Assessments/Referrals
False, CIA must be completed on all ENGAGED members, and if member refuses CIA/otherwise unable to complete, documentation must be in the care plan explaining this, and at least the last 3 questions must be answered
T/F Interventions are still required for some goals
False! No more interventions!
T/F Intensity is no longer required
True
T/F Member can provide verbal consent for unsecure email communication
True
If obtaining verbal consent, you must inform the member of the associated risk using language such as: “It is important to note that there is some level of risk that your PHI could be read or accessed by a third party when it is sent by unencrypted email.”
Document in Essette by either uploading the signed form or entering a note in the Collaborate goal stating the member consented and was informed of the risks.
Per our contract, what is the timeframe in which our members should see a PCMP, specialist, or licensed providers after discharge for a physical health diagnosis?
within 30 days of discharge
T/F Starting 9/2, you only have to use the new CIA on new members.
False -
Enrolled or Engaged Cases with incomplete/open CIA - Deactivate the existing CIA, then Open a new version and transcribe/complete it.
Engaged or Engaged Cases open with no CIA: Open a new CIA version. All CIAs must be completed in their entirety for all enrolled/engaged cases when the member is participating on either a short- or long-term basis. The only acceptable reason for an incomplete CIA is if the member/guardian explicitly refuses or declines to complete the assessment. This refusal/declination must be documented in the Care Plan.At a minimum, the last three questions of the CIA must always be completed.
T/F You outreach a member who states most needs have been met and they do not think they need much care coordination. They would like food bank resources and agree to a call a week later to check-in on resources provided. You do not need to add the food goal because you are just helping with one resource, so you can just put that in the collaborate goal.
A care plan specific to the resource(s) is required beyond the Collaborate goal, even if only 1 resource is provided to the member and/or care team.
T/F Tasks auto-populate based on blue ribbon program changes
In the Upload Title section, include Guardianship paperwork approved 1/1/24 in CM(PM)2024555555555
Per our contract, what is the timeframe in which our members should see a PCMP, specialist, or licensed providers after discharge for a behavioral health diagnosis?
7 days
T/F You cannot add a goal from the care plan, it must be added through the CIA.
False - you can add a goal through the care plan.
No, the member is not engaged because they did not agree to at least 1 phone call for loop closure
T/F We do not use alerts/special instructions anymore.
False - Alerts/special instructions include 1–2-word description if there is: Guardianship, DHS custody, POA, Preferred Name/Language/Gender Identity, Other Health Insurance, or Communication Plan.
T/F You must get compliance approval for personal representative paperwork for each new case, even if compliance approved the paperwork last year
False - you only need to get compliance approval again if you verified paperwork on file with family and they report there is new paperwork, or paperwork is expired
T/F A member who has Medicare primary coverage is eligible for full state plan Medicaid as long as they meet regular Medicaid income guidelines
False. A member on Medicare can only qualify for full state plan Medicaid if they are on SSI or a waiver.
Within 48 hours of case assignmet
T/F the only time you need to add a barrier for a goal is when the goal is not met
False, you also need a barrier if the goal was partially met
When must the blue ribbon be updated from referred/outreach to engaged/enrolled?
Within 48 business hours after goal and/or resource participation.
Where in Teams can you verify if an agency is a covered entity?
PHI Sharing List and Guidance channel
A member sees a provider that does not take Medicaid primary. The member has a different primary insurance (Medicare or a commercial payor) and they are attributed to the wrong provider, what do you do?
Do not change attribution since we cannot attribute to a provider the member has no intention to see, and we cannot assign a member to a provider that does not take Medicaid primary.
What is the name of the assessment MOS/MSS completes if they speak with a member before assigning to CC?
Initial Screening Assessment
T/F All goals must remain open until the case is ready for closure.
False, all goals EXCEPT collaborate must be closed in a timely manner, consistent with care plan/documentation updates.
What contract element will the new program groups (referred/outreach and engaged/enrolled) in the blue ribbon help us distinguish?
Reliably distinguish between care plans that count toward members who qualify for the 25 care plans per 1000 members.
Sally sends a referral to benefits in action via findhelp but the member has not heard from them after findhelp says they successfully reached the member. Sally waits to call benefits in action, why might she be waiting?
Waiting for a signed ROI for Sally to communicate with BiA outside of findhelp
How do you determine who Lead is?
Lead is the organization most connected to the primary needs