ICL

Medicaid Services Coordinator

US-NY-New York
Position Number
78541107
Department
Medicaid Service Coordination
Type
Regular Full-Time
FLSA Status
Non-Exempt
Minimum Salary
USD $39,500.00/Yr.
Maximum Salary
USD $39,500.00/Yr.

Overview

Medicaid Service Coordinators (MSCs) assist persons with developmental disabilities and their families in gaining access to services and supports appropriate to their needs. OPWDD delivers almost all service coordination through its Medicaid Service Coordination program (MSC). MSCs  use a person-centered planning process in developing, implementing, and maintaining an Individualized Service Plan. Plan of Care Support Services (PCSS) is an alternative form of service coordination. PCSS providers assist individuals to review and update their Individualized Service Plan. PCSS is delivered by a qualified Medicaid Service Coordinator

Responsibilities

  1. SERVICE COORDINATOR RESPONSIBILITIES ASSOCIATED WITH THE ISP

The service coordinator's responsibilities associated with the ISP are related to the three areas below.

Developing the person's ISP:

  • Uses person centered planning to identify the person's desired outcomes and those supports and services the person wants and needs.
  • Develops the Preliminary ISP (PISP) (for people enrolled in the HCBS Waiver).
  • Develops the person's Individualized Service Plan (ISP) and Service Coordination Agreement (for all MSC enrollees).
  • Implementing the person's ISP:
  • Coordinates the access and delivery of supports and services chosen in the ISP.
  • Locates or creates natural supports and community resources.
  • Locates funded services, helps determine eligibility, completes referrals, and facilitates visits and interviews.
  • Ensures essential information is made available to providers and others with the appropriate consent of the individual.
  • Maintaining the person's ISP:
  • Uses a person centered planning process to review the ISP and Medicaid Service Coordination Agreement   at least every six months and makes any necessary revisions to ensure these documents are up-to-date.
  • Works to ensure that all supports and services being provided are consistent, to the extent reasonable, with the person's needs and goals.
  • Service coordinators should ensure that planning meetings use a person centered planning process so that ISPs will be individualized   
  • In addition to activities related to the ISP, the service coordinator is responsible for the following MSC-related activities:
  • OTHER SERVICE COORDINATION ACTIVITIES ASSOCIATED WITH MSC

 

  • Meets with the person, person's family, and advocate to explain MSC, their roles, and the role of the service coordinator. Also ensures the person is aware of his or her ability to choose, to the greatest extent possible, which MSC vendor and service coordinator will provide services to him or her.
  • Assists the person in completing the Consumer Application for Participation in Medicaid Service Coordination   form and for enrollment in TABS.
  • Conducts monthly face-to-face service meetings with the person (unless less frequent service meetings are officially approved by the Commissioner of OPWDD)  
  • Works with a person who wants to change MSC vendors by referring the person to the DDSO that will assist in the completion of the Request for Change of Medicaid Service Coordination Vendor form  
  • Works with a person who wants to withdraw from MSC to ensure the person is making an informed choice. Assists in the completion of the Withdrawal from Medicaid Service Coordination  
  • Works with an HCBS Waiver participant who withdraws from MSC to identify a Plan of Care Support Services vendor   ACTIVITIES ASSOCIATED WITH THE PERSON'S HEALTH & SAFETYCritical roles for the service coordinator are monitoring the person's health and safety needs and working toward improving the quality and safety of the living environment Service coordinators are responsible for reporting any suspected unmet health or safety needs. If an unmet health or safety need places an individual in imminent danger of being harmed, the service coordinator must do whatever is reasonable to protect the person (e.g., call for emergency assistance and remain on site until the situation is addressed).For individuals who live in OPWDD certified residences, the service coordinator must:
  • The reporting requirements and standards differ for individuals who live in OPWDD certified residences and for individuals who live independently or with family members. However, regardless of where the individual lives the DDSO should be informed of any dangerous situations or reports made to outside state or law enforcement agencies.

Report suspected unmet health or safety needs in any OPWDD certified residential setting. The Service Coordination Observation Report   is one form service coordinators may use to report unmet health and safety needs.

  • Ensure that for residents of IRAs, the person has an Individual Plan of Protective Oversight.
  • For people living in a CR or Family Care, document in the safeguard section of the ISP the supports needed to keep the person safe from harm and actions to be taken when the health or welfare of the person is at risk. This must include fire safety issues.
  • Report, in consultation with the service coordination supervisor, suspected child abuse to the State Central Register of Child Abuse and Maltreatment at 1-800-342-3720.
  • Comply with Part 624 (Reportable Incidents, Serious Reportable Incidents and Abuse in Facilities Operated or Certified by OPWDD) and take reasonable steps to prevent violation of Part 633 (Protection of Individuals Receiving Services in Facilities Operated and/or Certified by OPWDD), and subpart 635-9 (Provision of Required Services) (Appendix One).
  • For individuals who live independently, with others or at home with family, the service coordinator must:
  • Document in the safeguards section of the ISP that plans are in place to protect the person's health and safety. This must include a summary of fire safety needs.
  • Report, in consultation with the service coordination supervisor, suspected child abuse to the State Central Register of Child Abuse and Maltreatment at 1-800-342-3720.
  • Address suspected abuse, neglect, and financial exploitation of adults, including situations where an individual cannot care for him or herself. This may require reporting to the local adult protective system. In New York City, suspected abuse or neglect of adults is reported to Protective Services for Adults. Outside New York City, contact the local county department of social services to determine which office has responsibility for this function in the county where the individual lives.
  • Comply with Part 624 (Reportable Incidents, Serious Reportable Incidents and Abuse in Facilities Operated or Certified by OPWDD) and take reasonable steps to prevent violation of Part 633 (Protection of Individuals Receiving Services in Facilities Operated and/or Certified by OPWDD), and Part 635 (Subpart 635-9 (Provision of Required Services) (Appendix One). ADVOCATING FOR THE INDIVIDUALAnother critical role of the service coordinator is advocacy. An individual may have a formal "advocate" who performs a variety of functions, but here we are talking about something different - advocacy tasks that are specific to a service coordinator.
  • Most of the activities performed by a service coordinator on a daily basis have some element of advocacy associated with them. Two groups of activities that are especially critical deal with protecting and upholding a person's rights, and ensuring that the person's living environment is safe. Some specific examples include:

 

  • For further information regarding what actions should be taken regarding dangerous situations, service coordinators should refer to the Handbook for All OPWDD Providers - Part 624. Section seven of the handbook addresses the application of this regulation to non-certified programs and services. (Vendors can obtain copies of the handbook from the OPWDD Regulatory Affairs Unit, see Appendix Two for contact information.)
  • Advocating on behalf of the person if his or her rights are denied.
  • Intervening when a person is in jeopardy of being evicted from his or her home without apparent cause.
  • Taking all reasonable steps to ensure that the person obtains adequate health care.
  • Working toward improving the quality and safety of the person's living environment if necessary. Service coordinators meet with people in a variety of settings. During these visits, it is the responsibility of the service coordinator to observe if the person appears healthy and if the environment in which the person lives is safe. If service coordinators observe signs of ill health they must advocate for the person by assisting the individual to access health care.
  • Obtaining information about the quality of services provided by an agency by reviewing the most current inspection reports issued by Quality Assurance. These reports are found at each respective facility or program certified by OPWDD.
  • Advocating in the school setting. This includes addressing educational issues and working collaboratively with school personnel to meet the needs of the person.    The local OPWDD Revenue Support Field Office (RSFO) can provide assistance with Medicaid-eligibility issues that cannot be resolved by the person, family or other appropriate service providers such as the residential or day provider.
  • The service coordinator ensures that all necessary documentation is completed so that a person's enrollment in Medicaid is not unnecessarily interrupted. People receiving Supplemental Security Income (SSI) are eligible for Medicaid based on their eligibility for SSI. They are authorized for Medicaid through the Social Security Administration and are subject to periodic disability reviews. Most people enrolled in Medicaid who are not receiving SSI must have their Medicaid cases re-certified on an annual basis.
  • ENSURING THE PERSON'S MEDICAID ELIGIBILITY IS MAINTAINED
  • The service coordinator must maintain the documents included in the consumer's Service Coordination Record. These documents will substantiate a vendor's monthly billing for federal and State audits.
  • MAINTAINING REQUIRED MSC DOCUMENTS

A bachelor’s degree in a health or human services ield:Socialork,Sociology,Psychology,Health,Nursing,Medicine,Rehabilitation Counseling, Therapeutic Recreation, Nutrition, Occupational Therapy, Physical Therapy, Speech Pathology, Audiology, Music Therapy, Education. Special Educationplus one year experience working with people with a developmental disability

Qualifications

Bachelor’s degree in: Social Work, Sociology, Psychology, Health, Nursing, Rehabilitation Counseling, Therapeutic Recreation, Nutrition, Occupational Therapy, Physical Therapy, Speech Pathology, Audiology, Music Therapy, Education, Special Education

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