Model of Care Training Senior Care Options 2016
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1 Mdel f Care Training Senir Care Optins 2016
2 Attesting t Cmpletin f this Mdel f Care Training Please nte: At the end f this Mdel f Care Training presentatin yu will be required t submit an attestatin t having cmpleted this training. It is imprtant that yu submit the attestatin as directed in rder t meet requirements f the Centers fr Medicare & Medicaid Services.
3 What is Senir Care Optins (SCO)? A special prgram fr peple 65 and lder wh are eligible fr Medicaid. Includes all benefits ffered by bth Medicare and Medicaid, delivered thrugh a cmbinatin f the Senir Care Optins prgram, netwrk f healthcare prviders, and cmmunity-based services and prgrams. Sme members will have bth Medicare and Medicaid cverage and thers will have nly Medicaid. The current cverage area is Sufflk cunty nly (acute care hspitals are Bstn Medical Center, Carney Hspital, St. Elizabeth Medical Center and Tufts Medical Center.
4 Benefit Design The benefit plan design cvers: Medicare Parts A and B Medicare Part D Medicaid benefits including lng-term services and supprts Supplemental benefits (e.g., acupuncture, visin, Weight Watchers, fitness reimbursement, nn-prescriptin drug stre items) There is n cst sharing fr any cvered service.
5 Primary Care Team (PCT) All members are assigned a: SCO Care Manager wh crdinates care acrss the care cntinuum. Geriatric Supprt Services Crdinatr (GSSC) wh crdinates hme and cmmunity based services. Primary care prvider Additinal staff may be incrprated int the care team as needed: Specialty prviders (depending n chrnic cnditins) Behaviral Health Care Manager Scial Wrk Care Manger Pharmacist Geriatrician
6 Frmal Assessments SCO Care Managers meet face-t-face with members t cmplete tw initial assessments within 30 days f the member s effective date: Health Risk Assessment (HRA) Minimum Data Set-HC (MDS) Assessments capture pertinent member infrmatin (e.g., medical, behaviral health, medicatin histry) t develp their Individualized Care Plan.
7 Individual Care Plans (ICP) ICPs are develped by the PCT in cllabratin with the member. ICPs Include member-centric prblems, interventins and gals, as well as services the member will receive, as apprved by the PCT, including: Medical cnditins management Lng-term services and supprts Skilled nursing, OT, PT, ST Behaviral health and substance use Transprtatin Other services, as needed
8 Mdel f Care Gals Tailr the cmbinatin f services prvided t each individual member in rder t best meet his/her specific needs and challenges (persn centered care) in the least restrictive setting. Cllabratin between the Primary Care Team and ther clinicians t imprve and assure: Access t essential services, including medical, mental health, cmmunity-based, and lng-term scial and supprt services. Care crdinatin thrugh an identified pint f cntact. Seamless transitins f care acrss health care settings, prviders and health services. Apprpriate utilizatin f services.
9 Prvider s Rle with the Primary Care Team PCPs will be asked t: Apprve and sign ff n initial Individual Care Plans (ICP) and updates made by the Primary Care Team ver the curse f the year. Be available t the SCO Care Manager t discuss changes in member status, rder requests (e.g., DME, pharmacy r ther), and ther services needed t supprt a member thrugh transitins f care r t help them remain in the cmmunity. Review the Centralized Enrllee Recrd (CER) when necessary t crdinate care fr a member with the Primary Care Team.
10 Prvider Requirements All prviders in the BMC HealthNet Plan SCO netwrk must be initially credentialed and re-credentialed by the health plan every tw years. All netwrk prviders must participate in annual BMC HealthNet Plan SCO training.
11 Advance Directives BMCHP encurages all prviders t discuss with ur members the imprtance f advance directives, and t assist in their preparatin, if requested. Advance directives, living wills, durable pwers f attrney fr health care, and health care prxies can be fund in the member s Centralized Enrllee Recrd (CER), which yu can request frm yur SCO Care Manager at
12 Delivering Culturally Cmpetent Care t SCO Members Many BMCHP SCO members will be frm ther cuntries r different cultures, r have physical disabilities. BMCHP has resurces n ur website t assist yu: bmchp.rg/prviders/resurces/training/culturalcmpetency
13 Centralized Enrllee Recrd (CER) A single, centralized, cmprehensive recrd cntaining infrmatin relevant t maintaining each member s general health and well-being, and clinical infrmatin cncerning illnesses and chrnic medical cnditins. The CER dcuments the member s medical, functinal and scial status. The CER will g live nline by Spring 2016 and will be accessible via BMCHP s nline prvider prtal. Yu may als access needed dcuments via yur member s SCO Care Manager.
14 Behaviral Health DMEPOS High End Radilgy Dental Clinical Vendrs Beacn Health Strategies Manages inpatient and utpatient behaviral health and substance use services. Prir authrizatin may be required fr certain services. Nrthwd Manages durable medical equipment, prsthetics, rthtics, and medical supplies (DMEPOS) netwrk. Prir authrizatin is required fr all DMEPOS dispensed and billed by a DMEPOS supplier. evicre Manages utpatient nn-emergency high end radilgy (MRI, CT, PET, Nuclear Cardilgy) Prir authrizatin may be required fr certain services. DentaQuest Manages the dental netwrk. Prir authrizatin may be required fr rutine dental care.
15 Pharmacy Services The frmulary will be different than ur Medicaid prduct; it will fllw Medicare Part D requirements. Cpays and ver-the-cunter drugs will be cvered by Medicaid. Prescriptins can be filled at any netwrk pharmacy. The frmulary and assciated clinical plicies can be fund at senirsgetmre.rg/pharmacy/druglist.
16 Quality: Perfrmance & Health Outcme Measurement BMCHP s Quality Imprvement Prgram is based n the Institute fr Healthcare Imprvement s (IHI) Triple Aim framewrk, which imprves members health, experience and affrdability f health care. Leadership regularly reviews, priritizes and deplys initiatives t encurage and imprve netwrk perfrmance in select areas measured by the STAR Ratings prgram (2017) (Part C&D Measures). Part C: Breast Cancer Screening Clrectal cancer screening Diabetes Care Plan All-Cause Readmissins Getting Needed Care Member Cmplaints Part D: Appeals Prcessing Member Access & Perfrmance Getting Needed Prescriptin Drugs High Risk Medicatin Medicatin Adherence (Diabetes, Hypertensin, Chlesterl) Medicatin Therapy Management Cmpletin These initiatives ften include utreach t ur members and netwrk prviders t cllabrate n imprving quality f care, health utcmes, medical expense and the patient experience.
17 Member Appeals Member appeal (standard) Member request fr review f an adverse determinatin f health care services a member believes he/she is entitled t receive (prcessed w/in 30 days) Member appeal (expedited) Member/prvider request fr expedited review f an adverse determinatin f health care services a member believes he/she is entitled t receive (prcessed w/in 3 days) Prvider must assert that waiting the standard timeframe wuld result in serius risk r harm t the member s life/cnditin. Prviders may be asked t wrk with BMCHP t prcess appeals (e.g., prviding additinal clinical infrmatin t supprt member s request).
18 Member Grievances Member grievance Any expressin f dissatisfactin t BMCHP, a prvider, facility, r Quality Imprvement Organizatin by a member r his/her representative made verbally r in writing. Prvider s respnsibility when a grievance is filed: Cperate fully with BMCHP s Appeal & Grievance staff, RNs and Medical Directrs wh may reach ut t yu as part f the investigatin. Respnd in a timely manner t an Appeal & Grievance Specialist s request(s). Fr Standard Grievances, yu are allwed 5-7 business days t prvide the requested infrmatin. Fr Expedited Grievances, yu must respnd in as timely a manner as the situatin requires, within the timeframe determined by BMCHP.
19 Attestatin Thank yu fr cmpleting the Mdel f Care training. Click here t cmplete the required attestatin.
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