A deeper understanding of Support Coordination
How each support coordinator helps each individual is specifically geared toward that person but there are guidelines in which each SC follows to deliver those services.
- Timing is everything! We have very specific guidelines with a timetable of how we do things set forth by the Division of Developmental Disabilities. When we are assigned an individual for Support Coordination we need to have an approved plan within 30 days. This takes considerable planning to reach out to individuals, families, providers to ensure that everyone is on the same page to create the best plan for each person. Once we have a plan developed, we monitor the effectiveness of the services implemented in the plan. We do this by phone calls monthly and visits quarterly. The SC visits the individual the month after the plan is implemented to ensure that what has been put into place is working or to make adjustments as needed. This gives the provider time to develop goals for the outcomes that the team has discussed and then these goals are discussed with the SC. Monthly after this the SC will make phone calls to the individual, provider or guardian to ensure there is progress toward these outcomes looking at the goals that the provider has developed, we can see if each individual is making progress or if things should change. When the SC reaches out to the guardians, it is helpful for the guardians to provide as much information as possible so we can anticipate needs, trends and successes.
- We monitor monthly and visit quarterly and families can join the SC on visits to the provider if they are interested and should plan this with their SC. At the quarterly visits the SC usually goes to the provider to get updates on goals, MD visits, trips, and any changes in medication. The more information we get from the guardian, the better we can serve you. This way we can bring information of changes at home that may have an impact on your loved one to the provider. While we need to make these visits and phone calls, we find that advanced planning helps. Below is a timeline of the typical course of the year.
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The SC may ask a battery of questions that may not seem relevant at the time but may be useful in preventing any lapses in service or correlate to something a provider many have mentioned. The support coordinators have been extensively trained to listen to these details and have helped prevent undesirable situations.
- There are many reason why we may need to know things. When the SC askes about when the Medicaid recertification is, they are asking to prevent a gap in Medicaid services. Previous to the Fee-for-Service world, if your Medicaid lapsed, it may not have been a big deal because all of the services that were not paid for through Medicaid dollars. Now, when Medicaid lapses, the individual may not be able to receive services as the providers may not get paid. When you get that Medicaid recertification letter, let your SC know. It is even helpful to get a copy of that letter as your recertification will usually be the same time annually so the SC can make note of it and remind you to complete it annually if you are the representative payee.
- If someone is living at home with their family, it is very important to inform the SC about emergency plans if something were to happen to a family member. Many people want to give this some thought and then do not want to revisit this however, we have worked diligently to help people get needed services after a crisis and would prefer to have a plan in place to turn a crisis into a seamless transition.
Differences between an IEP (Individualized Education Plan), IHP (Individualized Habilitation plan) and an ISP (Individualized Service Plan) meeting.
- All of these plans put the individual at the center of planning, review effectiveness of current services and outline services going forward. While the IEP and IHP have the goals incorporated into the plan, the ISP does not have an area to do this but rather, it leaves it up to the providers to develop the goals based on the outcomes (the end result that we want to achieve) We have found that getting these goals after the provider has had time to trial them for each individual is crucial to our oversight and we have started to add these goals in general terms to the ISP for an easy reference and better planning.
- Additionally the Boggs Center has a website where families can add information to better help SC’s obtain the information they need. We encourage all families to sign up for this website, create a profile and share it with your support coordinator.
- The link to this site is: http://njsupportingcommunitylives.org/people-and-families/portfolio/ this site is a wealth of information and has been very beneficial to families in tandem with support coordination services.
- While the IEP and IHP meeting would occur every year on the annual date, the ISP meeting (as you can see from the chart above) should occur 3 months before the annual due date. This will give the team time to meet, discuss action plans and changes going forward and review what is working and what may not be working. The SC also gets updates like medication changes, new doctor’s or a change in insurance information. The team reviews the PCPT, the most recent ISP, any professional evaluations and assessments, Tier/level of care, discussion of current status, preference, needs and vision of future and annual medical appointments, progression of outcomes/goals and discussion of actions needed and review of Medicaid and redetermination, changes in services or providers are also reviewed. Then 2 months before the annual due date the new plan is generated with the changes incorporated and sent to the individual/guardian to review and sign. The signed ISP is then uploaded to the DDD’s electronic database called the irecord and approved by the Support Coordination Supervisor. Once this approval occurs, an authorization to bill is generated for all of the service providers in the plan which makes it crucial to get the plans approved at least 30 days before the actual annual date to prevent a lapse in service. The same rich descriptive information that is in the IEP and IHP is in the ISP and PCPT but the information in the NJCAT (New Jersey Comprehensive Assessment Tool) is the driving force as this is the basis for the individual’s budget. If there are discrepancies from the current overall functioning to what the NJCAT says, a reassessment can be requested
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We have recently sent out a letter asking for your feedback on our services. It is very important to us to do the best we can for you so please complete it and return it to us at your earliest convenience.
It is an honor and privilege to provide these services and thank you for choosing Spectrum CMC as your Support Coordination agency.
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The Murphy Administration has created
www.GetCovered.NJ.gov
to serve as a portal for individuals seeking health coverage. The site includes information about plan options, financial assistance and contact information for New Jerseyans who want help to get covered. Please take a moment to explore the options available and encourage your friends and neighbors to do the same.
As part of this effort, the Department of Human Services is also working with five community organizations to support enrollment efforts. These organizations are providing application assistance and organizing outreach events. Let them know if you need help enrolling. The organizations are:
- The Center for Family Services (1-877-922-2377)
- The Family Resource Network (1-800-355-0271)
- The Oranges ACA Navigator Project (1-973-500-6031)
- Fulfill Monmouth & Ocean (1-732-918-2600 or 1-732-731-1400)
- Urban League of Hudson County (1-201-451-8888, ext. 217)
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Promotion at Spectrum Care Management & Counseling
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You may remember from an earlier newsletter being introduced to Corrinne. Corinne has been a Support Coordinator with Spectrum CMC for several years and recently has been promoted to Support Coordinator Supervisor. Corrinne will be Supervising South Jersey Support Coordinators and their families.
Congratulations Corrinne!
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