Level of Care Level Of Care Requirements Level

Level of Care Level Of Care Requirements

Level of Care Objectives: Goal: To gain further understanding of Level of Care, and the associated business processes to meet this requirement After this module, participants will be able to: § Understand Level of Care (LOC) requirements § Review the Case Management Agency (CMA) and Eligibility Information Sharing form. § Read the LOC certification and find the necessary information for eligibility determinations § Perform accurate data entry on the Long-Term Care pages in CBMS

Spectrum of Care Alternative Care Facilities Long-Term Hospital Care More Skilled Care More Independence HCBS Nursing Facilities In-Home Services CCT

Level of Care Requirements LOC can be met in two ways: § Case Management Agency (CMA) assessment § Hospitalization period as part of 30 consecutive days of institutionalization/HCBS

CMAs Determine LOC Provide case management Provide case planning Provide referrals to other agencies Serve clients by county of residence Also known as the Single Entry Point or Community Centered Board

CMAs Visit Colorado. gov/HCPF to locate your CMA Search CMA

Waiver Activity! Log into Colorado. gov/HCPF and search for Waivers. Identify 5 interesting facts a out the waiver you have been assigned to research and provide a teach back to the group

Adult HCBS Waivers

Program of All-Inclusive Care for the Elderly (PACE) Medicare/Medicaid managed care program Provides frail individuals with comprehensive services based upon their needs Available Denver Metro, El Paso, Pueblo, Delta, Montrose, Weld and Larimer Counties

Children’s HCBS Waivers

Medical Institutions Should plan for 30 days to get paid Hospitals make referrals before discharge HCBS/PACE; OR Nursing Facility Nursing facilities make CMA referral At admit Prior to discharge

Eligibility Sites § Make referral to CMA upon receipt of application § Do not delay!

CMA and Eligibility Information Sharing Form

Assessment Process § Referral is sent to the Case Management Agency for assessment of Level of Care § Desk aid available on how to complete the form § www. colorado. gov/hcpf/long-term-services-and-supports-casemanagement-tools § Case Management Agency returns the results to the eligibility site

Long-Term Care Level of Care

PEAK LOC Cert

Assessment Process § Make sure you notify the Case Management Agency of either an approval or a denial § For approvals report eligibility date and income back to CMA

Level of Care Data Entry pages 30 Day Med Requires LTC Institution Summary Requires LTC Level Of Care Summary NF Requires LTC Institution Summary Requires LTC Level Of Care Summary HCBS Requires LTC Level Of Care Summary

Level of Care Data Entry Let’s enter the Level of Care

Level of Care Data Entry Important! § Remember to enter the end date. This is the date the certification is valid through § A re-assessment or certification is required annually on most HCBS cases § Nursing Facility stays usually have an open end date

LOC Certification

Note on Switching Waivers § When switching waivers or from HCBS to NF, remember that there can only be one med code per day

Level of Care Goal: To gain further understanding of Level of Care, and the associated business processes to meet this requirement Participants are now able to: § Understand Level of Care (LOC) requirements § Review Case Management Agency (CMA) and Eligibility Information Sharing Form § Read the LOC certification and find the necessary information for eligibility determinations § Perform accurate data entry on the Long-Term Care pages in CBMS

Questions?

LTC Institution Data Entry § Let’s walk through data entry of the Long Term Care Institution Page

LTC Institution Data Entry Status and National Provider ID: Ensure that the Status is Active and the ID number is populated.