CMA Team
Initial Authorization is needed withing 24 hours except for...
COC and Hospice members (PDO without DMS)
When must the Welcome Call (Phone Call to Schedule Initial Assessment) be completed after a member is assigned?
Within 24-48 business hours
For an HCBS member, when is a FL Fall Risk Assessment required due to a condition/status change?
After a fall
During an Initial Assessment, which statement correctly reflects the documentation requirements related to CARES 701B?
A. The CM only documents that the 701B is located in Community Care.
B. The CM must document whether the CARES 701B was available in Doc360, unavailable, or unavailable due to COC from a previous health plan.
C. The CM documents the 701B only if the member requests it.
D. Documentation of the 701B is not required.
The CM must document whether the CARES 701B was available in Doc360, unavailable, or unavailable due to COC from a previous health plan.
A CM has made one unsuccessful phone call to a member. Can the CM submit a UTR referral at this point?
No. The CM must complete all required outreach attempts, including at least two phone call attempts and a drive-by visit, before submitting a referral to the FL UTR queue.
how to create an assignment to Send POC to Facilities for for Initial/Annual/POC Reviews with Updates?
CMAs do not mail copies of POC to Facilities.
CMs must provide copy during Facility visit.
Which Initial Assessment outcome should be selected if the member asks to delay the visit to a later date?
Member/Caregiver Rescheduled - Member request to defer the visit
For a Nursing Facility (NH) resident, what assessment should be completed at the Annual Assessment if a new FL 701B is NOT due to CARES?
FL 701T Assessment
A member has no Advanced Directives and cannot provide copies of any legal documents. What action is required during the Initial Assessment?
Complete and obtain a signed Authorized Representative form and educate the member on the importance of Advanced Directives.
A member has not answered calls or drive by visits for three months. During a drive-by visit, a neighbor reports that the member still resides at the address but is often away during the day. Should the CM submit an MDS or UTR referral?
The CM should submit a UTR referral, not an MDS referral. The member has not formally declined services; therefore, the case meets the criteria for Unable to Reach, provided all required outreach efforts have been completed and documented.
Assignment to Send POC to PCP Use for Initial/Annual/POC Reviews with Updates Priority is high only when..
Always
For HCBS members, when must the Initial Assessment be completed including documentation?
Within 5 business days of enrollment date
Which form is NO LONGER required to be completed at the HCBS Annual Assessment if it was signed at the Initial Assessment and the member's choice has not changed?
FL Freedom of Choice
Which of the following must always be documented during the Initial Assessment regarding follow-up and communication?
A. Member's favorite provider
B. Next scheduled contact, contact method, preferred communication method, and routine contact requirements.
C. Only the next annual assessment date
D. The PCP's office hours
B. Next scheduled contact, contact method, preferred communication method, and routine contact requirements.
A member verbally states they no longer want LTC services, refuses further case management, and understands the impact of the decision. What action should the CM take?
The CM should document the member's refusal, submit the FL MDS referral using the appropriate activity type, and follow the process for termination of services as directed by the MDS team.
how to request to CMA team to Mail plastic sleeve with magnetic base & 5 Wishes to member/RP?
CM now required to provide during visit.
Which Initial Assessment outcome should be selected when the member has services initiated?
Successful - Services Accepted and Not COC
A member requests to voluntarily suspend services for a short period of time. Which form should be completed?
FL Consent for Voluntary Suspension
Which statement is identified as one of the most frequently missed items during chart audits?
A. Listing the PCP's fax number
B. Documenting the member's favorite provider
C. Documenting that the POC and POC Summary were developed, reviewed with the member/POA, and verbal agreement was obtained
D. Recording the member's preferred pharmacy
C. Documenting that the POC and POC Summary were developed, reviewed with the member/POA, and verbal agreement was obtained
A CM completed two phone attempts and one drive-by visit but discovered the member was hospitalized. Should the CM proceed with a UTR referral?
No. The member's whereabouts are known. The CM should attempt outreach through the hospital, authorized representative, or discharge planner before considering UTR status.
What information is needed in an assignment to initiate services for Adult Day Care services?
HSC approval number
Provider name
Provider address
Provider phone and fax number
Frequency of Services
Number of hours approved per day i.e. 4, 6.5 or 8
Which Initial Assessment outcome should be selected when the member only wants Case Management services and does not need additional services?
Service Not Needed - Member only wants Case Management
Which of the following assessments are required as part of an HCBS Annual Assessment?
FL 701B Assessment, FL Plan of Care, FL Plan of Care Summary FL Fall Risk Assessment, FL Authorization for Release of Information Form and FL Supplemental Assessment Tool (if the member has an unpaid caregiver)
At every Annual Reassessment Visit, if signatures are not obtained during the visit, what action must occur?
B. Complete a Signature Attempts Activity Tracker with Outcome Type "Unsuccessful" and Activity Outcome "Signature Attempted"
A Member moved to another Region at Florida, do I need to report this member as OOSA?
The CM should review if member moved to a UHC covered Region, if member moved to a covered Region member should be transferred to another Team, or if member moved to a non covered region OOSA process should be completed. In both cases a 2515 is required.