accept all managed care organization (MCO) referrals if space is available. The only reason a STAR+PLUS provider refuse to accept a referral is if the member's condition makes the member inappropriate for the facility according to the facility's personal care licensure. Having a communicable disease does not necessarily make a member inappropriate for placement in an AL setting. Transmission of communicable diseases and conditions can be prevented through the implementation of infection control procedures, including universal precautions. Licensure standards for personal care facilities require facilities to have Infection Control Policy and Procedures, including universal precautions, in operation to safeguard employees and residents from and other diseases, and contagious conditions. If transmission of the condition or disease cannot be controlled, the member cannot be placed in a AL setting. To receive AL services the applicant must first be determined eligible for. Program Support Unit (PSU) coordinate with Medicaid for the Elderly and People with Disabilities (MEPD) specialist, where applicable, to complete the Medicaid eligibility determination. The MCO discusses residential options with the member, allowing to choose hisher preference. If AL is chosen, a verbal referral is made to the provider as an alert that space is needed. The starting date for services is a negotiated date between the MCO, the member and the AL provider. The initial copayment amount is computed based on the starting date. , Individual Service Plan (Pg. 1), and applicable attachments are sent as follow-up, along with a copy of , Notification of Managed Care Program Services, which authorizes the provider to deliver services, and , Managed Care Programs Communication, confirming the negotiated service initiation date. Note: Appropriate action must be taken if the facility finds that a member threatens the health and safety of himselfherself. If a stove or cooking unit needs to be disconnected, the service coordinator, in cooperation with the IDT, makes this decision. The IDT must also include the MCO, the AL provider and the member's family or , if any. The AL provider can disconnect the stove or cooking unit if the member exhibits a behavior that threatens the health and safety of himself . He must inform the service coordinator of the disconnection by the next business day after it occurs. The MCO investigates the situation and documents any recent or previous incidents that indicate a threat to the health or safety of the member or others. If the decision is made to
accept all managed care organization (MCO) referrals if space is available. The only reason a STAR+PLUS provider refuse to accept a referral is if the member's condition makes the member inappropriate for the facility according to the facility's personal care licensure. Having a communicable disease does not necessarily make a member inappropriate for placement in an AL setting. Transmission of communicable diseases and conditions can be prevented through the implementation of infection control procedures, including universal precautions. Licensure standards for personal care facilities require facilities to have Infection Control Policy and Procedures, including universal precautions, in operation to safeguard employees and residents from and other diseases, and contagious conditions. If transmission of the condition or disease cannot be controlled, the member cannot be placed in a AL setting. To receive AL services the applicant must first be determined eligible for. Program Support Unit (PSU) coordinate with Medicaid for the Elderly and People with Disabilities (MEPD) specialist, where applicable, to complete the Medicaid eligibility determination. The MCO discusses residential options with the member, allowing to choose hisher preference. If AL is chosen, a verbal referral is made to the provider as an alert that space is needed. The starting date for services is a negotiated date between the MCO, the member and the AL provider. The initial copayment amount is computed based on the starting date. , Individual Service Plan (Pg. 1), and applicable attachments are sent as follow-up, along with a copy of , Notification of Managed Care Program Services, which authorizes the provider to deliver services, and , Managed Care Programs Communication, confirming the negotiated service initiation date. Note: Appropriate action must be taken if the facility finds that a member threatens the health and safety of himselfherself. If a stove or cooking unit needs to be disconnected, the service coordinator, in cooperation with the IDT, makes this decision. The IDT must also include the MCO, the AL provider and the member's family or , if any. The AL provider can disconnect the stove or cooking unit if the member exhibits a behavior that threatens the health and safety of himself . He must inform the service coordinator of the disconnection by the next business day after it occurs. The MCO investigates the situation and documents any recent or previous incidents that indicate a threat to the health or safety of the member or others. If the decision is made to
sph-rev-18-2-section-7000.docx