FFS Iowa Health Home Program IMPA Pamela Lester

FFS Iowa Health Home Program IMPA Pamela Lester RN, BSN Program Specialist March 2019

Objectives • Understand how to submit an enrollment request. Update an assessment or disenroll. • Learn the reporting functions within IMPA to know when patients are actively enrolled, assessments are coming due and attesting for payment. 2

Enroll a Patient 3

Enroll Patients: Log into IMPA, hover file and select health home 4

Step 2 • Select the NPI from the drop down list (Not all providers in the list may be health home providers; as the NPI drop down is based on the security and the group they were assigned to. ) • Select the address for the provider. This is based on the NPI and address. • Enter the state id and click on Continue. 5

Click on New 6

Verify State ID 7

Identify if the State ID matches the name and DOB 8

Patient is a dual or a waiver 9

Patients on a Waiver Make Quarterly contact with the identified case manager 10

Enter Assessment Date, Tier and Relating DX Codes, click enroll 11

You have just submitted an enrollment request. • • An enrollment request must be extracted and then processed before final approval of eligibility is established. Month end processing occurs roughly around the 20 th of each month (except February). An enrollment request can be: – – Eligible for enrollment and not assigned by the month end process Eligible for enrollment and assigned to the health home by the month end process Not eligible for enrollment at this point in time Pending enrollment. A pending enrollment request is where an existing request for assignment has not been finalized. 12

Month End Dates 2019 5 th Business day before the end of the Month. • • • April 24, 2019 May 27, 2019 June 24, 2019 July 25, 2019 August 26, 2019 • • September 24, 2019 October 25, 2019 November 25, 2019 December 24, 2019 13

Types of Waivers • • Aids/HIV Elderly Health and Disability Intellectual Disability Children Mental Health Brain Injury Physical Disability 14

Enrollment Request Pending 15

Patient is enrolled 16

Update an Assessment 17

Update an Assessment: Log into IMPA, hover file and select health home 18

Enter State ID Click Search Click Select 19

Click Update 20

Enter Date, Tier, Reason and related DX codes. 21

Reasons • Tier Change • Assessment Date and Tier Change 22

Dis-enroll a Patient 23

Dis-enroll Patients: Log into IMPA, hover file and select health home 24

Enter State ID Click Search Click Select 25

Click Dis-enroll 26

Select Reason and Click Dis-enroll 27

Reasons • • • Member Request – A member can request to dis-enroll from the program as this is a voluntary program to participate in. Provider Request – A provider can request disenrollment on behalf of a member. Death Failure to comply – This would be when a member is not abiding by the agreement they signed with the provider. The provider can dis-enroll them. Unable to assign IHH – This reason is specific for the IHH (will not be used for health homes) Enrolled in HCBS Waiver – This patient has a waiver that requires them to be in the IHH for TCM services or patient has a care manager and you do not agree to talk to the case manager quarterly. 28

Available Reports • Current Enrollment Activity Report The current report provides information on members for a given NPI (national provider identifier). Any patient that has a change in status or an update will show up in this report. This is only for the current month. • Billing Report The current report provides information on all of your members enrolled in the program. • Assessment Coming Due The assessment coming due report will provide for those state id that are currently enrolled in Medicaid and have an assessment coming due within the next 3 months. 29

Available Reports Continued • • Member Roster Report The Assigned report provides a listing of members assigned to a health home or an integrated health home. The Unassigned report provides a listing of members that are no longer assigned or have never been assigned to a health home or an integrated health home. The Not Processed report provides a listing of members that have requested enrollment into a health home or an integrated health home and will be processed at month end processing. Participating Waiver Members Report This report provides users with a listing of eligible and enrolled members that are also participating in an active waiver program along with their case manager contact information. The information provided in this report is for the current month only. 30

Guide for Health Home Services • This guide helps identify Possible health home services and aligns with PCMH 31

Not Processed Provides a listing of members that have requested enrollment into a health home or an integrated health home and will be processed at month end processing. Approximately 6 business days before the end of each month. – The information provided on this report are: • State id • Name • Assessment Date • Tier • Assigned • Last Action Date 32

Member Roster Not Processed 33

Assigned Provides a listing of members currently assigned to a health home or an integrated health home The information provided on this report are: • State id • Name • Assessment Date • Tier • Assigned • Last Action Date 34

Assigned 35

Unnassigned Provides a listing of members that are no longer assigned or have never been assigned to a health home or an integrated health home – The information provided on this report are: • State id • Name • Assessment Date • Tier • Assigned • Last Action Date • Reason 36

Unassigned 37

Participating Waiver Members Click on Review then participating waiver members. Enter NPI, select address and click continue. 38

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Questions? Medicaid Health Home Program: Pamela Lester Health Home Program Manager Healthhomes@dhs. state. ia. us 515 -974 -3050 http: //www. ime. state. ia. us/Providers/healthhome. html 40