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SCL Questions and Answers
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Click on a question below to reveal or hide its answer.
- Q.
- Clarify the date of submission to Carewise Health for people whose DOB and LOC end date are in the same month.
- A.
- If the person’s level of care (LOC) end date and date of birth (DOB) are in the same month, the SCL2 request will be reviewed without penalty. However, providers are serving at risk without an authorization, so it would be best practice in these scenarios to submit prior to the LOC end date. Please note that the LOC dates will flow with the original LOC dates and not adjusted to DOB.
- Q.
- Can you please talk about the process of transitioning folks into SCL2 that currently receive the SCL enhanced rate from an ICF/IID transition (those whose funding expires in 2014 and 2015 respectively)?
- A.
- If a person has transitioned from an ICF through Money Follows the Person (MFP), the person will receive an SCL allocation at the end of the MFP period. At that time the person will enter into SCL2 as a new allocation.
New Allocations – Individuals entering SCL waiver for the first time
Within 60 days from the allocation date, the case manager submits via fax to Carewise Health for the initial LOC and 120-day POC prior authorization (PA):- Copy of Allocation Letter.
- A complete psychological evaluation that includes an IQ test and current adaptive behavior assessment.
- Physical examination conducted within the last twelve (12) months.
- MAP-24C as applicable (if receiving existing waiver services).
- SCL Initial Level of Care form.
- Life Story less than one year old.
- MAP-530 pages 1 and 2; no Person Centered Plan required at this time.
- MAP-531
- MAP-350.
The case manager has 120 days based on the PA dates to submit the full plan to Carewise Health for review and continuation of services.
Within the 120 days, submit to Carewise Health for a PA:- My Life Story*.
- Supports Intensity Scale – My Support Profile.
- MAP-530.
- Person Centered Plan of Care Document – (Narrative) and Team Signature.
- Updated MAP-350.
- Physical examination conducted within the last 12 months*.
- MAP-531.
- Other MAPs, plans, and supportive documentation as applicable (MAP-532, PBSP, Supported Employment Plans, etc.)
*It is not necessary to send items already sent in the initial packet unless there has been some type of change or update. - Q.
- Is there still a period of T2033 at enhanced rate after MFP ends?
Individuals in MFP transitioned into the Enhanced SCL rate for 1 year and then on day 366 it went to the regular rate. Will this continue with SCL2 or no longer occur? - A.
- Once the individual transitions into SCL2, the individual will receive the rates for services as defined in the SCL2 regulations. There are no enhanced rates for people transitioning from MFP.
- Q.
- If a client's current LOC ends 2/13/14 but the client's birthday isn't until 10/18/14, is the client's LOC extended to 10/18/14 or do we send in SCL1 information? Please advise.
- A.
- If the person’s birth month occurs after the LOC end date the LOC period and PA will remain unchanged.
The case manager will submit a recertification packet including (SCL1 forms):
Carewise Health will issue a Confirmation Notice of LOC and PA ending on the individual’s 2014 birthdate. Up to 30 days prior to the LOC end date, the CM shall submit to Carewise Health:- SCL LOC Recertification Form.
- My Life Story.
- Supports Intensity Scale – My Support Profile.
- MAP-530.
- Person Centered Plan of Care Document – (Narrative) and Team Signature.
- Updated MAP-350.
- Physical examination conducted within the last 12 months.
- MAP-531.
- Other MAPs, plans, and supportive documentation as applicable (MAP-532, PBSP, Supported Employment Plans, etc.).
- Q.
- If LOC date ends 2/28/14 and birthday is 3/6/14, do we have to complete SCL1 for five days, or can we submit SCL2 prior to 2/28/2014?
- A.
- Yes, you must submit the SCL1 forms and then submit SCL2 forms on the birthdate.
- Q.
- If a person changes case management agency and the person receives a new LOC, how does that fit into the transitioning to SCL2?
- A.
- Participants will not transition into SCL2 until 2014 DOB. Updated MAP-109 and admitting/discharging MAP-24C required for case management transfer. If it is time for reassessment then new case manager can complete the MAP-351.
- Q.
- If an individual within his or her SCL2 plan is transitioning to a new case management company, does the case manager do the plan as initial or re-certification?
- A.
- In SCL2, a change in case management is requested as a modification to the Plan of Care. It is not an initial plan, just a change in service providers. The case manager should also send the appropriate 24C. The plan and LOC time frame will remain the same. If other changes are needed, then the new case manager will send in modifications for those additional services that need to be changed.
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