Colorado s Accountable Care Collaborative

Transcription

1 Colorado s Accountable Care Collaborative Region 2 Region 3 Provider Manual Region MY-RCCO

2 Contents Page Number Getting Started 3 Welcome to the Accountable Care Collaborative (ACC) 3 What is a Regional Care Collaborative Organization (RCCO)? 3 What is a Primary Care Medical Provider (PCMP)? 3 What are the Goals of the RCCO Program? 3 Performance Measurement Areas 4 What is the structure of the Colorado RCCO Program? 5 Colorado RCCO Map 5 Colorado Access Regional Contract Managers & Additional RCCO Staff 6 Medical Home Model Principles 7 Attribution 8 Accountable Care Collaborative Client Selection Methodology 9 Passive Enrollment 11 Fax Enrollment Form 12 PCMP Practitioner Information Worksheet 12 How To Update, Delete and Add Clinics/Providers to Worksheet 14 Getting Paid 16 Accountable Care Collaborative Prior Authorization Request (PAR) 17 Accountable Care Collaborative Program Referral Requirement 18 Care Management 19 RCCO Care Management Categories 20 Delegation of RCCO Care Management 21 Other Helpful Information Colorado Access Portal 23 HCPF Eligibility Portal 26 Statewide Data Analytics Contractor (SDAC) 27 Are there any transportation benefits for Medicaid RCCO clients? 28 Nurse Hotline 30 Informational Website Links 31 Appendices 32 Page 2

3 Notes Getting Started Welcome to the Accountable Care Collaborative (ACC) The Accountable Care Collaborative (ACC) is a new Medicaid program to improve clients' health and reduce costs. Medicaid clients in the ACC will receive the regular Medicaid benefit package, and will also belong to a "Regional Care Collaborative Organization" (RCCO). Medicaid clients will also choose a Primary Care Medical Provider (PCMP). What is a Regional Care Collaborative Organization (RCCO)? The RCCO connects Medicaid clients to Medicaid providers and also helps Medicaid clients find community resources and social services in their area. The RCCO helps providers to communicate with Medicaid clients and with each other, so Medicaid clients receive coordinated care. A RCCO will also help Medicaid clients get the right care when they are returning home from the hospital or a nursing facility, by providing the support needed for a quick recovery. A RCCO helps with other care transitions too, like moving from children s health services to adult health services, or moving from a hospital to nursing care. What is a Primary Care Medical Provider (PCMP)? A primary care medical provider (PCMP) is a Medicaid client's main health care provider. A PCMP is a Medicaid client's medical home, where he/she will get most of their health care. When a Medicaid client needs specialist care, the PCMP will help him/her find the right specialist. All clients enrolled in the ACC have a PCMP. What are the Goals of the RCCO Program? By assisting Medicaid clients in getting connected to a PCMP as their Medical Home and by ensuring the medical, specialty, mental health care and other related services are well coordinated, clients experience in the health care system will improve. Clients will be the primary drivers of their healthcare decisions, but will have the support and assistance they need to achieve their personal healthcare goals. In addition, by having a primary source of medical care that attends to both sick care and wellness and prevention activities, the overall health of Medicaid clients will improve. Finally, when clients are more satisfied and empowered in their healthcare decisions and overall health improves, the total cost of care is reduced. Colorado has chosen to measure three specific health care activities as indicators of program success. Those measures include: Page 3

4 1. Emergency Room Visits: Medical care in an emergency room is costly, disruptive, and not always necessary for every condition. By helping Medicaid clients understand what alternatives they have for using the emergency room for non-emergent conditions, unnecessary use of emergency rooms will be reduced. 2. Inpatient Readmissions Within 30 Days: Inpatient care is necessary for many healthcare conditions and circumstances, and as such is an essential component of the healthcare continuum. However, rapid readmission to inpatient care can often be avoided if Medicaid clients get the assistance they need to ensure timely post-discharge after care with their PCMP, understand their discharge instructions and medications, and have adequate supports to make a successful and sustained transition out of the hospital. 3. High Cost Imaging: This refers to costly diagnostic procedures such as MRIs and CT scans. While these are valuable, necessary tools, they are often unnecessarily repeated when multiple providers are involved in a client s care. By ensuring better communication and coordination of care between providers, some of these duplicative services can be eliminated. Notes The following table details the performance measures associated with the above healthcare costs and activities. Measurement Areas Emergency Room Visits per 1,000 full time enrollees (FTEs) Hospital Readmissions per 1,000 FTEs Performance Target Level 1 Target: Utilization shows grate than 1.0% but less than 5.0% Improvement Level 2 Target: Baseline utilization minus 5.0% or more Level 1 Target: Utilization shows greater than 1.0% but less than 5.0% Level 2 Target: Baseline utilization minus 5.0% or more Outpatient Service Utilization per 1,000 FTEs (MRI, CT scans, and X-ray tests) per 1,000 FTEs Level 1 Target: Utilization shows greater than 1.0% but less than 5.0% improvement Level 2 Target: Baseline utilization minus 5.0% or more Overall Program Goal: Reduce total cost of care by $20/per member per month Sources: Page 4

5 Notes What is the structure of the Colorado RCCO Program? The State s Accountable Care Collaborative has divided the counties across the state into regions called Regional Care Collaborative Organizations (RCCO). The RCCO helps manage care of those ACC members living in the counties within their region. Colorado Access is the RCCO for Regions 2, 3 and 5. The table below shows the counties served by each RCCO. Colorado s Accountable Care Collaborative Organization Map Page 5

6 Notes Colorado Access Regional Contract Managers & Additional RCCO Staff Each RCCO is required to have key personnel available if you have questions or need assistance. Please do not ever hesitate to call any one of us if needed. We are here to help you serve your RCCO Medicaid clients. Region 2 Contract Manager & Community Liaison Dave Rastatter dave.rastatter@coaccess.com Medical Director Dr. Mark Wallace mark.wallace@coaccess.com Region 3 Contract Manager & Community Liaison Molly Markert molly.markert@coaccess.com Medical Director Dr. Deb Parsons debra.parsons@coaccess.com Region 5 Deputy Director, Medicaid & Contract Manager & Community Liaison Vice President, Medical Services & Senior Medical Director Region 5 Julie Holtz julie.holtz@coaccess.com Dr. Genie Pritchett genie.pritchett@coaccess.com Additional RCCO Staff Executive Director Medicaid April Abrahamson april.abrahamson@coaccess.com RCCO Project Manager Amy Akapo amy.akapo@coaccess.com RCCO Program Services Manager Drew Kasper drew.kasper@coaccess.com RCCO Program Services Coordinator Michelle Pryor michelle.pryor@coaccess.com RCCO Instructional Design Developer Glenda Robertson glenda.robertson@coaccess.com As a contracted PCMP, you may be providing services to Medicaid clients who live in other RCCO regions. Below is information regarding key contact information for the other four Colorado RCCOs. Please feel free to contact the RCCO who is responsible for your client who resides in another geographic area. They want to hear from you if you have questions or need assistance. See Appendix A for a contact list for all of Colorado s RCCOs. Page 6

7 Notes Medical Home Model Principles The Accountable Care Collaborative Program administered by the State of Colorado s Department of Health Care Policy and Financing outlines the following Medical Home Model Principles in their Contract with Colorado Access for the Regional Care Collaborative Organization. The following are the principles of the Medical Home Model: 1) The care provided is: a) Member/family-centered; b) Whole-person oriented and comprehensive; c) Coordinated and integrated; d) Provided in partnership with the Member and promotes Member self-management; e) Outcomes-focused; f) Consistently provided by the same provider as often as possible so a trusting relationship can develop; and g) Provided in a culturally competent and linguistically sensitive manner. The Contractor s PCMP network 2) A PCMP that is: shall provide for extended hour on a) Accessible, aiming to meet high access-to-care standards such as: evenings and weekends and b) 24/7 phone coverage with access to a clinician that can triage; alternatives for emergency room visits for after-hours urgent care. i. Extended daytime and weekend hours; The Contractor will determine the ii. Appointment scheduling within: appropriate requirements for the hours for urgent care, number of extended hours and days for symptomatic, non-urgent care weekend availability based on the needs of the Contractor s Region, days for non-symptomatic routine care; and and submit these requirements to iii. Short waiting times in reception area. the Department for approval. The c) Committed to operational and fiscal efficiency. Contractor shall assess the needs d) Able and willing to coordinate with its associated RCCO on medical of the Contractor s Region on a regular basis, no less often than management, care coordination, and case management of quarterly, and submit a request to Members. the Department to adjust its e) Committed to initiating and tracking continuous performance and requirements accordingly. process improvement activities, such as improving tracking and follow-up on diagnostic tests, improving care transitions, and improving care coordination with specialists and other Medicaid providers, etc. f) Willing to use proven practice and process improvement tools (assessments, visit agendas, screenings, Member self-management tools and plans, etc.). g) Willing to spend the time to teach Members about their health conditions and the appropriate use of the health care system as well as inspire confidence and empowerment in Members health care ownership. Page 7

8 h) Focused on fostering a culture of constant improvement and continuous learning. i) Willing to accept accountability for outcomes and the Member/family experience. j) Able to give Members and designated family members easy access to their medical records when requested. k) Committed to working as a partner with the RCCO in providing the highest level of care to Members. Notes Attribution Attribution is the process of using claim data to identify which Medicaid clients are linked to PCMPs. This information is based on HCPF claim data from the past three years. The claim information included is office visits with the Colorado primary care providers. The intent of attribution is to preserve PCMP-patient relationship and to ensure member choice of providers. HCPF sent the letter on the next page to all contracted PCMPs to explain and clarify how Medicaid clients are enrolled in the RCCO Program. Page 8

9 Notes Accountable Care Collaborative Client Selection Methodology The Statewide Data and Analytics Contractor (SDAC), Treo Solutions, is responsible for enrolling clients into the ACC program as of October This document addresses frequently asked provider questions about how the SDAC enrolls clients into the ACC program and connects them to a primary care medical provider (PCMP). Which clients are not currently able to enroll in the ACC program? Only people who are currently eligible for Medicaid are able to enroll in the ACC program. Clients sometimes gain and lose eligibility many times in a given year. This means that a person who is part of your patient panel may have been Medicaid-eligible three months ago but is no longer eligible for Medicaid. Certain clients will not be enrolled into the ACC program at this time. Some of these groups may be enrolled starting next summer (2012). These include: Clients already enrolled in a Medicaid managed care program Clients eligible for both Medicare and Medicaid Clients residing in an institutional setting (for example, a nursing facility) within the last 3 months Clients residing outside of the ACC focus communities whose usual source of care is not known or is not a participating ACC provider What is a focus community and where are the focus communities located? Until the program expands statewide, it is limited to certain areas that the Regional Care Collaborative Organizations (RCCOs) have identified as having the infrastructure to support the ACC program. For the purposes of program enrollment, this designation is limited to the county of residence of the eligible client. The program began in the following counties: Larimer, Moffat, Weld, Adams, Arapahoe, Bent, Otero, Prowers, Pueblo, Denver, Boulder, Jefferson, and El Paso. However, we are expanding rapidly and expect more counties to be included in the coming months. How does the SDAC enroll eligible clients into the ACC program? The remaining clients (who have not been excluded from enrollment based on the factors described above) are the pool of Medicaid clients from which the SDAC selects clients for the ACC program. Enrollment is closely tied to client attribution to a PCMP because the PCMP is an essential part of the program. The Department s objective is to maintain existing client-provider relationships. To meet this objective, the SDAC looks at a Medicaid client s past 36 months of Medicaid claims for Evaluation & Management (physician) codes to determine the medical provider the client has seen most frequently. This process has one of four outcomes: Page 9

10 1. The client has a clear pattern of using a certain primary care provider and the provider is participating in the ACC. In this case, the client will be enrolled into the program, and the identified provider will be the client s PCMP. 2. The client has a clear pattern of using a certain primary care provider but the provider is not participating in the ACC. In this case, the client will not be enrolled into the ACC program. 3. The client has a clear pattern of using two or more providers equally. In this case, the client will be connected to the provider visited most recently. If this provider is participating in the ACC program, the client will be enrolled into the ACC program with that provider as the PCMP. 4. The client has no clear pattern of using any primary care provider. In this case, if the client has a family member with an identified PCMP, the client is enrolled into the ACC program with that PCMP. If the client does not have a family member with a PCMP, he or she will be enrolled without a PCMP, and given the opportunity to select a PCMP after enrolling into the program. Notes Is enrollment mandatory? Do clients have to stay in the program once the SDAC has selected them for enrollment? No, enrollment is not mandatory. Medicaid clients are enrolled into the ACC program through a process called passive enrollment. With passive enrollment, clients are automatically enrolled into the program but may choose to opt out of the program. The clients selected for enrollment receive a letter informing them they will be enrolled into the ACC program in 30 days, and may opt out of the ACC program during this time. The letter also states that, once they are enrolled, they will have an additional 90 days to opt out of the program. This letter also includes the name and contact information for the RCCO in which the client is enrolled (based on where the client lives), and the name of the group practice, clinic, Federally Qualified Health Center, or individual provider that will be the client s PCMP. Clients are allowed to choose a different PCMP if they wish. If a client was not attributed to a PCMP, it is the RCCO s responsibility, along with the enrollment broker, HealthColorado, to reach out to the client to help with choosing a PCMP. I still have Medicaid clients on my panel that are eligible for the ACC but have not been enrolled. Why? The Department is currently trying to maintain a ratio of two-thirds adults to one-third children in the ACC program. Because the Medicaid population is roughly the inverse of that (two-thirds children to one-third adults), this narrows the pool of potential enrollees. As a result, there are children who are otherwise eligible for ACC program enrollment and connected to a participating provider, but are not enrolled. CONTACTS: Program, Jerry Smallwood Media, Joanne Zahora: Improving access to cost-effective, quality health care services for Coloradans Page 10

11 Passive Enrollment Notes Passive Enrollment is the term used to describe how Medicaid clients are enrolled in the RCCO Program. A Medicaid client who is eligible for enrollment in the RCCO Program receives a letter to advise them of their enrollment and who their assigned PCMP is (if available). Passive enrollment refers to the fact that a member must choose to decline participation in the program, or, opt out. If the client takes no action to decline participation, they are automatically enrolled. The client has 30 days from the date of the Passive Enrollment letter to opt out. HealthColorado is the organization (called the Enrollment Broker ) that assists members in the process of enrollment and selecting a PCMP. Each month HealthColorado sends out letters to members that have been passively enrolled in the ACC Program. The members do not need to do anything if they wish to remain in the program. The Passive Enrollment letter will indicate the client s assigned PCMP as determined by the attribution process described above. The member must call HealthColorado if they want to select another contracted PCMP or if they want to opt out of the Program. If the member has no clear connection to a PCMP as described the attribution process above, the Passive Enrollment letter will indicate that they need to call HealthColorado to select a PCMP. The client receives a current RCCO Provider Directory and a RCCO Client Handbook when they receive the Passive Enrollment letter. The Provider Directory lists all contracted PCMPs from which the member makes their PCMP selection. The Client Handbook provides detailed information about the RCCO program. Clients are informed that they may opt out off the RCCO Program without cause 90 days after enrollment and may change their PCMP selection at any time while enrolled in the program. Colorado Access and PCMPs may not make the call to the enrollment broker on behalf of the member, but can assist the member with making the call. See Appendix B & C for the Passive Enrollment Letter. Page 11

12 Fax Enrollment Form Notes HCPF has created a form that will help clients when they visit your office and have not chosen your practice as their PCMP. You may only give this form to Medicaid clients who are designated in the Web Portal as: 1. Accountable Care Collaborative Program members; and 2. Unattributed (does not have a PCMP). For clients enrolled in the Colorado Access RCCO programs, the Medicaid 3. eligibility web portal will indicate that their PCMP is Colorado Access. If a client already has a PCMP and wishes to change, the client must call HealthColorado directly at in the Denver metro area, or outside metro Denver. You may not use the fax enrollment form for the purpose of switching from one assigned PCMP to another. You may only give this form to Medicaid clients who come in for an appointment. You may not mail or this form to Medicaid clients to recruit them to choose your practice. Please fax this form to HealthColorado at (303) once the client has completed it. As an alternative,may mail it to: HealthColorado 303 E. 17 th Ave, Ste. 105 Denver, CO See Appendix D for the Fax Enrollment Form. PCMP Practitioner Information Worksheet The PCMP Practitioner Information Worksheet procees is extremely important. Colorado Access submits these worksheets to HCPF who in turn submit them tohealthcolorado. Proper updates to this worksheet maximize a PCMPs ability to receive new attribution. These worksheets are not only used for Attribution, but also for Colorado Access & HCPF Provider Directories. Page 12

13 Notes Dates to Remember 20 th : You will receive your PCMP Practitioner Information Worksheet quarterly in March, June, September and December. 25 th : Once you receive this worksheet, any additions, deletions or updates need to be made and the worksheet will need to be returned to Michelle.Pryor@coaccess.com no later than the 25 th of the respective month *If either of these dates fall on the weekend or a holiday, be sure to send in the information the Friday before. Changes to PCMP Practitioner Information Worksheet will not require contract revisions with either Colorado Access or the Department. Key information to be included on this spreadsheet Organization Legal and DBA names Organization & Practitioner Medicaid Provider ID#s Organization Location(s) Whether Organization or Individual provider should be listed on Passive Enrollment Letter RCCO the Practice is located within All Practitioner Names Practitioner Information: o o o o o o o o Gender Provider type and designation (ie. MD, DO, PA, NP) Board Certification Specialty population interest Languages spoken Office Hours Medicaid Panel Size Limit Participation in the ACC and/or taking new Medicaid patients Page 13

14 Notes How To Update, Delete and Add Clinics/Providers to Worksheet The following provides more detailed instructions about how to add, delete and update information for your practice on the PCMP worksheet. Screen shots of the spreadsheets are provided below. ADD Used to add an existing provider/clinic entry. You would want to use the ADD function any time a new provider started working in your clinic or practice. 1. Scroll to the end of your provider/clinic entries 2. Select ADD from drop down in first column for the first empty row after your entries. 3. Enter your clinic and provider information for the row. 4. Save the Excel Worksheet. Page 14

15 Notes UPDATE Used to modify an existing provider/clinic entry. You would use the UPDATE function if any of the data fields for one of your providers had changed. For example, if one of your providers has become fluent in another language, you would want to update that information in the Languages Spoken field. 1. Select UPDATE from drop down in first column for the row that you want to update. 2. Make any changes you need to the row. 3. Save the Excel Worksheet. DELETE Used to remove an existing provider/clinic entry. You would use the DELETE function any time a provider left your practice. 1. Select DELETE from drop down in first column for the row that you want to delete. 2. Do not delete the row; we will do that for you. 3. Save the Excel Worksheet. Page 15

16 Notes Getting Paid How will I be paid for the medical services I provide to RCCO clients? Nothing has changed in the RCCO Program in terms of how you bill and are paid for the Medicaid covered services you provide for Medicaid clients. You will continue to be paid by Fee-For-Service (FFS) Medicaid in the same way you always have. HCPF publishes a guide to Medicaid billing called The Little Billing Book This booklet contains general Colorado Medical Assistance Program billing information. Use this booklet as a guide to the comprehensive billing information in the Provider Manual sections. The layout of the booklet allows providers print the pages front-to-back. Click the image to the right to view, The Little Billing Book. Page 16

17 Notes Accountable Care Collaborative Prior Authorization Request (PAR) Issue date: January 19, 2012 Changes submitted through the Colorado Medical Assistance Program Web Portal (Web Portal) Effective February 1, 2012 Beginning February 1, 2012, (B ) for more information. Supply and Medical PARs may no longer be submitted through the Web Portal. Please refer to the January 2012 Special PAR Bulletin. Also beginning on February 1, 2012, Dental PARs will not be accepted through the Web Portal. See Appendix E for a Special PAR Bulletin. See Appendix F for an Outpatient Bulletin, The PAR option will not be available from the Web Portal Main Menu during this temporary change, and is anticipated to be unavailable for up to six weeks. During this time, Dental PARs will need to be submitted on paper to the fiscal agent, ACS at: ACS P.O. Box 30 Denver, CO Related questions should be directed to ACS Provider Services at The Department of Health Care Policy and Financing will communicate any updates as they become available. There will be no disruption to the PAR Status Inquiry or the PAR Letter services through the Web Portal. Users will still be able to submit a PAR Status Inquiry on any PAR that has been submitted to the ColoradoPAR Program Web Portal (CareWebQI) or to ACS. Users will continue to receive PAR Letters via the File and Report Service (FRS) in the Colorado Medical Assistance Program Web Portal. You may continue to check Provider Services in the Providers section of the Department s Web site at colorado.gov/hcpf for Medical Assistance Program news and updates. Page 17

18 Notes Accountable Care Collaborative Program Referral Requirement July 17, The Accountable Care Collaborative program will no longer require that specialists get an administrative referral from the Primary Care Medical Provider. This means that the PCMPs Provider Billing ID is not needed on a specialty claim for the claim to be paid. This policy will be officially effective after new RCCO contracts are executed. Based on stakeholder feedback, the Department has decided that an administrative referral or a claims based referral for specialist services is not necessary. Instead, the Department will work with RCCOs to ensure that PCMPs & Specialists establish protocols for a clinical referral process. A clinical referral process would ensure there is coordination and an appropriate exchange of information between specialists and Primary Care Medical Providers but would not be tied to payment. The Statewide Data and Analytics Contractor will develop data to help RCCOs and PCMPs understand where clients are going and build processes for sharing clinical information. If you are interested in providing input on the clinical referral process, please contact Leslie Weems at Leslie.Weems@state.co.us for information about our next Provider and Community Relations Subcommittee meeting. Page 18

19 Care Management Notes Who Should I Contact for Care Management? General Contact Number (Follow phone prompts based on purpose of call) MY-RCCO ( ) TTY (deaf or hard of hearing) my.rcco@coaccess.com Page 19

20 RCCO Care Management Categories Notes Category #1: Routine and Intensive Care Management The primary functions of Routine and Intensive Care Management Category include: Stratification of Delegate s Member population according to care needs identified through HRAs, Care Plans, and other relevant sources. Health Risk Assessments (HRAs) involve performance of outreach (to the applicable population) for the purpose of administering RCCO HRAs. Delegate shall do HRAs on the Delegate s Member population after initial enrollment unless the RCCO has communicated completion of an HRA through mailing or telephonic outreach. HRAs allow for immediate identification of significant Care Management needs. Individual needs assessments for attributed Members after enrollment and at other necessary times. This would include screening for special health care needs (e.g. behavioral health, high-risk health problems, functional problems, language or comprehension barriers; and other complex health issues). Individual needs assessments shall involve a comprehensive collection, analysis and sharing of information about a Member s physical, emotional and psychosocial conditions used to determine areas of risk, educational opportunities, and service gaps. The HRA could be considered a part of this process. Development of individual Care Plans, as necessary, based on the needs assessment and other relevant sources. Care Plans shall establish treatment objectives, treatment follow-up, outcomes monitoring, and a processes to ensure the Care Plan is revised as necessary. The Care Plan shall reflect the Member s desires and provide a professionally established, Member-focused road map of Interventions to increase a Member s self management skills, awareness of warning symptoms of disease instability/progression, and to increase the Member s understanding and course of his/her chronic condition(s). At least one Goal, on the Care Plan, should be Member identified, as the Member s desired intention. Assisting with access to care issues such as transportation, referrals for care and appointment scheduling, connecting Members to community resources, and distributing health promotion information. Assisting Members who may require coordination of health care services from multiple providers, facilities and agencies, to obtain those services and to coordinate with the behavioral health organizations, non-primary Care Providers (e.g. specialists) and social services provided through community agencies and organizations. Includes facilitating referrals, assisting new Members in continuity of care and Care Coordination (inc. Medicaid/Medicare), and in attaining non-health care services. Intensive Care Management to the relevant Member population with Intensive Care Management needs. Examples of Intensive Care Management Member characteristics: Page 20

21 1) Members with complex medical needs and treatment regimens. 2) Members who need additional assistance in managing their medical care. 3) Members having difficulty contacting other physicians or obtaining medical equipment or medications. 4) Members who lack adequate social support systems. 5) Members with both physical and behavioral health needs. Notes Category #2: Transitions of Care Providing assistance during care transitions from hospitals or other care institutions to home or community-based settings; or during other transitions, such as the transition from child health services to adult health services, or from hospital or home care to care in a nursing facility. This assistance shall promote continuity of care and prevent unnecessary re-hospitalizations. Process includes documentation and communication of necessary information about the Member to providers, institutions and individuals involved in the transition. Delegation of RCCO Care Management The RCCO-HCPF contract defines certain terms of Care Management delivery that Colorado Access can provide for your RCCO patients. When a PCMP is capable of providing Care Management functions, as defined in the RCCO-HCPF contract, Colorado Access may delegate those functions to the PCMP. Full Delegation PCMP is delegated for both categories of RCCO Care Management Partial Delegation PCMP is delegated for one category of Care Management. Colorado Access does the remaining Care Management category No Delegation Colorado Access handles both categories of RCCO Care Management Page 21

22 If I want to pursue delegation of RCCO Care Management, where do I start? Notes PCMP fills out Pre- Delegation Questionnaire and s to Drew Kasper at RCCO (optional step) Dialogue underway. When ready, PCMP fills out their section of the Pre-Delegation Audit Tool and sends to RCCO with supporting documents RCCO reviews information and schedules visit to PCMP site (by Program Services Manager and RCCO Contract Manager), to review the tool and Care Management program in detail. Customized Transition Process Agreement is completed, including designation of Care Management Categories for Delegation, and agreement on transition processes. RCCO reviews the findings of the predelegation audit and provides PCMP with a formal follow-up response. While this represents the typical process flow, Colorado Access wants to accommodate your individual practice needs. For instance, we would be happy to walk through the pre-delegation audit tool with you, as a first step, if you prefer. Please let us know, what works best for you. To access the RCCO Care Management Pre-Delegation Questionnaire or Audit Tool, please contact your RCCO Contract Manager, or the RCCO Program Services Manager, Drew Kasper at drew.kasper@coaccess.com, Page 22

23 Notes Other Helpful Information - Colorado Access Portal See Appendix G for a Colorado Access Portal Access Request Form. Page 23

24 Notes When searching by name you may receive multiple results Scroll through the list until you locate the correct member. Page 24

25 Notes How Do I Apply for a Username and Password? Page 25

26 Link to HCPF Eligibility Portal: Notes The screen sub-heading that previously read Prepaid Health Plan will now read Accountable Care Collaborative. If the client is enrolled in the ACC program, one of the following phone numbers will be at the bottom of the last screen under the heading Prepaid Health Plan or Accountable Care Collaborative Contact Phone Number RCCO RCCO RCCO : Page 26

27 Notes If the client is enrolled in the ACC program with Colorado Access, Colorado Access will be listed next to the RCCO Name and if the member is unattributed, the PCMP Name will be blank. If the member is attributed to a PCMP their name will be listed next to PCMP Name. Statewide Data Analytics Contractor (SDAC) The Statewide Data Analytics Contractor (SDAC) is responsible for providing secure electronic access to clinically actionable data to the Regional Care Collaborative Organizations (RCCOs) and Primary Care Medical Providers (PCMPs) to help them meet the goals of the Accountable Care Collaborative (ACC), which is to improve client health and reduce costs. The SDAC help RCCOs and PCMPs by allowing PCMPs and RCCOs to better coordinate Medicaid clients care by providing secure access to diagnoses, prescription, and other health information. They also provide reports to PCMPs and RCCOs to help eliminate avoidable and duplicative procedures. In addition, the SDAC analyzes claims to identify potentially preventable health events (e.g. ER visits, hospital readmissions). The SDAC currently provides numerous reports however, they are currently working to provide profiles of individual clients based upon predictive modeling, identification of areas for clinical process improvement at the client, provider, and RCCO levels. They are also working towards providing aggregate reporting of cost and utilization performance indicators. See Appendices H, I, J, and K for: SDAC Dashboard Portal Access Request Form Colorado SDAC Dashboard User Guide Colorado SDAC: Dashboard Quick Reference Guide Colorado SDAC Frequently Asked Questions (FAQ) Page 27

28 Are there any transportation benefits for Medicaid RCCO clients? Yes, non-emergency transportation to healthcare appointments is a benefit covered under the Medicaid program. HCPF contracts with a vendor called First Transit Colorado NEMT (Non-Emergency Medical Transportation). Notes The letter on the next page describes First Transit and the process by which Medicaid clients can arrange for transportation to and from their non-emergency medical appointments. See Appendix L for NEMT Transportation Flyer (printable). Page 28

29 Notes Dear Medicaid Client: Beginning January 1, 2012, all Medicaid Non-Emergency Medical Transportation (NEMT) will be provided through Colorado Medicaid s new transportation broker, First Transit Colorado NEMT. Call Colorado NEMT at the new number below for all of your non-emergency medical transportation trips in You can call us at this number to schedule your 2012 trips starting Monday, December 19, 2011: CO4-NEMT First Transit is the new Medicaid NEMT broker for the counties of Adams Arapahoe Boulder Broomfield Denver Douglas Jefferson Larimer Weld First Transit is committed to ensuring that you receive the best possible service. After January 1, 2012, if you have a concern regarding the services you receive or would like to compliment someone for his or her efforts, please call our Comment Line at: NEMT-1ST First Transit is working with transportation providers from around the region to make sure that your transportation experience will meet our standards for performance. You will receive quality transportation from trained and skilled drivers who are trained in exceptional customer service driving safe and clean vehicles that have been inspected by our own mechanics. We use a reservations and scheduling system that works with many local providers including the RTD s Access-a-Ride service. As the General Manager for First Transit Colorado NEMT, I will do everything I can to make your Medicaid NEMT service a customer-focused, comfortable experience. We look forward to serving you beginning in Rob Andresen General Manager First Transit Colorado NEMT Page 29

30 Notes Nurse Hotline See Appendix M for a printable version of this flyer. Page 30

31 Informational Website Links Notes Health Care Policy and Financing Informational Web Links: Health Care Policy and Financing Website Information About RCCOs ACC Provider Information Colorado Access Informational Web Links: Colorado Access RCCO Colorado Access RCCO Provider Information Colorado Access RCCO Member Information Colorado Access WeCARE (Colorado Access Resource Exchange) Page 31

32 Appendices Appendix A Colorado RCCO Contact List Appendix B Passive Enrollment Letter (English) Appendix C Enrollment Letter (Spanish) Appendix D Fax Enrollement Form Appendix E Special PAR Bulletin Appendix F Outpatient Bulletin Appendix G Colorado Access Portal Access Request Form Appendix H SDAC Dashboard Portal Access Request Form Appendix I Colorado SDAC Dashboard User Guide Appendix J Colorado SDAC: Dashboard Quick Reference Guide Appendix K Colorado SDAC Frequently Asked Questions (FAQ) Appendix L NEMT Transportation Flyer Appendix M Nurse Hotline Flyer Page 32

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34 MY-RCCO