Service Options Using Resources in a Community Environment (SOURCE) is a State Plan enhanced primary care case management program that serves frail elderly and disabled beneficiaries to improve the health outcomes of persons with chronic health conditions, by linking primary medical care with home and community-based services. The program builds on the state’s primary care case management program, Georgia Better Health Care Program (GBHC). The Division of Medical Assistance in the Department of Community Health administers SOURCE to approximately 6,900 elderly and disabled beneficiaries statewide.
SOURCE Offices - Updated 01/30/2012
SOURCE Fact Sheet - Updated 01/10/12
SOURCE integrates primary medical care with supportive services through case managers who work with the member and their primary care physicians (PCP). Beneficiaries who meet eligibility criteria enroll with a SOURCE site as their primary care provider who coordinates all medical and social services. The program was established to:
- Integrate primary care, specialty care and home based care to eliminate fragmentation;
- Reduce emergency room use, hospital and nursing home admissions caused by preventable medical complications;
- Stabilize social and lifestyle factors that affect compliance, health status and quality of life;
- Insure that current gaps in Medicaid benefits for medical and supported living services are addressed so they do not negatively affect health outcomes and cost; and
- Reduce the need for long-term institutional placement.
Upon enrollment, the case manager completes an assessment during a home visit and prior to the appointment with their disciplinary team. The case manager works closely with the member’s PCP and his/her medical director to coordinate care. The assessment provides more extensive information to the physician about the beneficiary’s social history, home environment and functional status than would be obtained during an initial visit. Case managers contact participants at least once a month and make home visits at least once every quarter. Care path protocols are completed at each quarterly home visit.
Based on assessment information, participants are assigned one of the three levels of care that meet the state’s nursing home level of care criteria. Levels one and two include people with substantial cognitive and/or physical impairments and individuals who are deemed Level three have at least one chronic condition and a need for medical monitoring, but less functional impairment. To address risk factors related to functional capacity and the progression of chronic conditions, care paths have been developed and implemented for each level.
Care paths are sets of standardized outcomes for each level of care, with customized plans for each person to achieve those outcomes. Replacing traditional HCBS care plans, care paths provide a case management structure that regularly measures the achievement of targeted key outcomes for individuals enrolled. Based on functional ability not diagnosis, care paths cover areas such as: keeping medical appointments, service provider performance, skin care, medication compliance, transfers, informal supports, nutrition/weight, key clinical indicators, ADLs/IADLs and problem behavior.
SOURCE contractors receive a flat per member per month case management fee billed on the CMS 1500.
If you are interested in enrolling to become an Enhanced Primary Care Case Management provider, you must complete the Medicaid enrollment application located at the GHP Portal. Completed applications should be mailed to Department of Community Health, Aging and Community Services Unit, 2 Peachtree Street NW, 37th Floor, Atlanta GA 30303.
Upon review of your application and determination of eligibility, if you have met the program requirements, information for completing a readiness review of your organization will be sent to you. Please allow 30 days for the enrollment process and readiness review to be completed.
See attached enrollment criteria for additional information or call (404) 463-6570.