During the initial assessment for the ADvantage Program, a DHS Health Care Management Nurse visits the Applicant in his or her home to complete an assessment for medical eligibility. The Uniform Comprehensive Evaluation Tool, or UCAT (Part III), is the document used to determine medical level of care. Every year thereafter, the ADvantage Case Manager completes the reassessment UCAT as part of the service plan development process and for assuring continued program eligibility.
Case Manager's responsibility:
- Monitor each assigned Member's Service Plan dates so the reassessment process is started 40 to 60 days prior to the service plan end date.
- Complete the annual UCAT assessment, being sure to fully document the Member's current situation, needs and supports.
- Review the UCAT to make sure that documentation is complete and all scores are justified.
- Coordinate the IDT, develop the new service plan, and submit the reassessment service plan packet to the Medicaid Services Unit (MSU, formerly known as ADvantage Administration) at least 30 days prior to the service plan end date.
Service Plan Authorization Unit's Responsibility
- Review and enter the authorized service plan.
- Inform the Case Manager, via Service Plan Condition or Service Plan Review (SPR) of any issues affecting authorization of any requested services.
- Forward all service plan documents for imaging.
Recertification Nurse's Responsibility:
- Review the imaged UCAT and score the UCAT Part III for nursing facility level of care.
- If medical eligibility is approved, enter annual certification dates (consistent with service plan year dates) into the state system.
- If medical eligibility cannot be approved based upon the Case Manager's UCAT documentation, request a home visit by the DHS County Nurse to evaluate for nursing facility level of care.