Dec 26-refresher Activity 1

The recipient is referring to the covered service of Personal Care. This service involves assistance with bathing and getting dressed, which is exactly what the recipient mentioned in their statement. Personal Care is specifically designed to help individuals who have difficulty performing these tasks on their own, making it the appropriate answer in this context.

The recipient is referring to Home Accessibility Adaptation Services. They mention needing bars put in their bathroom to hold themselves up, indicating a need for modifications to their home to make it more accessible and safe for them to navigate with their walker.

The recipient is referring to Nutritional Assessment/Risk Reduction Services because they are unsure about what type of food is right for their grandfather who has Crohn's Disease. They want to make sure they are giving him the right foods to prevent his condition from worsening.

This answer is correct because it specifies the specific criteria that must be met in order for recipients to be eligible for PACE Plans. The answer states that recipients must have a PACE level of care, be 55 years or older, and live near a PACE region. This means that recipients who meet these criteria will be eligible for PACE Plans.

Recipients can enroll into PACE under Medicaid Pending, meaning that individuals who have applied for Medicaid but are still waiting for their application to be approved can still enroll in the PACE program. This allows them to receive the necessary healthcare services and support while their Medicaid eligibility is being determined.

PACE, which stands for Program of All-Inclusive Care for the Elderly, is a Medicare and Medicaid program that aims to assist individuals in meeting their health needs within the community rather than being admitted to a nursing home or another care facility. This program provides comprehensive medical and social services to eligible individuals, allowing them to receive the necessary care and support while remaining in their own homes and communities.

The Good Cause request was approved.

The correct answer is "All of the above" because recipients who enroll through Med Pending and start services cannot change their plan while in Med Pending, they may be billed for services if Medicaid is denied, and they may also disenroll.

The correct answer is the LTC Program is a program that provides long-term care services to elder and disabled adult enrollees. This answer is supported by the information given in the question, which states that the LTC Program provides services to elder and disabled adult enrollees. This indicates that the program is specifically designed to cater to the long-term care needs of elderly individuals and disabled adults.

The recipient is categorized as Voluntary because she has APD: WL, which stands for Agency for Persons with Disabilities Waitlist. This indicates that she voluntarily joined the waitlist for the Agency for Persons with Disabilities, suggesting that she willingly sought out the services provided by this agency.

The member is currently receiving their services through FFS/Straight Medicaid.

To search for cases in FMMIS, the information that should be used includes the Recipient ID, Social Security number, or gold card number. These are the specific identifiers that can be used to locate and retrieve relevant cases from the system.

The correct answer is to document the caller's Name, Agency & Title, Work Phone Number, Statement of Authority and continue with the call. This is the appropriate response because it allows the worker to gather necessary information about the caller's identity and authority before proceeding with the call. This ensures that the worker is speaking with a legitimate representative from the Department of Children and Families or Community Based Care, and helps maintain the confidentiality and security of the information being discussed.

If the recipient wants the auto-assignment into Freedom, the correct action to take is to select accept assignment. This means that the recipient will be enrolled in the Freedom Health (Specialty Plan) as desired.

The correct answer is "Member was auto assigned." This means that the member did not actively choose the health plan but was instead assigned to one automatically.

The correct answer is 07/30/2014. This is because the recipient calls in on 10/17/2014 to make a plan change, which means they are already past the date of 07/30/2014. Therefore, no plan change can be made without using a GC reason.

Continuity of Care refers to the seamless and uninterrupted provision of healthcare services to patients when there are changes in their healthcare plans. In the given options, both scenarios involve a recipient transitioning from one plan to another, which could disrupt their healthcare services. Therefore, in both cases, Continuity of Care would apply to ensure that the recipient receives the necessary care without any interruptions. Hence, the correct answer is "All of the Above."

MMA plans must provide continuity of care for up to 60 days. This means that individuals enrolled in MMA plans are guaranteed access to necessary medical services for a period of 60 days, ensuring that their healthcare needs are consistently met. This provision aims to promote and maintain the quality and consistency of care for MMA plan beneficiaries.

The correct answer is to explain Continuity of Care and refer to the new plan for more information. This is the appropriate response because Continuity of Care ensures that individuals can continue to receive care from their previous healthcare provider even after switching to a new plan. By explaining this concept to the caller and referring them to the new plan for more information, you can help them understand their options and make necessary arrangements for their appointment.

The recipient is referring to Adult Companion Care. This service involves having someone around to help and watch over the individual who is becoming forgetful and needs assistance with daily tasks. Adult Companion Care provides companionship and supervision to ensure the safety and well-being of the individual.

The recipient is referring to Homemaker Services. This is evident from the statement that Sue helps with cooking and helping around the house. Homemaker Services typically involve assistance with household tasks such as meal preparation, cleaning, and other chores related to maintaining the household.

To complete a plan change from PACE into a LTC plan, the recipient must call the Elder Helpline. This suggests that the Elder Helpline is the appropriate channel for requesting a plan change in this scenario. It implies that the recipient cannot complete the plan change online or through other phone lines such as SSA or SMMC.

The icon represents enrollment. It is commonly used to indicate the process of signing up or registering for a program or service. This could refer to enrolling in a course, joining a membership, or becoming a participant in an event or activity. The icon may be used to prompt users to take action and complete the enrollment process.

The recipient is excluded from enrolling into a LTC (Long-Term Care) plan because they are currently living in an Intermediate Care Facility for Persons with Developmental Disabilities. This indicates that they are already receiving the necessary care and support in their current living arrangement, so enrolling in a LTC plan would not be necessary or appropriate.

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Recipients are allowed to request enrollment into PACE. This is indicated by the option "PACE" in the given answer choices.

If a caller does not want the LTC auto-assignment plan before the cut-off date, the agent should process the change through the wizard. This means that the agent should use the appropriate software or tool to make the necessary changes to the caller's plan. This ensures that the caller's preferences are taken into account and that the appropriate plan is assigned to them.

The date 12/31/2299 indicates an open end date because it is the latest date provided among the options. The year 2299 implies that there is no specific end date set, suggesting that the event or situation will continue indefinitely.

This member is receiving their Medicaid through the Department of Children and Families.

The special condition that is active is HomeSafenet. This is indicated by the fact that it is listed as an answer option and there is no mention of any other special condition being active.

The correct answer is that the cut-off is the last day of the month. This is supported by the statement "The cut-off day is the second to the last day of the month." The other options provided in the question are incorrect as they mention different cut-off days, such as the Thursday before the 2nd to the last Saturday of every month or immediately after the green check mark appears in HealthTrack. Therefore, the last day of the month is the correct cut-off day for MMA.

The caller is expressing dissatisfaction with being enrolled in a plan that they claim they did not choose. They also mention that their preferred doctor does not accept the plan and they do not want to switch doctors. This situation aligns with GC9, which states that the caller wants to keep their current doctor and does not want to switch.

MMA stands for Medicare Advantage, which is a type of medical plan offered by private insurance companies that provides Medicare benefits. Therefore, checking the box for MMA would indicate enrollment into a medical plan.

The correct answer is GC17. This GC (General Condition) states that a customer who is locked into a contract and has a medical condition can switch to a new plan if their doctor advises it and the new plan covers their specialists. In this case, the caller has HIV and their doctor has recommended switching to Clear Health Alliance/Positive HealthCare because their new specialists accept that plan. Therefore, GC17 would apply in this situation.

The Special Conditions tab would indicate if the recipient has been pre-approved for CMS. This tab is likely to contain information about any specific conditions or requirements that the recipient needs to meet in order to be eligible for CMS. It may include details about any medical or financial criteria that need to be met, as well as any documentation or paperwork that needs to be submitted. By checking the Special Conditions tab, one can determine if the recipient has been pre-approved for CMS or if there are any additional steps or requirements that need to be fulfilled.

By clicking the icon below in HealthTrack, you can find information about the eligibility span. This means that you can access details regarding the period of time for which an individual is eligible for Medicaid benefits. It may include the start and end dates of their eligibility, allowing healthcare providers to determine if the individual is currently eligible for Medicaid coverage.

The caller states that they called last month to change their plan during open enrollment, but their doctor says their plan is still the same. The caller also mentions that the agent they spoke to promised a confirmation letter and information from the new plan, but they haven't received anything yet. Upon checking, it is found that although there was a call for a plan change, no change was processed by the system. In this situation, calling a supervisor for approval to use a GC1610 would be the appropriate course of action. This suggests that the GC1610 is a tool or process that can be used to rectify the situation and process the plan change for the caller.

If a caller states they want to see if they are eligible for LTC (Long-Term Care) and they have active MMA (Medicaid Managed Care) coverage, they would be referred to the Elder Helpline. The Elder Helpline is a resource that provides information and assistance regarding long-term care services for the elderly. Since the caller already has active MMA coverage, the Elder Helpline would be the appropriate referral to help them navigate and access the necessary long-term care services they may be eligible for.

Based on the information provided, the correct course of action is to inform the caller that they will need to select a plan due to the type of Medicaid that is on file. This suggests that the caller's Medicaid coverage requires them to choose a plan, regardless of their preference or the auto-assignment from Freedom Health.

To pull up the history on one individual, you would click on the "Recipient's Name" option. This suggests that the recipient's name is a clickable link or button that leads to the individual's history. Clicking on it would likely open a new page or display a dropdown menu showing the recipient's past activities or interactions.