MI Health Link. DWMHA Provider Roundtable Meeting January 25, 2016, 9am-11am 1/25/2016

Transcription

1 MI Health Link DWMHA Provider Roundtable Meeting January 25, 2016, 9am-11am 1

2 Welcome and Introductions Provider Organization Roll Call DWMHA Department Roll Call 2

3 MI Health Link Program Updates Enrollment Level I Referrals Admissions/Transitions _2945_ ,00.html 3

4 MI Health Link Ombudsman Program Contact Info MI Health Link Ombudsman Toll Free at MHLO ( ) Monday - Friday 8 A.M. to 5 P.M. help@mhlo.org 4

5 5

6 6

7 7

8 8

9 MI Health Link Level 2 Referrals Sent to ICO & Pending By Provider from to n= UPG Detroi PsyGe nics, JVS ACCES Wayn Adult Guida Wayn t Detroi South STEP ACC e Well- nce CLS North Devel New Hegira CCS opme TMHS LBS NSO DWM S e Centra t East west east Center HA Inc. Center Being Ctrs nt Ctrs State l City 9 Sent to ICO Pending

10 250 MI Health Link- All ICO Admission as of Molina HAP/Midwest AmeriHealth Fidelis Aetna Total Inpatient Readmits < 30 days Connected with Appts Still Inpatient

11 Authorization Updates Dana Lasenby Service provision for MI Health Link requiring mild to moderate services was reviewed Expect 2/15/16 as a start date for the improved authorization request process. Process for State Psychiatric Hospitalization Placement How do modifiers work with authorizations already in the system? A. We may need to do a cross walk to ensure new authorizations are not rejected and that there is a smooth transition. If an enrollee has authorizations in the system and presents to another provider, how will they know how many units of service are available? A. The new provider will need to enter appropriate requests for authorizations based on their assessments. Generally speaking, there is an opportunity for the enrollee, the new provider and the former provider to coordinate the care. Potential for an Authorizations Profile in MHWIN. More discussion on this topic. 11

12 Procedure Code Work Group Updates Mary Allix Review the history of the Procedure Code Work Group An external PCWG will be Bulletins posted on the website. Providers have an opportunity to volunteer to be part of the external PCWG. Members of the external PCWG will be selected. The Bulletins will be the source of truth for codes to be used for MI health Link, Autism or SUD services. What is the process for billing injectibles? A. Injectible answers will be discussed at the upcoming Procedure Code Work Group. E&M Codes Bulletin will be forthcoming. Please send any questions to Bulletin on Assessments is on the DWMHA website 12

13 Claims Updates Tracey Lee Where to get the 835 when processing a batch of claims? A. It is in the Claims Management module, under the "View AP Checks to Vendors and Print EOB and Remittance Advice" link. The providers should be used to going there to see their payments and print remittance advices. That screen has a lot of options for each Check #/EFT that the provider has. The download 835 will only appear on batches that were sent as an 837, all others just have the other links such as "Print remittance advice", "Print EOB", "Download EOB in Excel", etc. How do we void a claim that s been adjudicated and paid in MHWIN? Voiding a claim is called reconsideration. A reconsider form will be revised and available for MI Health Link providers on the website. The DWMHA will be going to bi-weekly check runs. Valid claims must be in the system by Wednesday at 12noon. 13

14 Contractual/Quality Monitoring Updates Ricarda Pope-King We have been on this journey since August, May 1, 2015 is when the contract went into place, are in the third quarter of this contract year. Expect Starlit Smith s team will start coming out to your provider sites and review the MI Health Link contractual obligations. Some of those reviews will be adherence to the Level II Assessment turn around time lines. Contract management will be working with the providers to address opportunities of improvement. 14

15 Level I Referral/Access/Appointment Issues/Level IIMI Health Link Enrollees May Change ICOs Reminder that if a provider receives a referral that is in service with another provider. Send an to pihpcarecoordination@dwmha.com requesting to have the referral put on the other provider s level II queue. The Level I referrals will continue and be ramped up as their year of enrollment comes around again, May,

16 Level 2 Provider Support Flow Chart Level 2 Referral Que Review your assigned providers daily Provide MH Win support where needed Does Provider have a good understanding of MI Health Link What are the barriers to meeting the timeline. Identify areas of opportunity ICT Meetings Discuss with providers ICT Record number of ICT that have taken place Provide assistance where needed IICSP Has IICSP taken place What are the opportunities and successes of MI Health Link Record Information and report in weekly Integrated Healthcare Huddle 16

17 Group Scenario #1 1. I had a new consumer, an identified enrollee of MI Health Link whose referral date was 1/13/16. The enrollee was scheduled for an intake on 1/21/16 and they called to cancel without rescheduling. The referral documents were due to be sent to the ICO on 1/28/16. I called the enrollee on 1/23/16 and left a voic , and then I tried again on 1/24 but the phone number was not in service. 17

18 Scenario #1 Take Aways - When a level 2 referral is received, the assigned worker needs to document that the referral was received on the date it was placed in the provider queue. - There is a 15 day time period from receipt of a referral for a level 2 assessment to be completed. - From the date of a no-show, there are 7 days in which to make 3-5 attempts to complete the level 2 assessment. These attempts are through phone, mail, etc. to reschedule appointment as this is a great opportunity to engage new enrollee in the exceptional behavioral health services you provide. - If an enrollee has a non-working or wrong number in the chart, the ICO care coordinator should be contacted in order to explore other contact options. - All attempts to complete a level 2 assessment need to be documented in the notes section of the referral. - Once all avenues are exhausted to contact an enrollee, if you cannot complete level 2 state reason within the note section of the referral unable to reach or declined to participate request the referral to be closed. 18

19 Scenario #2 2. A consumer has been in service with my agency for a few months, and I was made aware the consumer is now an enrollee with MI Health Link Health Plan, a level 2 referral was placed on my provider queue. The referral date was 1/24/16. I attempted twice to contact enrollee, once on 1/25 and again on 1/27, and had to leave a voic each time. Both attempts were documented in the notes section of the referral. The last time I saw the enrollee was on 1/21/16 and there have only been minimal environmental changes with the enrollee s case. 19

20 Scenario #2 Take Away - Staff should check MI Health Link Level 2 request que in MH Win Daily. - An assigned worker documents receipt of the referral in the notes section of that referral. - If an enrollee has been in service with a provider and the enrollee was recently seen and/or is well-known to a provider, then there will more than likely be enough information to complete a LOCUS assessment if one has not been done within the past 12 months. A Bio-psycho-social (BPS) is assumed to have been completed as this is part of intake process. Send the LOCUS/SIS and BPS to ICO immediately. - The ICO requires, at the very least, the LOCUS/SIS/ASAM assessments and therefore a referral should not be held in the queue until the BPS. However, you cannot send Integrated BPS that includes ASAM without a Consent to Share completed. Provider should contact enrollee and get Consent to Share signed immediately to not delay the referral even if it requires a home visit. - On next visit enrollee should receive MI Health Link Handbook and should review ICO Care Coordinator Contact information to prepare for ICT meeting. 20

21 Scenario #3 3. I met with an enrollee to complete a level 2 assessment, my EMR is not connected to MH WIN. I couldn t attach the level 2 documents to the referral. I scanned the documents in my computer (in PDF format) and saved them on my desktop. I uploaded all three documents into the all scanned and uploaded documentation section in MH-Win, and then I got a call from the care coordinator from DWMHA in a few days asking me about updates. 21

22 Scenario #3 Take Aways - The all scanned and uploaded documentation area in the consumer chart is not connected to the referral module for level 2 request. Therefore, only using this area will not allow you to send level 2 to ICO. - The LOCUS/SIS/ASAM, BPS, and consent must be scanned and uploaded into the level 2 module of MH WIN by completing the ICO is provided your information as Behavioral Health Care Coordinator. You must open the module answer all pertaining fields and upload each document separately, review that you see all uploads under your completed response to the referral then Save and Send to ICO. An ASAM will require an MDCH consent form. - If there are no notes indicating actions taken on a referral (in the notes section of the referral), remember to check the box for all notes that you want the ICO Care Coordinator to receive without checking the box notes will remain in referral but will not accompany information sent back to ICO. - If you have difficulty completing the referral within MH-WIN please contact your assigned PIHP Care Coordinator for technical assistance, if unknown send 22 immediately to pihpcarecoordination@dwmha.com and request assistance.

23 Scenario #4 4. I have completed a BPS and the SIS referral has been sent to the assigned MCPN. I obtained the MDCH consent form and documented all this in the notes section of the referral. After the referral became overdue, I figured I would just wait until I heard from the MCPN and complete referral. I document this activity on 11/15/2015 and I did not add any more notes since I was waiting for the SIS. I got a call from the care coordinator at DWMHA in January asking about updates, and with so many other things going on, I feel frustrated because I have been waiting on the SIS. 23

24 Scenario #4 Take Aways - It is important to document in the notes section of the referral reasonable attempts to gain information related to the status of SIS assessments. Support Coordinators work with SIS Assessors with scheduling the assessments therefore you are responsible to stress the importance of completing this assessment asap with all parties, ie. Enrollees, Assessors, and Guardians. Updates such as scheduling, delays, and ETA should be documented. - If it is known that a member receiving IDD services is eligible for MI Health Link but no level 2 referral have been requested, a SIS assessment can still be requested to MCPN as all IDD members should have one completed. Supports Coordinators can contact pihpcarecoordination@dwmha.com and request assistance with coordinating enrollee to receive a level 1 assessment. 24

25 Scenario #5 5. An enrollee of MI-Health Link was scheduled for their level 2 assessment on 1/23/16 and they were a no-show. I documented this in the notes section of the referral that day. I had been particularly busy that week so I called the enrollee on 1/26/16 and left a voic . On 1/28/16 I did the same thing. I contacted a member a third time on 2/1/16, and felt as if I had done my due diligence. 25

26 Scenario #5 Take Aways - When an enrollee has a scheduled appointment to complete a level 2 assessment and they no-show, it is important to make 3-5 attempts to complete the level 2 within a 7-day time frame. It is my obligation to ensure that I complete this referral request as soon as possible as this is part of my new business (The New Health Plan that my company accepts) so I have to make time for this process in my daily activities. - If an enrollee is already in service consistently and there has been no significant change in level of care, there may already be enough information to complete the Level 2. Therefore, the existing assessments I have completed for this consumer can be uploaded/attached to a level 2 request and sent to ICO in the allotted 15-day time frame. An ASAM will require an MDCH consent form. - On consumers next scheduled session I will provide MI Health Link Handbook, review contact information for ICO Care Coordinator and inquire when and who consumer would like to be present at ICT meeting as this is the opportunity for me to create addendum updates to IPOS to include ICO Care 26 Coordinator roles and responsibilities.

27 Scenario #6 6. I am fully aware of the 15 day time period from the level 1 referral date in which I am to complete a level 2 assessment. I have a new MI Health Link member scheduled for a level 2 assessment. The referral date on the queue is 1/1/2016, and this enrollee s appointment is scheduled for 1/12/16 (within the time frame). The member was a no-show at their appointment on 1/12, and I knew I had 2 days to complete the level 2 from that date. I contacted the enrollee on 1/13 and left a message. On 1/14 the enrollee called back and indicated the reason they were a no-show was because they did not have transportation. 27

28 Scenario #6 Take Aways - Enrollees now have access to transportation services via their ICO, I will assist member in scheduling transportation services through ICO. - Reschedule the appointment and document these outcomes within the note section of the referral to support the efforts in completing the level 2. - I will contact ICO Care Coordinator introduce myself and role, explain why the level 2 assessment will be late, inform that transportation is a barrier to accessing services for enrollee so ICO Care Coordinator can assist enrollee with obtaining transportation services for physical health appointments. - We are a team that will work to assist enrollee to limit access issues for the service/care that member has reported will improve quality of life. 28

29 Scenario #7 7. I completed the LOCUS/SIS and BPS for a MI Health Link enrollee s level 2, and I attached the LOCUS/SIS to the level 2 after uploading the BPS. The enrollee left the appointment without signing the MDCH consent form, and their next appointment is scheduled outside the 15 day time period. 29

30 Scenario #7 Take Aways -An MDCH consent was created with consumers in mind who are receiving substance abuse treatment. -Although the ICO has requested the BPS, LOCUS/SIS, and the consent, a LOCUS/SIS is the main document they require. A BPS and consent can be sent to ICO Care Coordinator later time by method of choice as we will be in constant communication with each regarding consumer/enrollee. 30

31 Scenario #8 8. I have been seeing a consumer for several months and we have made progress with their goals. I found that them on my calendar for a level 2 assessment. Remembering the guidelines, I documented the fact that I received the referral and began to reach out. Unfortunately, I have not been able to reach them even though I went as far as to make 5 documented attempts within the 15 day time period from the referral date. I am worried that if I speak with the ICO and DWMHA the referral will be closed despite all of our progress. 31

32 Scenario #8 Take Aways -A referral is simply a referral, and the member will more than likely continue in services. The documented attempts are essential on the dates they occur, and enlisting the help of the ICO care coordinator may help. Request PLEASE KEEP REFERRAL OPEN and continue with efforts to complete the level 2 assessment. -Again, if the enrollee s level of care has not significantly changed, you may already have at least enough information to complete the level 2 in order to send to ICO. 32

33 Acute Care Policy Overview 33

34 Overview of Acute Care Process Psychiatric Intervention Center (PIC) will notify DWMHA Care Coordinator (CC) of MI Health Link admissions CC will contact the hospital and obtain verbal information related to enrollee s discharge needs CC notifies the Integrated Care Organization (ICO) of admission via secure using the standardized Communication Notice CC will support and ensure enrollee becomes or remains linked to outpatient behavioral health services CC will support specialized residential process by each MCPN, as appropriate 34

35 Overview of Acute Care Process (continued) The hospital SW will fax or send electronically via secure pertinent enrollee discharge information to include demographic information, aftercare appointment date and time as well as discharge medications CC will share the discharge information with the ICO by updating the Communication Notice and sending via secure CC will follow-up with the behavioral health service providing agency to ensure that the Integrated Care Team (ICT) and subsequent treatment planning is completed and includes the ICO 35

36 Acute Care Process Addition Though the CC includes behavioral services provider s clinicians (therapists/case managers) when enrollees are admitted psychiatrically, it will be an expectation that a behavioral service provider clinician participate in the discharge planning of a rapidly readmitting enrollee who has been assigned but not yet opened with a behavioral service agency If the enrollee has not begun behavioral services with an agency, the CC will contact the case management/act services supervisor to request that a case manager be assigned and deployed to the appropriate hospital this is only for rapidly readmitting enrollees CC, hospital treatment team, enrollee, and behavioral health services representative will engage in the discharge planning meeting to encourage the chances of enrollee being connected to outpatient services 36

37 Communication We are here to help make this a smooth program. a. pihpcarecoordination@dwmha.com b. pihpauthorization@dwmha.com c. pihpclaims@dwmha.com d. pihpprovidernetwork@dwmha.com e. procedure.coding@dwmha.com f. Provider- MI Health Link 37