Intro to ECM/CS
Health Net, Molina, Anthem, Blue Shield, LA Care, and Kaiser
The care manager must reach out to the new assigned member with ____ hours
48 hours
What are the required intake forms?
Informed Consent
Grievance Procedures
Child Abuse Reporting
Notice of Privacy Practices
Release of Information
Consent for Telehealth/Email
When are care plans due?
When your member is hospitalized, when should your next appt be?
Follow up within 7 days of discharge
Name at least 4 core services of ECM
•Linkage to housing services
• Aiding with health appointments and pharmacy needs
• Reducing avoidable ER/IP visits
• Setting goals & Health Promotion
• Day-to-day wellness activities
• Connection to resources (utility assistance, food
resources, transportation, workforce development, mental health treatment, etc)
• Skills for self-advocacy
• Transition of Care Support from an Inpatient Setting
What section does the outreach attempts need to be documented?
Under outreach on NPC before converting over to a lead
What are the assessment timelines?
All assessments should be completed within 30 days of enrollment
Name the 5 components of SMART goals
Specific, measurable, attainable, relevant & timebound
What is the minimum amount of contact with each member?
At least 1x a month, higher acuity = more contact.
CHW and/or CM will receive a MIF and make ___ outreach attempts within ____days.
5 outreach attempts within 60 days
Who is the liaison for BHW and UMPH?
Teodora Guerra
1. Assessment
2. Treatment Plan
3. Progress notes
How often are care plans updated?
Every 6 months (or sooner if needed)
What is a Case Conference?
Formal Presentation of member’s assessment care plan, presentation, progress, recommendations, etc. Both care team and non-care team participants attend to provide recommendations.
Name the 3 types of CS (at CII)
1. Housing Transition Navigation Services
2. Housing Deposits
3. Housing Tenancy and Sustaining Services
What is the role of the CHW after CM enrolls the member?
Once member has been enrolled in ECM/CS services, the CHW will schedule a (One-time)initial case consult with team members to go over the case, expectations, goals, and treatment plan emailing all parties.
When are the PCQ's required?
• Every 6 months
• Upon successful discharge
Who should be involved in the care planning process?
Member, significant family members, the CM.
What is a Care Team Meeting?
Care team participants and supervisors convene to discuss the member’s care plan, progress/barriers, etc. Serves to define care team roles and responsibilities & communicate progress of various tasks, member status, etc
What are the caseload expectation ranges for care managers and housing navigators?
Housing Navigators 30
How long does it take to receive authorization for services?
2-3 weeks
When does a CM need to complete documentation for re-authorization?
Services are re-authorized at 12 months if care plan is still applicable; PCQ must be submitted for re-authorization at 12 months and every 6 months thereafter.
What are the steps after a care plan is completed?
-Review with supervisor
-Provide copy to member
-Provide services based off of care plan
What is the 3 components of your note?
a. Data/Description
b. Assessment
c. Plan