Care coordination resources
Medica Choice CareSM MSC+
- Advance Directive Planning
- Assessment Schedule
- Audit
- Behavioral Health Home Coordination
- Benefit Inquiry Exception Request
- Care Coordination Accountability
- Care Coordination Operations - CC Ratios
- Care Coordination Delegation Oversight
- Choice of Primary Care Provider
- Collaboration with Tribal Case Managers
- Conversion Rate Request Process
- Coordination with Certified Community Behavioral Health Clinics
- Denial, Termination or Reduction (DTR)
- Evaluation of Care Coordinator's Performance
- Home Care
- IDT Process for Delegates
- Interdisciplinary Care Team
- Most Vulnerable Beneficiaries Identification
- Pre-Admission Screening Process
- Provider and Vendor Concern Reporting
- Range of Choice
- Remote Assessment
- Transfer Responsibilities
- Transitions of Care
- Unable to Reach/Refusing Member
Assessments
- Supplemental Waiver Personal Care Assistance (PCA) Assessment and Service Plan
- Assessment Schedule Policy
- Care Coordinators will NOT complete a PCA Reassessment for members that are new to Medica with a current PCA authorization (i.e. from another health plan or fee for service) unless member has had a change in condition, a change in services or supports, or per member request.
- PCA Reassessments can be done up to 60 days before the end of the authorization period.
- Reassessments can be done early only for change of condition or supports.
- PCA reassessment cannot be completed early due to using up units before the end of the authorization period.
- PCA Assessment must be completed if denying PCA services and submitted with the Denial Termination Reduction (DTR) Form.
- For members on other waivers managed by the county (i.e.: CADI), Medica will accept the MnCHOICES Assessment completed by the county waiver case manager.
Authorizations
Keep in mind:
- Complete Referral Request Form (RRF) is to be submitted to Medica.
- Include the PCA Assessment with the RRF when there is an increase of 8 or more units from the previous assessment.
- Must use an in network provider.
- Services can start as early as the date of the assessment (initial assessment) if there is a provider already in place.
- Authorizations cannot extend beyond one year.
- Authorization dates should line up with Elderly Waiver (EW) waiver span or HRA reassessment dates.
- Medica will honor PCA Assessments and authorizations when member newly enrolls with Medica. The Care Coordinator (CC) can use the Flexible PCA Verification Form to determine number of units left in the authorization.
- Medica/Care Coordinator will authorize an Out of Network (OON) PCA provider with Medica for up to 120 days from the date of enrollment with Medica. Indicate this on the RRF in the comment section.
- OON PCA provider requests other than for newly enrolled members cannot be authorized by the Care Coordinator and requires a utilization management review.
- 45 day temp auths should be used for temporary changes in condition.
- To determine hours, must review PCA assessment to determine what has changed on the assessment and approve the increase of units based on the PCA assessment. Changes must be documented in the member’s record.
- A DTR is not done to reduce back to the previous level of services.
- Temp auth cannot exceed 45 days, if increased need beyond 45 days, another PCA assessment must be completed.
- To reduce or terminate a PCA authorization a DTR form must be completed and include the PCA Assessment. An RRF will not be accepted.
- Supplementary Summary Charts
- Assessment Summary
- When the CFSS Home Care Rating is PQR please also include:
- CFSS-to-PCA Conversion worksheet
- The previous PCA Assessment
Resources
- Air Conditioner PCP Support letter
- Care Coordinator Contact Info Update letter
- Care Plan Change letter
- Change of Care Coordinator letter
- Documents letter
- Eligibility Renewal Reminder letter
- Member Refusal letter
- On-going No Contact letter
- Post-Visit letter
- Post-Visit Institutional Letter
- Welcome Letter
- PCP Letter (Updated 10.2022)
- PCP Letter-Unable to Reach or Refusing
- Provider Signature Care Plan Cover Letter
- Provider Signature Care Plan Summary Letter
- Provider Signature Care Plan Sharing Requirements
- Provider Signature Requirements Frequently Asked Questions
Assessment and Care Plan
- Assessment Checklist
- Collaborative Care Plan - Version 3
- Collaborative Care Plan Instructions
- Medica Leave-Behind Document (Revised 9/2023)
- Medication List Form
- Member Engagement Questionnaire
- Transfer Member Health Risk Assessment
- Unable to Contact/Refusal Care Plan
- Medication Safe Disposal Handout
- Medication Safe Disposal Handout Instructions
Referrals
Institutional
- Institutional Member Assessment
- Nursing Home Checklist for MSHO and MSC+
- Nursing Facility Chart Coverage Guide
Miscellaneous
- Home Care At a Glance Grid
- Bridging Client Checklist
- Bridging Shopping Preference Form
- Bridging Referral Form
- 2024 DHS MMIS Capitation Dates
- 2024 Medica CC HRA Completion Report
- Submit a Care Coordinator Concern
- SBAR for Interdisciplinary Team Case Consult
Health Improvement Programs
- Complex Case Management/Health Support Referral Form
- Tobacco Cessation Program When and Where to Get Care
- Tips for Good Oral Health Tip Sheet
- Depression Management Talking Points for Care Coordinators
- Depression Management Tip Sheet for Members
Contacts and Group Numbers
- Provide A Ride Transportation Directory
- Provide a Ride Transportation Out of Network Request
- Provide A Ride Transportation Authorization Form for over 30 60 Mile Rule
- Provide A Ride Transportation Request Form
- Provide A Ride Elderly Waiver request form
- Provide A Ride Transport Request Process Over 30 60 Mile
- Certification of need form CON special transportation