Adult Medical Behavioral Anchors



Adult Medical Behavioral Anchors

ATTITUDE

Acceptance of feedback from FTS/Supervisor/Trainers - Evaluates the way worker accepts trainer’s criticism and how the feedback is used to further the learning process and improving performance

Unacceptable or Rating of 1 – Rationalizes mistakes, denies that errors were made, is argumentative, refuses to or does not attempt to make corrections. Considers criticism as a personal attack.

Acceptable or Rating of 3 – Accepts criticism in a positive manner and applies it to improve performance and further learning.

Superior or Rating of 5 – Actively solicits criticism/feedback in order to further learning and improve performance. Does not argue or blame others for errors.

Attitude toward Family Support Services – Evaluates how worker views new career in terms of personal motivation, goals, organization, and acceptance of responsibilities of the job.

Unacceptable or Rating of 1 – Sees career only as a job, uses job to boost ego, abuses authority, demonstrates little dedication to the principles of the profession.

Acceptable or Rating of 3 – Demonstrates an active interest in new career and in casework responsibilities, demonstrates dedication to the principles of the profession.

Superior or Rating of 5 – Utilizes off-duty time to further professional knowledge, actively soliciting assistance from others to increase knowledge and improve skills. Demonstrates concern for engaging in best casework practice and maintains the high ideals in terms of professional responsibilities and principles.

RELATIONSHIPS

Attitude toward the family and/or vunerable adult(s) served by CFC - Evaluates the worker’s ability to interact with families and individuals in an appropriate and efficient manner; working in partnership with the family, involving then in problem solving, recognizing their right and capacity to be decision makers in realizing an improved quality of life.

Unacceptable or Rating of 1 – Abrupt, belligerent, overbearing, arrogant, uncommunicative. Overlooks or avoids “service” aspects of the job. Exhibits traits of an authoritarian: rigid, black and white thinker, racist, hierarchical, power motivated, or overly empathetic, over-accommodating, etc. Dictates plan to the family and/or vulnerable adult(s) and does not involve them in problem solving; turns them away with no services or any attempt at referral for services; does not identify any family strengths; displays a condescending attitude toward the family and/or vulnerable adult(s)s and their concerns; and focuses only on the presenting concern(s) without consideration of other interventions.

Acceptable or Rating of 3 – Courteous, friendly and empathetic. Communicates in a professional, unbiased manner. Is service oriented. Generally acceptable “non-verbal” skills. Actively listens to the family and/or vulnerable adult(s) while keeping a good rapport; shows respect toward them; generally engages them in problem solving; makes referrals to appropriate community partners and usually explores creative alternatives; does not run up the ladder of inference to make assumptions regarding those being served; considers other standard needs of the family and/or vulnerable adult(s) beyond the presenting concern.

Superior or Rating of 5 – Is very much at ease with clients. Quickly establishes rapport and leaves people with the feeling that the worker was interested in helping them. Is objective in all contacts. Excellent “non-verbal” skills. Encourages the family and/or vulnerable adult(s) to assume ownership of problem solving; actively listens to them and responds appropriately; approaches them with respect and honesty at all times; utilizes creativity in exploring all avenues to achieve positive outcomes with the family and/or vulnerable adult(s); exhibits masterful knowledge of available community resources to meet their needs; takes a holistic approach to the assessment of the needs of the family and/or vulnerable adult(s) by focusing on their strengths; actively engages them in creating a road map for their future, based upon attainable outcomes.

Relationship with Cultural Groups, other than one’s own – Evaluates the worker’s ability to interact with members of ethnic or racial groups other than own (including ethnic, racial, religious, sexual orientation, and socio-economic), in an appropriate manner

Unacceptable or Rating of 1 – Is hostile or overly sympathetic. Is prejudicial, subjective and biased. Treats members in this grouping differently than members of his/her own group.

Acceptable or Rating of 3 – Is at ease with members of other groups. Serves their needs objectively and with concern. Does not feel ill at ease in their presence.

Superior or Rating of 5 – Understands the various cultural differences and uses this understanding to competently resolve situations and problems. Is totally objective and communicates in a manner that furthers mutual understanding.

5. Relationship with other Cabinet personnel and community partners – Evaluates worker’s ability to effectively interact with other co-workers and partners in various positions and in various capacities. Identifying the key partners, involving others in moving the family and/or vulnerable adult(s) toward targeted outcomes, engaging them as a full partner.

Unacceptable or Rating of 1 – Patronizes or is antagonistic toward other Cabinet and Department members. Gossips. Is insubordinate, argumentative, sarcastic. Resists instructions. Considers self superior. Belittles others. Is not a team player. Fawns on others. . Does not view or engage the family and/or vulnerable adult(s)s as allies in moving them toward targeted outcomes; does not identify key partners (including other Cabinet and community partners) and/or keep them connected; is reluctant to share information with other partners; and does not acclimate the family and/or vulnerable adult(s) to the team approach to problem solving.

Acceptable or Rating of 3 – Respectful of other Cabinet personnel and community partners. Accepts role in the organization. Good peer and FTS relationships. Is accepted as a group member. Generally involves the family and/or vulnerable adult(s) and Cabinet and community partners as allies in moving toward targeted outcomes; identifies obvious partners but may fail to identify other potential key partners; utilizes conflict resolution methods and problem solving techniques appropriately; makes efforts to acclimate the family and/or vulnerable adult(s) to the team approach toward problem solving but does not check for acceptance.

Superior or Rating of 5 – Is at ease in contact with all Cabinet and Department staff, including superiors. Understands superiors’ responsibilities. Respects and supports their position. Peer group leader. Actively assists others. Consistently embraces the family and/or vulnerable adult(s) and Cabinet and community partners as allies in moving toward targeted outcomes; is highly effective in identifying key partners (including other Cabinet and community partners) and keeping them connected; and assures that the family and/or vulnerable adult(s) is/are acclimated to the team approach to problems; and utilizes conflict resolution methods and problem solving techniques appropriately.

6. Focuses on Cabinet outcomes rather than programmatic issues.

Unacceptable or Rating of 1 – Provides only programmatic services without regard to Cabinet outcomes; considers providing program services as entire purpose of job; and does not seek to understand what issues brought the client to the Cabinet or what steps are required to achieve targeted outcomes.

Acceptable or Rating of 3 – Provides programmatic services and generally understands the need for a holistic approach to providing services; regularly partners with client to identify targeted outcomes and plan an approach to achieve those outcomes.

Superior or Rating of 5 – Understands the need for a holistic, comprehensive approach to providing services which will lead to success in achieving Cabinet outcomes; consistently involves others in planning and providing/referring for services; and understands long term client goals and the need for partnering.

7. Working with Resistant Clients – Evaluates the worker’s ability to deal effectively with resistant clients by remaining calm and respectful, with an understanding but authoritative manner.

Unacceptable or Rating of 1 – Cannot deal effectively with a resistant client. Does not remain calm, understanding, respectful but authoritative. Manner and actions tend to make resistant clients even more resistant. Provokes non-resistant clients to become resistant.

Acceptable or Rating of 3 – Can generally deal effectively with a resistant client by remaining calm, understanding, respectful but authoritative. Manner and actions tend to make resistant clients less resistant. Actions do not provoke non-resistant clients.

Superior or Rating of 5 – Deals very effectively with resistant client by remaining calm, understanding, respectful but authoritative. Manner and actions make resistant clients cooperative. Actions do not provoke non-resistant clients.

8. Engaging Interviews: Establishes rapport and creates a safe dialogue environment which welcomes the client and provides trust, respect and assurance. Shows empathy. Employs open-ended questions and probing follow-up questions. Utilizes active listening skills. Welcomes family as an equal member of the team while creating a safe, empowering environment which promotes outcome based results.

Unacceptable or Rating of 1 – Cannot establish rapport. Questions client only about programmatic issues; asks closed-ended questions and rushes through communication; does not utilize active listening techniques; fails to create a safe dialogue environment; sees service to the family as just a job duty; runs up the ladder of inference in judgment of the family; and perpetuates the stereotype of uncaring bureaucratic government agencies. Does not show empathy or respect.

Acceptable or Rating of 3 – Has a repertoire of tools to establish rapport and does so appropriately, given the context of the situation. Can generally establish rapport with the family and/or vulnerable adult(s). Utilizes a combination of open- and closed-end questions; allows the client(s) to fully express themselves during the interview process. Takes time during the interview to question beyond the scope of the presenting issue and to fully listen to and respond to the family’s concerns; understands and utilizes the dialogue model; generally employs active listening techniques. Sees the family as a partner in the problem solving progress; creates a safe, welcoming environment which encourages participation from the family and/or vulnerable adult(s)s; suspends judgments while facilitating them through assessments. Shows empathy and respect.

Superior or Rating of 5 - has a repertoire of tools to establish rapport and does so with great skill. Welcomes the client and creates a safe welcoming environment from the beginning of the interview; allows the client to fully express concerns, questions, opinions and suggestions; recognizes the family is a full partner in the problem solving progress; encourages participation from the family; takes notes in a non-distracting manner; exhibits respect and honesty; always employs active listening techniques and asks a combination of open- and closed-ended questions; asks probing follow-up questions and restates the client’s points for clarification; understands and utilizes the dialogue model; effectively utilizes “I” statements; suspends judgments while facilitating the family through assessments; takes whatever time is required to fully listen to and respond to the family’s concerns; acknowledges and encourages family’s contributions and celebrates successes with the family. Shows great empathy and respect.

9. Accountability: Follow up and ensuring tasks are completed and team remains focused on outcomes. Follow through on responsibilities and communications.

Unacceptable or Rating of 1 – Feels accountable only for meeting program requirement deadlines; fails to keep client and others informed of case progress and often blames others for lack of progress; does not adhere to timelines standard s and acts with no sense of urgency; and makes promises that are unrealistic and offers excuses when promises cannot be kept.

Acceptable or Rating of 3 – Accepts accountability for actions; is willing to accept occasional leadership roles on project teams and generally follows through on assigned tasks; attempts to keep expectations realistic; adheres to timelines standards and acts with a sense of urgency when called for; and usually keeps others informed of actions.

Superior or Rating of 5 – Fully accepts accountability for actions and consistently follows through on tasks; readily accepts leadership roles on project teams; keeps others fully informed of progress; sets realistic expectations for self and others; always adheres to timelines standards and acts with a sense of urgency when called for; and accepts responsibility for completion of tasks.

SAFETY

10. Protection – Evaluates the worker’s ability to identify actions workers can take in the field and in the office to protect themselves.

Unacceptable or Rating of 1 – Does not know actions to take in the field or in the office to protect themselves. Does not use these precautions when making home visits or when meeting clients at the office. Puts themselves and others at risk.

Acceptable or Rating of 3 – Can articulate actions to take in the field and in the office to protect themselves. Uses these precautions when making home visits or meeting clients in the office. Rarely puts themselves or others at risk.

Superior or Rating of 5 - Can articulate actions to take in the field and in the office to protect themselves. Diligently uses these precautions when making home visits or meeting clients in the office. Extremely skilled in avoiding conflict and calming clients.

ADULT MEDICAL PROGRAMMIC BEHAVIORAL ANCHORS

APPLICATION PROCESS

11. Application Process—Evaluates the participant’s ability to conduct a timely application interview, protect the client’s application date, establish case name/number, determine the proper category of assistance, and allow appropriate authorized representatives.

Unacceptable or Rating of 1 - Fails to conduct client interview timely. Fails to protect the client’s application date. Fails to refer potential SSI recipients to SSA to apply for benefits. Establishes incorrect case number. Fails to complete hard copy application when KAMES is not available. Fails to complete a PA 62 document for SSI only and SSI Alert recipients. Fails to approve or deny applications within processing time frames.

Acceptable or Rating of 3 - Conducts interviews timely and protects client’s application date. Follows correct procedures for application processing. Follows correct procedures for making a referral to SSA for potentially eligible SSI recipients. Establishes a correct case number. Completes hard copy applications when KAMES is not available. Completes a PA 62 document for SSI Alert and SSI only recipients. Approves and denies within processing time frames.

Superior or Rating of 5 - Always conducts a timely interview and protects client’s application date. Always follows correct procedures for application processing. Maintains communication with co-workers who possess companion cases. Maintains correct procedure for making an SSI referral to SSA for potentially eligible recipients. Works applications as soon as possible after receiving complete verification, so that client notification is timely and accurate. Always completes hard copy applications and PA 62 documents when appropriate. Always determine the proper category of assistance. Demonstrates willingness to assist co-workers at any time when their own work is completed.

TECHNICAL ELIGIBILITY

12. Aged, Blind, and Disabled—Evaluates the ability of the participants to verify and establish that all applicants meet at least one of these criteria for eligibility.

Unacceptable or Rating of 1 - Fails to verify that the client is either aged, blind, or disabled. Fails to determine the correct category code of assistance for SSI and non-SSI clients. Fails to initiate a MRT referral when a field determination of blindness or disability cannot be made. Fails to make a correct field determination of blindness or disability.

Acceptable or Rating of 3 - Verifies that the client is either aged, blind, or disabled. Determines the correct category code of assistance for SSI and non-SSI clients. Makes a correct field determination of blindness or disability. Initiates a MRT referral when a field determination of blindness or disability cannot be made. Completes KAMES screens correctly.

Superior or Rating of 5 - Always verifies that the client is aged, blind, or disabled. Always determines the correct category code of assistance for each client. Initiates all MRT referrals correctly and timely. Consistently follows procedures when making field determinations.

13. Enumeration, Residency, and Citizenship—Evaluates the ability of the participant to verify and apply the element of enumeration, residency and citizenship.

Unacceptable or Rating of 1 - Fails to enumerate the client and other possible members. Fails to accept the client’s statement of residency unless the worker has doubts. Fails to question the client sufficiently about citizenship and applies incorrect policy. Denies Medicaid eligible non-citizens. Approves Medicaid ineligible non-citizen.

Acceptable or Rating of 3 is defined as: Can complete enumeration, residency and citizenship elements correctly. Complete KAMES screens and PA 62 documents correctly.

Superior or Rating of 5 - Always completes and verifies enumeration, residency and citizenship correctly.

14. Third Party Liability (TPL) and KHIPP—Evaluates the ability of the caseworker to determine when to apply the elements of Third Party Liability and the Kentucky Health Insurance Premium Payment program.

Unacceptable or Rating of 1 - Incorrectly applies the policies regarding Third Party Liability and KHIPP. Fails to verify cooperation with KHIPP. Fails to use the correct forms to verify TPL and KHIPP.

Acceptable or Rating of 3 - Can apply the correct policy regarding Third Party Liability and KHIPP. Completes the correct forms to verify TPL and KHIPP.

Superior or Rating of 5 - Always applies the correct policy verifying client cooperation with TPL and KHIPP.

FINANCIAL ELIGIBILITY

15. Resources—Evaluates the caseworker’s ability to consider resources appropriately including: the use of resource limits, liquid assets, annuities, vehicles, excluded resources, burial reserve policy and trusts.

Unacceptable or Rating of 1 - Fails to question client or authorized representative thoroughly regarding all resources of the client and spouse/parents. Fails to determine which resources are countable and which are excluded. Unsure of correct resource limits for specific categories of assistance. Answers KAMES related questions inappropriately. Incorrectly considers resources as income.

Acceptable or Rating of 3 - Can apply resource policy correctly for all categories of assistance. Questions clients or authorized representative about all resources. Completes all related KAMES screens with correct resource information. Obtains complete verification and documentation of all resources. Does not confuse resources with income.

Superior or Rating of 5 - Always considers all resources correctly. Thoroughly questions the client or authorized representative about the resources of the client and spouse/parents. Always consider the correct resource limit for each specific category of assistance. Consistently obtains complete verification and documentation of all resources. Always differentiates between countable and excluded resources. Never considers resources as income.

16. Income—Evaluates the caseworker’s ability to correctly consider all income of the client and spouse/parents if appropriate, apply appropriate gross and net income limits, average and convert income when needed, classify income as countable, excluded, earned or unearned, correctly enter income onto the KAMES and PA 62 systems, and to properly verify all income and document the case accordingly.

Unacceptable or Rating of 1 - Fails to question the client or authorized representative thoroughly regarding all income of the client and spouse/parents if applicable. Fails to differentiate between income as countable or excluded, earned or unearned. Fails to consider types of income correctly. Fails to average and convert income correctly. Fails to use calculation codes and “same for” lines correctly. Fails to correctly verify income, and document how it is being considered. Considers resources as income.

Acceptable or Rating of 3 - Can consider countable and excluded income correctly. Questions the client or authorized representative regarding income received by the client and spouse/parents. Can determine whether income is earned or unearned. Properly averages and converts income correctly. Correctly averages and converts income when needed and enters it on the KAMES system using appropriate calculator codes and “same for” lines. Can enter income correctly on the PA 62 system. Verifies and documents all income. Considers all income as income, and not as a resource.

Superior or Rating of 5 - Always considers income correctly. Thoroughly questions the client or authorized representative regarding all income received by the client, and spouse/parents. Always considers earned/unearned, countable, and excluded income correctly. Consistently averages and converts income correctly when needed, and enters it on the KAMES system using appropriate calculation codes and “same for” lines. Always enters all income correctly on the PA 62 system when appropriate. Always verifies and documents the consideration of income in case comments. Always differentiates correctly between income and resources.

17. Self-Employment—Evaluates the caseworker’s ability to apply correct policy regarding the calculation and treatment of all types of self-employment including farm, non-farm and rental income, and to understand the definition of self-employment income.

Unacceptable or Rating of 1 - Cannot define self-employment. Considers self-employment as wages. Fails to conduct a thorough interview, which determines the existence of self-employment income. Fails to question the client about the possible costs/deductions related to self-employment income. Fails to verify and consider all sources of self-employment/farm income. Fails to complete correctly the self-employment screens on KAMES. Fails to verify all deductions associated with the self-employment income.

Acceptable or Rating of 3 - Can define self-employment income. Considers self-employment income correctly, and completes appropriate KAMES screens. Questions client or authorized representative regarding self-employment income and deductions. Properly verifies and documents self-employment income.

Superior or Rating of 5 - Defines self-employment income, and how it differs from other income types. Always considers self-employment income correctly. Always completes self-employment income screens correctly on KAMES. Thoroughly questions the client or authorized representative regarding self-employment income and deductions (expenses). Consistently verifies and documents self-employment income.

18. Relative Responsibility—Evaluates the caseworker’s ability to apply the correct policy regarding the income and resources for spouses living together, spouses living apart, or couples in LTC (long term care), or a blind or disabled child living with their parents.

Unacceptable or Rating of 1 - Fails to count, or incorrectly considers the income and resources for both spouses when both are technically eligible and living together. Fails to count the income and resources of the spouse or parent(s) during the month of separation when: spouses live apart or the couple is in LTC, or the blind or disabled child is living with parent(s). Continues to consider the spouse or parent(s) income in the month after separation and ongoing, when the individual or blind/disabled child is in LTC.

Acceptable or Rating of 3 - Correctly considers the income and resources for both spouses when both are technically eligible and living together. Count the income and resources of the spouse or parent(s) during the month of separation when: spouses live apart or the couple is in LTC, or the blind or disabled child is living with parent(s). Removes from consideration the spouse’s or parent(s) income in the month after separation and ongoing, when the individual or blind/disabled child is in LTC.

Superior or Rating of 5 - Correctly and consistently considers the income and resources for both spouses when both are technically eligible and living together. Correctly and consistently counts the income and resources of the spouse or parent(s) during the month of separation when: spouses live apart or the couple is in LTC, or the blind or disabled child is living with parent(s). Removes from consideration the spouse’s or parent(s) income in the month after separation and ongoing, when the individual or blind/disabled child is in LTC.

19. Spend Down—Evaluates the caseworker’s ability to determine “time limited” Medicaid eligibility for clients who are both technical and resource eligible, but exceed the income limit for regular Medicaid.

Unacceptable or Rating of 1 - Fails to verify that the client is technically and resource eligible. Fails to determine which type of spend down is most beneficial to the client, retroactive or current quarter. Uses paid bills incorrectly to meet the spend down excess. Fails to obtain unpaid itemized bills to verify medical expenses, or does not verify amounts still owed on old bills. Fails to follow special procedures for renal dialysis patients. Fails to consider allowable spend down medical expenses.

Acceptable or Rating of 3 - Verifies that the client meets technical and resource criteria. The participant can use program “3J” to work cases before entering them on KAMES. Properly determines what type of spend down is most beneficial. Obtains unpaid, itemized bills to verify medical expenses, and verifies amounts owed on old bills. Follows special procedures for renal dialysis patients. Considers allowable spend down medical expenses.

Superior or Rating of 5 - Always verifies technical and resource eligibility. Consistently uses program “3J” to work the case before entering it on KAMES. Explores all options to determine which type of spend down case is most beneficial to the client. Always obtains the proper itemized bills to verify medical expenses, and verifies the current amounts owed on old bills. Applies the special procedures for renal dialysis patients in a timely manner. Consistently enters spend down cases correctly on KAMES.

20. Companion Cases — Evaluates the caseworker’s ability to use a PA 1B (companion case) work sheet to determine whether it is more beneficial for companion Medicaid cases as opposed to one family related case.

Unacceptable or Rating of 1 - Fails to use a PA 1B work sheet to determine which type of Medicaid case(s) are most beneficial to the client and their family.

Acceptable or Rating of 3 - Can use a PA 1B work sheet to determine which type of Medicaid case(s) is most beneficial to the client and their family.

Superior or Rating of 5 - Always uses a PA 1B work sheet to determine which type of Medicaid case(s) is most beneficial to the client and their family.

21. QMB, QDWI, SLMB, QI-1 (Z cases)—Evaluates the caseworker’s ability to determine in which “Z” case program the client meets the eligibility requirements.

Unacceptable or Rating of 1 - Fails to verify the client’s receipt of Medicare Part A or B or both. Fails to verify the client’s SMI premium expense. Fails to verify client’s income, and does not apply “relative responsibility” rules for considering the spouse’s income. Does not verify retroactive resources for all programs other than QMB. Incorrectly enters the case on KAMES.

Acceptable or Rating of 3 - Verifies the client’s receipt of Medicare Parts A and B, and the SMI premium expense. Verifies the client’s income and correctly applies “relative responsibility” rules for spouse’s income. Verifies prior three months resources to make a correct retroactive determination for all programs other than QMB. Correctly enters the case on KAMES.

Superior or Rating of 5 - Always verifies the client is in receipt of Medicare Parts A and B or both, and the expense for the SMI premium. Can explain and apply the rules of “relative responsibility” for the spouse’s income. Always verifies the prior three months resources to make a correct retroactive determination. Applies all “Z” case program policy correctly. Always enters the case correctly on KAMES.

22. Pass Through—Evaluates the caseworker’s ability to evaluate RDDI beneficiaries on-going medicaid eligibility for former SSI or SSA recipients by verifying whether they meet one of five criteria.

Unacceptable or Rating of 1 - Cannot evaluate potential Pass Through eligibility. Fails to complete and send the PA 9 to SSA to verify that the client meets one of the five criteria. Incorrectly enters cases in the wrong categories on KAMES. Fails to use the PA 1A, Supplement A work sheet (Pass Through Computation Sheet) to verify the client’s eligibility, and cannot calculate the Pass Through amount. Fails to verify the client’s RSDI income. Cannot explain the Pickle Amendment letter.

Acceptable or Rating of 3 - Evaluates individuals for potential Pass Through eligibility. Completes and sends PA-9 to SSA to verify Pass Through eligibility. Completes the PA 1A, supplement A to verify the client’s eligibility, and calculate the Pass Through amount. Verifies the client’s RSDI income, via PA-9. Enters the correct category on KAMES. Explains the Pickle Amendment Letter to applicants.

Superior or Rating of 5 - Evaluates individuals for potential Pass Through eligibility. Completes and sends PA-9 to SSA to verify Pass Through eligibility. Completes the PA 1A, supplement A to verify the client’s eligibility, and calculate the Pass Through amount. Verifies the client’s RSDI income, via PA-9. Enters the correct category on KAMES. Explains the Pass Through program and eligibility criteria to applicants, in addition to the Pickle Amendment Letter.

23. State Supplementation—Evaluates the caseworker’s ability to explain and work state supplementation cases which prevent institutionalization of the client by providing care for clients in either a licensed personal care home (PCH), licensed family care home (FCH), or caretaker services (CS) in their own home.

Unacceptable or Rating of 1 - Fails to explain the program and the benefits it provides. Fails to obtain verification of the client’s income and resources. Cannot apply special SSP relative responsibility rules and calculations for couples. Enters SSI recipient cases incorrectly on PA 62 system. Enters non-SSI cases incorrectly on KAMES. Fails to understand and explain potential dual eligibility.

Acceptable or Rating of 3 - Explains the program and the benefits it provides. Obtains verification and documentation of all income and resources. Correctly applies special SSP relative responsibility rules and calculations for couples. Enters cases correctly on KAMES and the PA 62 system. Explains dual eligibility to clients.

Superior or Rating of 5 - Consistently explains the program and the benefits it provides. Consistently verifies and documents all income and resources. Correctly completes all forms and work sheets. Correctly and consistently applies special SSP relative responsibility rules and calculations for couples. Consistently enters all cases correctly on KAMES or the PA 62 system, depending on SSI status. Completely explains “dual eligibility” to applicants.

24. Long Term Care (LTC)—Evaluates the caseworker’s ability to understand, explain, and work each Long Term Care program which includes: LTC, Hospice, Home and Community Based Services, Acquired Brain Injury Waiver Program, and supports for Community Living.

Unacceptable or Rating of 1 - Fails to verify that the client meets the “level of care.” Applies income and resource standards incorrectly. Fails to consider community spouse allowances and family allowances when appropriate. Cannot apply special LTC relative responsibility rules and calculations for couples. . Fails to provide fact sheets to clients. Fails to complete work sheets and mandatory forms. Fails to understand and implement the policy and procedures governing LTC programs. Fails to address and initiate estate recovery when appropriate. Fails to consider transfer of resources policy. Fails to report LTC admission of SSI only and SSI alert clients to SSA. Fails to thoroughly verify and document all income and resources. Fails to enter cases correctly on KAMES or the PA 62 system.

Acceptable or Rating of 3 - Verifies that the client meets the “level of care” standard. Will request appropriate verification and documentation of all income and resources. Correctly applies special LTC relative responsibility rules and calculations for couples and community spouses. Correctly considers spouse’s resources. Correctly applies the policy and procedures governing all LTC programs. Completes work sheets and mandatory forms. Considers estate recovery policy when appropriate. Reports LTC admission to SSA when appropriate. Enters verification correctly on the KAMES and PA 62 systems.

Superior or Rating of 5 - Always verifies that the client meets the “level of care” standard. Consistently requests appropriate verification and documentation of all income and resources. Consistently applies community spouse allowances and family allowances as appropriate. Correctly and consistently considers spouse’s resources, and completes a Resource Assessment, when appropriate. Completes all work sheets and mandatory forms during the application process. Consistently reports all LTC admissions to SSA when appropriate. Correctly works all cases on the KAMES and PA 62 systems.

25. Verification—Evaluates the caseworker’s ability to correctly verify each element of eligibility for Adult Medicaid certifications, recertifications, and interim changes.

Unacceptable or Rating of 1 - Requests insufficient or unnecessary verification. Fails to use verification forms correctly. Fails to use all sources of verification correctly when working a case. Cannot access and/or interpret inquiry screens correctly to obtain available verification. Fails to enter verified information onto KAMES screens or PA 62 documents correctly. Incorrectly discontinues or denies cases for non-mandatory verification.

Acceptable or Rating of 3 - Requests appropriate verification and uses it correctly to work cases. Utilizes appropriate verification forms. Accesses and interprets available systems to obtain verification. Differentiates between mandatory and optional verification. Enters correct verification onto the KAMES system.

Superior or Rating of 5 - Always requests proper verification and uses it to correctly work cases. Correctly interprets all sources of verification. Documents cases on all returned verification, and explains inconsistencies in comments. Always accesses and interprets available systems to obtain verification. Correctly and consistently utilizes all available verification documents, and clarifies any verification inconsistencies.

26. Documentation—Evaluates the caseworker’s ability to correctly and thoroughly document all Adult Medicaid cases with information necessary to support any decision in the case.

Unacceptable or Rating of 1 - Fails to document basic elements of eligibility such as identity, technical, financial, resource eligibility as well as any case inconsistencies. Fails to document all actions in the case thoroughly. Uses uncommon abbreviations and acronyms in comments. Includes editorial comments inappropriately.

Acceptable or Rating of 3 - Documents basic elements of eligibility and benefits in the comments section. Documents income, resources, medical expenses, etc. Uses standard abbreviations and acronyms in comments. Does not editorialize or include personal comments/beliefs in notes.

Superior or Rating of 5 - Documents all elements of eligibility in comments section. Comments on verification when needed to clarify inconsistencies. Documents income, resources, medical expenses, etc. in the comments section. Cases are documented thoroughly so they are easily read and understood. Avoids uncommon abbreviations and acronyms. Never editorializes or includes personal comments/beliefs in notes.

27. Re-certifications and Reviews—Evaluates the caseworker’s ability to understand and utilize the recertification and review process, adhere to times frames and verification requirements, and the scheduling and management of appointments.

Unacceptable or Rating of 1 - Fails to schedule assigned re-certifications timely. Fails to explain and request needed verification at the recertification interview. Fails to mail out re-certification forms and to complete them timely when returned. Fails to conduct timely reviews according to policy. Fails to process re-certifications on KAMES and the PA 62 system timely. Allows cases to improperly discontinue due to worker inaction.

Acceptable or Rating of 3 - Schedules assigned re-certifications timely. Complete case reviews timely. Explains and requests needed verification at re-certification interview. Processes most re-certifications within appropriate time frames. Ensures that correct certification periods are assigned.

Superior or Rating of 5 - Always schedules re-certification appointments, and reviews cases per policy requirements. Always explains and requests needed verification at re-certification interview. Schedules appointments to meet the needs of the client or authorized representative. Always processes re-certifications and reviews correctly and within the appropriate time frames.

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