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Case Manager: Personal Care Attendant (PCA) Learning Module. BCBS Secure Blue--MSHO BluePlus PMAP MN Senior Care. Presented by Annette Sietsema , RN, BAN Kandiyohi County Public Health Nurse/Case Manager. BCBS Members Affected. BluePlus PMAP Members (population under age 65)

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Case Manager: Personal Care Attendant (PCA) Learning Module

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Case manager personal care attendant pca learning module

Case Manager: Personal Care Attendant (PCA) Learning Module

BCBS Secure Blue--MSHO

BluePlus PMAP

MN Senior Care

Presented by Annette Sietsema, RN, BAN

Kandiyohi County Public Health Nurse/Case Manager

For Kandiyohi County Public Health & Kandiyohi County Family Services----August 2006


Bcbs members affected

BCBS Members Affected

BluePlus PMAP Members

(population under age 65)

Minnesota Senior Care

(PMAP over age 65)

Secure Blue Members

Kandiyohi County Public Health & Kandiyohi County Family Services


Legislative 2005 changes to the pca program

Legislative (2005) Changes to the PCA Program

A “Statement of Need” for PCA services

“PCA Flexible Use Agreement”

New documentation requirements*

PCA individual provider numbers required*

*The CM does not facilitate these areas

Kandiyohi County Public Health & Kandiyohi County Family Services


Pca referral process

PCA Referral Process

Each program is slightly different.

It is the FIRST step of each plan that is unique in its application.

All subsequent steps for each plan are identical thereafter.

Kandiyohi County Public Health & Kandiyohi County Family Services


It all begins with a phone call

It all begins with a phone call…

  • Who yougonna’ call?

    • No not the Ghost Busters

    • In fact YOU don’t have to call anyone

    • It is now the responsibility of the PCA Provider to make the first contact

Kandiyohi County Public Health & Kandiyohi County Family Services


So who does the pca provider call

So who does the PCA provider call?

It is different for each type of BCBS plan…

Does the provider know that they need to make the first call?

Does the provider know who they have to call?

“I’m the case manager what am I suppose to do?”

Kandiyohi County Public Health & Kandiyohi County Family Services


Your new titles will be educator advocate collaborator

Your new titles will be: EducatorAdvocateCollaborator

"Case Management in Hospital/Health Care Systems is a collaborative practice model including patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to self determination.“

http://www.acmaweb.org

Kandiyohi County Public Health & Kandiyohi County Family Services


Educating the provider

Educating the Provider

You will play an important role in facilitating the initiation of PCA services for your clients. Much of what you will be doing will support and educate providers as we all begin this new (and somewhat cumbersome) process.

Kandiyohi County Public Health & Kandiyohi County Family Services


Step 1

STEP #1

We will examine Step #1 of each program separately

(With great anticipation & bated breath…)

Kandiyohi County Public Health & Kandiyohi County Family Services


Step 1 blue plus pmap

Step #1: Blue Plus PMAP

PRIOR to rendering PCA services to a BCBS MN Public Programs member—PROVIDERS must contact the member’s individual case manager:

CALL:

651-662-5520

1-888-878-0139

Kandiyohi County Public Health & Kandiyohi County Family Services


Step 1 mn senior care

Step #1: MN Senior Care

PRIOR to rendering PCA services to a BCBS MN Public Programs member—PROVIDERS must contact the member’s individual case manager.

CALL SENIOR PUBLIC PROGRAMS INTAKE @

651-662-5540

1-800-711-9868

Kandiyohi County Public Health & Kandiyohi County Family Services


Step 1 secure blue msho

Step #1: Secure Blue--MSHO

PRIOR to rendering PCA services to a BCBS MN Public Programs member—PROVIDERS must contact the member’s County Care Coordinator. If the PROVIDER does not know who the County CM is they may contact Sr. Public Programs Intake for assistance in locating the member’s county care coordinator.

CALL SENIOR PUBLIC PROGRAMS INTAKE @

651-662-5540

1-800-711-9868

Kandiyohi County Public Health & Kandiyohi County Family Services


Steps two three four five

Steps Two, Three, Four & Five

For all three BCBS programs the subsequent steps are identical...

Kandiyohi County Public Health & Kandiyohi County Family Services


Step 2

Step #2

An assessment of the member’s need for PCA services will be completed by a PHN, EW Case Manager or County Care Coordinator.

Kandiyohi County Public Health & Kandiyohi County Family Services


Step 3

Step #3

A BCBS Case Manager (not us!) will submit the Statement of Need to the member’s primary care clinic after the assessment has been completed.

Kandiyohi County Public Health & Kandiyohi County Family Services


Step 4

Step #4

The members primary care provider will review and order PCA services (a Nurse Practitioner is also qualified to do this)

The practitioner is to return the form to BCBS within 24 hours.

Kandiyohi County Public Health & Kandiyohi County Family Services


Step 5

Step #5

The BCBS Case Manager will forward a copy of the completed Statement of Need with the determination letter issued to the PCA provider and the member

Kandiyohi County Public Health & Kandiyohi County Family Services


A closer look at secure blue msho

A closer look…at Secure Blue/MSHO

The County Care Manager (us) responsibility once the Provider has requested PCA services….

Verify the need—you may need to make a home visit

Call Secure Blue (Bobbi Cooper)

Remind the PCA agency about the new process for PCA authorization of need

Update the CSP and fax to Secure Blue

Discuss “Flexible Use” option with client and fax completed form to Secure Blue—remember to obtain signature

(if BCBS does not receive the form they will assume that the PCA hours will be flexed month to month.

Kandiyohi County Public Health & Kandiyohi County Family Services


Flexible use option

Flexible Use Option

http:[email protected]_bluecrossmn/documents/public/post71a_080647.pdf

Kandiyohi County Public Health & Kandiyohi County Family Services


A few words from deb floren

A few words from Deb Floren

Kandiyohi County Public Health & Kandiyohi County Family Services


Questions comments

Questions/Comments

Are we in love yet?...

Kandiyohi County Public Health & Kandiyohi County Family Services


Closing thoughts

Closing Thoughts

Any fool can make things bigger, more complex and more violent. It takes a touch of genius—and a lot of courage—to move in the opposite direction.

~Albert Einstein

Kandiyohi County Public Health & Kandiyohi County Family Services


Reference

Reference

BCBS (2006). Legislative changes to PCA program. BCBS Provider Bulletin. As found at: http:[email protected]_bluecrossmn/documents/public/post71a_080647.pdf

Kandiyohi County Public Health & Kandiyohi County Family Services


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