Presentation on theme: "A Nurse Care Management program for IDD Waiver Members FAQ’s (Frequently Asked Questions ) SelectCommunity 1."— Presentation transcript:
A Nurse Care Management program for IDD Waiver Members FAQ’s (Frequently Asked Questions ) SelectCommunity 1
What is SelectCommunity? SelectCommunity is a Nurse Care Management service that is offered through TennCare Select. The SelectCommunity Program was developed for persons with Intellectual Disabilities to allow for Care Management coordination and continuity of care of physical and behavioral health covered services. The Nurse Care Manager will work with the ISC, the Provider agency, DIDD Case Manager, and any Medical Providers that support the individual. There is no charge to the individual, family or provider’s for this service. This is an added layer of service that is provided to the individual and the Circle of Support. The Nurse Care Managers provide support and coordination of services to the individual and the entire team/Circle of Support that provide support to the individual. This service was only offered to Arlington Class members until 06/1/2010. Now it is open to all Waiver Members. The individual and/or family/conservators are included in all decision making. The Nurse Care Manager strives to maximize the member’s fullest potential by addressing all of his/her developmental, physical and behavioral health needs. The individual’s quality of life is of primary concern. The Nurse Care Manager is an active member of the Circle of Support. 2
What Company manages SelectCommunity? 3 VSHP, a subsidiary of BlueCross BlueShield of TN (BCBST), manages SelectCommunity. VSHP is a TennCare Managed Care Company The Bureau of TennCare has contracted with VSHP to offer the SelectCommunity Program BCBST/VSHP has offices in the West, Middle & East Grand Regions of the state.
Who Qualifies for SelectCommunity? 4 The target population for SelectCommunity includes the TennCare Members with Intellectual and Developmental Disabilities who are actively enrolled in one the State of Tennessee’s 3 Section 1915 (c) Home and Community Based Services (HCBS) waiver programs for persons with intellectual disabilities. The three (3) waiver programs are : Arlington Waiver Statewide or “Main” Waiver Self-Determination Waiver
What qualifications does the Nurse Care Manager have? 5 All of SelectCommunity's Nurse Care Managers are Registered Nurses. They are required to have At least 3 years of professional nursing experience At least 2 years of providing Care Management services Prefer Nurses that are Certified Case Managers (CCM) and Certified Developmental Disabilities Nurse (CDDN) If not CCM or CDDN certified the Nurse Care Managers are required to take the above certification exams when eligible. The Nurse Care Managers are provided initial and ongoing training related to Intellectual & Developmental Disabilities
What does the Nurse Care Manager do? 6 The Nurse Care Manager (NCM): Is the leader of the Care Management team for SelectCommunity Will be the primary point of contact, for instance if a conservator, medical provider or a member of the Circle of Support (CoS) contacts the NCM with a need for the individual, the NCM will follow up on that request and/or need and inform the CoS of the outcome. The NCM will keep the CoS updated on all of his/her activities for the individual. The NCM will make face to face visits with the individual and provide a written report to the provider agency and to the CoS as requested. The frequency of the Face to Face visits are based on the individuals’ needs The NCM is an active part of the Circle of Support and will attend all CoS/ISP meetings. The NCM will assist in locating specialists and in scheduling appointments for the individual. The NCM will attend medical appointments as needed with the individual and his/her family and/or support staff.
What does the Nurse Care Manager do? 7 The NCM will provide coordination of the full array of services that the individual is receiving. The NCM will assist in obtaining authorizations for services that are covered by TennCare Select. The NCM will verify that the services that have been authorized by TennCare Select are provided. The NCM will work with the Circle of Support (CoS) including the ISC, DIDD Case Worker, DIDD Provider Agencies, ICF/IDD and Nursing Facility providers implementing the Individuals Plan of Care.
When can I enroll? 8 Individuals can enroll at any time, it is open enrollment for SelectCommunity statewide.
How do I enroll? 9 You should have received a letter in the mail from the Bureau of TennCare, the legal conservator will need to sign the form and return: Via mail to the Bureau of TennCare or Fax to : MCC Change Unit at 1-866-581-5735 What if I didn’t get a letter? What if I lost my letter? Complete the “Opt-In Form” that is on the last slide of this presentation and submit to the TennCare Solutions Unit via Fax or mail. (Faxing the form is the fastest way to opt in) Or you may Call TennCare Solutions unit at 1-800-878-3192 and ask to sign up for the SelectCommunity Program
Will my TennCare Company Change? 10 Individuals who sign up for SelectCommunity will have TennCare Select as their Medicaid Managed Care Company. If the individual is already a TennCare Select member, their insurance will not change, they will receive the additional service of a Nurse Care Manager. SelectCommunity is only offered through TennCare Select If the individual is currently enrolled with another Managed Care Company, their insurance will change to TennCare Select.
Will I have to change Doctors? 11 Individuals who have Medicare will NOT have to change providers, Medicare is the primary payor with TennCare Select being the secondary payor. (Medicare will pay first then TennCare pays second) If you do not have Medicare and TennCare Select is the primary payor the doctors will need to be in the TennCare Select network. If you have a MD that is not in the network, SelectCommunity can send a representative from their Provider Relations office to that MD’s office to discuss signing up to become a TennCare Select Provider. If the individual’s physician does not enroll into the TennCare Select network SelectCommunity will work with that member/conservator to find them a new physician/provider that is in network.
How can I find out if my Doctor is a TennCare Select Provider? 12 You or your representative can call your Providers office and ask if they are a provider for TennCare Select or You or your representative can check VSHP web site at http://www.bcbst.com/FindADoctor/# http://www.bcbst.com/FindADoctor/#
When will my TennCare Select become effective? 13 The effective date is set by the Bureau of TennCare. Your current insurance will remain effective until the effective date of your TennCare Select.
Will TennCare Select Cover Dental services? 14 Dental services are not covered for adults by TennCare, however if the individual is unable to cooperate with the dentist and requires anesthesia for his/her dental work, TennCare Select will pay for the hospital and anesthesia charges. The actual Dental work is a Waiver service.
What if we change our mind after we sign up for SelectCommunity? 15 The individual or conservator will be allowed to quit the program if they change their mind.
How long does the NCM services last? 16 Your Nurse Care Manager will contact the individual and/or conservator as soon as SelectCommunity is notified by the Bureau of TennCare that you have enrolled. Care Management services will begin immediately when SelectCommunity receives notification that you have enrolled, regardless of the effective date for your TennCare Select. Nurse Care Management services are provided as long as the individual is enrolled in TennCare Select. The individual will not be discharged from NCM services unless they or their conservator request for the NCM services to stop.
SelectCommunity Opt-In Form 18 Yes, I want to sign up for TennCare Select/SelectCommunity. Please tell us: Date: _____________________________ TennCare member name: _______________________________________________________ TennCare Social Security Number: _______________________________________________ Is your address different than what TennCare has on file? If so, please tell us: Your New Address: ____________________________________________________________ City, State, Zip: ________________________________________________________________ TennCare member (or guardian/conservator) signs here: _____________________________ * For the fastest service: Please FAX to: 1-866-581-5735 Attention: TennCare Solutions Unit Or you may mail to the address below: If you mail the form in the process could take up to 6 weeks TennCare Bureau P.O. Box 820 Nashville, TN 37202-9968 The Bureau of TennCare will send you a letter that tells you when this change is made. Your new Nurse Care Manager will be in touch as soon as SelectCommunity receives your information from TennCare. Return this page only if you want to sign up for SelectCommunity.