Commonwealth Care Alliance

Commonwealth Care Alliance

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Skilled Nursing Facilities

Event Triggers and Required Forms: Admissions and Discharges from Nursing Facilities for both SCO and OneCare

Admission

When a SCO member is admitted to a nursing facility, the nursing facility must submit a short-term Status Change Form (SC-1) to the MassHealth Enrollment Center with “SCO Member” clearly indicated on the form, regardless of the length (short- or long-term) or type of the stay (skilled or custodial). Appropriate boxes on form should be checked.

MMQ and MDS (for short or long-term stays)

Event Triggers Approval/Forms
Admission 1. Status Change Form (SC-1) (All new admissions)
Event Triggers Approval/Forms
Continued Stay.
If member stay anticipated to be more than three months.
1. MMQ (when available)
2. MDS 3.0 (when available)

 

Transition from short-term stay to long-term stay

Event Triggers Approval/Forms
Short-term stay becomes a long-term stay.
As soon as there is supportive documentation that the plan is to remain in the SNF for long-term, SC-1 is completed and facility bills patient-paid amount determined by MassHealth. Member can be in short-term status a maximum of 6 months
Status Change Form (SC-1).—Note: When it is decided that the member will become long-term, eligibility for MassHealth is re-determined and the patient-paid amount is calculated by MassHealth upon completion of additional forms requested by MassHealth, such as the LTC supplement. The SNF completes forms requested by MassHealth.

 

Discharges

Event Triggers Approval/Forms
Upon discharge of short-term stay of less than 6 months. 1. Status Change Form (SC-1)
Upon discharge of a long-term stay greater than 6 months. 1. Status Change Form (SC-1)
2. MDS 3.0 is required before discharge

 

Status Changes

Event Triggers Approval/Forms
When a member meets the MMQ significant change criteria. 1. MMQ
2. MDS 3.0
Where Do I Send the Information
Status Change Forms (SC-1):
MassHealth Enrollment Center
P.O. Box 1231
Taunton, MA 02780

Fax: (617) 887-8777***fax a copy to Commonwealth Care Alliance at 617-830-0534

MMQ electronic submission: via the MassHealth Online Service Center; fax a copy to Commonwealth Care Alliance at (617)830-0534

MDS 3.0: submit to CMS and SCO Clinical Coordinator via fax to Commonwealth Care Alliance at (617) 338-4096

 

Claims Hold Policy

Providers are required to submit all paperwork and electronic submissions to MassHealth/CMS within the required time frames to ensure claims payment.