HCBS Case Management 525-05-30-05
(Revised 6/1/12 ML #3335)
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Purpose
The purpose of HCBS Case Management is to
assist a functionally impaired individual to achieve and maintain independent
living, in the living arrangement of their choice, until it is no longer
appropriate or reasonably possible to maintain or meet the individual's
needs in that setting. In order to facilitate independent living, the
HCBS Case Manager enables the elderly or disabled person and/or family
to explore and understand options, make appropriate choices, solve problems,
and provides a link between community resources, qualified service providers,
and the client/applicant accessing needed services. The HCBS Case Manager
also advocates for and promotes client-focused systems of service delivery,
exercises an awareness of the larger target population in need, and exercises
prudence in each referral to and/or linkage with resources and services,
utilizing those services and resources effectively.
Standards
for HCBS Case Managers
The service shall be performed by a social worker or agency that employs individuals licensed to practice
social work in North Dakota and who has met all the requirements to be enrolled as either an Individual or Agency Qualified Service Provider in NDAC 75-03-23 and agreed to comply with policy.
- Case Managers employed by a County Social Service Agency are eligible to receive payment for the service of Case Management and authorize services under the SPED and EXSPED Programs upon receiving a written notice from the HCBS Program Administration that an individual in the SPED or Expanded SPED Program Pool is authorized for services under the SPED or Expanded SPED Program.
- Case Managers employed by a County Social Service Agency are eligible to receive payment for the service of Case Management under the HCBS or TD Waiver and authorize services if the individual is eligible for services under either waiver.
- Individual Case Managers or an Agency who is enrolled as a QSP for the Service of Case Management are eligible to receive payment for the service of Case Management under the HCBS or TD Waiver and are eligible to authorize services for an individual, if the individual is eligible for services under either wavier.
Case file documentation must be maintained:
- In a secure setting
- On each individual in separate
case files
Standards for Targeted Case Management (TCM) for persons in need of Long term Care.
- The service shall be performed by a social worker or agency that employs individuals licensed to practice social work in North Dakota. and who has met all the requirements to be enrolled as either an Individual or Agency Qualified Service Provider (QSP) or an Indian Tribe/Indian Tribal Organization who has met State Plan requirements and requirements to be enrolled as a QSP or Developmental Disabilities Program Manager (DDPM) who is a Qualified Mental Retardation Professionals (QMRP) or has one year experience as a DDPM with the Department.
The following enrolled provider types are eligible to receive payment for TCM
- Case Managers employed by a County Social Service Agency who have sufficient knowledge and experience relating to the availability of alternative long term care services for elderly and disabled individuals.
- Developmental Disabilities Program Manager (DDPM) who is a Qualified Mental Retardation Professionals (QMRP) or has one year experience as a DDPM with the Department
- An Individual Case Manager or Agency Case Manager that has sufficient knowledge and experience relating to the availability of alternative long term care services for elderly and disabled individuals.
- Indian Tribe or Indian Tribal Organization who has met the provider qualifications outlined in the North Dakota State Plan Amendment
The following enrolled provider types are eligible to receive payment for TCM and Authorize Service(s)
- Case Managers employed by a County Social Service Agency are eligible to approved services under SPED, EXSPED and Medicaid State Plan - Personal Care (MSP-PC), (see Chapter 535-05).
- DDPMs are eligible to approve services MSP-PC.
- If the client is a recipient of services funded by the SPED, Expanded SPED Programs, or MSP-PC the one case file will contain documentation of eligibility for TCM as well as for the service(s)
The following enrolled provider types are eligible to receive payment for single event TCM.
- County HCBS Case Managers, DDPMs, enrolled Individual or Agency Case Managers and enrolled Indian Tribe or Indian Tribal Organizations.
- If the client requests a contact more than once every six months the Case Manager needs to obtain prior approval from a HCBS Program Administrator.
- Indian Tribe or Indian Tribal Organizations are limited to providing TCM Services to enrolled tribal members.
Targeted
Case Management (TCM)
The individual receiving TCM will meet the following
criteria:
- Medicaid recipient.
- Not a recipient of HCBS
(1915c Waiver) services.
- Not currently be covered
under an other case management/targeted case management system or payment does not duplicate payments made under other program's authorities for the same purpose..
- Lives in the community
and desires to remain there; or be ready for discharge from a hospital
within 7 days; or resides in a basic care facility; or reside in a nursing
facility if it is anticipated that a discharge to alternative care is
within six months.
- Case management services provided to individuals in Medical institutions transitioning to a community setting. Services will be made availalbe for up to 180 consecutive days of the covered stay in the medical institution. The target group does not include individuals between the age of 22-64 who are served in Institutions for Mental Disease or inmates of public institutions.
- Has “long-term care need.”
Document the required “long-term care need” on the Application for Services,
SFN 1047. The applicant or legal representative must
provide a describable need that would delay or prevent institutionalization.
- The applicant or referred individual must agaree to a home visit and provide information in order for the assessment to be completed.
Activities of Targeted Case Management
1-Assessment/Reassessment
2-Care Plan Development
3-Referral and Related Activities,
4-Monitoring and Follow-up Activities
(Details outlined in section- HCBS Case Management - Service Activities, Standards of Performance, and Documentation of HCBS Case Management Activities)
- The focus or purpose of TCM is to identify what the person needs to remain in their home or community and be linked to those services and programs.
- An assessment must be completed and a Care Plan developed. The client’s case file must contain documentation of eligibility for TCM. The HCBS Comprehensive Assessment must be entered into the SAMS Web Based System.
- Targeted case management is considered a “medical need” and thus included as a health care cost. Use of Medicaid funding for targeted case management may result in the recipient paying for/toward the cost of their case management. The client must be informed of that fact by noting Case Management Service and cost on the Individual Care Plan. Clients must also check and sign acknowledgment that if they are on Medicaid they may have a recipient liability. Payments from the Medicaid Program made on behalf of recipients 55 years or older are subject to estate recovery including for Targeted Case Management.
- If the only medical need is Targeted Case Management, then the SPED individual need not apply for Medical Assistance.
- The case record must include a HCBS Comprehensive Assessment (entered into the SAMs system or DDPMs current data system) and narrative which includes:
- Name of the individual,
- Dates of case management service,
- Name of the case management provider/staff.
- Nature, content , units of case management service received, and whether goals specified in the plan are achieved
- Whether the individual has declined services in the care plan
- Coordination with other case managers,
- Timeline of obtaining services,
- Timeline for reevaluation of the plan
Limits:
Case management does not include direct delivery of services such as counseling, companionships, provision of medical care or service, transportation, escort, personal care, homemaker services, meal preparation, shopping or assisting with completion of applications and forms (this is not an all-inclusive list).
Case file documentation must be maintained:
- In a secure setting
- On each individual in separate case files
HCBS Case Management
- Service Activities, Standards of Performance, and Documentation of HCBS
Case Management Activities
HCBS Case Management Service consists of the
service activities or components listed below.
- Assessment
of Needs - This component is completed initially and at least annually
thereafter. At least one home visit is required during the assessment
of needs process.
Clients must be given a “Your Rights and Responsibilities”
brochure DN 46 and verification must
be noted on the
SFN 1047 Application for Services by the client that a DN 46 was received.
During the assessment process, when applicable,
the information needed for submission to Dual Diagnosis Management (DDM)
is obtained.
The case management entity shall use the existing and established procedures
for requesting a level-of-care determination from (DDM).
For an adult (at least 18 years of age): Complete
a comprehensive assessment and gather input from other knowledgeable persons
as authorized by the applicant/client.
For a child (under 18 years of age): Complete a
Social History (in lieu of the comprehensive assessment used for adults)
AND submit the necessary documents to DDM for a level-of-care determination.
Prior approvals given for service combinations and
service authorization requests that are continuing must be reviewed and
re-approved by the HCBS Program Administrator on an annual basis.
The combination of a HCBS services and hospice service
requires prior approval by a HCBS Program Administrator with the exception
of intermittent Respite Care Service.
Clients who may be eligible for services under the
ID/DD Waiver are referred to the Regional Development Disability Program
Administrator.
- Care
Planning
Care Planning is a process that begins with assessing
the client’s needs. It includes the completion of the HCBS comprehensive
assessment after which the case manager and client look at the needs and
situations described in the comprehensive assessment and any other problems
identified and work together to develop a plan for the client's care.
- All needs are identified
in the comprehensive assessment and the services authorized to meet those
needs are identified on the ICP SFN 1467. Additional information regarding
needs and consumer choice will be outlined in the narratives in the HCBS
comprehensive assessment;
- For each functional impairment
identified for which a service need has been authorized the narrative
note must include: the reason the client is unable to complete the task,
who is completing the task, number of units, and time per week allocated
for the task and the anticipated outcome;
- For each ADL or IADL that
is scored impaired and no services have been authorized the narrative
note must include the reason the client is unable to complete the task
and who is providing the service or how the need is being met;
- Refer to the Authorization
to Provide Services, SFN 1699, to choose and discuss with the client the
services and scope of the tasks (limits to the tasks) that can be provided.
A written, signed recommendation for the task of vital signs provided
by a nurse or higher credentialed medical provider must be on file outlining
requirements for monitoring is required, and the frequency. For the task/activity
of exercise a written recommendation and an outlined plan by a therapist
for exercise must be on file.
- The HCBS Case Manager shall
review with the client or the client's representative the following information
about qualified service providers (QSP) available to provide the service
and endorsements required by the client:
- Name, address and telephone
number of Qualified Service Provider.
- Whether Qualified Service
Provider is an agency or individual.
- The unit rate per Qualified
Service Provider.
- If applicable, limitations
of the Qualified Service Providers available.
- If applicable, endorsements
for "specialized cares":
- Global Endorsements (Only
a provider who carries a global endorsement may provide these activities
and tasks. Refer to the QSP list to determine which global endorsements
the provider is approved to provide.) Global Endorsements include: Cognitive/Supervision,
Exercises, Hoyer Lift/Mechanized Bath Chair, Indwelling Bladder Catheter,
Medical Gases, Prosthesis/Orthotics/Adaptive Devices, Suppository, Ted
Socks, and Temperature/Blood Pressure/Pulse/Respiration Rate.
- On the SFN 1699, Authorization
to Provide Services, document the name of the agency or person who is
to be contacted and provided the results of the client’s blood pressure,
pulse, rate of respiration, or temperature.
- Client Specific Endorsements
(These activities and tasks may be provided only by a provider who has
demonstrated competency and a Request for Client Specific Endorsement,
SFN 830, is on file in the client's file. The provider must obtain documentation
that a health care professional has verified the provider's training and
competency specific to the client's need and provide a copy to the Case
Management Entity. The Case Management Entity shall forward a copy of
the SFN 830 to HCBS Program Administration. Client Specific Endorsements
include: Apnea
Monitoring, Jobst Stockings, Ostomy Care, Postural/Bronchial Drainage,
Rik Bed Care (Specialty Beds).
- Providers who can provide
the required care and whom the client has selected will be listed on the
ICP, SFN 1467. When a change in service provider occurs between case management
contacts – the client or legal representative may contact the case manager
requesting the change in provider. The contact and approval for the change
in provider must be verified in the case managers documentation and noted
on the ICP which is sent to the Department. A copy of the updated care
plan must be sent to the client or legal representative. However, changes
in services or the amount of service must be signed by the client or legal
representative and approved.
- The service, amount of
each service to be provided, the costs of providing the selected services,
the specific time-period, and the source(s) of payment are recorded on
the ICP, SFN 1467, and Authorization to Provide Service, SFN
1699. Clients must be made aware of funding caps and documentation
must verify that the client has been informed of the service limits when
developing the care plan at a minimum of every 6 months. If an individual's
needs exceed the service limit, they would be issued a denial notice and
would have the right to appeal.
- Contingency plans;
- Contingency planning must
occur if the QSP selected is an individual rather than an agency. The
backup provider or plan must be listed on the SFN 1467.
- The case manager shall
review with all clients or the client’s representative the client stated
goal. The goal must be recorded on the ICP, SFN 1467 and described in
the narrative section of the comprehensive assessment on an annual and
6 month basis.
- For Medicaid Waiver Only:
Complete
SFN 1597, Explanation of Client Choice.
- For Medicaid Wavier Only: New clients who are eligible for the Affordable Care Act Benefit must be given Affordable Care Act Benefit letter and a copy of the letter must be sent to the Department (includes a client whose waiver service closed and reopened).
- The final step in Care
Planning is to review the completed SFN 1467, Individual Care Plan with
the client/legally responsible party and obtain required agreements/acknowledgments
and signatures. See the instructions for completing the Individual Care
Plan, SFN
1467.
- When services are reduced, you must provide the
client or their legal representative with a completed SFN 1647.
Interim care plans are limited to clients who receive
services though the HCBS Medicaid Waiver and require services immediately,
or who are affected by a natural disaster or other emergency. An
interim care plan may be developed for a client, who is on Medicaid, has
an approved LOC Determination that was completed within the previous 90
days, and the case manager is unable to complete an immediate visit. When
services are needed immediately the case manager will need to complete
a face-to-face visit and complete an assessment within 10 working days
of the request. During natural disasters or other emergencies a face-
to- face visit must be made within 60 days of the request. Prior approval
from the Department is required.
- Example 1: A client who
is currently in a Nursing Home, has a LOC in place, and is on Medicaid,
plans to return home and the Case manager is unable to see the client
on the day of transfer home. An interim care plan could be written and
services could begin however a face-to-face visit would need to be completed
within 10 days.
- Example 2: A current client
has a LOC in place, is on Medicaid but because of flooding their residence
is not accessible, an interim care plan could be written so services could
continue for up to 60 days before a face-to-face visit is required.
Medicaid eligibility redetermination is completed
by Economic Assistance. A client who is receiving service through the
HCBS Waiver is required to be eligible for Medicaid. If in the redetermination
process it is determined the client is not eligible for Medicaid, payment
for services stops the day Economic Assistance sends the termination notice.
If the client has an established ICP and Authorization and the termination
is overturned, waiver services could be paid during that period of time.
- Implementing
the Individual Care Plan - The Case Manager assures that services
are implemented and existing services continued, as identified in the
Individual Care Plan. This activity includes contacting the QSP and issuance
of an Authorization for Service(s) SFN 1699 to be delivered. Refer to
instructions for completing the Authorization To Provide Services, SFN
1699.
- Monitoring
- Service monitoring is an important aspect of case management and involves
the case manager's periodic review of the quality and the quantity of
services provided to service recipients. The Case Manager monitors the
client's progress/condition and the services provided to the client. As
monitoring reveals new information to the Case Manager, regarding formal
and informal supports, the care plan may need to be reassessed and appropriate
changes implemented. The case management entity is responsible to monitor
the service plan and participant health and welfare. If the client’s care
needs cannot be met by the care plan and health, welfare, and safety requirements
cannot be assured; case management must initiate applicable changes or
terminate services. If the case is closed, the client is made aware of
their appeal rights. The case manager shall document all service monitoring
activities and findings in the client's case file.
- The HCBS case manager shall
monitor the services provided under the Individual Care Plan on an as
needed basis but not less than direct client contact at least once every
three months.
- Monitoring for Targeted
Case Management (TCM) - The same case management monitoring schedule followed
for SPED and Expanded SPED recipients applies even when TCM covers the
cost of case management.
- Residents of basic care
facilities under Basic Care Assistance Program must have two face-to-face
visits per year (annual and 6-month review), no other contacts are required.
- Monitoring
for Abuse,
Neglect, or Exploitation: When completing monitoring tasks if the case
manager suspects a Qualified
Service Provider or other individual is abusing, neglecting, or
exploiting a recipient of HCBS the following protocol is to be followed
by the HCBS Case Manager.
In all situations:
Notify the Program Administrator responsible for
complaint resolution in writing of all
actions taken to follow up on a suspected case of abuse, neglect,
or exploitation of an HCBS recipient.
Documentation
must include:
- Identify and document in
writing the name of the recipient.
- Identify and document in
writing the name of the qualified service provider or other individual.
- Document in writing a complete
description of the problem or complaint.
Process:
- Immediately report suspected
physical abuse or criminal activity to law enforcement.
- If you have reasonable
grounds to believe the recipient’s health or safety is at immediate risk
of harm, make a home visit to further assess the situation and take whatever
action is appropriate to protect the recipient.
- If you can document that
no immediate risk exists, but a problem requires further action, work
with the recipient and other interested parties to resolve the matter
as soon as possible.
- If the HCBS Case Manager
and Nurse Manager/Trainer determine that a incident is indicative of abuse,
neglect, or exploitation, the HCBS Case Manager must immediately report
the incident to the Department.
- Comply with North Dakota
State law Chapter 50-25.1, CHILD ABUSE AND NEGLECT.
- When the service is provided
on Reservation Lands, the Tribal Laws that govern abuse and neglect on
that reservation must be followed.
Process specific to the client's living arrangements,
individuals implicated, or the Provider type (all incidents/actions must
be reported to the Medical Services Program Administrator):
- Client lives in his or
her own home and the qualified service provider is an Individual or Agency
enrolled QSP:
If you can document that no immediate risk exists,
but a problem requires further action, work with the recipient and other
interested parties to resolve the matter as soon as possible.
- If the provider is a Basic
Care Facility or Residential Care Facility that is licensed as a Basic
Care Facility:
Notify the Ombudsman Program Administrator, Aging
Services Division
And
The North Dakota Department of Health Facilities.
- If the qualified service
provider is an Assisted Living Facility:
Notify the Ombudsman Program Administrator, Aging
Services Division
And
The DHS Program Administrator responsible for Assisted
Living Licensing.
- If the complaint involves
the provision of home delivered meals, contact the HCBS Program Administrator.
- Client lives in his or
her own home and is being abused, exploited, or neglected by an individual
other than the QSP:
File a report with law enforcement and/or Adult
Protective Services as indicated by the seriousness of the allegation.
- If the client is living
in a AFFC Home:
Contact the CSSB responsible for AFFC licensing,
And
Contact the Regional Representative at the Human
Service Center responsible for AFFC licensing.
And
Contact the Aging Services Division Adult Family
Foster Care Licensing Program Administrator.
- If the case involves a
Licensed Child Foster Care Home, the regional representative responsible
for the children's foster care licensing must be contacted.
- If the case involves a
client who is receiving DD Services, contact the client's DD Program Manager
or the Regional Program Administrator.
The Department of Human Services may remove a Qualified
Service Provider from the list of approved providers if the seriousness
and nature of the complaint warrants such action. The Department will
terminate the provider agreement with a Qualified Service Provider who
performs substandard care, fraudulent billing practices, abuse, neglect,
or exploitation of a recipient. North Dakota Administrative Code section
75-03-23-08 lists reasons why the Department may terminate a Qualified
Service Provider.
- Reassessing
- The case manager reassesses the client, care plan, and services on an
ongoing basis, but must do a reassessment at six-month intervals and the
comprehensive assessment annually. At the six month and annual visit,
the client stated goal must be reviewed and progress or continuation of
the goal must be noted in the narrative of the comprehensive assessment.
- Termination
of Service - When documenting that service(s) on the Individual
Care Plan were terminated, and indicating the reason(s) for termination,
refer to Section 05-40 Closures, Denials, and Terminations.
Contacts
with Clients
For SPED and EXSPED -
- An Initial Assessment is required to establish eligibility for services and following implementation of the service a contact shall be made with a NEW client within the first 30 days of implementation of services. Quarterly contacts with the client are required. Of the four, two must be home visits; one is at the time of the annual assessment and the other at the time of the six month assessment. The other two contacts may be by telephone (if the client can communicate over the phone) or office visit.
Waiver:
- HCBS and TD Wavier Services: An Initial Assessment is required to establish eligibility for services and following implementation of the service a contact shall be made with a NEW client within the first 30 days of implementation of services. Quarterly contacts with the client are required including an annual assessment, 6 month reassessment and two quarter contacts. All four contacts must be face to face and take place in the client residence. One of the quarterly visits must include a completion of a Medicaid Waiver Quality review, (this visit should not occur during the annual or 6-month contact), and a copy of this review needs to be sent to the Department.
- Services under the HCBS Waiver that are specific to Adult Residential and Transitional Care Services provided to clients as a result of the need for independent living skills training, support and training provided to promote and develop relationships, participate in the social life of the community, or develop workplace task skills including behavioral skill building requires all four contacts to be face to face. The annual and six month contact need to occur in the client’s residence. The other contacts must be face to face but can occur at other locations. Case Management coordinates an annual interdisciplinary team conference and invites the legal representative and others as requested by the client.
All required contacts must include responses
to the following questions:
- Date
- Reason for contact. (initial,
annual, six month, quarterly, collateral, returned call, received call,
etc)
- Location of visit (home
visit, care conference, hospital visit, office visit, telephone contact,
letter sent, etc)
- A description of the exchange
between yourself and the client or the collateral contact. If this is
a face to face visit- describe the environment, clients appearance, and
communication style.
- A listing of identified
needs, which includes the services the client is currently receiving.
- Service delivery options,
which includes discussion about service caps, and potential service available,
needed, or requested.
- Summary of care plan, which
includes the outcome of the discussion of the agreed upon services requested,
including other agencies or individuals providing care.
- Identify client stated
goals, progress, change in goals, etc at the initial, annual and six month
contact in this narrative note or in question #1.H.1. Describe the client's
stated goals and results or progress
- Review the Individual Service
Plan developed by the Adult Residential Provider (who provides services
primarily to individual with TBI) or the Transitional Care Provider at
the annual and semi-annual interdisciplinary team meeting and document
the results of the Individual Program Plan
- Client satisfaction
- Do the amount, duration
and frequency of services meet the client’s needs?
- Does the provider, provide
the services outlined on the care plan and authorization in the amount,
duration and frequency expected.
- Follow-up plan,
- Case Managers initials
Reimbursement/Payment
for Service
The Case Management Entity may bill for case management if the applicant/client
meets the eligibility criteria of the programs as identified in HCBS
Case Management - Service Activities, Standards of Performance, and Documentation
of HCBS Case Management Activities.
Request for reimbursement must be supported by documentation in the
client’s case file that case management service activities were completed.
When a change in funding source occurs, initial Case Management can
be claimed under the new funding source the month of transfer (opening
under new funding). The annual case management cycle starts with this
action. No claim for case management can be made to the funding source
being closed. Initial case management is allowed to establish the case
under the new funding source.
A higher rate may be used for higher-level case management for clients
eligible for Medicaid Waiver for Home and Community Based Services. Higher
level case management is limited to cases that require case management
participation in care plan meetings with an interdisciplinary team on
a regular basis or a case that requires frequent face to face visits to
assist care plan development and monitoring. Case managers must get prior
approval from the Department of Human Services before they can bill using
the higher-level case management rate.
Administrative
Tasks (Non-billable)
Any task or activity that is not directly related
to the assessment or reassessment of an individual, development, implementation,
or monitoring of a care plan; or termination/closure of a case cannot
be billed as case management. Administrative tasks such as those listed
below are examples of non-billable activities:
- Assisting a provider with
billing issues or enrollment; participating in appeal hearings; attending
training or staff meetings; supervising/scheduling of In-home Care Specialists,
etc.
Level
of Care Determination (LOC)
It is the responsibility of the County to initiate the screening either
by telephoning Dual Diagnosis Management (DDM) or by submitting information
to DDM (the web based method is the preferred method to submit information
to DDM).
A LOC determination/screening must be completed
for a client who is requesting services through a waiver program, or a
client who under the age of 18 and requesting SPED services. LOC determinations
must be updated as significant changes occur that would impact the LOC
determination outcome and at minimum on an annual basis. Following are
the screen types listed on the LOC Determination Form.
- Tech Dependent Waiver
- HCBS Waiver
- HCBS Waiver/MSP-PC (Check
only if eligible for both)
- SPED under age 18
- MSP-PC/SPED under age 18.
(Check only if eligible for both)
- MFP-Final and if the client
is receiving a HCBS Waiver service, complete a referral to a HCBS Program
Administrator to assist with the eligibility determination process.
For the purposes of opening/re-opening or prematurely
closing
a HCBS screening, see the instruction for the SFN 1288.
No screening will be needed if Waiver Services are
re-implemented within 90 days of the client's discharge from the nursing
home or swing bed and prior to end date of the LOC of the current HCBS
screening.
Upon completion of LOC determination, DDM will submit
to the Medical Services Division a list of the recipients, with the approval
or effective date of eligibility, ID Number, and date of birth. This information
will then be entered on the Nursing Home Eligibility file in the payment
system. DDM will also send written confirmation of HCBS (NF) determination
to the County for filing in the client's record.
When a HCBS client screened for Medicaid Waivered
services appears to no longer meet nursing facility (NF) care (Screen
Type: HCBS), a re-screening should occur. A significant improvement in
the recipient's medical/physical status or a decrease or cessation of
services provided are examples that could trigger a re-screening. DDM
needs to be informed of the reason for the screening and intended outcome
to "other." If DDM concurs the recipient no longer needs NF
care, an ending date of services needs to be given to Medical Services
by using the SFN 1288 plus a closure form, SFN 474, to Medical Services/HCBS.
The ending date is the responsibility of the case manager and needs to
allow sufficient time in which to give the client a ten calendar day notice
of service termination under the Medicaid Waiver funding source. DDM will
report screening terminations with closing dates to Medical Services.
Medical Services will input the ending date of services on the computerized
screening.
Nursing
Facility (HCBS)
Level of Care Determination
But The Client Is
Not Receiving Waivered Services
The stop date on the screening is important for
Medicaid recipients having a spouse in the household. The recipient is
treated, for Medicaid budgeting purposes, as if living in the nursing
facility only when RECEIVING services paid by the Waiver. At such time
as Waiver funded services are NOT provided, the screening must be "closed"
so that the correct budgeting method is reflected in TECS. Submit SFN
1288, CSSB Request for HCBS NF Determination, so a closing date is entered
on the Nursing Home Eligibility File in MMIS.
Case
File Contents
- For all programs, all case
files should have (at a minimum):
- Application for Service
SFN 1047
- Copy of Comprehensive Assessment
and narrative notes (updated every six months)
- Completed/Signed Individual
Care Plan(s) SFN 1467 (updated every six months)
- Authorization to Provide
Services SFN 1699 (updated every six months)
- Monthly Rate Worksheet
(if daily rate client) (SFN 1012 updated annually)
- HCBS Notice of Denial or
Termination SFN 1647 (if applicable)
- HCBS Case Closure/Transfer
Notice SFN 474 (if applicable)
- A canceled SFN 1699 (if
applicable)
- The case file for each
Medicaid Waiver client must contain:
- Verification the person
is a Medicaid recipient
- Medical information (if
applicable)
- Record of current level-of-care
determination(s) (updated annually)
- Completed/Signed Explanation
of Client Choice SFN 1597
- CSSB Request for HCBS NF
Determination SFN 1288 (if applicable)
- The case file for each
Expanded SPED client must contain:
- Transmittal Between Units
SFN 21 (update annually)
- Expanded SPED Program Pool
Data SFN 56
- Add New Record to MMIS
Eligibility File, ExSPED, SFN 677
- The case file for each
SPED client must contain the:
- SPED Program Pool Data
SFN 1820
- Add New Record to MMIS
Eligibility, SPED, SFN 676
- SPED Income and Asset SFN
820, HCBS Income and Asset Assessment (updated annually)