INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT O Aligning Respite Care with Personal Care Services OBJECTIVE • To explain how to align Respite care with Personal care services • To discuss how to complete EDCD Waiver Transfers and Discharges Aligning Respite Care with Personal Care Services • During the planning stages to determine how to disperse the respite authorizations that ended on 6/30/14, some Medicaid providers expressed the desire to align respite care with personal care services. • The most feasible way to honor this request was to give the provider the option to align their services. (See Medicaid memo dated 3/4/2014) Aligning Respite Care with Personal Care Services Optional Alignment of Services - EDCD Waiver Only Effective July 1, 2014, when the personal care renewal is due, the provider may align the respite end date with the personal care end date. This option is only available to providers who provide both respite care and personal care services to the member. Requesting Alignment of service Submitting requests to align services Providers may submit the request for services by Fax, direct data entry (DDE) or by telephone. Requesting Alignment of service • If submitting by Fax, the provider must indicate the request on the DMAS 98 by checking the “Alignment” box. • If submitting the request by DDE, the provider will need to include the information on aligning the respite care end date under the “Additional Information Comment” section Question and Answers • Questions? Aligning Respite Care with Personal Care Services The following information will be needed regardless of mode of submission: • The request must include the case ID numbers for both respite and personal care. (If the respite care and personal care services are on two separate authorizations) • The request cannot be for dates outside the existing respite authorized periods. General Rules regarding the Optional Alignment • Respite services may be aligned with personal care services • Personal care services cannot be aligned with respite services General Rules regarding the Optional Alignment If the personal care renewal end date extends past the respite care end date, the provider will need to submit a request to renew respite services and include all required documentation/information required for review *Refer to Example 1* Aligning Respite Care with Personal Care Services Example 1: – The member’s personal care service ends on 12/15/14. The provider is submitting a request to renew the personal care for dates of service (DOS) 12/16/14 – 12/15/15. – The member’s current authorization for respite is DOS 6/30/13 3/21/15 – The member’s new authorization for personal care will end past the current respite authorization end date. – The respite service will not be automatically extended with the personal care service end date – The provider will need to submit clinical documentation for respite care service in order to have the end date aligned with the personal care end date Aligning Respite Care with Personal Care Services If the personal care end date is prior to the current respite end date, the authorized end date for respite will be cut back to align the dates with personal care. The ARC 1030 will be used. “Service is medically necessary; Date of service and/or units changed. However services were not reduced.” *Refer to Example 2* Aligning Respite Care with Personal Care Services Example 2: • The member’s current authorization for personal care ends on 8/2/14. The provider is submitting a request to renew the personal care for dates of service (DOS) 8/3/2014 – 8/2/5015 • The member’s current respite authorization is for DOS 6/30/2013 – 10/18/15 Alignment of Respite with Personal Care will reflect the following : • The DOS for personal care 8/3/2014 – 8/2/2015 • The DOS for respite care 6/30/13 – 8/2/2015 EDCD Waiver Discharges EDCD Waiver Transfers and Discharges EDCD Waiver Discharges • Providers must submit a discharge request for members they are no longer providing services. For example: (This list does not include all possible examples of discharges) – – – – – Members transferring to another EDCD waiver provider Member no longer meets the criteria for services The member no longer request services The member is deceased The member has not received services for over 30 days – The member is transferring to another waiver (DD/ID) EDCD Waiver Discharges Discharge requests are submitted to KEPRO: – A DMAS 225 – Submission via DDE – By Fax - DMAS 98 The provider should include: • The discharge date • The specific services the member is being discharged from • Document why the member is being discharged EDCD Waiver Discharges – By fax – On the DMAS 98 the provider can check the transfer box to indicate if the member is transferring to: • Another provider • DD/ID waiver – On the DMAS 98 the provider may also document additional comments on page 1 EDCD Waiver Discharges Providers admitting members transferred from another provider – The member must be discharged from the previous provider before they can be enrolled for services – If the previous provider did not submit the DMAS 225, the new provider may submit a copy of the discharge DMAS 225 or a transferring letter from the previous provider with the last billable date of service. – If submitting by fax check the type of transfer on the DMAS 98 by checking the transfer box EDCD Waiver Discharges • If a provider is unable to obtain discharge documentation from the previous provider and several attempts were made to contact the provider with out success, this information should be included on the service authorization request. EDCD Waiver Transfers • Transfer documentation requirements for members transferring to another EDCD waiver provider can be found in the Elderly or Disabled with Consumer Direction Waiver Services Provider Manual Chapter IV p. 52.