Medicaid Services Update

To:  All ADvantage Case Management and Home Care Provides

Subject: Medical Orders for Skilled Nursing Services

Date:  November 22, 2021

Effective Monday, December 13, 2021, medical orders must be obtained before Skilled Nursing Care can be authorized by ADvantage.  Skilled Nursing Care refers to a Member’s need for care or treatment (e.g., filling a medication planer, providing wound care, etc.) that can only be performed by a licensed nurse.  Medical orders are required by the Home Care Act and must be obtained before the Skilled Nursing Care begins.

The ADvantage process for authorizing units for Skilled Nursing Care (G0299 and G0300) will require a signed Medical Order.  To ensure this happens timely, the process below should be followed.

1. Either the Case Manager or the assigned Home Care RN initiates a discussion with the other regarding the Member’s need for Skilled Nursing Care.
2. The Home Care Nurse is responsible for:
   1. Obtaining the completed and signed Medical Order.
   2. Forwarding a copy to the Case Manager via a Plan Note with Attachment.

                                               i.     Plan Note type = Documentation, sub-type = Medical Order

                                             ii.     The content of the Note should document the specific skilled care to be provided by the nurse and include frequency and any limits in duration.

                                            iii.     This gives the Case Manager the information necessary to add the service to the Member’s person-centered service plan.

1. The Case Manager is responsible for:
   1. Updating the Identified Needs by documenting the specific skilled care, duration and frequency as documented in the Home Care Nurse’s Plan Note.
   2. Adding the requested units to the Member’s service plan using BOTH G0299 & G0300 at the frequency and duration documented in the Home Care Nurse’s Plan Note, and
   3. Adding the Case Manager Supervisor to the Home Care Nurse’s Plan Note to request review and submission for SPA Review.
2. The Case Manager Supervisor is responsible for:
   1. Submitting the Plan for SPA Review (unless corrections are required).
3.  
   1. Attaching the Medical Order to the Plan Note to enable authorization, and
   2. Setting Plan Note status to Communication to enable ongoing communication.

The MSU is developing a Medical Order template (similar to that used for Medicare home health) for use when submitting the request to the member’s medical professional (MD, DO, PA, NP, APRN) for signature.

A bulletin will be sent when the Medical Order is ready for use.  Until that time, a physician’s prescription detailing the service(s) to be provided, along with frequency and any limits in duration, is acceptable.

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