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Provider update: April 15, 2020

To:  All ADvantage Case Management Providers

Subject:  Case Management Process Changes related to COVID-19 Emergency Plan

Date:  April 15, 2020

Dear Providers,

The Human Services Department has been working with our state and federal partners to initiate emergency plans to support our provider network as we go through this difficult time together.  Please see below for a summary of those changes specific to your service types.

Pandemic Tracking Reminder

  • On March 26, a bulletin was sent to providers requiring pandemic reporting by Home Care and Case Management providers be submitted every Wednesday.  There are still providers not in compliance.
  • The bulletin and guidance for completing the report can be found at this location.

MSU Audit Process Change

  • All Audit processes are modified to only include electronic data contained in the Harmony system.

Case Management Services

  • Beginning immediately, please use code 63 – 'Pandemic Related Telehealth' when entering a web claim in Authenticare to capture electronic member interactions (phone calls, video chat, etc.) done specifically as a response to the COVID-19 pandemic.  For example:
    • If the call is a case management activity ordinarily done electronically, such as a monthly monitoring visit, the appropriate code for that activity should be used.
    • If the call is a quarterly monitoring visit that would require an in-home, code 63 would be used.
  • Update to signature requirements:
    • We are aware that some case managers may not have access to printers or scanners. In these cases, the case managers should document the Member's agreement with choice of service plan services and providers in a Plan Note using "Pandemic" as justification.
      • Please complete all required Documents (not Word merge forms) in Harmony, which will capture the date of the activity.  Examples include:  Service Team Release of Information; Request for Grab Bars; Transfer forms; etc.
      • For new plans, case management will be conditionally authorized for up to 120 days.
    • Formally signed documents that indicate the date the meeting occurred will be required to remove the condition.
  • The ADvantage Eligible Provider Exemption process is waived for the period of the emergency, allowing legal guardians, powers of attorney, and spouses to provide personal care services to Members.
  • Nursing Facility Respite services may be extended from 30 days to 60 days depending on the individual Member's needs.
    • During the period of the emergency, nursing facility respite services may be provided at a non-ADvantage certified facility.  The assistance of MSU staff may be required in the event this is needed.
  • No service plan changes will be accepted that result in the removal or reduction of services to the Member unless requested by the Member.
    • A blanket authorization doubling the quantity of Home Delivered Meals currently authorized for every Member is being applied and should be in place by Monday, 4/13/2020.
    • For Members who do not need the increased number of meals, we request that case managers remove the additional meals from the plan to be consistent with person-centered planning principles and to reduce the strain on our meal provider network.
  • All electronic interactions with Members must be completed in accordance with HIPAA requirements.

As always, we appreciate the support you provide to our Members.

If you have questions on the content of this bulletin, please submit a Provider Question with an Inquiry type of COVID-19 Question / Issue.

Thank you.


ADvantage Administration | State Plan Personal Care

Office: 918-933-4900 | CareLine: 800-435-4711

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