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Care Management

Your LTC care manager will help you get the care you need and work with you to develop a person-centered care plan to achieve your unique health goals.

Your plan of care is the document that tells you all about the services you get from our LTC program. Your care manager will talk to you and any family members or caregivers you want to include to decide which LTC services will help. They will use the initial assessment and other information to make a plan that is just for you. Your plan of care will tell you:

  • What services you are getting
  • Who is providing your service (your service providers)
  • How often you get a service
  • When a service starts and when it ends (if it has an end date)
  • What your services are trying to help you do. For example, if you need help doing small chores around your house, your plan of care will tell you that an adult companion care provider comes two days a week to help with your chores.
  • How your LTC services work with other services you get from outside our Plan, such as from Medicare, your church or other federal programs
  • Your personal goals

We don’t just want to make sure that you are living safely. We also want to make sure that you are happy and feel connected to your community and other people. When your case manager is making your plan of care, they will ask you about any personal goals you might have. These can be anything, really, but we want to make sure that your LTC services help you accomplish your goals. Some examples of personal goals include:

  • Walking for 10 minutes every day
  • Calling a loved one once a week
  • Going to the senior center once a week
  • Moving from a nursing facility to an assisted living facility

You or your authorized representative (someone you trust who is allowed to talk with us about your care) must sign your plan of care. This is how you show you agree with the Plan and the services we decided.

Your care manager will send your PCP a copy of your plan of care. They will also share it with your other healthcare providers.

Updating your Plan of Care

Every month your care manager will call you to see how your services are going and how you are doing. If any changes are made, she or he will update your plan of care and get you a new copy.

Your care manager will come to see you in person to review your plan of care every three months. This is a good time to talk with them about your services, what is working and isn’t working for you, and how your goals are going. They will update your plan of care with any changes. Every time your plan of care changes, you or your authorized representative must sign it.

Remember, you can call your care manager any time to talk about problems you have, changes in your life, or other things. Your care manager is available to you when you need them.

Your Back-Up Plan

Your care manager will help you make a back-up plan. A back-up plan tells you what to do if a service provider does not show up to give a service. For example, your home health aide did not come to give you a bath.

Remember, if you have any problems getting your services, call your care manager.

Private Duty Nursing (PDN) Real-Time Reporting Process

We want to ensure that your child is receiving the services required to keep them safe in your home. Please contact Sunshine Health right away when a Private Duty Nursing shift is missed. Here are a couple ways to reach us:

  1. Contact your child’s Care Manager
    If you don’t know who your child’s care manager is, call Member Services at 1-866-796-0530 (TTY 1-800-955-8770).
  2. Contact your child’s Care Manager’s supervisor
    If you don’t know who your child’s care manager’s supervisor is, call Member Services at 1-866-796-0530 (TTY 1-800-955-8770).
  3. Call the 24-hour Sunshine Health Nurse Advice Line
    1-866-796-0530 (TTY 1-800-955-8770)
    • Press 1 for Member
    • Press 2 for LTC or 3 for MMA
    • Press 5 for Nurse Advice Line
  4. Email Sunshine Health
    • Include your child’s name, Medicaid ID number and home health provider, the date and time of the shift missed, and your contact information.

When we are notified of a missed shift, your child’s Care Manager will:

  • Contact your child’s home health agency to identify the issue with coverage.
  • Work with the home health agency to ensure services will occur as authorized.
  • Help with finding another home health agency who can provide care to your child.  

Please contact your child’s Care Manager if you have any questions or concerns.