OLTLService Coordination

HCSIS Glossary of Terms

Alerts

An alert is an electronic message triggered from an action in HCSIS to inform the user of an event that occurred or did not occur as expected within the system. Alerts may be used for informational, reminder or escalation purposes. Some alerts, called Smart Alerts, contain hyperlinks to other screens in HCSIS, while others convey only textual information. For more information about Smart Alerts, see the definition later in this document.

Service Coordinators may receive an alert for any of the following actions:

  • ACT 150 Program Cannot be End Dated
  • ACT 150 Program End Dated
  • Consumer Approaches the Age of 60 (Applicable to Act 150 and Attendant Care only)
  • Contact with the Individual Not Made
  • Eligibility Reviewer Action
  • Follow-up Required Service Note Created
  • Individual Added to Caseload
  • ISP Review Due in 30 Days
  • ISP Status Set to Pending Revision
  • ISP Status Set to Approved
  • Orientation Meeting Pending
  • Physical Due in 60 Days (Applicable to CSPPPD only)

The following table describes the alerts received by a Service Coordinator:

Alert Title / Alert Definition
ACT 150 Program Cannot be End Dated / The Service Coordinator receives the "ACT 150 Program Cannot be End Dated" alert when the eligibility for anACT 150 consumer who turned 60 cannot be end dated because a plan exists in HCSIS. This alert is automatically removed from the list of pending alerts after 14 days.
Note: This alert is applicable to Act 150 only.
ACT 150 Program End Dated / The Service Coordinator receives the "ACT 150 Program End Dated" alert when the eligibility for anACT 150 consumer who turned 60 is end dated. This alert is automatically removed from the list of pending alerts after 14 days.
Note: This alert is applicable to Act 150 only.
Consumer Approaches the Age of 60 / The Service Coordinator receives the “Consumer approaches 60” alert 30 days before the consumer’s 60th birthday. When this alert is selected in the Pending Alerts screen, the hyperlink will navigate the end user to the Consumer Demographics screen for that consumer. This alert is automatically removed from the list of pending alerts after 14 days.
Note: This alert is applicable to Act 150 and Attendant Care only.
Contact with the Individual not Made / The Service Coordinator receives the “Contact with the Individual Not Made” alert when the specified timeframe for contact after a case is assigned has passed and the contact log has not been completed. When this alert is selected in the Pending Alerts screen, the hyperlink will navigate the end user to the Individual Facesheet screen for that consumer. This alert is automatically removed from the list of pending alerts after 14 days.
Eligibility Reviewer Action / The Service Coordinator and SC Supervion roles receive the “Eligibility Reviewer Action” alert when the Eligibility Reviewer changes the waiver/program status in a consumer’s waiver/program enrollment record from ‘Submit to State’ to either ‘Rejected by State’, ‘Enrolled’ or ‘Ineligible’. This alert is automatically removed from the list of pending alerts after 14 days.
Follow-up Required Service Note Created / The Service Coordinator receives this alert if the follow-up due date passes for a follow-up service note that has not been addressed. This alert is automatically removed from the list of pending alerts after it is opened or after the follow-up is completed.
Individual Added to Caseload / The Service Coordinator receives the “Individual added to caseload” alert after the consumer has been assigned to a Service Coordinator in the Register for Services process. The alert’s hyperlink navigates the end user to the Individual Facesheetscreen where further information for the consumer can be found. This alert is automatically removed from the list of pending alerts after 14 days.
ISP Review Due Within 30 days / The Service Coordinator receives the “ISP review due within 30 days” alert when an annual plan has not been submitted for approval within 30 days of the existing plan’s end date. When this alert is selected, the hyperlink takes the user to the individual’s ISP information. This alert is automatically removed from the list of pending alerts when the new annual plan has been submitted for approval or after 14 days.
ISP Status Set to Approved / The Service Coordinator receives the “ISP status set to approved” alert when the ISP has been approved by the State ISP Approval Role. This alert is automatically removed from the list of pending alerts after 14 days.
ISP Status Set to Pending Revision / The Service Coordinator receives the “ISP status set to pending revision” alert when the ISP status is changed to “Pending Revision” by either the SC Supervisionor State ISP Approval role. The alert’s hyperlink will navigate the end user to the Draft Plan with the indicated consumer selected and Pending Revision Plan version displayed. This alert is automatically removed from the list of pending alerts when the revised plan has been submitted for approval or after 14 days.
Orientation Meeting Pending / The Service Coordinator receives the “Orientation meeting pending” alert if all three of the following situations occur:
  1. Five days have passed since the case was assigned to the Service Coordinator’s caseload.
  2. There are fewer than three contact attempts indicated in the Contacts screen.
  3. The orientation meeting has not been scheduled.
When this alert is selected in the Pending Alerts screen, the hyperlink takes the user to the Meetings screen for that consumer. This alert is automatically removed from the list of pending alerts when the orientation meeting is scheduled or after 7 days.
Physical Due in 60 Days / The Service Coordinator receives the “Physical due in 60 days” alert 60 days prior to the annual physical review date. When this alert is selected in the Pending Alerts screen, the hyperlink will navigate the end user to the Physical Assessment screen of the ISP. This alert is automatically removed from the list of pending alerts after 14 days.

Caseload

A caseload refers to the consumers that are assigned to a particular Service Coordinator (SC). The Service Coordinator works with the consumers in his/her caseload to assist in the development of an Individual Service Plan (ISP), locate services and coordinate and monitor the provision of identified services.

Caseload Facesheet

The Caseload Facesheet is a screen that allows a user to see his/her entire caseload listed by consumer name, Master Client Index (MCI) number, date of birth, primary funding source, and ISP end date for each consumer. It also displays the total number of consumers in a caseload. The user can link from this information directly to more detailed information for a specificconsumer.

Category of Plan Changes

When creating or editing an ISP, the Service Coordination role must select the type of plan change. The following bullets enumerate the types of plan changes available in HCSIS:

  • Annual Review: Select when performing an annual review on the ISP or when completing a waiver transfer in HCSIS. This category of plan change allows you to change the plan start and end dates so that you can set the dates for the new plan, and if completing a waiver transfer, change the waiver/program type. The new annual plan’s start date must be the day AFTER the existing plan ends. If there needs to be a timespan between the two plans, select Plan Creation instead of Annual Review. The preparation and creation of the new ISP may take place at any time during the existing ISP.
  • Critical Revision: Use in a situation where a consumer’s services need to be changed. This plan change type copiesthe existing approved plan into a new draft plan that can be modified. You will not be able to update the plan start and end dates because you are not creating a new plan, but rather you are updating the existing plan.
  • Plan Creation: Indicates that a plan is being created for the first time. You will be able to set proposed plan start and end dates. Additionally, use this option to copy the assessment information (i.e. plan information excluding services) from an expired plan. The new plan cannot have start and end dates that overlap with any existing plan.
  • Waiver Transfer:Use in a situation where the consumer is transferring from one waiver/program to another. The waiver transfer process involves using both the waiver transfer and annual review categories of plan change. The waiver transfer plan change type copies the existing approved plan into a new draft plan that can be modified. You can update the plan end date to end the existing plan. For waiver transfers, the plan’s end date can be in the past. After changing the plan end date for the existing plan, you will need to perform an annual review on the existing plan to create a new plan for the remainder of the fiscal year under the new waiver.

(County/Joinder)/SC Entity

The (Cnty/Jndr)/SC Entity is the office that manages the various SC Entities or Service Coordinators that provide Service Coordination services to consumers across the Commonwealth. Consumers are associated with the (Cnty/Jndr)/SC Entity that corresponds to the geographic location where they live. The term Cnty/Jndr is used by the Office of Developmental Programs (ODP). The term SC Entityis used by theOffice of Long Term Living (OLTL).

Effective Dates

The Effective Dates are also known as start date and end dates in HCSIS.

  • Effective start date is the date the information begins being valid for the consumer.
  • Effective end date is the date that information is no longer valid and becomes historical.

There are two ways that effective dates are referenced in HCSIS. The first implies the date range that a specific piece of information is valid in the HCSIS system.

For example, a consumer’s address information has an effective start date and end date so that it is possible to document the exact dates that the consumer lived at that location.

The second way that HCSIS references effective dates relates to the span of time when a plan is active. The effective dates of an ISP cannot exceed one year and they must cover the start and end dates of all the services in the ISP.

The date format used in HCSIS is MM/DD/YYYY.

Eligibility

Eligibility refers specifically to the qualification of a consumer to receive waiver/program specific services funded by OLTL. The eligibility documented in the HCSIS Eligibility screens is not the same as the financial eligibility.

Eligibility Documentation

Eligibility Documentation encompasses the forms and documents used during the eligibility determination process. The Eligibility Documentation screen allows users to track the status of the specific documents that are required for waiver/program eligibility. Users can indicate that a document is in a particular status including: Submitted, Received and Completed.Users can also enter comments about the required document that may be pertinent to eligibility decisions.

Follow-up Service Notes

The Follow-up Service Notes allows the Service Coordinator to set reminders for future action that is needed based on the service note.Follow-up Notes may also be necessary based on findings from a previous service note. If the follow-up service note is not addressed by the follow-up date, an alert will be sent to the Service Coordinator.

History

History is a record of an individual’s eligibility background. History records are automatically created when changes are made to an individual’s eligibility records in HCSIS. In the History screen, HCSIS displays a line for each edit that has occurred, in order from most recent to least recent. To view the history on a HCSIS screen, click [View History]. Note: Entering an effective end date, even if the date is in the future, automatically sends the eligibility record into history.

Home and Community Based Services

Home and Community Based Services are services provided in the community that allow a consumer to function as independently as possible.

Identifier

Identifiers are unique numerical codes associated with a consumer in HCSIS. Identifiers can be a Social Security Number (SSN), a Master Client Index (MCI) Number or a Medicaid (MA) number for a consumer. SSN has a format of XXX-XX-XXXX. MCI has a format of XXXXXXXXX.

Individual Facesheet

The Individual Facesheet is a read-only screen that contains general information from several other screens (such as ISP, Demographics, etc.) to summarize key information about a specific consumer. It provides easy navigation to theDetailed Demographics Information and Service Notes screens.

Individual Service Plan (ISP)

The Individual Service Plan (ISP) is a consumer’s summary of his or her planned services and supports, identified as a result of the consumer and Service Coordinator’s review of preferences and needs. The plan must be revised at least once per year, with several regular reviews taking place during the year.

Note: The terms Individual Service Plan and Individual Supports Plan are used interchangeably.

Level of Care

The Level of Care screen allows users to record that the consumer has been assessed by a qualified professional to be a specific Level of Care. Level of Care options include:

  • ICF/ORC - Intermediate Care Facility / Other Related Conditions - Consumers determined to have an ICF/ORC level of care may be eligible for OBRA.
  • NF - Nursing Facility- Consumer determined to havea NF level of care may be eligible for the Michael Dallas, Attendant Care or Independence waivers.
  • NF/Special Rehab - Nursing Facility / Special Rehabilitation -Consumers determined to have a NF/Special Rehab level of care may be eligible for the COMMCARE waiver.

The Level of Care screen is not required for consumers inthe Act 150 program, but should be completed if the consumer is NF level of care eligible.

Outcome

Outcomes represent the service goals of the consumer. They can represent a continuance or change to current situations, services and/or supports. Outcomes can offer reasoning for the services and supports identified on the plan. They are based on consumer identified priorities; are responses to formal and informal information gathering; and are linked to the appropriate informal and formal services.

Outcome Summary

The Outcome Summary screen in HCSIS collects detailed information about each outcome for the consumer including start and end dates, reasons for the outcome, concerns related to the outcome and any relevant assessments in determining the outcome progress or status. At least one outcome is required for all plans.

Pending Approval/Review

The Pending Approval/Review screen is used to review ISPs that have been submitted for review and/or approval. An ISP will only appear on this screen if it has the pending review status or the pending approval status. Conversely, an ISP will not appear on the Pending Approval/Review screen if the ISP is in draft status, approved status or pending revision status.

An ISP converts to the pending review status when the Service Coordinator submits the ISP for review to the SC Supervisor. After the ISP is marked as “reviewed” in HCSIS by the SC Supervisor the ISP converts to the pending approval status. After the State ISP Approval role approves the plan, the ISP converts to the approved status.

Pending Revision

The Pending Revisionscreen is used to review ISPs that have been disapproved and require changes before they will be approved. The screen will contain comments from the SC Supervisoror State ISP Approval role that explain why the plan was not approved. The SC uses this screen to review the comments for the ISP and convert the ISP back to draft status for the necessary revisions. An ISP will only appear on this screen if it has been disapproved, i.e. in pending revision status. It will not appear if the ISP is in draft status, approved status, pending review statusor pending approval status.

Read-Only

"Read-only" means that you cannot edit or delete information in a field, record or screen. You can only view it on your screen in HCSIS.

Service Coordination (SC) Entity

A Service Coordination (SC) Entity is the specific part of the organization providing Service Coordination services.

Service Notes

Service Notes are notes that document meetings and other contacts with a consumer, the consumer’s family or service staff. These notes are recorded in the service notes portion of a consumer’s records in HCSIS.