2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Long-Term Carethe agent to members for the purpose of filingcertain federal tax forms and paying federal incometax withholding, FICA, and FUTA taxes. The FMAalso files state income tax withholding andunemployment insurance tax forms, pays theassociated taxes, and processes payroll based onthe eligible SDCB services authorized andprovided.Presbyterian’s care coordinator ensures adequatesupport for participants who choose the SDCB.Termination from the Self-Directed CommunityBenefitPresbyterian Centennial Care may involuntarilyterminate a member from the SDCB wheneverthe following circumstances occur:The member refuses to follow HSD rulesand regulations after receiving focusedtechnical assistance on multiple occasions,and support from the care coordinator orFMA, which is supported by documentationof the efforts to assist the member.There is an immediate risk to the member’shealth or safety by continued self-direction ofservices, for example, the member is inimminent risk of death or serious bodily injury.Examples include but are not limited to thefollowing: the member (i) refuses to includeand maintain services in his or her care planthat would address health and safety issuesidentified in his or her CNA or challenges theassessment after repeated and focusedtechnical assistance and support fromprogram staff, care coordination, or FMA; (ii) isexperiencing significant health or safety needsand refuses to incorporate the carecoordinator’s recommendations into his or hercare plan; or (iii) exhibits behaviors thatendanger himself, herself, or others.The member misuses his or her SDCBbudget following repeated and focusedtechnical assistance and support from thecare coordinator and/or FMA, which issupported by documentation.The member expends his or her entire SDCBbudget before the end of the care plan year.The member commits Medicaid fraud.Presbyterian Centennial Care will submit to HSDany requests to terminate a member from theSDCB with sufficient documentation regarding therationale for termination. Upon HSD approval,Presbyterian Centennial Care will notify themember regarding termination in accordance withHSD rules and regulations. The member shall havethe right to appeal the determination by requestinga fair hearing.Presbyterian Centennial Care will facilitate aseamless transition from the SDCB to ensure thereare no interruptions or gaps in services. Involuntarytermination of a member from the SDCB shall notaffect a member’s eligibility for covered services orenrollment in Centennial Care.Presbyterian Centennial Care will notify the FMAwithin one business day of processing theoutbound enrollment file when a member isinvoluntarily terminated from SDCB and when amember is disenrolled from Centennial Care. Thenotification should include the effective date oftermination and/or disenrollment, as applicable.10-62014 Practitioner and Provider Manual - Ver. 3