A Service Facilitator Of Lucy Hill Services

A designated office within the state agency is responsible for coordinating, scheduling, and facilitating appeals for Medicaid beneficiaries. All appeals are heard by an impartial hearing officer employed by or on contract with the Agency. The designated office handles the appeals process from receipt of the request from a beneficiary/client through the final administrative decision. During the hearing process, the designated office is responsible for ensuring that the use or disclosure of beneficiary information is in compliance with federal law (HIPAA), state law and Division of Medicaid policies, and procedures regarding the safeguarding of beneficiary information.

Documentation and communication are constant challenges that healthcare providers face when seeking continuity of care for their patients. Every time a patient moves from a hospital to a nursing home, or from a skilled nursing facility to home health or hospice, the staff that cares for the patient is at risk for a gap in patient care and communication. Home health and hospice agencies rely heavily on Medicaid and other insurance for reimbursements in order to continue to provide care for their patients and keep the doors to their agencies open. Thorough and timely documentation is the key to ensuring proper reimbursement for nursing services and other therapies provided from insurance agencies. This same

Mr. Williams submitted his application for Medicaid benefits on August 5, 2015. The Gulfport Regional Office (RO) forwarded a Disability and Blindness Report to Disability Determination Services (DDS), who has the responsibility of making disability decisions for the Division of Medicaid (DOM), on August 13, 2015. DDS notified the RO on October 16, 2015, that Mr. Williams was not disabled for Medicaid purposes. The RO issued a Notice of Adverse Action on October 23, 2015.

On 9/15/2016, CM met with the client for Bi-Weekly ILP Review. Client was dressed appropriately for the weather. She was well groomed. As usual client in the meeting was loquacious, and loud. Client continues to be hostile towards this worker. Client continues to repeat to this worker as quote: "I am not mad with you, and this has nothing to do with you. It's all about DHS and your supervisor." Client was hostile due to an Authorization of Release Form client signed for staff to contact her therapist Dr. Iris Yankelevich for a copy of the client psychosocial and psychiatrist evaluations. Client continues to report that she didn’t signed the Authorization of Release Form because the form stated that the form is for HRA 2010e and she doesn’t know how many time she need to repeat herself that she doesn’t meet the ‘CRITERAI FOR SRO”. CM tries to explain to the client that staff is requesting a copy of her psychosocial and psychiatrist evaluation, but then client continue to talk over CM and threat to contact the Coalition and DHS. Client continues to set in her way and refuses to work with staff to meet her unmet needs. CM observed that the client walk with a book bags and a small shopping cart. Client reported she walk with all her documents and letters from Adult Protective Services & Social Security Administration stating that she is capable of living independently.

Medical: Ms. Williams failed to submit her medical documentation. Ms. Williams is expected to submit her medical evaluation or physical by 03/2017. Case Manager explained to Ms. Williams that if she failed to submit the documents required she would be considered as non-compliance.

CCIB received a Corrective Plan of Action (CAP) detailing the visit to the home on 10/18/17 by Service Coordinator, Sally Cano. Ms. Cano arrived at the home, but no one was there. Ms. Cano proceeded to check Delta Home 3 (located next door) and found 2 of Delta Home Care IV residents along with residents from Delta Home Care 3 at the home. As Ms. Cano was leaving, she observed a bus arrive at the Delta Home Care 2. The bus driver reported that there was no staff at the home and that the residents were waiting outside. It was observed the Delta Home Care 2, 3, and IV to be lacking staff. On 10/19/17, RP and Quality Assurance specialist (QAS) Jesus Ozeda went to the facility to observe the staff to resident ratios and to collect the staff schedules

On September 21, 2012, ACEDS Case Action Update/Display documented by Social Service Representative, Richard Gordon stated that Ms. Williams arrived to the agency to apply for Supplmental Nutrition Assistance Program (SNAP) benefits, and Medicaid for her child only. During the visit, CARE interface revealed that Ms. Williams had an open Medicaid case in Maryland (#47403882500). Maryland Social Services also reported that she was employed by CPR Medical as of August 9, 2012, and paid bi-weekly $850.00. Ms. Williams also reportedly received unearned monthly income from SSI in September 2012 in the amount of $440.34, and in October 2012, in the amount of $370.54. As a result, Ms. Williams was denied expedited Foodstamps pending paystubs and her application was marked as "pending."

The first author of the article, Medicaid Funding for Assisted Living Care: A Five-State Examination, is Eric Carlson. Carlson is the directing attorney under the National Senior Citizens Law Center (NSCLC). He graduated summa cum luade from the University of Minnesota, and obtained his law degree from Boalt Hall School of Law at the University of California Berkeley. Most of his career has been spent advocating for older adults in nursing homes and assisted living facilities. Carlson is very knowledgeable on these topics, and frequently presents to other attorneys and social workers at conferences nation-wide about these issues (NSCLC).

I sent the forms to the member on 06/06/2016 as per request but she doesn’t want to fill them out. She went to the Medicaid office (115 Chrystie St., NY, NY 10002) on Wednesday June 8,2016 and they informed that her case is being handle and not further documentation is needed. Medicaid Office gave this case # 0237738221E. That’s the reason why she doesn’t want to fill out further documentation.

Ms. Pollard wanted to know when Javon'Tay would receive the DD waiver. ISC explained the process, than she asked about receiving a case manager. She said she was told by the other lady he would receive a case manager, which would take him out to his appointments and take him places.

Carla, you have shown knowledge of Department policies and procedures and pose questions when concerns arise. You have shown an understanding and practice of HIPAA laws as is evident in your ability to remain confidential with all investigations. Carla, you have shown knowledge of the Department’s goals and also Division programs as evidenced by your investigative plans and requests for HCBS. You also have shown you have knowledge of the state statutes, rules and regulations as they relate to abuse/neglect/exploitation also evidenced by your investigative plans. Throughout your hotline investigations, you have shown that you are able to identify eligible adults and risks, formulate intervention plans, ask appropriate questions during interviews

Tara informed me that she has over 20 years of experience in the behavioral health field. Tara stated she started out working at a home health agency that worked with the geriatric population. Tara is a Behavioral Health Technician, and holds a High Needs Case Manager position with Southwest Network. Tara explained that Southwest Network provided counseling services, medication management, and various behavioral health services to adults and children. In Tara’s role she works primary with children with high behavioral needs. Tara main role as a case manager is to be the liaison for the agency in regards to the behavioral health services with the child’s team or family. Tara explains although she does not do the initial assessments she with the clients she does complete annual assessments to determine if the services the child is receiving are appropriate; while making changes if necessary. Tara explained Southwest Network is funded by Mercy Maricopa Integrated Care (MMIC). MMIC makes the determination on if and when a client will receive services. If there is a case where a child is having major behaviors Tara can complete an assessment and request for a behavioral coach. MMIC is able to approve or deny the request based off the data Tara provides to them. Subsequently, if a child is not doing well in their home and the family or team is looking at a high level of inpatient care this too has to be approve. Tara would submitted a packet with supporting documentation to MMIC. MMIC again as the ability to approve or deny this request. Tara is also responsible for filing appeals when cases are denied for services. Tara would work with the child’s family or team to ensure the child is getting the services they need to be able to function within their daily

I- CM inquired if client received a phone from LA Family Housing to schedule a CES assessment appointment. CM inquired if client visited the Bob Hope Patriotic Hall to fill out VA claims for service connected disabilities, and to start his “Veteran” California Driver’s License application process. CM informed client the procedures of referring him to dental. CM conducted a 90 day ISP with client. CM continued to inquire if client was interested in creating a savings plan. CM continued to assess client’s mental health and medication compliance

SSA received a phone call from Verna Goecke-PRPV inquiring if the Bond family was aware of Katlyn’s discharge from the facility. She stated that she had not heard from Mr. Bond regarding the discharge notice and according to Katlyn she had not discussed the discharge arrangements with her parents. SSA shared that two messages had been left on Karen Kohn’s cell phone. We discussed that in the event the family did not arrive to the meeting location this morning, PRPV was willing to transport Katlyn to the family home. Verna asked SSA to email the family’s home address in the even they needed to transport Katlyn to the home.

Kellie Shelton’s inability to complete F2F visits within the allotted time frames put Senior’s at risk. Seniors were put in an extreme vulnerable risk when home visits were not completed. Kellie Shelton’s lack of completing documentation in case compass, gathering evidence to prove/disapprove the allegations and the inability to follow up and complete cases within 60th calendar day put Seniors at risk. There were times when the lack of information in case compass was missing which place the RA at risk