Case Manager Medically Dependent Children Program Handbook
- 1000
- Overview and Eligibility
- 1100
- Program Goal and Handbook Purpose
- 1200
- Program Definitions
- 1300
- Eligibility
- 1310
- Residency
- 1320
- Citizenship
- 1330
- Age
- 1340
- Financial Eligibility
- 1350
- Disability
- 1360
- Medical Necessity
- 1370
- Individual Plan of Care (IPC)
- 1380
- Living Arrangement
- 1390
- Monthly Service Utilization
- 1400
- Safeguarding Personally Identifiable Information
- 1410
- Requests for Information About a Deceased Individual
- 2000
- Intake and Interest List Procedures
- 2100
- Initial Requests
- 2100.1
- Caregiver Support Assessment Initiative
- 2110
- Interest List Release and Notification
- 2110.1
- Rural Addresses
- 2110.2
- Referrals from Midland Document Processing Center
- 2120
- Transfer of Individuals Between Waiver Interest Lists
- 2130
- Conflict of Interest
- 2140
- Creating the Case File
- 2200
- Initial Contact
- 2210
- Scheduling a Home Visit
- 2210.1
- Scheduling a Home Visit after the Release Closure Date
- 2210.2
- Outbreak of Transmittable Disease in the General Population
- 2220
- Declining MDCP Services
- 2230
- Failure to Contact the Individual
- 2300
- Initial Home Visit
- 2310
- Reviewing the Enrollment Materials
- 2310.1
- Individual is Still Unsure about Applying for MDCP Services
- 2310.2
- Opportunity to Register to Vote
- 2310.3
- Explaining Long Term Services and Supports
- 2320
- Initiating the Individual Plan of Care
- 2330
- Assessment for Medical Necessity
- 2330.1
- Authorization to Release Medical Records
- 2340
- Freedom of Choice
- 2350
- Choosing a Provider
- 2360
- Applicant Without Medicaid
- 2400
- Initial Presentation of the Consumer Directed Services Option
- 2500
- Contacting the CSIL Unit for Interest List Release Activities
- 2510
- Contacting the CSIL Unit to Report the Status of Interest List Releases
- 2520
- Closing the Interest List Release for an Applicant Choosing CLASS
- 2530
- Contacting the CSIL Unit to Reopen an Interest List Closure
- 2540
- Adding Names Back to CSIL
- 2540.1
- Earliest Date for Adding an Individual Back to CSIL After Denial
- 3000
- Eligibility Determination and Individual Plan of Care Development
- 3100
- Eligibility Determination
- 3110
- Medicaid Eligibility for the Initial Application
- 3110.1
- Medicaid Buy-In and Medicaid Buy-In for Children
- 3110.2
- Coordination of Disability Determinations
- 3111
- Qualified Income Trust (QIT)
- 3111.1
- Determination of Copayment
- 3111.2
- Refusal to Participate
- 3111.3
- Refund of Copayment
- 3111.4
- Refusal to Pay the Copayment
- 3120
- Medical Necessity
- 3121
- Medical Necessity Determination for Applicants Residing in Nursing Facilities
- 3122
- Medical Necessity Determination for Applicants Recently Discharged from Nursing Facilities
- 3123
- Medical Necessity Inquiry through the Online Portal
- 3130
- Individual Plan of Care Development
- 3130.1
- Setting Funds Aside in the IPC
- 3130.2
- Coordinating IPC Development with the Provider
- 3131
- Determining Cost Effectiveness
- 3132
- The Individual Plan of Care Service Initiation Date and Effective Period
- 3132.1
- Determining the Number of Weeks in the Initial IPC Period
- 3133
- Notifying MEPD of Approved IPC and MN
- 3134
- Other Resources and Services
- 3135
- Coordinating with IDD Services During the Development of the Initial IPC
- 3135.1
- Access to the CARE System
- 3200
- Personal Care Services (PCS)
- 3200.1
- PCS Data Reports
- 3200.2
- Using the PCS Data Reports
- 3210
- Procedures for the MDCP Applicant Who Receives PCS
- 3220
- Procedures for the MDCP Applicant Who Does Not Receive PCS
- 3230
- FMS for the MDCP Applicant Accessing CDS
- 3240
- Coordination of Services in the MDCP IPC and Personal Care Assessment Form
- 3300
- Targeted Case Management (TCM)
- 3300.1
- Coordination of TCM and MDCP Services
- 3400
- Reserved for Future Use
- 3500
- Money Follows the Person Option
- 3500.1
- Individuals Without Medicaid
- 3500.2
- Individuals With Medicaid
- 3510
- Individuals Currently Residing in a Nursing Facility
- 3520
- Limited Nursing Facility Stay for Medically Fragile Individuals
- 3520.1
- MFP Procedures for Requesting a Limited Nursing Facility Stay
- 3520.2
- Case Manager Receipt of Form 2406
- 3520.3
- Regional Nurse Approval
- 3520.4
- Submission of Form 2406 to the DADS Physician
- 3520.5
- Determination of Medical Fragility by the DADS Physician
- 3520.6
- Initial Home Visit for Individuals Approved for a Limited Nursing Facility Stay
- 3520.7
- Coordination of the Limited Nursing Facility Stay
- 3530
- Money Follows the Person Demonstration (MFPD)
- 3530.1
- MFPD 365-Day Entitlement Period
- 3540
- Closing NF Authorizations for Individuals Transitioning to Community Services
- 3550
- Accessing Relocation Services
- 4000
- Services
- 4100
- Medically Dependent Children Program (MDCP) Services
- 4110
- Respite
- 4111
- Out-of-Home Respite
- 4112
- Respite Service Limits
- 4112.1
- Exception to the Respite Service Limits
- 4112.2
- Denying Requests to Exceed the New Service Limit
- 4113
- Respite Service Authorizations
- 4114
- Respite Service Schedule Changes
- 4120
- Flexible Family Support Services
- 4121
- Flexible Family Support Services in Child Care
- 4122
- Flexible Family Support Services for Independent Living
- 4123
- Flexible Family Support Services in Post-Secondary Education
- 4124
- Flexible Family Support Services Limits
- 4124.1
- Exceptions to the Flexible Family Support Services Service Limit
- 4125
- Flexible Family Support Services Authorizations
- 4126
- Service Schedule Changes to Flexible Family Support Services
- 4130
- Adaptive Aids
- 4131
- Individual Role in Adaptive Aids
- 4131.1
- Third-Party Resources for Adaptive Aids
- 4131.2
- Adaptive Aid Bidders
- 4131.3
- Specifications for Adaptive Aids
- 4131.3.1
- Specifications for Adaptive Aids with Individual Personal Costs
- 4131.4
- Special Requirements for Van Lifts/Vehicle Modifications
- 4131.5
- Bids for Adaptive Aids
- 4131.5.1
- Bids for Adaptive Aids with Individual Personal Costs
- 4132
- Service Limits on Adaptive Aids
- 4133
- Bid Verification for Adaptive Aids
- 4134
- Individual Personal Costs for Adaptive Aids
- 4135
- Adaptive Aids Service Authorization
- 4135.1
- Approval of Adaptive Aids Not Listed in Section 4132, Service Limits on Adaptive Aids
- 4136
- Adaptive Aid Delivery Time Frames and Confirmation
- 4140
- Minor Home Modifications
- 4141
- Individual Role in Minor Home Modifications
- 4141.1
- Minor Home Modification Bidders
- 4141.2
- Specifications for Minor Home Modifications
- 4141.2.1
- Justifications for Minor Home Modifications Less Than $1,000
- 4141.2.2
- Specifications for Minor Home Modifications with Individual Personal Costs
- 4141.3
- Bids for Minor Home Modifications
- 4141.3.1
- Bids for Minor Home Modifications Less Than $1,000
- 4141.3.2
- Bids for Minor Home Modifications with Individual Personal Costs
- 4141.4
- Home Owner Approval of Minor Home Modifications
- 4142
- Service Limits on Minor Home Modifications
- 4143
- Bid Verification for Minor Home Modifications
- 4144
- Individual Personal Costs for Minor Home Modifications
- 4145
- Minor Home Modification Repairs and Maintenance
- 4146
- Minor Home Modification Service Authorization
- 4147
- Minor Home Modification Time Frames and Completion Confirmation
- 4150
- Transition Assistance Services (TAS)
- 4151
- Transition Assistance Services (TAS) Description
- 4151.1
- Deposits
- 4151.2
- Essential Furnishings
- 4151.3
- Moving Expenses
- 4151.4
- Site Preparation
- 4152
- Limits on Transition Assistance Services (TAS)
- 4153
- Authorizing Transition Assistance Services (TAS)
- 4153.1
- Changes to Transition Assistance Services (TAS)
Authorization
- 4154
- Transition Assistance Services (TAS) Delivery Time Frames and Confirmation
- 4155
- Failure to Leave the Nursing Facility
- 4160
- Financial Management Services
- 4200
- Notification and Service Authorization System
- 4210
- Applicant/Individual Eligibility Notification
- 4220
- Provider Notification
- 4230
- Service Authorization System (SAS)
- 4231
- Service Authorization System (SAS) Data Entry
- 4232
- Service Authorization System (SAS) Data Entry for Service Reductions, Suspensions, Denials and Case Closures
- 4233
- SAS Data Entry Procedures for CDSA Provider Transfers
- 5000
- Ongoing Case Management
- 5100
- Changes to the Individual Plan of Care (IPC)
- 5110
- Interim Plan of Care
- 5120
- Budget Revision
- 5130
- Prorating the Cost Limit for an Applicant/Individual Who Will Turn 21 Years of Age
- 5140
- Provider Transfers During the IPC Period
- 5141
- CDSA Transfers During the IPC Period
- 5142
- Assessing an Individual's Satisfaction When a Change in Provider is Requested
- 5143
- Sharing Information with New Providers Regarding Health and Safety Issues
- 5200
- Service Delivery Issues Reported to DADS Staff
- 5300
- Service Delivery Issues Reported by the Provider
- 5310
- Primary Caregiver Refuses to Comply with the IPC
- 5320
- Provider is Unable to Verify Individual’s Medicaid Status
- 5330
- Provider is Unable to Begin Services on the Service Initiation Date
- 5340
- Provider Initiated Changes to the Delivery of Services
- 5400
- Convening a Meeting to Resolve Issues
- 5500
- Loss of Medicaid
- 5510
- Coordination of Fair Hearings with the CRU
- 5520
- Case Manager Responsibilities and Effective Dates of Appeal Decisions
- 5600
- Change in Address
- 5700
- Change in Primary Caregiver
- 6000
- Monitoring Services
- 6100
- Monitoring Services and Follow-up Contacts
- 6110
- Monitoring Transition Assistance Services (TAS)
- 6120
- 30-Day Contact
- 6130
- IPC Service Monitoring
- 7000
- Annual Reassessment
- 7100
- Annual Reassessment Overview
- 7100.1
- Opportunity to Register to Vote
- 7110
- Annual Eligibility Requirements
- 7120
- Medical Necessity Determination
- 7130
- Individual Plan of Care Development
- 7131
- Setting Funds Aside in the IPC
- 7132
- Completing the Annual Reassessment IPC
- 7133
- Personal Care Services
- 7133.1
- PCS Data Reports
- 7133.2
- Using the PCS Data Reports
- 7133.3
- Procedures for Individuals Not Receiving PCS
- 7134
- Coordinating with IDD Services During the Development of the Annual IPC
- 7135
- FMS for the MDCP Individual Accessing CDS
- 7136
- Coordination of Services in the MDCP IPC and the Personal Care Assessment Form
- 7140
- Notifications for Program Eligibility and Service Authorizations
- 7141
- Respite Service Authorizations
- 7142
- Flexible Family Support Services Authorizations
- 7143
- Practitioner's Orders or Form 2428 for Respite or Flexible Family Support Services
- 7144
- Program Ineligibility at Annual Reassessment
- 7150
- Service Authorization System Data Entry
- 7160
- In-Home Record Review
- 7161
- MDCP Nurse Procedures
- 7162
- Case Manager Procedures
- 7163
- Case Manager Procedures Regarding HCSSAs When Additional Action is Required
- 7164
- Case Manager Procedures Regarding the Consumer Directed Services Option when Additional Action is Required
- 8000
- Consumer Directed Services
- 8100
- Overview
- 8110
- Definitions
- 8200
- Individual Choice in the CDS Option
- 8210
- Initial Presentation of the CDS Option
- 8220
- CDS Option for Ongoing Individuals
- 8300
- Developing the Individual Service Plan
- 8400
- Initiation and Transition to the CDS Option
- 8410
- Initial Orientation of the Employer
- 8420
- Service Back-Up Plans
- 8430
- Corrective Action Plans
- 8500
- Employer Difficulty Managing the CDS Option
- 8600
- Transfer Procedures
- 8610
- Termination of Participation in the CDS Option
- 8620
- Re-enrollment in the CDS Option
- 8700
- CDS Contact Chart
- 9000
- Service Reductions, Suspensions, Denials, Case Closures, Appeals and Fair Hearings
- 9100
- Notification Forms for Service Reductions, Suspensions, Denials and Case Closures
- 9110
- Exceptions to the 30-day Notification Time Frame
- 9200
- Service Reductions
- 9300
- Denying Requests for Specific Services
- 9400
- Service Suspensions
- 9410
- Notification of Service Suspensions
- 9420
- Extension of Suspension
- 9430
- Resuming Services
- 9440
- Procedures for Temporary Nursing Facility Admissions
- 9500
- Service Denials and Case Closure
- 9510
- Ineligibility
- 9520
- Failure to Maintain Enrollment
- 9530
- Death of Individual
- 9540
- Institutional Placement
- 9541
- Additional Procedures for Permanent Nursing Facility Admissions
- 9550
- Aging Out
- 9551
- Aging Out to the Community Based Alternatives (CBA) Program
- 9552
- Aging Out to the STAR+PLUS Waiver Program
- 9560
- Interest List Releases to Other Waiver Programs
- 9570
- Transfer of An Individual to Another Service Area
- 9571
- Procedures for the Original Case Manager
- 9572
- Procedures for the New Case Manager
- 9600
- Appeals and Fair Hearing Procedures
- 9610
- Appeals Process
- 9611
- Case Manager and Designated Data Entry Representative Procedures
- 9611.1
- Procedures for Loss of Medicaid
- 9611.2
- Procedures for Medical Necessity (MN) Denials
- 9611.3
- Procedures for Utilization Review Findings
- 9612
- Sending Additional Information
- 9620
- Fair Hearing
- 9621
- Fair Hearing Decision
- 9621.1
- Action Taken on Fair Hearing Decision
- 9621.2
- Procedures for Sustained Decisions
- 9621.3
- Procedures for Revsersed Decisions
- 9621.4
- Procedures When Denied Medical Necessity (MN) is Overturned
- 9622
- Fair Hearing Exception
- 9622.1
- Fair Hearing Exception Process
- 9622.2
- Community Services Policy Staff Actions
- 10000
- Case Management Procedures for Utilization Review
- 10100
- Medically Dependent Children Program Utilization Review
- 10110
- New Service Limit Exception Procedures and Utilization Review
- 10200
- Concurrent Reviews
- 10300
- Utilization Review Observations and Findings
- 10310
- Reporting Observations by the Utilization Review Nurse
- 10320
- Utilization Review Finding Reports to the Regional Director
- 10330
- Regional Director Response to Utilization Review Findings
- 10340
- Final Utilization Review Findings
- 10350
- Exception Process for Utilization Review Findings
- 10400
- Implementation of Utilization Review Observations, Recommendations and Findings
- 10410
- Implementation of Utilization Review Findings
- 10420
- Case Manager Procedures for Completing Changes
- 10430
- Individual’s Agreement/Disagreement with the IPC Change
- 10440
- Exception to Implementing Termination/Decrease of Services from the Utilization Review Finding
- 10450
- Notifications
- 11000
- Service Authorization System Help File
- 11100
- Medically Dependent Children Program (MDCP)
- 11200
- Create an Initial Service Authorization for MDCP
- 11205
- Client – Initial Service Authorization
- 11210
- Address Area – Initial Service Authorization
- 11215
- Location – Initial Service Authorization
- 11220
- Other Information
- 11225
- Phone – Initial Service Authorization
- 11230
- Authorizing Agent – Initial Service Authorization
- 11235
- Enrollment – Initial Service Authorization
- 11240
- Service Plan – Initial Service Authorization
- 11245
- Level of Service – Initial Service Authorization
- 11250
- Diagnosis – Initial Service Authorization
- 11255
- Medical Necessity – Initial Service Authorization
- 11260
- Service Authorization – Initial Service Authorization
- 11265
- Consumer Directed Services (CDS) Calculation of the Individual Plan of Care (IPC)
- 11270
- Service Authorization for CDS Option – Initial Service Authorization
- 11300
- Reauthorize MDCP Services for Another IPC Period
- 11310
- Address, Location, Phone and Authorizing Agent – Reassessment
- 11320
- Enrollment – Reassessment
- 11330
- Service Plan – Reassessment
- 11340
- Service Authorization – Reassessment
- 11350
- Level of Service – Reassessment
- 11360
- Diagnosis – Reassessment
- 11370
- Medical Necessity – Reassessment
- 11400
- Terminations
- 11410
- Terminating All Services
- 11420
- Terminating a Specific Service Code
- 11500
- Individual Plan of Care (IPC) Changes
- 11510
- Provider Transfers
- 11520
- Service Plan – IPC Changes
- 10530
- All Other IPC Changes