Medicaid Options for Long Term Care
Medicaid's Options for Long Term Care agencies (also known as Single Entry Points) are the administrative agencies responsible for approving functional requests for long term care, including nursing home placement, Home and Community Based Services, Home Care Allowance, Adult Foster Care, assisted living placement and Consumer Directed Attendant Support Services. There are 23 such agencies in Colorado, each responsible for specific counties. To locate an Options for Long Term Care agency, please click here.
The Initial Assessment
When an individual is approved for Medicaid and requires long term care, the responsible agency must conduct a face-to-face assessment in order to determine the level of care required and to generate a care plan. In order to determine functional eligibility, the agency must complete a ULTC100.2 assessment form, which is designed to capture the complexities of need and to quantify the needs in a way that allows for adequate planning to care for and treat individuals. In order to receive services through the Options for Long Term Care agency, an individual must score a 2 on at least two activities of daily living (bathing, toileting, eating, transferring, mobility and dressing), or score a 2 on supervision for behavior and/or memory impairment and cognition.
The agency must complete the ULTC 100.2 and other associated forms assessment within two business days of discharge from a hospital, five business days from discharge from a nursing home, or ten business days from the community. The case manager assigned from the agency determines whether an individual needs assistance, what his/her capacity for payment is and the feasibility of available forms of care.
Often individuals face difficulties in the face-to-face assessments. The assessment is designed to measure a person's inabilities which may necessitate assistance, however, many individuals get caught up in emphasizing what abilities they still have, to the exclusion of their difficulties. It is important for individuals to remember that to get assistance, the agency needs to fully understand what you can't do as opposed to what you can.
Care Determinations that Options for Long Term Care Makes
The Options for Long Term Care agency is the agency responsible for making determinations and transitions in status for Medicaid recipients. Individuals who move from straight Medicaid to HCBS, to an assisted living, to adult foster care, to nursing homes or back to the community must do so with the case manager's approval.
When an individual is discharged from a nursing home, the Options for Long Term Care agency in the resident's county will be responsible for coordinating the discharge date, be it to the community, HCBS, home care allowance, adult foster care or another nursing home. This is to ensure continuity of care and no variations from the care plan, including arranging for home care, transfers of orders and updating state records.
If the ULTC100.2 is more than six months old at any of these points, the case manager must conduct a new one to redetermine functional ability. Otherwise, the assessment must be updated every twelve months.
The Care Plan
Care plans are comprehensive documents designed to fully encompass the plan for treatment for individuals needing long term care services. They usually must include a statement of goals for the client, the services needed, assessments and diagnoses of capacity, co-payments and the client's financial ability, prior authorizations for services, arrangements for services, referrals to community resources, input from friends and family and coordination of services.
The care plan guides services from home care, to specific regimens in nursing homes. It must be updated when the client's condition changes or at regular intervals.
For more information on Options for Long Term Care agencies or help with finding the appropriate agency, please contact us at 303-333-3482.