SPECIAL ASSISTANCE IN HOME PROGR by fjzhangxiaoquan

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									    SA/IH Case
  Management:
 An In-Depth Look
            Presented By
NC Division of Aging and Adult Services
        Adult Services Section
   Adult Programs Representatives         1
        Objectives for This
            Workshop
   Explore and Understand the SA/IH Case
    management process.
   Understand importance of good communication
    between Eligibility and Services
   Review the RAI-HC Tool
   Use the RAI CAPS and Worksheet to create a
    Service Plan.
   Review an SA/IH Economic Assessment Worksheet.
   Complete Transmittals for a real Case.
                                                2
        Objectives for This
            Workshop
 Review   ongoing case management activity
 Discuss reassessments/continued need for
  SA/IH and services.
 What to do when the client is no longer
  eligible for SA/IH – Notices and Hearings.
 Discuss Wait Lists
 Review SA/IH Reports

                                               3
     What is the SA In Home
            Program?
The State/County Special Assistance In-
 Home Program for Adults (SA/IH) provides
 a cash supplement to help low-income
 individuals who are at risk of entering an
 Adult Care Home, and would like to remain
 at home.
 SA/IH provides an alternative to placement
 in an Adult Care Home (ACH) for individuals
 who could live at home safely with
 additional support services and income.
                                               4
  Open Lines of
Communication Are
KEY to a successful
   SA In-Home
     Program

                      5
Communication between Eligibility
   and Services must include:
   Determination that the client meets all eligibility
    criteria.
   Determination that the client’s needs can be met
    safely at home after completing the RAI
    assessment.
   Amount of the SA payment.
   Redeterminations and changes in situation.
   Status of SA/IH slot availability.
   Status of the waiting list.


                                                      6
    Communication, continued….
 Income Maintenance Caseworker (IMC) will
  communicate the maximum SA/IH payment.
 Case Manager will communicate the SA/IH
  payment authorized based on the needs of
  the client.
 SA/IH Program Interagency Transmittal form
  will be used by social workers as the
  communication tool.


                                               7
   Tools to guide the Case
 Manager through the process
 SA/IH  Flow Chart—outlines the referral
  process.
 SA/IH Case Managers Checklist—
  excellent tool for organization and to
  assure critical time limits are met.




                                        8
    Referral and Screening
 Referrals may come either through
  Eligibility or Services. One should
  communicate to the other that a referral
  has been received.
 If the IMC determines a client is potentially
  eligible, communicate with the case
  manager so the RAI-HC assessment can
  begin.
 SA/IH Program Referral/Mini Screen
  Questionnaire can be used.                      9
    Referral and Screening
 Referral to the case manager must include
  the Slot authorization number and EIS ID
  number.
 A staff member must be designated to
  maintain and distribute slot authorization
  numbers (can be eligibility or services).
 The designated staff member must
  communicate the ongoing status of available
  slots to both services and IMC staff.

                                                10
  Referral and Screening
 Case  manager initiates Resident
  Assessment Instrument (RAI) within 10
  work days of the referral from eligibility.
 IMC continues to process SA
  application.




                                            11
      SA/IH Eligibility Criteria
   Client is at least 18 years old.
   Client is eligible for Medicaid as a
    categorically needy aged, blind, or disabled
    individual.
   Needs ACH level of care and lives in, or
    desires to live in a private living arrangement
    in a county that offers SA/IH.
   Requests SA/IH payments and services at
    home in order to remain there safely.
   With appropriate services, and SA/IH
    payment he/she can have his/her health,
    safety and well-being maintained at home.       12
          Eligibility process
 IMC determines SA benefits eligibility and
  communicates that decision to the case
  manager.
 Case manager determines the need for the
  program using the RAI-HC assessment and the
  SA/IH Economic Assessment Worksheet.
 Final determination of the payment is made by
  the case manager and communicated to the
  IMC.

                                                  13
SA In-Home and SA Program
  Eligibility Comparisons




                            14
SA In-Home and SA Program Eligibility and
         Budgeting Comparisons




                                            15
     Eligibility for Other Benefits
                 SA-5400

   SA-IH is a non-countable benefit for
    the following programs:
     – Supplemental Security Income (SSI)
     – Medicaid
     – Subsidized housing (HUD Section 8)
       and other federal housing programs
                                            16
 Eligibility for Other Benefits

 SA-IH is a countable benefit for the
  following programs:
  Food Stamps
  LIEAP




                                     17
    Case Manager’s
         Role
 Advocate
  – For the Program
  – For the clients
 Gatekeeper
  – Communicate
  – Educate
  – Prioritize


                      18
                 IMC Role
 Source of referrals for potential recipients
 Determination of SA-IH financial eligibility
 Communicate approvals/denials/changes/
  redetermination of eligibility to the Adult
  Service case manager




                                                 19
           Service codes for case
               management
   The DSS-5027 will reflect the service code through
    which case management will be provided.
   Case management can be provided through
    Medicaid At Risk CM (395)
   Individual and Family Adjustment (330)
   Guardianship (107)/Representative Payee (331)
   All Services codes are found in the SIS manual
    online at the link below:
   http://info.dhhs.state.nc.us/olm/manuals/
     dss/rim-01/man/SIS.pdf


                                                     20
   Case Management
       Activities
 Assessing
 Service Planning
 Monitoring/follow up
 Ongoing contacts
 Reassessing (quarterly,
  annually)

                            21
          Assessment
 Key to determining if living at home with
  the SA/IH payment and services is
  appropriate.
 Automated RAI-HC tool is used.
 Must begin within 10 days of SA/IH IMC
  referral.
 30 days to complete assessment.
 Must include the Economic Assessment
  Worksheet to determine financial need
  and SA/IH payment.
                                              22
        The RAI-HC Tool

 Is a comprehensive, standardized
  instrument for evaluating the needs,
  strengths, and preferences of clients and,
 Includes function, health, social support,
  service use, environment and,
 Identifies clients who could benefit from
  further evaluation of specific problems
  and risks for functional decline.
                                           23
      Services Assessment
            Process
 RAI Assessment is completed, and the
  results..
 Trip triggers which..
 Generate a CAP report.
 SW reviews the triggers on the CAP sheet.
 SW reviews CAP guidelines for additional
  information.


                                              24
    SA/IH Economic Assessment
        Worksheet SA-5600
 Since there is no financial component to
  the RAI, the CM must use the SA/IH
  Economic Assessment Worksheet.
 Page 3 of the Worksheet asks vital
  questions that help determine the Service
  Plan.
 http://info.dhhs.state.nc.us/olm/manuals/
  doa/saih/man/SAIHf9.pdf


                                          25
     What is the purpose of the
      Economic Worksheet?
 Identifies sources of income.
 Indicates how income is being used.
 Reveals a surplus or deficit.
 Will help identify unmet needs.




                                        26
    Completion of the Assessment
              Process

o   SW and client identify priorities from the
    RAI CAPS and the Economic Assessment
    Worksheet
o   Economic Assessment Worksheet is
    completed –all three pages.
o   SW and client develop a service plan
    together.
                                                 27
              Service Plan
  Adult and Family Service Plan (DSS-6221).
 Include goals utilizing the SA/IH payment.
 Must address all needs identified in the
  assessment to include medical, social, ADL’s,
  IADL’s, economic, and mental health.
 Outline goals and activities, and the roles of
  all involved.
 Plan must include specific target dates.

                                               28
              Service Plan
   Must also include case management services
    provided.
   Must be revised as the client’s needs change.
   Must be signed by the case manager, client
    or their representative within 7 days of SA/IH
    payment authorization date (Keyed in EIS).
   Needs to be reviewed quarterly.
   A new service plan must be completed
    annually, should be updated as changes
    occur throughout the year.
                                                 29
           Goal Planning
 GOALS   SHOULD BE SMART.
 Specific
 Measurable
 Achievable
 Realistic
 Time limited.



                             30
          Sample Service Plan
Checklist Goal        Target   Activities/ Person/
for       Mrs. K.’s   Date     Services Agency
Change hair will                           Resp.
         be                    1 hour of
Mrs. K.  washed                in home     DSS SW
         twice per 07/04/10    aide
cannot   week and                          Be Happy
bathe                          services    Home
         she will
and                            3 days      Health
         have a
wash her bath at               per week
hair     least
without every
help     other day
                                                      31
           Case Management
             responsibilities
 Review   the service plan with the client.
 Communicate to the client how the
  SA/IH payment is to be used.
 Monitor to assure that the SA money is
  being used appropriately.
 For large projects or items encourage
  clients/family to obtain estimates.


                                               32
            Case Management
              responsibilities
   Help the client establish payment plans if
    needed.
   Regularly inform clients about progress in
    meeting goals.
   Continue to assess and document how the
    SAIH program is helping to keep the client
    safely at home.
   Asking for receipts may be necessary if
    there is concern regarding how the money
    is being spent.
   Monitor to assure that all service needs,
    not just financial needs, are being met.   33
         Ongoing Case
     Management Monitoring
 Monthly contacts - Can be made with the
  client, family, and/or the service provider.
 Quarterly Reviews - Must be done in person
  to review the provision of service and
  utilization of the payment.
 Annual Reassessment is also in person.




                                             34
Annual Reassessment Process
   Complete a new RAI assessment and Economic
    Worksheet.
   FL-2 form which reflects domiciliary level of care
    must be current. IMC will inform you of what is
    needed. Social Worker should be prepared to
    assist.
   Complete a new service plan before anniversary of
    SA/IH application date (signed by the client and
    case manager).
   Advise IMC of continued eligibility decision on the
    interagency transmittal form.
   Send any required notices to the client.           35
    Hospital Stay – Level of Care
             Changes?
 After a hospital stay the recipient’s needs
  may have changed. - Make sure that the
  Fl-2 is still appropriate for SA.
 If not SA/IH must be terminated.
 If still appropriate, make any changes to
  the assessment and service plan as
  needed.
 SA/IH must be terminated when an
  absence is over 30 days.

                                                36
     Denials and Terminations
 Financially ineligible/not eligible for Medicaid.
 No Need for SA/IH Money or Services
 Failure to meet programmatic qualifications:
    – Death
    – Absence of over 30 days
    – Move out of county or state
    – Client voluntarily withdraws
    – Client’s safety, health and well-being
      cannot be maintained at home
                                                  37
     Waiting Lists for SA/IH
       SA-5000 I. C. 6.

   If all slots are in use and the county has
    decided not to request additional slots,
    or the request has been denied, do not
    take additional applications. Explain to
    applicants that the SA/IH is full and
    offer to refer them to other services or
    place them on the SA/IH waiting list.


                                             38
         Waiting Lists for SA/IH
            SA-5000 I. C. 6.

 Each county DSS must designate a staff person to be
  responsible for maintaining the waiting list. The purpose
  of the waiting list is to make the SA/IH slots available on
  a first come, first serve basis.
 As spaces become available, contact the individuals on
  the list to determine if they wish to apply.
 Be sure the individual understands that this contact does
  not constitute an application, and that they or the
  representative must come to the county DSS to make an
  application.
 Document the waiting list if an applicant on the list
  chooses not to wait for a slot and enters an ACH.
                                                                39
Establishing a Waiting List
       SA-5000 II. A.
o Counties that wish to increase their current number of
  slots should request additional slots prior to filling all
  assigned slots in order to avoid having to use a waiting
  list.

o If, however, all of a county’s allotted slots are filled,
  and the county has decided not to request additional
  slots, please discuss with the Adult Programs
  Representative prior to initiating a waiting list.

o If it is decided that a waiting list is appropriate,
  individuals may request to be placed on a waiting list.
  Figure 2 is the waiting list form for the SA/IH and
  instructions for completing the waiting list form. Use of
  this SA/IH Waiting List form will provide that consistent
  information is obtained.                                40
     Maintaining the Waiting List
           SA-5000 II. B.

   Please use and maintain this waiting list in
    accordance with the Requirements for
    Provision of Services Manual, Section VI
    Prompt Provision of Services.




                                               41
    Required SA/IH Reporting
 Monthly Exports of RAI-HC data –On floppy
  disks - Mail to Monica Nealous at DAAS.
 Monthly Slot Utilization Reports – Excel
  Workbook - Email to:
  Monica.Nealous@dhhs.nc.gov
 Quarterly SA/IH Payment Tracking Reports
  – Excel Workbook - Email to
  Monica.Nealous@dhhs.nc.gov

                                          42
SA/IH Payment Tracking Excel
         Workbook
 The Payment Tracking Workbook provided
  37 categories under which to report to
  DAAS how the SA/IH payment is spent.
 An ―other‖ category is provided for
  anything that truly does not fit under the
  umbrella of one of the 37 categories.



                                               43
SA/IH Payment Tracking Excel
         Workbook
 Due to DAAS every quarter by the last
  workday of the second month following
  the reporting quarter.
 Example: 2nd quarter for 2010 ends
  June 30th. The Payment Tracking Report
  is due to be emailed to DAAS by August
  31st.


                                           44
      Online Links to Reports

 SA/IH Payment Tracking Excel
  Workbook
http://info.dhhs.state.nc.us/olm/manuals/do
  a/saih/man/SAIHf8.htm#TopOfPage
 Payment Tracking Schedule
http://info.dhhs.state.nc.us/olm/manuals/do
  a/saih/man/SAIHf8.htm

                                          45
SA/IH Slot Utilization Report

   An SA/IH client should be entered on one
    report sheet only:
    – Pending
    – Terminated or
    – Denied
 Counties with a waiting list should utilize
  any empty slots as quickly as possible.
 These reports are due to DAAS each
  month.
                                                46
       SA/IH Slot Utilization
             Report
   http://info.dhhs.state.nc.us/olm/manuals/
    doa/saih/man/SA-
    IH_Slot_Utilization_Monthly_Report.xls




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Questions????




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Thanks for coming!!




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