Programs Assist Clients in Determining Eligibility to Receive Services

By Diane Lee, Public Information Officer, Garrett County Health Department

Two programs which have been available through the Garrett County Health Department for many years have been paired together under a new director, making it easier to access both programs. Adult Evaluation and Review Services (AERS) and the Administrative Care Coordination Unit (ACCU) are now being managed by Tiffany Fratz. 

Services from AERS consists of a licensed nurse or Social Worker performing an in-home assessment for older adults or functionally disabled adults and children.  The assessment determines the level of service eligibility.  The assessor will develop a plan of care with recommendations based on an individual’s need that will enable that person to live in the community.  

There are different types of evaluations which include:

• Home and Community-based Services (HCBS):  Evaluations for community Medicaid recipients who are seeking Home and Community-based services. Individuals must be Medicaid eligible, and they must meet medical criteria for care that is determined through the assessment process.
• Pre-Admission Screening and Resident Review (PASRR):  Requires that all applicants to Medicaid-certified Nursing Facilities be given an assessment to determine whether they might have mental illness or intellectual disability.  Individuals who test positive at a Level 1 screening are then evaluated through a Level II Pre-Admission Screening and Resident Review.  The results of this evaluation determine the need, appropriate setting, and recommendations for services.  This screening is for individuals with intellectual or mental disabilities that require long term care placement.
• Senior Care:  Aged/Disabled adults at risk for nursing facility placement who wish to remain living in their homes/community that do not have full Community Medical Assistance benefit.  Individuals who do not receive Medicaid benefits and meet financial and medical eligibility criteria may be eligible for services based on the assessment recommendations.

The first step to receiving an in-home or in the community evaluation is to call Maryland Access Point (MAP) at 301-334-9431.  Maryland Access Point is a “one-stop” information service that provides individuals with a single point-of-entry to accessing resources that promote lifelong independence. For questions directly related to the AERS program call 301-334-7740.

In early March of this year, the Administrative Care Coordination Unit (ACCU) moved to the AERS Department.  ACCU serves as a local resource for all Maryland HealthChoice (MHC) members.  MHC is a healthcare organization that provides services to Medicaid recipients by contracting with a network of licensed/certified healthcare providers. ACCU can help members with the following:

• Understanding your HealthChoice benefits and how to access the services.
• Explain your provider choices and how to change providers.
• Help you find a healthcare provider or specialist in your network.
• Help you find a dentist.
• Link to Medicaid transportation services.
• Assist with getting your prescriptions filled.
• Assist with the benefit renewal process through the Maryland Health Connection.
• Help keep your information updated and obtain a new Medicaid card if your card is lost or stolen.
• Assist resolving billing issues.
• Explain your appeal and grievance rights.

HealthChoice is Maryland’s Medicaid managed care program.  Most people who qualify for Medicaid are required to enroll in a Managed Care Organization (MCO). A MCO is a group of doctors, clinics, and other health care providers who work together to take care of HealthChoice members’ health care needs.

MCOs are responsible for providing most of your health care services including most pharmacy services.  Some services, such as mental health and substance use disorder services, and certain drugs are covered by the State and not your MCO.

ACCU has a local Ombudsman, an advocate for your health care needs, who can work with you when there is a medical issue involving care coordination with the MCO.  

In addition to Fratz as the Director, the AERS Department is staffed by nurses Martha Layton, Kay Perry, and Judy Sines, and office secretary, Elaine Stemple. For more information, please call 301-334-7740 Monday through Friday from 8 a.m. to 4:30 p.m.

Cutline: At the Garrett County Health Department, Adult Evaluation and Review Services (AERS) and the Administrative Care Coordination Unit (ACCU) combine to assist clients in determining eligibility for various services and help them navigate Medicaid’s Managed Care Organization. Pictured above are staff members, Layton, Perry, Fratz, Sines, and Stemple.