When it’s necessary to make an addendum

The Life Plan is a living document subject to continuous updating and monitoring by the Care Manager. Sometimes, changes occur outside the annual or semi-annual review meeting. When changes occur, the Care Manager must ensure the Life Plan is revised; however, not all changes require an addendum.

Updates requiring an addendum

• Changes to the Member’s services, including starting or ending a service, increase or decrease in units, and changing Providers
• SART service requests
• Changes or errors which impact the Provider’s ability to bill
• Sentinel events such as:
  • Major medical events
  • Accidents or events resulting in significant personal injury
  • Significant changes or improvement in behavior or physical functioning
  • Major psychiatric event or decompensation resulting in extended inpatient psychiatric evaluation
• Changes requiring updates to the Member’s safeguards, such as changes in medication administration, supervision levels, or support services following hospitalization discharge or other sites of care change
• Telehealth preferences for CCO and HCBS waiver services 
• Requests for fewer face-to-face visits for Tier 4 Members
• Member, family, or representative requests to add or change information in the Life Plan

Other updates that can wait until the next review meeting

• Changes to health and safety that are not a sentinel event as described above
• Changes to medical or healthcare Providers
• Non-goal-related activities or changes that do not impact billing