Home and Community Services
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Many people who need long-term care services (LTC) can get that care in their homes and communities. This kind of care often costs less than care received at a hospital or nursing facility. The Montana Department of Public Health and Human Services contracted with Mountain-Pacific Quality Health to help Montanans with Medicaid stay in their homes.
Contact us: By phone at 1-800-219-7035 | By fax at 1-800-413-3890
To make sure people are not inappropriately placed in nursing homes for long-term care, Mountain-Pacific reviews cases for any signs of mental illness or intellectual disability. If we identify any mental illness or intellectual disability indicators, we offer referrals for specialists who can help these clients.
Contact us: By phone at 1-800-219-7035 | By fax at 1-800-413-3890
Mountain-Pacific contracts with the State of Montana Department of Public Health and Human Services to determine if residents in a long-term care facility (nursing home) still need to be there. The state is required by the federal government to have some type of continued stay review in place. Every six months, each facility in Montana gives us a list of their Medicaid residents and why they need to be there. Every two months, each Montana facility gives us a list of their skilled Medicaid residents. These residents need a higher level of care than a standard resident. One of our nurse reviewers goes over these lists and then gives them to the State for their records.
Contact us: By phone at 1-800-219-7035 | By fax at 1-800-413-3890
Mountain-Pacific Quality Health helps Montanans with Medicaid avoid unnecessary institutionalization or hospitalization. We work with local agencies to review each Medicaid client’s plan of care to authorize skilled home health services. We make sure home health services are
- medically necessary,
- skilled in nature like nursing, physical therapy, occupational therapy and speech therapy, and
- can be appropriately provided at the person’s home.
Our registered nurses authorize a specific number of home visits and review any additional requests for ongoing services, as needed.
Contact us at 1-800-219-7035
Personal assistance services, or PAS, are provided to people with full Medicaid coverage who need help with day-to-day activities at home. For example:
- bathing
- going to the bathroom
- moving around the house
- eating
- healthy eating, meal planning and preparation
- personal hygiene and grooming
- exercise
- doing laundry
- shopping for food or medical supplies
- getting to medical appointments
Through the Community First Choice option, people at risk of institutionalization can also receive these services as part of an individualized, person-centered care plan.
Our registered nurses visit people eligible for these services at their homes. Social workers also assist by conducting interviews. Together, we determine what level of care an individual needs. If an applicant’s needs meet program guidelines, Mountain-Pacific staff complete an authorization form. The form includes how often the person needs care. The form then goes to a provider agency selected by the applicant or a representative.
We revisit the authorization as necessary, and a complete assessment is performed at least once a year.
What is Community First Choice?
The Affordable Care Act established Community First Choice (CFC). It is a new Medicaid plan option that gives home and community-based care to Montanans who would otherwise need to be institutionalized. Montana is one of only four states currently approved to offer the CFC plan.
Why is CFC a good fit for Montana?
The Montana Medicaid Personal Assistance Service (PAS) program meets most of the CFC requirements:
- Hands-on help and guidance for day-to-day activities, like bathing, toileting, meal preparation, shopping, laundry and other activities
- An option that allows Medicaid clients to have a say in their delivery of care services
- Making sure people meet the level of care requirements — and Mountain-Pacific Quality Health contracts with the Montana Department of Public Health and Human Services to conduct reviews for this. We have determined that about 82% of current PAS users meet these requirements.
What is new with CFC?
State staff from the Senior and Long Term Care Services Division worked with Medicaid Personal Assistance Service (PAS) program users and their representatives, home care agencies, case management and Mountain-Pacific Quality Health to expand health care services for the CFC option. Together, we
- increased the average number of support hours for Medicaid patients;
- improved the self-directed service model through
- the implementation of the person-centered planning process,
- training for Medicaid patients about choosing caregivers,
- allowing Medicaid patients to decide how and when services are provided.
What is Mountain-Pacific Quality Health’s role?
Mountain-Pacific does two things:
- We find out if a Medicaid patient meets institutional level of care requirements.
- We assess each Medicaid patient referred to the Personal Assistance Service (PAS)/CFC program to discover his or her personal health care needs. Then we create a profile of authorized services for that patient.
To make a referral for PAS/CFC services, Contact Us at (800) 219-7035.
8/2/18 – Medicaid Waiver Process
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