Managed Care

What is Managed Care? 

Any arrangement for health care in which an organization, such as a Health Maintenance Organization (HMO), another type of doctor-hospital network, or an insurance company, acts as intermediary between the person seeking care and the physician/facility administering the care.

After a hospital stay, you may be told you need post-acute care before returning home. Depending on the level of care you need, you may qualify for a skilled nursing and rehabilitation stay within a skilled nursing facility.

Need more information on the Managed Care programs in your State? View the available programs by state on Medicaid.gov. 

 

During Your Stay in a Skilled Nursing Center

At time of Admission:
Once your insurance company has agreed to the admission,  you will arrive at the facility and be greeted by our Admissions team who will complete your admission agreement (please bring a copy of your insurance card). Admissions will also provided you with a list of contacts at the facility who can assist with answering questions for you and/or your representative.

• Case Manager - Assists with questions related to your insurance and coverage
• Business Office Manager - Assists with questions regarding billing and financial liability
• Social Worker - Assists with transition planning, community resources and coordinating care conferences
• Director of Nursing - Provides information on medical needs and plan of care
• Director of Rehab - Provides information on therapy needs and plan of care

 

Within 24 Hours of Admission:
Once you are admitted to the center, you will be assessed by nursing and therapy to set a plan of care to meet your goals for recovery. Therapy will set up a schedule for you and physical, occupational and speech therapy services as prescribed.

 

Within 72 hours of Admission:
Social services will meet with you and your representative to discuss your discharge goals, barriers to discharge and/or concerns you may have regarding your discharge plan. You will also be given a targeted discharge date which is coordinated with your physician, care team and managed care organization. On average, patients admitted for Short-Term Rehabilitation services remain in the facility 15-20 days based on your treatment plan, progress and medical needs.

If for some reason your targeted discharge date needs to be changed, social services will notify you and your representative.

 

Weekly:
The center's interdisciplinary team which may include therapy, nursing, social services, business office and case management will meet to discuss how you are progressing towards you transition goals. A team member will share the updates with you and your managed care plan.

Why do we share your progress with the managed care plan?
The facility Case Manager (CM) works closely with your managed care plan on your discharge goals. The CM provides on average weekly updates on your progress to ensure the services you are receiving are covered and meet the plans criteria and guidelines for skilled services.

 

When it's Time to Return Home or Transition to Next Level of Care:
When you have met your post-acute (skilled nursing facility) goals, social services will set up any home care services or equipment you might need at home. You will also receive a discharge summary with instructions. For Medicare Advantage members, you will receive a Notice of Medicare Non-coverage (NOMNC) 48 hours prior to discharge. Issuance of a NOMNC is a Centers for Medicare and Medicaid (CMS) requirement for Medicare patients and allows you to appeal if you do not agree with the discharge. 

 

About Heartland Health Care Centers and ManorCare Health Services:
ManorCare Health Services and Heartland Health Care Centers are pleased to be your choice for  your post-hospital skilled nursing and rehabilitation services. We have a track record of returning patients home. For more information, please contact a location near you.