Medicaid Service Update

To:  ADvantage Case Management Providers

Subject: Case Management Supervisor Reviews

Date:  January 3, 2023
 

In accordance with OHS Policy (317:35-17-14. Case management services), the Case Manager completes and submits a person-centered service plan for the Member, signed by the Member and the Case Manager, to the Case Manager Supervisor for approval and submission to the ADvantage Administration. 

All Member initial, annual, or revised service plans must be routed to a Case Manager Supervisor for review and approval prior to submission to ADvantage.  The Case Management Supervisor conducts the service plan review and approves and submits the plan to ADvantage OR returns the plan to the Case Manager with notations of errors, problems, and/or concerns to be addressed.

If the plan is returned for corrections by the Case Management Supervisor, the Case Manager re-submits the corrected service plan to the Supervisor. The Case Management Supervisor will review and will either approve and submit the plan to ADvantage or return the plan for additional corrections, going through the cycle as many times as needed until the Case Manager Supervisor is confident in the quality of the Member’s plan.  

If the Case Manager submitting a service plan is also a Case Manager Supervisor, they must route any plans they have completed to another Case Manager Supervisor at the agency for review, approval and submission to ADvantage.  The acting Case Manager and the reviewing Case Manager Supervisor cannot be the same person.  
 

Per ADvantage Program Service Standards, each Case Management provider is required to staff four positions. The required positions are:

• Case Manager,
• Case Management Supervisor,
• Back-up Case Management Supervisor, and
• Continuous Quality Improvement (CQI) Manager. 

Case management providers are required to have a minimum of three staff to cover the required four positions.  The CQI Manager can be held by the Case Management Supervisor, provided they meet all other CQI qualifications. 

Please be advised that there is an established process to be followed by all Case Managers when submitting New Plans, Reassessments, Resubmissions and Plan Changes for Supervisor Review.  In Harmony, the Case Manager must:

Step 1 – Update the plan status to Supervisor Review, and
Step 2 – Add a Plan Note to the Supervisor requesting review and submission of the service plan. 
(Note type=Service Plan, Note sub-type=Supervisor Review)  

Each of the following Job Sheets provide step by step instructions on this process and are available in the Harmony Library site, Chapter 4 – Case Management Agencies:

• ADv_CMAgency_CM Initial IDT.pdf
• ADv_CMAgency_Annual Recertification (Member).pdf
• ADv_CMAgency_resubmission following Receipt of Not Authorized Service(s).pdf     
  

Failure to follow established processes will result in a delay in the authorization of the Case Management service line. If a provider would like initial or additional Harmony training, it can be scheduled using the following link:
Harmony Training (office365.com)

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