IA Health Link and Amerigroup Iowa
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1 IA Health Link and Amerigroup Iowa Navigating the Transition to Amerigroup Foster Care Caretaker Orientation 1
2 Who is Amerigroup Iowa? A partner with the Iowa Department of Human Services (DHS), which administers Medicaid through the IA Health Link program One of three statewide managed care organizations (MCOs) selected to offer Iowa Medicaid and Health and Wellness Plan coverage through the IA Health Link program 2
3 Why is there a transition? The Department of Human Services (DHS) looked at ways to redesign managing care in the Medicaid program. DHS identified a need for enhanced care coordination and service integration for adults and children. Amerigroup Iowa was chosen as one of four MCOs to address this need in Iowa to: Enhance quality of care and access to services Improve health outcomes Create a more predictable and sustainable Medicaid budget 3
4 Program overview Amerigroup will coordinate care and benefits Same Medicaid benefits, based on medical necessity Children in foster care, subsidized adoptions or guardianship are covered if they meet the state s eligibility guidelines Independent enrollment brokers are available through Iowa Medicaid Member Services to provide: Information on current Medicaid managed care plans Conflict-free choice counseling in choosing an MCO 4
5 Amerigroup Iowa s main goals Our goals in helping qualified Iowa children in foster care, subsidized adoptions and guardianship stay healthy include: Integrating care as part of members overall health care Improving members well-being and health outcomes 5
6 What s staying the same? Case managers will stay involved in decisions on*: Medical care Placements Safety issues Medication Transportation Service choices * For children in foster care, guardianship or subsidized adoption assistance. 6
7 Care coordination team What s changing? 24/7 Amerigroup On Call/Nurse HelpLine, available in over 150 languages Psychotropic medication management Standardized reporting and monitoring of health outcomes and key performance indicators Ombudsman for member advocacy 7
8 What is care coordination? We ll help arrange the care youths need by: Assigning a Care Coordination Team Helping them partner with a care coordinator and case manager, who will identify and refer services to meet their needs, including: Special health care needs Transitional supports as youths reach adulthood Continuing to offer care through Integrated Health Homes and Chronic Condition Health Homes (for eligible youths) 8
9 What does an Amerigroup care coordinator do? Care coordinators: Help youths get needed services by finding gaps in both physical and behavioral health care Educate families and team members about the service needs of youths All youths will have a care plan to address their physical and behavioral health needs. 9
10 Amerigroup Member Services Our Member Services representatives are available to answer questions about your health care benefits, member handbook, ID cards and more You can call them Monday through Friday from 7:30 a.m. to 6 p.m. Central time (except holidays) 10
11 Psychotropic Medication Management Every youth with one or more psychotropic* medicines will have their medicines looked at by the Amerigroup Iowa medical director or pharmacy review team. The goal is to ensure: Evidence-based medication guidelines are followed for youth The medicine is right for the diagnosis *Psychotropic medicines pertain to drugs that affect mood. 11
12 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) checks (Iowa s EPSDT program is Care for Kids) Early Identifying problems early, starting at birth Periodic Checking children's health at periodic, age-appropriate intervals Screening Doing physical, mental, developmental, dental, hearing, vision and other screening tests to detect potential problems Diagnosis Performing diagnostic tests to follow up when a risk is identified Treatment Treating the problems found 12
13 EPSDT checks (cont d) EPSDT Checks include: Health and developmental history Physical exams Immunizations appropriate to age and health history Assessment of mental/behavioral health Family planning services and adolescent maternity care Tuberculin (TB) risk review and skin test Nutrition review Vision and hearing screenings 13
14 Periodicity Table INFANCY EARLY CHILDHOOD MIDDLE CHILDHOOD ADOLESCENCE AGE 1 Prenatal 2 Newborn d 4 By 1 mo 2 mo 4 mo 6 mo 9 mo 12 mo 15 mo 18 mo 24 mo 30 mo 3 y 4y 5 y 6 y 7 y 8 y 9y 10 y 11 y 12 y 13 y 14 y 15 y 16 y 17 y 18 y 19 y 20 y 21 y HISTORY Initial/Interval MEASUREMENTS Length/Height and Weight Head Circumference Weight for Length Body Mass Index 5 Blood Pressure 6 SENSORY SCREENING Vision 7 Hearing 8 DEVELOPMENTAL/BEHAVIORAL ASSESSMENT Developmental Screening Autism Screening Developmental Surveillance Psychosocial/Behavioral Assessment Alcohol and Drug Use Assessment 11 Depression Screening 12 PHYSICAL EXAMINATION 13 PROCEDURES 14 Newborn Blood Screening 15 Congenital Heart Defect Screening Critical 16 Immunization 17 Hematocrit or Hemoglobin 18 Lead Screening 19 or 20 or 20 Tuberculosis Testing 21 Dyslipidemia Screening 22 STI/HIV Screening 23 Cervical Dysplasia Screening 24 ORAL HEALTH 25 or or or or Fluoride Varnish 26 ANTICIPATORY GUIDANCE 14
15 Initial health screen The initial health screen is the first tool we use to help develop the best plan to meet your child s health care needs. The initial health screen is available: In your child s New Member Welcome Package you can complete this copy and return it in the self-addressed envelope provided, or Online you can log in and complete the assessment at The initial health screen should be completed within 90 days of enrollment. 15
16 Taking Care Of Baby and Me This program offers support for mothers who are going to have or just had a baby, offering: Fast answers to their health questions 24/7 when calling Amerigroup On Call at (TTY 711) A special gift when going to a prenatal checkup A pregnancy book that shows easy ways they can take care of themselves 16
17 What is the role of the Amerigroup ombudsman? The Amerigroup ombudsman office provides private, fair help to members, their representatives and caregivers of Amerigroup Iowa members who have health care-related issues. We work with advocacy groups and state agencies to discuss trends and issues within the community, too. To reach the Amerigroup Ombudsman office, call , ext
18 Value-added Benefits In addition to your child s regular Medicaid benefits, Amerigroup offers extra benefits and services, plus the Healthy Rewards program. FREE Boys & Girls Club Membership for kids 6-18 at participating clubs in your area (excludes summer camp) FREE comfort item, such as a stuffed animal or journal for eligible children FREE personal backpack for belongings for eligible children LiveHealth Online so members can video chat with a doctor on their smartphones, tablets or computers, day or night FREE Healthy Families Program Our program has information on exercise, making healthy choices and more for eligible children 18
19 No copays Value-added Benefits (cont d) High School Equivalency Test (HiSET) Assistance covers the cost of a prep course and a voucher to take the test for free Mobile and web access to change doctors, update personal information, find community events, order a new ID card and more 19
20 Online self-service tools Member ID cards can be accessed online using the Amerigroup ID number.* All basic functions such as changing a PCP or finding a provider can be accessed online* or by calling Member Services. Anyone can research available PCPs or other providers online. Only approved Amerigroup personnel can make changes to this information through the member website or Member Services. * 20
21 Contact Us Amerigroup Member Services: Phone: (TTY 711) Online: Amerigroup Ombudsman: , ext Iowa Medicaid Member Services:
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