OUTREACH NAVIGATION EFFECTIVE JULY 1, 2015

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1 EFFECTIVE JULY 1, 2015 I. Breast and Cervical Cancer Control Navigation Program Overview The Breast and Cervical Cancer Control Program (BCCCP) will expand to two distinct service lines starting July 1, These are Caseload Services and Outreach Navigation Services. Each service line will have its own distinct goals. To reflect this change in program services the term Outreach Navigation will refer to those clients who are not enrolled in BCCCNP and DO NOT receive paid clinical services through BCCCNP, but instead receive Navigation Services ONLY. A. Navigation Services: Individualized assistance (navigation) to NON-ENROLLED INSURED women, </= 250% FPL) aimed at identifying and addressing the individual barriers they may have which would impede access to screening, diagnosis and/or treatment services. Women provided Outreach Navigation Services will NOT count in the agencies BCCCNP caseload. Medicare clients and HMP clients eligible to receive navigation services. These clients are NOT eligible to receive Caseload Services. B. Caseload Services: Assist ENROLLED insured and underinsured women in obtaining appropriate screening, diagnostic, and/or treatment services in a timely manner. Women receiving at least ONE (1) reimbursed service through the BCCCNP WILL COUNT in the agencies BCCCNP caseload. Please see Caseload Services Policy for more program service information C. Navigation Defined A BCCCNP Navigator is an agency staff member who provides individualized assistance to women. The navigator will identify and assist individual women in overcoming individual barriers. Navigation services can be provided by one person or shared by several individuals. The person providing navigation services will depend upon the type of navigation services required. Addressing non-clinical barriers (i.e. transportation) does not need a health care professional to provide services. Some navigation services will require clinical oversight and a health care professional (RN, Advanced Nurse Practitioner, Physician, Physician Assistant) is needed to assure timely and appropriate delivery of diagnostic services for an abnormal breast or cervical screening abnormality. July 2015 Page 1

2 II. OUTREACH Navigation Services* Introduction: A. Introduction 1. Beginning July 1, 2015, Outreach Navigation Services* will be provided to NON- ENROLLED INSURED* women meeting BCCCNP age and income requirements. 2. OUTREACH Navigation is aimed at identifying and addressing the barriers (Table 1) that may interfere with INSURED women < 250% FPL receiving screening/ diagnostic and/or cancer treatment. *Insured clients include Healthy Michigan Plan (HMP) clients AND Medicare clients. These clients are eligible for Navigation Services ONLY, not Caseload Services. B. Reimbursement for OUTREACH Navigation* 1. Agencies will be reimbursed $60.00/client upon: Data entered into entered into the Michigan Breast and Cervical Information System (MBCIS)* Completion of client screening and/or diagnostic procedures Initiation of cancer treatment services in BCCCNP MTA (if diagnosed outside BCCCNP) or through own insurance provider. Continuation of cancer treatment services (Yearly at re-determination date) if enrolled in BCCCP MTA. 2. Documentation Required for Reimbursement of Navigation Services Information from each client encounter is documented on individual Navigation Services Encounter Forms (See attached) Client data from the Encounter Form needs to be documented in MBCIS. 3. Agencies can bill for Outreach Navigation Reimbursement AFTER all required documentation AND the Navigation END Date is entered in MBCIS for the client. Authorization for payment is generated when Navigation End Date entered Billing date is the same as the Navigation End Date Use CPT G9012 Coordinated Care; Case Management Services Not Elsewhere Classified (NEC). From July 1 September 30, 2015 use ICD-9 code V65.49 Beginning October 1, 2015 use ICD 10 code Z71.89 (Other specified counseling). 4. Agencies that billed Medicaid for client navigation prior to July 1, 2015: Cannot bill both Medicaid and BCCCNP for Outreach Navigation Services. Should ONLY bill BCCCNP for Outreach Navigation Services. NOTE: If insured client receives an abnormal breast or cervical screening result but cannot obtain diagnostics through her insurance company because of a high deductible she is eligible to enroll in BCCCNP Caseload Services. Agency will NOT be reimbursed $60.00 for this client. Client WILL count in Agency s Caseload if Diagnostic Services paid by BCCCNP. Agency will receive $ for this client. July 2015 Page 2

3 Table 1: Barriers to Receiving Healthcare Outreach Navigation Version Barrier Type Barrier Detail Ideas for Barrier Resolution System Barriers Access Barriers Has trouble scheduling appointments No health care provider Difficulty getting time off from work Complexity of health care system ( not sure where to start) Other 1. a.) Determine reason for scheduling difficulties. Phone tag, provider not answering calls assist as necessary b.) Schedule appointment for the client 2. Assist with finding and scheduling with a provider that takes client s insurance. 3. Assist client with finding facility that can schedule at times convenient to client and advocate for provision of services a time that does not risk a client losing her job 4. Identify what the client needs (screening or diagnostics), and what are the barriers to getting that done. (who to call, where to go, what paperwork is needed) Financial Barriers 1. Insurance Issues 2. Transportation Problems 3. Family Care issues 5. Refer client to health care facilities in a neighborhood or near public transportation whenever possible 1. a.)provide education on how to use insurance b.) Assist with finding a provider; how to determine services covered/not covered by insurance, arrange for appointments 2. a.) Identify transportation options, friends, family, church, b.) provide financial assistance through public transportation, cabs, gas cards 3. a.)identify child care options including family, friends, church and other community organizations. b.) Identify appointment times that will not create child care issues and advocate for appointment times that are not a conflict. July 2015 Page 3

4 Psychosocial Barriers Communication Barriers 1. Education importance of screening 2. Education on diagnostic procedures to decrease fear 3. Address concerns re: abnormal result/cancer diagnosis 4. Other 1. Need interpreter 2. Literacy issues 3. Communication concerns with medical personnel Reasonable Transportation assistance can be paid for with BCCCNP funds: Bus Passes, Gas Cards, Contracts with cab companies for reduced rates 1. a.) Provide education to BCCCNP clients regarding cancer and the importance of cancer prevention and early detection b.) Provide education on the process of cancer screening c.) Assess client beliefs/fears about cancer and the tests/ treatment associated with it; provide education and emotional support 2. Provide education and answer questions on the importance and process of follow-up care on abnormal screening results 3. Provide support, education and referrals to a client with abnormal results or a cancer diagnosis 4. Advocate in the health care system for culturally competent care for women who need alternations to normal care process to meet the client s cultural customs 1. a.) Provide translation services as required for non-english speaking clients b.) Multi-media education messages (i.e. web links) available in languages common to your area. 2. Clients typically will not identify to you literacy issues, however, identify where possible literacy issues. Provide low-literacy clients alternative learning materials through verbal instruction, pictures and video. 3. Identify where clients have concerns around provider communication. Educate, advocate and refer as appropriate to resolve communication concerns July 2015 Page 4

5 III. OUTREACH Navigation*: EFFECTIVE JULY 1, 2015 A. Intake Assessment: Outreach Navigation of INSURED Clients (< 250% FPL) 1. Outreach Navigation will be provided to insured, eligible women requiring assistance with obtaining needed breast/cervical cancer services through their insurer. 2. During the first Outreach Navigation encounter the BCCCNP navigator* will: a. Perform a needs assessment to identify: Indicated screening/diagnostic and or treatment services and Potential barriers (Table 1) that may impede receipt of identified services. b. Obtain socio-demographic information from the clients (See attached Intake Assessment Form) c. Explain the Outreach Navigation program services and assistance provided by navigator based on the information provided to the navigator by the client. B. Provision of Outreach Navigation Services The BCCCNP agency navigator will: 1. Implement strategies to resolve identified barriers so the client can receive needed breast/cervical screening services through the healthcare system. 2. Assist the client in obtaining indicated screening and/or diagnostic and/or treatment services. 3. Identify a date to contact the client to determine if required services were received and/or if any further assistance is needed. 4. Document on the Navigation Encounter Form and in MBCIS*, type of navigation services provided: screening, diagnostic, and/or treatment. C. Termination of Outreach Navigation Services Outreach Navigation services end when the client completes the required screening/diagnostic services and/or begins cancer treatment. 1. If Service/Diagnostic Results Normal (NO Cancer diagnosed) Navigation Ends Client added to recall/anniversary list to contact in one year to determine if navigation required in obtaining screening services. Enter Navigation END Date in MBCIS. Navigation END date is the last date of contact with the client. July 2015 Page 5

6 2. If Screening/Diagnostic Results Abnormal (Cancer Diagnosed) a. Client s cancer treatment covered by insurance Client assisted with obtaining treatment through insurance. Navigation ends when cancer treatment begins. Navigation end date is date of cancer treatment b. Client s cancer treatment partially/not covered by insurance. Client given option to terminate insurance coverage and enroll in BCCCNP MTA. For Breast Cancer Clients: Contact MDHHS Navigation Consultant for assistance with referral to breast cancer patient navigator in client s community. Refer to ACS for additional resources. Navigation end date is date client begins cancer treatment. 3. Client did not receive scheduled screening/follow-up services. BCCCNP navigator determines why services not received. Further contacts, if needed, determined by navigator based on patient needs and adherence to screening/diagnostic services. Check Navigation Pending on Encounter form and enter date for next contact. If client no shows for scheduled services or decides to not obtain a scheduled service (refuses) contact MDHHS BCCCN Program Director or Navigation to discuss client s case. D. Outreach Navigation* Staff Requirements: 1. Outreach Navigation services can be provided by one person or shared by several individuals. 2. The BCCCNP navigator does not need to be a health care professional to provide non-clinical services to enrolled clients. 3. Unmet client needs are identified and then, if needed, divided among team members based on the skills of each team member. 4. Specific responsibilities: Identifies client specific needs for obtaining: screening, diagnostic, and/or treatment services Assesses/addresses barriers to receiving care. Assists client with scheduling services* July 2015 Page 6

7 *NOTE: Navigator DOES NOT Schedule clinical services for client NOR obtain screening/diagnostic exam results EXCEPTION: MTA CLIENTS (PER MTA POLICY) MUST obtain pathology report confirming cancer Copy of Client Identification Copy of citizenship information Identifies date to contact client to determine if screening/diagnostic services received and further navigation services needed. Assures all required information is documented in the Outreach Navigation Services Component of the Michigan Breast and Cervical Information System (MBCIS) according to program procedures. IV. Annual Re-Screening for Insured Clients A. For HMP referred clients: 1. Through an established linkage with Medicaid, the Michigan BCCCNP can identify if former BCCCNP women referred to HMP have enrolled a. This information will be used to determine if the client receives annual screening services. b. If the client is enrolled in HMP but has not received her screening services, she will be contacted by the BCCCNP navigator and encouraged to schedule the required screening. B. For Marketplace Insurance referred or insured clients: 1. The client will be placed on a recall list and contacted by the agency navigator at a specified date (yearly) to determine if she has obtained insurance. 2. If she has obtained insurance, she will be asked if she has obtained the needed screening services through her insurance provider. If screening services have not been received, she will be assisted to complete these services. 3. If she does not have insurance, she may be re-enrolled in BCCCNP to receive these screening services. V. Outreach Navigation for Medicaid Treatment Act Clients A. Effective July 1, 2015 ALL BCCCNP MTA clients will become Outreach Navigation Clients 1. Agency is required to follow the procedure for verifying cancer diagnosis, identity and citizenship as described in the BCCCNP MTA Policy. 2. MTA client contact information MUST be entered in the MBCIS OUTREACH NAVIGATION database July 2015 Page 7

8 B. NEW MTA Clients: 1. On Outreach Navigation Intake Assessment Form: Check YES in the BCCCNP MTA Client Section and complete the Client Contact Information ONLY 2. On the Outreach Navigation Encounter Summary: Complete Client Last Name, First Name, Birth Date, Phone Number, and MBCIS number is known. In the BCCCNP MTA Clients ONLY Section check the Enrollment box Enter Enrollment Date on form. Enrollment Date = Date the MTA application is signed. This is also the FIRST ENCOUNTER Date. Enter First Encounter Date in MBCIS. Navigation Begins. 3. MTA Follow-up Date OR MTA END date a. For clients diagnose with CIN 2/CIN 3-CIS: MTA End Date entered as SECOND ENCOUNTER Date* in MBCIS. $60.00 per MTA client will be paid to the agency when SECOND ENCOUNTER date is entered in MBCIS. Verify client has completed treatment PRIOR to entering SECOND Encounter Date in MBCIS. Navigation Ends b. For clients diagnosed with Invasive Breast/Cervical Cancer, DCIS or LCIS: Contact client 3-4 months after treatment is initiated to verify client is receiving treatment, and to determine if additional navigation resources are needed. Follow-up date contacted is entered as the SECOND ENCOUNTER Date* in MBCIS. $60.00 reimbursement per MTA client will be paid to the agency when SECOND ENCOUNTER date is entered. Navigation Ends C. For RENEWING MTA Clients (Yearly Re-determination) 1. Complete the following in the BCCCNP MTA Clients ONLY Section on the Outreach Navigation Encounter Summary: Check the Re-Enrollment box Re-Enrollment Date = Date the MTA application is signed. This is also the FIRST ENCOUNTER Date. Enter this date in MBCIS. Navigation Begins. July 2015 Page 8

9 2. Follow-up Contact Date Contact client 3-6 months after MTA re-enrollment application signed to verify client is still receiving treatment and to determine if additional navigation resources are needed. Follow-up Contact Date is entered as the SECOND ENCOUNTER Date* in MBCIS. $60.00 reimbursement per MTA client will be paid to the agency when SECOND ENCOUNTER date is entered in MBCIS. VI. Quality Improvement Evaluation A. Data will be collected, analyzed, and evaluated on 1. The total number of women provided Outreach Navigation Services in BCCCNP; goal is 4000 women for Program Year The total number of women provided Outreach Navigation Services per agency. 3. Number of days (time period) for navigation services to be completed. (Calculated as number of days from Navigation Start Date to End Date) 4. Types of barriers encountered by the client. 5. Client receipt of cancer screening, diagnostic testing, and/or treatment services. Reasons for not completing services (refused, cannot locate, other will be documented in Outreach Navigation MBCIS. July 2015 Page 9

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