Medicaid Services Update

ADvantage

Definition

Notification & Monitoring

Unstaffed

The Member is not receiving any units listed on their authorized Service Plan.  This includes service codes:

·  T1019 Personal Care Assistant (PCA)

·  T1019-TF Advanced Supportive/Restorative Aide (ASR)

·    After a 2-week period of monitoring the unstaffed Member, the Home Care (HC) Provider is required to notify the Case Manager (CM), via Harmony Note, that the Member is unstaffed.  (Note Type:  Notification; Note Sub-Type:  Unstaffed.)

·    When a Member is unstaffed, the CM contacts the Member and HC Provider weekly to provide more frequent monitoring of health and safety, major life changes, and possible need to change providers.  Weekly phone monitoring by the CM occurs until the Member is staffed.

*Partially Staffed

(See Note below.)

The Member is receiving some units but is not receiving all units listed on their authorized Service Plan.

·    After a 2-week period of monitoring the partially staffed Member, it is recommended the HC Provider notify the CM, via Harmony Note, that the Member is partially staffed.  (Note Type:  Notification; Note Sub-Type:  Partially Staffed.)

·    When a Member is partially staffed, it is the recommended best practice that the CM contact the Member and HC Provider weekly to provide more frequent monitoring of health and safety, major life changes, and possible need to change providers.  Weekly phone monitoring is encouraged until the Member is staffed.

Staffed

The Member is receiving all units on their authorized Service Plan. 

·    Once the Member is staffed, after being unstaffed or partially staffed, the HC Provider should notify the CM via Harmony Note.  (Note Type:  Notification; Note Sub-Type:  Staffed.)

Unstaffed by Choice

The Member requests to not receive any units listed on their authorized Service Plan.

·    After a 2-week period of monitoring the “unstaffed by choice” Member, it is recommended the HC Provider notify the CM via Harmony Note, indicating the Member is “unstaffed by choice.”  (Note Type:  Notification; Note Sub-Type:  Unstaffed.)

·    When a Member is “unstaffed by choice”, it is the recommended best practice that the CM contact the Member to discuss closing the authorized service line(s) for PCA and/or ASR on the Member’s Service Plan.  Until the PCA & ASR service line(s) are closed, the CM contacts the Member weekly to provide more frequent monitoring of health and safety and major life changes.

*Note:  A Member is not considered unstaffed when receiving all or a portion of their authorized units, whether by a permanently assigned or a substitute/fill-in PCA/ASR.  This Member is considered staffed or partially staffed.

State Plan Personal Care (SPPC) Members

SPPC

Definition

Notification & Monitoring

Unstaffed

The Member is not receiving any units listed on their authorized Service Plan.  This includes service code:   T1019 (PCA).

·    When the SPPC Member is unstaffed, the Provider communicates with the Member and makes efforts to staff. It is recommended the Provider contact the unstaffed Member weekly, by phone, to actively monitor health and safety, and share ongoing efforts to provide staff.

·    When the SPPC Member is unstaffed for thirty (30) days, the Provider notifies the State Plan Care Unit. The State Plan Care Unit nurse contacts the SPPC Member and, when the Member chooses, initiates a transfer to another Provider of choice.  If the Member has no Provider preference, the next Provider on the Certified Agencies Report will be assigned. 

·    If the SPPC Member chooses to remain with the current provider agency (does not wish to transfer to another provider agency), no further notification is needed until SPPC Member is unstaffed for 90 days.

*Partially Staffed

(See Note below.)

The Member is receiving some units but is not receiving all units listed on their authorized Service Plan.

·    When the SPPC Member is partially staffed, the Provider communicates with the Member and makes efforts to staff. It is recommended the Provider contact the partially staffed Member weekly, by phone, to actively monitor the health and safety of the Member and share ongoing efforts to provide staff.

·    When the SPPC Member is partially staffed and notifies the Provider agency they wish to transfer to another agency, the Provider notifies the State Plan Care Unit. The State Plan Care Unit nurse contacts the SPPC Member and, when the Member chooses, initiates a transfer to another Provider of choice.  If the Member has no Provider preference, the next Provider on the Certified Agencies Report will be assigned.    

Staffed

The Member is receiving all units authorized on their Service Plan.

·    Once the SPPC Member is staffed, after being unstaffed or partially staffed, the Provider documents within Harmony Notes but does not notify the SPCU unless the Member becomes unstaffed after another thirty (30) days.

Unstaffed by Choice

The Member requests to not receive any units listed on their authorized Service Plan.

·    When the SPPC Member is “unstaffed by choice”, the Provider communicates with the Member weekly by phone to actively monitor the health and safety of the Member and documents no services by choice.  When the SPPC Member is “unstaffed by choice” for thirty (30) days, the Provider notifies the State Plan Care Unit.  

·    When the SPPC Member is “unstaffed by choice” for ninety (90) consecutive days, the Provider sends a Service Termination Request to the SPCU indicating no SPPC services are being provided. The SPCU nurse will contact the SPPC Member to discuss closing the authorized services and completing a Voluntary Withdrawal from SPPC services.