Must meet the required definition of a “qualified ...

UCare Connect Expansion Care Coordination Requirement Grid

Updated 3.15.2021

The assigned Care Coordinator/Case Managers herein after referred to as Care Coordinator (CC) must meet the required definition of a "qualified professional". Care coordination services incorporate case management and consist of a comprehensive assessment of the member's condition, the determination of available benefits and resources, the development and implementation of an individualized care plan with performance goals, and monitoring and follow-up, as described in the grid below.

*Please refer to the DHS eDocs Form Names Grid on last page for DHS form names and information. All related UCare forms can be found, HERE, all DHS forms can be found HERE, all DHS Bulletins can be found HERE.

Table of Contents

Initial Assignment

Initial Assessment Comprehensive Plan of Care Medicaid Eligibility Renewals Coordination with Local Agencies

Member Death

Initial Contact with Member

Product Change Regular to Medicare

Plan of Care Signature Page

Reassessments 90 day grace after MA Terms

DTR Requirements Medically Necessary Services

Documentation Requirements

Care System or County Primary Care Clinic Change

(PCC) Entry Assessments Monthly

Activity Log Ongoing Contact with Member POC updates

Advance Directives

Transfer of Member between Delegates

Policies and Procedures

Unable to Reach or Refusal

Admissions Nursing Facility from Community Reassessment

Transition of Care-TOC Actions for When a Member

Moves Change in Care Coordinator

1 Revised 3.15.2021

Initial Assignment

Initial Contact with Member

Community Non-Waiver Members (Includes members in a Group Home)

Community Waiver Members

Institutionalized Members

UCare provides the member with a care navigator welcome letter within 10 calendar days of initial assignment.

? Initial assignment is the first day the delegate receives the enrollment roster. Upon receiving the monthly enrollment roster, the CC is required to:

? Look each member up in MN-ITS to determine waiver status.

? Return members to UCare via the Monthly Activity Log if the member is open to a waiver or TCM. **Do not continue

care coordination for these members.**

The CC is required to:

If MN-ITS indicates the member is The CC is required to:

Contact the member within 60 days of the enrollment date to complete a health risk assessment (HRA). The enrollment date is the first day of the month the member enrolls with UCare. Make a minimum of 4 attempts to contact the member within 60 days of enrollment. Contacts may be by phone, face-to-face, on different days, and at different times, and/or by using the "Unable to Contact Letter" on UCare's website. At a minimum, the documentation must include at least 3 phone call attempts to reach the

open to a waiver, send member back on the Monthly activity log.

If you are aware of a member that demonstrates a Clinical need e.g Medical/Mental Health/SUD for care coordination please complete a UCare Care Coordination Referral form located on the UCare website.

? Contact the member and/or SNF staff to arrange a face-to-face visit within 60 days of the enrollment date.

? Complete the assessment using the Institutional Care Coordination Document (ICCD) form.

? For members residing in a group home that are identified as institutional on the care coordination enrollment roster, complete the 3428H, and follow the Community Non-Waiver Members process.

member and documentation that a follow-up letter to reach the member

was sent. A good faith effort should

be made to obtain a working phone number for the member. (Sending the "Case Management Welcome

Letter" is not considered an

attempt to contact the member).

2 Revised 3.15.2021

Care System or County Primary Care Clinic Change (PCC)

Unable to Reach or Refusal

Initial Assessment

Community Non-Waiver Members (Includes members in a Group Home)

Community Waiver Members

Institutionalized Members

The CC completes the following: ? Confirm member has an established PCC

? Ensure PCC is reflected correctly on the care coordination enrollment roster. o If the care coordination enrollment roster does not reflect the correct PCC the CC must submit a Primary Care Clinic (PCC) Change Request form and submit it to UCare. Submit to UCare no later than the 24th day of the month to ensure the change will be made the following month. o If the member states they plan to establish care with a new PCC, the CC works with the member in scheduling the appointment to establish care. o Ensure the PCC is in UCare's provider network, if not, the current CC should work with the member to establish care at an in-network provider, prior to completing a PCC change form.

If the CC is unable to contact the

If MN-ITS indicates the member is

member or the member refuses an

open to a waiver, send member back

assessment within 60 days of enrollment date, or within 365 days

on the Monthly activity log. **Do not initiate care coordination

from the last assessment, the CC is for these members.**

required to:

? Enter a refusal in MMIS with the activity date as the date the CC spoke to the member.

? Add the member to the Monthly

Activity Log as a refusal or unable

to contact and return to UCare by the 15th day of the following

month.

The CC is required to: ? Complete the initial HRA with the

member face-to-face within 60 days of enrollment using DHS3428H form. When completing the HRA, all questions and sections must be acknowledged and completed.

If MN-ITS indicates the member is open to a waiver, send member back on the Monthly activity log. **Do not initiate care coordination for these members.**

The CC is required to: ? Review the facility's MDS assessment

and obtain copy of the signature page and plan of care (POC) for the member's records. ? Document review of the assessment and other pertinent information on the Institutional Care Coordination

3 Revised 3.15.2021

Community Non-Waiver Members (Includes members in a Group Home)

Community Waiver Members

Institutionalized Members

? Determine the HS code based on member need/risk and agreement to care coordination services.

Document (ICCD) form. ? Complete the ICCD form in its

entirety.

? Enter the HRA on the Monthly Activity Log and submit the log to UCare by the 15th day of the following month.

? Return members to UCare who are not appropriate for care coordination.

? Enter the DHS-3427H in MMIS within 30 calendar days of the assessment date.

The assessment must be conducted face-to-face unless a telephonic HRA is approved by UCare.

? Make a face-to face contact with the member.

? Document any discussion with the facility if modifications are needed to the POC.

? Enter the HRA on the Monthly Activity Log and return to UCare by the 15th day of the following month.

Product

If there is a change in CC due to a product change, the existing (sending) CC is If there is a change in CC due to a product

Change- This is required to send a copy of the current HRA, POC and relevant case notes to change, the existing (sending) CC is

when a member the new (receiving) CC.

required to send a copy of the current

moves from

HRA, POC and relevant case notes to the

Connect

The CC is required to:

new (receiving) CC.

Regular or

? Provide the member with the name and telephone number of the new CC

Expansion to

within 10 days of the assignment if the CC has changed. This may be done The CC is required to:

Connect +

by phone or UCare approved letter and must be documented in the case ? Provide the member with the name and

Medicare, and

record.

telephone number of the new CC

vice versa.

? Obtain, and review the current HRA and update the POC received from the within 10 days of the assignment if the

previous (sending) CC. Update POC as appropriate.

CC has changed. This may be done by

? Complete the Transitional Health Risk Assessment form and attach to the most current assessment (DHS-3428H). This may be conducted via phone

phone or UCare approved letter and must be documented in the case record.

or in person.

? Obtain, and review the current ICCD

? If unable to obtain a completed HRA and POC that was completed within

and update the POC received from the

the last 365 days, or if there has been a change in condition, the CC is

previous (sending) CC. Update POC as

appropriate.

4 Revised 3.15.2021

Entry of Assessments on Monthly Activity Log Admission to a Nursing Facility from the Community

Community Non-Waiver Members (Includes members in a Group Home)

Community Waiver Members

Institutionalized Members

required to complete a new HRA (DHS-3428H form) and POC face-toface. ? Enter the DHS-3427H form into MMIS. ? Enter all assessments on the Monthly Activity Log.

? Complete the Transitional Health Risk Assessment form and attach to the most current assessment. This may be conducted via phone or in person.

? If unable to obtain a completed current ICCD the CC is required to complete a new ICCD face-to-face.

? Enter all assessments on the Monthly Activity Log

The CC is required to:

? Enter all assessments and refusals on the Monthly Activity Log. ? Submit the Monthly Activity Log to connectintake@ by the 15th calendar day of the following month.

If a member is admitted to a Nursing N/A Facility and their stay is expected to be less than 90 days, keep the member open to care coordination. If it is expected that the member will be admitted for greater than 90 days, the CC is required to return the member to UCare via the Monthly Activity Log. UCare Responsibilities: ? Complete all Preadmission

Screening and Resident Review (PASRR) activities. ? Notify the delegate when a PASRR is received. CC Responsibilities: ? Monitor the daily authorization report for admissions. ? Assist with transitions and complete TOC log.

5 Revised 3.15.2021

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