Training for CareStar

1

• Training for CareStar
• Kim Donica
• Office of Ohio Health Plans
• Ohio Department of Job Family Services

2
Referral Process

• Referrals to Home Choice
• ODJFS 02361
• Can come from a variety of sources including
• Consumers
• Family Members
• Advocates
• Nursing Facilities
• AAAs
• CILs

3
Referral Process

• ODJFS 02361 is submitted to ODJFS Home Choice
  Intake and Care Coordination Unit (HCICCU).
• HCICCU reviews and determines which waiver would
  most appropriately meet consumers needs.
• If OHC, then HCICCU sends a copy of ODJFS 02361
  along with a request for HC assessment to
  CareStar.
• CareStar will receive notification of slot
  release at the same time.

4

• HOME Choice Eligibility Requirements
• OAC 51013-51-02

5
Eligibility

• To participate consumers must
• Reside in NF, ICF/MR or hospital for at least 6
  months
• Stay must be continuous
• Can include a combination of NF, ICF/MR or
  hospital stay
• If at time of assessment the consumer does not
  meet this requirement, but it is anticipated they
  will prior to discharge, the consumer could still
  be eligible for program.

6
Eligibility

• To participate consumers must
• Be receiving Medicaid benefits in the
  institutional setting for at least 30 days prior
  to discharge.
• Consumers may be admitted to facility under a
  different funding source and switch to Medicaid
  during the course of their stay. As long as 30
  day requirement met, consumer would meet this
  eligibility requirement.

7
Eligibility

• To participate consumers must
• Be receiving Medicaid benefits in the
  institutional setting for at least 30 days prior
  to discharge.
• If the consumer does not meet this requirement at
  the time of assessment, but it is anticipated
  that they will prior to discharge, the consumer
  could still be eligible for the program.

8
Eligibility

• To participate consumers must
• Meet an Institutional Level of Care (SLOC, ILOC,
  ICF/MR LOC)
• For purposes of HOME Choice only, ODJFS is
  presuming level of care.
• Consumers do not have to be waiver eligible in
  order to participate in program.

9
Eligibility

• To participate consumers must
• Relocate to a qualified residence
• A home owned or leased by the consumer or family
  member
• An individually leased and lockable apartment
  rented by the consumer or family member
• A community-based residential setting with no
  more than four unrelated persons

10
Eligibility

• Qualified Residence
• A community-based residential setting with no
  more than four unrelated persons.
• Adult Foster Home (AAAs)
• Adult Family Home (ODH)
• Assisted Living Facility (ODH)
• Non-ICF/MR Residential Facilities (ODMR/DD)
• Type 1 Residential Facilities (ODMH)
• Type 2 Residential Facilities (ODMH)
• Supported Living (ODMR/DD)

11
Eligibility

• Qualified Residence
• A community-based residential setting with no
  more than four unrelated persons.
• Group Home for Children
• Family Foster Home (ODJFS)
• Medically Fragile Foster Home (ODJFS)
• Pre-adoptive Infant Foster Home (ODJFS)
• Specialized Foster Home (ODJFS)
• Treatment Foster Home (ODJFS)
• HCBS Adult Foster Care (ODMR/DD)

12
Eligibility

• The assessor/case manager assess HOME choice
  eligibility at the same time they are assessing
  waiver eligibility.
• HOME Choice eligibility is determined via the
  HOME Choice Eligibility Checklist.

13
Eligibility

• HOME Choice Eligibility Checklist is fillable-can
  be completed electronically and printed.
• HOME Choice Eligibility Checklist has a section
  for each of the eligibility criteria.
• Includes a place to indicate consumers interest
  in employment.

14
Eligibility

• Home Choice is built on Ohios existing system of
  services and supports.
• HOME Choice participants will be enrolled on
  either
• One of Ohios existing HCBS programs
• or
• State Plan Services

15
Eligibility

• The assessor/case manager recommends a qualified
  program of services and supports (either waiver
  or state plan) or
• recommends denial of HOME Choice program.

16
Eligibility

• T-MR/DD Waiver is being opened up for HOME Choice
  participants who have an ICF/MR level of care and
  who have nursing needs greater than what is
  available via the State Plan. (intermittent
  nursing needs lt 14 hours a week)
• T-COW is being opened up for HOME Choice
  participants who meet level of criteria, who are
  over 60 and who have nursing needs greater than
  what is available via the State Plan.
  (intermittent nursing needs lt 14 hours a week).

17
Eligibility

• For enrollment on T-COW or T-MR/DD, AAA and/or
  CBMR/DD completes their initial assessment and
  makes a recommendation for enrollment based on
  their assessment of the consumers needs.
• AAA and/or CBMR/DD will send their recommendation
  to the HCICUU.

18
Eligibility

• HCICUU will review case and determine if it is
  appropriate for consumer to be assessed for T-COW
  or T-MR/DD.
• HCICUU sends a copy of ODJFS 02361 along with a
  request for HC assessment to CareStar.
• CareStar will receive notification of slot
  release at the same time.

19
Eligibility

• Approval for program cannot occur until consumer
  actually is discharged from facility and moves
  into qualified residence.
• HOME Choice Participation has three distinct
  periods
• Pre-Transition Period (period of time where
  activities occur prior to moving to community)
• Demonstration Period (begins the date of
  discharge and runs 365 calendar days)
• Post-Demonstration Period (begins day 366 after
  discharge from facility)

20
Eligibility

• If consumer is ineligible for the HOME Choice
  program, the ODJFS HCICCU notifies the consumer
  in writing and issues hearing rights.
• All hearings related to the denial of HOME Choice
  are led by the ODJFS HCICCU.

21
Informed Consent

• HOME Choice Informed Consent required for all
  HOME Choice participants.
• If the assessor/case manager determines consumer
  will be eligible for HOME Choice then informed
  consent is completed.

22
Informed Consent

• The assessor/case manager should review all
  components of informed consent with consumer
  and/or authorized rep and/or guardian and obtain
  all needed signatures.
• Special section that outlines guardian
  requirements.
• Guardian must report level and type of contact
  with consumer during past six months.
• Required information that must be reported to
  CMS.

23
Screening Tools

• TBI Screening Tool
• Can be used as a tool to help identify a possible
  TBI and possible need for referral.
• Brain Injury Association of Ohio is a provider of
  Transition Coordination Services.
• Tool and instructions in tool box.

24
Transition Coordination

• If a consumer appears to be eligible for the HOME
  Choice program, the assessor/case manager assists
  the consumer in choosing a Transition
  Coordination Provider.
• List of Transition Coordination Providers by
  county
• Consumer has free choice of provider

25
Transition Coordination

• Available to all HOME Choice consumers in the
  pre-transition period to help consumers plan and
  arrange for services and supports they will need
  as a result of relocating from an institution to
  the community.
• Transition Coordination is discontinued once a
  consumer moves into the community except in cases
  where housing navigation may be needed during the
  demonstration period.

26
Transition Coordination

• Includes
• Housing Navigation
• Benefits Coordination
• Assistance with Accessing Transition Services
  (goods and services)
• Linkage with community resources
• Coordinating actual physical move

27
Transition Coordination

• Once a consumer chooses a Transition Coordination
  provider, the assessor/case manager completes the
  HOME Choice Demonstration and Supplemental
  Service Plan indicating the chosen Transition
  Coordination Provider.

28
HOME Choice Service Plan

• Transition Coordination is authorized on the HOME
  Choice Demonstration and Supplemental Service
  Plan by the assessor/case manager.
• The HOME Choice Demonstration and Supplemental
  Service Plan is an electronic fillable form.
• Includes basic information such as date,
  identified need/problem, goal, intervention/action
  , units/date span and provider.
• The assessor/case manager submits the HOME Choice
  Demonstration and Supplemental Service Plan to
  the ODJFS HCICCU.

29
Eligibility Determination

• Once assessment process is complete the
  assessor/case manager submits to the ODJFS
  HCICCU
• HOME Choice Eligibility Checklist
• HOME Choice Informed Consent Form
• HOME Choice Demonstration and Supplemental
  Service Plan

30
Eligibility Determination

• The ODJFS HCICCU
• Reviews and enters information into the HOME
  Choice tracking system.
• Verifies Medicaid eligibility and
  institutionalization dates.
• Sends a letter notifying consumer of their
  preliminary approval for their program (pending a
  move to a qualified residence).
• CareStar ccd on letter

31
Eligibility Determination

• The ODJFS HCICCU
• Contacts the identified TC provider and verifies
  their willingness/ability to provide transition
  coordination services to the consumer.
• Authorizes the payment of the first deliverable
  to the Transition Coordination provider.
• Notifies the assessor/case manager of the TC
  providers acceptance of referral and initiation
  of TC services.

32
Pre-Transition Activities

• During the consumers pre-transition phase the
  assessor/case manager
• Schedules and leads team meetings for the
  purposes of discharge planning.
• Works to identify post discharge services and
  supports and develops a service plan.
• Coordinates activities and consumers discharge
  date with the transition coordinator.

33
Pre-Transition Activities

• During the consumers pre-transition phase the
  assessor/case manager
• Assists the consumer with securing service
  providers.
• Authorizes goods and services on the HOME Choice
  Demonstration and Supplemental Service Plan as
  needed.
• Submits the request for the Quality of Life
  Survey to the ODJFS HCICCU at least two weeks
  prior to consumers discharge.

34
Enrollment

• The assessor/case manager completes the HOME
  Choice Enrollment Form once the consumer is
  actually discharged from the facility.
• Information regarding qualified residence is
  obtained from the transition coordinator.

35
Enrollment

• The completed HOME Choice Enrollment Form is
  submitted to the ODJFS HCICCU as soon as consumer
  moves from the facility to the community.

36
Enrollment

• The ODJFS HCICCU
• Reviews the HC Enrollment Form and enters
  information into the HC tracking system.
• Verifies Medicaid eligibility and
  institutionalization dates.
• If at this time consumer has not met either the
  30 days of Medicaid requirement or the 6 months
  institutional stay they will be denied HOME
  Choice enrollment.

37
Enrollment

• The ODJFS HCICCU
• Notifies the consumer and CareStar in writing of
  consumers enrollment on HOME Choice.
• Starts the 365 Demonstration Period clock.

38
Enrollment

• Consumer is enrolled on waiver and HOME Choice
  and services begin.

39

• Questions?

40

• HOME Choice
• Services and Supports
• OAC 51013-51-04

41
Services

• Three Categories of Services
• Qualified Services
• Demonstration Services
• Supplemental Services

42
Services

• Qualified Services
• Existing waiver and state plan services
• Available during the both the demonstration and
  post demonstration periods.
• Eligible for enhanced federal match.

43
Services

• Demonstration Services
• Available only during the 365 day demonstration
  period (except for community transition services
  i.e. goods and services that can be accessed
  during the pre-transition phase).
• Eligible for enhanced federal match.
• Authorized on the HOME Choice Demonstration and
  Supplemental Service Plan.

44
Services

• Demonstration Services
• Consumers enrolled on ODJFS-administered waiver
  may receive certain HOME Choice Demonstration
  Services including
• Independent Living Skills Training
• Community Support Coach
• Community Transition Services (Goods Services)
• Social Work/Counseling Services
• Nutritional Consultation Services

45
Services

• Demonstration Services
• Independent Living Skills Training
• Training focused on
• Financial Management Skills
• Social Skills Development
• Health Management Skills
• Home Management Skills
• Personal Skills
• Community Living Skills

46
Services

• Demonstration Services
• Independent Living Skills Training
• Can receive up to 144 hours during the 365-day
  demonstration period (in individual, group or
  classroom setting).
• New service-providers could include CILs,
  mental health providers.
• Must be approved by ODJFS

47
Services

• Demonstration Services
• Community Support Coach
• An individual who provides guidance, education
  and works to empower the consumer, authorized
  representative and family members.

48
Services

• Demonstration Services
• Community Support Coach shall assist the consumer
  in
• Making informed independent decisions
• Setting and achieving short and long term goals
• Identifying options and problem solving
• Managing multiple tasks

49
Services

• Demonstration Services
• Community Support Coach
• Can receive up to 72 hours during the 365-day
  demonstration period
• New Service-Providers can be either agencies or
  non-agency providers
• Must be approved by ODJFS

50
Services

• Demonstration Services
• Community Transition Services (Goods Services)
• Goods and services that will assist in a
  consumers successful transition into the
  community.

51
Services

• Demonstration Services
• Community Transition Services (Goods Services)
• Does not include
• Experimental or prohibited treatments
• Cost of room and board
• Uniforms and memberships
• Electronics used for entertainment purposes
• Cable/internet access

52
Services

• Demonstration Services
• Community Transition Services (Goods Services)
• Up to 2,000 available per consumer
• Non-traditional providers-paid through FMS

53
Services

• Demonstration Services
• Social Work/Counseling Services
• Service to the consumer, authorized
  representative and/or family member on a short
  term basis to promote the consumers physical,
  social or emotional well being.
• Designed to promote the development and
  maintenance of a stable environment for the
  consumer.

54
Services

• Demonstration Services
• Social Work Counseling
• Can include crisis intervention, grief
  counseling and other social service interventions
  that support the consumers health and welfare.
• Does not include case management services.

55
Services

• Demonstration Services
• Social Work Counseling
• May receive up to 36 hours during the 365-day
  demonstration period
• Providers-Agencies or non-agency providers
• Must have existing provider agreement and sign a
  HOME Choice provider addendum.

56
Services

• Demonstration Services
• Nutritional Consultation
• Provides 11 nutritional guidance to consumers
  with special dietary needs.
• Includes the development of a nutrition
  intervention plan.

57
Services

• Demonstration Services
• Nutritional Consultation
• May receive up to 36 hours during the 365-day
  demonstration period
• Providers-Agencies or non-agency providers
• Must have existing provider agreement and sign a
  HOME Choice provider addendum.

58
Services

• Supplemental Services
• For consumers enrolled on ODJFS-administered
  waivers these include
• Service Animals
• Communication Aids
• Transition Coordination
• Available only during the 365 day demonstration
  period (except for Transition Coordination)

59
Services

• Supplemental Services
• Service Animals
• May include but are not limited to
• Seeing eye dogs
• Hearing dogs
• Service monkeys

60
Services

• Supplemental Services
• Service Animals
• Includes
• First years costs associated with the raising of
  the animal
• Housing, feeding, upkeep and medical care of the
  animal during training
• Actual training of the animal, student training,
  and related transportation, room/board and
  administrative activities
• Equipment and Supplies

61
Services

• Supplemental Services
• Service Animals
• Providers are existing service animal providers
  who sign a HOME Choice provider addendum
• Up to 8,000 ----one time maximum

62
Services

• Supplemental Services
• Communication Aides
• Includes
• Augmentative Communication Devices or Systems
• Computers and Computer Equipment
• Other Mechanical and electronic Devices
• Cable and Internet Access
• Cost of Installation, Repair, Maintenance and
  Support of Any Covered Communication Aide

63
Services

• Supplemental Services
• Communication Aides
• Providers could be existing DME providers who
  sign HOME Choice addendum
• Up to 5,000----one time maximum

64
Services

• A list of eligible providers for each
  demonstration and supplemental service will be
  provided at later date.

65
Service Planning

• The assessor/case manager determines the type and
  amount of demonstration and supplemental services
  that are needed.
• All HOME Choice Demonstration and Supplemental
  Services must be authorized by the assessor/case
  manager on the HOME Choice Demonstration and
  Supplemental Service Plan.

66
Service Planning

• The HOME Choice Demonstration and Supplemental
  Service Plan must be sent by the assessor/case
  manager to the ODJFS HCICCU.
• THE HCICCU then forwards the HOME Choice
  Demonstration and Supplemental Service Plan to
  the FMS.
• The provider submits claims to the FMS and the
  FMS pays the provider.

67
Service Planning

• Service Planning Considerations
• Demonstration and Supplemental Services are time
  limited.
• The assessor/case manager needs to consider the
  consumer's ability to maintain service animal or
  communication device such as a computer prior to
  authorizing service.

68
Service Planning

• If the assessor/case manager determines that it
  is not medically necessary for a consumer to
  receive a requested demonstration or supplemental
  service it is appropriate for the assessor/case
  manager to deny the request.
• Notice of denial of service and hearing rights
  must be sent to the consumer.

69
Service Planning

• Information regarding denials of HOME Choice
  Demonstration and Supplemental Services and
  hearing information related to such denials must
  be tracked and reported to ODJFS.

70

• Questions?

71

• Assessor/Case Manager Responsibilities

72
Good and Services

• During the 365-day demonstration period the case
  manager may need to assist the consumer in
  accessing Community Transition Services (goods
  and services).
• Only available to consumers who have funds still
  available.
• Contact ODJFS HICCU if you are unsure if funds
  are still available.

73
Good and Services

• If consumer needs to access funds, and funds are
  available, the case manager completes the
  Estimated Use of Goods and Services form
  indicating how funds are to be used.
• The form is an estimate.

74
Goods and Services

• The form contains a framework of acceptable uses
  of the transition funds.
• Other requests not identified as a category on
  form require ODJFS approval.
• The case manager should contact the ODJFS HCICCU
  to discuss these request prior to submitting the
  form.

75
Goods and Services

• The ODJFS HCICCU will consider other requests on
  a case by case basis.
• Once the Estimated Use of Goods and Services Form
  is completed, the case manager sends the form to
  the HCICCU for review.

76
Goods and Services

• The ODJFS HCICCU will notify the case manager if
  it is ok for the consumer to go ahead and access
  the funds.

77
Goods and Services

• The case manager will work directly with the HOME
  Choice Financial Management Service to access
  funds.
• The case manager submits check requests along
  with supporting documentation i.e. invoice, copy
  of receipt, etc. directly to the FMS. (form to be
  used will be distributed at a later date)

78
Goods and Services

• The case manager tracks the actual use of funds
  on the HOME Choice Goods Services Usage Log.
• If a consumer changes their mind on how they want
  to use their funds, a new estimated use of goods
  and services funds form is not required.
• Unless consumer is requesting something in the
  other category.

79
Good and Services

• Once purchases are made all receipts are turned
  in to the FMS.
• The case manager must track to insure consumer
  does not exceed 2,000.

80
Goods and Services

• If in doubt, call the ODJFS HCICUU!

81
Incident Reporting

• The assessor/case manager educates the consumer
  and/or family about protection from harm
  measures.
• Providers of HOME Choice services to consumers
  enrolled on ODJFS-administered waivers must
  adhere to our incident reporting procedures.

82
Back-Up Plans

• In addition to typical back-up planning CMS
  requires specific elements in consumer back up
  plans.
• These include
• Transportation
• Direct Service Workers
• Repair and Replacement of needed equipment

83
Complaints

• Complaints about HOME Choice program from
  consumers and family members must be tracked and
  reported.
• This includes specific complaints about the
  failure of back-up systems.

84
Change in Status

• It is the assessor/case managers responsibility
  to notify the ODJFS HCICCU of a change in the
  consumers status.
• Changes should be communicated in a timely
  manner.
• Change in status is communicated via the HOME
  Choice Change in Status Form.

85
Change in Status

• Changes that require reporting include
• Move to a new qualified residence
• Includes type of qualified residence and type of
  housing assistance received, if applicable.

86
Change in Status

• Changes that require reporting include
• Institutionalization
• Includes admissions to hospital or NF.
• Must report admission and discharge dates.
• 365 Demonstration Period clock stops while in
  hospital or NF. Clock resumes upon discharge.

87
Change in Status

• Changes that require reporting include
• Disenrollment from HOME Choice
• Due to
• permanent placement in NF
• move to unqualified residence
• voluntary withdraw
• death
• completion of demonstration period

88
Disenrollment

• If consumer is in hospital or NF for longer than
  60 days they will be dis-enrolled from HOME
  Choice.
• If after discharge, the consumer has time and
  services left in their demonstration period they
  may re-enroll in HOME Choice.

89
Disenrollment

• All disenrollment notices and applicable hearing
  rights will be generated from the ODJFS HCICCU.
• The ODJFS HCICCU will lead all hearings related
  to disenrollments from HOME Choice.

90
Post Demonstration Planning

• 90 days prior to the end of the demonstration
  period the ODJFS HCICCU will send the consumer
  and CareStar a letter notifying them of the
  upcoming end of the demonstration period.

91
Post Demonstration Period

• The case manager should discuss with the consumer
  their service needs and adjust service plans as
  needed to address the end of the demonstration
  period.
• The case manager should assist the consumer with
  community referrals, if needed, to help
  compensate for the loss of the demonstration/suppl
  emental services.

92
Tool Box

• Includes
• Step-by-step process flow
• Copies of all required forms
• OAC Rules
• Transition Coordination Maps and Contact Info
• ODJFS Contact Info
• Other Important Resource Information

93

• Questions?

94

• Thanks!