New York State DOH Health Home CMART Support

New York State DOH Health Home C-MART Support Calls-Session #2 February 27, 2013 1

AGENDA � Technical Specifications Update � Change in 2012 Submission Data Requirement � Q+A Themes from February 13 th and 20 th � Definitions of Elements 1 -18 � Questions and Comments � Feedback, Help, and Ongoing Support 2

Questions? �Please submit your questions in writing to the webinar �If you would like to ask your questions, raise your hand (making sure you have entered your audio pin code) and we will unmute the call one at a time 3

HH-CMART – Technical Specifications Update � Change for Plan. ID field on bottom of page 6 and top of page 20. FFS members field will be filled in with ‘ 8888888’ not ‘ 9999’. New Specifications are available on Health Home Website � Page 6 changed ‘ 9999’ to ‘ 8888888’ � Page 20 – Changed ‘ 9999’ to ‘ 8888888’ 4

Change in 2012 Submission Data Requirement � We have received a lot of feedback about the first file submission and have decided to reduce the amount of data for the first reporting period. � The first report will only require data collected by the FACT-GP and Health Home Functional Assessment � This data will NOT be entered into the HH-CMART tool. This data will be entered into an excel document and submitted via the HCS system. A template will be introduced next week. � The date for submission of this data has NOT changed. Data from Calendar year 2012 is still due Monday, May 13, 2013 � All other reports are due no later than the first Monday of the second month following the end of the reporting period (see updated deadlines on table in next slide) 5

Reporting Periods and File Submission Dates (UPDATED) Reporting Period Report Date Element HH-CMART File Submission Date FACT-GP and Health Home Functional Initial Assessment all enrollees (Jan-Dec 2012) Excel template Monday, May 13, 2013 First Two Quarters 2013 (Jan. June 2013) 2/2013 Monday, Aug 5, 2013 Third Quarter 2013 (July-Sep 2013) 3/2013 Monday, November 4, 2013 Fourth Quarter 2013 (Oct-Dec 2013) 4/2013 Monday, February 3, 2014 For each file submission, use a copy of the original version of the HH-CMART 6

Questions and Answer Themes From Previous Presentations � FACT-GP - For a member entering a Health Home, a FACT-GP and Health Home Functional Assessment must be completed at 1) enrollment, 2) annually and 3) at disenrollment. ◦ The results of these assessments are used to adjust the risk scoring for members and applicable rates. ◦ These tools do not take the place of the comprehensive assessment needed to develop a care management plan for the member. ◦ The care manager should use all resources available for each member to ensure an appropriate care management plan is formulated. 7

Questions and Answer Themes From Previous Presentations � Field#1, Plan. ID and Members switching plans – If a member switches plans in the middle of a reporting period, the HH-CMART data should report where that person is at the end of that reporting period. � Switching Health Home within a Reporting Period- Each Health Home should have HH-CMART data to report � Data Vs. Billing - The HH-CMART tool is for data submission purposes only and is not to be intended to be used for billing purposes. � Phase 3 Health Homes-CMART Submission – Phase 3 Health Homes that have not started providing Health Home services should be reporting data starting from when they received the first assignment file and started active outreach and engagement. 8

� How Questions and Answer Themes From Previous Presentations to submit data/who submits data - Data reporting process should be determined between the Health Home and the downstream providers. The Health Home is responsible to collect all the data and submit to NYS DOH � Resources – Lead Health Homes should have passed all HHCMART files and documents to their downstream providers. If this has not occurred, contact your lead Health Home and the Department of Health. ◦ Previous Webinars are located under the February 2013 tab here: http: //www. health. ny. gov/health_care/medicaid/program/medicaid_ health_homes/meetings_webinars. htm ◦ Updated Specifications Manual and User’s Guide can be found here: http: //www. health. ny. gov/health_care/medicaid/program/medicaid_ health_homes/assessment_quality_measures/process_measures. htm ◦ Today’s power point slides and webinar audio file will be on the Health Home website by early next week. 9

Gap Analysis and Mapping Q: AIRS system and HH-CMART – Conduct a Gap Analysis/Mapping ◦ What is the element definition? ◦ Do I have it in my system? ◦ If I do, where is it? And how do I extract it to the HH-CMART? � EXAMPLE: Is there something currently being captured or documented that provides that element’s information? ◦ Yes, data is captured. Is there any reformatting or mapping that needs to be done from it’s current form to the formats specified for collection? ◦ No, there is a gap. If the information is not currently captured, how could systems change and staff trained to capture for future? 10

HH-CMART Submission Elements Each element is color coded by data collection needs for each element by reporting period ◦ Green = changes each reporting period ◦ Red = Once in, remains the same always ◦ Orange = Needs to be reviewed for new information each report ◦ Blue = DOH will fill in * Color Coding See slides from Feb. 20, 2013 Webinar power point: http: //www. health. ny. gov/health_care/medicaid/progr am/medicaid_health_homes/meetings_webinars. htm 11

Element Definitions � 1 – Plan. ID: The organization’s OMC Plan ID. FFS members should be filled in with ‘ 8888888’ If a member changes health plans during a reporting period, use the Plan. ID for the member at the end of the reporting period. HH-CMART User Manual Appendix has a list of Plan. IDs. � 2 – HHID: This is the MMIS number and will be the same for all members in the Health Home’s file. ◦ More than one Care Management Provider - If a member changes care management providers during the reporting period, the Health Home will need to combine the data for the member for the reporting period. For example, if the member is with agency A for one month and Agency B for the next two months, the data will be combined by the Health Home to one row for the member for the reporting period. ◦ More than one Health Home - If the member changes Health Homes, report the data connected with each Health Home for the partial period. Member may be in more than one Health Home file for a CM provider. HH-CMART has HHIDs in drop down on the main menu screen. * see below. 3 – Report Date: Should reflect the quarter for the end reporting period, Q/YYYY 12

� 4 Element Definitions – CIN: Medicaid Client ID Number. Valid CIN must be provided for every record and should be the CIN from the reporting period. � 5/6 – Last/First Name of member � 7 – Date of Birth of member � 8 – Trigger. Date: Imported as MM/DD/YYYY. This is the same thing as the “Begin Date” on the Health Home Patient Tracking System for the first record submission for the member. ◦ It is the first day of the month when outreach and engagement began. � 9 – Program. Type: Members should be placed in a category based on the primary issue for care management. Members may have conditions for more than one category; select the category based on the member’s primary focus for care management. ◦ Categories are – HH Behavioral health, HH Chronic Adult, HH Children, HH Developmentally Disabled, HH LTC, and Missing ◦ We use Program Type in analyses to subset populations when analyzing outcomes. This allows more focused evaluation of impact for people with similar conditions. 13

Element Definitions � 10 – Able. Contact: Indicates if Health Home was able to contact member regarding participation in care management. ◦ Contact is defined as a verbal interchange (phone or in-person) between member/ legal representative/ family and Health Home staff. Contact does not include mailings or attempts to contact (voice message or unsuccessful in-person attempt to locate member). ◦ Hiatus Period – A hiatus period is a three month span during which the Health Home cannot bill for outreach efforts for any member who has not be able to be engaged in the Health Home in the previous three months. Ongoing outreach efforts can be undertaken during the hiatus period; hiatus period signifies the billing status for the member. � 11 - Contact. Date: Completed for those who were contacted (Able. Contact = ‘YES) and left blank for those not contacted. This is the date of initial contact or verbal interchange between member/legal representative/family and Health Home staff. ◦ ‘Missing’ should be used for members who were contacted but the date is not known � 12 – Outreach. Effort: Count of in-person or phone contacts or attempts to locate and interact with the member during the reporting period. ◦ The count includes interactions or attempts prior to the member’s agreement to participate in the Health Home. The interaction where the member agrees to participate in the Health Home is not counted. ◦ Outreach contacts are reported for all members even if the member did not agree to participate in the Health Home. Efforts made during hiatus period should be included in counts even if not billing for outreach. 14

Element Definitions � 13 – Appropriate. CM: Indicates if the member met criteria for participation in the Health Home. ◦ Appropriateness may be determined through a review of data or an assessment of member needs. � 14 – Assessed. CM: Indicates if the member received an initial comprehensive assessment for needs with an initial care plan. An initial review of a priority problem is not a comprehensive assessment. ◦ A comprehensive assessment includes: physical/functional, psychosocial, environmental/residential, care-giver capability, medication lists and/or compliance). � 15 – Assess. Date: Date when the initial comprehensive assessment with care plan is completed. If the member is not assessed or not able to be contacted, the Assess. Date will be blank. ◦ The completion of the comprehensive assessment and care plan may occur over more than one interchange. In these cases the date of the interchange when the initial assessment and care plan is completed should be used as the date. 15

Element Definitions 16 – Opt. Out: Indicates if member/legal representative/family refused to participate in the Health Home. ◦ Foe members offered participate, the response should be either ‘OPTED OUT’ or ‘DID NOT OPT OUT’. ◦ For members who were not offered participation because the member was not able to be contacted or was not appropriate for participation, the response should be ‘NOT APPROPRIATE HH’. 17 - Engaged. CM: Indicates if the member agreed to participate in the Health Home. ◦ Engagement is the agreement of the member/ legal rep/ family and care manager that there is a need for care management and the member is willing to participate. 18 –Engaged. CMDate: This is the date when the member agrees to participate in the Health Home. ◦ It is the ‘Begin Date’ in the PTS for the first record submission for the member with the Outreach/Engagement code = ‘E’. ◦ If the member does not engage in CM (Engaged. CM = ‘NO’), this element through #34 will be blank. 16

Feedback and Help � We encourage your feedback ◦ Case Scenario development ◦ Clarify fields so that the thinking behind how a question is answered in the HH-CMART is the same across the board � Email the Health Home Team at HH 2011@health. state. ny. us with the Subject : HH CMART Or Call the Health Home provider line – 518. 473. 5569 � Health Home website, Assessment and Quality Metrics menu, Process Measures section: http: //www. health. ny. gov/health_care/medicaid/program/medicaid _health_homes/assessment_quality_measures/process_measures. ht m 17

Ongoing support �Weekly call every Wednesday from 10 a. m. to 11 a. m. ◦ The next call will be March 6 th �Slides from all webinars be accessed by visiting the Health Home website at: http: //www. health. ny. gov/health_care/medicaid/program/m edicaid_health_homes/meetings_webinars. htm 18