December 29, 2017

Dear Care Coordination Partners:

Effective 1/1/18, Care Coordination responsibilities for Blue Plus members residing in the nursing home will be changing. We reviewed the changes during Fall training. This communique is a summary of those changes and a reminder to begin implementing these changes January 1, 2018.

All documents associated with the following changes have been updated and are now posted on the web portal:

  1. Nursing home guidelines are revised with these new requirements and MSHO and MSC+ are now combined into one document. New title: Nursing Facility Care Coordination Guidelines MSHO and MSC+.
  1. 6.13 MSHO/MSC+ Nursing Home Member Checklist has been updated with the new requirements and MSHO and MSC+ are combined into one checklist.
  1. Updated 6.15 NH Member Annual Assessment-Care Plan Review (word and PDF versions)—Begin using this new form at the next annual assessment. Section V has been added to document semi-annual contacts on this form*.

*If the member is due for a semi-annual contact before an assessment has been completed using this new form, the Care Coordinator may document their semi-annual visit in their case notes or use the 6.21 Nursing Home Follow up Contact Form for SecureBlue and MSC+ members.

  1. 8.35 Nursing Home Visit Summaryletter. Now required to be sent to the member or their family representative (if applicable) following the assessment.
  1. New 8.35.01 Unable to Reach - Nursing Home Visit Summary Letter. If a member is identified as having a responsible party who makes decisions on behalf of the member, the care coordinator is responsible to make at least 1 attempt to reach the responsible party at the member’s initial and annual assessments. If you are unable to reach the responsible party, send 8.35.01 Unable to Reach- Nursing Home Visit Summary Letter to the responsible party within 90 days of the face to face visit (assessment).
  1. 8.29.01 NH Visit Summary Letter-Intro to Doctor Letter. This letter should be sent to the member’s PCP within 90 days following the initial and annual assessments. This can replace the 8.28 Intro to Doctor letter if it is sent within 90 days of enrollment.
  1. New: Transitional Health Risk Assessment option now available for product changes only

A new 6.15 Nursing Home Members Health Risk Assessment/Care Plan Review is required for product changes (within 30 calendar days for MSHO or 60 calendar days for MSC+ from enrollment notification).

Care Coordinators have two options for when a member has had a product change:

  1. Perform a face-to-face visit and complete a new 6.15 Nursing Home Members Health Risk Assessment/Care Plan Review.Enter assessment in Bridgeview as a 6.15 NH Assessment with assessment type of Product Change.
  2. Perform a face to face visit and complete the section on the 6.15 called 6.28.01Nursing Home Transitional Health Risk Assessment for Product Change. The 6.28.01 requires a review of the current 6.15 Nursing Home Member Health Risk Assessment/Care Plan Review done in the last 365 days. In addition, the Care Coordinator must document any updates to the care plan and discussions with member and/or Responsible Party. Enter assessment in Bridgeview as a 6.28.01 NH Transitional HRA with assessment type Product Change.

All changes will be reviewedin the upcoming Blue Plus Winter Webinar on Jan 23rd 1-3 p.m.

If you have any questions, please contact your Partner Relations Consultant.

Thank you,

Government Programs Partner Relations Team,

Blue Cross® and Blue Shield® of Minnesota is a nonprofit independent licensee of the Blue Cross and Blue Shield Association