Health Home Enrollment System

Transcription

1 Health Home Enrollment System User Guide for Health Home Providers Web Portal Prepared for the Office of MaineCare Services Maine Department of Health and Human Services Prepared by the Muskie School of Public Service, USM Nicante, Inc. Version 1.0; January 2013

2 Health Home Enrollment System Web Portal -- User s Guide for Health Home Providers MaineCare, in partnership with Medicare, Anthem BCBS, Aetna, and Harvard Pilgrim Health Care, has participated in the multi-payer patient centered medical home (PCMH) demonstration project. The multi-payer pilot will expand from its initial 26 practices to include 50 new practices in January MaineCare has worked closely with the multi-payer pilot to align with Maine s Health Homes Initiative. Upon approval of Maine s Health Homes SPA, anticipated for January 2013, MaineCare s participation in the multi-payer pilot will be through its Health Homes Initiative. In addition to the 76 practices participating in the multi-payer pilot, MaineCare has identified approximately 58 additional practices that are also eligible to qualify as Health Homes outside of the multi-payer pilot. In all, 134 practices (approximately one-third of MaineCare primary care providers) will meet criteria to be Health Homes. Maine s PCMH pilot and Health Homes initiative include Community Care Teams (CCTs). CCTs throughout the state partner with PCMH practices to better coordinate and connect the highest need patients to additional healthcare and community resources. Under Maine s Health Home initiative, the PCMH and the CCT together form the Health Home. Section 2703 of the Affordable Care Act establishes the State Option to Provide Health Homes for [Medicaid] Enrollees with Chronic Conditions. This option encourages states to develop a Health Homes program, under which the State may receive a 90% federal match for two years, to provide Medicaid beneficiaries that have two or more chronic conditions or a serious and persistent mental health condition, the following services: Comprehensive care management Care coordination and health promotion Comprehensive transitional care from inpatient to other settings Individual and family support Referral to community and social support services Health promotion Use of health information technology Health Homes will be implemented in two stages Stage A and B. Stage B Health Homes will provide health home services for adult members with serious mental illness and children with severe emotional disturbances. Stage B Health Homes will be implemented later in Stage A includes members with selected chronic conditions and will be implemented as of January 1, A complete list of qualifying conditions for Stage A and B can be found in Appendix A. The Health Home Enrollment System (HHES) web portal is to be used by Health Home Providers to manage members acceptance for Health Home Services. The HHES system allows the provider to review their health home panel, add and delete members in the panel and monthly attest to the provision of health home services. Web Portal: The web portal for HHES can be found: Note: All member Information in user guide is fabricated. Page 1

3 Figure 1: Health Home Enrollment Portal Entrance Accessing HHES: You must register with the Muskie School of Public Service in order to gain access to the Health Home Portal. Click on the here link on the Login page to enter your provider information (Figure 1). This includes name, phone, , pay to provider tax ID, and provider site (Figure 2). A Username will automatically be assigned to you or you can change it to the username of your choice. Click the Request Access button (Figure 2). When your information has been processed, you will be contacted by the Muskie School of Public Service with a password (Figure 3). Please contact Catherine Gunn at the Muskie School of Public Service for any questions on registration for the site: cgunn@usm.maine.edu; phone: (207) ; fax: ( ). Note: All member Information in user guide is fabricated. Page 2

4 Figure 2: HHES User Registration Page Figure 3: User Registration Confirmation Note: All member Information in user guide is fabricated. Page 3

5 Passwords: Passwords must be at least 8 characters long and contain at least one number and one special character (special character Passwords are case sensitive. Passwords will expire every 60 days. There will be a warning message on the website dashboard letting you know how many days are left before the password must be changed. The menu on the left hand side of the screen has an option to change the password. If the password has already expired, you will be prompted to change it at that moment. You will be asked to enter your current password (the one that is expiring) and then enter your new password. If you forget your password or get locked out of the site, please contact Catherine Gunn ( ) to reset it. If the site has not been used for more than 15 minutes, you will be returned to the Log In page. After your account has been activated enter your username and password, and click the log in button (Figure 4). Note: All member Information in user guide is fabricated. Page 4

6 Figure 4: Health Home Enrollment Portal Your Health Home provider information will be displayed (Figure 5). You will see the number of members in your panel and the number of pending members. Pending members are not yet on your panel. Your Provider Menu will be on the left hand side of the screen. Figure 5: Provider Home Page Note: All member Information in user guide is fabricated. Page 5

7 Provider Panel: The Provider Panel option will show you the rendering providers at your sit based on MIHMS enrollment information (Figure 6). Figure 6: Provider Panel Page Member Panel: This menu option will display all the members that are active in the Health Home program for your site (Figure 7). Claims analysis was used to identify members with qualifying conditions. Providers will also be able to identify members with qualifying conditions that were not identified through claims. Figure 7: Member Panel Page Select a member to view the member panel and see their information and conditions of eligilibity (Figure 8). Note: All member Information in user guide is fabricated. Page 6

8 Figure 8: Member Detail Page Member Additions: This screen dispays the members that are pending Health Home membership or auto-assignment (Figure 9). The Previous Member Requests and Auto-Assignments section will show who was approved and who was denied. Denials may be due to Member opt-out or for other program related reasons. This screen will also allow you to request the addition of a member that you believe should be included in the Health Home program. Note: All member Information in user guide is fabricated. Page 7

9 Figure 9: Add Member Page In order to request a new member, you must enter their Member ID number and Date of Birth (Figure 10). Figure 10: Add Member Example Note: All member Information in user guide is fabricated. Page 8

10 Click the Validate button to locate the member in the system (Figure 11). After the member has been validated, a list of chronic conditions will be displayed. Click the check box(es) next to the conditions the member possesses in order to be eligible for the Health Home program. You must also confirm that the evidence of these conditions is in the EMR. The request cannot be submitted until both the conditions and EMR confirmation have been entered. Figure 11: Add Member Example The member will be added to the Member Additions page under Pending Member Requests with Provider Request in the Reason column (Figure 12). Figure 12: Example of Pending Member Addition Note: All member Information in user guide is fabricated. Page 9

11 This request will be forwarded to the Maine Department of Health and Human Services for approval. The decision from the State will be displayed in the Member Addition page under the Previous Member Request section (Figure 13). If the request was approved, the member will be added to your site s Member Panel. Figure 13: Example of Member Addition Acceptance Note: All member Information in user guide is fabricated. Page 10

12 Member Attestation: The Member Attestation page will list all of your active members in the Health Home program (Figure 14). This is where you will attest to the provision of Health Home services for a member at some time during the calendar month. This must be completed by midnight of the last day of each calendar month. After checking the Attest check box for each member, you must click the Save Attestation button in order for the attestation to go through. By checking the member boxes and saving the attestation, you are attesting that your practice has performed the minimum billable activity required by Section 91 of the MaineCare Benefit Manual to receive a monthly payment for these members. The enrolled Health Home members have received monitoring for treatment gaps and/or patient engagement and outreach activities. Your practice s monthly management fee will be calculated based on the members attested to for a given month. Figure 14: Monthly Attestation Screen Note: All member Information in user guide is fabricated. Page 11

13 Member Termination: The Member Termination page will allow you to remove members from your panel and to view previous terminations. If you wish to remove a member from your site s panel, choose the member by name and date of birth (Figure 15). Select the reason for termination. Click the Terminate Member button. The member will be placed in the Member Termination History section. No further action is required on your part (Figure 16). Figure 15: Member Termination Screen Figure 16: Member Termination Example Note: All member Information in user guide is fabricated. Page 12

14 Those members who were eligible for the Health Home program but did not wish to take part will be displayed in the Previous Member Requests (Figure 17) and Auto-Assignments section with the description as Opt Out of Health Home Services. Figure 17: Member Opt-Out Example Note: All member Information in user guide is fabricated. Page 13

15 Note: All member Information in user guide is fabricated. Page 14

16 Reports: There are two different reports available for providers: 1.) Member Panel Report 2.) Member Attestation Report Figure 18: Provider Reports Member Panel Report This report will list all the members in your panel. Choose the panel date you wish and click the View Report button. You will be prompted to save a PDF for viewing and printing. Figure 19: Member Panel Report Note: All member Information in user guide is fabricated. Page 15

17 Member Attestation Report This report will list the members in your Health Home program with the list of those that were attested to in the month chosen. If the Attestation Date Time and Attestation By columns are blank, then that member was not attested to in that month. You will be prompted to save a PDF for viewing and printing. Figure 20: Monthly Member Attestation Report Note: All member Information in user guide is fabricated. Page 16

18 Appendix A Stage A Qualifying Conditions (starts 1/1/2013) Substance Use Disorder Diabetes Asthma Heart Disease Overweight or Obesity (Body Mass Index (BMI) over 25) Chronic Obstructive Pulmonary Disease (COPD) Hypertension Hyperlipidemia Tobacco Use Developmental Disorders (Intellectual Disabilities and Autism) Acquired Brain Injury (ABI) Children Only o Seizure Disorder o Cardiac and circulatory Congenital abnormalities Other Mental Health (Non Serious Mental Illness (SMI)) o Psychosis with origin specific to childhood o Stress and adjustment disorders includes: o Acute reaction to stress o Adjustment reaction o Personality disorders o Disturbance of Conduct o Disturbance of Emotions o ADHD Hyperkinetic o Neurotic Disorders o Depression NEC o Other mental disorders includes: o Sexual deviations and disorders o Physiological malfunction arising from mental factors o Special symptoms or syndromes, not elsewhere specified o Specific non-psychotic mental disorders due to organic brain damage o Psychotic factors associated with diseases specified elsewhere Stage A Qualifying Service Use For selected conditions, use of certain services was also considered for Health Home eligibility Developmental Disability defined by use of MR Waiver Service Use ( 26) or ICFMR Service Use ( 40) Acquired Brain Injury (ABI) defined by use of Rehabilitative Service Use ( 102) Diabetes defined by use of Insulin Stage A At Risk Conditions Chronic conditions considered to put a member at risk of another condition: Other Mental Health (non-smi) Substance Use Disorder Diabetes Heart Disease Obesity COPD Hypertension Note: All member Information in user guide is fabricated. Page 17

19 Hyperlipidemia Tobacco Use Developmental Disorders (Intellectual Disabilities and Autism) Cardiac and circulatory abnormalities A member with one condition that is ABI, Seizure Disorder or asthma is not considered at risk for another condition. One more condition is required to qualify for Health Home Services. Stage B Qualifying Conditions (Start date to be determined) Stage B Adults Severe Mental Illness (SMI) Includes: o Schizophrenic Disorders o Major Depression o Bipolar and other affective disorders includes: Manic Disorders Bipolar Affective Disorders Other and unspecified manic-depressive disorders Other and unspecified affective psychoses o Other psychoses includes: Transient organic psychotic conditions Other organic psychotic conditions, chronic Paranoid states or delusional disorders Other non-organic psychoses o Any member receiving Community Support Services ( 17) Stage B Children with SED Children having an SMI diagnosis as defined above or using one of the following services Home & Community-Based Treatment ( 65) Children s ACT ( 65) PNMI Stay ( 97) Inpatient Psychiatric Stay ( 45 with Dx and 46 ) Note: All member Information in user guide is fabricated. Page 18