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.