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Enrollment

 
     
  Purpose: To ensure that participants meet the specific enrollment criteria as dictated by the State of Michigan and the Centers for Medicare and Medicaid Services (CMS). CentraCare is a unique comprehensive program that provides medical and supportive services to the frail and elderly as an alternative to nursing home care. The goal of CentraCare is to help individuals remain independent in their own homes and communities and to provide respite and assistance to the family or caregivers when recommended by the interdisciplinary team. CentraCare is seeking to form a partnership with the participant and caregivers to promote independence and quality of life.

Persons wishing to enroll and participate in CentraCare/PACE MUST meet the following four criteria:

     • Age 55 or older
     • Reside in Calhoun County (all zip codes), Kalamazoo County (all zip codes) or Eastern Van Buren County (zip
       codes: 49009, 49010, 49026, 49055, 49065, 49067, 49071, 49078, 49079, and 49087)
     • Meet Nursing Home Level of Care Guidelines as determined by the State of Michigan
     • Determined by the Interdisciplinary Team’s assessments to be able to live safely in the community
       with the support of CentraCare


CentraCare receives monthly payments from Medicare and Medicaid to cover services for participants. Most participants pay nothing. As a CentraCare participant, all health care services are provided and arranged by your personal care team. PACE participants may be fully liable for the costs of medical services from out-of-network providers without prior authorization with the exception of emergency services.

Assessing eligibility and getting enrolled at CentraCare can take several weeks. CentraCare is not a “sign up
today, start tomorrow” option for care. Please call our Enrollment Coordinators with questions at (269) 441-9313.

There are four steps to enrollment. Click on the steps below to review the enrollment process.

 
     
 
Step 1: Intake and Pre-enrollment Click bar for information
A referral is made to CentraCare from a variety of referral sources including self-referral.

The Enrollment Coordinator will attempt to contact the potential enrollee within 2–4 business days of the referral.

   • The intake information is obtained, for example, the enrollment candidate’s name, address,
     contact information, reasons for seeking enrollment, etc.
   • The Michigan Medicaid Nursing Facility Level of Care Determination Telephone Intake Guidelines Tool
     may be completed to begin the eligibility process. The Intake and Enrollment worker will use
     this state form to guide a conversation about the candidate’s health, memory, medications, medical
     concerns, ability to perform daily activities and tasks, etc.
   • If the referred person does not meet enrollment criteria, the intake worker will provide information about other
     community options or resources which may better fit current needs. (People can be reevaluated by
     CentraCare if their frailty increases to meet Nursing Home Level of Care at a later date)
   • Following the phone interview, if the referral is a potential participant, the Enrollment Coordinator will
     schedule a home visit, as soon as possible (no more than 2 weeks from the phone interview)
     to explain the program in detail and start the paperwork

 
     
 
Step 2: The Initial Home Visit Click bar for information

The Enrollment Coordinator will schedule a home visit as soon as possible (no more than 2 weeks
from the phone interview) to explain the program in detail and start the paperwork. Most of the
paperwork information which will be needed is shown below. Each person is unique—
other records may be required based upon your specific situation
.

   • The intake worker will work with the candidate and caregiver(s) to complete a biographical form
   • Obtain health insurance information
   • Obtain signed medical and financial information release forms
   • Determine Medicare and Medicaid eligibility status
   • Obtain family contact information (names, phone numbers, etc.)
   • Complete the Michigan Medicaid Nursing Facility Level of Care Determination Tool
     to determine clinical nursing facility eligibility

During the initial home visit the Enrollment Coordinator will also take the following steps to confirm Medicaid financial eligibility status:

   • Confirm Medicaid status with the State of Michigan
   • If candidate is potentially eligible, but not currently on Medicaid, the intake coordinator will submit an
     application to the State of Michigan with any necessary documentation after obtaining
     information from the potential participant and/or caregiver
   • Follow up with the State of Michigan to determine application status and/or if additional
     information is required

The Enrollment Coordinator will notify the potential enrollee of Medicaid eligibility status and request additional information as needed.

 
     
 
Step 3: Team Assessments Click bar for information

The Social Worker (LMSW) and the Home Care Nurse will go to the participants home to complete the Social Work and Home Care Assessments, respectively. Depending on the circumstances, these assessments may either be completed simultaneously or individually.

Then, 1–2 visits to the CentraCare Day Center will be coordinated by the Interdisciplinary Team (IDT), the potential enrollee, and family. Transportation may be provided by CentraCare. Family are encouraged to attend to assist in answering questions regarding the participant's health.

   • The first day will include a tour of the facility, meeting staff, a review of CentraCare, and discussions about
     how the potential enrollee, family members, and the IDT work together as a team to meet the needs
     of a participant enrolled in CentraCare
   • The IDT will begin to conduct their individual assessments of the potential enrollee on day one and
     complete assessments on day two. The IDT includes the Medical staff, Physical/Occupational Therapy,
     Dietician, Recreational Therapy and Transportation manager. Each will spend some time talking to the
     candidate for enrollment to determine needs and abilities

The IDT will meet to discuss their findings during the assessment and determine if the potential enrollee is appropriate for enrollment. If eligible for enrollment the potential enrollee and family will be invited to meet to review an individualized plan of care.

If the potential enrollee does not qualify for enrollment, the IDT will document the reason(s) for the denial of enrollment. The Social Worker will notify the person that they have been denied enrollment. In addition, the Enrollment Coordinator will send a letter clearly stating the reason(s) for the denial of enrollment and provide appropriate community referrals. A candidate’s denial letter will contain information about how to appeal the decision with the State of Michigan.

 
     
 
Step 4: Enrollment Click bar for information

If eligible for enrollment, the potential enrollee and family will be invited to attend a meeting with the Social Worker to review an individualized plan of care.

   • The care conference will be scheduled once assessments are complete
   • The IDT will discuss assessment findings and current health status and care needs
   • Enrollment into CentraCare is offered

If a participant accepts enrollment, the following will occur:

1  Participant, family and/or caregiver, will be invited to an enrollment meeting at the Center or in the
    participant's home. This meeting is to review the individualized plan of care, obtain necessary signatures for 
    enrollment, and answer any questions regarding the following:

   • The Enrollment Agreement (member handbook)
   • HIPAA Notice of Privacy Practices
   • The Participant Bill of Rights
   • The CentraCare Grievance process and Appeal process
   • The individualized Plan of Care
   • Advanced Directive, if not already in place
   • Obtain required signatures from the participant or their legal guardian on the following documents:
       – The Enrollment Agreement
       – Acknowledgment of Receipt of Notice of Privacy Practices
       – The Plan of Care

2  The participant receives:

   • A copy of their Individualized Plan of Care
   • A copy of the Enrollment Agreement
   • The HIPAA Notice of Privacy Practices
   • A CentraCare membership card
   • A copy of Emergency and Urgent Care Plan
   • A list of current CentraCare staff, including those that provide direct patient care
   • A sticker to be placed on the back of the Medicare and Medicaid card explaining they are
     enrolled in CentraCare
   • Notification that they are guaranteed access to services but not to a specific provider
   • A list of current contractors
       – This list is updated regularly and notice of changes is provided to participants in the newsletter
       – A complete up-to-date copy of the contracted provider list is given to all participants in
         September of every year

Participant start dates always fall on the first day of a month. Depending upon the date of enrollment paperwork and the State of Michigan's cut-off dates, enrollees might have to wait from two to six weeks to begin participating after enrolling.

 
 
CentraCare serves only people who need long-term care. This determination is made using the Michigan Medicaid Nursing Facility Level of Care Determination Tool. If it is decided you do not qualify for the kind of care provided by CentraCare, you will not be able to enroll. If that should happen you may appeal that decision to the State of Michigan at the following address:

State Office of Administrative Hearings and Rules
Department of Community Health
Administrative Tribunal

PO Box 30763
Lansing, Michigan 48909
(877) 833-0870

If you do not qualify to enroll in CentraCare, your eligibility for Medicare will not be affected.

 

Important Notice
If you are eligible for Medicare or Medicaid, the services or benefits you get once you become a participant in CentraCare are made possible through an agreement that we have with Medicare (The Centers for Medicare and Medicaid Services (CMS) of the United States Department of Health and Human Services) and Medicaid (the State of Michigan). When you become a Participant, you are agreeing to accept benefits ONLY from CentraCare in place of your usual Medicare and Medicaid benefits. CentraCare will provide the same benefits. As a CentraCare participant, all health care services are provided and arranged by your personal care team. PACE participants may be fully liable for the costs of medical services from out-of-network providers without prior authorization with the exception of emergency services.

Before you sign the Enrollment Agreement Signature Sheet, please read it carefully. Ask CentraCare staff any questions and make sure you understand everything.

 

Disenrollment
If you enroll with us, you may cancel your enrollment (disenroll) at any time. CentraCare will work with you to process your disenrollment as soon as possible. Your date of disenrollment will be determined based on the quickest processes allowed under Medicare and Medicaid. If you disenroll from CentraCare, your Personal Care Team will work with you and your family to plan for your future care needs. CentraCare will notify Medicare and/or Medicaid of your decision to leave CentraCare. You must continue to receive services from CentraCare for Medicare and Medicaid coverage of services, until the disenrollment is effective.

Note: You may not enroll or disenroll with CentraCare by going to the Social Security Office.


Advance Directives and Durable Power of Attorney for Health Care
It is important to CentraCare and your Personal Care Team to understand how you want your health care to be provided. A time may come when you are too sick to talk to your CentraCare Personal Care Team, your family, or your friends. It is CentraCare policy to discuss with you and your family, before you become too sick, what kinds of care you want provided. There are several ways for CentraCare to do this. CentraCare will keep a written and signed copy of the kind of care you want. Here are ways for you to inform CentraCare of your wishes:

     • You may give written instructions. This is called an "advance health care directive"
     • You may ask someone else to decide your care for you. This request must be in writing. This is called
       "durable power of attorney for health care"

 

Effective Dates of Enrollment
Participant start dates always fall on the first day of a month. Depending upon the date of enrollment paperwork and the State of Michigan's cut-off dates, enrollees might have to wait from two to six weeks to begin participating after enrolling. Your effective date of your enrollment is listed on your Enrollment Agreement.

 
   
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