Provider update: June 12, 2020
To: All ADvantage Case Management and Home Care Providers
Subject: Process Reminders related to COVID-19 Emergency Plan
Date: June 12, 2020
The Medicaid Services Unit (MSU) would like to remind providers that we are still functioning under emergency waiver rules. Until directed otherwise, the processes below are still in place to ensure Oklahomans are protected.
- IDTs and nursing assessments should be completed by phone whenever possible. Verbal consent for service providers and service planning may be obtained from Members and documented in Harmony. The amount of people going into a Member's home should be reduced as much as possible. Case management services will receive a short-term authorization of 120 days to allow for obtaining signatures when the current health emergency has ended. If the short-term authorization expires before the emergency has ended, please submit a PQ in Harmony so the authorization can be extended. If a Member's signature can be obtained safely by mail/email, the case manager may submit the signed document, prior to the end of the emergency, to have the condition removed.
- Routine monitoring visits by case managers should be completed by phone for Members to allow for a safe, low risk situation. Using technology such as FaceTime or Skype may facilitate visualization of Members in higher risk situations. For Members who do not have a phone or need an on-site visit, please follow guidance as outlined by the CDC and OSDH.
- Routine nursing visits for supervision of the personal care attendant (PCA) may be completed by phone.
- Agencies providing in-home services should follow guidance as outlined by the CDC and OSDH. Agencies should assess that staff entering homes are asymptomatic. Members should also be monitored for symptoms prior to entering into the home. Members who are symptomatic should be advised to call their physician's office for guidance.
- Case Management and Home Care agencies should continue to complete the "Pandemic Reporting" document on a weekly basis. This report is completed on the Provider Chapter, using the Provider Prime Role. Each agency will submit 1 form (2 if they provide both CM and HC). Case Management agencies should complete reporting for the Case Management agency employees and all assigned ADvantage Members. Home Care agencies should complete the reporting for Home Care agency employees and SPPC Members.
- If a Member has been exposed or tested positive for COVID-19, a Critical Incident (CI) report should be completed. If a Member has been exposed and later tests positive for COVID-19, a second Cl report should be submitted, documenting the positive test result. The Pandemic Exposure Supplemental Document is required if related to COVID-19 exposure or positive test. This supplemental document can be completed by any Harmony Provider role that is completing the CI document. The document is located on the PQ Ticket/Documentation Sub-Tab, in the same area where the CI document can be found. Detailed information can be found here: http://www.okdhs.org/services/aging/Pages/pu03262020b.aspx
- Requests for non-traditional or higher quantity equipment/supply items, needed to address issues related to COVID-19, should be submitted with justification to support the individual Member's needs.
- Case managers should conduct weekly calls to Members who are refusing PCA/PSA services during this emergency, assessing the health and safety of the Member during the time they are unstaffed. There will be no negative action for the agency if the Member is unstaffed by choice, if it is documented in the Member's record, preferably in a case management note.
- SPPC Members who are refusing PCA visits, due to the pandemic, should be contacted weekly by the Home Care agency, during the time they are unstaffed.
- 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. Case managers should educate the Member of the option to temporarily suspend service, so that if the service is needed in the future, it can be immediately implemented. If the Member still chooses to remove or reduce a service, the case manager should document that they have discussed service suspension with the Member, and the Member still wishes to end or reduce the service, in order for MSU to end or reduce the service.
- For Home Delivered Meals, the case manager may request up to two meals a day (or 14 meals a week), depending on the individual Member's needs. For new requests, two meals a day will not be automatically authorized, unless requested.
- MSU is only processing case closures for death, nursing facility permanent placements, signed Member withdrawal requests and 'moved out of state' during the time of this emergency. Cases are not being closed for 'unable to locate' at this time.
- All electronic interactions with Members must be completed in accordance with HIPAA requirements.
OKDHS wants to thank you for your public service. You are critical to the work that we do to ensure the safety of our state's seniors. If you have any questions regarding the information above, please submit a PQ in Harmony.
AGING SERVICES | MEDICAID SERVICES UNIT
ADvantage Administration | State Plan Personal Care
Office: 918-933-4900 | CareLine: 800-435-4711