When should I make a referral to Medical Assistance Personal Care (MAPC)?

First…

  • Is the person funded by Dane County Adult Community Services and receiving services from a Residential Agency or Adult Family Home?
  • Do they have Medicaid (or can become eligible for Medicaid)?

Second…

  • Do they need assistance with at least one hour of personal care every day (must be in their primary residence)?
  • Has their health or physical situation recently changed that is expected to last over 6 months (temporary change less than 6 months will not be authorized)?
  • Have you seen a change in level of care as assessed on the Wisconsin Long-Term Care Functional Screen completed by the Broker (0 will not allocate Personal Care time.)?
  • Does the client need hands-on assistance in any of these Activities of Daily Living (ADL)? (Typically, if the person needs assistance with their bathing and at least 1 other ADL below, they may qualify for at least one hour of Personal Care per day.)
    • Assistance with getting in/out of bed.
    • Assistance with using the bathroom (use and care of bedpan, urinal, commode, toilet).
    • Assistance with bathing, skin care, hair care.
    • Assistance with oral hygiene (teeth, mouth, denture).
    • Assistance with dressing and undressing.
    • Care of eyeglasses, hearing aids.
    • Assistance with mobility and ambulation (use of walker, cane, crutches).
    • Assistance with transfers.
    • Assistance with light housekeeping.
    • Meal preparation, grocery shopping, meal serving and assistance with feeding.
    • Accompanying member to medical appointments to assist member with ADLs listed above or delegated nursing task listed below.
  • Does the client need hands-on assistance in any of these “medically oriented” tasks?:
    • Seizure interventions.
    • Range-of-Motion exercises (ROM)
    • G-tube site care, set up feedings, pump usage (gravity or push).
    • Complex transfers specific to individual.
    • Catheter site care (SupraPubic, Foley).
    • Ostomy/stoma care (urostomy, colostomy, trach care).
    • Intermittent catheterization, urethral or Mitrophanoff catheterization (opening in abdomen), condom catheter.
    • Bowel programs, suppositories, enemas, digital stimulation.
    • Complex positioning.
    • Oral suctioning.
    • Hooking up BiPap, CPap or VPap, Inexsufflators (stimulates cough).

If yes to any of the above…

Please contact Kate Coerper in the Community Living Alliance Intake Department at (608) 242-8335 ext. 3361. Kate will gather demographic and other information with you over the phone to get the assessment and enrollment process started. You may also send the Intake form to Kate via e-mail at .

Then what happens…

  • Complete the application form and send it electronically to our Intake Coordinator, Kate Coerper. You can also call Kate directly with the information requested and she will complete the form over the telephone.
  • Kate Coerper sends the referral to CLA’s Registered Nurse—(608) 242-8335 x 3211 who will do a preliminary review and set up the individual’s chart. The current Lead RN is Joy Scadden who will assign the client to one of our Personal Care Coordinators (Registered Nurse).
  • The Personal Care Coordinator (PCC) will perform a nursing assessment, including medical information, and complete the Personal Care Screening Tool (PCST). They will contact the broker to collaborate with their Functional Screen.
  • If the individual has a “permanent” (6 months or longer) change in condition, the Broker must update the Functional Screen prior to the referral to determine level of care. No changes can be made for temporary increase in personal care needs.
  • Time-frame: Within 2-3 weeks, the PCC at Community Living Alliance will complete the PCST in the Forward Health Portal, and that determines the number of hours the individual is eligible for personal care. We can begin billing the personal care hours once the PCC makes a home visit with a qualified worker, and the staff are trained by the agency in the personal care needs of that consumer.
  • Whenever a Functional Screen is completed by the Broker or Personal Care Screening Tool is completed by the Personal Care Coordinator (RN), a contact must be made to the other for updated information.
  • Whenever there is a change in Residential agency or Broker, please notify the PCC.
  • Anytime someone is dis-enrolled from your services (moves to another county, death), please notify the PCC so the Prior Authorization can be stopped.