Managed Care Option
Managed Care Option
What is the Managed Care option?
Managed Care is an option offered by Prairie Mountain Health (PMH) Home Care Program. It consists of two sub-options:
Self Managed Care enables clients with assessed Home Care needs to accept full responsibility for their personal care as Self Managers. Individuals who choose this option rather than receiving their services through the regular PMH Home Care Program are responsible for coordinating, managing, and directing the non-professional services they need to continue living at home and in the community.
Family Managed Care enables the families of clients with assessed Home Care needs to accept full responsibility for their family member as a Family Manager. The Family Manager who chooses this option for meeting their family member’s needs is responsible for coordinating, managing, and directing the non-professional services needed by their family member to continue living at home and in the community.
To be eligible for Home Care/Managed Care Individuals must:
- be a Manitoba resident
- registered with Manitoba Health
- require health services or assistance with the activities of daily living
- require service to remain safely in their homes
- require more assistance than is available from existing supports and community resources.
How Do I Apply For Managed Care?
To apply for Managed Care you or your family member need to be a client of PMH Home Care Program and be eligible to receive Home Care Attendant / Home Support Worker services. If you or your family member is already receiving services from PMH Home Care Program, contact your Home Care Case Coordinator to discuss your interest in Managed Care and whether Managed Care is an appropriate resource for you or your family member.
If you or your family member is not a client of PMH Home Care and would like to determine eligibility for PMH Home Care services including Managed Care; please call your local Home Care Case Coordinator.
Key Points about PMH Managed Care Option
- Self/Family Managers will receive funding to either purchase services or to employ staff following the completion of a formal assessment and a signed agreement with PMH.
- Self/Family Managers are expected to use those funds to employ staff, or an agency, to meet the assessed care needs.
- An assessment by a PMH Home Care Case Coordinator will determine the type, and amount, of service needed according to the standards applicable to the PMH Home Care Program. This assessment will determine the amount of funding received by the Self or Family Manager.
- A reassessment will be conducted on a regular basis by a PMH Home Care Case Coordinator; at the request of the client or family member; or when the level of assistance required by the client changes. This will enable adjustments to be made as the need for services increases or decreases.
- Clients in Managed Care remain eligible for Home Care’s professional services such as Nursing.
- In the event of a violation of the Managed Care agreement, the agreement with PMH may be terminated and alternate PMH Home Care services will be arranged dependent on eligibility.
- The responsibility of ensuring backup services will be the responsibility of the Self/Family Manager.
- The Self/Family Manager will arrange to meet the needs of the client in accordance with the PMH Managed Care agreement.
- All Self/Family Managers will be required to set up and maintain a separate bank account. This account is used solely for receiving and expending Self/Family Managed Care funds and will be subject to semi-annual reports and audit reviews by PMH.
- As per Manitoba Health, Seniors and Active Living policy, hiring of family members is not allowed except in unique circumstances and with the approval of PMH.
- As per Manitoba Health, Seniors and Active Living policy, a one year enrollment in Home Care may be required if there are concerns of care or client instability.
- As a Self/Family Manager you may choose to hire an agency to provide the funded home care services or you may choose to directly employ your own staff. If you choose to employ staff as a Self/Family Manager you take on full responsibilities as an employer including: Registering with Canada Revenue Agency, Employment Insurance, Workers Compensation, making required payroll deductions etc. A payroll company may be hired to assist with these employer obligations. Alternatively, you may choose to engage a personal care agency to provide the care.