/ Department of Human Resources
Online Directives Information System / Index:
Revised:
Review: / MAN5400
01/01/09
01/01/11

SUBJECT: CCSP Care Coordination

CARE COORDINATION MANUAL TABLE OF CONTENTS

Chapter

/

Section

/

Subject

CCM TitleDisclaimer Page

Table of Contents Charts

100 /

Introduction to theCCSP

200 / The CCSP
210 / 1981 Omnibus Budget Reconciliation Act
220 / Waivered Services
230 / 1982 Georgia Community Care and Services for the Elderly Act
300 / AdministrativeOrganization
310 / Department of Human Resources
312 / Division of Aging Services, Community Care Services Program Section
314 / Division of Mental Health, Developmental Disorders and Addictive Diseases
316 / Division of Family and Children Services
320 / Department of Community Health
322 / ServiceProviders
330 / Physicians
340 / Area Agencies on Aging
342 / Lead AgencyProgrammatic Report
344 / Network Meetings
346 / Advocacy
400 / CCSP Process
500 / EligibilityCriteria
510 / CCSP MedicaidEligibility
600 / Care Coordination
610 / Telephone Screening Assessment
612 / Waiting List
620 / Initial Assessment
622 / Comprehensive Care Plan
624 /

Assessment Cost Limit Guidelines

626 / Client Choice of CCSP Provider
628 / Level of Care
630 / Triage
640 / Confidentiality
650 / Client Protection Assurance
660 / Documentation
670 / Helpand Deadlines
672 / Standardsof Promptness
700 / Care Management
710 / Brokering Services
712 / Brokering Services for MAO/PMAO Clients
714 /

BrokeringEmergency Admissions

716 / AuthorizingBrokered Services
720 / DischargePlanning
730 / Comprehensive Care Plan Review
740 / Follow-up Activity
742 / ServiceSpecificFollow-up Activities
744 / Cost Share (Client Liability)
750 / Care Coordination Supervision
760 / Care Coordination Monitoring
800 / Reassessment
900 / Ongoing Activities
910 / AddressChanges
912 / Transfers
920 / Care Coordination Conferences
930 / Interruptions in Service
940 / Medicare Home Health and CCSP
950 / Provider Requests Change in Service Units
960 / SAF Changes
962 / Billing Edits
964 / Prior Authorization/ Prepayment Review
966 / Third Party Reimbursements
970 / Terminations
1000 / CCSPAppeals
1002 / Legal Assistance
1010 / Initial Assessment Appeal
1020 / Level of Care Appeal Procedures
1030 / Outcomeof Initial Hearings
1040 / Final Appeals
1050 / UtilizationReview Process
1060 / Withdrawal of Hearing Request by Client
1070 / TimeLimits
1100 / CCSP Aging Information Management System (AIMS)
1110 / Client Registration
1120 / Service Authorization
1200 / Consumer Directed Option for Personal Support Services
1200 / Introduction
1210 / Eligibility
1220 / Support Broker Roles and Responsibilities
1230 / Employer/Employee Roles and Responsibilities
1240 / Fiscal Intermediary
Glossary
Abbreviations-Acronyms
Appendix 100 / Forms and Instructions
110 / Introduction
120 / Forms Reproduction
130 / List of Forms by Name and Form Number
Authorizationfor Release of Information, Form 5459
Authorization forRelease of Information & Informed Consent
Care Coordination Complaint Log
Care Coordinator’s Prior Authorization Request Transmittal (CCT)
CaseNotes
CCSP Care Coordination ADH Checklist
CCSP Care Coordination ALS Checklist
Client Referral Form – Home Delivered Meals
Client Registration Report for AIMS
Client Rights and Responsibilities
Client Transfer Form
Community Care Communicator (CCC), Form 5590
Community Care Lead Agency Programmatic Report (M-CCSP)
Community Care Lead Agency Supplemental Report (S-CCSP)
Community Care Notification Form (CCNF), Form 6500
Community Care Services Program Participation, Form 5389
ComprehensiveCare Plan (CCP) Service Order
Incident Reporting Form
Initial Hearing Summary
Initial Service Authorization Data Entry Form
Level of Care Page
Level of Care Cover Letters
Level of Care Denial Letters
Level of Care Termination Letters
Minimum Data Set – Home Care (MDS-HC)
Noticeof Denial, Termination, or Reduction in Service, Form 5382
Notice of Right to Appeal Decisions Regarding CCSP, Form 5381
Notice of Status of Request for Services From the CCSP
Nutritional Screening Initiative (NSI) Checklist
OSAHForm 1
Potential CCSP Medicaid MAOFinancial Worksheet
Prior Authorization Request, DMA-80
Provider Rotation Log
Provider Service Information Form
Request forHearing, Form 5383
Service Authorization Form (SAF)
Telephone Screening (TS)
Appendix 300 / Job Descriptions
310 / Lead Care Coordinator
320 / Care Coordination Registered Nurse
330 / Care Coordination Social Services Worker
340 / CCSP Screening Specialist
350 / Care Coordination Licensed Practical Nurse
Appendix 500 / Level of Care Criteria
510 / Intermediate Level of Care Criteria
Appendix 700 / Medicaid Classes of Assistance
Appendix 900 / Procedure Codes /Reimbursement Rates
Appendix 1100 / MHDDAD Regional Boards / Community Service Boards
Appendix
1200 / Forms and Instructions for Consumer Directed Option for Personal Support Services
Client Participation Agreement
Skills Inventory/Training Checklist
Employee Task List
Appendix 1300 / 1300 / Brochure: TheCCSP
1310 / Brochure: TheCCSP (InSpanish)
Appendix 1500 / Manual Transmission Cover Letters
1510 / MT 2007-107/06
1520 / MT 2007-2 08/06
1530 / MT 2007-3 11/06
1540 / MT 2007-4 12/06
1550 / MT2007-502/07
1560 / MT 2008-1 07/07
1570 / MT 2008-2 10/07
1580 / MT 2008-3 01/08
1590 / MT 2008-4 05/08
1590-1 / MT 2009-1 07/08
1590-2 / MT2009-2 01/09

MT 2009–2 01/09 TOC-1