Created in 2016, the Intensive Support Coordination (ISC) and Support Coordination (SC) Programs partner with the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) to provide additional support for Comprehensive (COMP) Supports Waiver and the New Options Waiver (NOW) participants.
As a provider, CareStar serves two (2) categories of individuals including the traditional Support Coordination (SC) group and the higher acuity, Intensive Support Coordination (ISC) group. CareStar’s role is to provide oversight for participants who are enrolled in the Programs. CareStar’s expert professionals assist waiver participants by identifying and addressing barriers and accessing needed resources and services offered through the waiver, as well as other community options, while maintaining family and other relationships and support. After Program enrollment, the Intensive Support Coordinator, serving as a Case Manager, works with the individual and other team members, to develop a Service Plan that will facilitate maintaining health and safety in the community.
Populations Served: The population served includes adults with developmental disabilities and complex medical or behavioral health needs.
Location: CareStar is a Statewide provider in this Program.
Application Process: To inquire about services or begin the enrollment process, contact one (1) of the six (6) DBHDD Regional Offices. For immediate assistance in managing a crisis, contact the Georgia Crisis and Access Line (GCAL).
Through the GA Department of Community Health, the Independent Care Waiver Program provides services to Medicaid members with a severe physical disability or a traumatic brain injury that assists these individuals to live in their home or community as an alternative to a hospital, nursing home or other facility setting. CareStar takes a person-centered approach to determine the individual’s needs and develop a care plan, which is then approved by the State. This Plan could include, but may not be limited to, service coordination, personal support, home health, emergency response, respite care, specialized medical equipment and supplies, counseling, and home modification.
Populations Served: Through the ICWP, CareStar serves individuals who are enrolled on a Medicaid health insurance plan and are between the ages of 21 and 64. Individuals with a severe physical disability must be able to manage their own services. Individuals with a severe physical disability or a traumatic brain injury must have a disability that substantially limits one or more Activity of Daily Living (ADL) requiring the assistance of another individual, be medically stable (but at risk of entering a hospital or nursing home without these services), and be safely placed in the community.
Location: CareStar is a Statewide ICWP Provider.
Application Process: To apply for services, contact the Georgia Medical Care Foundation (GMCF) at 678-527-3619 or 800-982-0411, ext. 3619. Callers will be asked a series of questions over the phone. Next, an application must be submitted, and an in-person assessment will be scheduled. Based on the results of the application and assessment, eligibility and approval for services will be determined. Then, the enrolled individual may select “CareStar of Georgia” from a list of Providers.
Population Health – Health Risk Assessments (HRA)
CareStar has partnered with Managed Care Plans to complete telephonic and in-person Health Risk Assessments, Health Needs Assessments and care planning for eligible members. CareStar completes the assessments to gather updated health history and to determine if there are any identified health or social service needs. Risks identified for the individual during the assessment are reported for additional care management follow-up. CareStar is committed to helping identify an individual’s needs and providing resources when necessary.
Population Served: Members of a managed care plan or other medical insurance provider.
Location: CareStar can perform these services where members reside or telephonically.
Multiple Sclerosis Society Case Management
Since 2016, CareStar has partnered with the National Multiple Sclerosis Society to provide Case Management and Assessment services to eligible individuals. The goal of the partnership is to help individuals living with and managing their Multiple Sclerosis, set goals for and receive appropriate care, support, and safety to improve their independence and quality of life. For each individual, CareStar will perform an initial assessment, develop a person-centered care plan, link the individual with caregivers and resources, and follow-up to ensure the plan is being executed and accomplished.
Populations Served: CareStar serves individuals of all ages, who have been diagnosed with Multiple Sclerosis and who the MS Society’s Case Management Program deem eligible.
Location: CareStar can perform services, both telephonically and in-person, across the United States.
Application Process: If you, or a family member, has been diagnosed with MS and believe could benefit from CareStar’s Case Management services, please contact an MS Navigator by calling 1-800-344-4867 and request to work with CareStar. If the Case Management Program eligibility and criteria has been met, the MS Society will refer the applicant to an authorized Case Management Agency (CMA). The CMA will contact the applicant to schedule and complete the assessment, develop goals, and develop a person-centered care plan.
Quality and Utilization Review
CareStar is proud to be Quality Improvement Organization-like (QIO-like) certified by the Centers for Medicare and Medicaid Services (CMS). As a leader in Case Management, Assessment, Technology and Software Development, CareStar uses this Certification to assist our customers with quality assurance, improved healthcare outcomes and reduced costs. Additionally, CareStar engages physicians in specialty areas including, but not limited to, Family Medicine, Cardiology, Pulmonology, Gastroenterology, Neurology, Vascular Surgery, Internal Medicine, and Cardiovascular and Thoracic Surgery, to expand our expertise and capabilities and ensure efficiency and accuracy of our QIO-like activities.
Administered by CMS, a QIO-like Organization is made up of a group of expert healthcare clinicians and professionals contracted to complete utilization reviews and analyze patterns of care related to medical necessity and quality review. State Medicaid Agencies and organizations contracting with CareStar for QIO-like services are eligible for an enhanced Federal match of funds up to 75 percent. The QIO-like Certification is one of CMS’s most significant programs to improve quality and efficiency of healthcare delivery. As of March 2020, CareStar is one of 76 organizations to hold this certification nationally.