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Managed Care/MCO update: Answers to your top questions (FAQ)

March 1, 2015, has come and passed, and the new Texas Medicaid Managed Care/MCO structure is officially upon us. Skilled nursing facilities across Texas are now grappling with the new requirements and, as a result, several questions and concerns have cropped up.

Here are answers to some of the most common questions we’ve received since the MCO update:

1)  An MCO Service Coordinator told me I cannot submit a Service Coordination Notification (SCN) form through SimpleLTC and that it must instead be faxed directly to them. Is this true?

No. It is true that the SCN form must be faxed to the MCO directly, but when a SCN form is submitted to SimpleLTC that is exactly what occurs. The users submits the form electronically via SimpleLTC, our system takes the submitted form and faxes it directly to the proper MCO, and the MCO receives a direct fax.

NOTE: At the time of this article’s publication, it appears that many Service coordinators are not aware that SimpleLTC has the ability to fax a SCN form on behalf of a provider. They may be instructing providers to fax SCN forms to them directly. Rest assured that SimpleLTC is doing exactly that for its providers, while at the same time simplifying and securing the process. If a Service Coordinator has any questions, we will be happy to speak with them. Our support team can be reached at 469-916-2803.

2) How does the new MCO structure affect our 3618s, 3619s and LTCMI workflow? We’ve heard MCOs will not be able to access 3618s or 3619s.

The 3618/3619, PL1 and LTCMI workflows are not affected by the new MCO process. Continuing to submit these forms is as important as ever, probably even more so.

MCOs have access via TMHP to view a member’s 3618/3619 forms in order to properly calculate the member’s service authorizations.

3) In what situations do we need to submit a Service Coordination Notification (SCN) form?

  • Use a SCN form to notify MCO Service Coordinators within one business day:

    • of an adverse change in a member’s physical or mental condition or environment that could potentially lead to hospitalization

    • of unplanned admission or discharge to a hospital or other acute facility, skilled bed, or another nursing home

    • if a member moves into hospice care

    • of an emergency room visit

  • Or within 72 hours of a member’s death.

4) Do we need to submit a Service Coordination Notification (SCN) form every time we submit a 3618 or 3619?

The best practice is to follow the required workflow for 3618/3619 and SCN forms, whether or not they correspond with each other. It might be helpful to think of SCN and 3618/3619 forms as separate processes that sometimes intersect.

For example, if the member is simply changing from co-insurance to full Medicaid or vice versa, an SCN form is probably not required. However, if the member is admitting or discharging for any of the reasons given in the answer to the previous question above, a 3618/3619 as well as an SCN form are both probably required.

If you have questions about when and whether to submit the SCN, you should continue to contact the HHSC Managed Care Expansion command center at ManagedCareExpansion2015@hhsc.state.tx.us.

5) We’ve had some issues with having the right access (user authorization) to submit Service Coordination Notification (SCN) forms. Has this been resolved?

Yes! Clinical, business office, and corporate staff now have the ability to submit SCN forms.

6) How can I access SimpleLTC’s MESAV Managed Care report?

  1. Sign in to SimpleLTC

  2. Click the “Texas” tab.

  3. Under your Texas tab, click “Reports”.

  4. Click Report 8: “MESAV Managed Care”.

  5. Choose the facility(s).

  6. Enter a date range and choose an output option.

  7. Click “Submit request”.

7) On the MESAV, what does the Plan Code mean under the Managed Care section?

You can view a chart of all MCO Plan Codes here. NOTE: These are the same codes that are also reflected in the Code column in the SimpleLTC MESAV Managed Care report.

8) How do I know if the MCO received my Service Coordination Notification (SCN) form?

An SCN form has three possible statuses:

  1. Draft: The form has been saved in SimpleLTC but has not been submitted.

  2. Submitted: The form has been successfully submitted to SimpleLTC and is in the process of being faxed to the MCO.

  3. Sent: The form has been successfully faxed to the appropriate MCO fax number

9) How can I verify the MCO and fax number to which my Service Coordination Notification (SCN) form was sent?

From the MCO Notification tab in the Form Activity view, find the resident and form in question. Then, click the Actions option in the right column, and choose Print. A copy of the form will be downloaded in PDF format. It includes the information provided on the form, as well as the MCO plan and the fax number to which the form was sent.

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