Texas Department of Aging and Disability Services
Case Manager Community Care for Aged and Disabled Handbook
Revision: 11-2
Effective: April 1, 2011

Section 8000

Service Authorization System Help File

8100  Community Care Authorizations

Revision 11-2; Effective April 1, 2011

8110  Authorizing CCAD Services Using the SAS Wizards

Revision 11-2; Effective April 1, 2011

The following Community Care for Aged and Disabled (CCAD) services can be authorized using the Service Authorization System (SAS) wizards:

  • Non-Community Based Alternatives (CBA) Adult Foster Care (AFC)
  • Day Activity and Health Services (DAHS)
  • Emergency Response Services (ERS)
  • Family Care (FC)
  • Home-Delivered Meals (HDM)
  • Primary Home Care (PHC)
  • Residential Care (RC) Services
  • Community Attendant Services (CAS)
  • Special Services to Persons with Disabilities (SSPD)

Note: The wizards cannot be used to authorize Client Managed Personal Attendant Services (CMPAS) or In-Home and Family Support Program (IHFSP). See Section 8220, Client Managed Personal Attendant Services (CMPAS) Without the Wizards, for instructions on CMPAS and Section 8700, In-Home and Family Support Program (IHFSP) Without the Wizards, for instructions on IHFSP.

8111  Wizard Sequencing — CCAD

Revision 11-2; Effective April 1, 2011

Each SAS CCAD is a prompting sequence that takes the user through a series of windows required for authorization or denial of services.

The five wizards used to authorize, terminate or monitor services are:

  • Financial wizard — Community Care for Aged and Disabled (CCAD) and Community Based Alternative (CBA)
  • Functional wizard — CCAD and CBA
  • Authorization wizard — CCAD
  • CBA/Community Living Assistance and Support Services (CLASS) wizard — CBA
  • Monitoring wizard — CCAD and CCAD

When authorizing services, users should complete the Financial wizard first, the Functional wizard second and the Authorization wizard last. Information from the Financial and Functional wizards must be submitted prior to accessing the Authorization wizard.

If the Functional wizard is accessed first, the user will see a pop-up Client Error window at the end of the wizard with instructions to complete the Financial wizard before an eligibility decision can be made. Both the Financial and Functional wizards must be completed and information from those wizards submitted before the Authorization wizard can run properly.

If the user closes a wizard prior to completion in order to access other records, then returns to that wizard, the first window in the sequence will display. Click on NEXT in each window to get to the desired location in the wizard.

8112  Automatically Populated Folders by the SAS Wizards — CCAD

Revision 11-2; Effective April 1, 2011

Once all five wizards completed, the system automatically populates the following folders and/or forms:

  • Applied Income/Co-Pay (Residential Care Cases)
  • Authorizing Agent
  • Case Ownership
  • Diagnosis
  • Enrollment
  • Level of Service
  • Service Authorization
  • Service Item
  • Title XX Eligibility
  • Community Care Fact Sheet
  • Form 2059, Summary of Client's Need for Service
  • Form 2060, Needs Assessment Questionnaire and Task/Hour Guide
  • Form 2064, Eligibility Worksheet
  • Form 2101, Authorization for Community Care Services
  • Monitoring Report
  • Provider Referral Supplement
  • Task/Hour Guide

8113  Records that Require User Entries Prior to Completing the SAS Wizards — CCAD

Revision 11-2; Effective April 1, 2011

Prior to working through the SAS wizards, the user must complete the following records:

  • Address
  • Phone (mandatory for ERS only)
  • Other Information
  • Case Ownership (if changes are needed)
  • Service Request

The user must submit the case to SAS once the address, phone and other information folders are completed. This creates or updates the Location record.

8114  Address Folder — CCAD Services Using the SAS Wizard

Revision 11-2; Effective April 1, 2011

The Address folder records the individual's addresses. The user creates separate address records to record an individual's home or mailing address (if different from the home address), a responsible party's address and/or an executor's address. Information from this folder prints on the Provider Referral Supplement.

To register a home or mailing address:

  1. Select the Folder icon for Address in the Client directory.
  2. Select Add and the Address record will appear.
  3. Select the Type code from the drop-down list in the Type field. The system defaults to 05-Mailing/Home.
  4. Type the intake date as the effective Begin Date for initials. Type the effective date of the address in the Begin Date field for changes.
  5. Type the address in the Address field.
  6. The Tel. No. field is used to record the phone number of the executor only. Do not use this field to record the individual's phone number
  7. Type the city in the City field.
  8. Select the state from the drop-down list in the State field. The system defaults to TX-Texas.
  9. Type the ZIP code in the ZIP Code field.

To register a responsible party's address:

  1. Select the Folder icon for Address in the Client directory.
  2. Select Add and the Address record will appear.
  3. Select the Type code 04-Other from the drop-down list in the Type field. The system defaults to 05-Mailing/Home.
  4. Type the intake date as the effective Begin Date for initials. Type the effective date of the address in the Begin Date field for changes.
  5. Type the following in the address lines:
  6. Line 1 – Enter the responsible party's name (First, Middle, Last). This line starts with "C/O" for "in care of."
    Line 2 – Enter the first line of the responsible party's address (usually a street number or a P.O. Box).
    Line 3 – Enter the first line of the responsible party's address (if needed, such as for an apartment number).
    Note: Do not enter identifiers, such as daughter, directions to the home or any other miscellaneous text in any of these fields.
  7. Type the phone number of the responsible party in the Tel. No. field, including the area code. Do not use parentheses. For example, enter 555-123-4567.
  8. Type the city in the City field.
  9. Select the state from the drop-down list in the State field. The system defaults to TX-Texas.
  10. Type the ZIP code in the ZIP Code field.

To register an executor's address:

  1. Select the Folder icon for Address in the Client directory.
  2. Select Add and the Address record will appear.
  3. Select the Type code EX-Executor from the drop-down list in the Type field. The system defaults to 05-Mailing/Home.
  4. Type the intake date as the effective Begin Date for initials. Type the effective date of the address in the Begin Date field for changes.
  5. Type the following in the address lines:
  6. Line 1 – Enter the executor's name (First, Middle, Last).
    Line 2 – Enter the first line of the executor's address (usually a street number or a P.O. Box).
    Line 3 – Enter the second line of the executor's address (if needed, such as for an apartment number).
    Line 4 – Enter the executor's telephone number, including the area code. Do not use parentheses. For example, enter 555-123-4567. Note: Do not enter identifiers, such as daughter, directions to the home or any other miscellaneous text in any of these fields.
  7. Type the city in the City field.
  8. Select the state from the drop-down list in the State field. The system defaults to TX-Texas.
  9. Type the ZIP code in the ZIP Code field.

Address Changes:

When an address changes, add a record using these same instructions and enter the new Begin Date. This record is an exception to the rule of entering an End Date in the existing record before creating another record. SAS reads the most recent address with a HOME type as the individual's current address.

8115  Case Ownership — CCAD Services Using the SAS Wizard

Revision 11-2; Effective April 1, 2011

The Case Ownership folder displays information about the caseload in which the individual resides. The Authorization wizard automatically creates a record with data about the first case manager who submits information about the individual.

Once a budgeted job number (BJN) record is populated and submitted to the server, the BJN field is disabled. Use the following instructions to delete the original BJN record and create a new record with changes, if needed.

  1. Select the Folder icon for Case Ownership in the Case Worker directory.
  2. Click the original BJN record to highlight.
  3. Select the Cancel button from the menu bar.
  4. Submit the individual record.
  5. After the record is submitted, again select the Folder icon for Case Ownership in the Case Worker directory.
  6. Select the Add button from the menu bar.
  7. Type the BJN of the employee in the BJN field.
  8. Type the Mail Code (without dashes) of the employee in the Mail Code field. The other fields in this window automatically populate when the user accesses the Mail Code field.
  9. Submit the individual record.

8116  Other Information — CCAD Services Using the SAS Wizard

Revision 11-2; Effective April 1, 2011

The Other Information folder contains additional information about the individual. Information from this record prints on the Provider Referral Supplement.

  1. Select the Folder icon for Other Information in the Client directory.
  2. Select the individual's marital status from the drop-down menu in the Marital Status field.
  3. Select the language requiring translation from the drop-down menu in the Translation Needs field, if applicable.
  4. Type directions to the individual's residence in the Directions field.

8117  Phone/Community Care — CCAD Services Using the SAS Wizard

Revision 11-2; Effective April 1, 2011

The Phone folder documents an individual's phone number. For ERS recipients, entering a land line (phone number) is mandatory. Additional records can be created to record numbers for relatives, friends or a responsible party.

To register phone information:

  1. Select the Folder icon for Phone in the Client directory.
  2. Select Add and the Phone record will appear.
  3. The system defaults to HO-HOME in the Type field. Select OT-OTHER from the drop-down menu to register additional phone numbers.
  4. Type the date the phone number is valid in the Begin Date field. This can be the same date as the Begin Date for enrollment.
  5. Type the phone number in the Phone No field. There is no End Date field for a phone record.

To cancel a phone record:

  1. Select the Folder icon for Phone in the Client directory.
  2. Select the phone record to be cancelled.
  3. Select CANCEL on the SAS toolbar.

When the records are completed, the user will submit them. By completing this step, the Location record will be created automatically.

8118  Service Request /Community Care — CCAD Services Using the SAS Wizard

Revision 11-2; Effective April 1, 2011

The Service Request folder displays the services for which an individual is to be screened. Entries in this folder are required before the wizards can be completed. The system defaults to CCAD.

For initial applications:

  1. Select the Folder icon for Service Request in the Wizards directory.
  2. Select the program for which the individual is applying or leave at the default.
  3. Select each service for which the individual is to be screened. There are no edits in this window to prevent selecting mutually exclusive services.
  4. When all requested services are selected, select the Folder icon for the appropriate wizard in the Wizards directory.

For updates, additions or changes:

  1. Select the Folder icon for Service Request in the Wizards directory.
  2. Select the program for which the individual is applying.
  3. Select each service already open and any new services for which the individual is to be screened. There are no edits in this window to prevent selecting mutually exclusive services.
  4. Business rules will run only on services selected in this window. Wizards overwrite old information as the user progresses through the windows. If currently open services are not selected in addition to the new services requested, data on currently open services may be deleted.

  5. When all requested services are selected, move to the Folder icon for the appropriate wizard in the Wizards directory.

8120  Financial Wizard

Revision 11-2; Effective April 1, 2011

The Financial wizard is a prompting sequence of windows used to assess financial eligibility for CCAD services. It can also be used to verify Medicaid eligibility for other programs. Windows are conditional and will only display, if needed. Some windows are for statistical data collection purposes only. The Financial wizard must run before the Functional and Authorization wizards can be completed to authorize services. For Personal Assistance Services (PAS), each time the financial eligibility changes, the Functional wizard must be processed.

If an application is being denied due to functional eligibility and financial eligibility has not been determined, the case manager may enter zeros in the financial information to be able to proceed to the functional wizard.

After selecting the program in the Service Request window, open the Financial wizard:

  1. Select the Folder icon for the Financial wizard in the Wizards directory.
  2. Progress through the wizard by completing the entries in each window, then select NEXT.

8120.1  Service Request Window (Read Only) — Financial Wizard

Revision 11-2; Effective April 1, 2011

The Service Request window in the Financial wizard displays information in read-only mode about the program or services to be tested.

  1. The status of the current service authorizations, if any, will display as Open or Closed. To make changes in the Service Request window, return to the Service Request folder.
  2. Select NEXT.

8120.2  Categorical Eligibility Window — Financial Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Categorical Eligibility window displays information in read-only mode about open Medicaid-related cases, active Supplemental Nutrition Assistance Program (SNAP) cases, and STAR+PLUS. If no information is displayed, the individual has no open eligibility records on the System for Applications, Verifications, Eligibility Reports and Referral (SAVERR). Benefit information from the SAVERR database is updated each time an individual record is retrieved into the Financial or Functional wizards.

A red "H" is displayed in the Medicaid Related Coverage field when the SAVERR record is on hold. If a case is on hold, the SAS record for Medicaid-funded services (PHC and Title XIX DAHS) will process only if the hold is removed or if the Service Authorization record is Forced.

Select NEXT.

8120.3  CAS Eligible Window — Financial Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The CAS Eligible window is a conditional window that displays only when the individual is applying for PAS and does not receive Medicaid.

  1. Select Yes if the individual passes CAS screenable requirements. Follow appropriate procedures to process a CAS application.
  2. Select No if the individual does not meet CAS screenable requirements.
  3. Select NEXT.

8120.4  Decline QI1 Window — Financial Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Decline QI1 window is a conditional window that displays only when the individual receives Qualified Individual (QI)1. The individual must be willing to decline QI coverage in order to receive CAS.

  1. Select Yes if the individual is willing to decline QI coverage.
  2. Select No if the individual is not willing to decline QI coverage.
  3. Select NEXT.

8120.5  Urgent Need Window — Financial Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Urgent Need window is a conditional window that displays only when the individual is applying for PAS and is not categorically eligible.

  1. Select Yes if the individual meets the criteria for a verbal (expedited) referral.
  2. Select No if the individual does not meet the criteria for a verbal (expedited) referral.
  3. Select NEXT.

8120.6  Potential Eligibility Window — Financial Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Potential Eligibility window is a conditional window that displays only when the individual meets the criteria for a verbal (expedited) referral for FC.

If No is selected in the Potential Eligibility window, the wizard will display conditional Income and Resource windows to record financial information and verifications. If Yes is selected, the wizard will skip the Income and Resource windows.

  1. Select No if the individual appears to be within the income and resource limits for FC based on the signed application, and financial verifications are available.
  2. Select Yes if the individual appears to be within the income and resource limits for FC based on the signed application, but financial verifications are not available.
  3. Select No if the individual does not appear to be within the income and resource limits for FC based on the signed application.
  4. Type the date that the individual's financial eligibility is determined based on information on the signed application.
  5. Select NEXT.

When financial verifications are received after services have been started, the user must re-enter this screen and select No in order to access the Income and Resource windows to record the verifications.

8120.7  Couple Information Window — Financial Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Couple Information window is a conditional window that displays information used to determine the income/resource limits for financial eligibility determination. The window will not display if the individual is a Supplemental Security Income (SSI) recipient.

  1. The window defaults to No.
  2. Select Yes if the individual is married and living in the same household with the spouse.
  3. Select NEXT.

8120.8  Income Window — Financial Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Income window is a conditional window used to record the value of countable income and the method of verification for that income. The wizard automatically calculates total countable income as each entry is made in the Amount column.

  1. Type the dollar amount of all countable income in the fields under the Amount column.
  2. Select the method of verification from the drop-down menu in the Verification column for each type of income.
  3. Select the check box under the Doc Filed column if verification for a particular type of income is filed in the case folder.
  4. Select NEXT.

8120.9  Resources Window — Financial Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Resources window is a conditional window used to record the value of countable resources and the method of verification for those resources. The wizard automatically calculates total countable resources as each entry is made in the Amount column.

  1. Type the dollar amount of all countable resources in the fields under the Amount column.
  2. Type the dollar amount of the individual's current monthly income in the Less Monthly Income field if those monies are included in the checking account, savings account or cash on hand totals.
  3. Select the method of verification from the drop-down menu in the Verification column for each resource.
  4. Select the check box under the Doc Filed column if verification for a particular resource is filed in the case folder.
  5. Select NEXT.

8120.10  Financial Totals Window — Financial Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Financial Totals window displays financial information about a categorically eligible couple or individual. The information is used for statistical purposes.

  1. For individuals receiving CAS, Medical Assistance Only (MAO) or SNAP:
    • Type the total income and resources amounts for the couple in the Total Income and Total Resources fields if the individual is married and living in the same household with a spouse; or
    • Type the total income and resources amounts for the individual in the Total Income and Total Resources fields in other circumstances.

    This window does not display for individuals receiving SSI only.

  2. Select NEXT.

8120.11  Financial Eligibility Summary Window — Financial Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Financial Eligibility Summary window displays total countable income and resources for non-categorically eligible individuals. The window indicates whether the individual is within or exceeds income and resource limits. Overall financial eligibility displays as Passed or Failed. The window also displays the date financial eligibility is determined.

  1. Type the date the application was received in MM/DD/YYYY format.
  2. Select NEXT.

8120.12  Workers Checklist Window — Financial Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Workers Checklist window displays information about individual rights and responsibilities, referral to Area Agencies on Aging (AAA) and citizenship status. The window also displays whether an individual is financially eligible for Title XIX, CAS or Title XX services, or if the individual is not financially eligible for CCAD services.

  1. Select Rights and Responsibilities Discussed with the Client to certify that the discussion of rights and responsibilities has taken place.
  2. Select Form 2307 given to the individual to certify that Form 2307, Rights and Responsibilities, was given to the individual.
  3. Select Referral to AAA if the individual is referred to AAA.
  4. Select Client not a U.S. citizen/is under 18 to indicate that the individual voluntarily acknowledges not having U.S. citizenship or that the individual does not meet the age requirement.
  5. Select GENERATE once the Financial wizard is complete.
  6. Select OK.

8130  Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Functional wizard prompts the user through windows required to assess functional eligibility. Some windows are conditional and will display only if needed. The Financial wizard must run before the Functional wizard can be completed to authorize services.

To open the Functional wizard:

  1. Select the Folder icon for Service Request in the Wizards directory.
  2. Select the program for which the individual is applying.
  3. Select each service for which the individual is to be screened. There are no edits in this window to prevent selecting mutually exclusive services.
  4. Select the Folder icon for the Functional Wizard in the Wizards directory.
  5. Progress through the wizard by completing the entries in each window, then select NEXT.

If the user has followed this procedure to access the Financial wizard and is moving directly from the Financial wizard to the Functional wizard, he does not have to repeat Steps 1 and 3 prior to opening the Functional wizard. Begin with Step 4.

8130.1  Service Request Window (Read Only) — Functional Wizard

Revision 11-2; Effective April 1, 2011

The Service Request window in the Functional wizard displays information in read-only mode about the program or services to be tested.

  1. The status of current service authorizations, if any, will display as Open or Closed. To make changes in the Service Request window, return to the Service Request folder.
  2. Select NEXT.

8130.2  Interview Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Interview window displays information about the most recent interview.

To delete previous assessment information, select Clear Assessment. Selecting Clear Assessment clears previous information from all of the screens in the Functional wizard.

  1. Select the Type of Assessment, Primary Contact and Location specific to the current interview.
  2. The Interview Date box displays the current date. Type a different date in the box, if necessary.
  3. Type the date services are requested in the Intake Date box.
  4. Type the date the case manager received Form 2110, Community Care Intake, in the Assignment Date box.
  5. Type the date the application is denied for an individual with no active service authorization record in the Application Denied Date box. For example, if an individual files an application for services, but dies before those services are authorized, enter the denial date in this box.
  6. Select the reason for the denial from the drop-down list in the Denied Reason box.
  7. Select NEXT.

8130.3  Household Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Household window displays information about other persons living in the household with the individual.

  1. Select YES if there are any other adults or CCAD/CBA individuals residing in the household. Default entries may appear in this field on reviews. Change the selection, if necessary.
  2. Type the name of any other adult (whether they are an individual or not) or CCAD/CBA individual (regardless of age) who lives in the household.
  3. For each name listed:
    • Select the CCAD/CBA box if the other person receives any CCAD or CBA service.
    • Select the Companion box if there is another person in the household who receives CCAD PAS.
    • Type the client number if the other person has a number.
  4. Select NEXT.

8130.4  Health Concerns Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Health Concerns window displays information about current health conditions resulting in functional limitations or physical, mental or emotional impairment for the individual. Individuals in DAHS must have a medical diagnosis. Individuals receiving CAS or Title XIX PAS must have a medical need.

  1. Select each condition that describes the individual's current health.
  2. Select Other for a condition not listed. Type a description of the condition in the box provided (maximum 254 characters).
  3. Select NEXT.

8130.5  Depression Details Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Depression Details window displays questions about depression. If either of the first two questions is selected, the response boxes on the next four questions are activated.

  1. Select each question to which the individual's response is Yes. The wizard will automatically enter a score in the Impairment Scoring window, based on the responses in this window. The score is editable only in this window.
  2. Select NEXT.

8130.6  Impairment Scoring Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Impairment Scoring window displays functional assessment information (Form 2060, Needs Assessment Questionnaire and Task/Hour Guide).

  1. For each task listed, select an Impairment Score of 0 – 3 from the drop-down menu or type a score of 0 – 3 in the Impairment Score field.
  2. Press ENTER or use the mouse to move to the next field. Use the scroll bar to the right of the window to scroll down through all of the functional tasks. Continue until all functional tasks have been scored.

  3. Type comments in the Task Comments box (maximum 254 characters). A separate Task Comments box is available for each functional task. Comments will print out on Form 2060 next to the appropriate task.
  4. If a caregiver partially assists with a task and it will be purchased, enter the part of the task or scheduled time the caregiver will do the task. This task will be marked as P/C. Example: Sue Jones, daughter, can lay out bathing supplies, but can't help the individual into the bath tub.

    If a caregiver is not available during the time purchased tasks are delivered, but provides care at all other times, the case manager may enter one comment for the entire Form 2060. Since bathing is the first task, a comment may be entered in bathing that applies to all tasks. Example: Sue Jones, daughter, assists with all tasks in the evenings and on weekends.

    It is not necessary to list the caregiver under other tasks unless the caregiver is performing all of the task (C) or part of the task during the service schedule (P/C).

    If an agency is providing part of a task, enter the schedule for the agency in the Comments section. Example: ABC Home Health provides bathing on M-W-F and individual needs task purchased on T-Th.

  5. For PAS, select To Be Purchased for each task that will be purchased.
  6. Note: If the applicant does not meet the minimal functional score required to qualify for PAS, do not select tasks in the To Be Purchased column. Do not complete this information because the applicant does not qualify for PAS services.

  7. Select View Activities to display a Task/Time Allocation window for that task. View Activities is selected by default for the laundry, meal preparation and escort tasks.
  8. The Activities Selected column displays as "read only" once activities are selected on the Task/Time Allocation window for a specific task.
  9. Select the SET DATE button when the functional assessment is completed or updated. The current date will be entered and cannot be changed.
  10. This date will default to zeros each time the Functional wizard is opened. The date must be set again at each update. Do not set the date if Form 2060 is not administered.

  11. Select NEXT.

8130.7  Task Purchased Details Window(s) — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

When the individual lives with another person, the Task Purchased Details window displays for each purchased cleaning, meal preparation, shopping and laundry task.

  1. Select the reason(s) that justify purchasing each task.
    • If the household member has stated he is unwilling and refuses to perform the task, check "Household member refuses to perform task." This individual will be listed as a "Do Not Hire."
    • If the household member works full time, check "Household member is unable to perform task."
  2. Select NEXT.

8130.8  Support Assisting Client Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Support Assisting Client window is used to enter or view information about support currently being provided. Impairment scores previously selected in the Impairment Scoring window display in read-only mode. P will display for each purchased task. Unless there are actually two supports for a task, only one code should appear on the printed Form 2060, Needs Assessment Questionnaire and Task/Hour Guide. If the task is purchased and there is no other support, then the blank is selected for the primary support type.

  1. Select a primary support type from the drop-down menu for each functional task listed.
    • If a task is being purchased and the individual does not receive assistance from a caregiver or other agency in performing the task, and the impairment score is 1 or 2, select self from the drop-down menu or leave the default of NA.
    • If a task is being purchased and a caregiver, other agency or the individual assists some of the time, select the appropriate primary support type from the drop-down menu. The part of the task the caregiver or other agency performs should be noted in the comment section for that task on the Impairment Scoring window.
    • If a task is not being purchased because a caregiver, other agency or the individual performs the task all of the time, select the appropriate primary support type from the drop-down menu.
  2. If the primary support type is caregiver, type the name and relationship in the Support Name field beside each functional task. If the primary support type is agency, type the name of the agency in the Support Name field beside each functional task.
  3. Once a name is typed in the Support Name field, that name will automatically display each time the same primary support type is selected. This field is editable. If another caregiver is assisting with other tasks, type the name and relationship in the Support Name field beside the functional task.

  4. The Support Quality and Reliability column displays when the impairment score is 3 for any of the four priority tasks (feeding, toileting, transfer or meal preparation), and the task is to be purchased. Select a score from the drop-down menu to describe the quality and reliability of the available support.
  5. Select NEXT.

8130.9  Caregiver Support Details Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

For a purchased task, a Caregiver Support Details window displays for each caregiver listed in the Support Assisting Client window. The caregiver name displays in read-only mode at the top of the screen.

  1. Select the reason(s) why the caregiver cannot fully perform the purchased task. The reason will default to blank each time the Functional wizard is opened and must be re-entered for each update.
  2. Select Yes or No to indicate if the caregiver is a paid attendant.
  3. Select NEXT.

8130.10  Paid Attendant Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011
  1. If Yes is selected indicating the caregiver is a paid attendant, this window appears. It is no longer applicable and will be removed at a future date.
  2. Select NEXT.

8130.11  Other Agency Support Details Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

For a purchased task, an Other Agency Support window displays for each agency listed in the Support Assisting Client window. The agency name displays in read-only mode at the top of the screen.

  1. Select the reason(s) why the other agency cannot fully perform the purchased task.
  2. Select NEXT.

8130.12  Task/Time Allocation Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

A Task/Time Allocation window displays by default for the laundry, meal preparation and escort tasks. It also displays for any other tasks that have View Activities selected on the Impairment Scoring window. Impairment scores previously selected display in read-only mode. Rules processed in this window determine whether the Supervisor window is required. If the individual lives with another person, an asterisk displays beside a purchased general household task.

  1. Type the number of minutes per day and days per week or the minutes per week in the appropriate field.
    • For meals purchased through HDM only, no entries are required in the number of Minutes per Day, Days per Week and Minutes per Week fields.
    • For the escort task, type how often the task is to be performed. If the task is to be performed less than once per month, no entry is required in Minutes per Day or Minutes per Week fields.
  2. Select the activities associated with performing the task.
    • For laundry, select Washer or Dryer, if the individual has one.
    • For meal preparation, select the specific meal(s), breakfast, lunch or dinner, to be purchased through PAS. Do not check "lunch" if lunch is purchased through HDM only. Use comments to document if lunch is also delivered through PAS on days not provided by HDM.
    • For meal preparation, select whether meals will be purchased through HDM only, HDM/PAS or PAS only.
    • For escort, if frequency in Days per Week is more than 1, then supervisory approval is required.
  3. Select NEXT.

8130.13  Task/Hour Guide Summary Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Task/Hour Guide Summary window displays a summary of information entered on individual Task/Hour Tasks windows. The tasks and impairment scores display in read-only mode when the individual is being screened for PAS eligibility. If the individual lives with another person, an asterisk displays beside a purchased general household task.

Use this window to enter the time allocation for any task where a Task/Time Allocation window was not completed.

  1. To add or delete purchased tasks or to change impairment scores, return to the Impairment Scoring window by selecting the BACK button.
  2. To enter or modify time allocations, type the number of minutes per day and days per week or the minutes per week in the appropriate box beside each task. Changes made on this window will automatically update the Task/Time Allocation window.
  3. Select the SET DATE button to record completion of the task/hour guide. Once the date is set for an assessment, it cannot be changed.
  4. This date will default to zeros each time the Functional wizard is opened. The date must be reset at each update. Do not set the date if the individual is not being screened for PAS eligibility.

  5. Select NEXT.

8130.14  Supervisor Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Supervisor window displays when supervisory approval to exceed maximum times is required.

  1. Select YES if supervisory approval is received to exceed the maximum daily or weekly times for a purchased task for any individual.
  2. Type the date of approval.
  3. Select the method of approval from the drop-down menu.
  4. Select NEXT.

8130.15  CCAD Attendant Hours Adjustment Window — Functional Wizard

Revision 11-2; Effective April 1, 2011

The CCAD Attendant Hours Adjustment window displays the total impairment score in read-only mode (not including the feeding/eating task).

The priority status displays and can be changed from Priority to Non-Priority.

Authorization calculations based on task/hour information and available aid and attendance (A & A) hours display in read-only mode. The wizard calculates the A & A hours to be deducted from the total authorization based on the monthly amount entered and the current maximum attendant care rate.

  1. Select No to change from Priority to Non-Priority.
  2. If the individual is using A & A or Home-bound Elderly funds to purchase services that meet the intent of A & A or Home-bound Elderly benefits, select the explanation(s) of how A & A or Home-bound Elderly benefits are being used. Leave the Monthly Amount box blank.
  3. If the individual is using all or part of monthly A & A or Home-bound Elderly funds to purchase services which do not meet the intent of A & A or Home-bound Elderly benefits, type the whole dollar amount being misspent in the Monthly Amount box. Do not select an explanation.
  4. The Current Status of Medical Need displays as "read only" based on entries made by the nurse in the Authorization wizard. The current status of medical need is not editable in this window.
  5. Select NEXT.

8130.16  Six Hour Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Six Hour window displays when less than six hours per week of personal attendant service is authorized.

  1. Select the reason an individual receives less than six hours per week of personal attendant services.
  2. Select NEXT.

8130.17  Home Environment Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Home Environment window displays information about the location and condition of the individual's residence, the existence or lack of barriers to service delivery in the home environment, and the availability of assistive devices and transportation.

  1. Under Residence, select the best description of the individual's living arrangement.
  2. Under Assistive Devices, select any device(s) currently available at the individual's residence. Select Other for any item not on the list and type an explanation in the box (maximum 254 characters).
  3. Under Laundry, select the best description of available appliances.
  4. Under Adequate, Unsafe and Questionable, select the item(s) that describe the condition of the residence.
  5. Under Miscellaneous, select special-equipped vehicle for transport if the individual has a specially equipped vehicle.
  6. Select NEXT.

8130.18  Emergency Response Services Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Emergency Response Services window displays only when ERS is requested.

  1. Select YES if the ERS applicant is home alone for eight or more hours each day or lives with an incapacitated person who cannot call for help or otherwise assist in an emergency.
  2. Select NEXT.

8130.19  Eligibility Determination Window — Functional Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Eligibility Determination window displays the results of the functional eligibility determination. A green check mark indicates that the individual is eligible for a specific service. A red X indicates that the individual is not eligible for a specific service. A message displays if the Financial wizard has not already been completed or if there is a discrepancy between current SAVERR information and the information in the Financial wizard.

  1. Select Generate once the Functional wizard is completed
  2. Select OK.
  3. Click on the Submit button on the SAS navigator bar to file records to SAS.
  4. The Functional wizard will deny PHC or PHC CDS if the individual is under age 21. The user will receive a pop-up message, "PHC failed because the individual is under 21 years old, or no birth date was recorded."

  5. Click on the Search button on the SAS navigator bar to re-pull the case or double-click on the individual's name in the SAS List Data window.

Records to be populated by the wizards will display in the appropriate folders, but will not contain all required information until after the Authorization wizard has been completed.

8140  Authorization Wizard

Revision 11-2; Effective April 1, 2011

Both the Financial and Functional wizards must be completed and the information submitted prior to accessing the Authorization wizard to authorize services. The Authorization wizard can be accessed directly without going through the Financial and Functional wizards to change providers, authorize a pending service or terminate some open services.

At the beginning of the Authorization wizard, the system will prompt the user to redo the Financial/Functional wizard if there is a discrepancy between current SAVERR information and the information in the Financial wizard. This will also occur if open services were unselected on the Service Request window, which results in data being lost.

8141  Service Request Folder — Authorization Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Service Request folder displays the services on which action is to be taken. Entries in this folder are required before the Authorization wizard can be completed.

For initial applications:

  1. Select the Folder icon for Service Request in the Wizards directory.
  2. Select the program for which the individual is applying.
  3. Select each service for which Form 2101, Authorization for Community Care Services, is to be created. Unselect any marked services on which no Form 2101 is needed. There are no edits in this window to prevent selecting mutually exclusive services.
  4. When all requested services are selected, select the Folder icon for the Authorization wizard in the Wizards directory.

For updates, additions or changes:

  1. Select the Folder icon for Service Request in the Wizards directory.
  2. Select each service in which changes will be made. Unselect any marked services on which no changes occur. There are no edits in this window to prevent selecting mutually exclusive services.
  3. When all requested services are selected, move to the Folder icon for the Authorization wizard in the Wizards directory.

8142  Eligibility Details Window — Authorization Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Eligibility Details window displays the results of the financial and functional eligibility determination. A green check mark indicates that the individual is eligible for a specific service. A red X indicates that the individual is not eligible for a specific service.

White radio buttons in the window default to one of the following for each service:

  • Accept if the individual or applicant is eligible for a particular service.
  • Reject if the individual or applicant is not eligible for a particular service.
  • Terminate if the individual is no longer eligible for a particular service and there is an open service authorization.

To indicate the action to be taken for each service, change the radio buttons as follows:

  1. Select Reject if the applicant didn't request the service, and there is no open service authorization.
  2. Select Deny if the applicant requested to be screened for a particular service, and Reject is displayed.
  3. Select Provider Transfer if the individual has requested a new provider for an ongoing service. Do not select Provider Transfer for an ongoing CAS service authorization when an agency transfer is completed in conjunction with an annual assessment.
  4. Select Terminate if there is an open authorization for a service and the service needs to be discontinued.
  5. Select NEXT.

8143  Service Code Selection Window — Authorization Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Service Code Selection window displays only if PAS, RC or SSPD are selected on the Service Request window.

  1. Select one service code for each requested service. If the service being authorized is CDS-related, choose the service code under the CDS column. Only one code can be selected per category.
  2. Note: Continue to authorize both RC and room and board at annual reassessment for those RC individuals who were authorized for RC before Sept. 1, 2003, and who did not have adequate income to pay their full room and board fee. When reauthorizing RC services for these individuals, be sure to select the room and board option for the appropriate living arrangement. For example, when authorizing 19K – RC Apartment, select 19O – RC – Room and Board – Apt.

  3. Select NEXT.

8144  Service Arrangement Window — Authorization Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Service Arrangement window displays a list of services as marked on the Service Request window. For each service:

  1. Select View Provider if a new provider will be selected for an initial or ongoing authorization, or if there is a change in the provider delivering a service.
  2. Notes:

    • When authorizing RC services and room and board for those individuals authorized for RC prior to Sept. 1, 2003, be sure to select View Provider for both the RC and room and board authorizations.
    • When authorizing CDS, Service Code 63V will also appear with Service Code 17V.
  3. Select Client, Doctor or Rotation to indicate how the provider is to be selected. The field defaults to Client, but is editable.
  4. Select the county in which the individual will receive the service. The field defaults to the county in the SAS location folder, but is editable.
  5. Select NEXT.

8145  Provider Selection Window — Authorization Wizard — CCAD

Revision 11-2; Effective April 1, 2011

A Provider Selection window displays when View Provider is selected on the Service Arrangement window. All providers for a particular service in the selected county will display in alphabetical order by name. If the service being authorized is CDS-related, the wizard will display only those contract providers that are CDS for that service and program group and county.

  1. Select the provider to deliver services by using the arrow keys on the computer keyboard or by using the Enter key.
  2. When the red arrow is pointing to the correct provider, double click on the provider name or contract number. Information about the selected provider name will display at the top of the screen.
  3. Note: When authorizing RC room and board individuals authorized for RC prior to Sept. 1, 2003, be sure to select the same provider selected for the RC service.

  4. Select NEXT.

8146  Worker's BJN and Nurse's BJN Window — Authorization Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Worker's BJN and Nurse's BJN window displays in read-only mode the worker information from the Ownership folder. When the nurse is completing the service authorization, the nurse's BJN displays in read-only mode.

Select NEXT.

8147  Information for Authorize Window — Authorization Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Information for Authorize window collects data for case managers and nurses to complete the service authorization. A separate window displays for each service to be authorized or terminated. Unique fields display on service-specific windows.

Type Authorization is displayed for each service. Type authorizations that require nurse action are:

  • Authorize Initial — CAS or DAHS
  • Refer Update — CAS at annual reassessment

Type authorizations that require case manager action are:

  • Refer Initial — PHC, CAS and DAHS
  • Authorize Initial — All services except CAS and DAHS
  • Authorize Update — All services
  • Refer Update — CAS with or without changes at annual reassessment
  • Authorize Terminate
  1. Edit the date Form 2101, Authorization for Community Care Services, is mailed to the contracted agency in the Form 2101 field. The system defaults to today's date. Edit the date, if necessary, for the mail date.
  2. For the Begin Date field, enter information according to the following:
    1. PHC:
      • Initial Referral — Pending, the case manager leaves the Begin Date field blank.
      • Authorization — The case manager enters the mail date (Same as Item #1) in the Begin Date field.
    2. CAS:
      • Initial Referral — Pending, the case manager leaves the Begin Date field blank.
      • Authorization — The DADS nurse enters the mail date (same as Item #1) in the Begin Date field.
    3. DAHS:
      • Initial Referral — Pending, the case manager leaves the Begin Date field blank.
      • Authorization of Case Manager Referral — The DADS nurse enters the mail date in the Begin Date field.
      • Authorization of Facility Initiated Referral — The DADS nurse enters the date of the physician's orders in the Begin Date field.
    4. For initial referrals other than PHC, DAHS or CAS, the case manager enters the effective date of the authorization in the Begin Date field. Note: This date should match the effective date on Form 2065-A, Notification of Community Care Services.
    5. For updates, the case manager enters the date the change is to be effective in the Begin Date field. The wizard will automatically close an open authorization for that same service effective the day before the begin date on the updated authorization.
    6. For reassessments other than CDS, complete the Begin Date field according to the following:
      • For PHC reassessments with changes in services, the case manager enters the effective date of the change in the Begin Date field.
      • For CAS reassessments without changes (pending), the case manager leaves the Begin Date field blank.
      • For CAS reassessments with changes, the nurse enters the effective date of the change in the Begin Date field.
      • For CDS reassessments, the case manager enters the day following the end date of the previous authorization in the Begin Date field.
  3. For the End Date field, the case manager enters information according to the following:
    1. For initial authorizations other than CDS authorizations, leave the End Date field blank.
    2. For CDS authorizations, the end date will pre-populate to be one year minus a day from the date entered in the Begin Date field.
    3. For terminations, enter the date the contracted agency is no longer authorized to deliver services in the End Date field.
  4. Select the termination reason from the drop-down menu.
  5. The Unit Type field will default to the correct unit type for that service. If the Unit Type field is activated, select the unit type for the service from the drop-down menu.
  6. The Adj. Units field will default to the number of units for that service. If the Adj. Units field is activated, the number of units can be edited.
    • For 28-SSPD, type 7.0 for 24-Hour Shared Attendant Services or the number of units per week for day care, counseling or interpreter services in the Adj. Units field.
    • For 28A-SSPD Case Management, type 1 in the Adj. Units field.
    • For RC room and board for those individuals authorized prior to Sept. 1, 2003, type the difference between the current room and board amount and the individual's income in the Adj. Units field.
  7. Select the PAS Incr. Approved field if supervisor approval is needed for increased hours.
  8. Select the living arrangement from the drop-down menu.
  9. If the individual meets criteria for Money Follows the Person (MFP), select Rider 37 from the Enrolled From drop-down menu. If the individual does not meet Rider 37 criteria, completion of this field is optional. Warning: Do not select "Nursing Facility" in this field for individuals who meet MFP criteria.
  10. For RC services, type the dollar amounts of the initial and ongoing co-payment in the appropriate fields.
  11. Type documentation or comments to the provider agency in the Comments field.
    1. For all PAS, enter the number of days the individual is requesting services and if the individual requires a specific schedule.
    2. Enter the caregiver name and tasks performed, unless SAS Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, will be sent to the provider containing that information.
    3. Enter the name of any person who should not be hired and designate as "Do Not Hire."
  12. Select the service authorization status from the drop-down menu:
    1. Select Authorize if:
      • initial services are being authorized by a nurse or a case manager; or
      • changes to the service plan are being authorized by a nurse or a case manager.
    2. Select Terminate if:
      • existing services are being closed by a nurse or a case manager; or
      • the "flavor" of a service is being changed based on fund type.
    3. Select Deny if:
      • initial PHC is being denied by a case manager; or
      • initial CAS or DAHS is being denied by a nurse.
    4. Select Pending if:
      • a case manager is referring a case to the provider for pre-initiation activities; or
      • the case manager completes an annual reassessment for CAS without changes.
    5. Select Reassessment Required if a nurse is requesting the case manager to reassess the case.
  13. Type documentation or comments to the provider agency in the Comments field.
  14. Select No Order/Statement or No medical need, if appropriate.
  15. Type the name of the practitioner in the Name field.
  16. Type the phone number of the practitioner in the Phone field.
  17. Type the license number of the practitioner in the Lic No field.
  18. Type the date of the practitioner's orders in MM/DD/YYY format in the Order Dt field.
  19. Type up to five diagnosis codes in the numbered Diagnosis fields for DAHS. Each diagnosis code should have five characters.
  20. Select NEXT.

8148  Information for Terminate Window — Authorization Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Information for Terminate window displays the services selected for termination on the Eligibility Details window.

  1. The Form 2101, Authorization for Community Care Services, Date field defaults to the current date. This field is editable.
  2. Type the end date of the service in the End Date field.
  3. Select the termination reason from the drop-down menu.
  4. Submit.

The system messages the user if changes in the functional assessment are needed based on the denial reason selected.

8149  Authorization Summary Window (Read Only) — Authorization Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Authorization Summary window displays the services that have been referred, authorized or terminated and the authorization status in read-only mode.

  1. Select Generate once the Authorization wizard is complete.
  2. Submit.

Note: When terminating an AFC or RC authorization, a pop-up message displays indicating there is an open Applied Income/Co-pay record that must be closed manually as a Force.

8150  Nurse Authorizations Using the Wizards — CCAD

Revision 11-2; Effective April 1, 2011

8151  Nurse Entries to Authorize Initial DAHS or CAS Using the Wizards — CCAD

Revision 11-2; Effective April 1, 2011

To authorize initial DAHS or CAS, the nurse must:

  1. Run the Authorization wizard, including completing the Information for Authorize PAS (PHC/FC) window.
  2. Submit.

When DAHS is authorized for an individual who is also receiving CBA or CLASS, DAHS is the secondary service. SAS recognizes DAHS as an overlapping service with CBA and CLASS, and no Force is required.

8152  Nurse Entries to Authorize Changes in CAS Using Wizards — CCAD

Revision 11-2; Effective April 1, 2011

To authorize changes in CAS at the annual reassessment, the nurse must:

  1. Run the Authorization wizard, making any changes in the Information for Authorize PAS (PHC/FC) window.
  2. Submit.

8160  Changes to CCAD Authorizations Using the Wizards

Revision 11-2; Effective April 1, 2011

The wizards will process most changes and will update all required SAS records. The wizards cannot process an action requiring a Force.

8161  Form 2060 Score Changes Using the Wizards — CCAD

Revision 11-2; Effective April 1, 2011

If the individual's Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, score changes:

  1. Select all currently open services in the Service Request window.
  2. Run the Functional wizard, making changes as needed, including setting the date for Form 2060.
  3. Submit by selecting the Submit button on the toolbar.
  4. Run the Authorization wizard.
  5. Submit.

8162  Adding, Changing or Terminating Services Within Service Group 7 Using the Wizards — CCAD

Revision 11-2; Effective April 1, 2011

Note: Generate and submit the Monitoring wizard before changes are made to services in the Authorization wizard.

  1. Select the services to be added, changed or terminated in the Service Request window. The system will prompt the user to redo the Financial wizard if there is a discrepancy between current SAVERR information and the information in the Financial wizard. If needed, make changes to the Functional Wizard.
  2. If changes were made in the Financial or Functional wizard, be sure to submit.

Making Changes Using the Authorization Wizard

The Authorization wizard can be accessed directly without going through the Financial and Functional wizards to change providers, authorize a pending service or terminate some open services.

  1. In the Service Request folder, select each service in which changes will be made. Unselect any marked services on which no changes occur. There are no edits in this window to prevent selecting mutually exclusive services.
  2. When all requested services are selected, move to the Folder icon for the Authorization wizard in the Wizards directory.
  3. The Eligibility Details window displays the results of the financial and functional eligibility determination. A green check mark indicates that the individual is eligible for a specific service. A red X indicates that the individual is not eligible for a specific service.
  4. The Service Code Selection window displays only if PAS, Respite, RC or SSPD are selected on the Service Request window.
  5. Select one service code for each requested service. If the service being authorized is CDS-related, choose the service code under the CDS column. Only one code can be selected per category.
  6. The Service Arrangement window displays a list of services as marked on the Service Request window. For each service, view and select a provider. All providers for a particular service in the selected county will display in alphabetical order by name. If the service being authorized is CDS-related, the wizard will display only those contract providers that are CDS for that service and program group and county. When the red arrow is pointing to the correct provider, double click on the provider name or contract number. Information about the selected provider name will display at the top of the screen.
  7. The Information for Authorize window collects data for case managers and nurses to complete the service authorization. A separate window displays for each service to be authorized or terminated.

Changes — RC Using the Wizards

Case managers can terminate the services that are mutually exclusive at the same time that they authorize Assisted Living (AL)/RC by selecting Terminate for those services. For RC, the wizard will close the Applied Income/Co-pay record when the end date is a future date. The wizard will not close the Applied Income/Co-pay record when terminating RC services with a prior end date.

After terminating the RC service authorization using the wizard:

  1. Open the Applied Income/Co-pay Folder and select the open co-pay record.
  2. Click on the Force box (it contains a check mark). Enter comments in the pop-up box and click on Unforce.
  3. Enter the end date used to terminate RC in the End Date field.
  4. Click on the Force box again (this time there is no check mark in the box). Enter comments, click on Force and Submit.

The following instructions are for individuals who were authorized for services before Sept. 1, 2003, and who did not have adequate income to pay their full room and board fee.

For these individuals, the user must choose AL/RC, along with AL/Room and Board, in the Service Request window.

  • Select SC 19N – RC – Room and Board – Non-Apt when the service being authorized is RC Non-Apt.
  • Select 19O – RC – Room and Board – Apt when the service being authorized is RC Apt.

In the Information for Authorize window, enter the difference between the current room and board fee and the individual's current income in the Adj. Units field. Example: The individual's current income is $300 per month and the current room and board amount is $398.54. Enter $98.54 in the Adj. Units field ($398.54 − $300 = $98.54).

  • Type the date the individual is authorized to receive RC services in the Begin Date field. Leave the End Date field at default zeros.
  • Type the RC provider contract number in the Contract No field. Do not type leading zeros.
  • Select Submit from the Command Menu or the toolbar to submit the authorization.

An RC individual can reserve his space in the facility during hospital, nursing facility or institutional stays.

To register a service authorization for RC bed hold charges:

  1. Select 19H-ASSISTED LIVING BED HOLD from the drop-down list in the Service Code field.
  2. Type the date the individual entered the hospital, nursing facility, etc. in the Begin Date field. Type the day before the individual was discharged from the hospital or nursing facility in the End Date field.
  3. Type the RC provider contract number in the Contract No field. Do not type leading zeros.
  4. Select Submit from the Command Menu or the toolbar to submit the authorization.

Changes — Transfers Between Programs

If the individual is transferring from FC to PHC, the wizard will detect the individual's eligibility for Title XIX funding and close the Title XX eligibility record, if required. The Service Authorization record will remain open.

If the individual is transferring from CAS to PHC or vice versa based on a fund code change, the wizard will detect the individual's eligibility, but will not close the Service Authorization record. In this situation, terminate the Service Authorization record, and then run the Financial, Functional and Authorization wizards to redo the Service Authorization record.

Other Changes

If the individual record has been denied in the Authorization wizard based on No Medical Need or No Order/Statement, the Functional wizard will detect the reason and fail the individual for PHC or CAS. In this situation, run the Authorization wizard to remove the selection, and then run the Functional and Authorization wizards.

If the individual's financial eligibility changes in the Financial wizard, the Functional wizard must be run to ensure that Form 2101, Authorization for Community Care Services, prints properly.

8163  Case Manager/Nurse Changes Using the Wizards — CCAD

Revision 11-2; Effective April 1, 2011

When the individual is assigned to another case manager/nurse, follow the instructions for editing the Case Ownership record. When the case manager/nurse runs the Authorization wizard, the Authorizing Agent record will be populated with information from the Case Ownership record.

8164  Change in Provider Agency Using the Wizards — CCAD

Revision 11-2; Effective April 1, 2011

To record a change in provider agency:

  1. Select each service that will have a provider change in the Service Request window.
  2. Select the Authorization wizard. Select View Provider on the Service Arrangement window so that the Provider Selection window will display. Select the new provider.
  3. In the Information to Authorize window, enter the first day the new provider is authorized to deliver services in the Begin Date field. Select Authorize in the Service Authorization Status field. Select Next.
  4. Submit.

8165  Change in Co-Pay Using the Wizards — CCAD

Revision 11-2; Effective April 1, 2011

When the co-pay changes:

  1. Select all currently open services in the Service Request window.
  2. Run the Functional wizard, making changes as needed.
  3. Submit by selecting the Submit button on the toolbar.
  4. Run the Authorization wizard, making any change in co-pay amounts on the Information for Authorize window.
  5. Submit.

8166  Deleting a Registered Task Using the Wizards — CCAD

Revision 11-2; Effective April 1, 2011

To delete a registered task:

  1. Select all currently open services in the Service Request window.
  2. Run the Functional wizard, making changes as needed.
  3. Submit by selecting the Submit button on the toolbar.
  4. Run the Authorization wizard.
  5. Submit.

8167  Increases or Decreases in the Number of Units Using the Wizards — CCAD

Revision 11-2; Effective April 1, 2011

When a service plan change results in an increase or decrease in the number of units:

  1. Select all currently open services in the Service Request window.
  2. Run the Functional wizard, making changes as needed.
  3. Submit by selecting the Submit button on the toolbar.
  4. Run the Authorization wizard.
  5. Submit.

8168  Priority Changes Using the Wizards — CCAD

Revision 11-2; Effective April 1, 2011

The wizards automatically determine the individual's priority level and display the level on the CCAD Attendant Hours Adjustment window.

To change an individual from Priority to Non-Priority:

  1. Select all currently open services in the Service Request window.
  2. Run the Functional wizard, making changes as needed, including changing the priority level on the CCAD Attendant Hours Adjustment window.
  3. Submit by selecting the Submit button on the toolbar.
  4. Run the Authorization wizard.
  5. Submit.

8168.1  Retroactive PHC and CAS Authorizations Using the Wizards — CCAD

Revision 11-2; Effective April 1, 2011

The wizards will not handle retroactive PHC authorizations at this time. See Section 8200, Authorizing CCAD Services Without Using the Wizards, and Section 8270, Primary Home Care (PHC) Without the Wizards.

8169  Transfers from Service Group 7 to Another Service Group Using the Wizards — CCAD

Revision 11-2; Effective April 1, 2011

If the individual transfers to another Service Group:

  1. Use the wizards to close all Service Group 7 services. See Section 8162, Adding, Changing or Terminating Services Within Service Group 7 Using the Wizards — CCAD, for instructions.
  2. Create an authorization for the new service group using instructions for that service.

8170  Monitoring Wizard

Revision 11-2; Effective April 1, 2011

The Monitoring wizard prompts the user through windows required to complete monitoring contacts. Some windows are conditional and will display only if needed. The Monitoring wizard can be used with open services and with services/programs that the individual wants to add. Process the Monitoring wizard before running the Authorization wizard to terminate services.

  1. Complete the Service Request window to confirm services to be monitored.
  2. Select the Folder icon for Monitoring wizard in the Wizards directory.
  3. Progress through the wizard by completing the entries in each window, then select NEXT.

8171  Service Request Window — Monitoring Wizard

Revision 11-2; Effective April 1, 2011

The Service Request window is completed to confirm which services are to be monitored.

  1. Select the program that is to be monitored.
  2. Select each service for which a monitoring contact is to be made. Unselect any services not to be monitored. There are no edits in this window to prevent selecting mutually exclusive services
  3. Select the Folder icon for the Monitoring wizard in the Wizards directory.

8172  Services Authorized Window — Monitoring Wizard— CCAD

Revision 11-2; Effective April 1, 2011

The Services Authorized window operates in two modes: initial and follow-up. The window displays all services selected on the Service Request window.

For an initial monitoring:

  1. Unselect any service that is not to be monitored by clicking to remove the U next to that service.
  2. For open services, the current provider number will be entered by default. This field is editable. If a service is not currently open, type the provider number to be printed on the monitoring report. If the provider number is left blank, the system will default to all zeros.
  3. Select NEXT.

For a follow-up monitoring:

The window displays a read-only copy of the selections made at the initial monitoring.

Select NEXT.

8173  Contact Window — Monitoring Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Contact window displays information about the most recent monitoring contact.

For an initial monitoring:

  1. Select Clear Monitoring to delete previous information from all of the screens in the Monitoring wizard.
  2. Select the primary contact and location specific to the current monitoring contact.
  3. The Interview Date box displays the current date. Type a different date in the box, if necessary.
  4. Select a reason for monitoring contact. Type any comments in the box provided.
  5. Select NEXT.

8174  Monitor Detail Window — Monitoring Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Monitor Detail window displays a line for each service to be monitored. Different fields are enabled depending on whether the monitoring contact is an initial or a follow-up contact.

For an initial monitoring contact:

  1. Highlight the service to be monitored by using the mouse to move the arrow to the correct line.
    • Select Add to insert a new line for the service highlighted.
    • Select Delete to remove an entire line.
  2. Select Problems Alleged if the individual expresses dissatisfaction with a service.
  3. If the user is familiar with the reason and action codes:
    • Select the reason(s) for dissatisfaction and the action(s) to be taken from the drop-down menus.
    • Type comments in the box provided. A separate comment box is available for each action selected.
    • Repeat the process for each service to be monitored.
    • Select NEXT.
  4. If the user is not familiar with the reason and action codes:
    • Select NEXT without selecting reason(s) and action(s).
    • If no reason(s) or action(s) are selected, the wizard will display the Reasons for Dissatisfaction window and the Actions Selection window where those selections can be made.

For a follow-up monitoring contact:

  1. Highlight the service selected for follow-up by using the mouse to move the arrow to the correct line.
  2. If findings in the follow-up contact concur with the initial findings:
    • Select Y in the Concur w/previous field.
    • Select NEXT.
  3. If findings in the follow-up contact do not concur with the initial findings:
    • Select N in the Concur w/previous field.
    • Select Problems Alleged to record additional or different reasons for individual dissatisfaction.
    • If the user is familiar with the reason and action codes:
      • Select the reason(s) for dissatisfaction and the action(s) to be taken from the drop-down menus.
      • Type comments in the box provided. A separate comment box is available for each action selected.
      • Repeat the process for each service to be monitored.
      • Select NEXT.
    • If the user is not familiar with the reason and action codes, select NEXT without selecting reason(s) or action(s).
    • If no reason(s) or action(s) are selected, the wizard will display the Reasons for Dissatisfaction window and the Actions Selection window where those selections can be made.
  4. If the individual has selected the CDS option or has a "flavor" of service (e.g. CAS, Service Code 17D), type this information in the Comments box.
  5. Select NEXT.

8175  Reasons for Dissatisfaction Window — Monitoring Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Reasons for Dissatisfaction window displays for each service where Problems Alleged is marked, but no reason has been selected on the Monitor Detail window.

The choices displayed at the top of the window are referred to as reason groups. The individually numbered reasons displayed in the middle of the window are reason items.

  1. Highlight the reason group that best categorizes the individual's dissatisfaction by using the mouse to move the arrow to the correct line.
  2. Select the reason item(s) that best explain the individual's dissatisfaction. A different list of reason items displays for each reason group. U will appear beside the selected items only after both a reason group and a reason item have been selected.
  3. Type comments in the box provided.
  4. Select NEXT.

8176  Actions Selection Window — Monitoring Wizard — CCAD

Revision 11-2; Effective April 1, 2011

An Action Selection window displays for each reason item selected on the Reasons for Dissatisfaction window.

The reason item displays at the top of the window. The individually numbered actions displayed in the middle of the window are action items.

  1. Highlight the reason item by using the mouse to move the arrow to the correct line.
  2. Select up to five action items for the reason item highlighted at the top of the screen. U will appear beside the selected items only after both a reason item and at least one action item have been selected.
  3. Select NEXT.

8177  Client Satisfaction Window — Monitoring Wizard — CCAD

Revision 11-2; Effective April 1, 2011

The Client Satisfaction window is the last window in the Monitoring wizard.

  1. Select Overall Client Satisfaction from the drop-down menu.
  2. For CBA only: Nurses select Yes or No to indicate whether the service plan is appropriate. This question may be viewed by all users but is enabled only for nurses.
  3. Select the monitoring status from the drop-down menu. Choose:
    • Pending if the monitoring contact is not yet complete.
    • Follow-up Required if subsequent contacts are necessary.
    • Completed if the monitoring contact is complete.
  4. Select Set Date to enter the current date in the Date field. Type a different date in the box, if necessary.
  5. If the monitoring status is Pending, select Close and save the case to Draft.
  6. If the monitoring status is Follow-up Required or Completed, select Generate, and then Submit.

8200  Authorizing CCAD Services Without Using the Wizard

Revision 11-2; Effective April 1, 2011

All CCAD services except CMPAS and IHFSP can be authorized using the wizards.

CCAD services can also be authorized without using the wizards by manually making entries in each required record. Services authorized without using the wizards will store information in the SAS database, but not in the CCAD database. Manually completed cases will not be included in statistical reports generated from the CCAD database.

Many of the records required for each Community Care service are required by more than one service within the Community Care Service Group. However, only one open record at a time is required regardless of how many services are being authorized with the exception of the Service Authorization record. One Service Authorization record is required for each service.

It is critical that all required records cover all authorization periods. There must be no gaps in dates or overlapping Begin and End dates.

All Service Group 7 records are open-ended. Entries are required only when a change occurs.

8200.1  Individual — CCAD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

The Client Details record will be system generated with information from the SAVERR database or from information entered by the case manager in the Create New Client window.

The Create New Client function should only be used when the case manager has verified that the individual does not have an existing SAVERR number. When the Create New Client function is used, SAS assigns an individual number that will be written to SAVERR within three days. During this time, the SAS record is checked against SAVERR. If the system finds that the individual already has a SAVERR number, the case manager will have to recreate the SAS authorization using the original SAVERR number.

Accurate biographical information must be entered in the Create New Client window to avoid issuance of duplicate numbers.

8200.2  Address Folder — CCAD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

The Address folder records the individual's addresses. Create separate address records to record an individual's home or mailing address (if different than home address), a responsible party's address and/or an executor's address.

Information from this folder prints on the Provider Referral Supplement.

To register a home or mailing address:

  1. Select the Folder icon for Address in the Client directory.
  2. Select Add and the Address record will appear.
  3. Select the Type code from the drop-down list in the Type field. The system defaults to 05-Mailing/Home.
  4. Type the intake date as the effective Begin Date for initials. Type the effective date of the address in the Begin Date field for changes.
  5. Type the address in the Address field.
  6. The Tel. No. field is used to record the phone number of the executor only. Do not use this field to record the individual's phone number.
  7. Type the city in the City field.
  8. Select the state from the drop-down list in the State field. The system defaults to TX-Texas.
  9. Type the ZIP code in the ZIP Code field.

To register a responsible party's address:

  1. Select the Folder icon for Address in the Client directory.
  2. Select Add and the Address record will appear.
  3. Select the Type code 04-Other from the drop-down list in the Type field. The system defaults to 05-Mailing/Home.
  4. Type the intake date as the effective Begin Date for initials. Type the effective date of the address in the Begin Date field for changes.
  5. Type the following in the address lines:
  6. Line 1 – Enter the responsible party's name (First, Middle, Last). The line automatically starts with "C/O" for "in care of."
    Line 2 – Enter the first line of the responsible party's address (usually a street number or a P.O. Box).
    Line 3 – Enter the second line of the responsible party's address (if needed, such as for an apartment number).
    Note: Do not enter identifiers, such as daughter, directions to the home or any other miscellaneous text in any of these fields.
  7. Type the phone number of the responsible party in the Tel. No. field, including the area code. Do not use parentheses. For example, enter 555-123-4567.
  8. Type the city in the City field.
  9. Select the state from the drop-down list in the State field. The system defaults to TX-Texas.
  10. Type the ZIP code in the ZIP Code field.

To register an executor's address:

  1. Select the Folder icon for Address in the Client directory.
  2. Select Add and the Address record will appear.
  3. Select the Type code EX-Executor from the drop-down list in the Type field. The system defaults to 05-Mailing/Home.
  4. Type the intake date as the effective Begin Date for initials. Type the effective date of the address in the Begin Date field for changes.
  5. Type the following in the address lines:
  6. Line 1 – Enter the executor's name (First, Middle, Last).
    Line 2 – Enter the first line of the executor's address (usually a street number or a P.O. Box).
    Line 3 – Enter the second line of the executor's address (if needed, such as for an apartment number).
    Line 4 – Enter the executor's phone number, including the area code. Do not use parentheses. For example, enter 555-123-4567.
    Note: Do not enter identifiers, such as daughter, directions to the home, or any other miscellaneous text in any of these fields.
  7. Type the city in the City field.
  8. Select the state from the drop-down list in the State field. The system defaults to TX-Texas.
  9. Type the ZIP code in the ZIP Code field.

Address Changes

When an address changes, add a record using these same instructions and enter the new Begin Date. This record is an exception to the rule of entering an End Date in the existing record before creating another record. SAS reads the most recent address with a HOME type as the individual's current address.

8200.3  Authorizing Agent/Case Manager — CCAD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

The case manager Authorizing Agent record is used for identifying who the case is assigned to when generating regional and unit statistical reports. The information in the case manager Authorizing Agent folder will be used in generating the Provider Referral Supplement.

To register a case manager Authorizing Agent record:

  1. Select the Folder icon for Authorizing Agent in the Case Worker directory.
  2. Select Add and the Authorizing Agent record will appear.
  3. Select CM-Case Manager from the drop-down list in the Type field.
  4. Select 7-Community Care from the drop-down list in the Group field.
  5. Select YES if there is no other existing case manager Authorizing Agent record. Select NO if there is another existing record in the Send to TMHP field.
  6. Type the date the case was assigned to the case manager or today's date in the Begin Date field. Leave the End Date field at default zeros.
  7. Type the case manager's BJN in the Auth Agent field. Type the BJN without dashes (for example, 04599C09). For statistical reporting purposes, this is the most important field.
  8. Leave the Agency field at the default selection 324-DHS.
  9. Type the case manager's name in the Name field.
  10. Type the case manager's phone number in the Phone field. Include the area code, phone number and extension. Type "0000" if no extension exists.
  11. Type the case manager's Mail Code (without dashes) in the Mail Code field.

When the Case Manager Changes

When the individual is assigned to another case manager, enter an End Date in the existing case manager Authorizing Agent record and create another record with the new information using these same instructions. To avoid gaps or overlaps in the case manager Authorizing Agent records, the End Date of the existing record should be one day before the Begin Date of the new record.

Currently, although SAS will accept multiple Authorizing Agent records, Texas Medicaid and Healthcare Partnership (TMHP) will only accept two Authorizing Agent records when a SAS file is transmitted to TMHP. Therefore, until this problem is resolved, select NO in the Send To TMHP field for all updates.

8200.4  Eligibility for Title XX Services — CCAD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

One Eligibility record is required for all Title XX Community Care – Service Group 7 authorizations. Only one open record is required regardless of how many Title XX services the individual is receiving.

When the Create New Client function is used to create an initial authorization, the Enrollment and Eligibility records must be submitted to the SAS database before the remaining records are completed.

To register eligibility for Title XX Community Care authorizations:

  1. Select the Folder icon for Title XX Eligibility in the Eligibility directory.
  2. Select Add and the Eligibility record will appear.
  3. Select CC-CCAD-ELIGIBLE from the drop-down list in the Type Elig-Code field.
  4. Type the date the individual is eligible to receive CCAD Title XX services in the Begin Date field. The Begin Date must match the earliest date the Title XX CCAD services are being authorized. Leave the End Date field at default zeros.
  5. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  6. Select A-TITLE XX from the drop-down list in the Category field.
  7. Select 1-TITLE XX from the drop-down list in the Cov. Code field.
  8. Select A-TITLE XX from the drop-down list in the Type Program field.

This record will remain open until the individual stops receiving a Title XX CCAD service.

To close this record:

No changes to this record are required when the individual's Title XX eligibility is reassessed unless the individual is determined to be ineligible. When the individual stops receiving all Title XX services, enter the last day of service in the End Date field.

8200.5  Enrollment — CCAD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

An individual should be enrolled in only one service group at a time. Only one Enrollment record should be open at a time regardless of how many services the individual is receiving. This record will remain open until the individual transfers to another service group or stops receiving Long-term Services and Supports (LTSS).

Note: An exception to multiple enrollment records is when a Service Group 3 individual receiving CBA services receives Service Group 7 DAHS. An enrollment record would exist for each service group.

When the Create New Client function is used to create an initial authorization, the Enrollment and Eligibility records must be submitted to the SAS database before the remaining records are completed.

To register enrollment for Community Care – Service Group 7:

  1. Select the Folder icon for Enrollment in the Program and Service directory.
  2. Select Add and the Enrollment record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. If the individual meets criteria for MFP, select Rider 37/28 (FAC to COMM) from the Enrolled From drop-down menu. If the individual does not meet MFP criteria, completion of this field is optional. Warning: Do not select Nursing Facility for individuals who meet MFP criteria.
  5. Type the beginning date of Community Care services in the Begin Date field. Leave the End Date field at default zeros.

When Changes Occur

No changes to this record are required if the individual transfers from one service within Community Care (Service Group 7) to another service in Community Care.

If the individual transfers to another service group without an overlap of services, enter the last day the individual received Community Care – Service Group 7 as the End Date of this record.

If the individual transfers to another service group and there was an overlap in services, enter the day the terminated service stopped as the End Date of this record. Create a new record for the new service with a Begin Date of the day the new service started, even if dates overlap.

If the individual stops receiving LTSS, enter the last day the individual received services as the End Date of this record.

8200.6  Location — CCAD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

The Location record is used to register the county and region in which an individual resides. This information is used in statistical reporting by region and county. The individual's county is also matched against a provider agency's list of authorized counties.

When an individual who has never received any DADS LTSS is registered in SAS, the Location record will be system generated from the information entered on the Create New Client window. The Location record will be created before the service authorization is filed to the DADS database.

When an individual who has never received any DADS LTSS is registered in SAS and already has a SAVERR number, the Location record will not be created until the initial individual file is submitted to the DADS database. Once the service authorization is submitted and filed to the SAS database, the Location record is system generated from information on SAVERR.

Warning: To avoid creating duplicate Location records, the authorizing agent should never add a Location record before the initial individual file is submitted to the DADS database.

If the county identified in the Location record is incorrect (because the county on SAVERR is actually the guardian's county, the individual has moved or any other reason), the location information must be corrected. SAVERR updates SAS every month on the day after SAVERR cutoff. Therefore, the most effective way to correct the county is to correct the county in SAVERR. Since Medicaid for the Elderly and People with Disabilities (MEPD), Social Security Administration or Texas Works staff must do most of these corrections, timely updates to SAVERR may not be possible. The county information can be corrected in SAS. However, the corrected record must be Forced or SAVERR will rewrite the information at the next SAVERR/SAS reconciliation.

To correct the location information:

  1. Select the Folder icon for Location in the Client directory.
  2. Select the existing open record from the list in the tree directory or the SAS List Data window on the right-hand side of the screen.
  3. Type the day before the new county will be registered in the End Date field.
  4. Select the Folder icon for Location in the Client directory.
  5. Select Add and a blank Location record will appear.
  6. Select the appropriate county from the drop-down list in the County field.
  7. Type the date the new county is being registered in the Begin Date field. Leave the End Date field at default zeros.

In order for SAVERR to not overwrite this record, move to the Force field and set the Force Flag. Enter comments explaining why the record is being forced.

8200.7  Phone — CCAD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

The Phone folder documents an individual's phone number and is mandatory for ERS recipients. Additional records can be created to record numbers for relatives, friends or a responsible party.

To register phone information:

  1. Select the Folder icon for Phone in the Client directory.
  2. Select Add and the Phone record will appear.
  3. The system defaults to HO-HOME in the Type field. Select OT-OTHER from the drop-down menu to register additional phone numbers.
  4. Type the date the phone number is valid in the Begin Date field. This can be the same date as the Begin Date for enrollment.
  5. Type the phone number in the Phone No field.

8200.8  Level of Service/Form 2060 — CCAD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

One open Level of Service Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, record is required for individuals receiving Adult Foster Care (AFC), Emergency Response Services (ERS), Family Care (FC), Home-Delivered Meals (HDM), Primary Home Care (PHC), Residential Care (RC) Services and Special Services to Persons with Disabilities (SSPD). Only one record should be open at a time regardless of how many Community Care – Service Group 7 services the individual is receiving. This record is used to document the individual's functional eligibility based on the Form 2060 score.

To register a Form 2060 level of service record:

  1. Select the Folder icon for Level of Service in the Medical directory.
  2. Select Add and the Level of Service record will appear.
  3. Select 20-2060 score from the drop-down list in the Type field.
  4. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  5. Leave the Contract No. field blank.
  6. Type the 2060 score in the Level field.
  7. Type the date the individual is functionally eligible for Community Care – Service Group 7 services in the Begin Date field. The Begin Date must match the earliest date the individual was authorized to begin receiving services. Leave the End Date field at default zeros.

This record remains open until the individual's score changes, the individual transfers to another service group, or the individual stops receiving a service that requires this record.

Retroactive PHC and CAS authorizations:

If the applicant is determined eligible for ongoing services based on the Form 2060 score, type the ongoing 2060 score with a Begin Date of the first day of the retroactive period.

If the applicant is determined ineligible for ongoing services based on the Form 2060 score, type 24 as the 2060 score with the Begin Date and End Date for the retroactive period.

Create a second Level of Service record for the individual's priority level. Always use Level 1, Non-Priority, with a Begin Date of the first day of the retroactive period.

When the Form 2060 score changes:

If the individual's Form 2060 score changes, enter an End Date in the existing open 2060 Level of Service record. Using these same instructions, add another record with the new information. To avoid gaps or overlaps in the records, the End Date of the existing record should be one day before the Begin Date of the new record.

When the individual transfers to another service within Service Group 7:

If this record is required for the new service, leave the record open. If the individual stops receiving all services that require a 2060 Level of Service record, enter the last day the individual received services as the End Date.

When the individual transfers to another service group:

If the individual transfers to another service group, enter the last day the individual received services as the End Date.

8210  Adult Foster Care (AFC) Without the Wizards

Revision 11-2; Effective April 1, 2011

The following records are either system generated or created by the case manager to authorize AFC – Service Code 18. Detailed instructions for completing each record are found in Section 8200, Authorizing CCAD Services Without Using the Wizards, and in this section.

When the Create New Client function is used for an initial service authorization, the Enrollment and Eligibility records must be submitted to the SAS database before the remaining records are completed. In all other situations, all the records may be completed before submitting to the SAS database.

  • Individual
  • Address
  • Authorizing Agent – Case Manager
  • Eligibility
  • Enrollment
  • Location
  • Phone
  • Level of Service – Form 2060, Needs Assessment Questionnaire and Task/Hour Guide
  • Service Authorization

Do not create a co-payment record for CCAD AFC individuals. CCAD AFC individuals pay room and board but do not pay a co-payment. Room and board is an agreement between the individual and the provider. It is not registered in SAS.

8211  Service Authorization — AFC Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register a service authorization for AFC:

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select 18-ADULT FOSTER CARE from the drop-down list in the Service Code field.
  5. Leave the Agency field at the default selection 324-DHS.
  6. Select 5-DAILY from the drop-down list in the Unit Type field.
  7. Type 1 in the Units field.
  8. Type the date the individual is authorized to receive AFC services in the Begin Date field. Leave the End Date field at default zeros.
  9. Type the AFC provider contract number in the Contract No. field. Do not type leading zeros.
  10. Select Submit from the Command Menu or the toolbar to submit the authorization.

See Section 8300, Changes to CCAD Authorizations Without the Wizards, for instructions for making changes to this record.

8220  Client Managed Personal Attendant Services (CMPAS) Without the Wizards

Revision 11-2; Effective April 1, 2011

The following records are either system generated or created by the case manager to authorize CMPAS – Service Code 27. Detailed instructions for completing each record are found in Section 8200, Authorizing CCAD Services Without Using the Wizards, and in this section.

When the Create New Client function is used for an initial service authorization, the Enrollment and Eligibility records must be submitted to the SAS database before the remaining records are completed. In all other situations, all the records may be completed before submitting to the SAS database.

  • Individual
  • Address
  • Authorizing Agent – Contract Manager
  • Authorizing Agent – Agency
  • Eligibility
  • Enrollment
  • Location
  • Phone
  • Applied Income – Co-pay
  • Service Authorization – Agency Model
  • Service Authorization – CDS Model

8221  Authorizing Agent/Contract Manager — CMPAS Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register a contract manager Authorizing Agent record:

  1. Select the Folder icon for Authorizing Agent in the Case Worker directory.
  2. Select Add and the Authorizing Agent record will appear.
  3. Select OT-OTHER from the drop-down list in the Type field.
  4. Select 7-Community Care from the drop-down list in the Group field.
  5. Select YES if there is no other existing contract manager Authorizing Agent record, and select NO if there is an existing record in the Send to TMHP field.
  6. Type the first date of service or today's date in the Begin Date field. Leave the End Date field at default zeros.
  7. Type the contract manager's BJN in the Auth Agent field. Type the BJN without dashes (for example, 04599C09). For statistical reporting purposes, this is the most important field.
  8. Leave the Agency field at the default selection 324-DHS.
  9. Type the contract manager's name in the Name field.
  10. Type the contract manager's phone number in the Phone field. Include the area code, phone number and extension. Type 0000 if no extension exists.
  11. Type the contract manager's Mail Code in the Mail Code field.

8222  Authorizing Agent/Agency — CMPAS Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register an agency Authorizing Agent record:

  1. Select the Folder icon for Authorizing Agent in the Case Worker directory.
  2. Select Add and the Authorizing Agent record will appear.
  3. Select OT-OTHER from the drop-down list in the Type field.
  4. Select 7-Community Care from the drop-down list in the Group field.
  5. Select YES in the Send to TMHP field.
  6. Type the date the case was assigned to the agency or today's date in the Begin Date field. Leave the End Date field at default zeros.
  7. Type Direct in the Auth Agent field.
  8. Leave the Agency field at the default selection 324-DHS.
  9. Type the name of the CMPAS provider agency in the Name field.
  10. Type the telephone number of the CMPAS provider agency in the Phone field.

Agency Changes

When the individual transfers to another agency, enter an End Date in the existing agency Authorizing Agent record. Using these same instructions, add another record with the new information.

8223  Applied Income/Co-Pay — CMPAS Services Without the Wizards

Revision 11-2; Effective April 1, 2011

This record registers the co-pay for CMPAS. If the co-pay for the initial month in which the CCAD individual receives CMPAS is prorated, then two Applied Income records must be created. The CCAD case manager will register the prorated co-pay amount in the first record and create a second record to register the ongoing co-pay amount. If one of these records is for a month prior to the month the information is being entered, a Force is required.

To register initial co-pay information for a CMPAS individual:

  1. Select the Folder icon for Applied Income in the Program and Service directory.
  2. Select Add and the Applied Income/Co-pay record will appear.
  3. Select CO-CO-PAY (AMOUNT OR PERCENTAGE) from the drop-down list in the A/I Type field.
  4. Select 2-CO-PAY (PERCENTAGE) from the drop-down list in the Co-Pay Type.
  5. Type the percentage of the cost of services that the individual is responsible for paying in the Percent field.
  6. Type the date that the individual is responsible for paying the percentage of the cost of services in the Begin Date field. Leave the End Date field at default zeros.

Co-Pay Changes

When the co-pay changes, enter an End Date in the existing Applied Income record. Using these same instructions, create another record with the new information.

8224 Service Authorization/Agency Model — CMPAS Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register a service authorization for a CMPAS individual using the Agency Model:

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in to the Service Group field.
  4. Select 27-CLIENT MANAGED ASSISTED SERVICES from the drop-down list in the Service Code field.
  5. Leave the Agency field at the default selection 324-DHS.
  6. Select 1-WEEK from the drop-down list in the Unit Type field.
  7. Type the number of hours per week of CMPAS services the individual is authorized to receive in the Adj. Units field.
  8. Type the date the individual is authorized to receive CMPAS services in the Begin Date field. Leave the End Date field at default zeros.
  9. Type the CMPAS provider contract number in the Contract No field. Do not type leading zeros.
  10. Select Submit from the Command Menu or the toolbar to submit the authorization.

See Section 8300, Changes to CCAD Service Authorizations Without the Wizards, for instructions for making changes to this record.

8225  Service Authorization/CDS Model — CMPAS Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register a service authorization for a CMPAS individual using the CDS Model:

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in to the Service Group field.
  4. Select 27A-CMPAS Client Directed Services from the drop-down list in the Service Code field.
  5. Leave the Agency field at the default selection 324-DHS.
  6. Select Y – Per Auth from the drop-down list in the Unit Type field.
  7. Type the number of dollars per year of CMPAS services the individual is authorized to receive in the Adj. Units field.
  8. Type the date the individual is authorized to receive CMPAS services in the Begin Date field. Leave the End Date field at default zeros.
  9. Type the CMPAS provider contract number in the Contract No field. Do not type leading zeros.
  10. Select Submit from the Command Menu or the toolbar to submit the authorization.

See Section 8300, Changes to CCAD Service Authorizations Without the Wizards, for instructions for making changes to this record.

8230  Day Activity and Health Services (DAHS) Without the Wizards

Revision 11-2; Effective April 1, 2011

The following records are either system generated or completed by the CCAD case manager and the DADS regional nurse for Title XIX and Title XX DAHS – Service Code 29 authorizations.

When the Create New Client function is used for an initial service authorization, the Enrollment and Eligibility records must be submitted to the SAS database before the remaining records are completed. In all other situations, all the records may be completed before submitting to the SAS database.

Using the instructions in Section 8200, Authorizing CCAD Services Without Using the Wizards, the CCAD case manager completes these records:

  • Individual
  • Address
  • Authorizing Agent – Case Manager
  • Eligibility for Title XX DAHS Only
  • Enrollment
  • Location
  • Phone

Using the following instructions, the DADS nurse completes these records to create an authorization for Title XIX or Title XX DAHS:

  • Diagnosis
  • Authorizing Agent – Nurse
  • Authorizing Agent – Practitioner
  • Service Authorization

When DAHS is authorized for an individual who is also receiving CBA or CLASS, DAHS is the secondary service. SAS recognizes DAHS as an overlapping service with CBA and CLASS, and no Force is required.

8231  Diagnosis — DAHS Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register diagnosis code(s) for a Title XIX or Title XX DAHS individual:

  1. Select the Folder icon for Diagnosis in the Medical directory.
  2. Select Add and the Diagnosis record will appear.
  3. Select 7-COMMUNITY CARE in the Service Group field.
  4. Type the date the diagnosis codes are effective in the Begin Date field. For an initial case, this is the date the individual is approved for Title XIX or Title XX DAHS services. Leave the End Date field at default zeros.
  5. Type the numeric code(s) for the individual's primary diagnosis in the Diagnosis fields. If the individual has additional diagnoses from practitioner's orders for PHC, list all diagnosis codes. Up to five diagnoses codes can be entered. There should be only one Diagnosis record for Service Group 7, even if the individual is receiving both PHC and DAHS.
  6. Select 09-ICD-9-CM CODE from the drop-down list in the Version field.

This record will remain open until the individual stops receiving a service that requires this record or there is a change in diagnosis.

8232  Authorizing Agent/Nurse — DAHS Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register a nurse authorizing agent for a Title XIX or Title XX DAHS individual:

  1. Select the Folder icon for Authorizing Agent in the Case Worker directory.
  2. Select Add and the Authorizing Agent record will appear.
  3. Select NU-NURSE from the drop-down list in the Type field.
  4. Select 7-COMMUNITY CARE from the drop-down list in the Group field.
  5. Select YES if there is no other existing nurse Authorizing Agent record in the Send to TMHP field. Select NO if there is another existing record.
  6. Type the date this individual was assigned to the nurse or the date of the Enrollment record in the Begin Date field. Leave the End Date field at default zeros.
  7. Move to the Auth Agent field and enter the BJN for the nurse.
  8. Leave the Agency field at the default selection 324-DHS.
  9. Type the nurse's name in the Name field.
  10. Type the nurse's phone number in the Phone field. Type the area code, phone number and extension. Type 0000 if no extension exists.
  11. Type the nurse's Mail Code in the Mail Code field.

This record will remain open until the case is assigned to another nurse, the individual transfers to another service that does not require this record or the individual stops receiving services.

Nurse Changes

When the individual is assigned to another nurse, enter an End Date in the existing nurse Authorizing Agent record. Using these same instructions, create another record with the new information. To avoid gaps or overlaps in the nurse Authorizing Agent records, the End Date of the existing record should be one day before the Begin Date of the new record.

Currently, although SAS will accept multiple Authorizing Agent records, TMHP will only accept two Authorizing Agent records when a SAS file is transmitted to TMHP. Until this problem is resolved, select NO in the SEND TO TMHP field for all updates.

8233  Authorizing Agent/Practitioner — DAHS Services Without the Wizards

Revision 11-2; Effective April 1, 2011

The DADS regional nurse registers the practitioner Authorizing Agent record. If the practitioner authorizing agent is not registered for a Title XIX or Title XX DAHS individual, the authorization will reject.

To register a practitioner Authorizing Agent for a Title XIX or Title XX DAHS individual:

  1. Select the Folder icon for Authorizing Agent in the Case Worker directory.
  2. Select Add and the Authorizing Agent record will appear.
  3. Select P-PRACTITIONER from the drop-down list in the Type field.
  4. Select 7-COMMUNITY CARE from the drop-down list in the Group field.
  5. Leave the Send to TMHP field at the default (blank) or select NO. The practitioner registration does not require an entry in this field.
  6. Type the beginning date of the practitioner's orders in the Begin Date field. Leave the End Date field at default zeros. The Begin Date must be equal to or earlier than the first day the individual is being authorized to receive services.
  7. Enter the practitioner's license number in the Auth Agent field.
  8. Select DADS from the drop-down list in the Agency field.
  9. Type the practitioner's last name in the Name field.
  10. Type the practitioner's phone number in the Phone field. Type the area code, phone number and extension. Type 0000 if no extension exists.
  11. Leave the Mail Code field blank.

8234  Service Authorization — DAHS Services Without the Wizards

Revision 11-2; Effective April 1, 2011

The DADS regional nurse completes the Service Authorization record for Title XIX or Title XX DAHS cases when services are approved.

To register a Service Authorization for a Title XIX or Title XX DAHS individual:

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select 29-DAHS from the drop-down list in the Service Code field.
  5. Leave the Agency field at the default selection 324-DHS.
  6. Select 1-WEEK from the drop-down list in the Unit Type field.
  7. Type the number of units per week of DAHS services the individual is authorized to receive in the Adj. Units field.
  8. Type the date the individual is authorized to receive DAHS services in the Begin Date field. Leave the End Date field at default zeros.
  9. Type the DAHS provider contract number in the Contract No field. Do not type leading zeros.
  10. Select Submit from the Command Menu or the toolbar to submit the authorization.

See Section 8300, Changes to CCAD Authorizations Without the Wizards, for instructions for making changes to this record.

8240  Emergency Response Services (ERS) Without the Wizards

Revision 11-2; Effective April 1, 2011

The following records are either system generated or created by the case manager to authorize ERS – Service Code 20. Detailed instructions for completing each record are found in Section 8200, Authorizing CCAD Services Without Using the Wizards, and in this section.

When the Create New Client function is used for an initial service authorization, the Enrollment and Eligibility records must be submitted to the SAS database before the remaining records are completed. In all other situations, all the records may be completed before submitting to the SAS database.

  • Individual
  • Address
  • Authorizing Agent – Case Manager
  • Eligibility
  • Enrollment
  • Location
  • Phone
  • Level of Service – Form 2060, Needs Assessment Questionnaire and Task/Hour Guide
  • Service Authorization

8241  Service Authorization — ERS Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register a Service Authorization for an ERS individual:

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select 20-ERS from the drop-down list in the Service Code field.
  5. Leave the Agency field at the default selection 324-DHS.
  6. Select 2-MONTH from the drop-down list in the Unit Type field.
  7. Type 1 in the Adj. Units field.
  8. Type the date the individual is authorized to receive ERS services in the Begin Date field. Leave the End Date field at default zeros.
  9. Type the ERS provider contract number in the Contract No. field. Do not type leading zeros.
  10. Select Submit from the Command Menu or the toolbar to submit the authorization.

See Section 8300, Changes to CCAD Authorizations Without the Wizards, for instructions for making changes to this record.

8250  Family Care (FC) Without the Wizards

Revision 11-2; Effective April 1, 2011

The following records are either system generated or created by the case manager to authorize FC – Service Code 17. Detailed instructions for completing each record are found in Section 8200, Authorizing CCAD Services Without Using the Wizards, and in this section.

When the Create New Client function is used for an initial service authorization, the Enrollment and Eligibility records must be submitted to the SAS database before the remaining records are completed. In all other situations, all the records may be completed before submitting to the SAS database.

  • Individual
  • Address
  • Authorizing Agent – Case Manager
  • Eligibility
  • Enrollment
  • Location
  • Phone
  • Level of Service – Form 2060, Needs Assessment Questionnaire and Task/Hour Guide
  • Level of Service – Priority
  • Service Authorization
  • Service Item

8251  Level of Service/Priority — FC Services Without the Wizards

Revision 11-2; Effective April 1, 2011

All FC individuals must have a priority level registered on the Level of Service record. This record is used to tell the billing system which rate the provider is authorized to use for each individual. SAS will accept the authorization without this record but provider claims will reject.

To register the Priority Level of Service record for an FC individual:

  1. Select the Folder icon for Level of Service in the Medical directory.
  2. Select Add and the Level of Service record will appear.
  3. Select PR-PRIORITY from the drop-down list in the Type field.
  4. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  5. Leave the Contract No. blank.
  6. Type 1 for Non-Priority cases or 2 for Priority cases in the Level field.
  7. Type the date the individual is eligible for this level of service in the Begin Date field. The Begin Date must match the first day the individual is authorized to receive this level of FC services. Leave the End Date field at default zeros.

Priority Changes

When the individual's priority level changes, enter an End Date in the existing record. Using these same instructions, create another record with the new information. To avoid gaps or overlaps in the Priority Level of Service records, the End Date of the existing record should be one day before the Begin Date of the new record.

8252  Service Authorization — FC Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register a Service Authorization for an FC individual:

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select 17C-PERSONAL ASSISTANCE SERVICES PAS from the drop-down list in the Service Code field.
  5. Leave the Fund field at the default setting. No entry is required in this field unless an individual who is eligible for full Medicaid benefits is being authorized to receive FC. For these situations, a Force is required to change the Fund.
  6. Leave the Agency field at the default selection 324-DHS.
  7. Select 1-WEEK from the drop-down list in the Unit Type field.
  8. Type the number of PAS hours per week the individual is authorized to receive in the Adj. Units field.
  9. Type the date the individual is authorized to receive FC services in the Begin Date field. Leave the End Date field at default zeros.
  10. Type the FC provider contract number in the Contract No field. Do not type leading zeros.

See Section 8300, Changes to CCAD Authorizations Without the Wizards, for instructions for making changes to this record.

8253  Service Item — FC

Revision 11-2; Effective April 1, 2011

The Service Item record is used to register tasks. At least one task authorized on Form 2101, Authorization for Community Care Services, must be registered for FC. Additional tasks can be registered, if desired.

To register a Service Item record for an FC individual:

  1. Select the Folder icon for Service Item in the Program and Service directory.
  2. Select Add and the Service Item record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select 17-PERSONAL ASSISTANCE SERVICES PAS from the drop-down list in the Service Code field.
  5. Select T-TASK from the drop-down list in the Type field.
  6. Type the two-digit code for one task authorized on Form 2101 in the Item field.
  7. Type the date that the individual is eligible for CCAD services in the Begin Date field. Leave the End Date field at default zeros.
  8. Select Submit from the Command Menu or the toolbar to submit the authorization.

When the individual stops receiving a registered task:

If the individual stops receiving the registered task, enter an End Date in the existing record. Using these same instructions, create another record with another task. To avoid gaps or overlaps in the Service Item records, the End Date of the existing record should be one day before the Begin Date of the new record.

When the individual transfers from FC to PHC:

When an individual transfers from FC to PHC, this record can remain open if the registered task is a personal care task and the individual is still authorized to receive the registered task. If the individual stops receiving PHC or FC, enter the last day of service as the End Date for this record.

8260  Meals Without the Wizards

Revision 11-2; Effective April 1, 2011

The following records are either system generated or created by the case manager to authorize Meals Service – Group 25. Detailed instructions for completing each record are found in Section 8200, Authorizing CCAD Services Without Using the Wizards, and in this section.

When the Create New Client function is used for an initial service authorization, the Enrollment and Eligibility records must be submitted to the SAS database before the remaining records are completed. In all other situations, all the records may be completed before submitting to the SAS database.

  • Individual
  • Address
  • Authorizing Agent – Case Manager
  • Eligibility
  • Enrollment
  • Location
  • Phone
  • Level of Service – Form 2060, Needs Assessment Questionnaire and Task/Hour Guide
  • Service Authorization

8261  Service Authorization — Meals Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register a Service Authorization for a Meals Services individual:

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select 25-MEALS from the drop-down list in the Service Code field.
  5. Leave the Agency field at the default selection 324-DHS.
  6. Select 1-WEEK from the drop-down list in the Unit Type field.
  7. Type the number of meals the individual is authorized to receive per week in the Adj. Units field.
  8. Type the date the individual is authorized to receive meals in the Begin Date field. Leave the End Date field at default zeros.
  9. Type the meals provider's contract number in the Contract No field. Do not type leading zeros.
  10. Select Submit from the Command Menu or the toolbar to submit the authorization.

See Section 8300, Changes to CCAD Service Authorizations Without Using the Wizards, for instructions for making changes to this record.

8270  Primary Home Care (PHC) Without the Wizards

Revision 11-2; Effective April 1, 2011

The following records are either system generated or completed by the CCAD case manager for non-CAS (Service Code 17) and the DADS regional nurse for CAS (Service Code 17D) authorizations.

Using the instructions in Section 8200, Authorizing CCAD Services Without Using the Wizards, and the following additional instructions, the CCAD case manager completes these records:

  • Individual
  • Address
  • Authorizing Agent – Case Manager
  • Enrollment
  • Location
  • Phone
  • Level of Service – Form 2060, Needs Assessment Questionnaire and Task/Hour Guide
  • Level of Service – Priority
  • Service Item
  • Service Authorization

8271  Level of Service/Priority — PHC Services Without the Wizards

Revision 11-2; Effective April 1, 2011

All PHC individuals must have a priority level registered on the Level of Service record. This record is used to tell the billing system which rate the provider is authorized to use for each individual. SAS will accept the authorization without this record but provider claims will reject.

To register the Priority Level of Service record for a PHC individual:

  1. Select the Folder icon for Level of Service in the Medical directory.
  2. Select Add and the Level of Service record will appear.
  3. Select PR-PRIORITY from the drop-down list in the Type field.
  4. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  5. Leave the Contract Number blank.
  6. Type 1 for Non-Priority cases or 2 for Priority cases in the Level field.
  7. Type the date the individual is eligible for this level of service in the Begin Date field. The Begin Date must match the first day the individual is authorized to receive this level of PHC services. Leave the End Date field at default zeros.

Priority Changes

When the individual's priority level changes, enter an End Date in the existing record. Using these same instructions, create another record with the new information. To avoid gaps or overlaps in the Priority Level of Service records, the End Date of the existing record should be one day before the Begin Date of the new record.

8272  Service Item — PHC Services Without the Wizards

Revision 11-2; Effective April 1, 2011

The Service Item record is used to register tasks. At least one personal care task authorized on Form 2101, Authorization for Community Care Services, must be registered for PHC. Additional tasks can be registered, if desired.

To register Service Item records for a PHC individual:

  1. Select the Folder icon for Service Item in the Program and Service directory.
  2. Select Add and the Service Item record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select 17-PERSONAL ASSISTANCE SERVICES PAS from the drop-down list in the Service Code field.
  5. Select T-TASK from the drop-down list in the Type field.
  6. Type the two-digit code for one personal care task authorized on Form 2101 in the Item field.
  7. Type the date that the individual is eligible for CCAD services in the Begin Date field. Leave the End Date field at default zeros.
  8. Select Submit from the Command Menu or the toolbar to submit the authorization.

This record remains open until the individual no longer receives this task or stops receiving either PHC or FC.

When the individual stops receiving a registered task:

If the individual stops receiving the registered personal care task, enter an End Date in the existing record. Using these same instructions, create another record with another personal care task. To avoid gaps or overlaps in the Service Item records, the End Date of the existing record should be one day before the Begin Date of the new record.

When the individual stops receiving PHC or FC:

No change is required to this record when an individual transfers between PHC and FC, as long as the individual is still authorized to receive the registered task. If the individual stops receiving PHC or FC, enter the last day of service as the End Date for this record.

Using the following instructions, the DADS nurse completes these records to create an authorization for CAS:

  • Authorizing Agent – Nurse
  • Authorizing Agent – Practitioner
  • Service Authorization

8273  Authorizing Agent/Nurse — CAS Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register a nurse Authorizing Agent record for a CAS individual:

  1. Select the Folder icon for Authorizing Agent in the Case Worker directory.
  2. Select Add and the Authorizing Agent record will appear.
  3. Select NU-NURSE from the drop-down list in the Type field.
  4. Select 7-COMMUNITY CARE from the drop-down list in the Group field.
  5. Select YES from the drop-down list in the Send to TMHP field if there is no other existing nurse Authorizing Agent record. Select NO if there is another existing record.
  6. Type the date this individual was assigned to the nurse or the date of the Enrollment record in the Begin Date field. Leave the End Date field at default zeros.
  7. Type the BJN for the nurse in the Auth Agent field.
  8. Leave the Agency field at the default selection 324-DHS.
  9. Type the nurse's name in the Name field.
  10. Type the nurse's phone number in the Phone field. Type the area code, phone number and extension. Type 0000 if no extension exists.
  11. Type the nurse's Mail Code in the Mail Code field.

This record remains open until the case is assigned to another nurse, the individual transfers to another service that does not require this record, or the individual stops receiving services.

Nurse Changes

When the individual is assigned to another nurse, enter an End Date in the existing nurse Authorizing Agent record. Using these same instructions, create another record with the new information. To avoid gaps or overlaps in the nurse Authorizing Agent records, the End Date of the existing record should be one day before the Begin Date of the new record.

Currently, although SAS will accept multiple Authorizing Agent records, TMHP will only accept two Authorizing Agent records when a SAS file is transmitted to TMHP. Until this problem is resolved, select NO in the SEND TO TMHP field for all updates.

8274  Authorizing Agent /Practitioner — PHC Services Without the Wizards

Revision 11-2; Effective April 1, 2011

The case manager registers the practitioner Authorizing Agent record for a PHC individual and the DADS regional nurse enters information for a CAS individual. If the practitioner authorizing agent is not registered for a PHC or CAS individual, the authorization will reject.

To register a practitioner Authorizing Agent record for a PHC or CAS individual:

  1. Select the Folder icon for Authorizing Agent in the Case Worker directory.
  2. Select Add and the Authorizing Agent record will appear.
  3. Select P-PRACTITIONER from the drop-down list in the Type field.
  4. Select 7-COMMUNITY CARE from the drop-down list in the Group field.
  5. Leave the Send to TMHP field at the default of No. The practitioner registration does not require an entry in this field.
  6. Type the beginning date of the practitioner's orders in the Begin Date field. Leave the End Date field at default zeros. The Begin Date must be equal to or earlier than the first day the individual is being authorized to receive services.
  7. Type the practitioner's license number in the Auth Agent field.
  8. Select DADS from the drop-down list in the Agency field.
  9. Type the practitioner's last name in the Name field.
  10. Type the practitioner's phone number in the Phone field.
  11. Leave the Mail Code field blank.

8275  Service Authorization — PHC Services Without the Wizards

Revision 11-2; Effective April 1, 2011

The case manager will complete the Service Authorization record for PHC and the DADS regional nurse will complete the Service Authorization record for CAS cases when services are approved.

To register a Service Authorization record for an initial PHC or CAS individual:

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select 17-PERSONAL ASSISTANCE SERVICES (PAS) or 17D-COMMUNITY ATTENDANT (CAS) from the drop-down list in the Service Code field.
  5. Leave the Agency field at the default selection 324-DHS.
  6. Move to the Unit Type field and select 1-WEEK from the drop-down list.
  7. Type the number of PAS hours per week that the individual is authorized to receive in the Adj. Units field.
  8. Type the date the individual is authorized to receive PHC or CAS services in the Begin Date field. This date will match the mail date unless it is a negotiated start date. Leave the End Date field at default zeros.
  9. Type the PHC provider's contract number in the Contract No field. Do not type leading zeros.

When creating a Service Authorization record for CDS PAS, a Service Authorization record for Service Code 63V must also be created:

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select 63-V CDS Monthly Administrative Fee.
  5. Leave the Agency field at the default selection 324-DHS.
  6. Move to the Unit Type field and select 2-Month.
  7. Type 1.00 in the Units field.
  8. Type the date the individual is authorized to receive CDS PHC services in the Begin Date field. Leave the End Date field at default zeros.
  9. Type the CDS PHC provider's contract number in the Contract No field. Do not type leading zeros.

See Section 8300, Changes to CCAD Service Authorizations Without Using the Wizards, for instructions for making changes to this record.

Retroactive PHC Authorizations

For retroactive PHC or CAS authorizations, Form 2101, Authorization for Community Care Services, is completed for the retroactive period and a second Form 2101 is completed if the individual is eligible for ongoing services. For the retroactive period, the Begin Date is the service initiation date if all other criteria are met. The End Date is the day prior to the initiation of ongoing services or the date of notification of ineligibility.

If the applicant is determined ineligible for ongoing services, one Service Authorization record for the retroactive period is required.

8280  Residential Care Services (RC or Emergency Care) Without the Wizards

Revision 11-2; Effective April 1, 2011

The following records are either system generated or created by the case manager to authorize Residential Care Services, which includes RC and Emergency Care. These services are authorized using Service Code 19. Detailed instructions for completing each record are found in Section 8200, Authorizing CCAD Services Without Using the Wizards, and in this section.

When the Create New Client function is used for an initial service authorization, the Enrollment and Eligibility records must be submitted to the SAS database before the remaining records are completed. In all other situations, all the records may be completed before submitting to the SAS database.

  • Individual
  • Address
  • Authorizing Agent – Case Manager
  • Eligibility
  • Enrollment
  • Location
  • Phone
  • Applied Income – Co-Pay (for Supervising Living Only)
  • Level of Service – Form 2060, Needs Assessment Questionnaire and Task/Hour Guide
  • Service Authorization

8281  Applied Income — RC Services Without the Wizards

Revision 11-2; Effective April 1, 2011

This record is used to record the co-pay for RC and must be completed even if the co-pay amount is $0. If the co-pay for the initial month the CCAD individual enters an RC facility is prorated, then two Applied Income records must be created – one record to register the prorated co-pay amount and a second record to register the ongoing co-pay amount. If one of these records is for a month prior to the month the information is being entered, a Force is required.

To register initial co-pay information for an RC individual:

  1. Select the Folder icon for Applied Income/Co-pay in the Program and Service directory.
  2. Select Add and the Applied Income/Co-pay record will appear.
  3. Select CO-CO-PAY (Amount or Percentage) from the drop-down list in the A/I Type field.
  4. Select 1-CO-PAY (Amount) from the drop-down list in the Co-Pay Type field.
  5. If the co-pay amount for the initial month is prorated, continue. If the amount is not prorated, skip to Step #13.
  6. Type the amount of co-pay the CCAD individual is responsible for paying for the initial month in the Amount field.
  7. Type the first day of the initial month in the Begin Date field.
  8. Type the last day of the initial month in the End Date field.
  9. Select the Folder icon for Applied Income/Co-Pay in the Program and Service directory.
  10. Select Add and the Applied Income/Co-Pay record will appear.
  11. Select CO-CO-PAY (Amount or Percentage) from the drop-down list in the A/I Type field.
  12. Select 1-CO-PAY (Amount) from the drop-down list in the Co-Pay Type field.
  13. Type the full amount of co-pay the individual is responsible for paying in the Amount field.
  14. Type the first day of the month the individual is responsible for paying the full amount of co-pay in the Begin Date field. Leave the End Date field at default zeros.

Co-pay changes:

When the co-pay changes, enter an End Date in the existing Applied Income record. Using these same instructions, create another record with the new information.

When RC services terminate, end the co-pay record:

  1. Terminate the RC service authorization.
  2. Open the Applied Income/Co-Pay folder and select the Open Co-Pay record.
  3. If the end date is in the past, click on the Force box (it contains a check mark). Enter comments in the pop-up box and click on Unforce. If the end date is the current date or a future date, enter the end date and submit.
  4. Enter the End Date used to terminate RC in the End Date field.
  5. Click on the Force box again (this time there is no check mark in the box). Enter comments, click on Force and Submit.

8282  Service Authorization — RC Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register a Service Authorization record for RC (RC Apt., RC Non-Apt. or Emergency Care):

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select the appropriate service code from the drop-down list in the Service Code field.
  5. Leave the Agency field at the default selection 324-DHS.
  6. Select 5-DAILY from the drop-down list in the Unit Type.
  7. Type 1 in the Adj. Units field.
  8. Type the date the individual is authorized to receive RC services in the Begin Date field. Leave the End Date field at default zeros.
  9. Type the RC provider's contract number in the Contract No field. Do not type leading zeros.
  10. Select Submit from the Command Menu or the toolbar to submit the authorization.

To register a Service Authorization record for RC Room and Board charges for individuals certified for RC prior to Sept. 1, 2003:

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select the appropriate service code from the drop-down list in the Service Code field.
    1. Select SC 19N – RC – Room and Board – Non-Apt when the service being authorized is RC Non-Apt.
    2. Select 19O – RC – Room and Board – Apt when the service being authorized is RC Apt.
  5. Leave the Agency field at the default selection 324-DHS.
  6. Select 2-MONTHLY for room and board.
  7. Type the ongoing monthly room and board amount in the Adj. Units field.
  8. Type the date the individual is authorized to receive RC services in the Begin Date field. Leave the End Date field at default zeros.
  9. Type the RC provider's contract number in the Contract No field. Do not type leading zeros.
  10. Select Submit from the Command Menu or the toolbar to submit the authorization.

An RC individual can reserve his space in the facility during hospital, nursing facility or institutional stays.

To register a Service Authorization record for RC bed hold charges:

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select 19H-ASSISTED LIVING BED HOLD from the drop-down list in the Service Code field.
  5. Leave the Agency field at the default selection 324-DHS.
  6. Select 5-DAILY from the drop-down list in the Unit Type field.
  7. Type 1 in the Adj. Units field.
  8. Type the date the individual entered the hospital, nursing facility, etc. in the Begin Date field. Type the day before the individual was discharged from the hospital or nursing facility in the End Date field.
  9. Type the RC provider's contract number in the Contract No field. Do not type leading zeros.
  10. Select Submit from the Command Menu or the toolbar to submit the authorization.

See Section 8300, Changes to CCAD Authorizations Without the Wizards, for instructions for making changes to these records.

8290  Special Services to Persons with Disabilities (SSPD) Without the Wizards

Revision 11-2; Effective April 1, 2011

The following records are either system generated or created by the case manager to authorize SSPD Service Code 28. Detailed instructions for completing each record are found in Section 8200, Authorizing CCAD Services Without Using the Wizards, and in this section.

When the Create New Client function is used for an initial service authorization, the Enrollment and Eligibility records must be submitted to the SAS database before the remaining records are completed. In all other situations, all the records may be completed before submitting to the SAS database.

  • Individual
  • Address
  • Authorizing Agent – Case Manager
  • Authorizing Agent – Agency
  • Eligibility
  • Enrollment
  • Location
  • Phone
  • Level of Service – Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, for 24-Hour Shared Attendant Services and Day Care
  • Service Authorization

8291  Authorizing Agent/Agency — SSPD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register an agency Authorizing Agent record for an SSPD individual:

  1. Select the Folder icon for Authorizing Agent in the Case Worker directory.
  2. Select Add and the Authorizing Agent record will appear.
  3. Select OT-OTHER from the drop-down list in the Type field.
  4. Select 7-COMMUNITY CARE from the drop-down list in the Group field.
  5. Select NO in the Send to TMHP field.
  6. Type the effective date for the authorizing agent to authorize services in the Begin Date field. Leave the End Date field at default zeros.
  7. Type the word Direct in the Auth Agent field.
  8. Leave the Agency field at the default selection 324-DHS.
  9. Type the name of the SSPD provider agency in the Name field.
  10. Type the phone number of the SSPD provider agency in the Phone field. Type the area code, phone number and extension. Type 0000 if no extension exists.

8292  Service Authorization — SSPD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register a Service Authorization record for an SSPD individual:

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select 28-SSPD or 28A-SSPD from the drop-down list in the Service Code field.
  5. Select DADS from the drop-down list in the Agency field.
  6. Select 1-WEEK for 28-SSPD or 2-Month for 28A-SSPD Case Management from the drop-down list in the Unit Type field.
  7. For 28-SSPD, type 7.0 for 24-Hour Shared Attendant Services or the number of units per week for Day Care, Counseling and Interpreter Services in the Adj. Units field. For 28A-SSPD Case Management, type 1 in the Adj. Units field.
  8. Type the date the individual is authorized to receive SSPD services in the Begin Date field. Leave the End Date field at default zeros.
  9. Type the SSPD provider contract number in the Contract No field. Do not type leading zeros.
  10. Select Submit from the Command Menu or the toolbar to submit the authorization.

See Section 8300, Changes to CCAD Authorizations Without the Wizards, for instructions for making changes to this record.

8300  Changes to CCAD Authorizations Without the Wizards

Revision 11-2; Effective April 1, 2011

8310  Authorizing Agent Entered the Wrong Contract Number — CCAD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

The Contract No. field in the Service Authorization record cannot be changed once the record is submitted to the SAS database on the DADS database. If the wrong contract number was submitted, the record must be cancelled. Once the record is cancelled, create another record using the correct contract number.

8311  Change in Provider Agency — CCAD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

When an individual changes from one provider agency to another provider agency, enter an End Date on the existing Service Authorization record. Create a new Service Authorization record for the new provider agency using the instructions for the appropriate service. To avoid gaps or overlaps, the End Date of the existing record should be one day before the Begin Date of the new record. Authorizations for overlapping services require a Force.

8312  Increases or Decreases in the Number of Units — CCAD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

When a service plan change results in an increase or decrease in the number of units, enter the End Date on the existing Service Authorization record. Create a new Service Authorization record using the instructions for the appropriate service. To avoid gaps or overlaps, the End Date of the existing record should be one day before the Begin Date of the new record.

The user must not decrease or increase units by changing the number of units on an existing record, unless correcting an error. If decreasing units for a prior time period, CMS will recalculate what the provider should have been paid and will take back the difference.

8313  Transfers from One CCAD Service to Another Without Wizards

Revision 11-2; Effective April 1, 2011

Type the day before the new service begins as the End Date for the existing Service Authorization record.

Using the instructions for the appropriate service, create a new Service Authorization record for the new service. To avoid gaps or overlaps, the Begin Date of the new record must be one day after the End Date of the existing record. Authorizations for overlapping services do not require a Force.

Check each required record for the new service. If it exists, is open and continues to be correct, leave it open. If not, create the required record using the instructions for the appropriate service.

Check the remaining folders and close any records that are not required for the services the individual will be receiving. Be sure not to close a record needed by another service the individual is receiving.

8314  Transfers from Service Group 7 to Another Service Group Without Wizards

Revision 11-2; Effective April 1, 2011

Enter the day before the new service begins as the End Date for the existing enrollment and Service Authorization record. To avoid gaps or overlaps, the Begin Date of the new record must be one day after the End Date of the existing record.

Identify the records that are required for the service that is being closed. Enter an End Date of the day before the new service will begin in all records that are specific to that service. For example, there is no need to close the Address, Phone and Location records because these records are applicable to all services, but the Form 2060, Needs Assessment Questionnaire and Task/Hour Guide – Level of Service record is closed because it is specific to Service Group 7.

Create the authorization for the new service using the instructions for that service.

8315  Closing Nursing Facility Records Due to Transitions to the Community — CCAD Services Without the Wizards

Revision 11-2; Effective April 1, 2011

If the date of discharge from a nursing facility is within 60 days prior to the new current start date for CCAD services, nursing facility records are closed either:

  • the date prior to the nursing facility discharge date; or
  • the date prior to start of CCAD services.
  1. Close the following records:
    • Enrollment
    • Service Authorization for:
      • Daily Skilled Care – Service Code 1 or 3
      • Unlimited Prescriptions – Service Code 60
      • State Personal Needs Allowance Supplement (PNA) – Service Code 50, if applicable
      • Any other nursing facility-related Service Authorization record – Service Code 1
  2. Do not close any of the following records:

    • Diagnosis
    • Medical Necessity
    • Applied Income
    • Level of Service – Resource Utilization Group (RUG)
    • Authorizing Agent
  3. Complete the CCAD wizards to authorize Community Care services.
  4. If the individual is receiving Community Care services under the terms of MFP, indicate this on the Information for the Authorize window.

8400  Draft Functionality in CCAD Wizards

Revision 11-2; Effective April 1, 2011

A functionality called Draft is available in conjunction with the CCAD wizards. Draft permits the user to store a partially finished case for completion at a later time. Draft appears as a button in the Navigator shortcut window.

If the software shuts down in an abnormal operation, the individual record is automatically saved in Draft. Access the case record in Draft after rebooting.

8410  Storing a Case in Draft — CCAD

Revision 11-2; Effective April 1, 2011

If the Service Request folder or one of the wizards has been accessed for a case:

  1. The user can close that case by clicking the X in the upper right-hand corner of the window on display. A message box will appear with the following choices:
    • Submit changes to the individual to the Outbox.
    • Save changes into Draft to continue with the individual later.
    • Delete changes/No changes made to the individual.
  2. Select Save changes into Draft to continue with the individual later.
  3. Select OK.

The user can exit out of the SAS application and the case will be saved in Draft, including all entries made to that point.

8411  Accessing a Case Stored in Draft — CCAD

Revision 11-2; Effective April 1, 2011

To continue working on a case previously stored in Draft:

  1. Select the Draft button in the Navigator shortcut window.
  2. Double click on the case name displayed in the SAS Data List window.

The case will open and is available for the user.

8500  CCAD Information

Revision 11-2; Effective April 1, 2011

8510  Financial Information — CCAD

Revision 11-2; Effective April 1, 2011

The Financial Info folder is located in the Case Management directory. Folders in the Case Management directory contain all of the information entered by the case manager or nurse for any given individual record. Selecting the Financial Info folder displays screen-by-screen snapshots of windows in the Financial wizard. The number of history files stored in this folder is unlimited, and files are stored for an indefinite period of time.

To view information in the Financial Info folder:

  1. Select the Financial Info folder in the Case Management directory.
  2. Click on the + to the left of the Financial Info folder to expand the tree and to display dates and summary information for the history files which can be viewed.
  3. Click on the + to the left of the File icon beside the date to be viewed to expand the tree and display additional folders.
  4. Double click on the specific date to view information entered in the wizard.

8520  Authorization Information — CCAD

Revision 11-2; Effective April 1, 2011

The Authorization Info folder is located in the Case Management directory. Folders in the Case Management directory contain all of the information entered by the case manager or nurse for any given individual record. Selecting this folder displays the submit date, time and BJN for each authorization. The number of history files stored in this folder is not limited, and files are stored for an indefinite period of time.

To view information in the Authorization Info folder:

  1. Select the Authorization Info folder in the Case Management directory.
  2. Click on the + to the left of the Authorization Info folder to expand the tree and to display dates and summary information for the history files which can be viewed.
  3. Click on the + to the left of the File icon beside the date to be viewed to expand the tree and to display additional folders.
  4. Double click on a specific folder to view information entered in the wizard. If there is a + to the left of the Folder icon, there are multiple records which can be viewed. It is important to expand folders to the lowest level of detail to get to the screen copy of the information entered on that window.

8530  Functional Information — CCAD

Revision 11-2; Effective April 1, 2011

The Functional Info folder is located in the Case Management directory. Folders in the Case Management directory contain all of the information entered by the case manager or nurse for any given individual record. Selecting this folder displays read-only summaries and snapshots of windows from the Functional wizard. The number of history files stored in this folder is not limited, and files are stored for an indefinite period of time.

To view information in the Functional Info folder:

  1. Select the Functional Info folder in the Case Management directory.
  2. Click on the + to the left of the Functional Info folder to expand the tree and to display dates and summary information for the history files which can be viewed.
  3. Click on the + to the left of the File icon beside the date to be viewed to expand the tree and to display additional folders.
  4. Select a specific folder to view information entered in the wizard. If there is a + to the left of the Folder icon, there are multiple records which can be viewed. Select the Assessment folder to view a summary of the results of an eligibility determination associated with a specific date. Other folders are screen-by-screen snapshots of history files.

8540  Monitoring Information — CCAD

Revision 11-2; Effective April 1, 2011

The Monitoring Info folder is located in the Case Management directory. Selecting this folder displays read-only summaries of windows from the Monitoring wizard. The number of history files stored in this folder is not limited, and files are stored for an indefinite period of time.

To view information in the Monitoring Info folder:

  1. Select the Monitoring Info folder in the Case Management directory.
  2. Click on the + to the left of the Monitoring Info folder to expand the tree and to display dates and summary information for the history files which can be viewed.
  3. Click on the + to the left of the File icon beside the date to be viewed to expand the tree and to display additional information about that specific monitoring contact.
  4. Select the Monitor Details folder to display information about problems alleged at that specific monitoring contact.

8600  CCAD Forms Directory

Revision 11-2; Effective April 1, 2011

The CCAD Forms directory is functional for cases worked through the wizards.

To view and/or print forms:

  1. Select the Folder icon for the desired report in the CCAD Forms directory. The report(s) will display in read-only mode.
  2. If there are multiple versions of the desired report (for example, more than one Form 2101, Authorization for Community Care Services), scroll down until the desired report is displayed.
  3. Select the Print icon on the toolbar. Select from the Print Range section to print the page that displays the desired report.

8700  In-Home and Family Support Program (IHFSP) Without the Wizards

Revision 11-2; Effective April 1, 2011

The following records are either system generated or created by the case manager to authorize IHFSP – Service Code 26-26A. Detailed instructions for completing each record are found in Section 8200, Authorizing CCAD Services Without Using the Wizards, and in this section.

When the Create New Client function is used for an initial service authorization, the Enrollment and Eligibility records must be submitted to the SAS database before the remaining records are completed. In all other situations, all the records may be completed before submitting to the SAS database. Once processed, automated reporting from the A&D Data Mart (Cognos) will be available.

8710  Authorizing Agent — IHFSP Services Without the Wizards

Revision 11-2; Effective April 1, 2011

The Case Manager authorizing agent record is used for identifying who the case is assigned to when generating regional and unit statistical reports. The information in the case manager Authorizing Agent record folder will be used in generating the Provider Referral Supplement.

To register a case manager Authorizing Agent record:

  1. Select the Folder icon for Authorizing Agent in the Case Worker Directory.
  2. Select Add and the Authorizing Agent record will appear.
  3. Select IH-In-Home from the drop-down list in the Type field. (Do not use Case Manager.)
  4. Select 7-Community Care from the drop-down list in the Group field.
  5. Select NO in the Send to TMHP field.
  6. Type the date the case was assigned to the IHFSP case manager or today's date in the Begin Date field. Leave the End Date field at default zeros.
  7. Type the IHFSP case manager's BJN in the Auth Agent field. Type the BJN without dashes (for example, 04599C09).
  8. Leave the Agency field at the default selection 324-DHS.
  9. Type the IHFSP case manager's name in the Name field.
  10. Type the IHFSP case manager's phone number in the Phone field. Include the area code, phone number and extension. Type 0000 or leave the extension blank if none exists.
  11. Type the IHFSP case manager's Mail Code (without dashes) in the Mail Code field.

Case Manager Changes

When the individual is assigned to another case manager, enter an End Date in the existing case manager Authorizing Agent record and create another record with the new information using these same instructions. To avoid gaps or overlaps in the case manager Authorizing Agent records, the End Date of the existing record should be one day before the Begin Date of the new record.

Currently, although SAS will accept multiple Authorizing Agent records, TMHP will only accept two Authorizing Agent records when a SAS file is transmitted to TMHP. Therefore until this problem is resolved, select NO in the SEND TO TMHP field for all updates.

8711  Enrollment — IHFSP Services Without the Wizards

Revision 11-2; Effective April 1, 2011

The case manager may find that the individual already has an open Enrollment record due to receipt of other CCAD Service Group 7 services. An individual should be enrolled in only one service group at a time. Only one Enrollment record should be open at a time regardless how many services the individual is receiving. This record will remain open until the individual transfers to another service group or stops receiving LTSS services.

If the individual does not have a Service Group 7 record or if the record is closed, proceed to register enrollment for the individual. When the Create New Client function is used to create an initial authorization, the Enrollment and Eligibility records must be submitted to the SAS database before the remaining records are completed.

To register enrollment for Community Care – Service Group 7:

  1. Select the Folder icon for Enrollment in the Program and Services directory.
  2. Select Add and the Enrollment record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select where the individual resides by selecting the appropriate living arrangement.
  5. Type the date of certification in the Begin Date field. Leave the End Date, Termination Code, and Waiver Type fields at default.

When Changes Occur

No changes to this record are required if the individual transfers from one service within Community Care (Service Group 7) to another service in Community Care.

If the individual transfers to another service group and there was an overlap in services, enter the day the terminated service stopped as the End Date of this record. Create a new record for the new service with a Begin Date of the day the new service started, even if the dates overlap.

If the individual stops receiving LTSS services, enter the last day the individual received services as the End Date of this record.

8712  Service Plan — IHFSP Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register a service plan for an initial IHFSP individual:

  1. Select the Folder icon for Service Plan in the Program and Service directory.
  2. Select Add and the Service Plan record will appear.
  3. Leave the Type field at the default selection AN-ANNUAL PLAN.
  4. Move to the Service Group field and select 7-Community Care from the drop-down list.
  5. Leave the Ceiling field at the default, zeros.
  6. Move to the Begin Date field and type the first day of the certification period.
  7. Move to the End Date field and type the last day of the one-year certification period.
  8. Move to the Amount Authorized field and enter the actual or estimated amount to be authorized for the entire plan year for both Capital and Subsidy.

Leave the Units Authorized field blank.

8713  Changes in SAS — IHFSP Services Without the Wizards

Revision 11-2; Effective April 1, 2011

There are times when the case manager needs to make adjustments to an individual's Service Plan or Service Authorization record(s). These changes can occur when:

  • an individual requests more funds;
  • an individual enters a nursing facility; or
  • spend down is initiated.

If any of these situations occur, the case manager needs to make adjustments to the records in SAS.

8714  Increase in Service Plan Amount — IHFSP Services Without the Wizards

Revision 11-2; Effective April 1, 2011

An individual has the option of requesting more funds for the certification year. Once this change has been approved, the case manager can enter the new amount into SAS.

To revise the amount to be authorized for the entire plan year:

  1. Search for the individual and open the record.
  2. Click on Service Plan in the left navigation bar. Open the existing record.
  3. Enter the revised amount to be authorized for the entire plan year.
  4. Click on Service Authorization in the left navigation bar. Open the existing record.
  5. Enter the revised authorized amount in the Units field.
  6. After completing the records, submit to the SAS database. Click on the computer disk on the toolbar.
  7. Check the Outbox and Inbox to ensure the submittal was successful.

8715  Service Authorization — IHFSP Services Without the Wizards

Revision 11-2; Effective April 1, 2011

To register a service authorization for IHFSP:

  1. Select the Folder icon for Service Authorization in the Program and Service directory.
  2. Select Add and the Service Authorization record will appear.
  3. Select 7-COMMUNITY CARE from the drop-down list in the Service Group field.
  4. Select 26 or 26A-IHFSP from the drop-down list in the Service Code field.
  5. Leave the Agency field at the default selection 324-DHS.
  6. Select 4-Per Authorization from the drop-down list in the Unit Type field.
  7. Type the 6-month authorized amount in the Units field.
  8. Type the Certification Date in the Begin Date field. Note: Do not enter a date earlier than Feb. 1, 2009. If the service was authorized before that date, enter 02/01/2009.
  9. Type an End Date which is the receipt due date.
  10. Type 1016574 as the Contract Number.
  11. Leave the NPI blank.
  12. Select Submit from the Command Menu or the toolbar to submit the authorization.

8716  Six Month Review — IHFSP Services Without the Wizards

Revision 11-2; Effective April 1, 2011

Changes often take place after the six month or annual review, but can happen at any time during the certification year. At the six month review, reconcile the previous funds. The individual must provide receipts for allowable services and must substantiate all funds through acceptable receipts or repayment.

To record changes in funds already authorized and/or to authorize new funds:

  1. Search for the individual and open the record.
  2. Click on Service Plan in the left navigation bar. Open the existing record.
  3. Enter the revised amount to be authorized for the entire plan year if it is different than what was estimated previously.
  4. Click on Service Authorization in the left navigation bar. The record that the case manager added at the initial certification appears. It had an End Date of the receipt due date. Because the record ended, add a new Service Authorization record for the new authorization period. Click on the sheet of paper on the top toolbar to add another record.
  5. Enter the authorized amount in the Units field. Remember, if the individual was in spend down, the amount authorized may be prorated considering the needed items or services and the months remaining in the certification period.
  6. After completing the records, submit to the SAS database. Click on the computer disk on the toolbar.
  7. Check the Outbox and Inbox to ensure the submittal was successful.

8717  Annual Review and Recertification — IHFSP Services Without the Wizards

Revision 11-2; Effective April 1, 2011

There are times when an individual will receive all his funds at the beginning of the plan year. Similar to the six month review, reconcile the previous funds. If funds have not been fully receipted and spend down extends into the next service plan year, the annual recertification date(s) should be consistent with the previous certification year (even though spend down may have reduced the length of the new service plan year).

SAS Actions at the Annual Review

First, create a new Service Plan record:

  1. Search for the individual and open the record.
  2. Click on Service Plan in the left navigation bar, and then click on the sheet of paper icon to add a record. Do not create another Service Plan record if the individual is in spend down.
  3. Select AN-ANNUAL PLAN as the type.
  4. Select 7-COMMUNITY CARE as the service group.
  5. Leave Ceiling at the default zeros.
  6. Enter the Begin Date, which is the effective date of Form 2352, Notification of Certification/Recertification, as the first day of the new certification period.
  7. Enter the End Date as the last day of the certification period. This date may not be one full year as spend down may have reduced the length of the certification period.
  8. Enter the amount authorized for the entire plan year for both Capital and Subsidy in Amount Authorized. The amount may have been prorated if spend down was initiated.

Next, create a new Service Authorization record:

  1. Click on Service Authorization in the left navigation bar. Click on the sheet of paper in the toolbar to add a record.
  2. Leave MHMR Case Number blank.
  3. Select 7-COMMUNITY CARE from the Service Group drop-down menu.
  4. Select 26 or 26A-IHFSP from the Service Code drop-down menu.
  5. Leave Fund, Termination Code and Agency at the default.
  6. Select 4-Per Authorization from the Unit Type drop-down menu.
  7. Enter the authorized amount in the Units field.
  8. Enter a Begin Date of the new authorization period.
  9. Enter an End Date which is the receipt due date.
  10. Enter 1016574 as the Contract Number.
  11. Leave NPI blank.

Repeat these steps if the individual is authorized funds for both service codes.

8720  Termination — IHFSP Services Without the Wizards

Revision 11-2; Effective April 1, 2011

When terminating an IHFSP record in SAS, consider whether IHFSP is the only service being received, or if there are other services that the individual will continue to receive.

8721  Terminations Where IHFSP is the Only Service — Services Without the Wizards

Revision 11-2; Effective April 1, 2011
  1. If IHFSP is the only CCAD (Service Group 7) service received, close the following records with the termination date:
    • Authorizing Agent
    • Eligibility
    • Enrollment – Select the appropriate term code from the drop-down menu
    • Service Plan
    • Service Authorization – Select the appropriate term code from the drop-down menu
  2. After completing the records, submit to the SAS database. Click on the computer disk on the toolbar.
  3. Check the Outbox and Inbox to ensure the submittal was successful.

8722  Terminations Where IHFSP is with Other Services — Services Without the Wizards

Revision 11-2; Effective April 1, 2011
  1. If the individual is receiving other CCAD (Service Group 7) services in SAS, only close the IHFSP records:
    • Authorizing Agent – Type IH
    • Service Plan
    • Service Authorization – Select the appropriate term code from the drop-down menu
  2. After completing the records, submit to the SAS database. Click on the computer disk on the toolbar.
  3. Check the Outbox and Inbox to ensure the submittal was successful.