2015 Supervisor’s Conference. Timeframes Determination of Need (DON) Scoring Local, State, Federal Services Person Centered Planning Minimum

IDOA Updates & Forum

2015 Supervisor’s Conference

Timeframes Determination of Need (DON) Scoring Local, State, Federal Services Person Centered Planning Minimum POC to start including Service

Authorization Guidelines Verification of Financial Information Medicaid Policy Verification of SSN Participant Outcomes & Status Measures (POSM) Electronic Visit Verification (EVV)

Ms. Smith Vignette - 03/18/13Reminders

Timeframes◦ CCU had 5 calendar days to contact Ms. Smith

after referral◦ CCU had 30 calendar days (without participant

delay) to determine eligibility from date of referral=Eligibility Determination Date (EDD)

◦ CCU had 15 calendar days from EDD to send Plan of Care Notification Form (POCNF)

◦ Provider(s) had 15 calendar days from date of POCNF to initiate services


Determination of Need (DON) Scoring ◦ Ms. Smith has no scores of 3; Side A DON score of 3

should be reserved for participant who cannot do any part of the task at all or requires constant supervision

◦ If B side is 0, there should be no CCP services or frequency indicated

◦ If B side is lowered from A side, notation should be made in service by other column, including “self” or “manages”

◦ Side B DON score should be adjusted for both formal & informal supports

◦ Empower the participant to continue to do as much for themselves as possible to maintain their independence


Local, State, Federal Services◦ Care Coordinators should explore all available

resources before authorizing CCP services◦ CCU Supervisors should make sure resource

manuals are kept up to date Person Centered Planning

◦ Always keep what the participant needs in mind, don’t assume or impose your values

Minimum POC to start/utilize Service Authorization Guidelines (refer to SAG slides later in document)


Verification of Financial Information◦ Because Ms. Smith did not have financial

verification during initial home visit, eligibility could not be determined

Medicaid Policy◦ Because Ms. Smith had greater than $4,000

assets & the CCU obtained verification of assets & placed them in her file, the CCU was not required to apply for Medicaid for Ms. Smith


Verification of SSN ◦ Need to verify SSN by seeing a card at initial assessment, this

will assist with new eCCPIS edits coming in the future

POSM◦ Completed upon initial assessment & annual redetermination◦ Check eCCPIS report for POSM uploads

Electronic Visit Verification (EVV)◦ Because Ms. Smith refused to allow her landline phone to be

utilized, the INH provider needs to use an alternate means for EVV—installing a fixed visit verification in Ms. Smith’s home or using a GPS enabled phone the agency has provided the HCA


All In-Home Service provider agencies & all Homecare Aides (HCAs) are REQUIRED to utilize EVV

For compliance for INH Quality Improvement reviews, IDoA compares EVV with billing in eCCPIS

Paper Hours of Service Calendars (HOSC) for time in/out should NOT be utilized for billing

Electronic Visit Verification

For instances in which there was a problem with the EVV system (e.g., GPS phone didn’t work, HCA forgot to clock out), the INH provider should produce documentation from the EVV system of the discrepancy◦ Paper HOSC may be utilized for these cases as

back up but should not be the norm

Electronic Visit Verification

HCA verification of tasks—policy “CCP Participant Verification of Services—update January 2014”—effective 4/1/2014

◦ All In-Home Service agencies required to have electronic or paper format to verify tasks performed by Homecare Aide at each provision of service

◦ If utilizing a paper form for verification of tasks do not include in/out times as is difficult to match EVV times

◦ If utilizing a paper form, it must be collected & reviewed by a supervisor minimally one time a month

Verification of Tasks

The homecare supervisor should contact the CCU if tasks are consistently not completed in accordance with the CCU POC

Deviations from CCU’s Plan of Care can be documented in same format/form as verification of tasks

When requested, electronic documentation, including EVV & verification of tasks must be able to be printed by the provider

Verification of Tasks

Annual must be <365 days◦ From date of previous EDD

POSM ◦ Required to be completed annually◦ Check eCCPIS report for POSM uploads

Reviewing old DON & POC◦ Prior to visit, CC required to do so & document by

checking box on page 2 of Comprehensive Assessment tool


Options discussed

Verified financial information

Medicaid Application completed◦ Per Mandatory Medicaid policy, copy of

application placed in file

$ Management referral made


Provider notification to CCU◦ CCP Providers are required to inform the CCU of

changes in the participant’s condition or demographics or if the participant is hospitalized; this communication should be documented in the case notes

Injury/Death Reporting Form◦ Required to be completed when injury or death

occurs during the provision of service that results in medical care


Temporary Service Increase (TSI)◦ CCU responsibility:

Assessment completed by CCU within 3 days of referral Forms needed: Comprehensive Assessment tool pages

1-3, 5, 8-10; CCP Consent Form, Client Agreement, POCNF

Notify provider(s)

◦ Provider responsibility: Service change implemented within 2 calendar days of

notification by the CCU


TSI Follow-up◦ Required to be completed 15 calendar days (if

done in hospital); 30 calendar days if community based

◦ Increase or remain the same?? (on the POCNF & the CAT) Since Ms. Smith’s services did not change from

previous assessment (TSI), it is a remain the same


Choices for Care/Prescreen Policy effective 10/01/14◦ CCU is required to check CMIS & eCCPIS to see if an

assessment was completed within last 90 calendar days If assessment was completed CCU is not to complete a new

assessment but is required to complete HFS Verification Form

When completing HFS Verification Form, CCU should complete the following sections of the form: resident name, birthdate, Social Security Number, & entire “following to be completed by CCU” section; CCU should also write in the DON score on the form

CCU is to send the HFS Verification Form to the hospital

Ms. Smith Vignette - 07/31/14 & 08/04/14 Reminders

What if an assessment had NOT been completed for Ms. Smith in the last 90 calendar days?◦ CCU would complete the Choices for Care assessment◦ CCU would leave copies of 2536 & OBRA Level I with

hospital; hospital is required to send these to the nursing facility

NH follow-up ◦ CCU should follow up with current participants once they

have entered the facility to see what future plans are◦ CCU should also notify provider(s) of participant’s status

Ms. Smith Vignette - 07/31/14 & 08/04/14 Reminders

NH follow-up DON creation◦ DON completed to best of CCU knowledge, asking

questions about environment & supports participant will be discharged to

Transfer to a new CCU◦ Transferring CCU makes a copy of the file, keeps

copy & sends original to receiving CCU Residing with family & scoring of the DON

◦ Consider what portion of tasks family is able to assist with, HCA should only be assisting participant, e.g., not cleaning the entire house

Ms. Smith Vignette - 08/29/14 Reminders

New CCU picks up case◦ Goal is to have as seamless transfer as possible so

participant has little interruption in service◦ If the provider participant has been receiving service

from is in the new area, participant can keep that provider

◦ Transferring CCU (with info provided by receiving CCU) should assist participant with choosing new provider if provider does not provide service in the new area

Data Entry for case transfer◦ Interstate CCU enters 40-048 CAT with EDD 9/3/14◦ Capital City CCU enters 01-002 CAT with EDD 9/3/14


Adult Day Service (ADS) initiated◦ ADS is required to complete individualized plan of care

(IPOC), utilizing the CCU plan of care, no later than the 4th week of service

◦ ADS will discuss any concerns or difficulty following CCU plan of care with the CCU

◦ ADS reviews medications Mrs. Smith takes, obtains orders from physician, documents if any of the meds she takes are self-administered while she is at the ADS

Reinstall of EHRS◦ Since Mrs. Smith has moved, the EHRS unit may need

reinstalled which would require the CCU to authorize installation on the CAT & Client Agreement


Update address & info with local Department of Human Services (DHS) office◦ Part of good case management includes reminding the

participant to notify & update DHS of any changes in address or situation

Creating a POC utilizing existing supports◦ Since Mrs. Smith has moved, the resources available

may have changed. The new CCU will review all available resources

Should Capital City CCU complete a new POSM on Ms. Smith?◦ It is up to the CCU’s judgment. Since Ms. Smith is new

to the CCU one should be completed


Monitoring call◦ Capital City CCU in their Request for Proposal

(RFP) promised to complete monthly monitoring phone calls


Transfer to MCO◦ Mrs. Smith became enrolled due to her move to

an MCO area Data Entry for MCO transfers

◦ CCU does 10-012 in Program Type 15 with an EDD of 12/01/14

Provider Notification Form◦ CCU completes Provider Notification Form & sends

to ALL providers Provider(s) continue to provide services with

no interruption


MCO case management◦ MCO is responsible for all case management for the

participant MCO access to additional services (PT, Gym) MCO & HDM referrals

◦ The MCOs are required to work with the AAA to determine what assessment/referral information is needed

Exceeding Service Cost Maximums (SCM)◦ MCOs are not required to follow IDoA SCMs◦ MCOs are required to have a participant sign a statement

acknowledging that upon return to CCP, services will be required to follow SCM

Coordination of Medical & in-home services


APS referral◦ CCP staff are mandated reporters of Adult Protective

Services (APS)◦ Staff witnessing the alleged abuse are required to make the

call themselves; others can also call to add info

◦ What if the grandson had been the family homecare aide (or an ADS staff)? If APS case substantiated as some indication or verified, file will

be sent to IDoA APS IDoA APS recommends HCA be allowed to serve but with closer

supervision, or no longer be allowed to serve CCP participants. IDoA OCCS prepares letter to inform provider agency of one of

the above


What if the grandson was not allegedly abusive to Ms. Smith, but was to the HCA?

◦ Review 240.350 CCP rule on cooperation; CCUs & provider agencies work together to implement suspension & Memorandum of Understanding (MOU) as appropriate

◦ Remember that timeframes for establishing MOU must be adhered to

◦ If timeframes are not met, MOU should not be developed or executed and provider reminded of timeframes

◦ Suspension of services may not be appealed because a suspension is not a final decision

◦ Failure to sign an MOU shall be grounds for termination of or denial of services

◦ An MOU remains in effect when a participant changes providers or CCUs; new provider and/or CCU must sign the MOU


Benefit of MCO case management

◦ The MCO case manager realized the confusion was a new onset

◦ The MCO has access to the physician due to medical coordination of services

◦ The MCO would have known if Mrs. Smith had not followed through with the physician visit


Opting out of MMAI◦ Currently Mrs. Smith has the right to opt out of MMAI

& continue with her waiver services (this is anticipated to change in late summer)

Data Entry for MCO to CCP transfer◦ Increasing the DON to accommodate SCM◦ Participant Transfer Form is completed by the MCO

What if CCU doesn’t receive Participant Transfer Form?

CCU required to notify ALL providers within 3 calendar days of notice of transfer


Full CCC assessment◦ CCU required to complete within 30 calendar days of MCO

disenrollment date◦ CCU is to score DON according to IDoA guidelines

POC within DON’s SCM◦ Participant now has to fall within SCM for her DON score◦ Increase/decrease on CAT? For Ms. Smith this is a decrease

because services decreased from last assessment done by the CCU

Good case management & person centered planning includes:◦ Community Resources – Transportation & Housing Options◦ Encourage volunteer opportunities & independence


Prescreening for SLFs◦ Ms. Smith will need a current DON to enter the

SLF; her last assessment was 6/18/15 which is more than 90 calendar days old

◦ A copy of the DON will be sent to the SLF with the completed 2536 & OBRA Level I


Referral & process for MFP:◦ Referrals must be made through the MFP website◦ Initial Outreach visit will be made to determine

eligibility & discuss transitioning out of the NH◦ Prescreen evaluation is completed◦ Becomes enrolled as an MFP participant◦ Deinstitutionalization assessment is completed◦ Housing options are discussed & worked on◦ Pre-transition case review occurs prior to transition

MFP One-Time services are available 365 days of post transition follow-up required

Money Follows the Person

Current MFP numbers (non-County CCUs as of 4/24/15)

56 1st contacts made by 15 CCUs 28 participants Enrolled or Considering 14 Transitions made by 8 CCUs (several Post-T case transfers) 19 CCUs have had 2 or less referrals Since beginning of MFP, CCUs have facilitated *326 transitions (*including Cook). 1,310 total transitions by all age/disability groups

Colbert- Cook county- (through March, 2015)

700 transitions- all age/disability groups (approx. 75% MFP-eligible) 111 individuals - housing/aging network 60 individuals- supported living (SLFs)

MDS-Q Assessments as Referrals-◦ HFS looking to possibly share MDS-Q requests made by residents but not referred

by the NF. Will increase referrals throughout the state if implemented.

Terminating not active MFP cases-◦ MFP CCUs check Re-DE list & terminate inactive/closed cases

MFP/Pathways Updates

MFP Sustainability Plan (submitted to Federal CMS 4/30/15)- Current MFP contracts for CCUs statewide thru September 30th, 2016 New contracts will be issued thru September 30th, 2020 (date extended for claiming)

◦ Last day to issue referral- July 1st, 2017◦ Last day to transition a participant- December 31st, 2017◦ Last possible 365 Post-T- December 31st, 2018

Waiver revisions?◦ HFS and IDoA to explore Waiver revisions upon completion of sustainability

timeframes◦ Aging Waiver to possibly add: Environmental Accessibility Mods & One-Time

Services

After MFP-◦ HFS and IDoA stressing that CCUs foster continued positive relations with MCOs to

consider sub-contracting MFP-type deinstitutionalization activities with the CCUs

MFP/Pathways Updates

CCU reviews being completed to:

◦ Verify compliance with Service Authorization Guidelines (Public Act 098-0008)

◦ Verify Determination of Need (DON) scoring compliance

◦ Verify compliance with CCP timeframes

◦ Verify compliance with CCP forms

CCU Reviews

The CCU was provided technical assistance regarding findings, with individual participant files reviewed as needed

The CCU was sent the Quality Improvement Review report with findings and corrective actions outlined

Training to Care Coordinators is the primary corrective action

CCU Review Corrective Actions

Since homecare aides are required to document tasks completed during each provision of service, CCUs are requested to specify frequencies in this column of the DON; without frequencies indicated the amount of service authorized may not comply with the Service Authorization Guidelines

Care Coordinators should consider the number of days per

week service is to be provided when specifying frequencies◦ For example, the frequency of “five times per week” should be

utilized if a participant receives service five times per week, is incontinent and requires assistance with bathing each time the homecare aide is present. A participant who attends Adult Day Service three times a week and needs assistance with taking medication at the ADS, should have the frequency “three times per week” indicated under “routine health.”

Service Authorization Guidelines: Suggestions to Improve Compliance

“As needed” may be an appropriate frequency for some tasks such as telephoning

A participant’s service can be flexible for which days the service is provided, however, the In-Home Service provider needs to know how many times per week service is to be provided

The participant can direct the homecare aide regarding which day a task is completed


For “outside home” Care Coordinators should encourage participants to utilize other transportation services besides the homecare aide

Care Coordinators should authorize transport or escort for In-Home Service no more than 1-2 times a week; exceptions should be documented, including attempts to find other resources

Participants who are actively on Medicaid should utilize this resource for transportation to medical appointments

Remember that In-Home Service agencies are not required to provide transportation via the homecare aide’s personal vehicle. Care Coordinators should refer to the In-Home Service agency’s Service Specific Application for information indicated by the agency for transportation/escort.

Service Authorization Guidelines: Authorizing Transport or Escort

Care Coordinators should document exceptions to Service Authorization Guidelines in case notes

Service Authorization Guidelines must be utilized for all In-Home Service authorization, including Family Homecare Aides

Service Authorization Guidelines do not apply to Adult Day Service


Eating◦ Seek adaptive utensils that can assist

◦ Recommend preparation of foods that do not require cutting

◦ If the participant cannot feed themselves, there has to be back up support as CCP cannot be there for all 21 meals a week

◦ HDM is not a service by other for eating

Determination of Need Scoring

Bathing◦ Bathing, grooming, dressing A side scores should

be similar

◦ Encourage use of assistive devices, such as bath seats, grab bars, etc.

◦ Daily personal care is not essential unless incontinence is an issue

◦ Do not impose your hygiene standards onto the participant


Grooming◦ Bathing, grooming, dressing A side scores should

be similar

◦ Encourage use of assistive devices, such as weighted or large grip brushes—can use foam or duct tape to modify

◦ Homecare aides can only file and clean nails—no cutting of nails


Dressing◦ Bathing, grooming, dressing A side scores should

be similar

◦ Encourage clothing with Velcro, elastic, etc. so participant can remain as independent as possible


Transferring◦ Consider the use of assistive devices, such as a walker,

lift chair, etc.

◦ A back up support is needed as CCP cannot be there 24 hours/day—how is the participant completing this task when CCP not present?

◦ For a participant who scores 3-3 & lives alone a safe care plan may not be able to be developed

◦ Homecare aides cannot do total lifting; the participant must be able to assist with the transfer


Continence◦ Encourage use of assistive devices, such as bed

side commodes, continence products, etc.

◦ A back up support is needed as CCP cannot be there 24 hours/day—how is the participant completing this task when CCP not present?

◦ Homecare aides cannot do catheter or ostomy care


Managing Money◦ Getting out to pay bills should be scored under

outside home instead of managing money

◦ Utilize IL Volunteer Money Management Program (IVMMP) if available in your area

◦ In-Home Service providers must have a policy on receipt handling; receipts must be returned to participant & documented

◦ Homecare aides cannot be responsible for money management


Telephoning◦ If the participant has no phone that is not

considered an impairment

◦ Encourage use of assistive devices, such as a magnifying glass, large number phone, etc.


Preparing Meals◦ Encourage meals that can be prepared ahead or

extras made

◦ A participant who lives alone should not have a 3-3 score on the DON—3 on the A side of the DON means the participant cannot even warm a meal & no one is there to prepare

◦ If Home Delivered Meals in service by others is indicated, B side score should be lowered


Laundry◦ Laundry & housework A side scores should be

similar

◦ A participant who can do part of the task such as folding should not be scored a 3 on the A side

◦ Consider location of laundry facilities when authorizing time to complete the task

◦ A participant with continence problems may need laundry completed more frequently


Housework◦ Housework & laundry A side scores should be similar

◦ Basic housekeeping tasks, not heavy seasonal cleaning, are to be completed by the homecare aide

◦ The homecare aide is to complete tasks for the participant, not the entire family

◦ Unless there is documentation in the CCU case notes of a medical necessity, housework should not be authorized more than 1 x a week

◦ The participant can direct the homecare aide regarding which day a task is completed


Outside Home◦ Distinction should be made between transport &

escort; escort is needed when the participant is either physically or cognitively unable to leave the residence alone

◦ See slide under Service Authorization Guidelines


Routine Health◦ Homecare Aides cannot set up or administer

medication; Adult Day Service can

◦ Consider how many days service provided: if participant needs reminded to take medications what happens when CCP not there? Back up support will be needed for those times


Special Health◦ Is something a licensed professional needs to

perform

◦ B side should be 0 unless participant going to a facility (Choices screen) or ADS will perform; homecare aides cannot perform special health functions

◦ Watch over-scoring of this function: when scoring A side consider frequency of professional visits


Being Alone◦ For a participant who scores 3-3 & lives alone a

safe care plan may not be able to be developed

◦ Can the participant recognize danger & alert others?

◦ For a participant who cannot be left alone, a back up support should be in place in case CCP service unavailable—e.g., homecare aide late, ADS closed due to weather


Referral is made (request for services)◦ CCU has 5 calendar days from the referral date

to respond to the referral by contacting the participant (preferably a phone call)

◦ The CCU should document the date the referral was received by the CCU, including if the referral was a fax from another agency

CCP Paperwork—Requirements for Timeframes

Initial Assessment◦ CCU has 30 calendar days to complete an Initial

Assessment from the date of the request for services.

◦ If participant delay occurs, the CCU should document this in the case notes, e.g., awaiting financial verification, participant not wanting to choose provider at time of assessment


Initial Assessment (continued)

◦ If a supervisor’s signature is required to approve an assessment, the supervisor must sign and date page 20 (Goals of Care) of the Comprehensive Needs Assessment. The date of the supervisor’s signature is the Eligibility Determination Date (EDD). Unless participant delay occurs, this must be within 30 calendar days from the date of request for services.


The date the Care Coordinator signs the Client Agreement is the EDD; it may be different than the date the participant/authorized representative signed

If eligibility not determined at the assessment, the participant can sign & date the CA but the Care Coordinator should not do so until the EDD

CCP Paperwork—Eligibility Determination Date & POCNF Reminders

The EDD is the date shown on section D of the Plan of Care Notification Form (POCNF) “Eligibility Finding” which is entered on the POCNF Input screen

The EDD on the Client Agreement & POCNF must match

CCP Paperwork—Eligibility Determination Date & POCNF Reminders

Implementation of Goals of Care

◦ CCU has 15 calendar days to make referrals & implement goals of care from the date the participant signed the Goals of Care on page 20 of the CCC tool. This includes all referrals to CCP providers and to non-CCP providers.


Implementation of Goals of Care

◦ The Eligibility Notification date which is entered on the POCNF Input screen is the date the CCU provides copies of the POCNF to the participant and all CCP providers.

◦ The CCU can leave the POCNF with the participant if eligibility is determined the date of the visit and all providers were notified

◦ The eligibility notification date must be within 15 calendar days of the EDD.

◦ If there was an adverse action and the CCU leaves the POCNF, the CCU can obtain a signed receipt from the participant/authorized representative rather than send the POCNF certified mail


Service Start Date◦ CCP Providers have 15 calendar days from the date of

notification to begin providing services to a participant.

◦ CCP providers have 5 calendar days to return the signed Client Agreement to the CCU after the initiation of services. Both CCUs and providers should monitor assure this is completed.

◦ Service start date is the date services initially began or were increased. If service remains the same the provider should utilize the same date the Care Coordinator signed the Client Agreement.


Client delay◦ Participant has 60 calendar days from the

signature on the Goals of Care to provide documentation verifying eligibility. Client Delay only pertains to CCP cases.

◦ The CCU must document participant delay in case notes

◦ Providers must also document participant delay, especially when initiating or increasing services & should report this to the CCU


Review your agency’s policies at least annually to be certain all required policies are in place & up to date

Review your agency’s pre-service curriculum to assure it covers all required topics & hours in CCP 240 rule

Plan your agency’s in-service in advance to assure all required topics & hours in CCP 240 rule are covered for the calendar year

CCP Provider Quality Improvement Reviews—Helpful Hints

Determination of Need Analysis (from December 2014 In-Home Service participant data)

◦ State-wide average DON score=47; last year=48

◦ State-wide average monthly authorized units=60; last year=59

◦ State-wide average monthly provided units=48; ◦ last year=49

CCU Reports provided today

Determination of Need Analysis (from October 2013 In-Home Service participant data)

Action Steps:

◦ CCUs should review your agency’s data with your Care Coordinators & supervisors

◦ CCUs should utilize CMIS to periodically run “Active CCP Averages” report by Care Coordinator

◦ CCUs should consider training and/or monitoring for Care Coordinators who have excessively high averages


CCU Medicaid Analysis Report from December 2014 data

◦ For each CCU contract number, the report shows number & percentage of participant with 0 & less than $2,000 assets on Case Authorization Transactions (CATs)

◦ Report also shows ratio of CCP participants with Medicaid ID to those with less than $2,000 assets; greater percentage equates to increased opportunity to generate FFP (federal match)

◦ CCUs are required to document actual assets—do not assume someone has 0 assets if they are on Medicaid


CCU Medicaid Analysis Report from December 2014 data

Action Steps:◦ IDoA may complete another Root Cause Analysis

◦ CCUs encouraged to utilize PACIS to obtain Medicaid status about participants

◦ CCUs encouraged to continue to communicate concerns with local FCRC to IDoA


Active Caseload & Redetermination List (generated 5/1/15)

◦ For each CCU contract number, the report shows number of authorized participants, redeterminations due, & analysis of time rede is past due

◦ State-wide 35.2% of authorized CCP participants have a rede past due per eCCPIS data; last year 31.2%

◦ State-wide average days late for CCP participants (of overdue redeterminations) is 462; last year was 378



◦ This year’s reports also have an additional page for MCO participants MCO participants for each CCU contract number were determined by

current initial & redetermination assessments under program type 15 For each CCU contract number, the report shows number of

authorized participants, redeterminations due, & analysis of time rede is past due

◦ State-wide 7.3% of authorized MCO participants have a rede past due per eCCPIS data

◦ State-wide average days late for MCO participants (of overdue redeterminations) is 109



Action Steps:◦ CCP participants are required to have annual

redetermination of need completed; Eligibility Determination Date of rede must be within 365 days of previous EDD

◦ CCUs should utilize CMIS to frequently run the “Next Assessment Report” to assure redeterminations being completed timely


CCUs: please do not put other information in name & address lines in CMIS; this info is utilized for mailings & other data analysis; the notes section in CMIS can be utilized

CCUS & providers: for any changes in contact information, please send email to [email protected] and notify IDoA’s Office of Service Development & Procurement [email protected]

Friendly Reminders

mailto:[email protected]

mailto:[email protected]

CCUs: please thoroughly explain the reason a participant’s services are denied, decreased, or terminated◦ Document the reason in the case notes & POCNF

Friendly Reminders

IDoA will advise CCUs & providers of the date by which FY 15 billings must be submitted, this date is usually in August

Billings past that date will need to be submitted through Court of Claims

CCUs: if your agency requires a supervisor review & approve the file prior to the file being processed, please factor this in to assure person(s) entering CATs has time prior to cut off date

Friendly Reminder—Billing

CCUs: assessments not entered into CMIS & transmitted to IDoA cannot be billed by you or your provider(s)

Providers: delete any rejected payments for which you have already been paid, i.e. duplicate billing accidentally submitted

eCCPIS has edit checks which compare submitted billings by providers & CCUs to the Public Health (IDPH) date of death records◦ If the face to face date on the CCU’s CAT is greater than the

IDPH date of death, the CAT rejects◦ If the service date on a provider’s billing is greater than the

IDPH date of death, the billing rejects

Friendly Reminder—Billing

IDoA has developed trainings for the network which are located in eCCPIS, menu option Information/Webinars

Trainings on eCCPIS

1.CCP Providers MCO Training

2.MCO Managed Care Coordination Conference 3.Reapplication and Redetermination

4.MCO Case Managers CCP 101

5.Provider Billing using eCCPIS

6.CMIS and eCCPIS Billing for CCUs

http://multimedia.illinois.gov/aging/IDOA-BEAMMCO-102314.html

http://multimedia.illinois.gov/aging/IDOA-MCO-ManagedCareCoordConf.html

http://multimedia.illinois.gov/aging/IDOA-MCO-ManagedCareCoordConf.html

http://multimedia.illinois.gov/aging/IDOA-Reapplication-and-Redetermination.html

http://multimedia.illinois.gov/aging/MCO-Case-Managers-CCP-101.html

http://multimedia.illinois.gov/aging/vrfp-billing-1.html

http://multimedia.illinois.gov/aging/vrfp-billing-2.html

Have a safe trip home

Thanks for all you do

Questions??

Documents

2015 Supervisor’s Conference. Timeframes Determination of Need (DON) Scoring Local, State, Federal Services Person Centered Planning Minimum