dc medicaid case management
For high-risk situations that require consultation and/or management of a perinatologist, practitioners should contact the high-risk case manager at the number above. To Elderly and Persons with Disabilities (EPD) Waiver Providers: On Friday, July 10, DHCF’s Conflict-Free Case Management Services Notice of Emergency and Proposed Rulemaking was published in the DC Register. The Provider Lookup database contains all providers with an open DC Medicaid provider number. They … Anacostia Service Center C. Individuals applying for Long Term Care Services and Supports can apply: • For individuals living or transitioning to a nursing facility: By working with District Medicaid nursing facility providers to submit your application. This week, our In Focus reviews North Carolina’s much-anticipated Prepaid Health Plan Services request for proposals (RFP), released by the Department of Health and Human Services, Division of Health Benefits on August 9, 2018, and District of Columbia’s Medicaid Managed Care RFP released on August 14, 2018. Appealing a Denied Service. If your child is in the DC Healthy Families (Medicaid) program, your child will be in the HealthCheck Program, also called Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). Three-day window payment policy holds strong headed into ninth year View Newsletter CY 2019 Outpatient Prospective Payment System Proposed Rule Summary View Whitepaper Annual schedule of CMS effective dates and files for systems maintenance View Report Modernizing Hospital Payment Methods for DC Medicaid View Case Study Value-Based Payment: The Role of Medicaid Programs … Back to top What Services Are Available To People Receiving Medicaid Case Management? States Date program began operation Current number of enrollees; California: 68,660 PCCM: 8/1984: 5,160 … Medicaid Case Management Beneficiary Freedom of Choice Attestation Directions:Use this form to note your top three choices for EPD wavier case management. Medicaid Waiver Information The waiver program provides an alternative to institutional residential services by offering a wide range of daily living, respite, vocational, employment, retirement, social, clinical, therapy and adaptive services and supports in the home and community in a variety of settings. We are big advocates for sharing knowledge. DC Medicaid/Alliance and Me. Case management services that assist individuals in gaining access to needed medical, social, educational, and other services. Miller ME(1), Gengler DJ. HIV Medical Case Management Guidelines (2014) Page 1 Introduction Medical Case Management (MCM) is traditional case management with the purpose of 1) retaining clients in medical care and 2) achieving positive health outcomes for clients in the District of Columbia (hereafter, DC). About DHCF The straightforward mission of the agency is to improve the health outcomes of low-income residents of the District by providing access to a full range of preventative, primary, urgent and critical health care services. Targeted case management. Conducts assessments with regard to functional, medical, social, and financial status. For utilization review, case management and related activities, we are continuing to process requests and answer calls via our toll-free numbers during standard business hours. Department of Health Care Finance Conflict-Free Case Management Self-Attestation Form Department of Health Care Finance 441 4th Street, NW Washington, DC 20001 (202) 727-5645 (fax) www.dc-medicaid.com Box 91560, Washington, DC 20090 or by fax to 202-671-4400. The District of Columbia’s Medicaid Managed Care Quality Strategy utilizes the Institute for Healthcare Improvement framework for optimizing health system performance (also referred to the “Triple Aim”) . Reviewers or Medical Directors are also available to discuss any and all utilization management decisions, questions or issues. The case manager can be contacted via phone (202) 821-1100. Health Policy. Thirty-nine states cover targeted case management to certain Medicaid beneficiaries with an SUD. Freund DA. MedStar Family Choice-DC's utilization management decision making is based on the medical necessity of the service and the existence of Managed Care Organization enrollment and coverage. Washington, DC 20043. Office Hours Monday to Friday, 8:30 am to 5:00 pm Connect With Us 250 E Street, SW, Washington, DC 20024 Phone: (202) 730-1700 Fax: (202) 730-1843 Those conclusions came as the CAB ruled on an “instant protest” filed by Amerigroup, a company that previously served as one of the DC’s managed care organizations (MCOs). You can also find it on DHCF’s website at. Case Management as: “a range of client-centered services that link clients with health care, psychosocial, and other services. View the Guidance. Provides adult day health, case management, homemaker, personal care aide, respite, assisted living, chore aide, community transition services, environment accessibility and adaptation services, individual directed goods and services, participant-directed community support services for aged individuals 65-no max age and individuals with physical disabilities ages 18-64
CareFirst CHPDC is the Washington DC provider of Medicaid and Alliance Benefits. %PDF-1.6
%����
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. The District of Columbia’s (DC) Health Services for Children with Special Needs Plan (HSCSN) is a Medicaid Managed Care Organization (MCO) for children who meet SSI-level or SSI-level-like criteria. While there are differing eligibility groups, this page is focused strictly on Medicaid eligibility for Washington DC elders, aged 65 and over, and specifically fo… To apply for Medicaid in the District of Columbia, seniors need to submit a “Combined Application for Benefits” either by mail to the Department of Human Services, Economic Security Administration, Case Record Management Unit, P.O. Complete the highlighted areas. Select a range by holding down the SHIFT key when above or below items are all ready selected. Medicaid Targeted Case Management (TCM) Benefits Showing 1-4 of 15 pages in this report . You can also find it on DHCF’s website at http://dhcf.dc.gov/node/1090492. Can I apply for Medicaid only for my children? If you are eligible for DC Medicaid, there are many ways to enroll with MedStar Family Choice-DC: Visit DCHealthyFamilies.com and click enroll and then select get started Call DC Healthy Families at 202-639-4030 or 800-620-7802. We hope to meet you at one of our centers soon! The HealthCheck Program gives your child a number of important check-ups. Access HelpLine Call the Access HelpLine to: Phone. Skip to main content. Case Manager Medicaid Elderly & Disabled Waiver, West Alabama – Northport, AL. Utilization management means ensuring that every dollar spent on patient care is a dollar well spent. Within sixty (60) days from the effective date of these rules (by September 1, 2015), EPD Waiver case management service providers shall ensure they have a copy of the DHCF Conflict-Free Case Management Self-Attestation Form (see attached) on file for each case manager prior to submission of any claims for case management services provided by that case manager. coronavirus.dc.gov The purpose of the Care Management program is to ensure that appropriate medical services are provided in accordance with state and federal regulations, statutes and policies to recipients of the District of Columbia (DC) Department of Health Care Finance (DHCF) state Medicaid Plan (fee for service) . Monthly care management fees: $2 for children, $3 for adults, $4 for disabled or elderly beneficiaries a Pediatric claims paid within 30 days; adult claims paid within 60 days The information regarding address and telephone for each provider is what is currently on file with the Department of Health Care Finance and may not always reflect current changes. Jointly funded by the state and federal government, health coverage is provided for varying groups of Washington DC residents, including pregnant women, parents and caretaker relatives, adults with no dependent children, disabled individuals, and seniors. Medical Case Management (MCM) is traditional case management with the purpose of 1) retaining clients in medical care and 2) achieving positive health outcomes for clients in the District of Columbia (hereafter, DC). There are several available behavioral (Mental Health) services and professional counseling services available to District residents. Medicaid managed care organizations (MCOs) provide comprehensive acute care and in some cases long-term services and supports to Medicaid beneficiaries. The high-risk case manager partners with the OB practitioner to provide reinforcement education for the high-risk condition and coordinate services needed. Case Record Management Unit . 2383 0 obj
<>/Filter/FlateDecode/ID[<1BC10E2A8506CD4B83B8FBDE2B509E61><79BBBD8BB908F8469285469DD881277A>]/Index[2368 27]/Info 2367 0 R/Length 90/Prev 958020/Root 2369 0 R/Size 2395/Type/XRef/W[1 3 1]>>stream
Medicaid Case Management jobs in District of Columbia All New Filter 103 jobs within 15 miles. Exhibit 1 Medicaid Case Management Enrollment As Of November 1986. The Alaska Medicaid Coordinated Care Initiative (AMCCI) is designed to assist Alaska Medicaid members who need help navigating the healthcare system and can benefit from case management services. To speak with a case manager: Rapid Response: 1-877-759-6224: 24 hours a day; seven days a week. Fax. Completed forms should be mailed or faxed to the respective EPD Waiver case management service provider employing the EPD Case Manager. h�b```�E,�Z� ������h , (�`�� ���" (��� �pØ)�-�QI`ძGL����z�:���C˂Y�+�E Gr�eQp��PGa�
��F"���-�ە��c':��76�!�a��Z]CM1�SBB
�����Y���7dɽ+�4?�<5����Ph����ŎYq�|v1���p�$�����Z�pT�X�¤���̌t��jz�v� �����̒j��f� Medicaid Case Management is a service available to older adults and adults with disabilities who live at home and who qualify for a DSHS-funded long-term care program, either Community Options Program Entry System (COPES Program) or Medicaid Personal Care (MPC Program). Case Management Services and PCP outreach and care coordination are also available to High Risk enrollees. Box 91560 . Professional Services Billing Codes and Reimbursement Rates for Administration of COVID-19 Monoclonal Antibody Infusions; Chronic Hepatitis C Treatment Coverage Policy: Removal of Minimum Fibrosis Score Requirement for Mavyret and Vosevi; Hospital Services Billing Codes and Reimbursement Rates for COVID-19 Vaccine … PO Box 34800. View the Guidance. DHCF and the new managed care plans – AmeriHealth Caritas DC, MedStar Family Choice DC, and CareFirst Community Health Plan DC … 2394 0 obj
<>stream
We have business continuity plans in place to serve our clients, health care providers, patients and communities while also protecting our staff and minimizing the spread of the illness. CASE MANAGEMENT Maintaining a cooperative relationship with a case manager is a very important part of participant’s care and well-being. Medicaid Reform: Four Studies of Case Management. Box 91560 Washington, DC 20090. An individual providing EPD waiver case management services on the effective date of these rules shall have sixty (60) days (until September 1, 2015) from the effective date of these rules to meet the requirements laid out in the rule. Within broad Federal guidelines, States can develop home and community-based services waivers (HCBS Waivers) to meet the needs of people who prefer to get long-term care services and supports in their home or community, rather than in an institutional setting. A case manager can communicate with other providers about a In fact, this type of review was required by law in 1972 for Medicaid and Medicare programs. The Center for Medicaid and CHIP Services (CMCS) is committed to working in close partnership with states, as well as providers, families, and other stakeholders to support effective, innovative, and high quality health coverage programs. At Qualis Health, we make this happen by combining evidence-based criteria, data analysis and high-quality reviews. In September 2019, the District of Columbia announced that it will be moving towards a fully managed Medicaid program over the next five years. Enter any combination of the provider's type, specialty, last name, first name, city, state, zip code or county. Comagine Health Reconsideration Review. The request can be made independent of a specific case. MTM is responsible for all non-emergency transportation (NEMT) within the Washington, D.C. metropolitan area. The Centers for Medicare & Medicaid Services (CMS) interim final rule with comment period (IFC) implementing section 6052 of the Deficit Reduction Act of 2005 (DRA) clarifies the Medicaid definition of covered case management and targeted case management (TCM) services. Read Mayor Bowser’s Presentation on DC’s COVID-19 Situational Update: March 11 The strategic goals and objectives of DHCF programs are dc.subject.classification: Health Care for Indigents: en: dc.title: Medicaid Primary Care Case Management, the Doctor-Patient Relationship, and the Politics of Privatization: en: dc.provenance: Citation prepared by the Library and Information Services group of the Kennedy Institute of Ethics, Georgetown University for the ETHXWeb database. Who we serve. The high-risk case manager partners with the OB practitioner to provide reinforcement education for the high-risk condition and coordinate services needed. Rosslyn, VA Lead State Medicaid Data warehouse Analytics SME Are you a Medicaid Management Information System (MMIS) subject matter expert with technicalfunctional Medicaid Data Analytics expe… g��\��n� In 2009, nearly one million individuals were receiving services under HCBS waivers. MCOs accept a … Mail. Medicaid managed care Medicaid and additional services in the United States through an arrangement between a state Medicaid agency and managed care organizations (MCOs) that accept a set payment – "capitation" – for these services. As of 2014, 26 states have contracts with MCOs to deliver long-term care for the elderly and individuals with disabilities. Provides case management for a high-volume caseload. Learn about our services and how to schedule a ride. An entity described in the rule shall notify DHCF of its election to continue or discontinue providing case management services within sixty (60) days of the effective date of these rules, and must submit a completed DHCF Conflict-Free Case Management Provider Decision Form to DHCF (, An entity that chooses to discontinue case management services shall securely submit the DHCF Conflict-Free Case Management Transition Template to DHCF (. To learn more about behavioral (Mental Health) services and drug treatment programs please click the links below. A Managed Care Organization committed to providing preventative services and support to its medicaid and alliance enrollees. All criteria applied in utilization management are available upon request. History of Peer Review The Federal government has expended significant dollars in developing and supporting review of care in facilities. DC Specialty Hosp DRG Pricing Calculator Eff 10-1-2020 DCS20015; DC APR-DRG FAQ Eff 10/1/2018 DCI18004; DC EAPG Never Pay List Eff 10/1/2018 DCO18021 ; DC Medicaid Beneficiary Disclosure and Commitment to Take Hepatitis C Medications; Conflict-Free Case Management Self-Attestation Form; DC EAPG Grouper Settings Eff 10/1/2018 DCO18022 Create alert All New ... Save. Our leaders. Coordinates services with contractors to ensure optimal service delivery. As part of this notice, there are a series of deadlines providers must be aware of: If you have questions, please submit these via email to, Read Mayor Bowser’s Presentation on DC’s COVID-19 Situational Update: March 11. MedStar Family Choice allows up to fourteen (14) days to process non-urgent authorization requests. J � d�(�U��A"
0��2A9�z �� CareFirst CHPDC is the Washington DC provider of Medicaid and Alliance Benefits. Yes, a parent may apply for his/her children only. Case Management Services - Case management is the coordination of services on behalf of the participant. ,D���00j�Lgre���T�pMc���I����b|��?�9��+�7�5��1\ab-��������n���+/dR�G��c`lg\�U��k�#�#�����` �@z�
-��P� �j=ߜ
U�S �V��
Complex care management AmeriHealth Caritas District of Columbia (DC) has integrated care management programs for enrollees who have special health care needs, behavioral health conditions, and chronic conditions such as asthma, diabetes, and high blood pressure. Medicaid case management: Kentucky's Patient Access and Care Program. Fax: 202-671-4400 . %%EOF
Case Records Management Unit 441 4th Street, NW, Suite 1C-15 Washington, DC 20001 Email: Medicaid@dc.gov Fax: (202) 535-1122 In Person: Take this completed and signed form to one of the Service Centers listed below. P.O. Office Hours Monday to Friday, 8:15 am to 4:45 pm Connect With Us 441 4th Street, NW, 900S, Washington, DC 20001 Phone: (202) 442-5988 Fax: (202) 442-4790 The coordination and follow-up of medical treatments is a component of Medical Case Management. Washington, DC. To complete enrollment activities and/or update your provider file, visit www.dcpdms.com; For assistance, contact the Maximus Provider Screening and Enrollment Customer Service Center at 844-218-9700 Monday through Friday (8:00 am – 5:00 pm). endstream
endobj
2369 0 obj
<. If you have any questions, please Call DC Health Link Customer Service at (855) 532-5465/TTY (855) 532-5465. Case Record Management Unit P.O. We offer face to face enrollee services, care coordination, case management, health screenings, health education, healthy cooking demonstrations, physical fitness programs and enrollee resources. : American Enterprise Institute; 1984. Assists individuals and their families with developing a plan of care. (WASHINGTON, DC) – The Department of Health Care Finance (DHCF) announces the implementation of new managed care contracts, which will set the foundation to expand access to care and improve health outcomes for District residents. Provider Enrollment Application Instructions. The HRSA HIV/AIDS Bureau (HAB) defines Medical Case Management (MCM) DC Entered Phase Two of Reopening on June 22. Case Records Management Unit 441 4th Street, NW, Suite 1C-15 Washington, DC 20001 Email: Medicaid@dc.gov Fax: (202) 535-1122 In Person: Take this completed and signed form to one of the Service Centers listed below. �P�;0��O=�T����N�Yׁ��i��«3��L,g_�שy2M� ���i�׃P/30Jt4 #��H1i�ق@����"�]"@|��`FD��, �1G@L�P��R� �dU��OK�p��C!,&�P�A!�J6�N
�J�[�$�-��jkD�A0��e@��Pw0�������:��"@$$ 6 List of EPD Case Management Providers Directions: Review this list of approved EPD Waiver Case Management Agency providers and identify your top three (3) choices. In order to ensure compliance with the Centers for Medicare and Medicaid (CMS) regulations governing conflict-free standards for the delivery of case management in its Home and Community-Based regulations, DHCF is requiring that each case manager self-attest that he or she meets the CMS standards for conflict-free case management services. 35 Medicaid Case Manager RN jobs available in Washington, DC on Indeed.com. Economic Security Administration: 1-202-727-5355 or 1-877-759-6883 Medicaid Targeted Case Management (TCM) Benefits Showing 1-4 of 15 pages in this report . medicaid breast and cervical cancer treatment program: 29-44: mental health grants: 29-45: medicaid reimbursement for federally qualified health centers: 29-46: mobile community outreach treatment team services: 29-47: targeted case management services for abused and neglected children: 29-48: medicaid program: reimbursement: 29-49 The DC MDW initially scheduled data warehouse implementation in September of 2016, but missed that deadline. SOن��ܨ�0�*�A�F������)�Îۀ��Y��(�[~��0'P-J�)�6���)��S*Äc&��)p��ޮ0�|�ǜ�&ާSB[�|��p�]a�1mf��S,�Z2����s�y������(��t��j�R|_d�X��@�j�ڏ��6�P�:2P-8��3�#P{ ��J��xNaL��i�=��u2PKm!�U�pW��U����3�l��A� gڔJPh�� ڮԪ)+Ӕ��3��2)s��I�u��A�d�"Μ�� �J��y�WA�@or2M 7xdM�� Often times people cope with mental illness by using drugs or alcohol. This program starts right after your child is born and lasts until your child turns 21. How to Enroll in MedStar Family Choice-DC. All high- risk conditions should be reported to the high-risk obstetrical case manager. From our award-winning publications and clinical … Author information: (1)Urban Institute, Washington, DC 20037. 2. Competitive Health Plans and Alternative Payment Arrangements for Physicians in the United States: Public Sector Examples. A Managed Care Organization committed to providing preventative services and support to its medicaid … Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. We have business continuity plans in place to serve our clients, health care providers, patients and communities while also protecting our staff and minimizing the spread of the illness. Participants in primary care case management ... DC: Medicaid and CHIP Payment and Access Commission, June 2011). Finance (DHCF) state Medicaid Plan (fee for service) . The DC Medicaid Program currently supports more than 260,000 active members, more than 11,000 Providers eligibles, and more than 300 reports. If you have any questions, please Call DC Health Link Customer Service at (855) 532-5465/TTY (855) 532-5465. PDF Version Also Available for Download. Anacostia Service Center 2100 Martin Luther King Avenue, SE … The District of Columbia (DC) Department of Health Care and Finance (DHCF) decided to implement a new Medicaid Data Warehouse (MDW). endstream
endobj
startxref
However, some factors common to the parent (including income and resources) will be used to determine eligibility for the children. The latest from our team. Answers and More>> Latest News. Per the notice, the emergency rulemaking was adopted on July 1, 2015 and shall become effective for services rendered on or after that date. If you are pregnant and need to check for Medicaid eligibility. The case manager can be contacted via phone (202) 821-1100. Because these members may have trouble navigating the healthcare system, they may become frequent utilizers of the hospital emergency room for issues that may be better treated in a primary … For utilization review, case management and related activities, we are continuing to process requests and answer calls via our toll-free numbers during standard business hours. Informational Bulletins for LTC Providers, Important Notice for Primary Care Providers, DC HIE Onboarding Requirements for the Behavioral Health Transformation Rule, Medicaid Electronic Health Record Incentive Program, Americans with Disabilities Act Information, DHCF Notice of Non-Discrimination and Accessibility Requirements Statement, DHCF Conflict-Free Case Management Provider Decision Form.docx, DHCF Conflict-Free Case Management Self-Attestation Form.docx, DHCF Conflict-Free Case Management Transition Template.xlsx. 0
As pioneers in specialty drug management, industry leaders in Medicaid pharmacy programs and disruptors in pharmacy benefit management, we partner with our customers and members to deliver a best-in-class healthcare experience. In order to select more than one type, specialty or county single click the first then select more by holding the CTRL key and clicking more. Ward 8 Health and Wellness Center 2300 Martin Luther King Jr … (800) 251-8890. Washington, DC 20090 . If you identify an enrollee that would benefit from either of these services, please contact CareFirst CHPDC at (202) 821-1132 , or complete the referral form below. DHCF and the new managed care plans – AmeriHealth Caritas DC, MedStar Family Choice DC, and CareFirst Community Health Plan DC (formerly known as Trusted Health Plan) – have worked together in preparation for this milestone in the District’s Medicaid reform efforts. 2368 0 obj
<>
endobj
Case management services are optimized when offered in a climate that allows direct, open, and honest communication and collaboration among the case manager, the client/support system, the payor, the primary care provider (PCP), the specialty care provider (SCP), and all other service delivery professionals and paraprofessionals. On Friday, July 10, DHCF’s Conflict-Free Case Management Services Notice of Emergency and Proposed Rulemaking was published in the DC Register. h�bbd```b``�"ւHF� f/�L
`�7`�,��"u~�H�6 ɸ�����KH��y�����yl2#����� K1. DHCF Conflict-Free Case Management Self-Attestation Forms are subject to inspection and audit and must be produced upon request. Apply to Case Manager, Registered Nurse Case Manager, Registered Nurse and more! Who we are. 1987; 7:163–173. Case management is a shared process of conducting assessments, planning, counseling and advocating for options and services to meet the participant’s and … Last Updated 3/22/2017-DC Office on Aging, Aging and Disability Resource Center Step 2: Review Case Management Options and Complete Attestation Form Documents: 1. DC Entered Phase Two of Reopening on June 22. Please see Section 15 of the DC Medicaid Provider Manual for more information about requesting a reconsideration. (800) 731-2314. While a case manager cannot provide medical, financial, legal, or other services, case managers can help with referrals to these services. APPROVED ELDERLY & PERSONS WITH PHYSICAL DISABILITIES (EPD) WAIVER CASE MANAGEMENT ONLY Last Updated 2/28/17 Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. The plan provides a higher level of care coordination and case management for the more complex children it … PDF Version Also Available for Download. Fifteen states cover transitional case management for certain beneficiaries with an SUD. Notes: