January 15, 2014 J 15 2014 Presented by: West Central Florida - - PDF document
January 15, 2014 J 15 2014 Presented by: West Central Florida Area Agency on Aging (WCFAAA) 1 Introductions Program Updates ADRC Information and Referral Overview SHINE Overview SSMC LTC and Medicaid Waiver Overview SSMC
1 J 15 2014
Presented by: West Central Florida Area Agency on Aging (WCFAAA)
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January 15, 2014
Introductions Program Updates ADRC Information and Referral Overview SHINE Overview
SSMC LTC d M di id W i O i
SSMC LTC and Medicaid Waiver Overview Enrollment Management Adult Protective Service SGR Case Narratives Performance Outcome Measure Overview Client Satisfaction Q & A
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Jacquee LaFrance, Information & Referral and Quality Assurance Manager
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assist people in finding the services they need while explaining the clients options. Information & Referral is the art, science and practice of bringing people and services together.
make good decisions for themselves.
the “front door” to the West Central Florida Area Agency on Aging
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the I&R department.
community resources such as housing, transportation, food pantries, SNAP, & volunteer associations (when available) etc.
reached directly at 1.800.336.2226
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The database used by our I&R Department is
available online via the agency’s website
www.agingflorida.com If you have knowledge on any potential resources
please refer to the inclusion and exclusion criteria handout for application criteria and guidelines.
Refer to Handouts 2, 3, and 4.
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Dani Gray
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What can SHINE do for your clients?
comparisons
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Call 1-800-963-5337 All calls are screened by Data Entry Operators
and then assigned to a counselor
SHINE counselors can counsel over the phone
sites
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SMMC LTC Planning and Preparation SMMC LTC Overview and Specifics
C i i C f MW C
Continuing Care for MW Consumers Ways to Ensure a Smooth Transition Additional Resources
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CURR CURRENT
Screening
FUTU FUTURE
Waivers
Listing
g care planning
& Medicaid pays the Provider
Waiver Specialists Monitor
& QA Activities
Management for ALL recipients via MCOs
(PSA 6)
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Current ADRC SMMC LTC Functions:
Information, referral and awareness Options counseling, advice and assistance Streamlined eligibility determination for public programs public programs Person-centered transition support Quality assurance and continuous Improvement
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New ADRC SMMC LTC Functions:
LTC Program Education Utilization of new HCBS Client Intake and Screening Assessment Nursing Home Placement Assistance for community (Screening, 3008, RFA, etc.) Waiting List Release LTC Program Education and Screening (in home) Medicaid Eligibility Application Assistance Assist Recipients with Grievances/Complaints Annual Re-Screening for waiting list individuals
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1.
January 2013 – Enrolling in MW programs commences, DOEA Reporting
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March - May: Training
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June: New Service Provider Enrollment Deadline
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July: Screening DCF Under 60 for Waiver waitlist, R f l A f MW d d Referral Agreement for MW programs amended
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September: Halt CDC Enrollment, begin Waiver monitoring upload
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October: Staffing Plan due October 1st, AHCA begins mailing SMMC LTC recipients letters, Active Client files uploaded to FTP site, Enrollment halt (excluding NHTR)
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December 2013: NHTR Enrollment Halt
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In preparation for SMMC LTC, WCFAAA has
performed the following. Development of a Transition and Staffing Plan Involvement of Board and Community Stakeholders Communication with ADRC Partners Updates to Referral Agreements and MOUs Realignment and training of staff for new duties
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February 1, 2014 is a big day.
It is the PSA 6 SMMC LTC “Go Live” date. WCFAAA staff changes will occur for purposes of SMMC LTC. p p DOEA Reporting for Medicaid Waiver Programs will end.
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What is it?
It stands for Statewide Medicaid Managed Care Long Term Care (SMMC LTC). A new system through which Medicaid recipients who qualify and become enrolled will receive long- term care services from a managed care plan. It has two key components: Long Term Care (implemented August 2013 – March 2014) and Managed Medial Assistance (implementation in mid 2014)
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It is not
Part of National Health Care Reform or the Affordable Care Act passed by the US Congress SMMC LTC will not change Medicare benefits.
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Recipients are mandatory for enrollment if
they are:
65 years of age or older and need a nursing home level of care OR level of care OR 18 years of age or older and are eligible for Medicaid by reason of disability, and need a nursing home level of care
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Recipients must enroll in SMMC LTC if they
are 18 or older and enrolled in the following:
Assisted Living Waiver Aged and Disabled Adult Waiver
Consumer-Directed Care Plus Program (CDC+) g ( )
Channeling Services Waiver Frail Elder Program Long Term Care Community Diversion Waiver Or, they live in a nursing home and have Medicaid as the primary payer.
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Recipients who may choose to enroll in a
Long Term Care Program (but are not required to enroll) include:
Medicaid recipients enrolled in the Developmental Disabilities home and community based services y waiver, and Medicaid recipients waiting for waiver services Medicaid recipients enrolled in the Program of All Inclusive Care for the Elderly (PACE).
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A recipient currently residing in a nursing
facility cannot be enrolled until they have
Received proper level of care from Comprehensive Assessment and Review for Long Term Care Services (CARES) Been approved for Medicaid Been approved for Medicaid
A recipient cannot be enrolled to receive home
and community based services until they have:
Received proper level of care from CARES Been released from the wait list Filed a Medicaid application
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October 2013: Pre-Welcome Letters sent by
Enrollment Broker (EB/Automated Health Systems (AHS))
November 2013: AHCA sends Welcome Letters
regarding selecting managed care provider through EB.
December 2013: AHCA sends Reminder Letters
to all clients.
December 2013/January 2014: Clients
counseled by EB/AHS regarding managed care
February 1, 2014: Clients enrolled in managed
care plans.
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Mandatory recipients will receive a letter that
includes:
make a choice, called an “auto assignment”
Guidance about obtaining more information
Recipients have a least 30 days to choose a
plan from those available in their region
If no plan is chosen by the date provided in
the notification letter, the auto assignment will take place on the specified date.
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After joining a plan, recipients will have 90
days to choose a different plan in their region.
After 90 days, recipients are locked in and After 90 days, recipients are locked in and
cannot change plans unless:
enrollment effective date, known as the open enrollment period.
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ADRC is the gatekeeper for all new clients
needing home and community based services.
ADRC conducts Intake & Screening for
eligibility education on managed care eligibility, education on managed care
resources.
Clients are prioritized based on greatest
need and placed on waitlist (Assessed Priority Consumer List).
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Client information is sent to DOEA who
maintains statewide waitlist and approves clients for release.
Once client is released, ADRC assists
clients(if needed) to file application for
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clients(if needed) to file application for financial eligibility w/DCF, and obtains 3008 from Doctor.
Concurrently, ADRC refers cases to CARES
to complete the Level of Care (LOC). CARES also completes the 701(b).
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7 CARES feeds LOC via Client Tracking
System to EB. DCF will also be expected to electronically upload the eligibility information to the EB.
Once financial eligibility and medical Once financial eligibility and medical
eligibility are approved, the client is enrolled by the EB with their voluntary choice or mandatory assignment to a managed care organization for services.
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Enroll Online at
www.flmedicaidmanagedcare.com
Call the choice counseling call center at 1-
877-711-3662, and speak to a choice counselor counselor
Request an in-person meeting
center or selecting “schedule an appointment” on the above website.
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SMMC LTC Choice Counseling is available
to:
best for them
Help recipients know how to access covered services and additional benefits available under each plan
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LTC plans must continue enrollees’ current
services for up to 60 days until a new assessment and care plan are complete and services are in place.
Service providers that have not contracted Service providers that have not contracted
with an enrollee’s LTC plan must continue serving the enrollee
provider and new care plan has been developed
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The LTC must authorize and pay for services
rendered by the non-contracted provider until:
provider in writing that reimbursement will end on a specific date.
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Refer recipients to choice counselors for
assistance with choosing an SMMC LTC plan.
Refer recipients to WCFAAA Elder Helpline
for general questions related to SMMC LTC. for general questions related to SMMC LTC.
Contact the local Medicaid Area Office if you
are having trouble getting paid for services rendered.
813-350-4800 or (800) 226-2316 www.mymedicaid-florida.com – Area Office 6
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Ensure the following consumer documents
are kept current: Assessments; Care Plans; Levels of care; and Levels of care; and Case narratives
Submit technical assistance requests to LTC
Coordinators and Manager to help resolve client eligibility issues
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Assist with client eligibility issues
Loss of Medicaid coverage, no more than 60 calendar days (AKA SIXT) Recipients will not be disenrolled from their plan If eligibility is not restored, the recipient will be disenrolled, and will not receive services. Recipients are not responsible for paying the plan for services during temporary loss. There is a 30 day grace period to get eligibility re- established for the consumer.
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Updates about the Statewide Medicaid
Managed Care program are posted at: http://ahca.myflorida.com/SMMC
You can sign up to receive email updates
about the program at this website.
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Qu Quiere res Taco s Taco Bell Bell?
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Care Plan ALL
ALL services for 31 days, then revise for remaining 11 months if CM & API agree to continue services.
Problem continues: Many instances of only
CM care planned for 1 month and all other services care planned for 12 months!
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Include Assessment Summary page with all
assessments and updates.
Call API within 24 hours if client refused or
delayed services DOCUMENT ALL CONTACT delayed services. DOCUMENT ALL CONTACT ATTEMPTS AND DISCUSSIONS!
Call API if all recommended services were not
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Specific dates individual was contacted by
CM during the 31 days following referral.
Specific dates the individual was assessed Specific dates the individual was assessed Individual’s abilities, needs and deficiencies
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specific services and service dates for
services provided during 72 hours following referral (include NDP– non-DOEA)
services provided and frequency at which
they were provided during 31 days following referral.
consumer satisfaction of services all contact and discussions with APS staff
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If services could not be provided for reasons
beyond control of provider, document all actions taken in an attempt to provide services and/or contact the referred individual
If services were delayed, document why, when
b d h h d d services began, and which services were provided.
CM must staff service delay issues with API
immediately.
If the API and CM disagree on need for services
requested by API, the CM Sup and API Sup jointly review and resolve.
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all contacts and discussions with Nursing
Home Diversion providers (if applicable)
when follow-ups are performed
befo before re 14 calendar days to ensure services started ( befo before re 14 calendar days to ensure services started ( call to client) Before services are terminated, the client will be seen face-to face by a Lead Agency case manager. If the CCE Lead Agency determines services can be safely terminated, APS will be contacted. APS will participate in a discussion of the client regardless of the status.
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Made sometime befo
before re 14th day to ensure that services have started.
If CM has already received confirmation of If CM has already received confirmation of
service delivery prior to day 14, no need to make additional call on the 14th day.
Calls should be documented and include
date that services started.
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Continue or terminate services?
“Need” vs. “Abuse, Neglect, Exploitation”
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Is the client likely to be a victim of Abuse,
Neglect or Exploitation if services ended ?
Caregiver in the home? Income/assets – could they privately pay
for services?
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Client eligibility Client need/unmet needs Completion of Co-Pay worksheet Excessive billing Repetitive or duplicative documentation
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OBSERVATIONS!
case manager’s observations of the client:
What did you see in and around the home? What did the client or caregiver say? How did the client appear? Does the client’s appearance and environment correspond with the assessment?
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Note review:
At the end of your note, ask yourself the following: Does the note justify the time billed? Does the note justify the time billed?
If not, why not? What should be included or left out? Did you record the appropriate time spent and units of services?
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Note review:
sp spelli elling ng and gramm grammar errors.
the ability for someone else to read and understand the client’s situation.
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Tips to keep in mind…
previously stated documentation. They should provide a fresh picture of the client’s current condition.
potentially be seen by the client, caregiver, the DOEA, WCFAAA, and other providers.
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AVOID “EXCESSIVE” BILLING!
claimed. Example 1- Not sufficient
E l 2 S ffi i Example 2:- Sufficient
states they are satisfied with the services and no additional assistance is needed for the client/CG has remained stable. CM asked if client was able to talk. Client was sleeping when CM called. CM told CG to contact CM if any issues or concerns arise.”
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Assessment and/or case note documents the
client has unmet needs.
Incorporate into care plan. Add client to appropriate wait list. Document utilization of informal resources
such as community organizations, family, and/or friends.
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Documenting a serious concern in a client file
such as suspected self neglect, abuse, exploitation, and/or service provider issues, etc.
Follow up must be completed in a timely
manner and be clearly documented.
What are some examples?
58 59 60
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Currently achieving 9 of 9 goals.
Keep up the good work!
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MAKE IT SHORT & SWEET. Paint a picture of
the client’s changes in a few sentences.
Describe the changes from the last
assessment.
CM’s can review turnaround to ensure no
errors when compared to the original assessment.
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Mailed March 2013
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Case Management Survey
It’s all about YOU!
with respect.
the available services.
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Personal Care Survey
them as a person.
respectful.
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Homemaker Survey
treats them with respect.
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WCFAAA Survey
The results of the 2013 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.
GREAT JOB !!!
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Our clients are the inspiration for
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Sign-in & Refreshment 9:15-9:30 Introductions – Katie, 5 min 9:30-9:35 Program Updates – Katie, 5 min 9:35 – 9:40 ADRC Information and Referral Overview- Jacquee, 15 min 9:40- 10:00 SHINE Overview- Dani, 15 min 10:00-10:15 Statewide Medicaid Managed Care Long Term Care Programs (SSMC LTC) and Medicaid Waiver Review – Lauren 45 min, 10:15-11:00 Break at 11:00, restart at 11:10 Enrollment Management – Christy, 5 min 11:10-11:15 Adult Protective Service Referrals – Christy, 15 min, 11:15-11:30 SGR Case Narratives – Kristina, 15 min, 11:30-11:45 Performance Outcome Measure Overview – Kristina, 15 min 11:45-12:00 Client Satisfaction – Christy, 15 min 12:00 – 12:15 Q & A, Katie and Team, 15 min for last section 12:15-12:30
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Finding the Community Resource Directory on the WCFAAA Agency Website
Step 1. Go to http://www.agingflorida.com/ (WCFAAA’s Agency Website) Step 2. Click on the left side of the information tab titled “Find Help Here” Step 3. Scroll down to “Find Services In Your Area” http://www.refersoftware.com/floridaaging/Search.aspx?psa06
Options for Finding Information Once in the Community Resource Directory
may be added, this will reduce the amount of listings to include those closer to the area
There is the option of finding services in the following way:
then get broken down further for more specific selection of service needs.
“food” or “financial”. This will provide the largest amount of options. If too many
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Helpful Search Hints Service Searching using “Service” when you know one or more of the words in a service terms. Agency/Program Name Searching by using Agency/Program Name when you know one or more of the words in a service provider name or program name. For example, search with the words red and cross to find American Red Cross locations and see what services are offered. Not finding what you want? If you don’t find any matching results, change the drop down list from Any Word to Partial
many results matching the word you used for searching, try the following to see fewer matches: Use more words for searching. For example, search with the three words bill payment assistance instead of just the word assistance. Another example is to search with the words abuse counseling or abuse prevention instead of just abuse. Change the drop down list from Any Word to All Words or Exact Phrase. This is the most restrictive search. If you limited your search by ZIP Code or town, delete the limits. We're here to help 8:00 to 5:00 Monday through Friday, please feel free to contact the Elder Helpline at 1.800.336.2226 or 1.800.96.ELDER PLEASE NOTE: This database is comprised of statewide and national resources. Therefore you can search for resources needed from anywhere in the state.
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AGING & DISABILITY RESOURCE CENTERS STATEWIDE INTEGRATED DATABASE APPLICATION PLEASE RETURN FORM TO: WEST CENTRAL FLORIDA AREA AGENCY ON AGING, ATTN: JANET SANCHEZ JANET.SANCHEZ@AGINGFLORIDA.COM 5905 BRECKENRIDGE PARKWAY, SUITE F, TAMPA, FL 33610 OR FAX: 813-623-1342 Please clearly fill out all items. If not applicable, please mark N/A. Agency’s Legal Name: _______________________________________________________________ Agency’s Common Name (AKA): _______________________________________________________ Physical Address: ___________________________________________________________________ City: __________________________________ State: __________ Zip Code: ___________________ Is this location confidential? □ Yes □ No Is this location close to public transportation? □ Yes □ No Primary / Main Office Please list the accessibility features available at this location Fully Accessible Limited Access No Access Designated Parking Full Wheelchair Access Elevators Other Please explain: ________________________________________________________________ Mailing Address (If Different): ___________________________________________________________ City: ________________________________ State: __________ Zip Code: _______________________ Main/Toll Free Phone Number: __________________________________________________________ Fax: ____________________ TDD/TTY: ____________________ Other: _________________________ Website: __________________________________E-Mail: ____________________________________ Has your organization been in business at least one year? □ Yes □ No Month /Year Incorporated: __________________ IRS Status: ____________ Tax ID: _______________ License #: _________________________ (Attach copy of License) Agency Type: For Profit Non-Profit United Way Member Faith-Based City County State Federal Other Funded By: City Funding County Funding State Funding Federal Funding Fees United Way Fund Raising Donations Private Funding Other Please explain: ________________________________________________________________ Contact Information Director Name: ________________________________________Title: __________________________ Phone Number: ____________________Ext:_________ E-Mail: ________________________________ Main Contact Name: ____________________________________Title: __________________________ Phone Number: ____________________Ext:__________ E-Mail: _______________________________ Alternative Contact Name: _______________________________Title: __________________________ Phone Number: _____________________Ext:__________ E-Mail: ______________________________ Other Contacts: (Please include Type: Intake, Toll Free, Cell, etc.): ______________________________
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AGING & DISABILITY RESOURCE CENTERS STATEWIDE INTEGRATED DATABASE APPLICATION Agency Overview Brief Agency Description:________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Days and Hours of Operation: ____________________________________________________________ Service Area (City/County): ______________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Languages Spoken: Spanish Creole Other(s) __________________________________________ Fees / Payment Options: Private Pay/Fee for Service Private Insurance (specify)______________ Medicare Medicaid Other _____________________________________________________ The information below is obtained solely to better match client needs with the appropriate service providers and will not affect your application to enlist in our database as a resource. Serves: 18+ Specific Ages _________ to _________ Women Only Men Only Serves Specific Target Groups: Alzheimer’s/Dementia Other ______________________________ Do you offer discounted pricing or a sliding fee for seniors/disabled adult? Yes No If Yes, please explain: ___________________________________________________________________ Would you be willing to offer any pro bono services on a short term basis? Yes No If Yes, please explain: ___________________________________________________________________ Is your agency Lesbian, Gay, Bisexual, and Transgender (LGBT) Friendly? Yes No Does your agency provide staff with sensitivity training? Yes No Other _____________________________________________________________________________________ Programs and Services Name of Service/Program (1): ___________________________________________________________ Service Description: ____________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Eligibility / Criteria: _____________________________________________________________________ _____________________________________________________________________________________ Intake Procedures ______________________________________________________________________ _____________________________________________________________________________________ Name of Service/Program (2): ____________________________________________________________
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Service Description:____________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Eligibility / Criteria: _____________________________________________________________________ _____________________________________________________________________________________ Intake Procedures ______________________________________________________________________ _____________________________________________________________________________________ ***Please attach all requested information for additional Programs and Services*** Other Sites and Locations Site (2) Name: _________________________________________________________________________ Satellite Office/Site Please list the accessibility features available at this location Fully Accessible Limited Access No Access Designated Parking Full Wheelchair Access Elevators Site Address: _________________________________________________________________________ City: ______________________________ State: __________ Zip Code: ______________ Is this location confidential? □ Yes □ No Is this location close to public transportation? □ Yes □ No Site Phone Number(s) – Please indicate Phone Type (Intake, Toll Free, Cell, etc.): (1) ______________________ (2) _______________________ (3) ______________________ Site or Service Contact: ___________________________________________________________________________________ Specify if this location has different Eligibility, Programs and Services than the main office: _____________________________________________________________________________________ _____________________________________________________________________________________ ***Please attach all requested information for additional Sites and Location*** ACKNOWLEDGEMENT I, ____________________attest that the information provided on behalf of our agency/organization is true and accurate. I also understand and agree that misrepresentation or omission of pertinent information regarding the agency and/or services provided will result in the deletion of the agency or organization from the database without notice. Furthermore, it is acknowledged and understood that participation in the statewide database does not constitute an endorsement of the agency by the Department of Elder Affairs or by the Aging & Disability Resource Centers in Florida. Signature____________________________________________________________________________ Title ___________________________________________________ Date: _______________________ *** This form must be signed before information can be entered in Refer Database ***
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State of Florida Aging and Disability Resource Centers
Integrated Statewide Information & Referral Database Background information: Florida’s eleven Aging and Disability Resource Centers (ADRCs) have a long history as Elder Helplines and are committed to helping persons age 60 and above, and those who care about them, understand and navigate the complex web of services available through government funded programs, non-profit agencies, and for-profit businesses. In addition to serving seniors, the ADRCs also provide access to resources for adults with disabilities. Each ADRC may specialize in serving individuals with a particular
the entire community including children. Despite these differences, Florida’s ADRCs have a unique partnership, work in conjunction to serve their communities, and they share one statewide resource database. The ADRCs maintain this database to help people find information, resources, and services that can provide assistance on a variety of issues, enabling seniors, grandparents raising grandchildren, persons with a disability, and caregivers to make informed decisions. To support this goal, Florida’s ADRCs have set forth the following state-wide inclusion and exclusion guidelines for the Integrated Statewide Information and Referral Resource Database that they share. Specialized Populations Served: The database shall include entities that serve both Florida’s elders and their families. In specific counties, resources are included for specialized populations: Adults with severe and persistent mental illness.
Seminole counties. Adults with a developmental disability and their caregivers.
Escambia, Flagler, Franklin, Gadsden, Glades, Gulf, Hardee, Hendry, Hillsborough, Highlands, Holmes, Indian River, Jackson, Jefferson, Lee, Leon, Liberty, Madison, Manatee, Martin, Miami-Dade, Monroe, Nassau, Okaloosa, Okeechobee, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Sarasota, St Johns, St Lucie, Taylor, Volusia, Wakulla, Walton, and Washington counties.
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All adults with disabilities.
Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union. Comprehensive Information & Referral for all age groups.
Marion, Orange, Osceola, Seminole, Sumter, and Union counties.
These guidelines are uniformly applied so staff and the public are aware of the scope and limitations of the database. The following are minimum requirements for inclusion by all ADRCs:
human services for elders and their caregivers OR must address the needs of
maintain a license, certification, or registration.
considered for inclusion if they serve elders, their caregivers, address the needs of other populations in that service area as specified above or offer unique services that are not available in the service area.
databases at the discretion of that agency, as long as the minimum statewide criteria are met.
standards above. Inclusion is up to the discretion of each individual ADRC based on the populations served, as specified above:
Agency on Aging/Aging and Disability Resource Center, Lead Agency, or the Florida Department of Children and Families to provide services.
practitioners.
assisted living facilities, adult day care centers, home health agencies, etc.).
transact business in Florida.
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Human Relations. 10. Websites that provide services or information relevant to seniors and/or persons with disabilities.
by all ADRCs:
certification, or registration.
nationality, disability, marital status, or any other basis prohibited by law.
provided, licensing status, or any other pertinent matter.
specified time. IV. Each individual ADRC may elect to include additional specific criteria for populations served or resource inclusion/exclusion. Disclaimer: Inclusion in the statewide resource database does not constitute an endorsement of an organization, agency, or service by Florida’s Aging and Disability Resource Centers (ADRCs). Exclusion does not constitute lack of endorsement. The information contained in the database was provided by the organizations and agencies. To ensure accuracy of resource information, Florida’s ADRCs conduct annual updates
resource database. Florida’s ADRCs cannot guarantee the accuracy or completeness
and space requirements. Only providers who meet the statewide inclusion/exclusion guidelines above will be included in the statewide database. Final decision for inclusion/exclusion will be at the sole discretion of individual ADRCs. Appeals to these decisions must be forwarded, in writing, to the individual ADRCs. A response will be provided within thirty (30) days of receipt of appeal.
Adopted 04/08/10 Revised 2/23/2012 Revised 05/08/2012
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Potential Client in Community Makes Initial Contact to CARES, DCF, or EB for Enrollment in SMMC LTC ADRC = Aging and Disability Resource Center CARES = Comprehensive Assessment & Review for Long-Term Care Services CC = Choice Counseling DCF = Dept. of Children & Families EB = Enrollment Broker FTP = File Transfer Protocol GR = General Revenue HCBS = Home & Community-Based Services I & R = Information & Referral LOC = Level of Care NF = Nursing Facility OAA = Older Americans Act
DRAFT
Refer to ADRC ADRC conducts I&R ADRC obtains 3008 & refers to CARES ADRC determines if applicant already on file with DCF ADRC contacts applicant for continued interest in Medicaid. DOEA releases clients from waitlist to ADRC when funding becomes available ADRC assists applicant with DCF application* Waitlist for Medicaid HCBS YES Has SSI or Medicaid eligibility CARES completes 701B, determines placement recommendation, & LOC ADRC sends LOC & 2515 for HCBS to DCF DCF determines financially eligible for Medicaid Update waitlist
interested in non-Medicaid, refer to waitlist for OAA & GR NO Not Eligible EB can send CC materials in advance Client contacts EB EB enrolls client & sends confirmation letter Client enrolled For HCBS IF NO YES Client makes choice Eligible CIRTS transmits LOC completion to EB via FTP & DCF submits notice of app filed to EB via FTP CARES transmits LOC to ADRC & EB
FUTURE Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) Program Operations Friday, March 29, 2013
Client Interested in Medicaid NF or HCBS? YES Has pending ICP app w/DCF For NF NF Refer to Intake to enter demographic information in CIRTS HCBS Refer to Intake & Screening to conduct 701A IF NO YES
DRAFT
Waitlist for OAA & GR Programs NOTE: For clients already in the NF, CARES will handle using the current procedures. *Filing the DCF application can occur simultaneously with obtaining the 3008 36
Statewide Medicaid Managed Care (SMMC) Long-term Care (LTC) program
The Florida Medicaid program is in the process of implementing a new system through which Medicaid recipients will receive long-term care services. This program is called the Statewide Medicaid Managed Care Long-term Care Program.
The Long-term Care program is comprised of two types of health plans:
Who is required to participate?
Individuals are required to be enrolled in the Long-term Care program if they are:
level of care
by reason of disability AND need nursing facility level
(A/DA) Waiver
Directed Care Plus for individuals in the A/DA waiver
Waiver
Waiver.
Who is NOT required to Participate?
Individuals who are enrolled in the following programs are NOT required to enroll, although they may enroll if they choose to:
What services are provided under the Long- term Care program?
LTC Program Minimum Covered Services
Adult companion care Intermittent and skilled nursing Adult day health care Medical equipment and supplies Assisted living Medication administration Assistive care services Medication management Attendant care Nursing facility Behavioral management Nutritional assessment/ risk reduction Care coordination/ Case management Personal care Caregiver training Personal emergency response system Home accessibility adaptation Respite care Home-delivered meals Therapies, occupational, physical, respiratory and speech Homemaker Transportation, Non-emergency Hospice
What providers will be included in the Long-term Care plans?
Long-term Care plans may limit the providers in their networks based on credentials, quality indicators, and price – But they must include a minimum number of all of the providers listed in the chart below.
In addition, Long-term Care plans must offer initial contracts to certain providers within their region, including: nursing facilities, hospices and aging network services providers in their region. LTC Program Minimum Network Providers
Adult day care centers Homemaker and companion services Adult family-care homes Hospices Assisted living facilities Community care for the elderly lead agencies Health care service pools Nurse registries Home health agencies Nursing home
Other qualified providers under the LTC program include: Alarm System Contractors, Case Managers and Case Management agencies, Centers for Independent Living, Clinical Social Workers, Community Mental Health Centers, Community Transportation Coordinators, Dietician/ Nutrition Counselors, Homemaker/ Companion Agencies, Durable Medical Equipment and Home Medical Equipment providers, Licensed Practical Nurses, Mental Health Counselors, Occupational, Physical, Respiratory and Speech Therapists, Psychologists and Registered Nurses.
Plans must have a sufficient provider network to serve the needs of their plan enrollees.
When will the Long-term Care program begin?
The Long-term Care program will be implemented on a regional basis, for the first region enrolling on August 1, 2013 and the final region enrolling on March 1, 2014. July 30, 2013
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What Region am I in?
Region Counties
1 Escambia, Okaloosa, Santa Rosa, and Walton 2 Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, and Washington 3 Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union 4 Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia 5 Pasco and Pinellas 6 Hardee, Highlands, Hillsborough, Manatee, and Polk 7 Brevard, Orange, Osceola, and Seminole 8 Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota 9 Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie 10 Broward 11 Miami-Dade and Monroe
When will I be notified and be required to enroll?
Region Pre- Welcome Letter Welcome Letter Reminder Letter Last Day to Choose a Plan Before Initial Enrollment Date Enrolled in LTC Plans 1 11/1/2013 12/23/2013 1/20/2014 2/13/2014 3/1/2014 2 7/1/2013 8/26/2013 9/16/2013 10/17/2013 11/1/2013 3 11/1/2013 12/23/2013 1/20/2014 2/13/2014 3/1/2014 4 11/1/2013 12/23/2013 1/20/2014 2/13/2014 3/1/2014 5 10/1/2013 11/25/2013 12/16/2013 1/16/2014 2/1/2014 6 10/1/2013 11/25/2013 12/16/2013 1/16/2014 2/1/2014 7 4/1/2013 5/20/2013 6/24/2013 7/18/2013 8/1/2013 8 5/1/2013 6/24/2013 7/22/2013 8/22/2013 9/1/2013 9 5/1/2013 6/24/2013 7/22/2013 8/22/2013 9/1/2013 10 7/1/2013 8/26/2013 9/16/2013 10/17/2013 11/1/2013 11 8/1/2013 9/23/2013 10/21/2013 11/21/2013 12/1/2013
What do I have to do to choose a Long-term Care plan?
Prior to implementation in your region, you will receive plan selection materials from the choice counselor by mail. The dates for these mailings are listed above.
All Medicaid recipients receiving services in a nursing facility, or through the Nursing Home Diversion Waiver, Aged and Disabled Adult Waiver, Assisted Living Waiver, Channeling Waiver, or the Frail Elder Option will have the
enrollment into the Long-term Care program.
If a recipient is currently receiving services from a LTC plan that will also be a LTC plan in the region where the recipient resides, the recipient can choose to remain with the original plan, or the recipient can choose to enroll with a different plan.
A counselor will assist you in selecting the plan in your region that best meets your needs. To contact a choice counselor, you can use your computer to go to www.flmedicaidmanagedcare.com; or you can call 1-877- 711-3662 to talk to a choice counselor.
You can request an in person visit from a choice counselor as well.
The Aging and Disability Resource Center (ADRC) is also available to assist with any questions you may have.
What Long-term Care Plans are available in my Region?
American Elder Care Ameri- group Coventry Humana Molina Sunshine United 1 X X 2 X X 3 X X X 4 X X X X 5 X X X X 6 X X X X X 7 X X X X 8 X X X 9 X X X X 10 X X X X 11 X X X X X X X
Can I change LTC plans once I make a selection?
Recipients are encouraged to work with their choice counselor to choose the LTC plan that best meets their needs.
After joining a plan, the recipient has 90 days to change to another plan offered within their region.
After the 90-day deadline, recipients may only change plans for “good cause” reasons.
After the initial 12-month period, recipients may change plans during an open enrollment period.
Will my LTC plan continue the services I am receiving now?
The new plan is required to continue existing services unabated for up to 60 days, OR until the recipient receives a comprehensive assessment and a new plan of care is developed.
Where can I find additional information on this program?
Information on the LTC plans available in each region and on how to choose a LTC plan will be available on the Choice Counseling website ahead of when recipients will need to make a choice: www.flmedicaidmanagedcare.com.
Questions about the program can be emailed to: FLMedicaidManagedCare@ahca.myflorida.com
Updates about the Statewide Medicaid Managed Care program are posted at: http://ahca.myflorida.com/SMMC
Upcoming events and news can be found on the “News and Events” tab on the SMMC website: http://ahca.myflorida.com/SMMC
Keep up to date on information by signing up to receive program updates by visiting the SMMC website through the following link http://ahca.myflorida.com/SMMC and clicking the red “Sign Up for Program Updates” box on the right hand side of the page.
Find more information at the following: Youtube.com/AHCAFlorida
Facebook.com/AHCAFlorida
Twitter.com/AHCA_FL
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