Level of Care Reference Guide

Level of Care Reference Guide
The following guide applies to Tufts Health Plan Senior Care Options Skilled Nursing Facilities.
LEVEL OF CARE
FACILITY RESPONSIBILITIES
Short Term Stays and Discharges
NOTES
SEND INFORMATION TO:
Tufts Health Plan Inpatient
Admissions Management team:
Fax: 800-843-3553
Less than two months
Submit Inpatient Notification to Tufts Health Plan SCO
Greater than two full months
but less than six months
1. Submit Status Change Form (SC-1) to MassHealth
Enrollment Center. Fax a copy to Tufts Health Plan
SCO.
2. Submit MMQ electronically through MassHealth
Enrollment system. Fax a copy to Tufts Health Plan
SCO.
3. Submit MDS 3.0 to Tufts Health Plan SCO Clinical
Coordinator.
 “SCO Member” must be clearly written on the SC-1
form
 SC-1 form should indicate that the admission is short
term
 Ensure that the appropriate boxes are checked
 A physician’s signature is required
Submit Status Change Form (SC-1) to MassHealth
Enrollment Center. Fax a copy to Tufts Health Plan SCO.
 “SCO Member” must be clearly written on the SC-1
form
 SC-1 form should indicate that the admission is short
term
 Ensure that the appropriate boxes are checked
 A physician’s signature is required
Greater than six months
1. Submit Inpatient Notification to Tufts Health Plan SCO.
2. Submit Status Change Form (SC-1) to MassHealth
Enrollment Center. Fax a copy to Tufts Health Plan
SCO.
3. Submit MDS 3.0 to Tufts Health Plan SCO Clinical
Coordinator.
 “SCO Member” must be clearly written on the SC-1
form.
 SC-1 form should indicate that the admission is long
term.
 Ensure that the appropriate boxes are checked.
If a short term stay becomes a
long term stay after three
months
1. Submit Inpatient Notification to Tufts Health Plan SCO.
2. Submit Status Change Form (SC-1) to MassHealth
Enrollment Center. Fax a copy to Tufts Health Plan
SCO.
3. Submit MMQ electronically through MassHealth
Enrollment system at the end of the third month.
 “SCO Member” must be clearly written on the SC-1
form.
 SC-1 form should indicate that the admission is long
term.
 Ensure that the appropriate boxes are checked.
 MMQ does not need to be submitted until the end of
the third calendar month.
Status Changes
1. Submit MMQ electronically through MassHealth
Enrollment system. Fax a copy to Tufts Health Plan
SCO.
2. Submit MDS 3.0 to Tufts Health Plan SCO Clinical
Coordinator.
Phone: 800-672.1515
Upon discharge of short term
stay greater than two months
but less than 6 months
MassHealth Enrollment Center
Fax: 617-889-3285
Tufts Health Plan SCO Fax:
617-673-0784
MassHealth Enrollment Center
Fax: 617-889-3285
Tufts Health Plan SCO Fax:
617- 673-0784
Long Term Stays
MassHealth Enrollment Center
Fax: 617-889-3285
Tufts Health Plan SCO Fax:
617-673-0784
MassHealth Enrollment Center
Fax: 617-889-3285
Tufts Health Plan SCO Fax:
617- 673-0784
MassHealth Enrollment Center
Fax: 617-889-3285
Tufts Health Plan SCO Fax:
617-673-0784
Provider Relations
Originated 11/2014
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Tufts Health Plan Senior Care Options Level of Care Reference Guide

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