Care coordination resources
Medica DUAL Solution® (HMO D-DNP) (MSHO)
- Advance Directive Planning (PDF)
- Assessment Schedule Policy (PDF)
- Audit (PDF)
- Behavioral Health Home Coordination (PDF)
- Benefit Inquiry Exception Request (PDF)
- Care Coordination Accountability (PDF)
- Care Coordination Operations - CC Ratios (PDF)
- Care Coordination Delegation Oversight (PDF)
- Choice of Primary Care Provider (PDF)
- Collaboration with Tribal Case Managers (PDF)
- Conversion Rate Request Process (PDF)
- Coordination with Certified Community Behavioral Health Clinics (PDF)
- Denial, Termination or Reduction (DTR) – (PDF)
- Evaluation of Care Coordinator's Performance (PDF)
- Home Care Policy (PDF)
- IDT Process for Delegates (PDF)
- Interdisciplinary Care Team (PDF)
- Most Vulnerable Beneficiaries Identification (PDF)
- Provider and Vendor Concern Reporting
- Range of Choice (PDF)
- Transfer Responsibilities (PDF)
- Transitions of Care (PDF)
- Unable to Reach/Refusing Member (PDF)
- Adult Day Services and Adult Day Bath (PDF)
- Bridging (PDF)
- Condition-based Health Education with CHW Solutions (MSHO Supplemental Benefit) (PDF)
- Durable Medical Equipment (PDF)
- Extended PCA (PDF)
- FOODRx with Second Harvest Heartland (MSHO, ISNBC Supplemental Benefit) – (PDF)
- Gloves (PDF)
- Healthy Savings Fresh Produce Program (MSHO Supplemental Benefit) – (PDF)
- Home Care Nursing (PDF)
- Homemaking (PDF)
- Hospice (PDF)
- Housing Stabilization Services (PDF)
- Incontinence Products (PDF)
- Memory Fitness Program (MSHO Supplemental Benefit) (PDF)
- Nutritional Products (PDF)
- One Pass Fitness Program (MSHO, ISNBC Supplemental Benefit) (PDF)
- Over-The-Counter (OTC) Allowance Program (PDF)
- Papa Pals (MSHO Supplemental Benefit) – (PDF)
- Reemo Smartwatch Programs (PDF)
- Re-Admission Prevention (MSHO Supplemental Benefit) – (PDF)
- Utility Assistance Allowance Program (PDF)
- Web-Based Education Program Cell-ED (PDF)
Assessments
- Supplemental Waiver Personal Care Assistance (PCA) Assessment and Service Plan (PDF)
- 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.
Resources
- Care Coordinator Contact Info Update letter (DOC)
- Care Plan Change letter (DOC)
- Change of Care Coordinator letter (DOC)
- Documents letter (DOC)
- Eligibility Renewal Reminder letter (DOC)
- Member Refusal letter (DOC)
- On-going No Contact letter (DOC)
- Post-Visit letter (DOC)
- Welcome Letter (DOC)
- PCP Letter (DOC) (Updated 10.2022)
- Care plan cover letter (DOC)
- Care plan summary letter (DOC)
- Provider Signature Requirements Frequently Asked Questions
Assessment and Care Plan
- Assessment Checklist (DOC)
- Collaborative Care Plan - Version 3 (DOC)
- Collaborative Care Plan Instructions (PDF)
- Medica Care Coordinator Leave-Behind Document (PDF)
- Medication List Form (DOC)
- Medication Safe Disposal Handout (PDF)
- Medication Safe Disposal Handout Instructions (PDF)
- Self-Report Health Risk Assessment (PDF)
- Transfer Member Health Risk Assessment (DOC)
- Unable to Contact Refusal Care Plan (PDF)
Referrals
Institutional
- Institutional Member Assessment (Fillable PDF)
- Medica Nursing Home Checklist (DOC)
- Nursing Facility Chart Coverage Guide (PDF)
Miscellaneous
- Home Care At a Glance Grid (PDF)
- Bridging Client Checklist (PDF)
- Bridging Shopping Preference Form (PDF)
- Bridging Referral Form (DOC)
- 2023 DHS MMIS Capitation Dates (PDF)
- 2023 Medica CC HRA Completion Report (XLS)
- Submit a Care Coordinator Concern
- MSHO D-SNP Cancellation Form (PDF)
- MSHO Disenrollment Form (PDF)
Health Improvement Programs
- Complex Case Management/Health Support Referral Form (PDF)
- Tobacco Cessation Program
- When and Where to Get Care (PDF)
- Tips for Good Oral Health Tip Sheet (PDF)
- Depression Management Talking Points for Care Coordinators (PDF)
- Depression Management Tip Sheet for Members (PDF)
- Reemo Smartwatch Request Form
Contacts and Group Numbers
- Care Coordination Product Group Numbers for Special Needs Plans and MSC+ (PDF)
- Care Coordination Support Specialists Team Contact List (PDF)
- Contact Numbers for Key Staff in Medica Care Coordination Products (PDF)
- County, Care System and Agency Contact Numbers (PDF)
- Contracted PCA and Home Health Agency List (XLS)
- 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