOME Choice Participation has three distinct periods
              Pre-Transition Period (period of time where activities occur prior to
               moving to community)
              Demonstration Period (begins the date of discharge and runs 365
               calendar days)
              Post-Demonstration Period (begins day 366 after discharge from
               facility)
                    Eligibility
   If consumer is ineligible for the HOME Choice
    program, the ODJFS HCICCU notifies the
    consumer in writing and issues hearing
    rights.

       All hearings related to the denial of HOME Choice
        are led by the ODJFS HCICCU.
         Informed Consent

   HOME Choice Informed Consent required for all
    HOME Choice participants.

   If case manager determines consumer will be
    eligible for HOME Choice then informed consent
    is completed.
            Informed Consent
   The case manager should review all components
    of informed consent with consumer and/or
    authorized rep and/or guardian and obtain all
    needed signatures.

   Special section that outlines guardian
    requirements.
         Guardian must report level and type of contact with
          consumer during past six months.
           Required information that must be reported to CMS.
               Screening Tools
   TBI Screening Tool

       Can be used as a tool to help identify a possible TBI
        and possible need for referral.

       Brain Injury Association of Ohio is a provider of
        Transition Coordination Services.

             Tool and instructions in tool box.
         Transition Coordination
   If a consumer appears to be eligible for the
    HOME Choice program, the case manager
    assists the consumer in choosing a Transition
    Coordination Provider.

       List of Transition Coordination Providers by
        county
               Consumer has free choice of provider
       Transition Coordination
   Available to all HOME Choice consumers in the
    pre-transition period to help consumers plan and
    arrange for services and supports they will need
    as a result of relocating from an institution to the
    community.

           Transition Coordination is discontinued once a consumer moves
            into the community except in cases where housing navigation may
            be needed during the demonstration period.
       Transition Coordination
   Includes:

          Housing Navigation
          Benefits Coordination
          Assistance with Accessing Transition Services (goods and
           services)
          Linkage with community resources
          Coordinating actual physical move
       Transition Coordination
   Once a consumer chooses a Transition
    Coordination provider, the case manager
    completes the HOME Choice Demonstration
    and Supplemental Service Plan indicating the
    chosen Transition Coordination Provider.
        HOME Choice Service Plan
   Transition Coordination is authorized on the HOME
    Choice Demonstration and Supplemental Service Plan
    by the case manager.

       The HOME Choice Demonstration and Supplemental Service
        Plan is an electronic fillable form.

               Includes basic information such as date, identified need/problem, goal,
                intervention/action, units/date span and provider.


               The case manager submits the HOME Choice Demonstration and
                Supplemental Service Plan to the ODJFS HCICCU.
      Eligibility Determination
   Once assessment process is complete the
    case manager submits to the ODJFS
    HCICCU:
        ODJFS 02361 (if needed)
        HOME Choice Eligibility Checklist
        HOME Choice Informed Consent Form
        HOME Choice Demonstration and Supplemental
         Service Plan
         Eligibility Determination
   The ODJFS HCICCU:

       Reviews and enters information into the HOME Choice
        tracking system.
       Verifies Medicaid eligibility and institutionalization dates.
       Sends a letter notifying consumer of their preliminary
        approval for their program (pending a move to a qualified
        residence).

                Waiver administrative agency cc’d on letter
      Eligibility Determination
   The ODJFS HCICCU:

        Contacts the identified TC provider and verifies their
         willingness/ability to provide transition coordination
         services to the consumer.

        Authorizes the payment of the first deliverable to the
         Transition Coordination provider.

              Notifies the case manager of the TC providers
               acceptance of referral and initiation of TC services.
      Pre-Transition Activities
   During the consumer’s pre-transition phase
    the case manager:

            Schedules and leads team meetings for the purposes of
             discharge planning.

            Works to identify post discharge services and supports
             and develops a service plan.

            Coordinates activities and consumer’s discharge date
             with the transition coordinator.
      Pre-Transition Activities
   During the consumer’s pre-transition phase
    the case manager:

            Assists the consumer with securing service providers.

            Authorizes goods and services on the HOME Choice
             Demonstration and Supplemental Service Plan as
             needed.

            Submits the request for the Quality of Life Survey to the
             ODJFS HCICCU at least two weeks prior to consumer’s
             discharge.
                Enrollment
   The case manager completes the HOME
    Choice Enrollment Form once the consumer
    is actually discharged from the facility.

   Information regarding qualified residence is
    obtained from the transition coordinator.
              Enrollment


   The completed HOME Choice Enrollment Form is
    submitted to the ODJFS HCICCU as soon as
    consumer moves from the facility to the
    community.
                      Enrollment
   The ODJFS HCICCU:

        Reviews the HC Enrollment Form and enters
         information into the HC tracking system.
        Verifies Medicaid eligibility and institutionalization
         dates.
              If at this time consumer has not met either the 30 days of
               Medicaid requirement or the 6 months institutional stay
               they will be denied HOME Choice enrollment.
                   Enrollment
   The ODJFS HCICCU:

        Notifies the consumer and the state waiver
         administrative agency in writing of consumer’s
         enrollment on HOME Choice.

        Starts the 365 Demonstration Period clock.
              Enrollment




   Consumer is enrolled on PASSPORT and
    HOME Choice and services begin.
Questions?
    HOME Choice
Services and Supports
 OAC 5101:3-51-04
                 Services
Three Categories of Services:

 o   Qualified Services
 o   Demonstration Services
 o   Supplemental Services
                          Services
   Qualified Services

       Existing waiver and state plan services

             Available during the both the demonstration and post
              demonstration periods.


             Eligible for enhanced federal match.
                       Services
   Demonstration Services

          Available only during the 365 day demonstration period
           (except for transition services i.e. goods and services that
           can be accessed during the pre-transition phase).
          Eligible for enhanced federal match.
          Authorized on the HOME Choice Demonstration and
           Supplemental Service Plan.
                         Services
   Demonstration Services

       PASSPORT Consumer’s may receive certain
        HOME Choice Demonstration Services including:
            HOME Choice Nursing
            Independent Living Skills Training
            Community Support Coach
                         Services
   Demonstration Services

       HOME Choice Nursing

           Defined at intermittent nursing in amounts greater than
            what is available via the state plan (intermittent
            nursing > 14 hours).
                          Services
   Demonstration Services

       HOME Choice Nursing

           Can receive up to 44 hours a month.
           Providers include: MCHHA, other accredited agencies
            and non-agency nurses
                 Must have existing provider agreement and sign a HOME
                  Choice provider addendum.
                          Services
   Demonstration Services

       Independent Living Skills Training
           Training focused on:
                 Financial Management Skills
                 Social Skills Development
                 Health Management Skills
                 Home Management Skills
                 Personal Skills
                 Community Living Skills
                          Services
   Demonstration Services

       Independent Living Skills Training
           Can receive up to 144 hours during the 365-day
            demonstration period (in individual, group or
            classroom setting).
           New service-provider’s could include: CIL’s, mental
            health providers.
                 Must be approved by ODJFS
                      Services
   Demonstration Services

       Community Support Coach

         •   An individual who provides guidance, education
             and works to empower the consumer, authorized
             representative and family members.
                        Services
   Demonstration Services

       Community Support Coach shall assist the
        consumer in:
              Making informed independent decisions
              Setting and achieving short and long term goals
              Identifying options and problem solving
              Managing multiple tasks
                          Services
   Demonstration Services

       Community Support Coach

           Can receive up to 72 hours during the 365-day
            demonstration period
           New Service-Provider’s can be either agencies or non-
            agency providers
                 Must be approved by ODJFS
                      Services
   Supplemental Services

       For PASSPORT consumers these include:
                  Service Animals
                  Communication Aids
                  Transition Coordination

           •   Available only during the 365 day
               demonstration period (except for Transition
               Coordination)
                          Services
   Supplemental Services

       Service Animals

        •   May include but are not limited to:

              •   Seeing eye dogs
              •   Hearing dogs
              •   Service monkeys
                             Services
   Supplemental Services

       Service Animals

           Includes:

                 First years costs associated with the raising of the animal
                 Housing, feeding, upkeep and medical care of the animal
                  during training
                 Actual training of the animal, student training, and related
                  transportation, room/board and administrative activities
                 Equipment and Supplies
                           Services
   Supplemental Services

       Service Animals

           Providers are existing service animal providers who
            sign a HOME Choice provider addendum
               Up to $8,000 ----one time maximum
                           Services
   Supplemental Services

       Communication Aides

           Includes:

              •   Augmentative Communication Devices or Systems
              •   Computers and Computer Equipment
              •   Other Mechanical and electronic Devices
              •   Cable and Internet Access
              •   Cost of Installation, Repair, Maintenance and Support of
                  Any Covered Communication Aide
                          Services
   Supplemental Services

       Communication Aides

           Providers could be existing DME providers who sign
            HOME Choice addendum

                 Up to $5,000----one time maximum
                 Services


   A list of eligible provider’s for each
    demonstration and supplemental service will
    be provided at later date.
               Service Planning

   The case manager determines the type and amount of
    demonstration and supplemental services that are needed.

   All HOME Choice Demonstration and Supplemental Services must
    be authorized by the case manager on the HOME Choice
    Demonstration and Supplemental Service Plan.
       Service Planning
   The HOME Choice Demonstration and Supplemental
    Service Plan must be sent by the case manager to the
    ODJFS HCICCU.


   THE HCICCU then forwards the HOME Choice
    Demonstration and Supplemental Service Plan to the FMS.


   The provider submits claims to the FMS and the FMS pays
    the provider.
               Service Planning
   Service Planning Considerations:

         Demonstration and Supplemental Services are time
          limited.


         Case Manager needs to consider the consumer's
          ability to maintain service animal or communication
          device such as a computer prior to authorizing service.
          Service Planning
   If the case manager determines that it is not
    medically necessary for a consumer to receive a
    requested demonstration or supplemental service
    it is appropriate for the case manager to deny the
    request.

   Notice of denial of service and hearing rights must
    be sent to the consumer.
         Service Planning


   Information regarding denials of HOME Choice
    Demonstration and Supplemental Services and
    hearing information related to such denials must be
    tracked and reported to ODJFS.
Questions?
Case Manager Responsibilities
         Incident Reporting
   The case manager educates the consumer and/or
    family about PASSPORT’s incident reporting
    measures.

   Provider’s of HOME Choice services must adhere
    to PASSPORT’s incident reporting procedures.
                 Back-Up Plans
   In addition to typical back-up planning CMS
    requires specific elements in consumer back
    up plans.

       These include:

              Transportation
              Direct Service Workers
              Repair and Replacement of needed equipment
                   Complaints
   Complaints about HOME Choice program
    from consumers and family members must
    be tracked and reported.

       This includes specific complaints about the failure
        of back-up systems.
             Change in Status

   It is the case manger’s responsibility to notify the ODJFS
    HCICCU of a change in the consumer’s status.

   Changes should be communicated in a timely manner.

   Change in status is communicated via the HOME Choice
    Change in Status Form.
                 Change in Status
   Changes that require reporting include:

       Move to a new qualified residence

           Includes: type of qualified residence and type of
            housing assistance received, if applicable.
                  Change in Status
   Changes that require reporting include:

       Institutionalization

           Includes admissions to hospital or NF.

           Must report admission and discharge dates.

                 365 Demonstration Period clock stops while in hospital or
                  NF. Clock resumes upon discharge.
                  Change in Status
   Changes that require reporting include:

       Disenrollment from HOME Choice
           Due to:
                 permanent placement in NF
                 move to unqualified residence
                 voluntary withdraw
                 death
                 completion of demonstration period
              Disenrollment
   If consumer is in hospital or NF for longer
    than 60 days they will be dis-enrolled from
    HOME Choice.

   If after discharge, the consumer has time and
    services left in their demonstration period
    they may re-enroll in HOME Choice.
              Disenrollment
   All disenrollment notices and applicable
    hearing rights will be generated from the
    ODJFS HCICCU.

   The ODJFS HCICCU will lead all hearings
    related to disenrollments from HOME Choice.
Post Demonstration Planning

90 days prior to the end of the demonstration
   period the ODJFS HCICCU will send the
   consumer and the waiver administrative
     agency a letter notifying them of the
  upcoming end of the demonstration period.
    Post Demonstration Period

   The case manager should discuss with the consumer their
    service needs and adjust service plans as needed to address the
    end of the demonstration period.

   The case manager should assist the consumer with community
    referrals, if needed, to help compensate for the loss of the
    demonstration/supplemental services.
                       Tool Box
   Includes:

         CM step-by-step process flow
         Copies of all required forms
         OAC Rules
         Transition Coordination Maps and Contact Info
         ODJFS Contact Info
         Other Important Resource Information
Questions?
                  Next Steps
   ODA conducts training of PAA Staff

   ODJFS forms fiscal management and program
    management groups to begin meeting post
    implementation-Need ODA reps

   What do you need from us?
Thanks!

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:6
posted:11/29/2011
language:English
pages:78