Frequently Asked Questions

 

Question: How do I get on the program?
Answer: Just call your local Options office (1-866-247-6784) and one of our support specialists will gladly walk you entirely through the process.

 

Question: How long is the process to get on the program?
Answer: From the time you contact us and records indicate you qualify for the Program; our goal is to complete the entire process in less than 30 days. The initial steps are based on the timeliness of getting you in to see your doctor and getting your enrollment forms completed. Once all steps are completed, a Third Party Assessor (Molina) will assess your needs and place you on the program and you will start receiving services. Clients will remain with Molina for 45-days at minimum. During this time you will select a Managed Care Organization (MCO), United Healthcare or AMERIGROUP Community Care of New Mexico who will reassess your needs, which can take 2-3 weeks depending on the MCO's backlog.

 

Question: How can I make contact with my Managed Care Organization (MCO) Service Coordinator?
Answer: Contact your local Options office (1-866-247-6784) and we will provide you with the phone number or assist you in contacting your MCO Service Coordinator.

 

Question: How does Options screen your Caregivers?
Answer: When an applicant comes into our Options office or calls to seek employment, an initial prescreen is conducted to identify applicants that are a good fit for our organization. Questions are based on current regulations, as well as an overall general assessment to gain a better understanding of the applicant and their aptitude for being a great Caregiver. In some instances, when specific Clients are looking for a Caregiver, a series of questions are asked based on the Clients' needs to identify a good fit for the Client. On completion of new hire orientation, all applicants complete the New Mexico Department of Health's Caregiver Criminal History Screening background check to ensure the applicant doesn't have a criminal history that would pose a risk to a Client.

 

Question: Can a relative be my Caregiver?
Answer: Yes, relatives can become a Caregiver, as long as the relative is not the Client's spouse and assuming successful completion of the Caregiver Criminal History Screening and Caregiver New Hire Orientation.

 

Question: What is the difference between directed and delegated care?
Answer: The main difference between directed and delegated care is that within delegated care the Client "delegates" all employer-type responsibilities to the company. In other words, the company is responsible for tasks such as interviewing, hiring, training, disciplining and terminating employees. For the directed model the Client chooses to be responsible for all employer-type responsibilities, to include finding their own primary and back-up Caregivers. This model is only recommended for Clients that can totally accomplish these tasks, make and execute these decisions and take control of their own care.

 

Question: Why was I enrolled in the Delegated Model when I asked to be in the Directed Model?
Answer: The reason you were enrolled in the Delegated Model may be that your Managed Care Organization (MCO) Service Coordinator deemed you unable to guide your own care; the MCO inadvertently documented the wrong model of care; or a mistake was made and you accidentally elected a model other than the one you intended during the visit with your MCO Service Coordinator. When you believe that you are in the wrong model, simply contact us (1-866-247-6784) and we will assist you in explaining the programs and help you change to the right model.

 

Question: Can I appeal my assessment?
Answer: Yes, you can appeal your assessment and hours determination that you received from your Managed Care Organization (MCO), United Healthcare or AMERIGROUP Community Care of New Mexico by calling the numbers below. When you need assistance in this regard, your local Options office (1-866-24-7-Options [1-866-247-6784]) is glad to help you. United Healthcare Appeals – 877-835-9855 AMERIGROUP Appeals – 800-600-4441

 

Question: Can someone from Options sit in with me during an appeal/fair hearing?
Answer: Yes, on request, an Options representative will attend your appeal/fair hearing with you.

 

Question: Why can't my respite hours be completed by my primary Caregiver?
Answer: Per state of New Mexico Health & Human Services standards, respite hours are authorized solely to provide relief to the primary Caregiver, therefore only a backup or secondary Caregiver is authorized to provide respite care.

 

Question: Why did I get my hours cut?
Answer: Hours are cut due to a reassessment in the home by the Client's assigned Managed Care Organization (MCO), United Healthcare and AMERIGROUP Community Care of New Mexico. When the MCO determines the needs of the Client have changed and they therefore need less care, hours are reduced. One reason that MCOs reduce hours is due to more relatives living in or near the Client's home, which is considered natural support for the Client. Options does not control the number of Caregiver hours that Clients are authorized to receive.

 

Question: Why can't my Caregiver drive me to doctor appointments?
Answer: Caregivers cannot drive to doctor appointments because the state of New Mexico has allocated resources through the Managed Care Organizations (MCOs), United Healthcare and AMERIGROUP Community Care of New Mexico to provide transportation for Clients at no cost to them for travel to and from any medical appointments. To arrange transportation to a doctor appointment or for a medical procedure, contact your MCO at: United Transportation Services - 866-913-2492 AMERIGROUP Transportation Services - 866-442-4937

 

Question: Why can't my Caregiver stay at the appointment to get the information for my care?
Answer: Your Caregiver cannot be paid for staying with you during doctor's appointments because there are qualified medical providers at your doctor's office providing for your care and therefore the Medicaid PCO program will not pay two people to provide care to you at the same time.

 

Question: Can someone sit with my Mom overnight?
Answer: Unfortunately, State of New Mexico, Personal Care Option (PCO) regulations prohibit overnight stays by Caregivers.

 

Question: Do Caregivers get paid for mileage to compensate for the use of their personal vehicle to get to and from the Client's home and for errands?
Answer: Unfortunately, no. Mileage reimbursement for driving to and from the Client's home is not anticipated. A Mileage Reimbursement Proposal has been submitted that would pay Caregivers for the use of their personal vehicle for Client-related errands, however funding of that proposal is not available at this time.

 

Question: When do I (Caregiver) get paid?
Answer: When we receive your timely, accurate and compliant Time Sheet on Monday, you get paid the following Monday.

 

Question: Why do Caregivers get signed up for Back-Up Rate only to later have it reduced?
Answer: The Back/Up rate is for Caregivers that are just filling in a shift that can't be covered by the regular Caregiver. When a Back-up Caregiver works two consecutive weeks with the same client).

 

Question: What is the number to Options Corporate office?
Answer: 1-800-463-7704

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