Nursing Home Transition Case Management Procedures for AAA/ARC Part I

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1 Nursing Home Transition Case Management Procedures for AAA/ARC Part I 1) Referral from CARES to ARC a. Send referral packet with: i. DOEA-CARES Form 701B ii. AHCA Med-Serv Form 3008 iii. DOEA-CARES Form 608 (Freedom of Choice) iv. AHCA Med-Serv Form 2040 (Informed Consent) v. DOEA-CARES Form 602 (Referral- Nursing home admit date noted) 2) CARES will make referrals for regular transition clients (transition case management not needed) based on approved AAA/ARC nursing home transition matrices. 3) If Transition Case Management is recommended via CARES Referral process then the following will occur: a. If ICP approvedi. ARC will perform a client status check by contacting client and/or designated representative and verify length of nursing home stay by reviewing DOEA-CARES Form 602. Nursing home length of stay starts on the nursing home admit date, and ends on the date of discharge. ii. ARC will make referral to case management agency for transition case management. Transition case management cannot be billed until the client has reached 60 consecutive nursing home days at the time of discharge. (See step 4) b. If ICP pendingi. ARC will perform a client status check by contacting client and/or designated representative, verifying the length of nursing home stay by reviewing DOEA-CARES Form 602, checking status of DCF application, and provide financial eligibility assistance. Nursing home length of stay starts on the nursing home admit date, and ends the date of discharge. ii. Once the client is ICP approved, the ARC will make referral to the case management agency for transition case management. Transition case management cannot be billed until the client has reached 60 consecutive nursing home days at the time of discharge. (See step 4) 4) In order for case management agencies to bill, the following requirements must be met per the waiver handbooks: a. Client resided in a nursing home 60 consecutive days by the time of discharge. b. No more than 20 hours of transition case management can be billed within 6 months of waiver start date. c. Client has a completed and signed nursing home transition (NHT) plan. Updated 01/27/11 Page 1

2 d. Upon nursing home discharge, client is enrolled into the Aged and Disabled Adult Waiver or Assisted Living for the Elderly Waiver. i. NOTE: The first opportunity to bill is the waiver start date. 5) If the client status check shows that transition case management is no longer needed or the client goes home without transition case management, then the ARC must document the referral outcome and notify CARES via the DOEA-CARES Form ) ARCs may identify clients that need transition case management by documenting the need for transition case management on the DOEA-CARES Form 602, and submitting the form to CARES. Updated 01/27/11 Page 2

3 Nursing Home Transition Case Management Procedures for AAA/ARC Part 1 Referral from CARES to AAA/ARC includes forms: 701B, 3008, 608, 2040, 602 TCM Recommended Referral Regular Transition Referral (TCM not needed). Normal AAA/ARC procedures are followed. AAA/ARC may determine TCM is needed & submits DOEA Form 602 back to CARES. APPROVED Client s ICP Status PENDING AAA/ARC will: A. Check client s current status & verify length of NH stay B. Refer to case management agency for TCM If referral status check shows TCM is no longer needed, the AAA/ARC must document referral outcome and notify CARES via DOEA Form 602. AAA/ARC will: A. Check client s current status, verify length of NH stay, check status of DCF application, & provide financial eligibility assistance if needed. B. When ICP approved, AAA/ARC refers to case management agency for TCM. AAA = Area Agency on Aging ADA = Aged & Disabled Adult Waiver ALE = Assisted Living for the Elderly Waiver ARC = Aging Resource Center DCF = Department of Children & Families ICP = Institutional Care Program NH = Nursing Home NHT = Nursing Home Transition TCM = Transition Case Management ALL REQUIREMENTS MUST BE MET PER THE WAIVER HANDBOOKS IN ORDER TO BILL: A. Client resided in NH for 60 consecutive days by the time discharge occurs. B. No more than 20 hours of transition case management can be billed within 6 months of waiver start date. C. Client has a completed and signed nursing home transition (NHT) Plan. D. Upon nursing home discharge, client is enrolled in the ADA or ALE Waiver. [NOTE: The first opportunity to bill is the waiver start date.] DRAFT Updated 01/27/11 Page 3

4 Nursing Home Transition Case Management Procedures for Transition Case Managers Part II 1) Within 10 business days from receipt of referral from the ARC, the transition case manager will conduct a faceto-face visit to update the client s initial DOEA-CARES Form 701B and complete the nursing home transition (NHT) plan. The transition case manager will document the start of transition case management services on the NHT plan. 2) Once barriers to transition are removed, and the transition case manager has determined the client is ready to safely return to the community, then the transition case manager and the client or designated representative must sign the NHT plan. The transition case manager will notify CARES (via the NHT plan) of the client s estimated discharge date, and submit the updated 701B with the request for a level of care (DOEA-CARES Form 603). 3) The case management agency may bill for transition case management on the waiver start date. In order to bill, the following requirements must be met per the waiver handbooks: a. Client resided in nursing home 60 consecutive days by the time they discharged. b. No more than 20 hours of transition case management can be billed within 6 months of waiver start date. c. Client has a completed and signed NHT plan. d. Upon nursing home discharge, client is enrolled into the Aged and Disabled Adult Waiver (ADA) or Assisted Living for the Elderly Waiver (ALE). 4) Once the transition case manager has received the LOC, the transition case manager must submit Form 2515 to DCF and request ex parte. 5) Once DCF has provided the Notice of Case Action to the client and/or the transition case manager, the transition case manager must submit the Notice of Case Action to the ARC. 6) Within 14 business days of the waiver start date, the transition case manager must follow-up through face-to-face contact with the client to complete a 701B assessment in the community including completing the waiver care plan. This on-site follow-up should be completed as close to the waiver start date as necessary to ensure client s care needs are met, and a safe transition to the community has occurred. 7) If the client is currently unable to transition after transition case management services have been provided, the transition case manager will finalize the NHT plan and forward it to CARES for due process notification. Both the transition case manager and the client or designated representative must sign the NHT plan. a. CARES will review the NHT plan from the transition case manager and complete a Notification of Decision Regarding Nursing Home Transition (DOEA Form 620). CARES will send the DOEA Form 620, as well as Medicaid fair hearing rights to any client that does not successfully transition. b. In the case that a client is currently unable to transition out of the nursing home and into the ADA or ALE waiver, transition case management cannot be billed. 8) If client can transition without transition case management, then please follow the regular transition process by using approved AAA/ARC nursing home transition matrices. Updated 01/27/11 Page 4

5 Nursing Home Transition Case Management Procedures for Transition Case Managers Part 2 1. Transition case manager will receive referral from ARC. Within 10 business days of receipt, transition case manager updates client s 701B & completes NHT plan (face-to-face visit). *NOTE* If client can transition without TCM, follow regular transition procedures per AAA/ARC matrices. 2. Transition case manager notifies CARES of the estimated date of discharge using the NHT Plan & requests LOC. 3. ALL REQUIREMENTS MUST BE MET PER THE WAIVER HANDBOOKS IN ORDER TO BILL: A. Client resided in NH for 60 consecutive days by the time discharge occurs. B. No more than 20 hours of transition case management can be billed within 6 months of waiver start date. C. Client has a completed and signed nursing home transition (NHT) Plan. D. Upon nursing home discharge, client is enrolled in the ADA or ALE Waiver. [NOTE: The first opportunity to bill is the waiver start date.] 4. Upon receipt of waiver LOC, transition case manager submits Form 2515 to DCF & requests ex-parte. 5. The Notice of Case Action will be provided by DCF to the client & transition case manager will submit to the AAA/ARC. YES Successful Transition? NO 6. Within 14 business days, transition case manager must follow-up with a face-to-face client visit to complete 701B in the community to include completing the waiver care plan. 7. Transition case manager finalizes NHT Plan documenting reasons why the client was unable transition & submits to CARES for due process notification (the NHT Plan MUST be signed even if client is unable to transition). CARES will review NHT Plan outcome, complete a Notification of Decision Regarding Nursing Home Transition (DOEA Form 620) and send to the client. AAA = Area Agency on Aging ARC = Aging Resource Center ADA = Aged & Disabled Adult Waiver ALE = Assisted Living for the Elderly Waiver DCF = Department of Children & Families DOEA = Department of Elder Affairs ICP = Institutional Care Program LOC = Level of Care NH = Nursing Home NHT = Nursing Home Transition TCM = Transition Case Management DRAFT Updated 01/27/11 Page 5

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