Updated Outcomes Knowledge Check #1

What outcome would you choose when a CM reports the CA used wrong authorization information?

CM reports that a member's health has declined since the CFER was completed (August 2, 2023). Member is now using O2 continuously since a hospitalization (August 15th) for COPD exacerbation. What is the outcome?

CM says "I was so impressed by the way Alvin was able to dress himself and use the bathroom independently. He said he feels much stronger but does not want his hours changed. I think it is best to leave them at 11 hours/week and not make any reductions. That would upset him." What is the outcome?

Member reported an increase in shoulder pain to CM 2 weeks ago. CFER was completed in June. Shoulder pain is limiting her ability to complete ADLs as independently causing the need for increased assistance with ADLs. Member did not seek follow up with PCP or MD. She has an annual physical in the middle to end of October and is going to bring it up then.  What is the outcome?

CM reports that member had a recent fall on August 31st, since the CFER was completed on July 18th, causing an injury to her left foot/ankle. Member is now unable to bear weight, requiring additional assistance from paid caregiver to assist with wheelchair ambulation and transfers. What is the outcome?

CM/SC reports time is being increased for self-feeding to better meet the member's needs. Based off of only this information, what is the outcome?

CA reduced time for meal prep, laundry, and housework based on the member's report of spouse receiving LTSS services as well. Current documentation does not indicate a companion case. CM confirms the member's husband is not a UHC member. Member continues to require the same level of assistance with IADL tasks. What is the outcome?

CM confirms that member's natural support is willing and able to assist with IADL tasks outside of paid caregiver hours. CM is requesting an increase in time to provide additional support with IADL tasks.  What is the outcome?

Member reported independence with transfers when completing CFER. When CM completed in-person FA, she observed the member nearly fall when standing up from his chair. CM recommends authorized time for transfers for supervision for safety. CFER recommended removing authorized time for transfers due to members reported level of independence. What is the outcome?

Member had a seizure 1 week ago. Since the seizure, member has increased confusion and decline in cognitive function. Member is now requiring increased prompting and cueing with ADL tasks. PCP is not aware of seizure. Family will follow up at next appointment scheduled in one month. What is the outcome?

CA recommended timed audio reminders for medication to increase independence for a member diagnosed with mild-moderate Dementia. CFER acknowledges the member's cognition has declined over the last 6 months and is no longer aware of time. Time was reduced by 30 min/wk. CM/family member declined the EA as it is inappropriate for the member.  What is the outcome?

Member's previous FA indicates daily migraines with visual disturbances and dizziness causing a safety concern for member. Member has a history of falls due to black spots and visual auras with migraines. CFER did not acknowledge this diagnosis or impact when making recommendations. CM reports that the member continues to have daily migraines and frequent falls due to dizziness from migraines. What is the outcome?

CFER indicates that the member has had increased pain in left knee that occasional makes ambulation difficult. CA made a recommendation to change level of assist from level 2 to level 1 for standby assistance for safety. CM reports in CC that the member has increased pain in left knee and member needs hands on assistance for ambulation. What is the outcome?

CM comes to case consult requesting 10 hours/week. CB recommended 6 hours/week. Member previously received 12 hours/week. CM and CB align at 10 hours/week. What is the outcome?

Member previously received 15.5 hours/week of paid caregiver services. CFER recommended a change to 10 hours/week. CM comes to case consult requesting to remain the same at 15.5 hours/week. After discussing the FA/CFER findings, CM agrees to the CB recommendation of 10 hours/week. What is the outcome?