Applies to staff activities that include making referrals to, coordinating, and/or monitoring the delivery of specific LTSS or other health care services or other supports that may prevent someone from going into an institution.
This code refers to specific services or supports. Providing information about a program should be coded under category 1. Assisting with applications to programs should be coded under category 2.
This code refers to specific services or supports. Providing information about a program should be coded under category 1. Assisting with applications to programs should be coded under category 2.
Relevant activities include:
- Referral and/or coordination of services including gathering any information that may be required in advance of referrals, evaluations and provision of services.
- Preparing documentation for case review, monitoring an individual’s case, including meeting with support staff to discuss care, visiting an individual who is a ward of the county/state, and accompanying individuals to appointments.
- Gathering information for facilitating prior authorizations, including following up with other partner agencies for information.
- Informing or explaining an individual’s support plan and options. (If this is done as part of the Options Counseling process use code 5a or 5c depending on the individual’s Medicaid status).
- Providing follow-up contact to ensure an individual has received services. (If this is done as part of the Options Counseling process use code 5b or 5d depending on the individual’s Medicaid status).
- Arranging for transportation for an individual or family to access services, as well as arranging for or providing interpreter (including sign language) services that assist an individual or family to access and understand services.
This code should be used for all activities related to referral, coordination or monitoring of services, including:
- Paperwork
- Clerical activities, such as making copies
- Time spent reviewing voice mails or emails
- Time spent consulting with a supervisor or supervising
- Travel including time spent arranging transportation
3a. Medicaid eligible
3b. Individuals at risk of institutionalization and Medicaid spend down
The following criteria must be met to select this code:
- The time must be spent assisting an individual in accessing supports that may prevent or delay the individual from entering a nursing facility or other Medicaid-funded institution; and
- It must be documented that the individual must meet the 180 Day Eligibility Worksheet criteria.
If an individual is already Medicaid eligible and the relevant services are paid for by Medicaid, code under 3a.
