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2. Member Contact Assessment Training

Completed with ANY and ALL contact to/from the client and/or authorized representative (ie. Phone calls and visits; successful and unsuccessful) 

When NOT to complete – Contact with a Provider, unauthorized individual, or PHW

Documentation of the MCA must be completed within 24 hours of the contact


To initiate, log-in to PHW Envolve, access a Member’s case, select on “Fill Out Now” besides the MCA in the Assessments tab:


Part 1: The Member Contact Assessment

Who is the SC contacting?

  • Encounter Date: The date you spoke with the participant
  • Was assessment completed by a vendor? Answer should always be YES because you are a part of an SCE.
  • Assessment completed by (Name): Your name
  • Name of Agency completing the assessment: Answer is always “Amcord Care, Inc.”
  • Credentials of Staff completing assessment: Answer should always be “None”
    • Unless you do have any of those credentials
  • Contact Method: Face to Face, Telephone, Electronic, or Virtual contact. Choose whichever is applicable.
    • Electronic visit is likely NOT going to be done.
  • Was Care Management Virtual Visit offered? – If you were conducting a visit that is not Face to Face, you should be offering to do it virtually.
    • Based on your answer you may need to select whether the participant accepted the virtual visit or why they refused.
  • Was the legal representative invited to participate?: Did you or the participant try to involve the participant’s Legally Authorized Representative, if there is one at all?
    • Answer is based on if your participant has a rep and invited them or not
    • Based on you answer you may need to answer the following:
      • Did the Legal Representative participate in the contact?
      • Did the member request that the legal representative not participate?
  • Did the External Service Coordinator participate?: Answer should always be YES because you are the External Service Coordinator!
  • Where did the visit take place?: Better known as “where did the Contact take place?”
    • If this was a F2F visit, select the appropriate answer
    • If this was over the phone, select “Other”, and then your answer should match the answer in Contact Method
  • Select current residential location: Coordinator should be confirming the client’s address and type of residence, then choose the appropriate answer. 
    • If the answer was “Home (with a caregiver)” then the coordinator needs the following information about the caregiver. 
      • Caregiver name
      • Caregiver relationship 
      • Does the caregiver live with member? Answer should be – Yes
      • Does the caregiver provide natural support? – meaning does the caregiver provide informal/unpaid support?
      • Is the caregiver paid?– meaning does the caregiver provide formal/paid support?
    • If the answer was “Other” then the coordinator needs to state what the Other residential location is
    • If the answer was: “AFCH, ALF, Hospice, or Nursing Home” the the caregiver must state what the Residential location facility name
  • HIPPA verified: Answer should always be YES, because coordinator should ALWAYS be confirming HIPPA information with the participant.
    • Then list which HIPPA Information you confirmed with the particiant including:
      • Participant name
      • DOB
      • Phone number
      • Address
  • Select who provided information: Who did the SC speak to/receive information from during the contact?
    • If the SC spoke to anyone that was not the participant, they should be stating the name(s) and relationship(s) of these individuals.
  • Did enrollee’s demographics change?: Has any of the information about the participant changed?
    • If there was a change, then the coordinator must state what the changes are. 
  • Does the enrollee reside in New Mexico?: The answer is probably No

Part 2: Type of Contact

What is the Reason for this Assessment?

Only ONE “Type” should be selected unless otherwise instructed to do so specifically by PHW or Amcord leadership

 7 or 14 day follow up

Used for NPO participants (new to PHW or MCO transfers or the participant who lost eligibility for greater than 60 days) to follow up and ensure services are in place as per the service plan. 

DO NOT USE for non NPO participants!


Annual contact

This will be one of the most frequently used “Types” at this time.  Annual contact is used during your visit/call with the participant in which you are completing annual documents.  You should be looking at FP to see if an annual has recently been completed or if one is coming due.


Biannual Contact is not being used at this time


Care Gap/Plan is not being used at this time.


Change in caregiver support

Used when a participant reports that their informal support system has changed (ie. the participants’ daughter moved to another state and is no longer able to assist the participant with ADL/IADL’s OR participants’ son now moved into their home so will be able to assist with meal prep, cleaning, shopping, and laundry). 

SC will complete new assessments (MCA, InterRAI, PCSP, HRA, and FP documents) to reflect changes in caregiver support.  Prior to doing a change in caregiver assessment the SC should look at if an annual or quarterly are coming due, if they are then the annual or quarterly should be marked in all assessments.  If no annual or quarterly is coming due then SC can proceed with documenting assessments as change in caregiver support.


Change in Health condition

Used when a participant reports that they have had a change in health condition this can mean a new diagnosis that is affecting the participants functioning (ie. fall with hip fracture and no longer able to ambulate) OR diagnosis no longer present or effecting functioning (ie. hip fracture is healed and ptp is done PT and able to ambulate again).

SC will complete new assessments (MCA, InterRAI, PCSP, HRA, and FP documents) to reflect changes in health condition.  Prior to doing a change in health condition assessment the SC should look at if an annual or quarterly are coming due, if they are then the annual or quarterly should be marked in all assessments.  If no annual or quarterly is coming due then SC can proceed with documenting assessments as change in health condition.


Critical incident follow up

Used if instructed to do so from your Supervisor


Housing Need is not being used at this time


Incoming call received

Used when participant calls SC for an unscheduled call and ONLY when Monthly contact has already been completed for that month* (or if participant is unable to do monthly contact at time of first call)


Inpatient IET not utilized at this time


Monthly Contact

This will be the most frequently used of the MCA’s and is used for your first successful contact with the participant in any month when an annual or quarterly visits are not being completed.


New Member Orientation

(NMO/NPO) is only used for participants that are new to PA Health and Wellness (e.g. participants that just started waiver services, the participant has lost eligibility for more than 60 days, or participants that switched from another MCO to PHW).  This Type is selected for the first visit/call when the initial assessments are completed.

DO NOT USE for non NPO participants!


Outpatient IET not utilized at this time


Quarterly contact

Utilized for visit/call to complete quarterly assessments with the participant.  Participant should have an NMO/NPO (if new to PHW) or annual MCA already completed prior to selecting quarterly contact type.


Service Verification is not utilized unless specifically instructed to do so by PHW/Amcord Supervisor.


Transition Meeting is not utilized at this time


Unscheduled contact

Used when SC calls participant and ONLY when Monthly contact has already been completed for that month. (ie. SC is calling to confirm the upcoming visit with the participant that was previously scheduled).


Unsuccessful Outreach

Utilized for ALL ATTEMPTS to contact the participant/POA/authed rep that did not result in a successful contact (e.g. left voicemail, number disconnected, wrong number, etc).  Prior to any Unable to Locate (UTL) Letter being requested from PHW there must be 3 unsuccessful contact MCA’s on the file from different days and different times.


Welcome Call

Utilized for participants that are new to PA Health and Wellness, have lost eligibility for more than 60 days, or are a transfer from another MCO.  This documents the first call to the participant and is required to be completed within 2 days of participants start with the healthplan. DO NOT USE for non NPO participants! Inside of the Welcome Call MCA the date for the scheduled NPO visit must be noted. 



Part 3: Member Satisfaction

Assessing the quality of Provider Services

Member Satisfaction is filled out for Monthly Contacts and Comprehensive Needs Assessments (visits)

All services that apply to the participant MUST be checked off.
When selected there will be additional questions of “How satisfied are you with _____” and “Please Explain”
The participant’s own words should be used to explain their satisfaction or dissatisfaction. ?
If Dissatisfaction is reported, then SC should state how they will address the dissatisfaction, if possible.

  • Adult Day Center: Adult Day Care/Adult Day Program (ADC)
  • ALF Provider: Assisted Living Facility – likely won’t apply
  • Care Coordinator: Service Coordinator
    • All participants have a Service Coordinator (us!) so this should always be checked off and answered when completing the Member Satisfaction
  • Fiscal Management Agency: Only for participants that use Public Partnerships (PPL)
  • Health Plan: PA Health & Wellness
    • All of our participants are with PHW, therefore this should always be checked off and answered when completing the Member Satisfaction
  • Institutional Provider: Mental health institution, Rehab facility, or other institution.
  • Personal Care Attendant/Worker Provider: The HHA and/or PAS provider
    • Most participants have a PAS provider, therefore this will likely need to be checked off and answered when completing the Member Satisfaction.
  • Transportation Provider: MTM or MATP transportation

Part 4: Texting Program Opt-In

This section is not utilized at this time, you may leave this section of the MCA blank


Part 5: Quality of Life

This section is filled out for Monthly Contacts and Comprehensive Needs Assessments (visits).

  • Do you feel safe in your home/where you live?
    • If a participant reports they do not feel safe in their home SC is required to do additional planning with the participant to ensure their safety (e.g. If participant tells SC that they no longer feel safe in their neighborhood then SC should work to connect participant with housing resources and work with participant towards goal of moving to environment where participant feels safe). 

SC is required to let their Supervisor know if a participant reports not feeling safe in their home.

Some questions will prompt more based on the answer given. Answer them appropriately


Part 6: Community Transition Planning

This section is not utilized unless the participant is in a Long Term Nursing Facility placement


Part 7: Person Centered Service Plan

This section is filled out during all calls or visits and each drop down must be answered appropriately.

If the MCA is for a visit then the answer will be “yes” that the PCSP was completed or reviewed.

***IMPORTANT***
DO NOT Submit the MCA until it is Printed as a PDF File.

The MCA MUST be attached to any relevant session in Function Portal as a PDF attachment. To comply with this requirement. All Assessments completed in the PHW Envolve Portal disappear for 24 hours after pressing “Submit.”

Naming Convention

Be sure to save the MCA with the proper naming convention for PHW:

MCA_(MEMBER LAST NAME)_(MEMBER FIRST INITIAL)_(RECIPIENT ID)_(DATE OF ASSESSMENT)

e.g.  MCA_Smith_S_0123456789_08102020 

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