accept all managed care organization (MCO) referrals if space is available. The only reason a STAR+PLUS provider refuse to accept a referral is if the member's condition makes the member inappropriate for the facility according to the facility's personal care licensure. Having a communicable disease does not necessarily make a member inappropriate for placement in an AL setting. Transmission of communicable diseases and conditions can be prevented through the implementation of infection control procedures, including universal precautions. Licensure standards for personal care facilities require facilities to have Infection Control Policy and Procedures, including universal precautions, in operation to safeguard employees and residents from and other diseases, and contagious conditions. If transmission of the condition or disease cannot be controlled, the member cannot be placed in a AL setting. To receive AL services the applicant must first be determined eligible for. Program Support Unit (PSU) coordinate with Medicaid for the Elderly and People with Disabilities (MEPD) specialist, where applicable, to complete the Medicaid eligibility determination. The MCO discusses residential options with the member, allowing to choose hisher preference. If AL is chosen, a verbal referral is made to the provider as an alert that space is needed. The starting date for services is a negotiated date between the MCO, the member and the AL provider. The initial copayment amount is computed based on the starting date. , Individual Service Plan (Pg. 1), and applicable attachments are sent as follow-up, along with a copy of , Notification of Managed Care Program Services, which authorizes the provider to deliver services, and , Managed Care Programs Communication, confirming the negotiated service initiation date. Note: Appropriate action must be taken if the facility finds that a member threatens the health and safety of himselfherself. If a stove or cooking unit needs to be disconnected, the service coordinator, in cooperation with the IDT, makes this decision. The IDT must also include the MCO, the AL provider and the member's family or , if any. The AL provider can disconnect the stove or cooking unit if the member exhibits a behavior that threatens the health and safety of himself . He must inform the service coordinator of the disconnection by the next business day after it occurs. The MCO investigates the situation and documents any recent or previous incidents that indicate a threat to the health or safety of the member or others. If the decision is made to
overall service plan is within the member's ISP cost limit; and service plan is adequate and meets the individual's needs in the community. The provider includes his/her telephone number and address in the written request. The MCO provides written approval or disapproval of the request. In reviewing requests to exceed the respite limit, the MCO must consider the intent of espite ervices to relieve the caregiver during emergency or planned short-term periods. Approval to exceed the 30day maximum should be related to situations such as: members caregivers become ill, hospitalized or have a family emergency; extenuating circumstances that care to be required beyond routine or periodic respite relief; or a breakdown in member and/or family support, causing an increased risk of institutionalization because of the physical burden and emotional stress of providing continuous support and care to a dependent person. 7320 In-Home Respite Care Revision ; Effective , In-home respite care offers services provided by managed care organization (MCO) contracted providers, on a basis, to members unable to care for themselves because of the absence or need of relief for their unpaid caregiver. In-home respite care is provided in the member's own home, as authorized on the member's , Individual Service Plan (Pg. 1), when the unpaid caregiver needs relief. The provider is responsible for providing the tasks authorized on the member's ISP and , Needs Assessment Questionnaire and Task/Hour Guide, and , Addendum to Form H2060, during the time is receiving in-home respite care. The provider must document in the member's clinical record: the in-home espite ervices provider was given a briefing on the member's status, needs and preferences prior to delivering services; and dates and duration of the services delivered.
TAS does not pay for monthly rental or mortgage agreements or ongoing utility charges. 764 Site Preparation Revision ; Effective September , Site preparation can include the following services: moving expenses, which include the cost of moving the applicant's items from another location, or delivery charges on large purchased items; pest eradication, if the applicant's place of residence has been unattended and some type of extermination is needed; allergen control, if the applicant's place of residence has been unattended or the applicant is moving into a place that poses a respiratory health problem; or one-time cleaning, if the applicant's place of residence has been unattended or the applicant is moving into a private home or apartment where pre-move-in cleaning should not be expected (for example, a family friend has an empty house available, but cannot provide the cleaning). Transition Assistance Services cannot pay for septic systems. 7650 Estimated Cost of Items and Services Revision ; Effective September , The managed care organization service coordinator provides a description and estimated cost of each item identified as needed under each service category on , Transition Assistance Services (TAS) Assessment and Authorization. The actual cost of an item may be used, if known. The amounts, either actual or estimated, must be less than or equal to $2,500. The service coordinator must be as specific as possible when describing what items are needed and the estimated cost. The description must include size, color, specific types or any other identifying information, as specified by the , which will assist the TAS agency in meeting the needs.
7652 Changes to the Authorization Revision ; Effective September , If the Transition Assistance Services (TAS) agency or the member identifies additional required by the member after the TAS authorization has been sent, the TAS agency must obtain approval from the managed care organization (MCO) on , Transition Assistance Services (TAS) Assessment and Authorization, prior to obtaining the item/service. The TAS agency must stay within the total dollar amount authorized on Form 8604. If the total amount of the itemsservices needed is more than the total amount authorized, the TAS agency must obtain prior approval and an updated Form 8604 from the MCO. The MCO must send an amended Form 8604 updating the authorization to the TAS agency within two business days with the additional items and amounts authorized. MCO approval is required to authorize delivery of TAS services. 7660 Transition Assistance Services Agency Responsibilities Revision ; Effective September , The Transition Assistance Services (TAS) agency accepts all members referred by the managed care organization (MCO). Upon receipt of the authorization, the TAS agency must review the forms carefully and contact the MCO if there are any questions regarding what has been authorized. This contact must occur by the next business day of receipt of the forms, and before any TAS purchase is made. The MCO contacts the member, if necessary, to discuss the item in question. The MCO provides a revised TAS authorization form within two business days if it clarifies an item is authorized or approves a change to the authorization. The TAS agency purchases the authorized itemsservices and arranges and pays for the delivery of the purchased items, if applicable. The TAS agency only purchases services or items within the dollar amount authorized by the MCO. The TAS agency contacts the member or authorized representative, if necessary, to coordinate service delivery.