Medicaid Waiver Management Application (MWMA) Instructor
Contents
1. i E rn 5 va ra TL AViaTaTa ag A YA TA WA Fr i hi ae Mid A Medicaid Waiver Management Application MWMA Instructor Led Training for Quality Improvement Organization Staff VIS VI DE A Y I Kentucky Office of the Health Benefit and y n nec C Information Exchange Housekeeping Ground Rules Bathroom locations Please stay with the class Smoking location Work only with your assigned Individual Participant materials Use the appropriate log in credentials Hard copies If you finish a task early help your neighbor MWMA Training Portal Respect others and their points of view Food Drinks policy for this Let facilitators know if you get behind or need computer lab clarification Breaks Silence cell phones minimize texting and refrain from checking social media accounts Step out of the room when on computer lab equipment necessary to avoid disrupting the class E Do not disconnect any cables or equipment Complete online training evaluation Course Agenda Topic Minutes Welcome Introductions Housekeeping and Ground Rules 15 Lesson 1 MWMA Overview 30 Lesson 2 System Navigation 15 Lesson 3 Level of Care Review and Determination 45 Break 15 Lesson 4 Plan of Care Review 45 LUNCH Miscellaneous Tasks 60 Lesson 5 Application Review 45 Questions and Wrap up 60 Time 9 00 9 15 O 155945 9 45 10 00 10 002. s EKU learning management system TRIS Kenbucky Kentucky Office of the Health Benefit and Information Exchange Congratulations You have completed the Medicaid Waiver Management Application Instructor led Training Course Questions Are there any unanswered questions or concerns regarding today s training
3. Met status to Met Lesson Time 45 minutes Kentucky Office of the Health Benefit and Information Exchange Medicaid Waiver Application LOC Determination Overview Within MWMA the LOC Review and Determination screens are used to review information collected by the LOC Assessor and record if an Individual s LOC has been Met Not Met or if there is a LOI Kentucky Office of the Health Benefit and Information Exchange Medicaid Waiver LOC Assessment Process Q a The LOC Assessor The LOC Assessor The LOC Reviewer reviews rocetves task to records the results and makes 1 of 3 schedule an assessment results Geterminations apposntment for the and uploads necessary assessment document s Na Ce Cum e 6 A comespondence ls sent to notification is sent to A task is triggered to the LOC the Individual Authorized the Application Assessor to upload the toselectand initiator desc contact a Case Management wiy the LOC is Mot needed to make the LOC Agency y 8 4 A 7 N La assigns a Case Manager decision of The LOC Assessment is The CMA will monitor why submitted for reconskteration the LOC was Mot Met and outside of MWMA help facilitate the next steps Kentucky Office of the Health Benefit and Information Exchange Roles in the Medicaid Waiver LOC Assessment Process D IN Level of Care Level of Care Assessor Reviewer Case Management Applicati
4. POC to review and has reached the Service Details screen you are required to approve not approve or pend the services in the Individual s POC The Case Manager receives a system generated notification that all services have been approved and the POC status is updated to current If a service is Pended with a reason of LOI or CDO Budget the plan status will become Revisions Requested by QIO and the plan will be sent back to the Case Manager with a Revisions Requested by Plan Reviewer task If all services are Not Approved or Pended with a reason other than LOI or CDO Budget then the plan status is Current A Revisions Requested by Plan Reviewer task will also be generated for the Case Manager to be able to upload documents enbucky Kentucky Office of of the ps Benefit and Information Exchange E aP W e Kentucky Office of the Health Benefit and Information Exchange Check Your Understanding True or False If Not Approved or Pended is selected the Reason field displays and requires a response TH R a Plan of Care Recap You should now be able to e Describe how MWMA supports the Plan of Care lifecycle e Identify the MWMA user roles involved in the Plan of Care lifecycle Review a Plan of Care in MWMA Kentucky Office of the Health Benefit and Information Exchange MWMA Training Resources The following resources provide add
5. documents are sufficient to substantiate the waiver application or not Medicaid Waiver Management Application MWMA Kentucky Office of the Health Benefit and JE MI TEGE oa la ring va and u TT Waiver Application in MWMA e Kentucky Kentucky Office of the Health Benefit and Fes Exchange Check Your Understanding True or False An application with an uploaded document that has been marked as Invalid may still be referred to a waiver program Member Match Overview If the Medicaid Waiver Case Management Application cannot determine with 100 certainty that an Individual already exists within the KHBE system the Application Reviewer must make this determination using the Member Match screen A submitted waiver application that is ready for review by the Application Reviewer A submitted waiver application that has potential matches The Application Reviewer needs to resolve the partial match prior to reviewing the application A waiver application that has been resubmitted by the Application Initiator and needs to be reviewed by the Application Reviewer before the Application Reviewer refers it to a different waiver program p gt D EE Kentucky Office of the Health Benefit and Information Exchange Member Match Continued Potential Matches for this individual that already exist in KHBE Name Date Of Bath SSN Kentucky Office of of
6. the ge Benefit and Information Information Exchange ADM vm 11 Classroom Te EE LOI and Member Match D 1 Ri lt a ua hiji _ E ce a i tu s 4 Hi DEA a a E Rs A F lt i 4 A e i FAN KY gt AY a N b h N DI p Les 1 N Je si JE i me E Waiver Application Review Recap You should now be able to Describe the waiver application review process e Perform an application review Determine status of an uploaded document Use Member Match to identify an Individual within MWMA Kentucky Office of t Office of the kynec ect MWMA Training Resources The following resources provide additional information and instruction User Manual User Guide kynect Medicaid Waiver Management Application Lesson 4 e Quick Reference Guides Job Aids Using Member Match and Individual Summary Screens Quick Reference Guide Using Targeting Criteria Quick Reference Guide Online Courses Web based Training WBTs Reviewing an Application for Medicaid Waiver Services course 6 lessons yn gt Medicaid Waiver Management Application MWMA Instructor Led Training Course Wrap Up vr EE VS Ky Me Kentucky Office of the Health Benefit and Information Exchange MWMA information on CHFS website MVVMA Training Portal Hosted by Eastern Kentucky University
7. the MWMA enhance and streamline the Plan of Care processes MWMA enhances and streamlines current manual and paper based case management activities through the following functionalities e Generated tasks for each role when an action must be taken e Ability to enter comments on a POC that are visible to all applicable roles in MWMA e Ability to upload documents and attach them to the plan Medicaid Waiver Management Application Kentucky Office of the Health Benefit and Information Exchange MWMA POC Screens The Plan of Care Main Menu screen is includes the following eight sections that constitute an Individual s Plan of Care Create Draft D Plan of Core thin enn View Plan Details Goals Service Details oes ses Non Waiver Service Details ri Se DIRO Service Summary A fe Upload Documents ve Submit Plan Create Draft Plan Waiver Program Aquired Brain Injury Acute E ky VI f a P Ta de 4 Reel Intom A gt Lo Tas Overview of each section in Plan of Care A general understanding of the following sections will be useful before we practice initiating and submitting a POC ET Create Draft View Plan Goals Service Details Details Bed Non Waiver rep Upload Submit Plan Service Details Summary Documents MA SU p ii Prior Authorizations in Plan of Care After the Plan Reviewer has selected an Individual s
8. 10 45 11 00 11 45 12 45 1 345 1 45 2 30 2 30 3 30 Medicaid Waiver Management Application MWMA Lesson 1 MWMA Overview wy hm i a dea E Kentucky Kentucky Office of the gt i Health Benefit and Information Exchange Lesson Objectives Upon completion of this lesson you will be able to e Describe the features and benefits of the Medicaid Waiver Management Application MWMA e Describe the enhancements provided by MWMA to current business practices Lesson Time 75 minutes Kentucky Office of the Health Benefit and Information Exchange What is the Medicaid Waiver Management Application Collaborative effort between the Cabinet for Health and Family Services and the Kentucky Office of the Health Benefit and Health Information Exchange KOHBHIE Implementation of a web enabled case management application to support the delivery of home and community based services under the Medicaid waiver programs Two phased implementation April 2015 and December 2015 i 1 cr x 77 a mei B n r c Y A Information Exp 1 u i z ROTTI Excnarkpe e a gt U N a o p i ma Ni 4 i i eta EE 5 Ni o i Why is the Commonwealth Implementing MWMA Current Waiver Process Uses a variety of different databases paper files emails and spreadsheets Processes are cumbersome inefficient and du
9. Case Supervisor Kentucky Office of the Health Benefit and Information Exchange Roles involved in the Inability to Access Services Process fa DS Case Supervisor QIO Care Wise Talks to the Individual Reviews the inability to and submits the access services information inability to access and updates the MAXMC services system Kentucky Office of of the Heath Benefit and _Information Exchange i i os E Ti m E Em L fia CUL TT ii E pit a Li _ Reviewing the Record Inability to re Services Tasks i yu Kentucky Office of the Health Benefit and Information Exchange Program Closure Overview The Program Closure Update MAXMC task serves as a reminder to update the MAXMC system with the information provided from the Case Supervisor Kentucky Office of Office of the Health Benefit and Information Exchange SP vas Ne 1 ta DA y Case Supervisor QIO Care Wise Reviews the program Submits the program closure information and closure request updates the MAXMC Kentucky Office of af the Heath Benefit and Information _Information Exchange AA ED 11 in Class Exe Ba il Reviewing the Program Closure yapate MAXMC task E e Kenbucky Kentucky Office of the Health Benefit and Information Exchange Finalizing Capacity for Michelle P Waiver Overview Once the Individual is enrolled in Michelle P a task
10. Guide Kentucky Office of the Health Benefit and Information Exchange Medicaid Waiver SEE Application MWMA Lesson 3 Level of Care Review and Determination su MI OOD Kentucky Office of the Health Benefit and Information Exchange MWMA Lifecycle Application Initiator p LOC Assessor LOC Reviewer Assessment Agency QIO Completes LOC Assessment Reviews LOC Assessment and makes determination DCBS Caseworker DCBS Enrolls Individual in designated waiver program through KAMES Capacity Revievver Application Revievver CHFS Submits application QIO Reviews submitted application Determines if targeting criteria is met determines urgency of need and capacity in a waiver p 2 Case Supervisor Case Manager Case Management Agency Case Management Agency Case Supervisor assigns Individual Begins to perform case to a Case Manager management activities 2 1 c M Plan Reviewer ase Manager QIO Case Management Agency Submits Plan of Care Approves prior authorization and submits the POC as Current Kenbucky Kentucky Office of the bi x Health Benefit and sal Information Exchange Lesson Objectives Upon completion of this lesson you will be able to e Perform a Level of Care LOC assessment review Record the status of uploaded documents e Record a LOC Determination of Met LOI and change a Not
11. MWMA Lesson 1 MWMA Onboarding SN No paj I 7 TAS E D D TT LN J L Medicaid Waiver Management Application MWMA Lesson 2 System Navigation wy hm O gt dea E Kentucky Kentucky Office of the Health Benefit and E Information Exchange a Lesson Objectives Upon completion of this lesson you will be able to e Describe basic navigation in MWMA e Describe features of the Dashboard screen Lesson Time 30 minutes S x ry Tue System Navigation Overview Users are able to easily navigate MWMA through key links located on the 1 Top Navigation Bar 2 Left Navigation Bar 3 Center Dashboard Notifications Center Case Management Add New Case Note My Tasks Y Manage Existing Case Notes Initiate Transition App Case Individual Name Waiver Status Action Program Manage Program initiate Annual Recert triad Thomas Mike View Caseload Additional Case Manager Resources ent 100011321 Thomas Mike Print Blank Application Leam About Medicaid Waiver Services Kentucky Office of the Health Benefit and Information Exchange Exploring the Top Navigation Bar The user can navigate to different areas of MWMA by using the links that display on the top navigation bar located at the top of each screen lt A Welcome Pam Halpert Sign Out About Help Home Mess
12. age Center Quick Search Agency We Care QIO In EN QIO Top Navigation Bar Kentucky Office of the Health Benefit and Information Exchange Exploring the Left Navigation Bar SI ick Links The left menu navigation bar consists of Quick Links which are links to the most common Message Center tasks actions that pertain to the logged in user Notifications Center Other Links There are two main categories of Quick Links Print Blank Application 1 Message Center 2 Other Links Learn About Medicaid Waiver Services Frequently Asked Questions Kentucky Office of the Health Benefit and Information Exchange Exploring the Center Dashboard The Select Queue drop down menu is located on the top left of the Tasks section The Tasks section is always populated with tasks that are only assigned to the logged in user The Select Queue drop down menu allows the user to search for tasks that are assigned to their user group Select Queue Task Name App Case Submit the Plan of Care 100009509 Create Initial Plan of C_ 100009514 seat Lune Create Initial Plan of C 100009519 Create Initial Plan of C 100009506 Create Initial Plan of Care 100009536 Create Initial Plan of Care 100010556 Search Tasks Search By Individual Individual ID Search By Task Agency gency Whitewater Inc Assigned To Task Status County Program Task Name Due Date lt Case Note Type gt case note m
13. ed waiver application intake Streamlined Level of Care assessment submission and review processes Streamlined Plan of Care development submission and review processes Case Management Tools Case Manager Assignment Caseload Management Case Transfers Program Closures Case Notes and more Automated workflows tasks and notifications Electronic document submission and storage Prescreening tools Self Service capability for Individuals Families Streamlined application intake across multiple programs Waiver SNAP TANF Medicaid etc Improved assessment tools Streamlined Medicaid Eligibility and Waiver Enrollment Processes Automated waiting list management Electronic timesheets for participant directed services Streamlined Incident Reporting and Review Kentucky Office of u Office of the kynec ect MWMA Training Resources The following resources provide additional information and instruction User Manual User Guide kynect Medicaid Waiver Management Application Lesson 1 e Quick Reference Guides Job Aids Application Case and Program Status Quick Reference Guide Medicaid Waiver Management Application Onboarding Manual Transitioning the Use of the MAP 24 and MAP 24C Quick Reference Guide e Online Courses Web based Training WBTs Medicaid Waiver Management Application Overview course 3 lessons D D TT LN J L Medicaid Waiver Management Application
14. ion Initiator Application Reviewer Application Initiator uploads sufficient submits the application receives a task notification documentation and resubmits through MWMA to perform application application in MWMA review Application Review Application Complete Incomplete Initiator Application Application Notification Meets targeting criteria Does not meet targeting Waiver case active criteria Application closed Waiver Case Application Opened Closure Kentucky Office af Office of the kynec ect Par 76 Roles Involved in the Medicaid Waiver Application Review Process al in Application Initiator Application Reviewer Capacity Reviewer Enters I Reviews the documentation and Reviews the application and application and information on uses targeting criteria to comments entered behalf of the refer the application to a by the Application Individual waiver program Reviewer Kentucky Office of the Health Benefit and Information Exchange How does the MWMA enhance and streamline the application review process e Creates tasks for various roles involved in the review process e Allows entry of comments during the review process Comments are viewable by other Application Reviewers as well as the Capacity Reviewer Allows the review of supporting documents to occur concurrently with the review of the waiver application Keeps an electronic record of the Application Reviewer s determination whether the
15. issing for lt Note Period gt Create and Submit Plan of Care for newly assigned individual Initiate Annual Recertification Lack of Information Modify Plan of Care Perform Assessment Program Closure View Program Closure Record Assessment Results Revisions Requested by Case Management Admin Revisions Requested by Case Supervisor Revisions Requested by Plan Reviewer Schedule Reassessment Submit Annual Recertification Update Objective Status Update Service Actual Start Date Select From To Kentucky Kentucky Office ol of the Health Benefit and _Information Exchange itet E dl Y Kentucky Office of the Health Benefit and Information Exchange To follow along the instructor demo of MWMA System Navigation 1 Use the log in credentials provided by the instructors to log in to the desktop computer Launch web browser Internet Explorer IE e Firefox e Chrome Enter URL for MWMA Training Environment Log in using the QIO log in credentials on your ILT Exercise Data Sheet Kentucky Office of the Health Benefit and Information Exchange MWMA Training Resources The following resources provide additional information and instruction User Manual User Guide kynect Medicaid Waiver Management Application Lesson 2 e Quick Reference Guides Job Aids System Navigation Quick Reference Guide Performing Searches Quick Reference
16. itional information and instruction User Manual User Guide kynect Medicaid Waiver Management Application Lesson 10 e Quick Reference Guides Job Aids Plan of Care Status Quick Reference Guide Service Units and Rate Quick Reference Guide Determining Prior Authorization of Services Quick Reference Guide Understanding the ADD Functionality in MWMA Quick Reference Guide Using the ADD Module for ABI Waivers POC Submission Quick Reference Guide Using the ADD Module for Supports for Community Living POC Submission Quick Reference Guide e Online Courses Web based Training WBTs Managing a Plan of Care course 10 lessons FETTERE Medicaid Waiver Management Application Instructor Led Training Break J q j 4 r ES Medicaid Waiver Management Application MWMA Lesson 5 Miscellaneous Tasks e Kentucky Office of the Health Benefit and Information Exchange Lesson Objectives Upon completion of this lesson you will be able to Review the Record for Inability to Access Services Submitted and Update MAXMC tasks Review the Program Closure Update MAXMC task Finalize capacity for the Michelle P Waiver Lesson Time 45 minutes Kenbucky Kentucky Office of the Health Benefit and Information Exchange Recording Inability to Access Services Overview The record for inability to access services task serves as a reminder to update the MAXMC system with the information provided from the
17. on Initiator Administrator Enters assessment Reviews Reviews information Monitors why the results and assessment results when the LOC is LOC was Not Met uploads uploaded deemed Not Met and helps facilitate documentation documentation and and contacts the the next steps after meeting with records a Individual to review the Individual determination the decision ment Application Instructor Led Training re Review and Determination Kentucky Office of the Health Benefit and Information Exchange How does the MWMA enhance and streamline the LOC Review and Determination process e MWMA enhances and streamlines current manual and paper based processes by creating tasks for various roles involved in the assessment process including A task for the LOC Reviewer to make a LOC determination A task for the LOC Assessor when there is a LOI A task for the Application Initiator or Case Manager when the LOC is Not Met A task for the Case Manager to have the Individual apply for Medicaid when the LOC is Met A task for the Case Management Administrator 13 days after the Not Met decision is made to monitor the appeal process e Allows comments to be inserted by the LOC Reviewer when the LOC is met not met or pended Kentucky Office of the Health Benefit and Information Exchange MWMA LOC Review and Determination Screens MWWMA includes the following three LOC Review and Determination screens used by the LOC Reviewer A
18. plicative Kentucky Office of u Office of the kynec ect Features of the Medicaid Waiver Management Application MWMA will be built on the existing KHBE platform which houses kynect Kentucky s healthcare connection The application will Standardize and automate essential waiver program processes Provide an integrated comprehensive view of the individual s services and supports Enable a person centered approach to service delivery and Integrate with existing commonwealth systems providing consistency across technology standards and enabling a Cabinet wide view of information across Medicaid waiver programs ki Vr a a a y a Po E ME hange ES ON J x I i sa What Benefits Does the Medicaid Waiver Management Application Provide e Provides automated capabilities around the intake assessment eligibility determination plan of care case management incident management timesheet and reporting functions performed by waiver service providers NAC i EE DO Pe ONIN gt e Provides individuals and families with self service pa DV i access to manage their waiver program 7 A AN applications plan of care services and timesheets e Access to information in real time e Integrates with kynect Kentucky s healthcare connection as of 2 9 MWMA release What Can You Expect from this MWMA Training Spring Expect to receive training on 2015 these topics Standardiz
19. rts the Plan of Care lifecycle Identify the MWMA user roles involved in the Plan of Care lifecycle Review a Plan of Care in MWMA Lesson Time Kentucky Office of the Health Benefit and Information Exchange Plan of Care Review Overview Within MWMA the Plan of Care POC Review function is used to review a created and submitted Plan of Care for an Individual MWMA provides QIO with the tools to review POCs and review added services to make prior authorization decisions Plan of Care Lifecycle A Case Manager Based on information entered in A Plan Reviewer QIO approves completes the initial the Plan of Care the Plan will go prior authorization and submits Plan of Care and to either a Case Supervisor Case the POC as Current submits the plan for Management Administrator or review Plan Reviewer QIO kynect N ee ah Case Manager Initiates the POC for an Individual and submits the POC to be reviewed Kentucky Office of the Health Benefit and Information Exchange N r pe Roles in the Plan of Care Lifecycle Case Supervisor Revievvs the POC and makes comments on data entered by the Case Manager FN Case Management Administrator Reviews the POC when there is a provider conflict or an exceptional rate unit request Plan Reviewer Reviews the POC and submits a prior authorization decision Kentucky Office of the Health Benefit and Information Exchange How does
20. ssessment Detailed History Review Documents Level of Care Assessment Results Summary Soe voce Documents Upload ct Assessment Determination te 02 12 2015 02 11 2016 Sullivan Mark 02 13 2015 Kentucky Office of the Health Benefit and Information Exchange A Q Demo Time 20 minutes Tr Kentucky Kentucky Office of the Health Benefit and Fes Exchange Check Your Understanding True or False You can change a determination via the program summary screen Kentucky Office of the Health Benefit and Information Exchange MWMA Training Resources The following resources provide additional information and instruction User Manual User Guide kynect Medicaid Waiver Management Application Lesson 6 e Quick Reference Guides Job Aids Assessment Determination Quick Reference Guide e Online Courses Web based Training WBTs Performing an Assessment for Medicaid Waiver Services course 7 lessons Performing a Reassessment for Medicaid Waiver Services course 5 lessons FETTERE Medicaid Waiver Management Application Instructor Led Training Break Fi Medicaid Waiver Management Appli Lesson 4 Plan of Care 3 WIN TI x Kentucky Kentucky Office of the Health Benefit and E Information Exchange a Lesson Objectives Upon completion of this lesson you will be able to Describe how MWMA suppo
21. will be triggered to finalize capacity for the Individual Once the task is selected you will have the ability to confirm a spot in the waiver for the Individual Kentucky Office of the Health Benefit and Information Exchange r Wi gt v Medicaid Waiver Management Application MWMA Lesson 6 MWMA Application Review Kentucky Office of the Health Benefit and Information Exchange Lesson Objectives Upon completion of this lesson you will be able to e Describe the waiver application review process Perform an application review Determine status of an uploaded document Use Member Match to identify an Individual within MWMA Lesson Time 45 minutes on Instructor Led Tr Kentucky Office of the Health Benefit and Information Exchange Medicaid Waiver Application Review Overview Application Review serves as the second half of the waiver application process The Application Reviewer reviews the application details and submitted documents After completing their review the Application Reviewer will refer the application to the waiver program that best suits the Individual s needs according to the waiver program s designated targeting criteria 19 Kentucky Office of the i i Health Benefit and u x Information Exchange 3 gt Y Medicaid Waiver Application Review Process Application Application Submission Resubmission CE Applicat
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