MFAW Guidebook

Provider Selection

The Service Coordinator (SC) will provide the participant, parent(s), and/or responsible party(ies) with a regional provider list that includes current agency contact information. The SC will inform the family they may choose multiple agencies, this will be noted on the Provider List given to the participant, parent(s), and/or responsible party(ies).

• The participant, parent(s), and/or responsible party(ies)will select a provider agency or agencies within 30 days of receipt of the provider list.
• If the participant, parent(s), and/or responsible party(ies) has not chosen a provider agency or agencies in 30 days, the SC will contact the family to offer assistance with provider selection. If assistance is requested, the SC will inquire with provider agencies regarding staffing availability. Results will be communicated to the participant, parent(s), and/or responsible party(ies) for provider selection.
• If the participant, parent(s), and/or responsible party(ies) has not selected a provider agency or agencies in 90 days of receipt of the provider list, SHCN will close the case and send a closure letter. Participant will not be closed if actively pursuing services.

Role of the HCY Service Coordinator

• Develop a service plan by identifying the goals of the participant, parent(s) and/or responsible party(ies) and determine the services, funding sources, and outcomes needed in order to reach these goals.
• Complete necessary paperwork to obtain services and document the information in the SHCN Information System as per policy/procedure.
• Coordinate the plans of care for multiple agencies.
• Adjust supports and services of multiple providers based on changing needs of program participants.
• Multiple providers cooperate with each other to provide services to meet the needs of the participant. When multiple providers are utilized, it is expected that the providers, family, and SC will work together to coordinate the service utilization.

Multiple PDN Providers

There are times when one PDN agency is unable to staff all the PDN services authorized for a participant. A participant may utilize multiple PDN provider agencies to provide the authorized units of PDN services. Services must be prior authorized for each provider agency. A specific number of hours is authorized for each provider agency based on the anticipated services each agency will provide. The authorized hours can be adjusted and/or moved to another agency in the event an agency is not able to staff their authorized hours but another agency is able to staff the hours. Contact the appropriate Regional Office for SHCN to adjust the authorization. SHCN should be contacted within 72 hours if an unforeseen situation arises which results in a need to adjust the authorization.

Multiple Agency Selection

• The SC will educate the family on the process of having two or more agencies in the home. The SC, participant, parent(s), and/or responsible party(ies) will work together to coordinate how selected agencies can be best utilized to meet the needs of the participant based on family preference, caregiver availability, and staffing availability.
• The SC will discuss staffing with the participant, parent(s), and/or responsible party(ies) during each quarterly visit and as needed
• The SC should consider the need for authorizing PRN (as needed) hours to be used for the agencies to cover for one another.
• SC should outline the following information on the authorizations:
  • There are multiple agencies in the home
  • Services should be coordinated accordingly between agencies
  • PRN hours are authorized to be used to cover missed shifts
  • The total authorized hours should not be exceeded
  • Two or more nurses cannot be in the home providing services at the same time

Example Authorization

Agency 1 – PDN: 937 UNITS/MONTH FOR MONTHS WITH 30 DAYS & 966 UNITS/MONTH FOR MONTHS WITH 31 DAYS (BASED ON PDN: 50 HOURS/WEEK, PLUS 20 HOURS/MONTH PRN TO BE USED TO COVER MISSED SHIFTS BY SECOND AGENCY IN THE HOME, AS SCHEDULED BY THE PARTICIPANT/FAMILY). THE TOTAL AUTHORIZATION PROVIDED BETWEEN THE TWO AGENCIES SHOULD NOT EXCEED 112 HOURS/WEEK AND TWO OR MORE NURSES CANNOT BE IN THE HOME PROVIDING SERVICES AT THE SAME TIME.

Agency 2 – PDN: 1,143 UNITS/MONTH FOR MONTHS WITH 30 DAYS & 1,178 UNITS/MONTH FOR MONTHS WITH 31 DAYS (BASED ON PDN: 62 HOURS/WEEK, PLUS 20 HOURS/MONTH PRN TO BE USED TO COVER MISSED SHIFTS BY SECOND AGENCY IN THE HOME, AS SCHEDULED BY THE PARTICIPANT/FAMILY). THE TOTAL AUTHORIZATION PROVIDED BETWEEN THE TWO AGENCIES SHOULD NOT EXCEED 112 HOURS/WEEK AND TWO OR MORE NURSES CANNOT BE IN THE HOME PROVIDING SERVICES AT THE SAME TIME.