Quality Management and Utilization Reviews
Comprehensive and Ongoing Assessment and Planning
Page 8: Bullet 1, sub-bullet 5 - A parenthesis is missing here.
Page 10: Bullet 3 - Why is "the waiver enrollment date" underlined?
Services are Delivered, Reviewed and Modified as Needed
Comment: Is this for all providers or specific to Case Management? The first bullet/sub-bullet seems to speak to each service provider, but then the second sub-bullet is specific to Case Management. Then the third sub-bullet goes back to "each service provider". Recommend to separate and list bullets under either provider and case management for clarity
Page 12: Main Bullet
Comment: Sub-bullet 1 - Provide specificity in Manual. What DMAS form is to be used for the quarterly review? There is currently no consistency from CSB to CSB on what documentation is required to be used for quarterlies. There is also no consistency as to what has to be in that quarterly review. Specificity would be helpful to provide consistency.
Services Delivered are Consistent With Service Limits
Page 13: Bullet 1, sub-bullet 2 -
Comment: Need additional specificity for Service Facilitation - recommend separate sub-bullet. "The number of hours does require authorization." What hours? MT Units? PCA hours? Respite Hours? Companion Hours? The hours the SF is working?
Page 15: Bullet 2
Comment: Paper timesheets went away a long time ago, so the EOR and employee will not be signing them. Time is either logged via app, online portal, or by calling in using IVR. So billing for CD services will not be supported by a timesheet that is signed. This point in the manual needs to be removed.
Support Coordinator/Case Manager/Provider Responsibilities
Comment: Need to REMOVE “Provider” from this section. “Provider” should not be included in this title when the first paragraph says that the following things are the responsibility of the support coordinator/case manager, and doesn't mention the provider? None of the things listed are the responsibility of the provider.