9/22/2016 · 9/22/2016 3 person centered planning person-centered planning is creating an...

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Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.Confidential and proprietary.

MSHO/MSC+ FALLCARE COORDINATION TRAININGPartner Relations TeamGovernment ProgramsOctober, 2016

Agenda

•Person Centered Planning (Slide 4)

•Behavioral Health Homes (10)

•Bridgeview Review (13)

• STARS Initiatives (40)

•Depression QIP (49)

• Supplemental HRAs Review (52)

•BlueRide Updates (58)

•Release of Information (ROI) (61)

• 2017 MSHO Supplemental Benefits (65)

•MSHO Enrollment (69)

• ICD10 (73)

•Guidelines Updates (75)

•Review of Communiques since Webinar (79)

• Forms/Resources Updates (82)

•Audit Results (87)4

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HUBBARD

RED

LAKE

MAHNOMEN

STEELE

GRANT

MCLEOD

SHERBURNE

BENTON

August 2016

Government Market Solutions

Partner Relations Contacts

Nissa Roberts (651) 662-7613 [email protected]

Stormy Church (651) 662-1040 [email protected]

Melissa Rakow-Paré (651) 662-7872

[email protected]

Ricky P. Vang (651) 662-4523 [email protected]

• Catholic Charities

Jenna Rangel (651) 662-4529 [email protected]

• BCBS Care Coordinators

• Thomas Allen, Inc.

• Meridian Services

Kim Flom-Brooks (651) 662-9647

[email protected]

Melinda Heaser (651) 662-1815 [email protected]

• Essentia Health

• Genevive

• Health East

• Bluestone Physicians

• Fairview Partners

Cook

ST LOUIS

KOOCHICHING

ITASCA

CARLTON

PINE

AITKIN

CROW WING

CASS

BELTRAMI

WADENA

MILLE

LACS

BECKER

LAKE OF THE

WOODS

CLAY

NORMAN

PENNINGTON

MARSHALL

ROSEAUKITTSON

POLK

MORRISON

TODD

OTTER TAIL

DOUGLAS

POPESTEVENS

STEARNS

CHISAGO

ISANTI

WASHINGTON

WRIGHT

KA

ND

IYO

HI

ANOKA

HENNEPIN

SWIFT

BIG STONE

TRAVERSE

WILKIN

KANABEC

LAC QUI

PARLE

YELLOW MEDICINE

LYONREDWOOD

RENVILLE

MEEKER

CHIPPEWA

LINCOLN

MURRAYCOTTONWOOD

WATONWAN

NOBLES JACKSONROCK

PIPE-

STONE

BROWN

NICOLLET

LE

SUEUR

MARTIN FARIBAULT

SIBLEY

RICE

BLUE EARTH WASECA

FREEBORN

MOWER

GOODHUE

DODGEOLMSTED

RAMSEYCARVER

SCOTTDAKOTA

WABASHA

WINONA

FILLMORE HOUSTON

COOK

LAKE

CLE

AR

WA

TER

PR Team Manager Katie Gumtow(651) 662-2297


PERSON CENTERED PLANNING

mailto:[email protected]


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Person Centered Planning

Person-Centered Planning is creating an environment that:

• Treats individuals with dignity and respect

• Supports service plans that are built on the individual’s strengths, talents, and desires

• Encourages individuals to connect with their community and assists with developing relationships

• Engages in active listening and acting on the member’s communication to you

• Makes a sincere effort to understand the member as a unique individual

Sources of implementation requirements:

• Minnesota’s Olmstead Plan

• Jensen Settlement Agreement

• CMS HCBS Rule

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Person Centered Planning

Implementation of Person Centered Planning has been incorporated into:

Assessments• DHS-3428 Minnesota Long Term Care Consultation Services Assessment

Form• DHS-3428A MN LTCC Services Assessment (SW section)• DHS-3427 LTC Screening Document• 6.17 ICF/DD and HCBS Waiver HRA and Care Plan supplement• 6.28 Transitional HRA

Collaborative Care Plan• 6.02.01 CCP

Transitions • DHS-3936 My Move Plan Summary

Care Coordination Guidelines 6

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Person Centered Planning- Transition Requirements

Care Coordinator completes DHS-3936 My Move Plan Summary when the member moves:

• From facility to the community

• From their home to another location

• From one residential setting to another

• Required for EW only

The Care Coordinator is responsible to:

• Evaluate the member’s needs

• Build and share the Summary with the member

• Update the My Move Plan Summary

• Update the Collaborative Care Plan (if applicable)

• Communicate information to others involved (if applicable)

• Sign and keep a copy of the completed document in the member’s file7

Person Centered Planning Resources

DHS Documents:• #16-56-01 Lead Agency Requirements for Person-Centered Principles and

Practices – Part 1• #16-56-02 Lead Agency Requirements for Person-Centered Principles and

Practices – Part 2• #16-56-03 Lead Agency Requirements for Person-Centered Principles and

Practices – Part 3

•DHS 3936 My Move Plan Summary

•DHS 6803 What does person-centered mean for me? An Introduction.

• Person-Centered, Informed Choice and Transition Protocol

https://mn.gov/dhs/assets/PCP_protocol_tcm1053-165509.pdf

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https://mn.gov/dhs/assets/PCP_protocol_tcm1053-165509.pdf

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Person Center Planning Resources (CONT’D)

DHS Website:

http://mn.gov/dhs/partners-and-providers/continuing-care/provider-information/person-centered-practices/

DHS and Health Plan Collaborative Training:

Recorded DHS training Person Centered Practice and Planning presented on June 23, 2016: http://stream5.video.state.mn.us:8080/strobe/DHS-ltccassessment062316.html

Questions:

[email protected]

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BEHAVIORAL HEALTH HOMES

http://mn.gov/dhs/partners-and-providers/continuing-care/provider-information/person-centered-practices/

http://stream5.video.state.mn.us:8080/strobe/DHS-ltccassessment062316.html


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Behavioral Health Homes

• Effective July 1st 2016, Behavioral Health Home (BHH) services became available for Medicaid enrollees, including MSHO and MSC+ members.

•Behavioral Health Homes are an initiative by DHS.

•BHH provider must be in-network for our members to use.

• Provide the opportunity to build a person-centered system of care that can achieve improved outcomes for members.

• Providers complete specialized training and certification.

•Voluntary opt-in service.

•Members must meet eligibility under this benefit that is determined by a DHS certified BHH provider.

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Behavioral Health Homes

Care Coordinator Role:

• You will receive a notification from Partner Relations if your member is receiving BHH services.

• Contact BHH provider, provide contact information, and coordinate exchange of care plans.

•Ongoing collaboration, communication, and coordination of services and care.

• Care Coordinator and the BHH Care Coordinator should work together to avoid any duplication of services provided.

•Does not affect Care Coordination billing or other expectations.

Information on the DHS site on Behavioral Health Home services:http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_177945

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http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_177945

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BRIDGEVIEW REVIEW

Bridgeview

Bridgeview Care Coordination Delegate User Guide updated 9/2016

To access the User Guide:

Bridgeview Company Website Bridgeview Links Elderly Waiver Program Documents

Bridgeview Functions for ALL MSHO and MSC+ members for ALL living arrangements:•Assign Care Coordinators• Retrieve Enrollment Reports • Enter Assessments• Enter Service Agreements (EW only)

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Bridgeview-Entry Process

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DR downloads enrollment

SS or DR assigns CC to member

CC follows timelines to

complete/enter HRA

If on EW, CC/DR/SS enters

LTCC and Case Mix spans

CC/DR/SS enters Service

Agreements

CC/DR/SS follows instructions re:

HRA audit (if member selected)

DR: Delegate Rep

SS: Support Staff

CC: Care

Coordinator

Bridgeview- Enrollment Reports

All reports are available in Bridgeview. Click on the blue “Delegate Enrollment Report” link.

FAQ: What do I do if the Delegate Agency is not correct for my member?

Please follow the process for reporting enrollment discrepancies and email [email protected] with the discrepancy information

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• 1st report of the month

• NEW membersNew Cap

• 2nd report of the month

• full member list

• may also include some NEW members who enrolled at the very end of the previous month

Full Detail

• as needed for members who are retro-enrolled by DHS after capitation

• NEW and/or REINSTATED membersDaily Add


FAQ- what is the Daily Add report?

• This report is received by DHS after we have already run the NEW CAP and Full Detail. These are members who are retroactively enrolled or re-instated by DHS.

FAQ- what does “TERMED FUTURE X-2016” mean on the Full Detail?

• The member’s MA is closing at the end of this month. Most of the time this is due to MA renewal. CC can follow up with the member/FW to make sure MA renewal has been sent in.

FAQ- We didn’t receive the member on an enrollment report until XX day this month. What date do we use for our documentation?

• The date you receive the email notification that your enrollment is ready is your official notification of enrollment.

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Bridgeview- Assigning Care Coordinators

Enter Care Coordination Assignments and HRAs into Bridgeview for ALL members

When a member is assigned to your agency, use the Assign Care Coordinator function

Once a Care Coordinator is assigned, you may Assign or Edit the Care Coordinator by choosing Assign Care Co. or Edit Care Co. on the Member Selection screen

FAQ- What is the difference between Assign Care Co and Edit Care Co?•Assign CC: if you want to change the CC, choosing Assign CC will keep a history of

the previous CC.• Edit CC: use the Edit CC if you assigned the member to a CC and now want to

change it (i.e. you assigned the wrong CC, etc). This overwrites the previously assigned CC.

Bridgeview- Entering Assessments

To enter HRAs, select Assessments Due tab, or follow the reminder link from your main login page. (You can also add assessments from the Member Selection screen by clicking on Add Assessment).

“I” for Initial assessments ,“R” for reassessments. Past Due assessments will be displayed in red on your dashboard.

FAQ- Is there a specific date that assessments need to be entered by?

• The previous month’s assessment information should be entered no later than the 10th of the next month. Example: enter January assessments by February 10th.

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Bridgeview- HRA Form and Types of Assessments

Adding the Assessment:

There are several options under HRA Form Used and Type of Assessment. Choose the form and assessment type that you wish to enter.

HRA Form Used

Types of Assessment

Initial Product Change

Annual Health Plan Change

Significant Health Change Unable to Reach

Refusal

LTCC 6.28 Transitional HRA

6.15 Nursing Home Assessment FFS

6.17 HRA for Members on other waivers or receiving DD case management

No Form- can be used for refusals only


FAQ- what is the difference between Refusal and Unable to Reach? (CW only)

•Refusals: you spoke to the member/a-rep and they said they do not want an HRA. Enter NO FORM or 6.17 as the HRA Form Used and Refusal for Type of Assessment.

•Unable to Reach: you tried calling, sending letters, etc. and were not able to get in touch with the member/a-rep. Enter LTCC as the HRA Form Used and Unable to Reach for the Type of Assessment

3 attempted phone calls

Send Unable to Reach letter

Use date letter sent as the “assessment date”

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Important tips for Unable to Reach:

• Follow-up contacts need to be started with plenty of time to accommodate 3 attempts before the initial or 365-day deadline.

• If applicable, CCs should be reaching out to other contacts to obtain a working phone number. You may document those dates in Bridgeview as phone contact attempts.

• You may enter the same date in BV if your attempts occurred on the same date.

• The date of the Unable to Contact Letter should be the same date entered in BV and should be the same date as the activity date for the Refusal SD in MMIS.


FAQ- What do I need to enter for a new enrollee who is already on EW?

1. Enter the FFS LTCC or MnCHOICES assessment

2. Enter your HRA

3. Enter your LTCC and Case Mix date span

4. Enter your SA information

FAQ- what do I do If I’ve transferred a member and forgot to put in an HRA?

• You now have the ability to enter an assessment on these members. Put in the member’s ID# and click Add Assessment.

• This option is only available for 90 days post transfer.

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Bridgeview- Requesting an Edit or Deletion of an HRA entry

All roles can request an Edit, or Deletion of an HRA entered in error.

Click on the green Edit button to the left of the HRA you wish to Edit or Delete

Make the corrections using the drop boxes in the field(s) you wish to change. Fill in the Comments box with why you are requesting an edit/deletion. And click Request Edit or Request Delete

Bridgeview- Updating Member Information

All roles can make changes to the member information: Click on Edit Member Address

Fields that can be updated include:

Some changes could impact Care Coordination Delegate assigned to the member.

Changes made in the Bridgeview Web Tool are only changed in Bridgeview.

Manual changes are only effective for 90 days.

Address Rate Cell

Phone Living Status

Outreach Phone PCC

County of Residence

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Bridgeview- Updating Member Information

FAQ- Regarding the editing of a member address – Is this field to be updated with the member’s physical address, mailing address, A-Rep address, other?

• The address in Bridgeview should correlate with the member’s physical address. This will determine our enrollment assignment for the member. The address in Bridgeview does not impact letters or other information that Blue Plus mails out.

FAQ- I changed the address in Bridgeview but now it’s back to the old address. What happened?

•Manual changes in Bridgeview are effective for only 90 days and will then revert back to what’s on the DHS file. You need to update the financial worker using DHS 5181 to permanently change the member’s address in all systems.

FAQ- What is the Outreach Phone?

• This is meant to be an alternate phone number for the member or an authorized representative for the member or residing facility.

Bridgeview- HRA Audit

Delegates will receive an email from Partner Relations instructing them to go to the HRA Audit Dashboard in Bridgeview.

Click on the HRA Audit link to take you to the HRA Audit Dashboard

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From the Audit Dashboard, see the Helpful Hints at the top of the page.

Click on the Send Attachment link for the member.

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After clicking on send attachment within Bridgeview, Do NOT change the subject line or the “TO” address field on the auto-generated email

Follow the instructions in the email from Partner Relations to send in the documentation requested for each identified member.

Only ONE attachment per email

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Do Not Change

Do Not Change

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FAQ- I sent my audit information but I got an email from Partner Relations that they didn’t receive anything yet. Why?

•Please do not change the To field or the subject line on the auto generated email. Please include only 1 attachment on the email. If you have multiple documents to send for the member, please zip or scan them together before attaching. Do not forward an email that you have received from your scanner or attach an outlook item to the auto generated email. You will have to save your scan and then attach it to the email.

FAQ- what does P/F mean?

• Pass/Fail

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Bridgeview- Delegate Performance Reports

Quarterly Reports include MSHO and MSC+ data

Monitor HRA completion timelines

Some common action items are:• CC field is blank: go into BV and assign members to a CC•Assessment field is blank: go into BV and enter the HRA info• FLG: there was no HRA date entered and the member has been enrolled with

Blue Plus for more than a year. Go into BV and enter the HRA data if completed.• Field with NO: review the HRA date input in BV against the assessment form to

ensure the correct date was entered

No requirement to send report back to Blue Plus.

FAQ- why does it say NO when I put in a refusal?

•CMS counts the Refusals as non-compliant. 32

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BRIDGEVIEW SERVICE AGREEMENT REVIEW

Bridgeview- Pass Through (County Delegates Only)

Some Counties choose to contract with Blue Plus to act as a Pass Through billing provider for non-MHCP enrolled providers providing Tier 2 & 3 Services.

If the County’s NPI or UMPI number is entered as the Provider, the Pass Thru field will display

CC or support staff decides if the services authorized will be paid through the “pass-through” process or if the county is providing the service.

From the Pass Through Billing Drop Down:

Select “Yes” if billing on behalf of a non-enrolled Tier 2 or Tier 3 service provider

Select “No” if the County provides the services34

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Bridgeview- Service Agreements

SAs Prior to 07/01/2016Non-24 and 24 Customized Living service codes T2030 and Adult Foster Care S5141 (HQ) should NOT be entered as a daily units and rates for the old monthly service code

Incorrect Example:

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The correct way to enter a prorated service agreement for: T2030, T2030 TG, S5141, S5141 HQ prior to 07/01/2016

Correct Example:

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Did you know?The Bridgeview Web Tool will automatically calculate the “Total Authorized Units” field if you put a “0” in this field and the frequency is at “Daily”?

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Bridgeview- Service Agreements CDCS

•CDCS services are entered as monthly amounts based on the members’ case mix as listed in the DHS Long-Term Services and Support Service Rate Limits.

•CDCS monthly amounts are flexible as your member could need more services one month and not as many the next. Providers are not required to bill monthly but can bill for the services as needed each month.

• Providers cannot bill over the Annual Maximum CDCS budget amount OR Total Authorized amount for service agreement span.

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Bridgeview- Access

Forgot your Password?

• If you cannot recall your password when logging into the Bridgeview Company Web Tool, you will need to contact the Blue Cross help desk as indicated below on the login screen

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2016 STARS INITIATIVES

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2016 Gaps in Care Strategy Overview - MSHO only

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• Members who are identified as needing the following: Colon Cancer, Breast Cancer, Diabetes A1c, Diabetes Kidney, Diabetes Eye, will be notified through various communications, to encourage completion of preventive screenings.

• Annual wellness visit

• HRA completion and Osteoporosis treatment are incentivized as well

Preventive Screenings

being Targeted

• 1-3 mailings (voucher, kits, retail store invitation, HRA letter)• Outbound Reminder Calls (all gaps)• Incentives tied to completion of preventive screenings

How to Engage Eligible Members

• Go to the doctor’s office, complete in home test kit, potentially go to a retail store location

• Return voucher or in home kit by 12/31/16 to earn reward card

How to Complete Screenings

2016 Gaps in Care Strategy Overview – MSHO only

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• Colon cancer (FIT-CHEK kit,) diabetes A1c (finger stick,) and/or diabetes kidney screening (urine specimen)

In Home Test Kits Mailed August 3rd-16th(Home Access Health)

• Postcard will be customized to each member, showing only the preventive screening(s) each member needs to complete

Reward Voucher MailingMailed August 26th

• Automated outbound reminder calls to identified members encouraging completion of eligible screening(s)

Outbound Reminder CallsBegan September 20th

Silverlink

• Member lives w/in 75 miles of Duluth retail store & 10 miles of Roseville who are eligible for a Medicare Annual Wellness Visit. These members will receive a mailing asking them to schedule appt. at the closest retail store. BlueRide will provide transportation if needed.

Retail Store EngagementInvitations mailed in

September

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2016 GAPS in Care Outreach

Post card mailing to eligible members in August encouraging SecureBlue members to complete any Gaps in Care by 12/31/16.

Care Coordinator Gaps in Care reports will be sent again in October with instructions for Q4 Care Coordinator outreach. No response will be required via a tracker this year.

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2016 Gaps in Care Rewards

SecureBlue members who complete the eligible screening by 12/31/16 can earn the following reward(s) via a VISA gift card.•Mammogram = $50• Colorectal Cancer Screening = $25 for in-home screening kit/$75 for colonoscopy•Diabetes Kidney Disease Screening = $25•Diabetes Retinal Eye Exam = $25•Diabetes A1c Screening = $25•Annual Medicare Wellness Visit = $50

**Members can receive multiple reward cards for each screening identified as a gap for that member.**

Rewards will be in

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2016 Gaps in Care Rewards- FAQs

How does a member earn a reward card?• Schedule an appointment(s) for the recommended screening(s) or complete

an in-home test kit. Screening needs to be completed by 12/31/16.• Return a completed post card/voucher signed by an appropriate health care

professional to Blue Plus on or before 12/31/16.

What members are eligible?• SecureBlue MSHO members are eligible for a reward if they complete the

recommended screening(s) by 12/31/16. Only those identified as needing the screening will receive a mailing with information about the reward program.

What if they already completed the recommended screening(s) or the screening(s) is contraindicated?•Members can still earn a reward by returning a signed and completed voucher

indicating the date/location of the previously completed screening or why it’s not appropriate for the member.

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2016 HRA Refusal Reward

Members identified as refusing a Health Risk Assessment (HRA) in 2015 were sent a letter encouraging them to contact their Care Coordinator to schedule their HRA by 12/31/16 and earn a $50 reward.

• Needs to be completed by 12/31/16.

• CCs should offer a HRA and reward to CW refusals.

• Upon completion of the HRA, CCs can email [email protected] with the following info:• Name/ID• Date of HRA• Member’s mailing address• CC contact information

• Enter all HRA dates into Bridgeview for accurate reporting

Questions? Email [email protected]

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Osteoporosis Outreach

BCBS is contacting SecureBlue members monthly who have had a bone fracture in the previous 6 months with no follow up care or screening of the fracture.

This outreach includes both community and nursing home members.

We are offering in-home Bone Mineral Density (BMD) scans to these members through a vendor called Mobile Medical Examinations Services (MedXM).

What is the screening?•A BMD screening measures the risk for a bone fracture or osteoporosis using

ultrasound on the heel of the foot. • Screening is completed by certified health care technicians in the member’s

home. • Results shared with member and PCP.• The screening is at NO cost to the member. • Blue Plus will automatically send the member a $50 reward card.

*Lists of eligible members can be provided upon request.*47

Comprehensive Medication Review (CMR) Outreach

Current CMR outreach is managed by Prime Therapeutics and includes:

• Telephonic CMRs by Prime staff

• Face to Face CMRs with retail pharmacist or LTC consultant pharmacist (through vendor channels)

•Nursing Homes: Prime contacting Director of Nursing at specific LTC facilities to request scheduling a CMR for the eligible member

• CMR Pilot Program: Blue Cross is contracting with care systems to have their in-house pharmacists perform CMRs for their members. Current providers include Fairview, Mayo, and Essentia with more coming.

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DEPRESSION QIP

Depression QIP

Quality Improvement Projects:

• CMS and DHS contract requirement

• Initiatives that focus on one or more clinical or non-clinical area(s) with the aim of improving health outcomes and member satisfaction

•Approved by Centers for Medicare & Medicaid Services (CMS)

• Implemented over a 3 year period

• Collaborative effort with other MCO’s

•MCO’s are required to report progress annually to CMS

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Depression QIP

• 2016-2018

• SecureBlue MSHO only

•Community only

•Goal: improve antidepressant medication adherence

•Baseline data was collected during the spring audit- answers on LTCC and care plan.

•Monthly report sent to CCs identifying those who have not refilled their Rx for at least 35 days (based on pharmacy claims)

Care Coordinators role:1) Contact member; assess and assist with barriers2) Document and return member response on the “Tracker” to [email protected]

•MCO QIP group will be hosting training related to geriatric depression

All resources including printable member handouts are located in the “Quality Improvement Projects (QIP) link on the portal. 51


SUPPLEMENTAL HRA REVIEW


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Supplemental HRA Review

There are two supplemental Health Risk Assessment options:

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Supplemental HRA Options

6.28 Transitional HRA

6.17 ICF/DD and HCBS Waiver HRA

and Care Plan Supplement

Supplemental HRA Review- 6.28

6.28 Transitional HRA

•NEW enrollees (including product changes) who have had an LTCC/MnCHOICES HRA within the past 365 days.

• Review the current LTCC or MnCHOICES Summary and care plan.•By phone or in person• If unable to obtain, CC must complete a full LTCC and care plan.

•Next re-assessment HRA is due 365 days from the LTCC/MnCHOICES HRA, not completion of form 6.28.

•Not required for members who are transferred from one Delegate to another Delegate.

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Supplemental HRA review- 6.17

6.17 ICF/DD and HCBS Waiver HRA and Care Plan Supplement

• This form is used when a member is on another waiver and already benefits from another case manager.

• Regardless of having another CM, Care Coordination responsibilities are still required including:

• contacts with member and physician• health risk assessments• care planning• reassessments• all other responsibilities and timeframes outlined in the Guidelines.

• Review the current LTCC or MnCHOICES Summary and care plan.•By phone or in person• If unable to obtain, CC must complete a full LTCC and care plan.•Health related goals on 6.17 still need to be monitored and outcomes need to

be documented.55

Supplemental HRA Review- 6.17

A Screening Document does not need to be entered into MMIS. This task is completed by the HCBS or DD case manager only.

Document the date you reviewed the other case manager’s HRA/care plan on form 6.17 and as your HRA date into Bridgeview.

The next re-assessment is due within 365 days from this date.

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Supplemental HRA review- 6.17

• 6.17 must be attached to the other case manager’s HRA and care plan.

• If the other CM does not complete their assessment within your 365 day timeframe, do not enter a refusal in Bridgeview. Either complete an LTCC prior to the due date or complete form 6.17 when the other case manager’s HRA is done.

•We understand timeframes may not align; document your efforts and assess the member as soon as possible.

•A refusal for a member open to another waiver is only allowed if the member/responsible party refuses the assessment


B L U E R I D E U P D AT E S

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BlueRide Updates

We recognize that the call volume for BlueRide has increased due to new enrollment.

What is Blue Plus doing?

•Hired new Customer Service Representatives

• Implemented a call back system as of August 22nd. The system kicks on when the hold time is greater than 10 minutes. The caller will be given the option to leave a call back number and they will not lose their place in line.

•Designed a Care Coordination ride request portal. This portal is for one-way and round trip rides only. This portal replaces the email option and allows you to modify rides online.

• Extended BlueRide business hours from 7am-6pm M-F.

Note: The first two weeks of the month are the heaviest times for calls!

BlueRide Email Option

Other County workers (not care coordination staff) can still request a ride via the BlueRide Intake email box. [email protected]

Reminders:•Appointment must be 72 hours (3 days) from the date you are requesting the

ride.• Certification of Need (CON) is necessary if requesting special transportation. If

the member is already accessing special transportation, a new CON is not required. • Rides for the following month must be made after the 25th of the current

month. BlueRide can only schedule rides for active members and must verify with DHS reports.• There is a two business day turnaround for ride requests. After the ride has

been arranged, a BlueRide staff member will send a secure email back to the CC.• For multi-leg rides, please see the Care Coordination portal for the appropriate

form.

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R E L E A S E O F I N F O R M AT I O N

Release of Information (ROI)

What is covered by the MHCP application/renewal for Care Coordinators?

The release covers the sharing of medical information between health providers, school districts, health plans, insurance agencies, Minnesota Health Care Programs, county advocates, county and state case workers, and their contracted entities. This is for the purpose of determining health care payment and providing/managing/coordinating health care services.

*** In accordance with their own polices Care Coordination Delegates may choose to obtain their own release from a member at their discretion when sharing information already covered by the statement on the MHCP application.

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When Care Coordinators are releasing a member’s medical information in a manner that exceeds the scope of the MHCP application:

• Care Coordinators should obtain a Release of Information

• Care Coordinators should use their own release maintained in accordance with their own policies and procedures relating to member privacy and release of information

• Care coordinators should maintain copies of any release forms they obtain.

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General recommendations for Release of Information elements:

•Description of the information to be used/disclosed (e.g., medical information);

• Identification of the persons/parties to whom the information may be disclosed;

• Purpose of the use or disclosure;

• Expiration Date;

• Signature of the Member or Authorized Representative; and

• Statement regarding the right to revoke the authorization.

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2017 MSHO SUPPLEMENTAL BENEFITS

New 2017 MSHO Supplemental Benefits

Medication Reconciliation:

A member may have an in-home medication reconciliation from a

pharmacist during the week following discharge from a hospital or short

term nursing home stay. The pharmacist will review medications in

place prior to admission and reconcile prescribed medications at

discharge.

Home Delivered Meals

Up to two home delivered meals per day, for a period not to exceed

four weeks, are available following an inpatient hospital or short term nursing

home stay.

(Note: these are for community well and EW MSHO members only.)

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New 2017 MSHO Supplemental Benefits

Doctor on Demand

Offers live video physician or psychologist visits for

members on their computer, tablet, or phone, from the comfort of their

home. The visits may include assessment, diagnosis, therapy, and

prescriptions when necessary.

(Note: this is available to all MSHO members.)

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2016 MSHO Supplemental Benefits Continuing into 2017

• Silver & Fit Fitness Benefit

• Transportation to Silver and Fit: up to 12 visits per month

•Additional Podiatry Services:Up to 10 routine podiatry visits per calendar yearBenefit is for members who do not have a Medicare covered diagnosis in need of routine foot care

•Additional Dental Services:Allows for one additional preventive exam for a total of two exams per calendar yearAllows for two perio-maintenance dental visits for members with periodontal disease

• $750 Bathroom Safety Item BenefitMust use an in-network Durable Medical Equipment (DME) providerAll benefit or waiver options must be exhausted before use of this benefit Call the Clinical Guide Team at 1-866-518-8447 for prior authorization

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MSHO ENROLLMENT

MSHO Success

CMS and the State of MN started MSHO as a pilot in 1997 to better serve dually eligible beneficiaries ages 65 and older.

In June 2016, the federal Department of Health and Human Services published a report highlighting the success of those enrolled in the integrated MSHO program with improved outcomes.

The study compared the experiences of similar Medicare beneficiaries inside and outside of MSHO and found that MSHO enrollees were:• 48% less likely to have a hospital stay; those who were hospitalized had 26%

fewer stays• 6% less likely to have an outpatient ER visit; those who did visit an ER had 38%

fewer visits• 2.7 times more likely to have a Primary Care visit• 13% more likely to receive home and community based long term care

services (Elderly Waiver)70

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MSHO vs MSC+

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Coverage MSHO MSC+

Coverage Medicare Parts A, B, D and Medical Assistance combined into one

plan

Medical Assistance only

Insurance ID Card One ID card Three ID cards: Medicare, MSC+ and Part D plan for Rx

drugs

Customer Service One phone number Up to three numbers for 3 plans

Paperwork Reduced paperwork from only one plan Increased paperwork from 3 plans

Explanation of Benefits One document Separate EOBs from each plan

Materials One set of materials Multiple sets of materials

Medical Coverage No copay for covered services or preventive office visits No copay for Medicare preventive services but may

have office copays for non-preventive

Part B Drugs No copays Copays capped at $12/month

Part D Drugs Covered and included as part of the plan Not included; must enroll into a separate Part D plan

Nursing Home No 3 day hospital stay requirement for Medicare covered nursing

home services

Must have 3 day hospital stay for Medicare covered

nursing home services

Durable Medical Equipment Can use Blue Plus’s large DME network Must use Medicare approved DME provider

Incentives Rewards for completion of STARs related activities and preventive

visits.

No rewards

2016 Additional Benefits (varies each

year)

Silver and Fit Fitness benefit

Transportation up to 12x/month to fitness facility

Additional dental visits

Up to 10 routine podiatry visits

Up to $750 for bathroom safety items

90 day extended supply for certain Rx drugs

No additional benefits

Out of state coverage No out of state coverage except for emergencies. Medicare is primary; out of state coverage for

Medicare covered services.

Enrollment Resources

Resources for Care Coordinators include:• SecureBlue MSHO Enrollment Form•DHS/CMS approved member handouts•MSHO Enrollment Talking Points for CCs• Resources/who to contact

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I C D 1 0 D I A G N O S T I C C O D E S

ICD 10 Diagnostic codes on LTC Screening Documents

DHS has given direction that Care Coordinators (CC) should only use diagnostic codes that are part of a medical record.

• Care Coordinators should review and, if necessary, update diagnostic codes when entering screening documents into MMIS and service agreements into Bridgeview.

• If a CC cannot verify a diagnostic code: review the DHS Bulletin #15-25-11 for a “non-diagnosing provider code” to use. CC should not use any one code as a default.

• There is no requirement to contact a physician or any other diagnosing provider in order to obtain a diagnostic code to complete a health risk assessment.

• Do not utilize dx codes that has an unknown origin or that is no longer valid.

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GUIDELINES UPDATES

Guidelines Updates

All updates for September are in blue font and now posted on the care coordination web portal

Reassessments

If member is temporarily in the nursing home or hospital at the time of reassessment, a HRA is still required within 365 days. CC should use professional judgement to complete an assessment within the timeframes. Document any delays in reassessments.

Do not enter a refusal for a late assessment, even if the circumstance is unforeseen.

Case Closure Care Coordination ResponsibilitiesDate of death:•No need to notify Blue Plus. •Must send notification to the Financial Worker via DHS 5181.•May enter date of death into Bridgeview, however this is not mandatory. 76

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Guideline Updates (cont’d)

Revised TRANSFERS section under a new heading with three sub-headings as follows: • Transfers of Care Coordination to Another Delegate• Transfers of Care Coordination within your agency•Moving out of the Blue Plus Service Area

Moving out of Blue Plus Service Area •Do not send the Transfer of Care Coordination form to Blue Plus

Important reminder: Blue Plus Care Coordination does not end because the member moved out of the Blue Plus service area.

•Blue Plus is responsible for paying for EW services until member dis-enrolls. That may include situations where an EW provider in the new service area has not previously worked with Bridgeview. CC should provide them with BV contact information so they may enroll and submit claims for the services provided until disenrollment is official.

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Guideline Updates (cont’d)

HRA for other waiver, ICF/DD or DD member in community

Is there a current assessment/care plan from the HCBS waiver/DD case manager (completed within previous 365 days) that you have in your possession to review?

If no,

• You must complete a LTCC and Collaborative care plan within 30 days of enrollment as outlined in Initial Assessment section (or within 365 days if a reassessment)

If yes, • Obtain a copy and review other case manager’s assessment and care plan

• Complete 6.17 ICF/DD and HCBS Waiver Health Risk Assessment and Care Plan Supplement within 30 days of enrollment

• Attach the other case manager’s assessment/care plan to 6.17 ICF/DD and HCBS Waiver Health Risk Assessment and Care Plan Supplement and file in member’s MSHO/MSC+ file.

• All other CC responsibilities outlined in the guidelines continue to be required by the Blue Plus case manager.

Refusals by the member:• Refusals of the ICF/DD and HCBS Waiver HRA should be documented on form 6.17 ICF/DD

and HCBS Waiver Health Risk Assessment and Care Plan Supplement in the Date Assessment and Care Plan Reviewed field. This date should also be entered into Bridgeview to document the refusal date.

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C O M M U N I Q U E R E V I E W

Communiques

3.28.16 ID Card

• The PCC (Primary Care Clinic) and any reference to it has been removed from our ID cards. Blue Plus members have an open access network, which means they can see any physician in our network without a referral, and do not have to go to a clinic printed on an ID card.

• The member will still have a PCC assigned in our systems and the PCC will continue to be on the enrollment list.

• The process to make corrections to the PCC remains the same

6.6.16 Legislative Rate Increases

•Blue Plus information and instructions related to the MN Legislature authorized rate limit changes for services provided on or after July 1, 2016. See DHS Bulletin 16-25-01 for more information.

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Communiques (cont)

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7.19.16 Prior Authorization Enforcement

•Home care claims submitted by a provider without a prior authorization (PA) from Blue Plus will be denied. This may result in providers having to appeal the denied claims.

•Retroactive PAs are no longer being approved.

• To avoid a delay or an interruption of services, please complete the appropriate form and send to Blue Plus prior the start of home care services.

• 6.04.01 Recommendation for State Plan Home Care Services

or

• 6.04.03 MA Home Care Services Notification-Recommendation Non Disability

• If a provider contacts you requesting retro-approval for services already provided, you can refer them to provider services at 1-800-262-0820.


FORMS/LETTERS/RESOURCES UPDATES

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Forms, Resources, Letters Updates

The following forms were updated according to the new Person Centered requirements:• 6.02.01 Collaborative Care Plan• 6.28 Transitional HRA• 6.17 ICFDD and HCBS Waiver HRA and Care Plan Supplement

6.09 Medical Management Referral•Minor changes. Form is used to make referrals to our internal Health Coaches

for behavioral or medical short term case management

6.15 NH Member Annual Assessment-Care Plan Review•Minor changes including more ‘Comments’ boxes.

6.08 Transfer in Care Coordination Delegation• Includes fields to indicate both the ‘Old’ and ‘New’ Delegate• If any bolded item are left blank, it will not be processed. This includes the Old

and New Delegate, the residing address, effective date of transfer, and date of last assessment.• Both Delegates are now notified via email.

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Forms, Resources, Letters

6.02.03 Medicare-Medicaid Member Rights•Updated with new language block. CCs are required

to provide a copy of the Member rights to members annually with their care plan

6.12.01 CW EW Checklist MSC+•Added discussion of SecureBlue MSHO product

benefits and enrollment task

6.13.01 NH Member Checklist MSC+•Added discussion of SecureBlue MSHO product

benefits and enrollment task

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• 9.09 How to fix web browser issues•New resource with info on how to clear your browser’s web cache when

having difficulty using a website (portal or Bridgeview)

• 9.20 and 9.20.01 Nursing Home Chart Insert•Minor changes. Optional contact sheet for nursing home Care Coordinators

• 9.02.01 Partner Relations Map•Updates to PR Consultant regions

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(MSHO only)

*New* Member Handouts

• 9.23 STARS Health Care Directive SB 9-16

• 9.24 STARS Preventive Care SB 9-16

• 9.25 STARS Post Hospital Stay SB 9-16

• 9.26 STARS Diabetes Education SB 9-16

STARS Reward Vouchers

• 9.30 2016 STARS Annual Wellness Visit Reward

• 9.31 2016 STARS Mammogram Reward

• 9.32 2016 STARS Colon Cancer Screening Reward

• 9.33 2016 STARS Diabetes Eye Screening Reward

• 9.34 2016 STARS Diabetes Kidney Screening Reward

• 9.35 2016 STARS Diabetes A1C Screening Reward

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AUDIT RESULTS

Care Coordination Audit Results

Statewide audit results revealed:

• Elderly waiver files were at or above 95% in 27 of 36 elements.

•Community Well files were at or above 95% in 19 of 28 elements.

•Nursing Home resident files were at or above 95% in 8 of 11 elements.

There will be elements in next year’s audit that evaluate Person Centered Planning in assessment completion as well as in care plan creation. Please make sure you’re using the newest version of the LTCC released in July. The updated questions in the latest version will account for much of the Person Centered elements.

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QUESTIONS AND ANSWERS


THANK YOU!