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At the very least 60 percent of the full total members served every month must require a minimum of one-to-one staff assistance as evidenced by a value of three or greater in one or more of the ADLs of transferring, eating or toileting, as assessed on the MN/LOC Assessment.
Home management — Assisting with activities related to housekeeping that are necessary to the member’s health and comfort, including changing bed linens, housecleaning, laundering, shopping, storing purchased items and washing dishes.
The bathroom must be another room in the individual’s living area with a toilet, sink and an accessible bath.
At the member’s request, portable kitchen units could be removed from the living area.

  • Work with the Section 811 POC and the Section 811 PRA program owner or the owner’s designated agent to support the member so that they do not lose their housing due to a lack of services or a insufficient coordination of services.
  • There can be questions about eligibility for participants that are living in an AFC/ALF.
  • MEPD specialists send Form H2067-MC, Managed Care Programs Communication, or Form H1746-A, MEPD Referral Cover Sheet, and a copy of the completed MEPD Waiver Program Copayment Worksheet to Program Support Unit staff indicating the amount designed for the monthly ongoing copayment.
  • Continuing Medicaid eligibility
  • My hubby, JP, was diagnosed with multiple myeloma six years ago at the age of 48.

In cases where the hearings officer’s decision is 30 calendar days or even more before the end of the individual service plan in place once the appeal was filed, SPW termination works well at the end of the ISP in effect at the time the appeal was filed.
HCBS STAR+PLUS Waiver services must continue until the hearings officer makes a decision regarding the appeal of an active SPW member, if the appeal is filed by the effective date of the action pending the appeal.
If an appeal was requested by the effective date of the action, Program Support Unit staff must promptly notify the managed care organization .

For Employers

Once released from the CCSE Title XX interest list, the CCSE staff verifies the applicant’s MCO will not offer an equivalent service as a VAS and proceeds with the eligibility determination for the requested CCSE Title XX service.
Federal law prohibits the use of STAR+PLUS program funds for Medicare Part D prescriptions, copayments and costs.
STAR+PLUS program funds may be used for prescriptions, copayments and costs to the extent included in Medicare Part D or even to the extent included in private insurance if the member chooses private insurance instead of participation in Medicare Part D.
Sending unsigned applications delays the MEPD and HHSC eligibility processes and could adversely affect service delivery to applicants or members.
If the MEPD specialist receives an unsigned application from HHSC withForm H1746-A, MEPD Referral Cover Sheet, MEPD returns the application form to HHSC having an annotation on the cover form (Form H1746-A) that the application is unsigned and should be signed before HHSC can set up a file date.
Once HHSC staff receive an unsigned application from the MEPD specialist, it is the responsibility of HHSC staff to coordinate with applicants or members in getting applications signed and returned to the MEPD specialist for processing.

This notification can be by telephone or may be documented on Form H1746-A, MEPD Referral Cover Sheet, which PSU staff send to the MEPD specialist.
The MEPD specialist may view the SASO or LTC Online Portal to confirm that the applicant or member has met the MN criteria.

If the AFC service is provided in the member’s own house, the member is not required to cover room and board.
It is the responsibility of the managed care organization to ensure the member and the MCO-contracted AFC provider agency, as applicable, are notified in writing onForm 2327, Individual/Member and Provider Agreement, when room and board is waived.
It is the MCO-contracted AFC provider agency’s responsibility to notify the AFC home provider when room and board is waived.
The adult foster care home provider should be able to meet up with the member’s needs in the AFC setting in conjunction with the STAR+PLUS Home and Community Based Services program along with other available supports.
If the member’s needs for care exceed the capability of the AFC home provider, the managed care organization service coordinator must reassess the member and provide alternate care options.
The managed care organization must use the member to identify a dental provider or contracted provider no later than the first day of the member’s individual service plan .

Upon the MCO’s approval of the prior authorization request, the MCO must instruct the provider to proceed with construction of the chair and request that claims be billed directly through the MCO portal upon delivery of the chair to the NF resident.
Specific billing codes ought to be used to identify the power base type and each accessory or component.
To create a CPWC for an NF resident, the MCO must respond with a decision of approval, denial or modification within three business days of the receipt of the request.
This is in keeping with the Uniform Managed Care Contract, Section 5.06, Span of Coverage.

Improve Transitions Of Care

Prior to starting her own company she worked at Endo Pharmaceuticals Inc. where she was Senior Director of the Global Safety and Pharmacovigilance department.
In this role she was responsible for pharmacovigilance of most Endo products, marketed and investigational.
Marie was also responsible for the safety components in the next disciplines; Clinical Research, Medical Affairs and Clinical Education and Development.
In addition, she led the chance Management Team and was responsible for the creation and implementation of Endo’s risk management programs.
Additionally, she was Senior Director of Report Evaluation and Safety Surveillance for the Women’s Health Division and Consumer Products at Wyeth.

  • Both the MCO and PSU staff should be able to readily identify communications specific to these cases.
  • Another way in which we are pioneering home-based patient monitoring is through wearable patches that support the first detection of heart rhythm irregularities to prevent strokes.
  • In case a member or LAR is not able to complete the Consumer Self-Assessment, an individual appointed by the CDS employer to function as CDS employer’s DR must be able to complete the Consumer Self-Assessment for the member receiving services to take part in the CDS option.
  • If the date falls between the second and the last day of the month, the eligibility and ISP effective date is the first date of the next month.

PSU staff must coordinate with staff and providers, as appropriate, to ensure the current 1915 Medicaid waiver services end the day before enrollment in the STAR+PLUS HCBS program.
Withintwo business daysof notification of the MCO selection by the STAR+PLUS HCBS program applicant, PSU staff complete Section A ofForm H3676, Managed Care Pre-Enrollment Assessment Authorization, and uploads it in the XXXSPW folder on TxMedCentral, utilizing the appropriate naming convention.

QIT copayment amounts to the MCO contracted provider are shown on Form H2065-D in the comments section.
Pickle Amendment Group, TIERS TP 03 — Individuals age 21 or higher who would continue to be eligible for SSI benefits if cost of living increases were deducted from their countable income.
Yes, and services were approved, CCSE staff refer the member to the MCO to initiate service delivery.

The transition specialist must contact the member within five business days of the member expressing fascination with taking part in the TS Pilot to schedule an initial meeting.
At this meeting, the transition specialist must get yourself a signed agreement from the member to participate, collect the member’s information to find out eligibility for the TS Pilot, and schedule needed follow-up meetings.
Members who meet TS Pilot eligibility criteria and volunteer to participate can access the supports and services provided by the MCO transition specialist, including Cognitive Adaptation Training , other therapeutic interventions, and intensive transition supports.
See Section VI, Transition Specialists, for detailed set of supports and services that may be provided by the MCO transition specialist.

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