Case Management & Service Coordination
Case Management & Service Coordination
An excerpt from a Texas OIG Audit on MCO Service Coordination
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For the purpose of these cases, HIPAA has been preserved.
For the purpose of these cases, HIPAA has been preserved.
Activities of service coordination need to be documented. Most importantly, demonstration of "linking" the member client to non-waiver or community-based services. Many MCOs employ nurses with geriatric experience and may lack the person-centered community-based case management training. As compared to LIDDA Service Coordinators, which do not need to be a registered nurse or hold LMSW certificate. They do need to have a bachelors in any of the social sciences or criminal justice programs; even though their job descriptions are very much the same in authorizing, linking, crisis prevention and monitoring of waiver Medicaid services. State compliance & audit teams are constantly looking for case management activities that demonstrate crisis prevention, advocacy, service planning, and linking to community based-services. Below is a real life case example, where the progress note's names and times have been changed. Progress notes should read like a "story" address Non-medical drivers of health (NMDOH).
Activities of service coordination need to be documented. Most importantly, demonstration of "linking" the member client to non-waiver or community-based services. Many MCOs employ nurses with geriatric experience and may lack the person-centered community-based case management training. As compared to LIDDA Service Coordinators, which do not need to be a registered nurse or hold LMSW certificate. They do need to have a bachelors in any of the social sciences or criminal justice programs; even though their job descriptions are very much the same in authorizing, linking, crisis prevention and monitoring of waiver Medicaid services. State compliance & audit teams are constantly looking for case management activities that demonstrate crisis prevention, advocacy, service planning, and linking to community based-services. Below is a real life case example, where the progress note's names and times have been changed. Progress notes should read like a "story" address Non-medical drivers of health (NMDOH).
Service Coordination Narrative (DAP Method)
Date: 04/22/2010
Time: 2:35pm -3:40pm
Client: Peter Smith
Location: LIDDA Office
Objective: To provide service coordination for crisis prevention and linking to community-based services.
Data: Client and his uncle John met with SC at LIDDA office as scheduled to complete HARP application. Currently Peter's mother has passed and he is having difficult to pay his mortgage. As we know Peter and his mother are receiving Social Security benefits and is their only income. SC had previously suggested to take advantage of HARP program to reduce mortgage rate and prevent foreclosure. The team logged on government website to complete application. Log in and password was documented and team agreed to keep written documentation in electronic health record. After filling out application, team learned that of needed documents of insurance and mortgage company information, along with pay off amount of home. Team decided to meet next week in person to complete the application once documentation has been gathered. Peter was in agreement.
Team also discussed of perhaps bringing in a roommate to offset living costs.
Assessment: Deferred.
Plan: Peter and service planning team (SPT) agreed to meet next Tuesday 4/29/2010 at 3:30pm at LIDDA office. Team will bring requested items of insurance, mortgage info, and pay off amount. Team will complete HARP application to prevent homelessness. Team will also discuss how to bring in roommate in next meeting. End of documentation.
My Background: I have a background in case management, specifically with child adolescent BH and IDD service coordination with Medicaid waivers. Years of Texas surveys, audits, and certifications has given me the KSAs to bullet proof case management programing. Concurrent reporting and noting activities that correlate to a person centered plan is essential. Such documentation should identify the person centered practice of what is important to and for the individual. Your documented activities should be in concert with items identified in the plan; such as advocacy, monitoring, linking, and crisis prevention. These micro activities in care coordination is healthcare equity in action.
Take time to review your notes for healthcare disparities and inequities. Equity should be viewed as a tool to minimize plan risk, hence a macro retention activity to market share. I've seen case management programs crumble to due to non-compliance and even losing market share to a competitor. As in the above OIG case, the MCO has lost RFP contracts due to risk.
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