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: Vendor & Credentials
Who is completing the assessment?
This section is very self-explanatory. Example:
Part 2: The Member Contact Assessment
Who is the SC contacting?
Be sure to always check and fill out HIPAA details with the participant:
Part 3: 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!
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
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
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
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
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
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).
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.
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 4: Member Satisfaction
Assessing the quality of Provider Services
All boxes that apply to the participants current services should be checked off, at which time you will see additional questions appear that are required to be answered for each service. The participants’ own words should be used in this section (e.g. Susan stated “I love my caregiver, she helps me with everything I need). SC should ask open ended questions to gather more detailed information if needed (e.g. You said your caregiver helps you with everything, can you tell me what types of things she does for you each day?).
If the participant is reporting disatisfaction then SC should begin to plan with participant for how to address disatisfaction (e.g. If participant reports that PAS provider is not able to staff all of the times when participant needs support then SC should discuss options participant has to add an additional provider or change providers). SC should document any attempts to address issues with the participant.
Part 5: Texting Program Opt-In
This section is not utilized at this time, you may leave this section of the MCA blank
Part 6: Quality of Life
This section is required to be filled out at all visits/assessments with participants, but can also be filled out during monthly calls if Participant is providing new/relevant information during the call.
All additional boxes that appear based off of prior answers must be filled in completely
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.
Part 7: Community Transition Planning
This section is not utilized unless the participant is in a Long Term Nursing Facility placement
Part 8: Person Centered Service Plan
This section is filled out during all calls or visits and each drop down must be answered.
If the MCA is for a visit then the answer will be “yes” that the PCSP was completed or reviewed.
The MCA MUST be attached to any relevant note in Function Portal as a PDF attachment. To comply with this requirement, DO NOT Submit the MCA until it is Printed as a PDF File. All Assessments completed in the PHW Envolve Portal disappear for 24 hours after pressing “Submit.”
Be sure to save the MCA with the proper naming convention for PHW:
MCA_(MEMBER LAST NAME)_(MEMBER FIRST INITIAL)_(MAID NUMBER)_(DATE OF ASSESSMENT)