County Case Managers
Medical Supply Code T2029: Befor authorizing a medical supply or equipment under Elderly Waiver, please verify whether the item or supply would be covered under the medicaid benefit. The T2029 code should only be used when an item isn't covered under the medicaid benefit but you feel the member would benefit from this item. If you are unsure if the item is covered under medicaid, please call the provider contact center at (866)431-0802. (06/16/08)
Release of Information on Members: PrimeWest Health delegates case management to our county partners. Your facility's contract with PrimeWest contains a section which states your facility "...shall cooperate with and actively participate with PrimeWest Health, County Case Managers, the beneficiary and/or beneficiary's family or representative in the development, monitoring, and follow through of care coordination plans for eligible beneficiaries..."
In addition, the PrimeWest Health member agreed to the following stipulations when they signed your notice of privacy practices: A clinic/hospital is permitted or required to use or disclose the member's protected health information without the member's authorization under the following circumstances: treatment, payment, health care operations.
County Case Managers would utilize the PrimeWest Health member's information for either treatment or health care operations. The Office of Civil Rights has information posted at the following website to assist covered entities with interpreting this particular Code of Federal Regulations (CFR) (45 CFR 164.506).
http://www.hhs.gov/ocr/hipaa/guidelines/sharingfortpo.pdf (06/16/08)
Record Retention: As part of PrimeWest's requirement from the State, Counties must retain all client records for a period of ten (10) years. (02/20/07)
Enteral Nutrition Products:
A county case manager can authorize purchase of an enteral nutritional product through the waiver as an extended supply. The following applies to extended supplies and is out of the MHCP Manual Chapter 23A and should guide your decisions. Lead agencies must ensure and document in the community support plan, prior to the purchase of the supply or equipment, that the item meets all of the following criteria:
Not able to be funded through any other source. If an item is never covered by Medicaid, it is not necessary to seek a written denial from Medicaid. If an item may be covered by Medicaid, the medical supplier must seek authorization from Medicaid prior to seeking authorization of coverage under the EW program;
Specified in the community support plan as necessary to avoid institutionalization;
For the sole utility of the person;
Determined by prevailing community standards or customary practice and usage to be:
Medically necessary: appropriate and effective for the medical needs and health and safety of the person; or
Remedially necessary: appropriate to assist a person in increased independence and integration in their enviroment/community;
Appropriate and effective for the medical needs, diagnosis, and condition of the person;
Of an acceptable quality;
Timely (e.g., the accommodation is provided at the time it is needed);
The most cost-effective health service available to meet the medical needs of the person; and
An effective and appropriate us of Medicaid waiver funds.
A physician's order is required for all extended supplies and equipment purchases under the EW programs. (9/21/06)