Nov. 10, 2010
To avoid the risk of being taken off referral, all Case Management Provider agencies are required to meet the following standards effective March 1, 2011. Listed below are the Annual Reassessment Service Plan requirements.
The standards for the submission of Annual Reassessment Service Plans are as follows:
- Annual Reassessment Service Plans must be submitted for authorization no earlier than 60 and at least 30 calendar days before the current plan end date.
- Annual Reassessment Service Plans received more than 60 calendar days before the current plan end date will be returned to the Case Management Provider agency with the expectation that they will reevaluate the ADvantage Member and resubmit the Annual Reassessment Service Plan within the appropriate timeframes. Reassessment Plans submitted less than 30 calendar days prior to the current plan end date will be considered late.
- Case Management Providers who have 25 percent or more of their Annual Reassessment Service Plans turned in late for the most recent three (3) consecutive months beginning Dec. 1, 2010, will be involuntarily taken off referral for a minimum of three (3) months. The earliest “off referral” decision would become effective in March 2011.
- In order to be placed back on referral, the Case Management Provider must sufficiently demonstrate to OKDHS AAU that they have policies and procedures in place to ensure Service Plans are submitted within mandated policy timeframes.
RELATED REFERENCE SOURCES:
Oklahoma Administrative Code:
317:35-17-16. Member annual level of care reevaluation and annual reauthorization of services plan
“The case manager’s assessment of a member done within a 60-day period prior to the existing service plan end date is the basis for medical eligibility redetermination.”
In the correspondence from Aging Services Division Director, Lance Robertson, dated May 11, 2009, to ADvantage Providers
“This letter is to reassert directives provided during these most recent AAU meetings with agency representative that effective June 1, 2009, an ADvantage Program member’s reassessment service plan is to be received at the AAU at least 30 calendar days before expiration of the current service plan.”
Should you have any questions or concerns regarding the information provided above, please feel free to contact us via email at Provider Questions.