Medicaid Services Update

To:  All ADvantage and State Plan Personal Care In-home Service Providers

Subject: MSU Update - Member Home Visits and Required Signatures

Date:  September 29, 2021

Per the Medicaid Services Unit (MSU) bulletin dated 5/18/2021 titled Resuming Home Visits for ADvantage Members, Member Home Visits by both Case Managers (CMs) and Home Care (HC) Nurses were to resume on July 1, 2021.  The exception to this requirement was for Members who refused to receive in-home visits due to concerns regarding COVID-19.

Due to concerns of non-compliance with this requirement, the MSU researched the number of home visits being completed for Members having new and reassessment service plans submitted.  We have learned that approximately 85% of visits that should be completed in the home by both CMs and HC Nurses continue to be completed via phone. We believe this is also the case for quarterly in-home visits.  This is unacceptable.  

The decision to resume in-home visits was in response to health and safety concerns for Members due to the lack of in-home monitoring, as well as to ensure appropriate evaluation of Members’ needs prior to sending PCAs into the home.   The expectation remains that most required Member interactions will occur in the home and not by telephone.  It is not feasible that a Member will refuse face-to-face visits from only the CM and HC Nurse, but accept face-to-face services of other types.  If a Member refuses all face-to-face contact with care providers due to COVID – including Personal Care (PCA and ASR), Skilled or Extended State Plan Skilled Nursing, Adult Day Health, Hospice, etc. – the refusal must be clearly documented, and the CM must ­end each of these service lines on the Member’s service plan.  Other than in this instance, in-home Case Management and HC Nurse visits are required per ADvantage rules.

Additionally, effective Monday, October 11, 2021, the MSU will resume the requirement for wet signatures on all ADvantage Service Plan documents requiring signatures.  Signatures must be obtained at the time of the home visit and not mailed to the Member for signature and return. 

Documents requiring signatures are:

• ADv – Service Agreement/Team Release
• ADv - Permission to Modify Property
• ADv - Request for Installed DME
• ADv - Member Negotiated Risk Agreement
• ADv - Service Provider Safety Agreement
• ADv/SPPC - Voluntary Withdrawal Request
• SPPC - Member Service Agreement
• SPPC - Service Provider Safety Agreement

In the event the Member is refusing all face-to-face services and is therefore unable to sign required documents, the CM should clearly document on the Member signature line that “The Member refuses all face-to-face interactions due to COVID and is unavailable to sign.”  The CM should then date and apply their wet signature prior to submission to the MSU.

Per guidelines set forth in the 5/18/2021 bulletin:

• Porch or outdoor visits are encouraged for those Members reluctant to allow someone in their homes. 
• Preliminary assessments may be conducted by phone, but a follow-up home visit must occur to observe the Member’s situation, validate the verbal information obtained, ensure the Member’s health and welfare is maintained, and verify the person-centered service plan addresses all identified and observed needs.
• Prior to visiting any Member, Case Managers and Nurses should assess themselves for signs and symptoms of COVID-19. Those with ANY signs and symptoms, or those who have had close contact with someone with COVID-19 infection in the prior 14 days, should refrain from visiting a Member regardless of vaccination status. If this is the case, this information MUST be documented as such in Harmony or on the RN Evaluation.
• Prior to visiting a Member, Case Managers and Nurses should contact the Member and ask if the Member, or anyone living in the Member’s home, has current signs and symptoms of COVID-19, or if anyone has had close contact with someone with COVID-19 infection in the prior 14 days. Case Managers and Nurses should refrain from visiting the Member, regardless of vaccination status, if a positive response is received to the screening questions. If this is the case, this information MUST be documented as such in Harmony or on the RN Evaluation.
• Case Managers and Nurses must wear a face covering or mask (covering both mouth and nose) and social distance at least six feet between persons, regardless of vaccination status and in accordance with CDC guidance while in the Member’s home.
• Members may be asked to wear a face covering while the Case Manager and Nurse are in the home, but there is no requirement for a Member to do so. Please respect the Member’s choice to wear or not wear a face covering.
• The precautions listed in the initial bulletin (05.18.2021 - MSU Update - Resuming Home Visits to ADvantage Members) should continue to be followed, regardless of the vaccination status of the worker or the Member.

If you have any questions regarding the information provided above, please feel free to contact us via Harmony Provider Question.     

COMMUNITY LIVING, AGING AND PROTECTIVE SERVICES (CAP) MEDICAID SERVICES UNIT (MSU)
ADvantage Administration | State Plan Care Unit | Medical Eligibility Services
Office: 918-933-4900 | CareLine: 800-435-4711