Plan of Care

• HCBS Plan of care Prior Authorization user Manual

• Plan of Care Example-Screen prints of actual screen you will see when entering a Plan of Care with steps to complete and reminders.
  Plan of Care Example

Plan of Care Questions

What is a plan of care?
A plan of care is a document completed following the determination of eligibility for one of the many Home and Community Based Service (HCBS) programs. This document is subject to approval by the administrator of the HCBS Program. The plan of care must contain the following information:

• the services to be provided

• the frequency of each service

• who will provide each service

• the cost of each service

• The Area Agency on Aging creates plans of care for the frail elderly (FE) waiver.

• Community Developmental Disability Organizations (CDDOs) submit plans of care for the mental retardation/developmental disabilities (MRDD) waiver in most areas.

• Beneficiary caseworkers submit plans of care for the physically disabled (PD) waiver.

• Autism Specialist’s submit plans of care for the Autism Waiver.

What is my username and password to access Plans of Care?
The Username will initially be given to you and a password to access the first time. When you log in you will be able to change your password but your username will stay the same. This is a separate password than you use to access billing.

Does it matter which two services the family chooses to access each month?
No, there are a variety of combinations that could be arranged. They could access Autism Specialist and IIS, or Autism Specialist and Parent Support & Training, or Autism Specialist and Respite, etc.

Plan of Care Examples
Initial Plan of Care-need to access a total of two services
*Remember that Autism Specialist is not entered into the Plan of Care

If the child is approved on August 1st then the Plan of Care could look like this:
IIS worker (H2019) August 1-December 31 433 units
Respite (T1005) August 1-December 31 134 units

All services run on a calendar year so the second plan would start January 1 and run through December 31st.

You can also enter the exact number of hours used each month on the 1st day of the following month:

In August they used 400 units of IIS and 60 units of Respite.
So on September 1st you can enter August 1-August 31 400 IIS worker units and 60 Repsite units.

Make sure the Plan of Care is accurate and make sure not to deduct hours if you go in and Review a claim. Remember that units are entered per month not the entire time frame (months). If entered incorrectly it could allow you to over bill for hours and then they would be recouped.