Personalized care management and care coordination
For individuals needing home and community based services of 120 days or more per year, such as: Private Duty Nursing Service, Therapies in the home (Occupational, Physical, Speech), Home Health Aide Services, Personal Care Services in the home, Adult Day Health Care, and Consumer Directed Personal Assistance Services, our care management professionals will assist with accessing these services to meet your needs.
A health risk assessment
Prior to enrollment, you will be visited by a Registered Nurse who will perform a personal health risk assessment. This an extensive assessment of your current health needs.
Home Health Care (including nursing, home health aide, and medical social services)
Provides nursing, home health aides, personal care aides, physical, occupational, respiratory therapies, speech-language pathology, audiology, medical social work services, nutrition services and housekeeper services.
Nurse Support Line at all times
Our nurses are on call 24 hours a day, 7 days a week, to meet your needs or answer any questions.
Coordination of non-covered services
Our care management professionals, including Registered Nurses, and licensed Social Workers, will help identify and work with you to coordinate services provided outside of our service offerings.
Services include regular and routine dental services such as preventative dental check-ups, cleaning, x-rays, fillings, and other services to check for any changes or abnormalities that may require treatment and/or follow-up care.
Medical transportation, non-emergency
Our Member Services staff, along with Care Managers, will help coordinate non-emergent transportation to physicians, day programs, therapy sites, and other medically necessary services.
Personal Care (such as assistance with bathing, eating or dressing)
Personal care includes services such as assistance with bathing, eating or dressing provided by a Personal Care or Home Health Aide .
Private Duty Nurse
In the event that you need Private Duty Nursing care, our Care Managers will help to assess and coordinate for these services.
Durable Medical Equipment (DME)
In the event that you need Durable Medical Equipment such as wheelchairs, walkers, commodes, grab bars, etc., our Care Managers will help to assess and coordinate for these products.
Medical / surgical supplies
Our Care Managers can assess the need and coordinate the delivery of medically necessary medical and surgical supplies.
Rehabilitation therapies (such as physical, occupational, and speech therapies) whether at home or in the community.
Our Care Managers, based on medical necessity, can authorize rehabilitation therapies such as physical, occupational, and speech therapies. Whether at home or in the community.
Audiologists provide non-medical management of the auditory and balance systems. Specializing in the study of normal and impaired hearing, prevention of hearing loss, identification and assessment of hearing and balance disorders, dispense hearing aids and hearing assistive technology systems.
Podiatry (Foot Care)
Podiatry refers to foot care provided by a Doctor of Podiatry Medicine (DPM). Our Care Managers can coordinate these services as required.
Skilled Nursing Facility (if necessary)
A Skilled Nursing Facility is also commonly known as a “Nursing Home.” It provides 24-hour care in an institutional setting. This care includes room and board, nursing care, medication management, social work, dietary management, programs, and activities for 90 days. If long term nursing home service are required beyond 90 days, the member will be disenrolled from the MLTC Plan and enrolled in Medicaid Fee for Service. Care will remain in place and continue to be provided by the skilled nursing facility.
Prosthetics, Orthotics, and Prescription Footwear
Based on medical necessity, our Care Management Nurses, can help coordinate the authorization and delivery of prosthetic, orthotic, and prescription footwear as ordered by a physician.
A Registered Dietitian can assist in the planning for the provision of dietary intake appropriate for the individual’s physical and medical needs.
Medical Social Services
Services to help you with social and emotional concerns related to an illness. This might include counseling or help in finding resources in the community.
Respiratory Therapy include the services provided by a Respiratory Therapist in conjunction with the need for home oxygen, nebulizer, C-PAP, Bi-PAP, or other medically necessary respiratory equipment.
Social and Environmental Support
Social and environment support includes things such as chore services or home modifications. Home modifications may include accessibility options and modifications such as wheelchair ramps, etc.
Meals, Home delivered or in group settings (such as day care)
Home-delivered meals are meals delivered by volunteers to eligible recipients (programs are typically provided by local and county Office for the Aging or Senior Services). Congregate Meals are healthy and affordable meals provided in a group setting such as a day/community center.
Adult Day Health Care
Medically supervised services for individuals with physical or mental impairment. Services include: nursing, transportation, leisure activities, physical therapy, speech pathology, nutrition assessment, occupational therapy, medical social services, psychosocial assessment, rehabilitation and socialization, nursing evaluation and treatment, coordination of referrals for outpatient health, and dental services.
Social Day Care
Provides care and supervision in a protective setting for dependent adults living in the community. Services may include social and recreational activities, training that is essential for sustaining activities of daily living, hot meals, entertainment and education programs, intergenerational programs and personal care (including shower and beauty salon services) to name a few.
Personal Emergency Response Systems (PERS)
Also known as Medical Emergency Response Systems, let you call for help in an emergency by pushing a button. A PERS has three components: a small radio transmitter, a console connected to your telephone, and an emergency response center that monitors calls. Transmitters are lightweight, battery-powered devices. You can wear one around your neck, on a wristband, on a belt, or in your pocket.
Consumer Directed Personal Assistance Services
Provides member with the responsibility for coordination and management of their own home care services including hiring, training, supervising, and scheduling their own staff as an alternative to traditional home care services.
Doctors of Optometry are main providers of vision care and prescribe eyeglasses or contact lenses, or they may provide other treatments, such as vision therapy or low vision rehabilitations. Optometrists also test for glaucoma and other eye disease and diagnose conditions caused by systemic diseases such as diabetes and high blood pressure, referring patients to other health care practitioners as needed.