Provider Update: February 18, 2020
To: All ADvantage Case Management and Home Care Providers
Subject:Annual Case Manager and Registered Nurse Member Assessments
The Medicaid Services Unit (MSU) has received concerns regarding Home Care Registered Nurses being asked to change their assessment documentation to more closely support services in Member plans.
Both Case Managers and Home Care Nurses are required to complete an annual evaluation of ADvantage Members. These assessments are not intended as a duplication of efforts, but to provide the broad scope of information necessary for developing each Member's person-centered service plan. Each individual is responsible for the veracity of their assessment.
Case Managers are responsible for:
- Assessing level of care, community potential and program appropriateness; and
- Utilizing all available assessment information to:
- Evaluate the Member's current situation, strengths and needs;
- Identify potential services and activities (both formal and informal) to address each need; and
- Develop a service plan geared specifically toward supporting the individual Member to live safely within their home and community.
Home Care Nurses are responsible for:
- Assessing the Member's health and safety;
- Assessing the Member's specific health needs and prescribed medical services to ensure they meet the Member's needs; and
- Assessing the Member's functional needs to recommend an appropriate personal care plan.
All people are unique and bring their own views and skills to any given task. This is no less true for Case Managers and Nurses. While consensus is the goal, we recognize that there may be times when a Member's personalized plan of care is not in exact alignment with all assessment information. In the event this occurs, the Case Manager is to document (in either the UCAT or a Plan Note) the rationale for the variance between the person-centered service plan and any specific assessment or assessment domain. Doing so will address review discrepancies in advance and support timely processing by the MSU.
Please send any questions regarding the information above through the Harmony PQ chapter.