Seniors and People with Disabilities Information Memorandum

Transmittal

Meg Killgorecathcart Number: SPD-IM-08-091

Authorized Signature Issue Date: 12/9/2008 Topic: Systems Issues

Subject:SPD Systems related changes in preparation for the new Medicaid Management Information System (MMIS).

Applies to (check all that apply):

All DHS employees County Mental Health Directors Area Agencies on Aging Health Services Children, Adults and Families Seniors and People with Disabilities County DD Program Managers Other (please specify):

Message: In preparation for the new MMIS, modifications were made to both Oregon ACCESS and the SPD Mainframe related Systems. As of Monday, December 8, 2008, Oregon ACCESS Release 22.10 changes and enhancements were available. As of Today, Tuesday, December 9, 2008, the Mainframe changes and enhancements are available. Please see the attached description of the changes and enhancements included in the latest release/modifications. Following, are the list of the attachments: - MMIS Provider Overview - Oregon ACCESS Provider Changes - Oregon ACCESS Misc. Changes - Nursing Facility Authorizations - AMH Services Changes - Managed Care Enrollment If you have any questions about this information, contact: Contact(s): OIS Service Desk Phone: 503-945-5623 Fax: E-mail: Dhs.servicedesk@state.or.us

DHS 0080 (02/04)

MMIS Provider Overview Background: With the implementation of the new MMIS replacement system, it has been necessary to make changes to SPD mainframe systems and Oregon ACCESS. In the old MMIS all the provider information was in the MMIS provider file. You could see the information in the DMAP PRV1 and the SPD PRV8 screen and our systems could read the data files directly. The new MMIS will also have all the providers in their system. You will see the information displayed in the Provider section of the MMIS application. Our other DHS systems do not have direct access to the new MMIS data. SPD will continue to have a database of the MMIS provider information that can be used by Oregon ACCESS and other systems for case management, service planning and other processing. The SPD PRV8 will display information from the SPD database. Provider Enrollment: Enrollment will work similar to the way it does now. All HCW enrollment information will be entered into Oregon ACCESS and then sent to the new MMIS. Enrollment information for all other provider types will be entered directly into the MMIS centrally. While the basic concept and process is similar the actual information changed is quite different. For example, the new MMIS has different provider type and status codes, and it handles dates and addresses differently than before. Conversion A complete conversion of the old MMIS provider data has been done. An initial load of all existing provider information was processed and stored in the new MMIS and in our newly structured SPD database tables. The new MMIS will provide us with nightly downloads of any updated provider information. The information will be sent to us after business hours before any claims processing jobs are ran. We will store this information to be used throughout the mainframe and Oregon ACCESS. This should cut down on any delays with updated provider information to be used in claims processing. Different Information and Screen Displays The new MMIS uses different codes and data than we are used to. For consistency, we have updated our systems to use some of the terms and codes that

are used in the new MMIS. To reduce the impact of the changes we kept the screen layout as much the same as possible. These changes will be visible on the mainframe screens SPVF, PRV8 and the claim screen in the Client Pay-In System. Changes to Current Provider Data Provider Id: In the new MMIS the State Medicaid Provider number contains 9 digits. The good news is that for all of the providers that were converted from the old MMIS we will continue to use their 6 digit provider numbers in most cases. On some screens you may see the 6-digit number displayed with three leading zero’s. For example, if a provider has a current provider id of 612345 it may look like this: 000612345. This is true when non-SPD providers are displayed in the SPVF and PRV8 screens. As providers are added they will be issued a 9-digit number. If the provider is paid from an SPD system the SPD database will also issue a 6-digit number. Provider Type: The new MMIS contains new provider types. The old two-character type was converted to a two digit numeric type with a three digit numeric specialty. A list of those types will be provided. You can also see a short description on PRV8 that will make the transition easier to decipher. Entity: The Entity codes have changed. These are displayed on PRV8. CII – CIIS LQ – Long Term Care and Quality CDP – Count Developmental Disability Program IH – In-Home Program Program: On the new PRV8, this is the area that shows when a provider is active. Only the active periods are displayed. After the start and end dates of the program period you will find the program status, for example, AActive or an end reason of BTERMD. This is very different from what we are used to. In the past we would see all the lines and the reason described the entire line not just the last status. Program Status: The new MMIS uses a one-character field for provider status that ranges from 1-Z. To make the transition easier, the program status has been translated on SPVF so that you will see a value of I=Inactive and A=Active. On PRV8 the program status is displayed as a 7-character field using our old two-character code as part of the value in the front. For example, AA will now be displayed AACTIVE.

Old PRV8 example (two active lines, one inactive line) 06/20/2008 12/31/9999 AA 02/27/2008 06/19/2008 BT 03/01/1992 02/26/2008 AA New PRV8 example (both lines active) 06/20/2008 12/31/9999 AACTIVE 03/01/1992 02/26/2008 BTERMD

Current SPVF SPVF Provider Find 11/14/2008 SSN/TIN: (OMAP/MMIS) Prov Nmbr: Sounds Like:_ Prov Name Last: APPLE First: CAKE Business Name : ENRL STAT SSN/TIN City/ST Prov # Typ *** PROV NAME *** APPLE, CALL R ID 555-55-5551 PORTLAND, OR 664974 HK APPLE, DREAM B BT 555-55-5552 FOREST GROVE, OR 506897 AF APPLE, DRYERS BT 555-55-5553 FOREST GROVE, OR 502239 AF APPLE, EAT IC 555-55-5554 NEWBERG, OR APPLE, EAT BT 555-55-5555 NEWBERG, OR 500874 AF APPLE, EAT BT 555-55-5556 NEWBERG, OR 503751 AF APPLE, EAT BT 555-55-5557 NEWBERG, OR 596192 AF APPLE, JACKS ID 555-55-5558 PHOENIX, OR 598912 HK APPLE, KATE ID 555-55-5559 TILLAMOOK, OR 761809 HK APPLE, NORMA J IC 555-55-5560 HALFWAY, OR 701053 HK APPLE, ORANGE AA 555-55-5561 SALEM, OR 694974 HK APPLE, PIE VW 555-55-5562 TILLAMOOK, OR 761791 HK 70000I Read F3=Exit F8=Fwd F10=PRV8-DETAILS F11=Find F12=SPVM

This is the current provider find screen used on the mainframe called SPVF. The changes will be described below.

New SPVF

SPVF PROVIDER FIND 11/14/2008 SSN/TIN: (OMAP/MMIS) Prov Nmbr: Sounds Like:_ Prov Name Last: APPLE First: CAKE Business Name : ENRL STAT SSN/TIN City/ST Prov # Typ *** PROV NAME *** APPLE, CALL R I 555555551 PORTLAND, OR 667744 73 APPLE, DREAM B I 555555552 FOREST GROVE, OR 555551 70 APPLE, DREAM I 555555553 FOREST GROVE, OR 555552 70 Apple, Dryers I 555555554 WILSONVILLE, OR 000043562 16 APPLE, EAT I 555555555 NEWBERG, OR 555553 70 APPLE, EAT I 555555556 NEWBERG, OR 555554 70 APPLE, EAT I 555555557 NEWBERG, OR 555555 70 APPLE, EAT I 555555558 NEWBERG, OR 555556 70 APPLE, JACKS I 555555559 PHOENIX, OR 555557 73 APPLE, KATE I 555555560 TILLAMOOK, OR 776644 73 APPLE, NORMAN I 555555561 HALFWAY, OR 701053 73 Apple, Orange 555555562 Salem, OR 73 APPLE, PIE I 555555563 TILLAMOOK, OR 761791 73 APPLE, ROBERT I 555555564 NYSSA, OR 000211111 34 70000I Ready F3=Exit F7=Bkwd F8=Fwd F10=PRV8-DETAILS F11=Find F12=SPVM

Provider Name-The name will be now displayed in all CAPS or upper and lower case Enrl Stat- Changed to a 1 character field the values are: I=Inactive A=Active Prov #- Will be displayed as a 6 digit or 9: 6=Paid by SPD 9=Paid by MMIS Typ- Has been changed from a two character value to a numeric value

Old PRV8

PRV8 555551 OMAP Provider File Information 11/15/2008 Prov ID 555551 Prov Type AF SSN/TIN Ind S NMBR 555-55-5552 Prov Name APPLE, DREAM B Name Typ P DOB 03/13/1953 IRS Name FICA Ind 2 Phys Add1 Exc (DCR 1099) N Addr 16000 S ABIQUA ROAD FIPS Cnty 067 City/St FOREST GROVE, OR Zip 97381-0000 MAIL Add1 Addr City/St Zip 00000-0000 Tele 503-555-5555 Nat PHARM Prov Loc(ST) 01 Prov Prac 1 *** Credentials / Enrollment Status **|************** Facility ********* Pgm Code NHF Br (Lic) 3411 | Beds(Nmbr) 1 Beds(Lic) 1 Est Enrl (Rec Create Date): 03/01/1992 | Rel(only) N Non Rel(commercial) Y 1-Enrl Stat AA Enrl Beg 06/20/2008 | Res Y 2-Enrl Stat BT Enrl Beg 02/27/2008 | Prov Cert COM 3-Enrl Stat AA Enrl Beg 03/01/1992 | Contr Y Contr # 4-Enrl Stat Enrl Beg | Lic Beg 06/20/2008 5-Enrl Stat Enrl Beg | Contr End 05/31/2009 Last Chg: 08/08/2008 08:07:27 HSSKS01 Orig Appl 03/01/1992 MSG: MSG: F1=Help F2=PRV7-Add/Updt F3=Exit F12=Rtn-SPVM

This is the old PRV8.

New PRV8

PRV8 538199 MMIS Provider File Information 11/15/2008 Prov ID 538199 Prov Type 70-700 AF-Adult APD FC Prov Name APPLE, DREAM B Name Typ P DOB IRS Name FICA Ind 2 Phys Add1 16000 S ABIQUA ROAD SSN/TIN Ind S NMBR 570-92-9847 Addr FIPS Cnty 067 City/St FOREST GROVE, OR Zip 97381-9703 MAIL Add1 Addr City/St Zip 00000-0000 Tele 503-555-5555 Prov Loc(ST) 01 Prov Prac 1 *** Credentials / Enrollment Status **|************** Facility ********* Br (Lic) 3411 Entity: LQ | Beds(Nmbr) 1 Beds(Lic) 1 Est Enrl (Rec Create Date): 03/01/1992 | Rel(only) N Non Rel(commercial) Y PROGRAM: | Res Y SPD 06/20/2008 12/31/9999 AACTIVE SPD 03/01/1992 02/26/2008 BTTERMD Last Chg: 10/23/2008 CNV Orig Appl 03/01/1992 MSG: MSG: F1=Help F3=Exit F12=Rtn-SPVF

Prov Type - Includes the provider type and the specialty assigned to a provider. It also provides a short text description of the specialty. Entity - The program responsible for licensing. Program - Contains the program they are representing, the dates the provider is eligible to be paid through and the current status of the provider.

Oregon ACCESS Provider Changes With the implementation of the new MMIS, it was necessary to make modifications to both the mainframe and Oregon ACCESS. The underlying database that Oregon ACCESS uses for provider data was changed significantly. This attachment will address Oregon ACCESS only. The most significant visable changes were made to the provider search functions and the provider maintenance screens. In other areas we had small changes like displaying the 9-digit number or changing the way address we selected for a form. Provider Maintenance We will cover the changes on the following screens:

• Provider Search (Provider Maintenance) • Provider Overview • Provider Detail

The following Provider Maintenance screens had no changes or the changes were minimal:

• Credentials - No changes • Address - Minimal changes but an important note: When you add a

provider, if you only enter a physical address on the provider add screen then the physical address will be populated into both physical and mail. The new MMIS must have an address in each field even if the address if the same. Do not erase the mail address and leave it blank. Also you must change the mail address any time you time you change the physical address and the mail address should be the same. The new MMIS cannot default to the physical address when the mail to address is blank.

• Tax Info-Minimal changes (Updates to tax name must be made here) Provider in Other Parts of Oregon ACCESS Since provider information is used throughout Oregon ACCESS changes had to be made in many areas. There were be very minimal changes to the following screens:

• Provider Search to Select for Service - expanded the prov nmbr field – o Important Note: to look up a non-SPD provider you must use the

nine-digit number (the old DMAP number with three leading zeros) • Medical services Tab - expanded the prov nmbr field • Medical Trans List - expanded the prov nmbr field • Provider Report – displays all numbers assigned to a provider (six-digit,

nine-digit or both)

Current Oregon ACCESS Provider Search Screen

We hinformnew p

ad to make the new provider search screen scroll in order to display the new ation coming from the new MMIS. There will be three screen shots of the

rovider search screen shown below.

The New Oregon ACCESS Provider Search Screen

Changes are listed here on first scroll:

1) Renamed ‘OMAP/MMIS Prov Nmbr’ to ‘Prov Nmbr’ 2) Expanded field Prov Nmbr to accommodate 9 char prov id. SPD paid

providers will retain their old legacy 6 character provider. Any new SPD paid provider added through the new MMIS will also be assigned a 6 digit provider id to be used for payment. All other provider id’s will remain 9 digits

3) Change column header ‘OMAP#’ to ‘Prov #’ 4) Changed ENR (enrolment status) column to a 1 byte value that will either

display A for active or I for inactive 5) Number displayed in the Prov # column will be as follows:

a. For providers that are paid from a SPD maintained payment system, it will always display a 6 char provider number b. For all other providers, it will display the 9 digit MMIS provider number

6) Type column will display will display the new type and specialties that is used in the new MMIS

The second provider search scroll

7) The Type column is the new MMIS provider type and is right next to the

The new provider specialty

The third provider scroll

Current Provider Overview

New Provider Overview

1) In the Detail section the providers address was added to give us more room to display other information at the bottom

2) On the Provider Credential/MMIS Prov Info we also added and rearranged the screen to provide more information. We will display both of the SPD Prov # and the MMIS Prov #

3) The ENR status will display a longer description of our old two character code in the beginning with the rest of the characters following

4) The Enr Date will have two sets of dates. A beginning and an ending date for which the provider is active.

5) The new MMIS Provider Type and Specialty will be displayed here with the primary specialty of the provider displaying first. Note: Homecare Workers will only have one specialty 6) Added Tax information at the bottom of the overview screen

New Provider Detail

1) On the provider detail we now have the capacity to store two e-mail addresses. If you enter a primary address on the add screen then it will be populated into both the primary and the secondary however, you can modify them.

2) The preferred name will be on the top of the record and in the other name fields you will automatically see the same name called mail to name repeated. The name types options are now legal, mail-to, and preferred. You can no longer enter or modify a tax name here. You must enter or make changes to the tax name on the tax id panel.

3) We know have more options to enter different contact number for the provider by using phone type and phone codes. If you enter a contact phone number on the add screen it will automatically fill in the same number in these types shown here. You can modify any of the phone numbers whenever appropriate

Oregon ACCESS Misc. Changes & Fixes - Release 22.10 • CAPS 2 Assessment Wizard

o Prior to this release, the Assessment Date defaulted to the date the assessment was created in the wizard. The default has been removed because of a significant number of Service Desk requests to change the date after the Assessment was completed. The user will now be required to manually enter the Assessment Date.

o Prior to this release, the status of a pending PAS assessment was

changed from Pending to Incomplete after 45 days. This has been changed to 60 days to be consistent with other assessment types.

• CAPS 2 Service Planning

o The Clear Assigned Hours button on the Assignment of In-Home Hours screen will now reset the Total Hours Assigned fields to 0.

o The CAPS 2 Home Delivered Meals screen and form were changed.

The changes are as follows: ♦ The Rate field on the 595 Details screen has been removed in

CAPS 2. This field is no longer required with the implementation of MMIS.

♦ The Large Meal, Unit Price, Total Cost and Total Amounts fields were removed from the 595 N form. Minor wording changes were also made to the form.

o Per SPD-PT-08-022, the SDS 514 form found on the DHS Forms

Server must now be used when requesting an exceptional rate. The 514 Details window has been changed to read only in both CAPS and CAPS 2. This provides the ability to view information previously entered in these areas and prevents new information from being entered. The 514 and 514N forms have been removed from the forms list in Oregon ACCESS.

• Integration ENRC is being replaced by the new MMIS system. During integration an informational window will appear with Managed Care Enrollment Information in place of the ENRC option screen. See the Managed Care Enrollment attachment for more information.

• Remote ACCESS o The entire provider database will no longer be downloaded when a

case or assessment is checked out. This means no provider search can be performed in remote mode.

o Only providers on the case or assessment at the time of check out will

be downloaded. If a provider cannot be downloaded for some reason, “Provider Not Downloaded” will appear in the Provider Name field.

o The “Send 512 To” box will now be disabled in remote mode.

• LDS / Pay-In Report

The Amount column on this report has not been consistently calculating correctly for some time (pre-CAPS 2). As a result, this column was removed. The form will otherwise operate as before for CAPS and CAPS 2 cases.

Nursing Facility Authorizations Assessments, Service Category/Benefit, Level of Care and Plan of Care

How Information is Sent to the new MMIS Some information from Oregon ACCESS is sent to the SPD Service Eligibility system on the mainframe (SSEQ) and from there on to the new MMIS. MMIS needs to know the service category, the benefits and the level of care/rate level. In the old system the level of care was entered directly on the ELGF screen as part of the authorization. The new MMIS stores the level of care as part of the Recipient information. The level of care is used to obtain the correct rate for the NF services. We needed a way to collect the level of care/rate level on the SPD service eligibility side we can provide the information to the new MMIS. A Service Eligibility record is created or updated when a service category/benefit is approved or ended in the Client Assessment and Service Planning component of Oregon ACCESS. This action also triggers the mainframe Service Eligibility system to send information to the new MMIS. In order to make this work within the current structure we chose the Oregon ACCESS service category/ benefit selection as the place where the level of care information can be entered and transmitted to the other systems. In Service Eligibility on the mainframe the OA service category/benefit code will be split into two data items; the service category code of NFC and a separate data field with the level of care. The CM case descriptor code will always match the service category (NFC) and will not need to change when the level of care changes. We added an Oregon ACCESS service category/benefit code for each level of care or distinct rate. NFC - Basic All Inclusive NF2 - Pediatric NF3 - Comp Med Add-On NF4 - Enhanced Care NF5 - Outlier NF6 - Out of State NF NF7 - Benedictine You will normally choose NFC – Basic service category/benefit. When you are notified that a client is eligible for another level you need to first

end the NFC – All Inclusive Care on the appropriate day and then start the new service category/benefit with the effective date of the new level of care. Approving this benefit will update the SPD Service Eligibility (SSEQ) on the mainframe and then carry over to the new MMIS. You must then go into the new MMIS and update the Plan of Care details in the same way that you used to update ELGF – close the old line and open a new one so that the dates match. This works much like the CBC/512 records. Reminder: Remember you only need an NFC service category/benefit when the client is in long-term care. You do not need one for Medicare skilled stays.

AMH Service Cases (BPM case coding) Services provided to clients under the programs of the Division of Addictions and Mental Health will be paid out of the new MMIS. AMH will no longer be using the SPD Service Eligibility system (SSEQ/SL01) for their programs. This affects the AMH records in one of two ways: AMH Residential Programs – Starting December 1, 2008 the authorization and payment for all AMH residential services will be handled through the new MMIS. All the Community Based Care (CBC/512) records for AMH services (MH002 and MH003) have been closed effective 11/30/2008. We won’t be changing the existing BPM service eligibility records until we are sure all the past CBC claims have cleared. As time goes on these records will be closed or expire. 20-Hour Personal Care – This is an SPD Program that AMH clients can access. The BPM service category will continue to be used when a client is receiving 20-Hour Personal Care under the SPD rules and an AMH case manager authorized the service. The payment processes for this program are not affected by the new MMIS. Client Maintenance System (CMS) Coding AMH Clients CMS will no longer require a BPM case descriptor for AMH clients who have the residential coding added (MAN and MAR case descriptors with MVC need). These AMH cases should also have the NSS – No SPD Service Category case descriptor. Note: The coding for SPD Service Categories (DDC, APD, NFC, ICP, etc.) has not changed.

Managed Care Enrollment In the old MMIS system, local office staff used the ENRC and KSEL screens to enroll clients in managed care. Those screens are no longer available now that the new MMIS is implemented. In their place, two new screens have been created. The W238 and the W239 screens.

• The W238 screen looks and operates much like the old ENRC screen. • The W239 screen looks and operates much like the old KSEL screen.

Updates made on these screens will be sent to the new MMIS using a “real time” interface. While the new screens look and function much like ENRC and KSEL, there are some important differences.

• The new screens cannot be accessed directly like ENRC and KSEL. The new screens may only be accessed from the SCMS screen on the mainframe.

• The SCMS screen, in turn, is only available after a UCMS update is performed and a suspense record is created. There are a few ways to create a UCMS suspense record

o If you integrate from Oregon ACCESS successfully, a CMS suspense record will

be created. You may then go to the SCMS directly by typing SCMS,{case number} on a blank mainframe screen and pressing enter.

o If you do not need to make any changes to your CMS case, but need to update the

enrollment data, you may create a suspense record by doing the following: On the UCMS screen, enter the daily security code near the top of the

screen. Enter CHANGE in the incoming code field. Generally you should

use the first of the month as the effective date (Eff Date field) unless a change needs to be done on a specific date.

Press F9 to save the record, and you will be taken to the SCMS screen. From SCMS, press F17 to access the W238 screen. (see above for screen

shot)