Discharge or No?
John Doe is a UHC member who struggles with Alcohol Use Disorder. He has not answered your phone calls or text messages in 30 days. Is he appropriate for discharge?
NO!
UHC members must receive 90-days of consistent (at least once weekly) contact attempts, AND blasting activity to be considered for a non-engagement discharge.
Discharge note says: "Member is being discharged from Sentara CCM program."
1. WHY?
2. Has the member been contacted or contact attempt?
3. What discharge resources or next steps were they provided with if notified directly?
What notes are needed on the chart in order to appropriately document a discharge?
1. COC OR Core note (Depending on contact)
2. Exit/DC Note
A discharge note should always begin with.....
The reason they are being discharged!
Example: JD is being discharged from Sentara CCS/Optum IBHH/Humana CCS program due to...
Which staff members are able to approve a discharge, and co-sign a discharge note?
1. Madison
2. Anna
3. Lexie/Group Trainer (If in training!)
Michael Jones is a member who has recently been incarcerated. He is scheduled to get out in 15 days and has Active insurance, should he be discharged?
No! Any member who has an absense for 30 days or less should be kept. For longer durations, please reach out to me for a case by case discussion!
True or False: When discharging, you need to remove yourself as the referring provider.
True!
Should you notify a patient of their discharge before or after the Exit note has been input?
Before! We need to notate in the note weather or not they were informed or attempted.
What is the timeframe for non-engagement discharges for each plan, and should this be mentioned in the discharge note?
UHC: 90 days
Sentara: 30 days
Humana: 60-90 days
Yes! Their last contact date should be included in the note!
A member requests to be discharged from the program. Before you proceed with a discharge, what is your first step?
Messaging a team lead to reach out to the member. I am available for this as well, but all questions and concerns should first be brought to the team lead of that area, and I can be looped in as necessary.
Your Sentara CCM member has not answered your calls or texts in 32 days. They have been called twice. Are they appropriate for discharge?
No! They must receive AT LEAST weekly calls AND blast week activity in order to be appropriate for dc.
True or False: An Inactive patient can be searched in Tebra, and additional notes can be added after a discharge is complete.
True!
ALL member interactions must be documented regardless if they are Active or Inactive
True or False: The last step of a discharge is Inactivating the chart.
True! All other dc steps should be completed by this point. If the Exit note has been sent for co-sign, you can still Inactivate the chart!
How could we word a discharge for a member who has completed all of their goals, has all of their documentation, and has been spoken to about a CNA?They are also not utilizing the ER.
This is a discharge for elf-management. Please give yourself credit in the dc note for all steps that have been taken, and that if their needs change they can reach out for possible re-enrollment.
How long does a member have to renew their coverage before they need to be discharged?
14 days! They have 14 days to take a step toward renewal with you.
Elizabeth has not had Medicaid coverage for 30 days, and has not answered your calls for 14 days. You have called 8 times. Should she be discharged?
Yes! They must take Medicaid renewal steps with you within 14 days, with consistent contact attempts. Appropriate for dc.
True or False: An engagement note can still be placed if the member is being discharged.
True!
So long as they have Active Medicaid coverage.
Double trouble!
Which insurance plan has a Spreadsheet that ALL discharges must be added to?
Where is the information for this spreadsheet found?
UHC!
MCR!
A member is angry with you and requests a discharge. A supervisor has also reached out. How can we word this in a respectful way?
I want to hear from you! Examples:
1. Member became upset about....and verbally declined services. CM will proceed with dc steps at this time.
True or False: When you are made aware that a member needs to be discharged by leadership, you can do it when you have time.
False! Needs to be done immediately, usually by the end of the day.
A member who live in Kentucky, but plans to move back to VA within the next 6 months.
Discharge! If you are notified a member is LIVING out of state, they must be discharged. They may be able to re-enroll once they officially move back, but if they are living out of state, their medicaid should be set up in their current home state. Do not just go based off of PCC, confirm with member.
How many sentences should your dc note be at the very minimum?
3!
One for WHY, one for contact, and one for any next steps you will take or any resources you will provide the member with upon discharge.
Name the one instance where we would not Inactive a Tebra chart.
If the member is involved in OPT and will continue to receive services.
What is the difference between a non-enagagement discharge, and a non-participation discharge?
Non-engagement: This member has not responded to any consistent contact attempts in the timeframe specified by their insurance.
Non-Participation: This member may engage enough to stay in services, but not enough for goal driven behavior to occur. (Think members who only answer during blast week for 2-3 months in a row)
What does it mean when a UHC member has been removed from the MCR?
They are no longer eligible for services, and their name will be sent to you for immediate discharge.