This letter provides information regarding service coordination, a key feature of the STAR+PLUS Medicaid managed care program. Service coordination is a benefit offered to all STAR+PLUS members. In the nursing facility (NF), managed care organization (MCO) service coordinators (SCs) will partner with NF staff to ensure each member’s care is integrated and coordinated to avoid preventable hospital admissions, readmissions and emergency room visits.
Each MCO will have a SC (who can be a registered nurse, licensed vocational nurse, nurse practitioner, or social worker) assigned to a NF. The STAR+PLUS MCO SC will conduct face-to- face visits with the NF resident at least quarterly, and more frequently as determined by the member’s condition and level of care.
The STAR+PLUS MCO SC responsibilities include:
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assisting the member, family, NF staff and others to ensure timely and coordinated access to the array of Medicaid eligible services;
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coordinating with NF and providers serving the resident to reduce hospital admissions or readmissions;
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partnering with the member, family, NF staff and others in the development of a service plan, including services provided through the NF, add-on services, acute medical services, behavioral health services and primary or specialty care (Note: the authorization of additional services outside of the NF unit rate is based on medical necessity and benefit structure);
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assisting with the collection of applied income when a NF has documented two unsuccessful efforts, per the state-mandated NF requirements;
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visiting members living in NFs in person at least quarterly;
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performing assessments for appropriateness of a return-to-community setting at 30 days, 90
days and quarterly thereafter;
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working with NF staff, local authorities and relocation specialists to assist with safe discharge and setting up of long term supports and services in the community;
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notifying the NF within ten days of a change to its assigned SC; and
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returning a call from a NF within 24 hours after the call is placed by the NF.
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