Nursing Home Member Checklist

Member Name

MSHO/MSC+

Nursing Home Member Checklist

Refer to the Nursing Home Care Coordination Guidelines for specific details. (If a member switches Blue Plus products, they are considered a new member)
Timeframe* / Task
Day 1 / Enrollment information received. Date:
Within 10 days / Notified member of Care Coordinator assigned within 10 days or change in care coordinator. Date: Care Coordinator assignment enteredin Bridgeview.
Within
30 Days of notification of enrollment; on or after the enrollment date / 8.22 Intro Member Lettersent and/or phone call madeto new member. Date:
*MSHO Only*
Within
30 Days of notification of enrollment; on or after the enrollment date / Scheduled appointment at facility. Date: Initial Assessment (face to face visit) Completed 6.15 Nursing Home Member Annual Assessment/Care Plan Review. (If member is unable to fully participate reach out at a minimum one time to the guardian, POA or responsible party) Completed 6.28.01 Nursing Home Transitional Heath Risk Assessment for Product Change section on 6.15 (Used for product changes only)Must have completed form 6.15 within the last 365 days to use THRA Reviewed 6.26 Explanation of Supplemental Benefits (MSHO) If no discussion, why:
*MSC+ only*
Within 60 days of notification of enrollment; on or after the enrollment date / Scheduled appointment at facility. Date: Initial Assessment (face to face visit) Completed 6.15 Nursing Home Member Annual Assessment/Care Plan Review. (If member is unable to fully participate reach out at a minimum one time to the guardian, POA or responsible party) Completed 6.28.01 Nursing Home Transitional Heath Risk Assessment for Product Change section on 6.15 (Used for product changes only)Must have completed form 6.15 within the last 365 days to use THRADiscussion of MSHOenrollment (MSC+) If no discussion, why:
Within
90 Days of notification of enrollment; on or after the enrollment date / Assessment entered into Bridgeview by the 10th of the following month
Sent8.28 Intro to Doctor Letteror for clinic delegates, notification to PCP documented per clinic process. Date: OR
8.29.01 NH Post Summary Letter-Intro to Doctor Letter*This letter can be used in lieu of 8.28 Intro to Doctor letter if the face-to-face visit and this letter is mailed within 90 days of notification of enrollment. Date:
Within 90 days of Face-to-Face Visit for Initial / 8.35 Nursing Home CC Visit Summary Letter sent to member or responsible party.
Date:
8.35.01 Unable to Reach -Nursing Home Visit Summary Letter sent to responsible party. Date: (if applicable)
8.29.01 NH Post Summary Letter-Intro to Doctor Letter*This letter can be used in lieu of 8.28 Intro to Doctor letter if the face-to-face visit and this letter is mailed within 90 days of notification of enrollment. Date:
Semi-Annual Contact / Contact completed face to face, ata care conference or on the phone with member and/or responsible party.DocumentedSemi Annual contact on6.15 NH Member Annual Assessment -Care Plan Review
Reassessments
within365daysof
previous
assessment / Annual Reassessment(face-to-face visit)Completed 6.15 Nursing Home Member Annual Assessment/Care Plan Review. Date: Reviewed 6.26 Explanation of Supplemental Benefits. (MSHO) If no discussion, why:
Discussion of SecureBlue MSHO product benefits and enrollment (MSC+) Date: If no discussion, why:
Reassessment entered into Bridgeview by the10th of the following month.
8.35 Nursing Home CC Visit Summary Lettersent to member or responsible party within 90 days following reassessment. Date:
8.35.01 Unable to Reach -Nursing Home Visit Summary Letter sent to responsible party. Date: (if applicable)
8.29.01 NH Post Summary Letter-Intro to Doctor Letter-sent within 90 days following reassessment. Date:
Ongoing / Update Bridgeview of any changesin care coordinator.Attend Care Conferences as needed.Refer member to community resources for relocation/discharge planning as needed.Communicate with Primary Care Clinic as needed.Collaborate with other County or Clinic Care Coordinators if member transfers occur.Complete Transition of Care Logsas needed

Document 6.13 Updated 010118

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