Clinical eligibility is the first step for Choices for Care (CFC) eligibility when a person applies for services. The time in which clinical (and financial) eligibility is determined can have a direct effect on a person’s access to services. Currently CFC regulations require that clinical eligibility be determined within 30-days of receiving the person’s CFC application.

Factors that typically affect the time-frame for processing clinical eligibility include: 1) timeframe for receiving the CFC application from the Department of Vermont Health Access, 2) scheduling with the individual to conduct a clinical assessment, and 3) potential delays in the receipt of verification of clinical information from other healthcare professionals.

•  The Choices for Care applicant

•  Adult Services Division (ASD) clinical and supervisory staff

•  Department of Vermont Health Access (DVHA) Benefits Program Specialists

•  Area Agency on Aging and Home Health Agency Case Management staff

•  Other healthcare professionals involved in the clinical eligibility

Timely communication between DVHA and ASD LTCCC staff effects the ability of the LTCCCs to initiate the eligibility process. LTCCC staff and supervisors use the SAMS database to track workload by region to provide real time information on volume of applications.  This helps the supervisor and LTCCC staff mobilize staff to support areas of the state with greatest need.

•  December 2017, ASD initiated a quality improvement project to identify potential areas of improvement to decrease the total time required to complete the clinical eligibility process.

•  DVHA Benefits Specialists utilize the OnBase system to track workflow.  ASD staff and DVHA staff are developing a process which will allow ASD staff to utilize the same system to ensure consistency and efficiency of communication.

•  The LTCCC supervisor and program manager continue utilizing SAMS database to monitor workflow.

•  Use temporary staff to support high volume geographic areas.

•  Increase process efficiencies through the increased use of the SAMS database for assessments, care plans and approvals. This includes requiring 100% participation by CFC case management and home health agencies.