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South Country Health Alliance | Elderly Waiver: Comprehensive Health Assessment

Elderly Waiver: Comprehensive Health Assessment

Comprehensive Health Assessment

Comprehensive health assessment must be completed within the first 30 days of enrollment and no more than 365 days after the previous face-to-face. Assessments and reassessments MUST be face-to-face.

Health assessments must be completed within 30 days of enrollment if a member switches SCHA products (MSC+ to SeniorCare Complete, AbilityCare to SeniorCare Complete).

Health assessments do not have to be completed if the member switches programs (Community Well to Elderly Waiver, Elderly Waiver to Nursing Home). The member’s health assessment would be updated during his/her annual reassessment.

LTCC (DHS-3428_ENG) is the tool to complete the assessment/reassessment.

If the member switches SCHA products or transfers from another health plan and has a current LTCC/health assessment, a review or update of the health assessment with the member will be accepted.

  • The review MUST be completed within 30 days of enrollment and be face-to-face with the member.
  • Document in contacts that the comprehensive health assessment was completed and the tool that was used.
  • Document any member health and safety changes on the tool and in MMIS.
  • If the LTCC is used, please write under the R1 or R2 column that the review/update is the member’s health assessment.

LTC Screening Document (DHS-3427H-ENG) needs to be entered into MMIS within 30 days of enrollment.

ALL fields must be completed or marked as “not applicable” in the assessment tool in order for the assessment to be included complete.

Financial Eligibility

Member’s financial eligibility for EW services must be verified prior to initiating EW services. The care coordinator/case manager must communicate with the county financial worker, using the Lead Agency Case Manager/Worker Communication form (DHS-5181, which includes the verification of completeness of the DHS-3543) to determine the member’s eligibility for EW services and implement those service ONLY upon verification of eligibility (receipt of approval via DHS-5181).

The care coordinator/case manager should place a copy of DHS-5181 form in the member’s chart. DO NOT open EW Waiver Span if financial eligibility is not determined.