The Essentials of Health Home Care Management Agency Administrative Responsibilities. HHUNY Webinar November 20, 1013

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1 The Essentials of Health Home Care Management Agency Administrative Responsibilities HHUNY Webinar November 20, 1013

2 Topics Management of Capacity Tracking File Submissions CMART File Submission Health Information Technology Requirement Billing Education and Training 2

3 Management of Capacity Once there is an executed contract, along with an identified capacity, it is time to begin providing care management services for HHUNY. Converting Targeted Case Management providers (TCM) need to make sure that all TCM members are enrolled in the Health Home. Care Management Agencies (CMAs) receive names of potential HH members either through a DOH assignment sent via an Excel Spreadsheet or a community referral that are sent via secure . Timely follow up on these referrals is critical to our success. It is expected that you will begin outreach within the time frames specified in the HHUNY Care Management Standards. 3

4 Management of Capacity Verifying Medicaid eligibility via epaces is also critical If epaces indicates that a referred member has NO active Medicaid: Check epaces for a few weeks to determine if Medicaid is reinstated If possible provide outreach and assist individual in recertifying if necessary Names may be returned to Chris Mangione, indicating the lack of active Medicaid and noting any actions taken to outreach and assist If the CMA agency is not able to manage all of the referrals you receive, please contact Chris Mangione ( ) so that other arrangements can be made. Reports are now being developed that will provide you with feedback on the timeliness of follow up. 4

5 Client Consent Assignment Information sent to CMA s from the DOH list is non-consented information. The assignment file includes the names of the 5 most recent providers who have served the member; as this information is non-consented, these providers may not release information to you A person is considered enrolled once they have verbally agreed to participate in the Health Home Upon agreement to participate, persons should be asked to sign the Health Home Consent (DOH 5055), listing their Care Team members before any information may be shared. HHUNY provides pre-populated Consent Forms specific to each hub and RHIO for CMA use Refusal to sign does not preclude enrollment, but information may not be shared. Continued efforts should be made to educate the member on the purpose and value of giving consent. Consent may be withdrawn by the member through completion of a Withdrawal of Consent Form. 5

6 Management of Capacity Questions concerning the HHUNY assignment or community referral process? Contact: Chris Mangione at (585)

7 Tracking File Submission What is the tracking system? The DOH system to register (or enroll) persons in health home services Anyone that you serve must be registered by way of the DOH Tracking System in order to count (outreach or active) Persons identified as NOT having active Medicaid should NOT be included on the Tracking File. It is the step that needs to be taken in order to have the validation in place for billing purposes. Without information in the Tracking System, acuity scores may not be set Tracking File templates are given to each CMA once the contract has been signed. Tracking files are to be sent to HHUNY weekly via secure 7

8 Tracking File Submission Questions concerning Tracking File Submission? Contact: Kathy Berthod (585)

9 CMART File Submission What is a CMART File? The CMART file provides important information to both HHUNY and the State about the Health Home work you are doing. A spreadsheet is provided to you by HHUNY that must be completed and submitted once each quarter. The submission schedule is the 15th of the month following the end of the quarter you re reporting on. CMAs should refer to the DOH Health Home website ( d_health_homes/assessment_quality_measures/docs/hh_cmart_s pecs_v2.pdf) for documentation specifications including the definitions of the data elements being collected via the CMART. This information will help you determine where you will need to go in order to pull the correct data. Persons identified as NOT having active Medicaid should NOT be included on the CMART file. 9

10 CMART File Submission You will receive a secure from krose@ccsi.org containing the updated CMART Tool. Once you have completed your CMART tool, only submit it by replying to said . Questions concerning CMART? General Questions: Sarah Moravan (585) smoravan@ccsi.org Technical Questions: Keshia Rose (585) krose@ccsi.org 10

11 Health Information Technology Requirements A major component of the Health Home roll out includes taking advantage of health technologies that can help with the exchange of pertinent patient information regarding their care. Health Home information technology requirements have been sent to all Care Management Agencies. Expectations include: Joining the Regional Health Information Organization (RHIO) and using the information available to inform your care management work. Using DIRECT Messaging for secure transmission of Protected Health information. HHUNY also has additional technology standards (above and beyond those of the Care Management Agencies) that must be met to obtain health home status in NYS. Expectations include: Selecting and implementing a Care Management System for the Care Management Agencies use to create, update and share the Care Plan among HHUNY network providers and assist with NYS reporting. 11

12 Health Information Technology Requirements Questions about HH IT requirements? Contact: Nicole Hirt at (585) ext

13 Billing Billing processes differ depending upon whether the CMA is a converting TCM agency or a non-converting agency. Converting CMAs: Bill e-medny directly for care management services Collect and submit information needed in order for HHUNY to secure the administrative processing fee (Template 1) Non- Converting CMAs: For managed care enrollees, the CMA submits a limited number of data elements to be used in billing the MCOs For Fee-For- Service Medicaid recipients, the information submitted by the CMA is used to develop and submit an 837i to Medicaid. (Template 2).. 13

14 Billing If a TCM (converting agency) receives a denial on a Health Home clients, please review the denial codes to better understand the reason for a denial and what follow up is appropriate. Denial Codes may be found on the DOH website medicaid/program/medicaid_health_ho mes/rate_information.htm 14

15 Billing Questions about billing practices? Contact: John Lee (585)

16 Education and Training It is expected that representatives from CMA will participate in all webinars, administrative and Quality Assurance meetings designed to assure that HHUNY and its CMAs are doing the best possible work in support of our High Need Medicaid members. 16

17 DOH Health Home Website Helpful Resources Member Assignment, Tracking System, Billing and Rates medicaid_health_homes/rate_information.htm DOH Health Homes Provider Manual Information on Denied Health Home Claims: Assessment, Process and Quality Metrics: FACT GP, HH Assessment, CMART medicaid_health_homes/assessment_quality_measures/in dex.htm 17

18 Contact Information Management of Capacity Chris Mangione (585) HH IT Nicole Hirt (585) Billing John Lee (585) Tracking File Submission Kathy Berthod (585) CMART General Questions Sarah Moravan (585) Technical Questions Keshia Rose (585)

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