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Provider Update: January 8, 2014

CD-PASS Updates
Service Authorizations
  1. CD-PASS services are to be utilized as designated in the Member’s Service Plan Goals and Individual Budget Account (IBA) worksheet; specifically, they should be used according to the weekly authorization of units.  An Authorized Representative may be needed if a Member cannot manage within authorized limits.  Members may be removed from CD PASS if unable to manage within their weekly authorizations.

Authorized Representatives (ARs)
  1. An AR cannot sign or make decisions for a CD-PASS Member, unless the AR is also the Member’s legal agent (Power Of Attorney (POA), Legal Guardian (LG), other).  

  2. If an AR is designated, CDA/CM should engage them in the IDT process; the AR should be involved in service planning and assisting the Member to manage their services.  

  3. Members with high MSQs, high health risks, and/or recent APS involvement are only allowed to begin CD-PASS when they have an AR that is willing to assist.  If an AR is designated but not assisting, the CDA/CM should address with the Member and notify the AA if the AR continues to be uninvolved.

  4. At a minimum, an AR is required (and must be involved) with Members having an MSQ of 12 or greater, UCAT Score 117 or greater, or when there is a substantiated APS report of self-neglect/abuse in the past 12 months.

Eligible Caregivers
  1. CD-PASS services are not intended to take the place of regular care and general maintenance tasks or meal preparation typically shared or done for one another by spouses or other adults who live in the same household. Additionally, services are not authorized if they principally benefit the family unit.

  2. Legal agents (POA/LG/Other) and Authorized Representatives cannot also be the Member’s paid caregiver.

  3. Spouses are not eligible to be the paid caregiver unless an exception has been approved by AA. Documented approval by the AA is only provided in exceptional circumstances and is required before the spouse can be hired.

Monitoring
  1. Monitoring remains a key CM responsibility and should be enhanced when serving as a CDA/CM.  CDA/CMs are encouraged to utilize AuthentiCare to monitor the use of CD-PASS services and review Member’s monthly budget report during monitoring visits. 

  2. CDA/CMs should advise AA of mismanagement of services or substantial risk to Member’s health and safety, as Member may not be appropriate for CD-PASS.

Conditions and Service Plan Reviews (SPRs)
  1. The CDA/CM is required to submit revisions for denied services to AA for approval within 5 working days.  If service start date has already past, then the Member’s employee most likely will not be paid until the condition or SPR is resolved.  A priority response and review is expected in this situation.

  2. CDA/CMs are responsible for notifying Members when services are not authorized, even if a response to the condition and/or SPR has been completed and resubmitted.  The Member must know if services are not authorized so they can utilize their back-up plan until services are approved.

Enrollment Packets
  1. CDA/CMs are not responsible for completing Member/Employer or Employee packets.  The Member should contact PPL or their AR for assistance with these forms.  If the Member needs assistance beyond what PPL can provide, an AR is most likely needed.

Release of Information
  1. It is not recommended to add a PSA and/or APSA to a Member’s Service Team Release of Information (formerly ADv5).   Even if the PSA/APSA is a trusted friend or family member, they are the employee of the Member.  When contacting AA and PPL, they are not entitled to all Member/employer information even when on the release.

Statewide Expansion
  1. CD-PASS will be expanding to Adair, Cherokee, Haskell, Hughes, McIntosh, Muskogee, Okfuskee, Okmulgee, Seminole, and Sequoyah Counties beginning March 1, 2014.

  2. Expansions are planned for the fall of 2014 into the following counties: Atoka, Bryan, Choctaw, Coal, Latimer, Leflore, McCurtain, Pontotoc, and Pushmataha Counties.   

  3. Continued expansions will occur at regular intervals until 2016, when statewide expansion will have been achieved.  

  4. Notification of the date and affected counties for each additional expansion will be made through ADvantage bulletins.  Additional training days will be made available to agencies affected by the expansions approximately one month prior to each expansion.

Additional Resources
  1. CDA/CMs should encourage Members to contact PPL whenever needed to resolve employer or employee issues.  CDA/CMs may also contact PPL: 1-866-537-8379.

  2. Members may also contact AA for general ADvantage information, to apply for CD-PASS, and obtain information about service authorizations: 1-800-435-4711.

  3. CDA/CMs may contact AA through aauproviderquestion@aau.okdhs.org for questions related to the Member’s status or guidance on CD-PASS procedures.

  4. CDA/CMs and Members may access additional information on the PPL website, including the most current CDA/CM training slides, OPX guidelines, and Employer forms: www.publicpartnerships.com, username: okclient, password: okcdpass87.

  5. All Members have been provided an Employer Handbook and all of their employees should have an Employee Handbook.  CDA/CMs may also reference these on www.okdhs.org/library/pubs/.

    1. CD-PASS Employer Handbook – No. 12-33

    2. CD-PASS Employee Handbook – No. 13-01

If you have any questions regarding the information provided above, please feel free to contact us via Smarter Mail.

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