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.
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