The January meeting opened with a presentation from Kerri Ikenberry, Lois Aldrich and Joanna Jalbert on Community Case Management (CCM), an administrative activity of MassHealth. CCM authorizes and coordinates MassHealth Community Long Term Care (CLTC) services to a defined population of medically complex individuals. CCM collaborates with multiple agencies and payers. Their goal is to keep folks in the community and out of institutions.
Eligibility for in-home nursing services: individuals must be under 22 years old at the time of referral, require greater than 2hrs/day of skilled nursing care in the home and be a MassHealth recipient. CCM may be extended beyond the age of 22 years old. The top 5 diagnoses for CCM are: cerebral palsy; congenital malformations; neuromuscular disease; neurological disorders; and genetic disorders. Referrals come from everywhere (hospitals, nursing agencies, palliative care, physicians, etc) The individual/family is an integral part of the referral process.
A skilled nurse will call the individual/family to do a CLTC assessment. A home visit is scheduled, as well as a determination of medical necessity for services. Contact is made with other agencies. A service record is created and a copy is given to the family. Once services are authorized, a clinical manager becomes the contact for the family for any issues that arise. CCM Liaison Nurses will check on hospitalized CCM members, faciliate hospital discharge and assist discharge planners at rehabilitation facilities. They will work with the family to authorized equipment and therapy services.
For Home Health Services, individuals must be under the care of a physician, have a care plan and have a need for skilled nursing care. The physician and the home health care agency must determine if the individual can be maintained safely in the home. Coverage limitations include 112hrs/week for continual nursing services.
The Personal Care Attendant Program serves MassHealth members who require physical assistance with activities of daily living. The individuals/families are the employers of their PCAs and are responsible for recruiting, screening, hiring, training, and supervising. To get coverage, the individual must have MassHealth Standard or Commonhealth and have a chronic, permanent disability that impairs the individual’s ability to perform activities of daily living without physical assistance.
For more information, please consult www.mass.gov/masshealth. For information on rates for MassHealth programs and services, including home health care and personal care attendants, check out http://www.mass.gov/chia/gov/hcf/regulations.html
Our next presentation was from Sheila Rucki, Phd, PCNC, BC on Early Care & Education (ECE) and Out of School Time (OST) Programs. This new program works with early education and child care providers to support them in learning how to administer medication in the event of an emergency. Educators and administrators are trained in the Medical Administration in Child Care (MACC) program. This training includes administering medication for: anaphylaxis; seizures; skin integrity; severe asthma; and diabetes (excluding insulin injections). The goal is to educate child care providers to recognize problems and teach them how to manage situations within their abilities to provide care. A big part of this is teaching child care providers to learn about the emergency systems in their communities so that they can access skilled assistance ASAP for the children enrolled in their programs.
For more information, contact Thom Child & Family Services, located at 1506A Allen Street, Springfield, MA 01118, tele. 413.783.5500.