Self-Directed Community Benefits HSD/MAD/SDCB

Transcript:Self-Directed Community Benefits HSD/MAD/SDCB:
Self-Directed Community Benefits HSD/MAD/SDCB August 12, 2014 Resources Where to Find Information Community Benefit Rules 8.308.12 NMAC http://www.hsd.state.nm.us/providers/rules-nm-administrative-code-.aspx Centennial Care Policy Manual – SDCB Section http://www.hsd.state.nm.us/providers/managed-care-policy-manual.aspx Centennial Care Contract PSC 13-630-8000-0021 2 Community Benefits To be eligible for Community Benefits, a member must: be determined as a CCL2 or a CCL3 (Care Coordination Level); and have at least one Full Medicaid Category of Eligibility (COE); and have a current Nursing Facility Level of Care (NFLOC); and be assessed to need the Community Benefits. Centennial Care Contract section 4.5.7.1 8.308.12.10 NMAC 3 Care Coordinators and Support Brokers Every SDCB member must have a Care Coordinator (CC) and a Support Broker (SB). Both are equally responsible for ensuring that the member is successful in SDCB. Some duties are similar. It is the MCO’s responsibility to have internal policies to ensure that tasks are not duplicated. The CC and SB must work hand-in-hand to ensure the member’s needs are met. 4 Other SDCB Entities Every SDCB member must have an Employer of Record (EOR) to submit requests for payment. The Financial Management Agency (FMA) for SDCB is Xerox. The FMA subcontracts with TNT to process payroll and vendor payments. The FMA subcontracts with FOCoSonline to provide a web-based computer system for SDCB tracking. The Income Support Division (HSD/ISD) completes the financial eligibility for Community Benefits. ASPEN is HSD/ISD eligibility system. Omnicaid is HSD/MAD’s Medicaid system. 5 Member Responsibilities Members must have a solid understanding of the SDCB program, prior to enrolling in the SDCB. Members must cooperate with the CC and SB in order to utilize the SDCB program. Members must understand the consequences of not complying with the SDCB rules. Members must not rely on the CC and SB to manage their SDCB program. CCs and SBs are not Case Managers. SDCB is not for everyone. 6 Care Coordinator Responsibilities (pg 1) Conducts Comprehensive Needs Assessment (CNA) and Nursing Facility Level of Care (NFLOC) assessment During CNA/NFLOC, explains to member: 120 day mandatory enrollment in Agency-Based Community Benefits (ABCB) roles & responsibilities of member and Employer of Record (EOR), employees/vendors working relationship between the Support Broker (SB) and Care Coordinator (CC) what SDCB is, and how it works 7 Care Coordinator Responsibilities (pg 2) After initial SDCB discussion and member decides to transfer to SDCB, the CC: Obtains signed SDCB statement from member Provides the SBA Selection Form to member Sends SBA