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
Presented by: Senior Connection Center, Inc.
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February 18, 2016
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1 Every ‘star’ has a corresponding handout in back
Zeke Barbosa, Information & Referral Manager
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❏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 System – a professional association of more than 5000 individuals and
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“AIRS Certification is the professional credentialing program for individuals working within the I&R sector of human services” (AIRS.org)
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❏The I&R
Department is the “front door” to the S enior C
enter.
❏O
ur I&R S pecialists assist people in finding the services they need while explaining the clients’
❏Empower them to make
good decisions for themselves.
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includes the following: Assessment, Information G iving, R eferral G iving, Advocacy, Follow ups, R esource Database, etc.
community resources such as housing, transportation, food pantries, SNA P, & volunteer associations (when available) etc.
reached directly at 1.800.336.2226
I&R Department is available
any potential resources please refer to the inclusion and exclusion criteria handout for application criteria and guidelines.
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Kyrie-Leigh Chambliss SHINE Liaison/Volunteer Manager
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What can S
H S HINE do for your clients?
ssistance with Medicare claims, appeals and billing issues
ssistance
IS and MSP A pplications
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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
“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
“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.”
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TC Overview
DRC SMMC L TC Functions
TC Enrollment Process
TC FA Qs
dditional Topics
dditional Resources
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What is it?
Care (SMMC L TC).
system through which Medicaid recipients who qualify and become enrolled receive long- term care services through a managed care plan.
A ugust 2013 – March 2014) and Managed Medical A ssistance (implementation in mid 2014)
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nursing home level of care from Comprehensive A ssessment and Review for L
RES) and
nursing home level of care from CA RES;
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TC Program Education
A ssessment
ssistance for community
ist Release
TC Program Education and Screening (in home)
pplication A ssistance
ssist Recipients with G rievances/Complaints
nnual Re- Screening for waiting list individuals
ssurance
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DRC is the gatekeeper for all new consumers needing home and community based services.
DRC conducts Intake & Screening for eligibility, education on managed care options and other program and service resources.
and placed on waitlist (A ssessed Priority Consumer L ist).
are sent a Form 5000- 3008.
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who maintains statewide waitlist and approves consumers for waitlist removal/ release.
DRC assists consumers (if needed) to file A ccess Medicaid A pplication for financial eligibility with DCF, and
DRC refers cases to CA RES to complete the 701B A ssessment and generate a L evel of Care (L OC).
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RES feeds L OC through Health Track System to Enrollment Broker (EB).
DRC sends a Form 2515 to DCF to notify them that an L OC determination was made.
through Health Track System to the EB.
approved, the consumer is enrolled by the EB with their voluntary choice or mandatory assignment to a managed care organization for services.
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questions related to SMMC L TC.
ssist consumers with the Medicaid Eligibility process, as needed
TC Coordinators and/or Manager to help resolve consumer eligibility issues.
TC lost eligibility (SIXT) issues
Counselors for assistance with choosing an SMMC L TC plan.
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eligibility is established:
www.flmedicaidmanagedcare.com
711- 3662, and speak to a choice counselor
call center or select “schedule an appointment”
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requirements for Medicaid eligibility as determined by DC F and/ or medical LO C eligibility requirements as determined by C AR E S .
C E AC TV consumer who is found ineligible for the S MMC LTC Program?
CTV .
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TO BE, OR NOT TO BE...
an consumers that were terminated for failure to follow through with S MMC LTC eligibility process be eligible for enrollment in C C E ?
services, if the individual completed the eligibility process for SMMC L TC, and were determined to be ineligible.
CTV consumers who refuse to complete the SMMC L TC eligibility process?
services be terminated.
the fault of the consumer , i.e. documented attempts made to obtain Form 5000- 3008.
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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?
for SMMC L TC, if they were not previously terminated from the SMMC L TC pipeline for non- compliance.
from the pipeline for non- compliance, they must be placed back on the waitlist for SMMC L TC.
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C E AC TV consumer fails to complete S MMC LTC process within required timeframes?
CTV in CCE for 30 days following termination from SMMC L TC A PPL .
ead agency determines client’s intent to continue eligibility process, and assists with required SMMC L TC eligibility steps.
DRC will verify completion of eligibility steps
DRC will request that the lead agency provide notice of intent to terminate within 10 calendar days.
DRC can work with the lead agency as needed.
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MMC LTC , can the ADR C s release the client if they are also C C E APC L?
DRCS may not release the consumer for CCE services after the consumer has been released for SMMC L TC.
DRC will notify the lead agency of the EMS Release consumers.
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C release consumers with rank 5 from the C C E Waitlist, if the consumer was not already been released for SMMC L TC?
es, if the consumer is ranked 5 on both waitlists and was not released for SMMC L TC, the consumer may be released for CCE.
DRC may not skip rank 5 consumers to release rank 4 consumers.
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C E waitlist ranked 4 or 5, how do you counsel the consumer?
PCL status and informed of the requirement to complete the SMMC L TC eligibility process if they are released.
with a rank 4 and reassessed and their rank increases to 5.
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an a C C E APC L consumer be released for C C E if they fail to follow through with the S MMC LTC eligibility process?
CCE if they completed the SMMC L TC eligibility determination process and were denied eligibility.
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MMC LTC while the lead agency is assisting with the C C E eligibility process, may the lead agency bill for time spent making the consumer active in C C E ?
provided prior to consumer being determined SMMC L TC eligible and enrolled or denied eligibility.
provided if they assist with the Medicaid eligibility process for SMMC L TC?
consumer with SMMC L TC eligibility.
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an consumers who are MLTC AC TV continue to receive non- Medicaid program services?
services for up to 30 days.
A DRC and we will work with A DRC Medicaid Unit Contract Manager for research and determination.
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PPL consumers
ead A gency Tracking L
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TC Consumers
consumer is ML TC A CTV .
programs and ML TC A CTV may continue to receive non- Medicaid services for up to 30 days.
DRC to coordinate with A DRC Medicaid Unit Contract Manager for research and determination.
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CTV clients
Managers should first verify with consumers who are not already CCE A CTV whether they are interested in receiving SMMC L TC Program services.
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TC, please contact:
auren Cury, laur uren. n.cur ury@ aging ngflorida.com
an.don
ag agingflorida. a.com
ilds, kevin in.gil ilds@ agin ingflorid ida.com
ecil@ ag agingflorida. a.com
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Care program are posted at:
about the program at the above website.
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WE RIS E BY LIFTING O THE RS !
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The e DO EA c closel ely ex examines es clien ent case f e file e re record rds f for: r:
Client eligibility Client need/ unmet needs Completion of Co- Pay worksheet Excessive billing V erbatim Repetition or duplication
EW EM EMPHAS IS
endor Service Providers!
timesheets, service logs, 14- Day follow up to confirm client satisfaction
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O BS E S ERVATIO NS ! S ! O O BS E S ERVATIO NS ! S ! O O BS E S ERVATIO NS ! S !
as ase nar arrat atives m must con
ain t the cas ase man anag ager’s professi essional ob
ation
clien ent:
with the assessment?
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lient’s hygiene and grooming
lient’s dress (appropriate for the season? )
lient’s facial expression/ affect or mannerisms
lient’s interaction with the case manager, service workers, or others
hanges in client health status (recent illness, hospitalization, E R visits, accidents)
hanges in the C lient/ C aregiver relationship
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hanges in living situation (has someone moved in or out of the home? )
affecting the client
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enting U Unmet et Need eeds:
has unmet needs.
informal resources such as community organizations, family, and/or friends.
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PE (telephone? face- to- face?) and the PU PURPO PO S E (Client request? Annual, semi- annual, monthly or 14-day follow-up?) of each contact made.
stated documentation. They should provide a fresh picture
caregiver, the DOEA , SCC, and other providers.
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O ne line case narratives are not sufficient to justify units claimed. Ex Example 1 1
suf ufficient nt “Made monthly contact with the HCE caregiver” Example 2: e 2:- S uf ufficient nt “Made monthly contact with the HCE caregiver. CG states they are satisfied with the services and no additional assistance is needed for the client/ CG . Client’s condition has remained stable. CM asked if client was able to talk, but Client was sleeping at the time of call.”
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and units of services?
management services provided?
Proofread the case narrative. Check spelli lling, gram ammar ar and accu ccuracy. Nothing reflects so poorly upon you and your agency than a case note full
IP: C A SE NOTES THA T A RE DIFFICUL T TO REA D
annoy the reader! (i.e., reviewers, monitors)
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N O w w h ite e ou t, s scr ibbles es o
e
s.
C ross out the error with o h one ne line ne C
Date the correction Initial the correction
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The narrative is kept in continuous chronological
activities are properly documented. EV ERY contact on the client’s behalf is recorded in the case narrative.
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The case narrative must be clear and concise. It
should be written on a level to enable an independent reviewer to fully understand the client’s current status and services and obtain a good overview of the case.
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nting ng a s serious c conc ncern n in a n a client nt f file such a h as suspec ected ed s sel elf n neg eglec ect, a abuse, e, ex exploitation, and/or ser ervice e provider er i issues es, dep eplorable l e living conditions, et etc.
PS called?
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Summary of Department of Elder Affairs 2015 Monitoring Findings and Suggestions for Improvement
No Findings- Kudos to everyone for their dedicated work throughout the year.
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Summary of Department of Elder Affairs 2015 Suggestions for Improvement
CIRTS at least annually.
clients to ensure receipt of new or increased services.
discussion of the next best course of action when services are initially delayed or refused.
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Summary of Department of Elder Affairs 2015 Monitoring Findings and Suggestions for Improvement
forth in the Master Contract and time standards are established for the resolution of complaints. Minimum elements to be contained in complaint log: ❏ Date ❏ Nature of the complaint ❏ Determination of the complaint ❏ All actions taken to resolve the complaints’ dissatisfaction with services are to be recorded in the complaint log and should be recorded in the case notes.
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Observations from DOEA Monitoring & Quality Assurance Summit:
appropriateness of new or increased services.
worker logs in comparison to units billed in CIRTS.
APS client within 72 hours of the referral. Proficiently recording the specific services and service dates for crisis resolving services provided within 72 hours of the referral.
potential disclosure of personal health information. Report to your agency’s HIPAA Privacy Officer to determine if a violation of HIPAA occurred.
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during the 31 days following referral
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provided during 72 hours following referral (include NDP/Non-DOEA Services).
provided during 31 days following referral.
response from API.
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be contacted within 24 hours to discuss the delay of
DETAILS, DETAILS, DETAILS!
service delay: which service? client refusal-why? were all APS recommended services ordered?
Not just the case manager. Remember your file will be read by someone else (SCC, DOEA, and other CM’s)
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ABS O LUTE E C LARITY W HEN EN DO C UMEN ENTING THES ES E E C RITIC AL AND REQ EQ UIRED ED EL ELEM EMEN ENTS IN T THE C E C AS E E FILE! E!
Documentation of follow-ups
AT A MINIMUM:
(call to client). Document if the client is satisfied with services and if they are receiving services as care planned.
needed.
face-to face by a Case Manager and a new 701 B must be
be safely terminated, APS will be contacted to discuss client’s status 31 days.
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Continue or terminate services?
Manager and a new 701 B must be completed. If the CCE Lead Agency determines services can be safely terminated, APS will be contacted to discuss client’s status.
case.
the client may be placed on a waitlist for additional services, if appropriate.
Supervisor and Case Manager Supervisor will jointly review the case to resolve the issue(s).
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The provision of services may exceed 31 days if: 1) the emergency or crisis still exists and continuation of the services is needed for the resolution, or 2) the crisis is likely to return without the provision
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Connection Center!
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have maintained or improved their ADL score.
to reassessment. Measured in second year only.
who have maintained or improved their IADL score.
to reassessment. Measured in second year only.
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served within 72 hours (Case Management plus
CIRTS for Case Management and one other service within 72 hours of APS referral.
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continue to provide care is maintained or improved at reassessment.
current year. Measured annually.
ability decreased from previous year’s score.
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EN V
N VI RO N M N M EN T N T
m oderate risk environm ent scores im proved at reassessm ent.
reassessm ent in current year. M easured annually.
did not im prove.
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66%
clien ts wh o se n u tritio n sco re im p ro ved at reassessm en t.
co m p ared to reassessm en t in cu rren t year. M easu red in seco n d year o n ly.
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I M M I N E
N EN T N T RI SK SK
referral date.
CIRT S for CM or other service after referral date.
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PSA Wide Outcome Measure Achievement Levels for First Half of 2015-2016 Contract Year
monthly basis.
reflect the action taken?
compared to the original assessment.
nutritional counseling if available, etc.
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60 Home Delivered Meal Consumers 174 Frozen Home Delivered Meal Consumers 149 Personal Care Consumers* 157 Homemaker Consumers* +306 Case Management Consumers 846 Total Surveys Mailed (SGR & OAA) *Also Received Case Management Surveys
259 Surveys Returned 31 % Return Rate
It’s all about YOU!
❏ 92% believe their case manager listens to what they say. ❏ 95% believe their case manager is polite and treats them with respect. ❏ 95% believe this service maintains or improves their quality of life. ❏ 89% believe their case manager is knowledgeable about available services.
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97 % believe these services help them stay in their home.
respectful.
ratings as 12 out of 13 question responses were 90% or above.
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them with respect.
quality of life.
result of 10% believing their homemaker is not very thorough and does not do things the way they want them done.
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The results of the 2015 Customer Satisfaction Survey continue to indicate that the vast majority of clients are very satisfied and appreciative of the services they receive. The continued high level of satisfaction with case management services is commendable and is a testament to the dedication and efforts made by case managers throughout our five county service area.
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My case manager is very helpful and polite.
Yes they do a great job and I’m grateful for these services.
This service has been very good!
When I need something, she does her best to help
I thank you all for this help.
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My case manager has been very helpful and very professional.
We are so thankful for the help we have received. As the caregiver, we could not
in our home as long as we have.
Very good, efficient, and responsive.
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