Medicaid Waiver Management Application (MWMA) Instructor ...tris.eku.edu/MWMA/ILTPresentations/MWMA ILT Presentation_CHFS... · Medicaid Waiver Management Application (MWMA) Instructor-Led

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Medicaid Waiver Management Application (MWMA) Instructor-Led Training for CHFS/Contact Center

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Welcome to the Medicaid Waiver Management Application Training

Medicaid Waiver Management Application Instructor-Led Training Welcome

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Introductions

Introduce yourself to the room

• Name

• CHFS Division/Branch

• Waiver Program You Support

• Role

• Expectations for this training session

Medicaid Waiver Management Application Instructor-Led Training Introductions

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Housekeeping

• Bathroom locations

• Smoking location

• Participant materials– Hard copies

– MWMA Training Portal

• Food/Drinks policy for this computer lab

• Breaks– Step out of the room when

necessary to avoid disrupting the class

Medicaid Waiver Management Application Instructor-Led Training Housekeeping and Ground Rules

Ground Rules

• Please stay “with the class” – Work only with your assigned Individual

– Use the appropriate log in credentials

– If you finish a task early, help your neighbor

• Respect others and their points of view

• Let facilitators know if you get behind or need clarification

• Silence cell phones, minimize texting, and refrain from checking social media accounts on computer lab equipment

• Do not disconnect any cables or equipment

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Course Agenda

Medicaid Waiver Management Application Instructor-Led Training Course Agenda

Topic Minutes Time

Welcome – Introductions, Housekeeping and Ground Rules 10 8:30 – 8:40

Lesson 1: MWMA Overview 20 8:40 – 9:00

Lesson 2: System Navigation 15 9:00 – 9:15

Lesson 3: Waiver Application Initiation and Review 45 9:15 – 10:00

Break (10)

Lesson 4:Capacity Review and Urgency of Need 60 10:10 – 11:10

Lesson 5: Assessments 50 11:10 – 12:00

LUNCH

Lesson 6: Waiver Enrollment 20 1:00 – 1:20

Lesson 7: Plan of Care 75 1:20 - 2:50

Break (10)

Lesson 8: Waiver Case Management 60 3:00 – 4:00

Lesson 9: Transition 20 4:00 – 4:20

Questions and Wrap-up 10 4:20 – 4:30

SCL Waiver Program Staff-specific Items 30 4:30 – 5:00

Presenter

Presentation Notes

.

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Medicaid Waiver Management Application (MWMA) Lesson 1: MWMA Overview

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Upon completion of this lesson, you will be able to:

• Describe the features and benefits of the Medicaid Waiver Management Application (MWMA)

• Describe the enhancements provided by MWMA to current business practices

Medicaid Waiver Management Application Instructor-Led Training Lesson 1: MWMA Overview

Lesson Time: 20 minutes

Lesson Objectives

Presenter

Presentation Notes

Instructor Speaking Notes: Upon completion of this lesson, you will be able to: Describe the waiver application intake process Identify the elements in the MWMA intake screen Describe the benefits of MWMA on the waiver application intake process This lesson should take no more than an hour

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• Collaborative effort between the Cabinet for Health and Family Services and the Kentucky Office of the Health Benefit and Health Information Exchange (KOHBHIE)

• Implementation of a web-enabled case management application to support the delivery of home and community-based services under the Medicaid waiver programs

• Two-phased implementation: April 2015 and December 2015


What is the Medicaid Waiver Management Application?

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Current Waiver Process

− Uses a variety of different databases, paper files, emails and spreadsheets

− Processes are cumbersome, inefficient, and duplicative

New MWMA Application

− Standardizes and streamlines the waiver application process

− Improves care coordination and service delivery to waiver recipients and their families

− Self-service access will help individuals and families make more informed choices


Why is the Commonwealth Implementing MWMA?

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MWMA will be built on the existing KHBE platform which houses kynect, Kentucky's healthcare connection. The application will:

• Standardize and automate essential waiver program processes;

• Provide an integrated, comprehensive view of the individual's services and supports;

• Enable a person-centered approach to service delivery; and

• Integrate with existing commonwealth systems, providing consistency across technology standards and enabling a Cabinet-wide view of information across Medicaid waiver programs.


Features of the Medicaid Waiver Management Application

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• Provides automated capabilities around the intake, assessment, eligibility determination, plan of care, case management, incident management, timesheet and reporting functions performed by waiver service providers

• Provides individuals and families with self-service access to manage their waiver program applications, plan of care, services and timesheets

• Access to information in real-time

• Integrates with kynect, Kentucky’s healthcare connection (as of 2nd MWMA release)


What Benefits Does the Medicaid Waiver Management Application Provide?

Presenter

Presentation Notes

Instructor Note: Need to clarify that MWMA will integrate with kynect at a later point in time

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What Can You Expect from this MWMA Training?

• Standardized waiver application intake • Streamlined Level of Care assessment

submission and review processes• Streamlined Plan of Care development,

submission and review processes• Case Management Tools – Case Manager

Assignment, Caseload Management, Case Transfers, Program Closures, Case Notes and more

• Automated workflows, tasks and notifications

• Electronic document submission and storage

• Prescreening tools• Self Service capability for Individuals/Families• Streamlined application intake across multiple

programs (Waiver, SNAP, TANF, Medicaid, etc)

• Improved assessment tools• Streamlined Medicaid Eligibility and Waiver

Enrollment Processes• Automated waiting list management• Electronic timesheets for participant directed

services• Streamlined Incident Reporting and Review

Spring 2015

Winter 2015

Expect to receive training on these topics:


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MWMA Users

• Community Mental Health Center (CMHCs) staff

• Area Agency on Aging (AAAs) staff

• Quality Improvement Organization (QIO)

• CHFS staff• Case Management Agency staff

• Direct service providers• Individuals and Families

Spring 2015

Release

Winter 2015

Release


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CHFS MWMA User Roles


User Role DescriptionCapacity Reviewer Login specific to a waiver program; ensures that the Individual

meets targeting criteria, determines urgency of need, and determines if capacity is available in the waiver

Case Management Administrator

User at the CHFS level who oversees all Waiver activities; can perform all Case Manager and Case Supervisor operations in MWMA

Case Management Administrator-Read Only

User at the CHFS level who oversees all Waiver activities, but has “Read Only” access

Service Needs Assessor User who meets with the Individual to complete the Service Needs Assessment

Transition Reviewer User responsible for reviewing existing waiver participants and for confirming they are found enrolled in current records for individuals transitioning into the KHBE system

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Application Initiator Submits application.

Application Reviewer(QIO)

Reviews submitted application.

Capacity Reviewer(CHFS)

Determines if targeting criteria is met, determines urgency of need,

and capacity in a waiver.

LOC Assessor(Assessment Agency)

Completes LOC Assessment.

LOC Reviewer(QIO)

Reviews LOC Assessment and makes determination.

DCBS Caseworker(DCBS)

Enrolls Individual in designated waiver program through KAMES.

Case Supervisor(Case Management Agency)

Case Supervisor assigns Individual to a Case Manager.

Case Manager(Case Management Agency)

Begins to perform case management activities.


Submits Plan of Care.

Plan Reviewer(QIO)

Approves prior authorization and submits the POC as “Current”.

MWMA Lifecycle


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You should now be able to:

• Describe the features and benefits of the Medicaid Waiver Management Application (MWMA)

• Describe the enhancements provided by MWMA to current business practices


MWMA Overview Recap

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MWMA Training Resources

The following resources provide additional information and instruction:

• User Manual: User Guide: kynect Medicaid Waiver Management Application, Lesson 1

• Quick Reference Guides/Job Aids:– Application, Case, and Program Status Quick Reference Guide– Transitioning the Use of the MAP-24 and MAP-24C Quick Reference Guide

• Online Courses/Web-based Training (WBTs): Medicaid Waiver Management Application Overview course (3 lessons)


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Medicaid Waiver Management Application (MWMA) Lesson 2: System Navigation

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Lesson Objectives


• Describe basic navigation in MWMA

• Describe features of the Dashboard screen

Medicaid Waiver Management Application Instructor-Led Training Lesson 2: System Navigation


Presenter

Presentation Notes

Instructor Speaking Notes: Upon completion of this lesson, you will be able to: Describe the Plan of Care lifecycle Identify the roles involved in the Plan of Care lifecycle Submit a Plan of Care Describe the process of updating a Plan of Care This lesson should take no more than two hours

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System Navigation Overview

1. Top Navigation Bar

2. Left Navigation Bar

3. Center Dashboard

1

2

3

Users are able to easily navigate MWMA through key links located on the:

Presenter

Presentation Notes

Instructor Notes: Key links display in the main and left navigation bars The center of the page is also pre-populated with various activities to enroll, maintain, and manage an Individual in MWMA

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Exploring the Top Navigation Bar

The user can navigate to different areas of MWMA by using the links that display on the top navigation bar located at the top of each screen.

Presenter

Presentation Notes

Instructor Notes: The first image of a Top Navigation Bar is of a user logged in as a Case Manager Supervisor Home navigates the user back to the home page Start Application navigates the user to the Basic Information screen to start an application for an individual Case Management navigates the user to a screen where they are given the options to add a case note, manage case notes, access caseload management and access the program closure screen Message Center navigates the user to their MWMA inbox where they can view messages. These messages are often associated with tasks that have been generated for them to complete Quick Search navigates the user to a search screen where they are able to search for an Individual or a Case Manager The logged in user will appear next to Welcome The logged in user’s agency name will appear below the welcome The second image of a Top Navigation Bar is of the Case Manager Supervisor viewing the Case Manager’s home page The Case Manager name will appear next to “Viewing as” above the agency name (which should be the same agency for both the supervisor and manager) Back to Dashboard navigates the user back to the Case Manager Dashboard

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Exploring the Left Navigation Bar

The left menu navigation bar consists of Quick Links which are links to the most common tasks/actions that pertain to the user who is logged in.

There are three main categories of Quick Links:

1. Message Center

2. Case Management

3. Other Links

Presenter

Presentation Notes

Instructor Notes: Quick Links categories and corresponding links may change based on the role of the user Message Center: This section of the Quick Links navigation pane displays a link to the notification center. The notification center displays system-generated (“WCM System”) notifications Case Management: This section of the Quick Links navigation pane displays links for common tasks associated with Case Management activities for Individuals Other Links: This section of the Quick Links navigation pane displays links for common, miscellaneous tasks that pertain to the role of the user

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Exploring the Center Dashboard: TasksThe Select Queue drop-down menu is located on the top left of the Tasks section. The “My Tasks” queue is always populated with tasks that are only assigned to the logged-in user. The Select Queue drop-down menu allows the user to search for tasks that are assigned to their user group.

Presenter

Presentation Notes

Instructor Notes: A task is different from a notification (Message Center) in that the user must take action on a task and tasks are time-bound items that facilitate completion of an activity The Select Queue drop-down menu allows the user to search for tasks that are assigned to their user group (e.g., LOC Assessor, QIO Staff, etc.)

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Instructor Demo of MWMA –Basic System Navigation


Presenter

Presentation Notes

Instructor Notes: The instructor will review, through a walk through, the most common tasks carried out in MWMA, including: Home Dashboard Quick Search Quick Links Select Task Queue Search Tasks The instructor should also provide an overview of the ILT Exercise Data Sheet, including: Log in credentials Waiver program used for the exercises Various exercises (remind them of “stay with class”) Instruction: Tell participants to use their Data Sheet Tell participants to use the Case Manager (CM) credentials under “Application Intake” to log in to MWMA At the end of the demo, have the participants sign out of MWMA

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To follow along the instructor demo of MWMA System Navigation:

1. Use the log in credentials provided by the instructors to log in to the desktop computer

2. Launch web browser• Internet Explorer (IE)• Firefox• Chrome

3. Enter URL for MWMA User Acceptance Testing (UAT) Environment:

https://uat4.kywaiver.ky.gov4. Log in using the credentials on your ILT Exercise Data Sheet

Presenter

Presentation Notes

Instructor Notes: The instructor should also provide an overview of the ILT Exercise Data Sheet, including: Log in credentials Waiver program used for the exercises Various exercises (remind them of “stay with class”)

https://uat4.kywaiver.ky.gov/

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MWMA System Navigation Recap


• Describe basic navigation in MWMA

• Describe the features of the Dashboard screen


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• Quick Reference Guides/Job Aids:– System Navigation Quick Reference Guide– Performing Searches Quick Reference Guide


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Medicaid Waiver Management Application (MWMA) Lesson 3: MWMA Application Initiation and Review

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• Describe the waiver application initiation and review processes

• Describe the benefits of using MWMA to complete these processes

• Transfer a waiver application from one Application Initiator to another


Medicaid Waiver Management Application Instructor-Led Training Lesson 3: Waiver Application Initiation and Review

Lesson Objectives

Presenter

Presentation Notes

Instructor Speaking Notes: Upon completion of this lesson, you will be able to: Describe the waiver application intake process Identify the elements in the MWMA intake screen Describe the benefits of MWMA on the waiver application intake process This lesson should take no more than an hour

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Standardized application applies to all Medicaid Waiver programs.

Medicaid waiver application consists of the application initiation and application review phases. This is not assessment.

Medicaid Waiver Application Initiation and Review Overview

The waiver application initiation process is performed by theApplication Initiator, a designated person who enters application details and uploads substantiating documents into MWMA on behalf on an Individual/Legal Guardian/Authorized Representative.

The waiver application review process is conducted by the Quality Improvement Organization (QIO). Based on the responses provided to the application intake questions, QIO refers the application to the Medicaid Waiver program that best fits the Individual’s needs.


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Authorized Representative

Legal Guardian

Individual

Application Initiator

Enter s documentation and

information on behalf of the

Individual

Medicaid Waiver Management

Application (MWMA)


Roles in the Waiver Application Initiation and Review Processes

Application Reviewer

Provides documentation and

information on behalf of the

Individual

Reviews information and uploaded documents, enters

comments, and refers application to a waiver program

Presenter

Presentation Notes

Instructor Speaking Notes: As previously mentioned when we discussed roles in the waiver application process, the Application Initiator is the primary actor during the waiver application intake process The Application Initiator does not work in a vaccum. The Authorized Representative, and/or the Legal Guardian provide the Application Initiator information and documentation for entry in MWMA.

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LOC Reviewer(QIO)










Plan Reviewer(QIO)


MWMA Lifecycle


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The Application Initiator:

• Receives notification when a waiver slot has been reserved for them

• Facilitates the next steps for the Individual when an Individual’s LOC is “Not Met”


Application Initiator Transfer• Performed by the Case Management Administrator

• Waiver applications may be transferred between Application Initiators from the same agency or between Application Initiators from different agencies

• An MWMA Message Center notification is sent to the new Application Initiator once the transfer is complete

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Instructor DemoApplication Initiator Transfer

Demo Time: 10 minutes


Presenter

Presentation Notes

Instructor Notes: Instructor assumes the role of CMA and will demonstrate how an application can be transferred from one Application Initiator to another

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LOC Reviewer(QIO)










Plan Reviewer(QIO)


MWMA Lifecycle


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Medicaid Waiver Application Review Process


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MWMA Waiver Application Confirmation screen


Presenter

Presentation Notes

Instructor Notes: The Waiver Application Confirmation screen is where the Application Reviewer designates the Waiver program where the application is referred

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Instructor DemoReviewing, Entering Comments, and Referring a Waiver

Application in MWMA



Presenter

Presentation Notes

Instructor Notes: Instructor assumes the role of QIO or CMA and reviews one of the applications created by a learner in the previous lesson

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• Creates an electronic version of the waiver application that can be accessed by those with the appropriate role/privileges

• Validates data gathered when applicable (e.g., postal address, telephone number, required documentation, etc.)

• Automatically lists the substantiating documentation required based on the responses provided

• Electronically attaches substantiating documents to the waiver application• Creates tasks for various roles involved in the review process


Medicaid Waiver Management Application

(MWMA)

How does the MWMA enhance the waiver application initiation and review processes?

• Allows the review of supporting documents to occur concurrently with the review of the waiver application

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• Describe the waiver application initiation and review processes

• Describe the benefits of using MWMA to complete these processes

• Transfer a waiver application from one Application Initiator to another


Medicaid Waiver Application Initiation and Review Recap

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• User Manual: User Guide: kynect Medicaid Waiver Management Application– Lesson 3, Initiating an Application for Medicaid Waiver Services (p. 25)– Lesson 4, Reviewing a Submitted Medicaid Waiver Application (p. 44)

• Online Courses/Web-based Training (WBTs): – Initiating an Application for Medicaid Waiver Services course (6 lessons)– Reviewing an Application for Medicaid Waiver Services course (6 lessons)

• Quick Reference Guides/Job Aids:– Using Member Match and Individual Summary Screens Quick Reference

Guide


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Break

Medicaid Waiver Management Application Instructor-Led Training Break

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Medicaid Waiver Management Application (MWMA) Lesson 4: Capacity Review and Urgency of Need

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LOC Reviewer(QIO)










Plan Reviewer(QIO)


MWMA Lifecycle

Medicaid Waiver Management Application Instructor-Led Training Lesson 4: Capacity Review and Urgency of Need

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• Describe the Capacity Review and Eligibility Determination process

• Determine waiver eligibility using targeting criteria

• Determine Urgency of Need

• Reserve space for an Individual in a waiver program

Lesson Objectives



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Capacity Review and Eligibility Determination Overview

Waiver Program Eligibility is a phase of the application process in which:• an Individual’s application is reviewed • an Individual’s information is used to determine whether targeting criteria is met• the appropriate urgency of need is determined, and• available capacity within a waiver program is determined

If targeting criteria is met, the urgency of need merits immediate services, and the waiver has available capacity, the Individual can have their spot reserved to receive the waiver’s services.

If the urgency of need does not merit a reservation, or capacity is unavailable, the Individual may be placed on a waiting list to receive the waiver’s services.


Presenter

Presentation Notes

Instructor Notes: The Eligibility component of MWMA involves a review of the Individual’s application, similar to the role of the Application Reviewer. If the Capacity Reviewer disagrees with the App Reviewer’s referral, they can redirect the Individual to be reviewed for capacity in a different waiver program. Every waiver program uses their own standards for targeting criteria, and will continue to do so Every waiver program will continue to use their own standards for Urgency of Need selection Depending on the Capacity Reviewer’s selections for Targeting Criteria and Urgency of Need, the Capacity Reviewer can continue to either reserve space in a waiver program or place the Individual on a waiting list to receive the services

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Roles Involved in Capacity Review and Eligibility Determination

Reviews information and uploaded documents, enters comments, and refers application to a

waiver program

Application Reviewer Capacity Reviewer

Reviews application information, determines if

targeting criteria is met, the urgency of need, and

available capacity

Level of Care Assessor

Meets with the Individual to complete the LOC

Assessment


Presenter

Presentation Notes

Instructor Notes: The Application Reviewer submits the application to the Capacity Reviewer and the Level of Care Assessor receives the task to complete the Level of Care Assessment But Eligibility portion of MWMA is mainly completed by the Capacity Reviewer

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Capacity Review and Eligibility Determination ScreensMWMA includes the following screens that are used by the Capacity Reviewer:

Dashboard Individual Summary Application Review Screens Urgency of Need and Waiver Capacity

− Targeting Criteria− Urgency of Need− Waiver Capacity

The Capacity Reviewer first reviews the Individual’s application and views the same screens as the Application Reviewer. Once this is done, the sequence of screens and sections that display are dependent upon the Capacity Reviewer’s determination for targeting criteria, urgency of need, and waiver capacity.


Presenter

Presentation Notes

Instructor Notes: Pictured is the Urgency of Need and Waiver Capacity screen Dashboard: The dashboard screen displays a user’s tasks related to Waiver Capacity Review. To select an Individual to review for capacity, the user will select “start” from the right-hand side of the screen. Individual Summary: displays a basic summary of the Individual’s information as entered by the Application Reviewer Application Review screens: Services: displays the information collected by the Application Initiator about an Individual’s existing services as well as the services needed for the future. Clinical Information: displays the information collected by the Application Initiator about an Individual’s clinical background. Living Situation: displays the information collected on the Individual’s current living situation and preferred living situation. Caregiver Status: displays the collection of general details on the Individual’s primary caregiver, if applicable Current Conditions: describes the collection of information on the Individual’s health and behavioral conditions. Documents Needed: displays the documents that have been uploaded by the Application Initiator if they are required for the Individual. Urgency of Need and Waiver Capacity: After reviewing the Individual’s information, the Capacity Reviewer must determine if the Individual meets the waiver program’s targeting criteria. If they do not meet the criteria, the Capacity Reviewer can either send them to be reviewed for another program or the process will be finished as they are not eligible. If the Individual does meet the criteria, the Capacity Reviewer must then determine urgency of need on the next section. Urgency of Need- Waiver programs each have a specific determination for urgency of need, and the Capacity Reviewer will follow that depending on the Individual’s information that was reviewed. Depending on the UON determined, the Capacity Reviewer will either have the ability to reserve space in a waiver program or place the Individual on a waitlist Assessment Assignment: The Capacity Reviewer must assign an agency to perform the LOC Assessment. They can either search for an agency, or select the agency that is prepopulated if the Application Initiator’s agency is capable of performing the assessment.

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Urgency of Need and Waiver Capacity screen for SCL


Does the Individual have a Respondent Network?

• YES: Triggers “Perform SIS Assessment” task for the Service Needs Assessor

• NO: “Perform SIS Assessment” task remains on Service Needs Assessor’s Dashboard until the Individual has a prior-authorized plan of care. At that time, the Service Needs Assessor receives notification to schedule SIS Assessment three months from the day they receive the notification.

Presenter

Presentation Notes

Instructor Notes: Pictured is the Urgency of Need and Waiver Capacity screen Dashboard: The dashboard screen displays a user’s tasks related to Waiver Capacity Review. To select an Individual to review for capacity, the user will select “start” from the right-hand side of the screen. Individual Summary: displays a basic summary of the Individual’s information as entered by the Application Reviewer Application Review screens: Services: displays the information collected by the Application Initiator about an Individual’s existing services as well as the services needed for the future. Clinical Information: displays the information collected by the Application Initiator about an Individual’s clinical background. Living Situation: displays the information collected on the Individual’s current living situation and preferred living situation. Caregiver Status: displays the collection of general details on the Individual’s primary caregiver, if applicable Current Conditions: describes the collection of information on the Individual’s health and behavioral conditions. Documents Needed: displays the documents that have been uploaded by the Application Initiator if they are required for the Individual. Urgency of Need and Waiver Capacity: After reviewing the Individual’s information, the Capacity Reviewer must determine if the Individual meets the waiver program’s targeting criteria. If they do not meet the criteria, the Capacity Reviewer can either send them to be reviewed for another program or the process will be finished as they are not eligible. If the Individual does meet the criteria, the Capacity Reviewer must then determine urgency of need on the next section. Urgency of Need- Waiver programs each have a specific determination for urgency of need, and the Capacity Reviewer will follow that depending on the Individual’s information that was reviewed. Depending on the UON determined, the Capacity Reviewer will either have the ability to reserve space in a waiver program or place the Individual on a waitlist Assessment Assignment: The Capacity Reviewer must assign an agency to perform the LOC Assessment. They can either search for an agency, or select the agency that is prepopulated if the Application Initiator’s agency is capable of performing the assessment.

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ExercisePerforming Capacity Review

Exercise Time: 20 minutes


Presenter

Presentation Notes


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How does the MWMA enhance and streamline the capacity review and eligibility determination process?


(MWMA)

• Creates tasks for various roles involved in the review process, including:− A task for the Capacity Reviewer to review when the application is

referred to the Capacity Reviewer’s waiver program.

• Enables the Capacity Reviewer to quickly redirect the Individual to another waiver if they are eligible for review in a different program.

• Allows the Capacity Reviewer to review all application information, make determinations, and reserve an available space in the waiver program in a quick and documented manner.


Presenter

Presentation Notes

Instructor Notes: The main benefit is that the system enables for automatic and electronic communications between roles, as well as for decisions and determinations to be made quickly and more efficiently.

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• Describe the Capacity Review and Eligibility Determination process

• Determine waiver eligibility using targeting criteria

• Determine Urgency of Need

• Reserve space for an Individual in a waiver program

Capacity Review and Urgency of Need Recap


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• Quick Reference Guides/Job Aids:– Using Targeting Criteria Quick Reference Guide– Urgency of Need and Waiver Capacity Quick Reference Guide

• Online Courses/Web-based Training (WBTs): Determining Eligibility for Medicaid Waiver Services course (4 lessons)


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Medicaid Waiver Management Application (MWMA) Lesson 5: Assessments

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LOC Reviewer(QIO)










Plan Reviewer(QIO)


MWMA Lifecycle

Medicaid Waiver Management Application Instructor-Led Training Lesson 5: Assessments and Reassessments

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Medicaid Waiver Management Application Instructor-Led Training Lesson 5: Assessments


• Describe how an Individual is assigned to a Level of Care (LOC) agency

• Schedule a LOC Assessment

• Record LOC Assessment results

• Schedule a Service Needs Assessment

• Record SIS Assessment results

• Upload supporting LOC Assessment Service Needs Assessment results

• Monitor LOC “Not Met”


Lesson Objectives

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• Individuals receive a correspondence to select an agency to perform their LOC assessment and contact the agency

• A Case Manager or Case Supervisor uses the correspondence and the LOC Agency Assignment screen to find the individual in MWMA and assign them to an assessment agency

• The “Perform Assessment” task generates within the assessment agency’s Level of Care Assessor user group task queue

• The Level of Care Assessor records the assessment details and attaches documents in MWMA after performing the initial LOC assessment

• Assessment details and supporting documents are submitted to the LOC Reviewer (QIO) via MWMA, for QIO to make a determination on the LOC assessment

MWMA LOC Assessment Process Overview


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Medicaid Waiver LOC Assessment Process


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Authorized Representative

Legal Guardian

Individual

Case Manager, Case Supervisor or LOC

Assessor


(MWMA)

Receives correspondence

to select and contact an assessment

agency

Roles in the Medicaid Waiver LOC Assessment Process

Accesses MWMA, enters information

found in the correspondence,

locates the Individual, and assigns Individual

to the assessment agency


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Level of Care Assessor

Level of Care Reviewer Application Initiator Case Management

Administrator

Enters assessment results and

uploads documentation

after meeting with the Individual

Monitors why the LOC was “Not Met” and helps facilitate

the next steps.

Reviews assessment results,

uploaded documentation and

records a determination

Reviews information when the LOC is

deemed “Not Met” and contacts the

Individual to review the decision

Roles in the Medicaid Waiver LOC Assessment Process


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• MWMA enhances and streamlines current manual and paper- based processes by creating tasks for various roles involved in the assessment process, including:− A task for the LOC Assessor to perform the assessment− A task for the LOC Assessor to record results− A task for the LOC Reviewer to make a LOC determination

• Allows supporting documents to be attached to the LOC Assessment• Allows comments to be inserted by the LOC Assessor when

uploading supporting documents


(MWMA)

How does the MWMA enhance and streamline the LOC Assessment and/or Reassessment process?


Presenter

Presentation Notes

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MWMA includes the following four assessment screens used by the LOC Assessor:

Schedule Assessment

Individual Summary

Assessment Results

Documents Needed

MWMA LOC Assessment Screens


Presenter

Presentation Notes

Instructor Notes: Once the LOC Assessor completes scheduling the assessment, the Individual Summary screen displays a summary of Individual’s information. The LOC Assessor is guided to the Assessment Results screen where the assessment details are documented and then the Documents Needed screen where the supporting documents are uploaded.

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• An Individual’s LOC Reassessment process starts 40 days prior to their assessment end date

• The LOC Reassessment can only be completed within 30 days of the assessment end date

• Assessment details and supporting documents are attached resembling the LOC Assessment process

Medicaid Waiver Application Reassessment Overview


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• When an Individual’s LOC is “Not Met” for more than 13 days and no reconsideration was filed or LOC determination is not overturned by CareWise, the Case Management Administrator receives the “Level of Care Not Met-CMA Monitor” Task to monitor the process of appeals

• This is a “read-only” task designed to facilitate research and offline discussion with various parties before filing a program closure.

• The CMA will take the following actions:1. Assess the situation outside of MWMA (offline), such as appeals, etc.2. Track QIO/CareWise Health Reconsideration process3. Submit waiver program closure based on the assessment

“Level of Care Not Met – CMA Monitor” Task


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Instructor Demo –Monitoring LOC “Not Met”



Presenter

Presentation Notes

Notes: Instructor takes completed assessment and walks through LOC Determination process

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Assessments RecapUpon completion of this lesson, you will be able to:

• Describe how an Individual is assigned to a Level of Care (LOC) agency

• Schedule a LOC Assessment

• Record LOC Assessment results

• Schedule a Service Needs Assessment

• Record SIS Assessment results

• Upload supporting LOC Assessment Service Needs Assessment results

• Monitor LOC “Not Met”

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• Quick Reference Guides/Job Aids: – Level of Care (LOC) Assessment Agency Selection Quick Reference Guide– Assessment Determination Quick Reference Guide– Level of Care (LOC) Assessment Submission Quick Reference Guide– Supports Intensity Scale (SIS) Assessment Submission Quick Reference Guide

• Online Courses/Web-based Training (WBTs):– Performing an Assessment for Medicaid Waiver Services course (7 lessons)– Performing a Reassessment for Medicaid Waiver Services course (5 lessons)


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LUNCH


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Medicaid Waiver Management Application (MWMA) Lesson 6: Waiver Enrollment

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LOC Reviewer(QIO)










Plan Reviewer(QIO)


MWMA Lifecycle

Medicaid Waiver Management Application Instructor-Led TrainingLesson 6: Waiver Enrollment

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• Describe how MWMA supports the waiver enrollment process

• Describe the system integration points between MWMA, KAMES, and MCI

• Describe the manual enrollment process

Lesson Objectives


Medicaid Waiver Management Application Instructor-Led Training Lesson 6: Waiver Enrollment

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Waiver Enrollment Overview

• MWMA interacts with the Kentucky Automated Medicaid Eligibility System (KAMES) and the Master Client Index (MCI) to determine eligibility and update all systems with the correct Individual information

• The KAMES system determines an Individual’s Medicaid eligibility

• Once this occurs, DCBS enrolls the Individual in the waiver program, and MWMA sends out a nightly batch to update with the correct Individual information that is stored in MCI

• If the nightly batch does not update correctly and a technical issue causes KAMES and kynect not interacting, a Case Management Administrator can manually enter an Individual’s enrollment information into MWMA.

Presenter

Presentation Notes

After Capacity Review and LOC are determined, the Individual must be Medicaid Eligible to enroll in a waiver program. Unlike other MWMA processes, Waiver Enrollment is not one section or completed by a user or group of users, but is instead the culmination of processes and a series of system interactions. This process will occur electronically, and should not involve intervention unless the nightly batch does not correctly update, in which case the CMA can manually enter an Individual’s enrollment information.

74


Waiver Enrollment Process

Presenter

Presentation Notes

High level overview of the enrollment process. This describes how the process should go, in the event that the final step of the Nightly Batch does not function correctly, the CMA can manually enter information.

75


Roles Involved in Waiver Enrollment

Reviews application information, determines if

targeting criteria is met, the urgency of

need, and available capacity

Capacity Reviewer Level of Care Assessor

Meets with the

Individual to complete the LOC

Assessment

Level of Care Reviewer

Reviews the Level of Care Assessment

and determines if Level of Care

is met

Enrolls the Individual in

the designated waiver

program, through

KAMES, once the Individual has met the all

criteria

DCBS Worker Case Management Administrator

Can manually enter an

Individual’s enrollment information

into MWMA in the event that the automatic

batch does not update

Presenter

Presentation Notes

As we’ve seen, these role have direct roles in other sections and processes of MWMA. Their involvement in Enrollment is a function of their previous roles that impact the enrollment process, instead of directly completing actions in enrollment.

76


How does the MWMA enhance and streamline the waiver enrollment process?


(MWMA)

• MWMA serves to facilitate the enrollment process automatically, and only requires interaction in the event of an error

• Enrollment information is recorded on a nightly basis through an automatic update

• The interaction between systems like MWMA, KAMES, and the MCI allows each to have updated and current information

Presenter

Presentation Notes

Allows for the enrollment process to be handled automatically, and only involves DBCS enrolling an Individual through KAMES and the intervention of a CMA in the event of an issue. The nightly updates allow for current and up-to-date information for an Individual and their waiver services.

77


Waiver Enrollment ScreensDuring manual enrollment, the following screens are used:

Dashboard

Individual Summary

Program Summary Screen

Enrollment Screen

In the event that there is a technical issue and the MWMA nightly batch does not automatically update, the Case Management Administrator has the ability to manually enter enrollment information for an Individual.

Presenter

Presentation Notes

These screens are only applicable for a CMA in the event that the nightly batch does not update and they must manually enroll an Individual. Dashboard: The dashboard screen displays a user’s tasks. To select an Individual for manual enrollment, the CMA must use the “Quick Search” feature to search for a specific Individual. Individual Summary: Upon searching for an Individual, the Individual Summary screen displays a basic summary of the Individual’s information as entered by the Application Reviewer and is updated to this point in the MWMA process. To continue manual enrollment, the CMA must select the waiver program on the bottom portion of the screen. Program Summary: The Program Summary screen will display details and information for the specific waiver program that the Individual is seeking to be in enrolled in. The Program Action tab is on the right-hand side of the screen, and the user must select the “Record Enrollment” button to continue to the enrollment screen. Enrollment Screen: displays waiver enrollment details, including the Program Code; Waiver Enrollment Status; Enrollment Type; Enrollment Start and End Dates; and Medicaid Start and End Dates. Upon completion of the manual enrollment process, the information is updated in MWMA to reflect the current information stored in MCI. The Individual is now successfully enrolled in a waiver program.

78

Exercise- Manual EnrollmentManually Entering Enrollment Information in MWMA



Presenter

Presentation Notes

Notes Scheduling Assessments exercise (20 minutes) Recording Assessments and document upload (40 minutes)

79


Waiver Enrollment RecapYou should now be able to:

• Describe how MWMA supports the waiver enrollment process

• Describe the system integration points between MWMA, KAMES, and MCI

• Describe the manual enrollment process

80




• Quick Reference Guides/Job Aids: – Manual Enrollment Quick Reference Guide

• Online Courses/Web-based Training (WBTs): Enrolling an Individual in a Medicaid Waiver Program course (3 lessons)


81

Medicaid Waiver Management Application (MWMA) Lesson 8: Plan of Care

82









LOC Reviewer(QIO)










Plan Reviewer(QIO)


MWMA Lifecycle

Medicaid Waiver Management Application Instructor-Led Training

83

Lesson Objectives


• Describe how MWMA supports the Plan of Care lifecycle

• Identify the MWMA user roles involved in the Plan of Care lifecycle

• Review POC Provider Conflicts

• Review Exceptional Service and/or Rate/Unit Requests

• Monitor POCs not Submitted within 60 Days of LOC “Met”

Medicaid Waiver Management Application Instructor-Led Training Lesson 8: Plan of Care


Presenter

Presentation Notes

Instructor Speaking Notes: Upon completion of this lesson, you will be able to: Describe the Plan of Care lifecycle Identify the roles involved in the Plan of Care lifecycle Submit a Plan of Care Describe the process of updating a Plan of Care This lesson should take no more than two hours

84

Plan of Care Overview


Within the MWMA , the Plan of Care (POC) function is used to create and execute an Individual’s POC.

MWMA provides:• Case Managers with the tools to create POCs and submit POCs to QIO for

review• QIO with the tools to prior-authorize services and send Lack of Information (LOI)

information to Case Managers• CHFS with the tools to review provider conflicts and exceptional service and

rate/unit requests• CHFS with the tools to monitor when POC has not been submitted within 60 days

of LOC

85

Plan of Care Lifecycle


Presenter

Presentation Notes

Instructor Speaking Notes: This is the initial flow of the Plan of Care When an Individual is assigned to a Case Manager a task is triggered for the Case Manager to complete an Initial POC for the assigned individual Plan Reviewer is always the last reviewer Once a plan is made Current, it can always be updated. However, once the plan is updated it will go through the same review process as it did when the plan was initially submitted

86


Case Manager Case Supervisor

Initiates the POC for an Individual and submits

the POC to be reviewed.

Reviews the POC and makes comments on data

entered by the Case Manager.

Case Management Administrator

Reviews the POC when there is a provider conflict or an exceptional rate/unit

request.

Plan Reviewer

Reviews the POC and submits a prior

authorization decision.

Roles in the Plan of Care Lifecycle

Presenter

Presentation Notes

Instructor Speaking Notes: Case Manager: A designated member of a case management agency The Case Supervisor also has the ability to update all field within the POC Case Supervisor: A designated member of a case management agency Case Management Administrator: A CHFS staff member Plan Reviewer: A designated QIO staff member

87

Overview of each section in Plan of Care

The Plan of Care Main Menu screen includes the following eight sections that constitute an Individual’s Plan of Care:


Presenter

Presentation Notes

Instructor Notes: All of these sections will be covered in detail in our classroom exercise Create Draft Collects the proposed start date of the POC and the route of the POC View Plan Details Allows you to view the details entered in an Individual’s POC Goals Where you enter goals for an Individual in the POC Service Details Displays details of the services that are a part of an Individual’s Plan of Care. Services are also added to the plan from this screen Non-Waiver Service Details Enter services an Individual is currently receiving or plans to receive that are not affiliated with a waiver program Service Summary Displays both waiver services and non-waiver services associated with the POC Upload Documents Upload documents that are required for services that have been selected Submit Plan Sign and submit the POC for review

88

Accompanying Data and Documents are required for several waiver programs Accompanying documents are required to be submitted for Individuals in the following waiver programs:• Acquired Brain Injury (ABI)- Acute• ABI- Long Term Care• Supports for Community Living (SCL)


All ADD components can be completed in MWMA that are highlighted below:

Presenter

Presentation Notes

Instructor Notes: The table highlights ADD components that are viewable from the Individual Data Entry Main Menu screen in MWMA for all waiver programs. This is something Case Managers do today but now it can be completed within MWMA to help streamline processes.

89

When a Plan of Care is not submitted within 60 days of LOCThe “Plan of Care not submitted within 60 days of LOC” task generates for the Case Management Administrator when a Plano f Care is not submitted for the Individual within 60 days of LOC “Met.”

• This task is a “read-only” task with manual closure

• This task is designed to facilitate discussion with the Case Manager to understand the reason the Individual is not accessing services. Next step should either be submit the individual’s plan of care or file a program closure.


Presenter

Presentation Notes


90

Class Exercise-Monitoring POC Not Submitted within 60 Days of LOC



Presenter

Presentation Notes

Instructor Notes: Participants will initiate and submit an initial Plan of Care for an Individual *Training Team Prep: Create the following data for Data Sheet: Log in credentials for case managers All data field information for POC *Activity is dependent on successful completion of previous Case Management exercises

91


How does the MWMA enhance and streamline the Plan of Care processes?


(MWMA)

MWMA enhances and streamlines current manual and paper-based plan of care activities through the following functionalities:

• Generated tasks for each role when an action must be taken

• Ability to upload and attach documents to the POC• Ability to enter comments on a POC that are visible to all

applicable roles in MWMA• Allow CHFS to monitor POCs that are not submitted within

a certain timeframe

Presenter

Presentation Notes

Instructor Speaking Notes: Instead of scanning and faxing a plan and applicable documents back and forth, all information will be stored in MWMA and visible to all applicable roles at any time

92


Plan of Care Recap


• Describe how MWMA supports the Plan of Care lifecycle

• Identify the MWMA user roles involved in the Plan of Care lifecycle

• Review POC Provider Conflicts

• Review Exceptional Service and/or Rate/Unit Requests

• Monitor POCs not Submitted within 60 Days of LOC “Met”

93



• User Manual: User Guide: kynect Medicaid Waiver Management Application– Lesson 10, Managing a Plan of Care

• Quick Reference Guides/Job Aids:– Plan of Care Status Quick Reference Guide– Service Units and Rate Quick Reference Guide– Determining Prior Authorization of Services Quick Reference Guide– Understanding the ADD Functionality in MWMA Quick Reference Guide– Using the ADD Module for ABI Waivers POC Submission Quick Reference Guide– Using the ADD Module for Supports for Community Living POC Submission Quick

Reference Guide

• Online Courses/Web-based Training (WBTs): Managing a Plan of Care course (10 lessons)


94

Break


95

Medicaid Waiver Management Application (MWMA) Lesson 9 : MWMA Case Management

96









LOC Reviewer(QIO)










Plan Reviewer(QIO)


MWMA Lifecycle

Medicaid Waiver Management Application Instructor-Led Training

97


• Describe MWMA case management functionalities

• Submit initial case assignment request

• Review mandatory case notes

• Review case transfers with conflict

• Monitor inability to access services records

• Review waiver program closure requests

Lesson Objectives


Medicaid Waiver Management Application Instructor-Led Training Lesson 9: MWMA Case Management

98


Case Management- Initial Case Assignment Process Flows

99

• Once an Individual’s Level of Care (LOC) for a waiver program has been marked as met by the LOC Reviewer, a physical correspondence is sent to the Individual from MWMA.

• The Individual contacts CHFS for assistance in finding a case management agency within their area of preference

• The Case Management Administrator accesses MWMA and searches for the Individual using “Quick Search”

• Once the Individual is located, the Case Management Administrator navigates to the Individual’s Individual Summary screen and clicks “Submit Initial Case Assignment Request” from the Case Action column

• The Case Management Administrator searches for a case management agency by County within the Submission of Initial Case Assignment Request to a Case Management Agency screen and submits an initial case assignment request to that agency


Overview of Initial Case Assignment by a Case Management Administrator (CHFS Staff)

Presenter

Presentation Notes

Instructor Notes: If the Individual selects a case management agency from the list, the initial case assignment process is handled primarily by the Case Supervisor. If the Individual requests help from CHFS, the Case Management Administrator submits a request to an agency for initial case assignment for the Individual. The Case Management Administrator does NOT choose the agency for the Individual

100


101


102

Instructor DemoSubmitting an Initial Case Assignment Request



Presenter

Presentation Notes

Notes Participants will assume the role of a Case Supervisor and assign a Case Manager to an Individual Training Team Prep Either use the Case Copy Tool or have a separate data set of Individuals who already have LOC met. Assign these Individuals to each learner so the learners can then practice assigning a

103

Medicaid Waiver Case Management refers to the set of processes that enable Case Managers, Case Supervisors and other authorized users to provide case management services for an Individual. These processes include:• Case Note Management• Caseload Management (Case Transfers)• Program Closure Management


MWMA Case Management Overview

Presenter

Presentation Notes

Instructor Notes: Initial Case Assignment: The process of assigning a Case Manager or case management agency to an Individual for whom Medicaid Waiver eligibility or enrollment is being determined. Caseload Management: The process of managing the caseload of Case Managers and Case Supervisors who provide case management services to an Individual enrolled in a Medicaid waiver program. Case Note Management: The process of managing case notes for an Individual enrolled in a Medicaid waiver program. Case notes document meetings with Individuals and other case-related actions. Case Managers, Case Supervisors, and Case Management Administrators enter case notes in MWMA. Program Closure Management: The processes of managing Medicaid waiver program closure and recording a waiver program-enrolled Individual’s inability to access services

104

• Case Note Management involves the process of adding and managing case notes for an Individual. Once an individual is assigned to a case management agency, any Case Manager or Case Supervisor within that agency may add case notes to an Individual’s case.

• CHFS staff may search for any Individual in any agency and view that Individual’s case notes

• MWMA is not designed to bill for case notes. Case management agencies will continue to use their billing systems (e.g., Credible) for billable case notes


Managing Case Notes

Presenter

Presentation Notes

Instructor Notes: Types of case notes: Face to Face Family Contact Indirect Contact Medical Monthly Summary On Call Provider Contact Quarterly Summary

105

At the end of each month, MWMA will check if mandatory case notes have been submitted for an enrolled Individual for the note period.

– If a mandatory case note is missing at the end of the month, a task will be generated for the assigned case manager to add the missing mandatory case note.


Mandatory Case Notes

Presenter

Presentation Notes

Instructor Notes: Types of case notes: Face to Face Family Contact Indirect Contact Medical Monthly Summary On Call Provider Contact Quarterly Summary

106


Case Management- Create a New Case Note Screen

107


SCL, Face to Face Case Note, and the KY Focus Tool

Every time a Face to Face Case Note is submitted for an Individual enrolled in SCL, the KY Focus Tool must be uploaded.

MWMA will prevent the user from submitted a Face to Face Case Note without the KY Focus Tool.

108

Class ExerciseViewing Case Notes



Presenter

Presentation Notes

Instructor Notes Participants will view notes. Participants can use the same Individuals to search and view case notes.

109

• The case management of waiver cases may be transferred internally within the same case management agency, or requested to be transferred externally to another case management agency.

• Only a Case Supervisor or a Case Management Administrator can transfer cases.

• When an internal or external case transfer is performed, all open tasks of the current Case Manager or Case Supervisor is transferred to the new Case Manager or Case Supervisor.


Overview of Case Transfers

110


Case Management- Case Transfers screen: Internal Transfer

Presenter

Presentation Notes

Instructor Notes: In an internal case transfer, the Case Manager does not have the option to decline when a case is transferred by a Case Supervisor from another Case Manager In an external case transfer, the receiving case management agency has the option of accepting or declining the transfer If the receiving case management agency accepts the case transfer, that Case Supervisor processing the acceptance of the external transfer is required to assigned that case to a Case Manager. That Case Manager does not have the option to accept or decline the new case. If the receiving case management agency declines the case transfer, the originating Case Supervisor will see the declined transfer in their task queue

111


Case Management – External Case Transfer Request Declined

Presenter

Presentation Notes

Instructor Notes: When an external case transfer request has been declined by the selected agency, the originating Case Supervisor will see a task in their queue called “Case Transfer Declined.” When you click “Start” you’re navigated to the Case Assignment History screen where you can click on the hyperlinked “Declined” to see the comments left by the selected agency as to why they declined the transfer.

112

Program closure involves the process of submitting and managing program closure requests through MWMA. Program closure also includes recording the inability of individuals to receive waiver services.

The following table lists the various scenarios that would lead to program closure:


Overview of Program Closure and Disenrollment

Presenter

Presentation Notes

Instructor Notes: Every time an Individual moves out of a waiver program, a program closure request must be submitted for that waiver program. Program closure is necessary because different waiver programs have different exit criteria

113


Case Management- Program Closure and Disenrollment Process Flow

114


Case Management- Request Program Closure Screen

115

Class Exercise-Submitting an Involuntary Program Closure Request



Presenter

Presentation Notes

Notes Participants will submit a program closure request Training Team Prep Develop program closure data set. Individuals may be in various stages of waiver program (not necessary to be enrolled in waiver program)

116

Class Exercise-Reviewing a Program Closure Record



Presenter

Presentation Notes

Instructor Notes After submitting a program closure request, participants will do a Quick Search for the Individual whose program they closed, viewing: Individual Summary and program status LOC end date matches effective closure date POC is made historic Training Team Prep Develop program closure data set. Individuals may be in various stages of waiver program (not necessary to be enrolled in waiver program)

117

You complete an Inability to Access Services record in MWMA when an Individual is temporarily unable to access Medicaid waiver services for reasons including:• S/he enters a nursing facility, Intermediate Care Facility for

Individuals with Intellectual Disability (ICF-IID), a medical hospital, or a psychiatric hospital;

• There is no residence provider available; • S/he is out of the state


Overview of Temporary Discharge/Inability to Access Services

118


Case Management- Recording Inability to Access Services

119


Case Management- Recording Inability to Access Services

Presenter

Presentation Notes

Access the Program Summary screen by clicking the hyperlinked waiver program name that the Individual is enrolled in

120


The “Reasons for inability to access services” dropdown menu contains the following choices:

121


Presenter

Presentation Notes

Instructor Notes: “Is the currently enrolled program being closed for the Individual?” YES: Enter program end date in “Actual End Date” field. Submit a Program Closure Request separately. NO: Enter temporary discharge period end date in “Actual End Date” field.

122

Instructor DemoMonitoring Inability to Access Services Record



Presenter

Presentation Notes

Instructor Notes Instructor will demonstrate how the CMA takes action on the “Monitor Record for Inability to Access Services” task triggered when 55 days have passed since the Inability to Access Services Record start date

123

How does the MWMA enhance and streamline the case management processes?

MWMA enhances and streamlines current manual and paper-based case management activities through the following functionalities:• Electronic case notes entry and case notes management• Electronic Internal and external case transfers• Integrated waiver program closure and disenrollment • Electronic recording of inability to access services



(MWMA)

124


• Describe MWMA case management functionalities

• Submit initial case assignment request

• Review mandatory case notes

• Review case transfers with conflict

• Monitor inability to access services records

• Review waiver program closure requests


MWMA Case Management Recap

125



• User Manual: User Guide: kynect Medicaid Waiver Management Application,– Lesson 9, Performing Waiver Case Management (p. 117)

• Quick Reference Guides/Job Aids: – Case Notes Quick Reference Guide– Initial Case Assignment Quick Reference Guide– Performing Case Transfers Quick Reference Guide– Recording Inability to Access Services Quick Reference Guide– Submitting a Program Closure Request Quick Reference Guide

• Online Courses/Web-based Training (WBTs): Performing Case Management in the Medicaid Waiver Management Application course (9 lessons)


126

Medicaid Waiver Management Application (MWMA) Lesson 10: Transition

127


• Explain the process of transitioning an Individual into MWMA.

• Describe the system integration points between MWMA and MCI

• Use the applicable screens to transition an Individual to the MWMA system

Lesson Objectives


Medicaid Waiver Management Application Instructor-Led Training Lesson 10: Transition

128


Transition OverviewBefore the implementation of MWMA, Kentucky’s Medicaid waiver programs were not supported by an automated system.

• The Transition process serves to transfer those Individuals receiving waiver services prior to the implementation of MWMA into the new electronic system

• Components of MWMA have already occurred for these Individuals, as they are currently receiving services. They must now be entered into MWMA with the correct information

• The Transition process involves both the interaction between systems like MCI and KyMMIS, as well as information review by a user in the system

Presenter

Presentation Notes

MWMA serves to facilitate waiver processes electronically by capturing and storing information related to Individual’s waiver cases in a centralized location. Since no such system existed before the implementation of MWMA (“pre-MWMA”), the records for Individuals enrolled in waiver programs pre-MWMA need to be transitioned over to the new system. - Processes like Capacity Review, Assessment, POC, or Enrollment have all already occurred since the Individual is receiving services, they just need to be recorded in MWMA.

129


Transition Process Overview

Presenter

Presentation Notes

The transition record only goes to the Transition Reviewer if there is an inconsistency between the Level of Care information as populated by MMIS.

130


Roles Involved in the Transition Process

Completes the Transition process for an Individual into the MWMA system

Case Manager Case Supervisor

Completes the Transition process for an Individual into the MWMA system

Transition Reviewer

Applies corrective action to resolve discrepancies with

LOC end dates, using access to other Commonwealth

databases

Presenter

Presentation Notes

Both Case Managers and Case Supervisors can complete the transition of an Individual, but it must be for Individuals who are currently receiving services from your case management agency. The Transition Reviewer only reviews LOC inconsistencies and determines action to correct the information.

131

• Before an Individual can be transitioned, their information must be verified in MCI

• Upon MCI verification, MWMA automatically pulls the Individual’s enrollment information from MMIS

• If the Individual’s case management agency identified in MMIS does not match the user’s agency, the user cannot continue with transition

• If the Individual’s case management agency does matchthe user’s agency, the user can continue to review the Individual’s enrollment information

• The Transition Individual screen will pre-populate with the Individual’s information that must be reviewed

Transitioning an Individual



(MWMA)

Presenter

Presentation Notes

Instructor Notes: Transition Individual screen: the first part of the screen captures an Individual’s basic demographic details. The information entered on this screen is checked against MCI for verification. The user then progresses to the next section of the screen, which allows the user to review information regarding an Individual’s existing enrollment and waiver program services. After MWMA has verified the Individual in MCI, MWMA then retrieves waiver information from MMIS. Data provided by MMIS is pre-populated on this screen and cannot be edited by the user. If the case management agency identified by MMIS does not reflect the user’s case agency, the user will not be able to continue with the transition.

132

• MWMA Transition Period: April 20, 2015 through July 20, 2015

• LOC Reassessment and Transition

– If the LOC End Date is before June 30, 2015, perform the reassessment outside of MWMA, then transition the Individual to MWMA

– If the LOC End Date is after June 30, 2015, transition the Individual, then record the reassessment results in MWMA

Transition Timeline


133


Transition Screens

Waiver Transition Dashboard Transition Individual Information screen Transition Results screen

Depending on whether a Case Manager or Case Supervisor is transitioning the Individual, the Individual is automatically assigned to that Case Manager’s caseload, or the Case Supervisor assigns the Individual to a Case Manager from the case management agency.

The following screens are used in Transition:

The Transition Individual Information screen

Presenter

Presentation Notes

Instructor Notes: The primary screens in this process will not change depending on whether or not the user is a Case Manager or a Case Supervisor. Dashboard: Displays a Case Manager or a Case Supervisor’s tasks. On the left-hand of the screen will be an “Initiate Transition” quick link, that must be selected to begin the process. Transition Individual screen: the first part of the screen captures an Individual’s basic demographic details. The information entered on this screen is checked against MCI for verification. The user then progresses to the next section of the screen, which allows the user to review information regarding an Individual’s existing enrollment and waiver program services. After MWMA has verified the Individual in MCI, MWMA then retrieves waiver information from MMIS. Data provided by MMIS is pre-populated on this screen and cannot be edited by the user. If the case management agency identified by MMIS does not reflect the user’s case agency, the user will not be able to continue with the transition. Transition Results screen: Depending on the flow of the transition, this screen can either display a message confirming the transition as successful. Otherwise, it will display that the transition is under review.

134

Instructor DemoResolving Discrepancies in the Transition Record



Presenter

Presentation Notes

Notes Learners will transition individuals

135


Transition Recap


• Explain the process of transitioning an Individual into MWMA.

• Describe the system integration points between MWMA, MMIS, and MCI.

• Follow the applicable screens to transition an Individual to the MWMA system.

136


The following resources are provided for further information and instruction for this module.

• User Manual: User Guide: kynect Medicaid Waiver Management Application– Lesson 8, Transitioning Individuals into MWMA (p. 108)

• Quick Reference Guides/Job Aids:– Initiating an MWMA Transition Quick Reference Guide

• Online Courses/Web-based Training (WBT): Transitioning Individuals into the Medicaid Waiver Management Application course (3 lessons)


137

Medicaid Waiver Management Application (MWMA) Instructor-Led TrainingCourse Wrap Up

138

Congratulations!

You have completed the Medicaid Waiver Management Application Instructor-led Training Course!

Questions

Are there any unanswered questions or concerns regarding today’s training?

Medicaid Waiver Management Application Instructor-Led Training Course Wrap Up

139

Medicaid Waiver Management Application (MWMA) Instructor-Led Training for CHFSSupports for Community Living (SCL) Waiver Program Staff

140

• Once an Individual has a spot reserved for them in SCL by the Capacity Reviewer and the Capacity Reviewer has identified that the Individual has a Respondent Network, a Service Needs Assessment will need to be completed. The Service Needs Assessor will receive a task to perform a SIS Assessment.− Once the Service Needs Assessor clicks Start on the “Perform SIS

Assessment” task, they are prompted to schedule an assessment or opt out of scheduling an appointment.

• If the Capacity Reviewer identifies that the Individual does not have a Respondent Network, then the “Perform SIS Assessment” task remains on the SIS Assessor Dashboard until the Individual has a prior authorized Plan of Care.− At this time, the SIS Assessor receives a notification to schedule the

appointment to perform the assessment three months from the day they receive the notification.

SIS Assessment Process Overview (SCL only)

Medicaid Waiver Management Application Instructor-Led Training SCL Waiver Program Staff: Assessments

141

SCL Only Exercise-Scheduling a Service Needs Assessment and Recording

SIS Assessment Results


Medicaid Waiver Management Application Instructor-Led Training SCL Waiver Program Staff: Assessments

Presenter

Presentation Notes

Notes Scheduling Assessments exercise (20 minutes) Recording Assessments and document upload (40 minutes)

142

Provider Conflict

A “provider conflict” occurs during the Plan of Care creation process when an agency already provide case management services also is also selected to provide other services.

• The “Conflicting Case Management Pending Case Management Administrator Review” task generates

− Starting this task will direct the CMA to the Approve Case Management Conflict screen to approve or disapprove the provider conflict.

If the provider conflict is not approved, the POC is sent back to the Case Manager for revisions

If the provider conflict is approved, the POC is submitted to the Plan Reviewer (QIO).

Medicaid Waiver Management Application Instructor-Led Training SCL Waiver Program Staff: POC Provider Conflict

Presenter

Presentation Notes


143

Instructor Demo -Reviewing POC Provider Conflict


Medicaid Waiver Management Application Instructor-Led Training SCL Waiver Program Staff: POC Provider Conflict

Presenter

Presentation Notes

144

Exceptional Service and/or Rate/Unit Request

• Starting the “Exceptional Service Pending Case Management Administrator Review ” will direct the CMA to the Service Details screen to approve or disapprove the exceptional request.

− If it is not approved, the POC is sent back to the Case Manager for revisions

− If approved, the POC is submitted to the Plan Reviewer

• The “Conflicting Case Management and Exceptional Rate/Unit Pending Case Management Administrator Review” task generates when a POC both has an exceptional service request AND a provider conflict.

− Starting this task brings the user through both the Service Details and Case Management Conflict screens to approve/disapprove the provider conflict and exceptional request.

Medicaid Waiver Management Application Instructor-Led Training SCL Waiver Program Staff: POC Exceptional Service and/or Rate/Unit Request

Presenter

Presentation Notes


145

Instructor Demo -Reviewing Exceptional Service and Rate/Unit Requests


Medicaid Waiver Management Application Instructor-Led Training SCL Waiver Program Staff: POC Exceptional Service and Rate/Unit Requests

Presenter

Presentation Notes


146

Instructor DemoApprove/Decline Case Transfer Request with Conflict


Medicaid Waiver Management Application Instructor-Led Training SCL Waiver Program Staff: Case Management-Case Transfers

Presenter

Presentation Notes

Notes Participants will submit a program closure request Training Team Prep Develop program closure data set. Individuals may be in various stages of waiver program (not necessary to be enrolled in waiver program)

147

Transitioning an SCL Individual and SIS Assessment

• When an Individual enrolled in SCL is transitioned to MWMA, the Record Latest SIS Assessment for Transition Individual task is triggered for the Service Needs Assessor

• Service Needs Assessor enters the Individual’s latest SIS Assessment into MWMA

Medicaid Waiver Management Application Instructor-Led Training SCL Waiver Program Staff: Transition

Presenter

Presentation Notes

Instructor Notes:

148

Instructor DemoRecording Latest SIS Assessment for Transition Individual


Medicaid Waiver Management Application Instructor-Led Training SCL Waiver Program Staff: Transition

Presenter

Presentation Notes

Notes Learners will transition individuals