CCO Packet
Contact Information Rena Cleland-Health Home Program Manager [email protected] 1-800-869-7175 ext. 144069
Ashley Mitchell-Health Home Senior Contract Specialist [email protected] 1-800-869-7175 ext. 144125
Sara Ashley-Health Home Trainer [email protected] 1-888-562-5442 ext. 142020 Molina Numbers Prior Authorization Call 1-800-869-7175 and ask for Prior Authorization Inpatient Prior Authorization Call 1-800-869-7175 ext. 141194 Community Connector Secure email [email protected] Case Management Secure email [email protected] Patient Review and Coordination (PR&C) Secure email [email protected] Disease Management Secure email [email protected] Pharmacy Call 1-800-213-5525 Option 1,2,2 (external phone line) 1/10/2018
Care Coordinator Training Healthcare Services| Molina Healthcare | January 2018
Molina Healthcare Inc AGENDA • Welcome-Housekeeping • Training purpose-objectives • Molina Overview o Utilization Management o Transitions o Community Connectors o Case Management o Disease Management • Break • Health Homes • Clinical Care Advance • Clinical Care Advance-practice cases • Wrap up and Questions
1 1/10/2018
Objectives • Comprehensive overview of Molina Healthcare programs and services • Learn and practice documentation in Clinical Care Advance
Molina’s Mission
Our mission is to provide quality health services to financially vulnerable families and individuals covered by government programs.
In order to achieve our mission, it is essential that all team members have a clear understanding of all of the different services and departments interact and care for our members. It is through our partnerships and coordination of care that we ensure all members receive quality health services.
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Molina’s Values
Molina strives to be an exemplary organization: • We care about the people we serve and advocate on their behalf • We provide quality service and remove barriers to health services • We are health care innovators and embrace change quickly • We respect each other and value ethical business practices • We are careful in the management of our financial resources and serve as prudent stewards of the public’s funds
In order to achieve our mission, all of our team members need to be able to demonstrate the behaviors that bring our values to life. This training will assist you in doing this.
Molina Lines of Business • Apple Health (AH) • Apple Health- Adults (AHA) • Apple Health-Family coverage (AHFAM) • Apple Health Blind disabled (AHBD) (SSI) • Apple Health Premium (AHPREM) • State Children’s Health Insurance Program (SCHIP) • Molina Medicare Options Plus-Medicare Advantage Special Needs Program (MMOP) (Possible Dual Enrolled) • Molina Medicare Options HMC • Molina Silver Plan-Market Place • Molina Gold Plan-Market Place • IMC • BHSO • FFS (Clark, Skamania, Chelan, Douglas and Grant)
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Statistics Approximately 1.6 million people in Washington state are eligible for Medicaid (WA Population 6,897,012) Molina Washington = 780,000 (2/2/2017)
NPI Requirement. When calling into Molina to assist a member, you must provide your agencies NPI number. The one specifically associated with Health Homes. This is required for Molina staff to identify that they can speak with you regarding a member. You will get this number from your supervisor.
Behavioral Health Substance Use In most areas of Washington Managed Care doesn’t include • Inpatient Detoxification • Outpatient Mental Health Services Behavioral Health Organizations (BHSO) covers above mentioned. Integrated Managed Care (IMC)- Behavioral Health Services and Substance Use Disorder Services are now a part of IMC in Clark, Skamania, Grant, Douglas and Chelan counties. By January 2020 all counties in Washington state will take part in IMC.
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Utilization Management-UM Prior Authorization • Out patient Service Authorization, such as DME, Home Health, Office Visits, Radiology, sleep studies and surgery. • Inpatient Prior Authorizations (this does not include emergent admits) • Appeal and grievance process if a request is denied is as follows; • Prior Authorization staff will complete a re-review if the provider submits additional documentation from original request and/or will initiate a Peer to Peer call between providers if requested by the providers office. • Prior Authorization questions can be directed to: Phone 1-800-869-7175 and ask for Prior Authorization If you are experiencing problems getting through please contact one of these supervisors: 800-869-7175 enter extensions below. Donna 141175 Lavern 144094
Utilization Management Cont. Inpatient Concurrent Review • All Inpatient Services require prior authorization. The member may be admitted emergently. The provider is required to notify Molina of the admission within 24 hours of the emergent admit for authorization and continued stay. • Inpatient Authorization questions regarding discharge issues can be directed to 800-869-7175 ext. 141194 • Appeal and grievance questions regarding a denial of inpatient services can be directed to Member Services 800-869-7175 ext. 141002
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MOLINA HEALTHCARE TRANSITIONS PROGRAM
Molina Healthcare of Washington 2017
TRANSITIONS PROGRAM • Member Coordination of Care/High Risk to prevent re-admission • Encourage/Empower self-management of diagnosis o Provide Education/Teach Back • Follow members post discharge as indicated through ongoing Health Home engagement • Refer to Complex Case Management when indicated
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STATE Contract/Four Components • Face-to-Face visit prior to discharge-Notification via Pre Managed
• Follow-Up Phone Call post discharge Within 2-3 working business days Medication Reconciliation Health Homes requirement - HAP updated with action items related to admission
• Ensure Follow-up visit with PCP Within seven (7) calendar days Verify member has ability to make appt
• Home Visit Within seven (7) calendar days
Transitions Discharge Checklist
7 1/10/2018
Medication Reconciliation process If a Care coordinator requests that the Molina Pharmacy assist for medication reconciliation: Care coordinator documents on med rec form medications that are discussed or that they see in the home and emails to Molina Pharmacy. Med rec form scanned and uploaded into CCA and emailed to pharmacy Pharmacy completes form signature and email to [email protected]
Documentation of Med Rec Not enough to state “No new meds post discharge” Documentation examples: • Med Rec completed by PCP • Care Coordinator emailed medication reconciliation order form to [email protected] for med rec completion • Care Coordinator completed Med Rec • Med Rec completed by Pharmacist
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MTM Pharmacy – Referral Form
9 1/10/2018
Community Connectors
Community Connectors
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Molina Healthcare of Washington Disease Management and Prevention Program Goals: to prevent onset of disease and help stabilize existing disease progression.
• MHW DM team of nurses (aka Health Managers) outreach and engage members who are at risk for developing one of our targeted chronic conditions; newly diagnosed; and those with existing disease but are still considered impactable*. *impactable members are those who are not too advanced in their DM-targeted condition or other medical condition(s) they cannot improve. For example, a diabetic member who has had amputations, or has been dx with end-stage renal disease is not considered impactable.
• Level 1 and Level 2 members are typically those managed in this program.
MHW DM Program – Targeted Chronic Conditions Asthma – members >= 5 yrs. of age Prediabetes – adult members only Diabetes (type 1 and type 2) – ages Congestive heart failure (CHF) – adult members only Coronary artery disease (CAD) – adult members only Hypertension – adult members only Overweight and obesity – adult members only o We also manage the Weight Watchers program which is eligible to members 15-17 yrs. of age.
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Health Managers: • Identify, outreach and assess members with DM targeted conditions • Develop customized care plans and goals with member and educate and coach member to be self- sufficient in managing their disease • Work with PCPs and other specialist to help reinforce and supplement information member is given • Can manage members independently or help co- manage with other Care Management staff (i.e. Health Homes Care Coordinators)
How to Refer - Providers should submit a Care Management Referral form - Care Managers (ToC Care Coordinators, Health Homes Coordinators, Case Managers, etc.) can refer by: - Email [email protected]* - Warm transferring member to DM program: 888-562-5442, ext. 147121 *please provide details about what member needs help with specifically, and if you are transferring member or wanting help co-managing member.
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Questions?
Please contact Elise Reich, MPH, Manager of the Disease Management and Prevention program Direct: 425-424-7145 [email protected]
Principles & Practices of Case Management
Case Management 101
Molina Healthcare of Washington Updated for Health Homes 8/25/2014
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Integrated Care Management Levels of Intervention Case & Disease Management are integrated. This includes Long Term Care [LTC] and Behavioral Health [BH]. This results in 4 levels of case management.
Care Management Levels •Level I - Health Management •Level II - Case Management •Level III - Complex Case Management •Level IV – Imminent Risk
Member Identification Level I – Health Management (Corporate) Asthma – 3 Rx for short acting beta agonist (albuterol) w/o asthma maintenance w/in 6 months OR OR Test results outside normal limits (A1C, Microalbumine, Creatinine)
2 or fewer avoidable ED visits w/in 6 months OR
Targeted diagnosis with 1 inpatient admits within 6 months with at least ONE of the targeted conditions listed:
Cardiovascular CHF COPD Asthma Diabetes AIDS/HIV HTN Depression
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Member Identification Level II – Case Management Maternity (High Risk) OR 3-4 co-morbid conditions (including behavioral health) OR
3-5 avoidable ED visits within past 6 months OR Targeted diagnosis with 2 inpatient admits within 6 months with at least ONE of the targeted conditions listed: Cardiovascular CHF COPD Behavioral Health (sp. Codes) ESRD Asthma Diabetes Sickle Cell AID/HIV Cancer
Member Identification Level III – Complex Case Management 5 or more co-morbid conditions (including BH) OR
Reports health as “poor” OR
Actual expenditure of $100,000 or greater OR 6 or more avoidable ED visits within past 6 months OR
3 -4 IP admissions within a 6 month period r/t: Cardiovascular CHF COPD Behavioral Health (sp. Codes) ESRD Asthma Diabetes Sickle Cell AID/HIV Cancer
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Member Identification Level IV – Intensive Needs Case Management Imminent risk of IP admission (medical or psychiatric) r/t inability to self manage in current living environment OR
Needs assistance with 4 or more activities of daily living OR
5 or more IP admissions within a 6 month period r/t:
Cardiovascular CHF COPD Behavioral Health (sp. Codes) ESRD Asthma Diabetes Sickle Cell AID/HIV Cancer
Case Management Collaboration To refer to case management, send an email to [email protected]. If you have a member you think is level 3 or 4 you are required to send an Urgent email to the same email address and you will be connected to a case manager for collaboration- CM staff will enter all level 3 or 4 regarding CM.
Case Managers can be identified via a Health Homes referral file or seeing Case Management activity and an open case within CCA.
It is an expectation that a Health Home Care Coordinator will collaborate with any Case Manager engaged with the member before initiating outreach. This same expectation is placed on Molina Case Managers.
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Molina Healthcare of Washington
Patient Review & Coordination Program 2017
Updated: October 9,2017
Christi Sahlin, Manager and Deb Wehrman, Supervisor of PRC Team
1. What is PRC? (WAC) 2. PR&C Policy 3. Referral Criteria for PR&C Restriction 4. Identification of Members 5. Restriction Referral 6. Restricted? Now What? 7. Member Appeals 8. PR&C Letters 9. PR&C Placement Periods 10. Criteria for Restriction Removal
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Patient Review and Coordination (PRC) is a health and safety program of Molina Healthcare of Washington (MHW) for Medicaid members who need help establishing appropriate use of medical services.
A member may be assigned to PRC Restriction based upon the determination of the Molina Healthcare staff for persistent overuse, or inappropriate use of medical services, or at risk behavior.
Washington Administrative Code: WAC 182-501-0135 Molina Healthcare of Washington - Policy No. UM041
Any two or more of the following conditions occurred in a period of ninety (90) consecutive calendar days in the previous 12 months. The member: (i) Received services from four (4) or more different providers in different clinics, including physicians, ARNP’s and PA’s; (ii) Received similar services from two (2) or more providers in the same day; (iii) Had ten (10) or more office visits; (iv) Had prescriptions written by four (4) or more different prescribers; (v) Had prescriptions filled by four (4) or more different pharmacies; or (vi) Received ten (10) or more prescriptions.
NOTE: The criteria highlighted in red font are the primary criteria focused on for determining restriction decisions.
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Any one of the following occurred within a period of ninety (90) consecutive calendar days. The member: (i) Made two (2) or more emergency department visits—this cannot be a stand alone criteria (ii) Has a medical history that indicates “at risk” utilization patterns; (iii) Made repeated & documented efforts to seek health care services that are not medically necessary; or (iv) Has been counseled at least once by a health care provider, with clinical oversight, about the appropriate use of health care services.
The member received different prescriptions for controlled substances from two or more different prescribers in any one month.
Members must be ≥ 18 years old, unless referred by HCA Members are identified through: Electronic review of claims High usage reports Health Care Authority (HCA) referrals Provider referrals or requests MHW employees referrals Community partner referrals Fraud and Compliance referrals Internal referrals can be made via the PR&C email [email protected]
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The PRC team reviews member utilization and determines whether the member: Gets a warning letter/”Letter of Concern” and monitoring – PRC Care Coordination Program or If the member clearly needs restriction and possibly a Care Management Program
If the member needs restriction a review report is prepared by the Case Management Processor (CMP) and sent to the PRC Clinical Reviewer (RN) for review and decision.
The PRC Clinical Reviewer bases their decision on the review of several forms of information: PRC review report, K2, PRISM, Provider One, Member 360, CCA, QNXT, EDIE reports, and any other supportive outside clinical documentation including calling the member’s PCP and specialists
Placement Period: The member is placed in the PRC program for an initial 24 month period regardless if the member changes MCO’s or becomes a FFS client.
Member Communication: The member is sent the Letter of Restriction which indicates the restricted providers, including: PCP Controlled Substance Prescriber (can be the same as the PCP) Pharmacy Provider Assignment: Members may request different providers: Within 10 days from the date of the intent to restrict; or Within 30 days of the restriction date if the providers were assigned by Molina and then: Can only make changes every 12 months unless
The member moves out of the area
The PCP retires or moves out of the area
The member is dismissed by the PCP
QNXT: “Conditions Field” and “Alerts Field” document PRC Participation
QNXT will also display an “Alert Box” stating the member is enrolled in the PR&C Program.
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The length of time for a member’s PRC placement includes:
The initial period of PRC placement is a minimum of 24 consecutive months The second period of PRC placement is an additional 36 consecutive months The third and each subsequent period of PRC placement is an additional 72 months
Tracking members on a regular and ongoing basis throughout the restricted period; Follow up, communication and collaboration with various departments—i.e. MDs, case management etc., to assist and improve member outcomes. If a member is requesting a change in provider or pharmacy- determine if the change is appropriate per the WAC Care Coordination by PRC RN Case Managers based on complexity of member’s needs
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Specific instructions are provided to each member explaining how to appeal the restriction decision. The member may contact HCA The member may contact MHW appeals through: Verbal request to the Appeals line (extension 141002) Written request Faxed request The member may appeal the restriction: Within 10 days of the date of the intent to restrict (the process is placed on hold without restriction until determination is made.) *Note: If the decision is to uphold, 10 days post decision date becomes the new restriction start date. After 11 days of the restriction being placed, the member may appeal within 90 days of the date of restriction (however, the restriction remains in place while the determination is being made) After appeal, the member may ask for a fair hearing from the State The member may also appeal when the restriction is continued for an additional placement period
The member may be removed from restriction when either conditions (a) or (b) are met:
(a) The member successfully completes a treatment program that is provided by a certified Chemical Dependency service provider and Maintains appropriate use of healthcare services within PRC criteria guidelines for six months after the date the treatment ends
(b) Has proven appropriate utilization of healthcare services when the member reaches the initial 2 year restriction period or at the end of additional placement periods
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Referrals and Non Urgent Questions: ◦ [email protected]
Emergent and Urgent Questions: ◦ Christi Sahlin, Healthcare Services Manager 1-888-562-5442 ext. 147103
Health Homes
Molina Healthcare of Washington
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Health Homes Six Services-Three Tiers
• Comprehensive Care Management • Care Coordination • Health Promotion • Transitional Care • Individual & Family Support • Referral to Community & social support services
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Health Home Tiers
1. Tier One – From initial engagement up to uploading of HAP. Occurs only ONE time per member life. 2. Tier Two – intensive level of care coordination. Requires a face to face meeting with the Care Coordinator monthly. 3. Tier Three – low level of care coordination can be completed over the telephone with quarterly face to face HAP renewal meetings.
Client Outreach 1. The Health Home Lead entity will provide a list of clients who meet the eligibility requirements for Health Home services. 2. The Care Coordinator and/or support staff will contact the client by phone or in person to schedule the first home visit 3. Molina will assist the CCO in initial scheduling to build a case load quickly. Email [email protected] if you would like to request assistance. 4. Molina will send client the Health Home letter and brochure when they become eligible for Health Homes. 5. There are brochures available to each CCO
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Consents 1) HCA Health Home Participation and Authorization and Information Sharing Consent Form- getting member to Opt In to Health Homes and allows the Care Coordinator to share information. • Document a note in CCA and obtain signed consent at the face to face meeting with the member. • Scan and upload the signed consent into CCA in Contacts and return the original document to your CCO. • The care coordinator has 90 days from the time the member is referred to complete and upload the HAP into CCA 2)SUD consent- must be completed if the member has any history of SUD. 3) Adolescent Information Sharing Consent- for minors. 4) Molina ROI is required if a member wants to give another person permission to call into Molina to get information. When completed, scan and upload Molina ROI into CCA and send a copy to [email protected] 5) Opt Out form for members the decline services in Health Homes. The Care Coordinator/allied staff can sign for a member on the OPT form.
Consents – Participation Authorization and Information Sharing Consent
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Consents Cont…
Consents – Chemical Dependency
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Unable to Contact Unable to Contact (UTC): Due diligence requires 2 phone calls and two other attempts to complete UTC. After completing due diligence, if a member is unable to contact, the care coordinator will Send a secure email to: [email protected] and title the SUBJECT of email UTC Molina staff will confirm that Due Diligence is completed and documented in CCA and the member will be added to Molina’s UTC 90- day bucket. Continued outreach attempts will be completed by Molina outreach team and will process for disenrollment UTC members cannot be opted out we must continue to contact them please do not opt out if only unable to contact.
Due Diligence Checklist - UTC
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OPT- OUT Opt-Out: If a member has told you they want to opt- out of Health Homes, complete the following: 1. Complete a contact note in CCA that the member requests to Opt Out. Complete the Opt Out form and upload into CCA. 2. Whoever has spoke to the member when they made the request to Opt Out must be the person to complete the Opt Out form 3. Send secure email to [email protected] and title the SUBJECT email Opt Out. Molina staff will remove member from case load, close open cases/tasks/goals and officially opt the member out. Molina will enter HAP end date and notify HCA. 4. In situations of an adult that cannot give consent, without POA please contact Molina before opting out to make sure we are complying with standards.
Due Diligence Checklist – Opt Out
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Assessments Mandatory Assessments • PAM/PPAM/CAM • PHQ-9/PSC-17 • KATZ • BMI • The PAM/PPAM/CAM, PHQ-9/PSC-17 and BMI are available electronically via CCA. Please complete the previous three assessments electronically with every HAP update. • The KATZ must be completed on a paper copy and uploaded to CCA via a Contact Note. Please complete and upload the KATZ with every HAP update. • Must be completed every 4 months with HAP update and a contact note must be entered in CCA reflecting content of meeting with member
Assessments Cont. Alternative Assessments • AUDIT-Alcohol Use Disorders Identification Test • DAST-Drug Abuse Screening Test • GAD-7-Generalixed Anxiety Disorder 7 item scale • Falls Risk-My Falls-Free Plan identifies risk and provides suggestions to prevent falls • Pain Scales o Pain Scale, FACES, FLACC • The 5 alternative assessments must be completed on a paper copy and uploaded to CCA via a contact note • Only HCA approved assessments may administered to members
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Incident Reporting An incident is a negative event or occurrence which was not desired and/or anticipated for which the Health Home employee was present or came into contact or was otherwise made aware of. • CPS or APS report made by Health Home Staff • Suicide attempt made by member • Unexpected death of member • Homicidal ideation, threat or attempt of homicide • Extremely inappropriate behavior by member (e.g. inappropriate touching, sexual or offensive language directed at Health Home staff)
Incident Reporting Process 1. Get to safe place and call 911 if immediate threat 2. Report incident immediately to your supervisor or manager 3. Fill out HCA Incident Report Form-same day if possible 4. Send completed HCA Incident Report Form to [email protected] 5. Document incident and follow-up in CCA. (do not upload HCA Incident Report Form in CCA)
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HCA Incident Report Form
Resources & Access • PRISM - Look up patient claims data for the past 15 months- The information is often dated because it is based on claims data, but it gives you a snap shot of the member’s services utilization • Insignia - PAM, PPAM, CAM & Coaching for activation. You will input data and receive a score that will be entered into CCA • CCA (Clinical Care Advance)-Molina Healthcare of Washington Case management documentation system • Pre Managed – IP/ED utilization for the state of WA, live time. It also has a platform for CM staff to communicate plan of care with ED CM and SW.
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Educational Reference Material The following mandatory education material is provided to your agency. If you have not completed the following educational material contact your supervisor.
• HIPAA(must be completed annually) • Fraud & Waste • Employee Safety-Working in the field • Cultural Competency • Mandatory Reporting- Abuse/Neglect(must be completed annually) • Molina Health Home Policy and Procedures
HCA Mandatory Webinars
Special topic PowerPoints are located at the DSHS Duals website at: https://www.dshs.wa.gov/altsa/home-and-community- services/washington-health-home-program-going-training The mandated topics are: Outreach and Engagement Strategies Navigating the LTSS System: Part 1 Navigating the LTSS System: Part 2 Cultural and Disability Competence Considerations Assessment Screening Tools Medicare Grievance and Appeals (required if working for Duals) Coaching and Engaging Clients with Mental Health Needs
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DSHS 1st choice for Interpreter Services
2nd Choice for telephonic Interpreter
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Molina Virtual Urgent Care
Molina Numbers Prior Authorization: Call 1-800-869-7175 and ask the receptionist to forward you to the Prior Authorization Department. Escalated issues contact Donna: 141175 or Lavern : 144094 Inpatient: 1-800-869-7175, ext. 141194 Community Connector: To make a Community Connector referral email [email protected] Disease Management: [email protected] Case Management: Secure email [email protected] Subject line CM referral. Body of email provide member name and ID number and reason for the CM referral PR&C: [email protected] Pharmacy: 1-800-213-5525 Option 1,2,2 (External phone line)
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Log-In
MOLINA HEALTHCARE Clinical Care Advance- CCA
Molina Healthcare of Washington 2016 Objectives Initial Documentation Ongoing Documentation
• External Log-on • Update How-To’s • Search and Assign Member • Contact Forms • Create a Case • ToC Bundle • Create a Care Plan • Progress Notes • Enter Electronic Assessments • Upload Documents • HAP Assessment • Tasks • HAP Report • Opt Out/Unable to Contact • Address Book • Healthwise Knowledgebase External Clinical Care Advance Steps to Access Clinical Care Advance
Steps to access Clinical Care Advance: 1. Pre-requisites – Clinical Care Advance works only in Internet Explorer (8.0 and below). Any versions of IE 9.0 and above require “Compatibility Mode” to be turned on. 2. Please click on below link to Log-in into Care Advance. CCA Test: https://careadvance50testsso.molinahealthcare.com/External Production LIVE : https://CareAdvance.MolinaHealthcare.com/External 3. Click on Change Password External Clinical Care Advance Steps to Access Clinical Care Advance 3. If you are First-time user then you must change your password before login into Care Advance. Please Click on Change Password, to change your password.
*A special character is not a number External Clinical Care Advance Steps to Access Clinical Care Advance 4. Please type-in user name and old password received in an email. Type-in your new password in New Password and Confirm New Password. Please click on Change/Reset Password.
5. Please click on Ok to close the page. External Clinical Care Advance Steps to Access Clinical Care Advance 6. Please Type-in your username and your new password to login and then click Sign In. External Clinical Care Advance Steps to Access Clinical Care Advance 7. Please Click on Yes if you get below message.
8. Please click on a small flashing warning on top of the page which says “This website wants to install following add on ‘CKInteractiveDriver.cab’ from ‘The Trizetto Group’. External Clinical Care Advance Steps to Access Clinical Care Advance
9. Click on Install This Add-on…
10. Click on Retry
11. Click on Install. 12. This IE Add-on is required only for Letters functionality in Care Advance. If you face issues installing this IE Add-on then please work with your Help- Desk to get this installed. External Clinical Care Advance
Ongoing Password Changes: • After 90 days, you will be required to change your CCA password for security purposes. The system will not remind you unless you sign into the program. • To avoid any issues, attempt to sign into CCA at least once every month. When you are within 14 days of needing to change your password, CCA will alert you. To change your password, click the Change Password option when logging in.
• If you do not sign into CCA during this period of time, you will need to email [email protected] to get your password reset. This process can take 2-3 business days
CCA Search and Assign
CCA Home Page After logging in, you’ll be able to manage your cases on the Clinical Care Advance (CCA) Home Page Searching for a Member Searching for a Member Follow the steps below to bring a Member “into focus” 1. Begin by selecting the search button 2. Search for member using any criteria and click “find” or press Enter. a) You may search for a member using first & last name, or date of birth. A minimum of two letters is required in either field 3. Once the list of members populates, bring a member “into focus” by double clicking on the member’s name. Bringing a Member “In Focus” Adding an Assignment To add an assignment, select “Care Management” from the Standard Tools menu then select “Assignments”* 1. 2. Adding an Assignment – con’t Click “Add.” The add assignment page displays
#1) Click the search icon (magnifying glass) to perform a search for the appropriate queue/user #2) Enter your name into the “Search for Name” field. #1
Ashley Mitchell #2 Adding an Assignment – con’t #3) Once the user has been identified, select the appropriate “role” from the search menu-your only option should be “Case Manger”
#3
Select “save” (at bottom left of screen)
Note: Do not select the “Set as Primary” box
Creating a Case
Creating a Case To create a case, first bring a member “in focus” > Select the “Cases” icon from either the quick links tool bar or the Frequently Used Tools > Select “New Case” and select “Care Management” from the drop down menu > This will open up a new case Creating a Case – con’t You will need to fill in the following fields on the “Case & Description” tab: > Case Name: enter the case name that describes the case. All case names will need to start with “HH” and then the main reason why you are opening the case. (i.e. HH – Diabetes or HH-Care Coordination) > Description: Do not enter notes in this field, this field is for CM use only > Open Notes: Enter a brief description of the member and the situation. Can be no longer than 250 characters. > Case Acuity: select the appropriate case acuity (low, medium, high, catastrophic); if you select high or catastrophic, the member needs to be referred back to Molina for complex case management review > Case Type: select the appropriate case type level from the list > Main Diagnosis: search for and populate the main diagnosis > Custom Case Fields: select the appropriate case category from the drop down menu > Click Save Creating a Case – con’t
HH Care Coordination Level II Case Management
Do not use this field
Use this field Character limit is 250 Medium
Creating a Care Plan
Creating Care Plans • After the case is created, the Care Plan needs to be completed. • The first time the case is created and after save is pressed, CCA defaults to the same page you created the case on (i.e., Case & Description) You can access the Care Plan, by clicking the “Care Plan” tab at the top. • When entering the Care Plan after the first time, the user needs to access it through Menu Care Management Cases. This will bring you to the Care Plan Tab (see next page). Creating Care Plans • Tabs separate the Case Properties. The Care Plan tab is where the goals and action steps are created. The Case & Description tab is where you originally created your case. • The “Care Plan” tab allows users to manage action steps and goals.
HH Care Plans All Care Plans must include: > 1 Long Term Goal (the due date is greater than 60 days) (you are only allowed 1 long term goal) > At least 1 Short Term Goal (the due date is less than 60 days) • All Short Term Goals MUST have at least 1 “Action Step” • Only Short term goals have Action Steps • Action Step = “Intervention” in CCA • If your short term goal is not met before 60 days you will need to close it as “not met” and add a different short term goal Creating Care Plans – Entering a LTG While on the “Care Plan” tab of “Case Properties” select “Add Milestones”
Health Home Goal Setting 1. HH LTG 2. HH STG 3. HH Interventions Adding a LTG
Select “Goal” and “Continue” Creating a Goal Create name for the Goal. MUST start with “HH:” i.e. “HH: Lose 10 lbs” This MUST be copied and pasted from the “name” field to the “content” field.
HH LTG: Lose 10 Ibs
MANDATORY to copy the LTG goal here. Hint: Use member words. What you put in this field will appear on the HAP for the LTG.
Select a due date longer than 60 days Creating Care Plans – Entering a STG While on the “Care Plan” tab of “Case Properties” select “Add Milestones”
Health Home Goal Setting 1. HH LTG 2. HH STG 3. HH Interventions Creating Care Plans – entering a STG con’t Select “Goal” and “Continue” Creating a Goal Create name for the Goal. MUST start with “HH:” i.e. “HH: Lose 10 lbs”
HH STG: Get a YMCA membership
You do not need to copy and paste into this field.
Due date must be less than 60 days Creating Care Plans – Entering an Action Step While on the “Care Plan” tab of “Case Properties” select “Add Milestones” Add Action Step Select “Milestone” and “Continue” This your action step Create an Action Step 1. Remember to Associate with the appropriate goal.
1. Type in action step HH: Member will pick up YMCA application next Monday.
Hint: Interventions are your action steps for your STG. You do not need to type your action step in this field. 2. Use the Drop down and select the STG the action step is for. This is associating the action step to the 3 Select a due date. STG. Action steps should not be more than 60 days. Goals and Interventions/Action Steps Make sure to go to “Add Milestone” at least 3 times: 1) Long Term Goal 2) Short Term Goal 3) Action step/Intervention: one action step for the member and one action step for the care coordinator
The HAP report will print the “Content” of the Long Term Goal; but it will print the “Name” of the Short Term Goal and Intervention. So make sure to be descriptive on these parts.
Moving an Action Step
Moving/Associating an Intervention/Action Step If you forget to associate an intervention with the short term goal, in the Care Plan view: 1) Check the Intervention that you want to move or re- associate. 2) Select “Move” from the menu Moving/Associating a Milestone – Con’t
Select the short term goal to associate Intervention/Milestone with and click “Ok” Moving/Associating a Milestone – Con’t
Intervention is now associated with the correct goal
Click here to see goals within a case
Mandatory and Alternative Assessments
Electronic PAM/CAM/PPAM Go to Care Management Assessments Search for Activation in the Name section Select Contains or hit “Enter”
Select the appropriate assessment from the list. Select Take Assessment. Electronic PAM/CAM/PPAM Electronic PAM/CAM/PPAM When the assessment is completed, select continue and the score will populate on the second page. This will not automatically populate in the HAP Assessment. You will need to write the score down and enter it into your HAP Assessment. Click continue.
**THIS SCORE DOES NOT AUTOMATICALLY POPULATE IN HAP ASSESSMENT. THE SCORE MUST BE ENTERED INTO THE HAP MANUALLY Electronic PAM/CAM/PPAM Do not click the “view report” button. Click continue one more time. To access Insignia’s Coaching for Activation click “Care Management” and then “Insignia”
Copyright © 2014. Insignia Health Proprietary & Confidential 5 Copyright © 2014. Insignia Health Proprietary & Confidential 6 Electronic PHQ-9/PCS-17 Assessment Go to Care Management Assessments Search for PHQ or PSC-17 in the Name section Select Contains
Select the PHQ-9 Assessment. Select Take Assessment. Electronic PHQ-9/PCS-17 Assessment Electronic PHQ-9/PCS-17 Assessment When the assessment is completed, select continue and the score will populate on the second page. This will not automatically populate in the HAP Assessment. You will need to write the score down and enter it into your HAP Assessment. **THIS SCORE DOES NOT AUTOMATICALLY POPULATE IN HAP ASSESSMENT. THE SCORE MUST BE ENTERED INTO THE HAP MANUALLY Electronic PHQ-9/PCS-17 Assessment Then, select Continue until you hit the Congratulations page *If you do not move to the Congratulations page, the assessment will not save in CCA. Katz and Alternative Assessments To add the KATZ and optional assessments to CCA, you must scan and upload a copy of completed assessment. 2. Click on “Add 1. Click on Progress Note” “Care Management”
11 KATZ and Alternative Assessments Con’t 3. Click on “Browse” 4. Select the appropriate document to upload. Title the subject “HH-” then whatever document you uploaded. Press save at the bottom. HAP
HAP Assessment With a member is “in focus” 1. Go to “Care Management” in the tool bar 2. Click Assessments 3. Search for HAP Assessment (HINT: Search for Name “HAP”), click the filter button and chose contains. Then click “Take Assessment”. HAP Assessment – Con’t The first page of the HAP Assessment contains basic HAP enrollment information. NOTE: HAP begin date is the date you do the HAP. OPT in date, is the date the members signs the ROI and the HAP end date is one year minus one day from HAP begin date. You will only change these dates with annual HAP updates.
Do not populate “Date opted out” or “Reason for HAP Closure” HAP Assessment – Con’t These need to be changed when member changes tiers.
Enter member diagnosis. This appears on “diagnosis” field on HAP. No more than 140 characters.
Enter advanced directive conversation, communication of HAP to member and if there’s lack of peer supports. 250 character limit HAP Assessment – Con’t The second page contains the Required Assessments. BMI will automatically calculate based on Height/Weight entered in previous screen. You must manually enter PAM/PPAM/CAM & PHQ-9/PSC- 17 scores and date completed. HAP Assessment – Con’t The third page contains the Alternative Assessments. You must manually enter all alternative assessments scores and dates. HAP Assessment – Con’t This is just the validation that you have entered all of the information for the HAP Assessment. You are not required to print this page, however you have to click “continue” to complete the assessment. Printing the HAP
Printing the HAP Report Go to Custom Reports Select Report “CCA 121” HAP Report HAP Report – Con’t Click on “View Report”. If all required entries have been made, an image of the HAP will appear below. If not, a list of errors will appear and care coordinator will need to go back and fix the errors in order to print the HAP. HAP Report – Con’t How to Print the HAP
Click “Select Format” and select “PDF”. Then click “Export”. #2. #3.
#1. HAP with Errors If you have entered information incorrectly prior to printing HAP, you will get a list of errors. Refer to your HAP Error Cheat Sheet for assistance on how to fix.
HAP Updates
HAP Updates 1. Every 4 months the HAP must be updated. Hint: this cannot be done even 1 day early. 2. To complete a HAP update the Care Coordinator must update goals/action steps, complete all required assessments and update the HAP with new assessment scores and dates 3. HAP Updates must have a Contact Note entered to describe the face to face HAP update Completing/Changing Status of Goal or Intervention
1) Enter into “Edit” mode within HH Case
2) If applicable, you MUST edit a goal before you change the status. Once the status is changed, you are unable to edit the content within the goal 3) Select the goal
4) Select Change Status Completing/Changing Status of Goal or Intervention Cont…
5) Change the status from the drop-down options. Met: goal was completed Not Met: goal was not completed Redefined: DO NOT USE N/A: DO NOT USE STG’s must be reset every 60 days
6) For each Status that is changed, include a reason from the available drop down options. Click Save Completing/Changing Status of Goal or Intervention
7) When a goal is correctly met, you will see a green check mark on the side of the goal/action step. When a goal is correctly not met, you will see a purple “x” on the side of the goal/action step. Do not extend goal date under any circumstance MET
NOT MET How to Re-take Mandatory Assessments All mandatory assessments must be done with every 4 month HAP update. 1. Go to “Care Management” and click “Assessments” 2. Search for either “PHQ-9” or “Activation” 1. Searching for activation will pull up the PAM/PPAM/CAM How to Re-Take Mandatory Assesssments 3. Click on the assessment (hint: will turn dark blue) and click “Re-take assessment” below How to Re-take Mandatory Assessments cont. 4. Member responses to assessment taken previously will appear. Make sure to update assessment with current responses.
5. Complete assessment and click “Continue” until you have returned to page where you searched for the assessment How To Update A HAP Must be re-done with every HAP update 1. Return to the Assessments page
2. Find the line showing the previously completed HAP and select it. Toward the middle of the page, click Retake Assessment How To Update/Edit A HAP 3. Toward the middle of the page, click Retake Assessment
4. Complete any edits/updates within the HAP Assessment and finish the assessment. You MUST click continue to the end of the assessment, regardless of what edits were done, or it will not update your changes. How To Update/Edit A HAP 5. When you have finished updating the assessment, the history can be viewed to verify its completion.
6. Each version of the HAP will show up in the history. The far left contains a Status column. Complete: HAP successfully completed Aborted: HAP was aborted during a previous update In Progress: HAP has not been completed or was navigated away from before completion How To Update/Edit A HAP How to Change the Tier every month within a HAP: Update the HAP Tier monthly as needed for member engagement 1. Go through the before mentioned steps to update the HAP. 2. On the 1st page of the HAP assessment, locate the Tier Section. It’s found near the middle of the assessment page.
3. Select the Tier and update the date, then continue through the assessment until you’ve completed it.
Contact Form
Contact Template Form Use the Contact Form to document all successful and unsuccessful initial and subsequent contact with the members or providers Note: This Form is MANDATORY for all contacts 1. With the member in focus, find and enter the Progress Notes section Contact Template Form 2. Click the “add progress note” icon 1
3. Using the search icon for “Select Template”
2
Do not name until template is selected Contact Template Form 4. Expand Member Contact Records – Molina” and select “Contact Form”. Then press Select at the bottom. Contact Template Form – Step 1
Once the form is up, Name the contact form “HH” and a short description of the contact. Ex: “HH ToC Contact #2” Make sure “HH” is at the beginning of the Subject Line. Contact Form – Step 2 Fill out contact template form. All fields indicated as “Mandatory” must be completed. HIPPA must be verified every time. Contact Form – Step 2, Cont…
Do Not Use this Field
Use “Provider/Agency Contacts” when contacting member’s provider or provider agency Contact Form Step 2-Cont…
Enter notes from successful or attempted phone call or face to face here D.A.R Data/Action/Response
Do Not Use Use “Resource/Referrals” when these fields member has been provided with either Contact Template Form – con’t Once in the Contact Form, the following fields will auto populate > Assigned To, Title, Extension, System Address, and System Phone Number (MUST CLEAR FIELDS BEFORE ENTRY) If needed, enter the “Updated Phone Number” – note: this will not save to the address book. Please refer to the address book portion of this training to add new contact information Select Contact Type from the drop down menu (Mandatory) Select Contact Date from the calendar or enter Contact Date (Mandatory) Enter Contact Method from the drop down menu (ie. Phone, fax, face to face, etc.) (Mandatory) Select Contact Direction from drop down menu Select Respondent from the drop-down menu Enter Respondent Other if applicable Contact Template Form – con’t
Choose 2 HIPAA ID items from the HIPAA Identify/Authority Verification Section - typically DOB & Address are used (Mandatory) Select Purpose of Contact from options (Mandatory) Type Purpose of Contact if “Other” is selected (free text) Do Not document in Findings to be discussed with member and addressed in care plan as appropriate Select Outcome of Contact from drop down menu (Mandatory) Type Outcome of Contact if “Other” is selected (free text) IF Outcome Contact is “Successful”, enter outcome of contact (Opt-out, Opt-in, Withdrawal) Enter Length of Contact in minutes Enter Notes if appropriate Click Save
Notes: System Phone #: defaults to home; update as needed
Uploading and Viewing Documents
Scanning and Uploading to a Progress Note
1. To upload a document, it needs to be scanned into an email or computer source. Document(s) should be saved onto your desktop. This allows it to be found through CCA. If possible, put the document(s) into a PDF Format. Once documents are uploaded, they cannot be deleted.
2. While a member is “in focus,” go into Progress Notes Scanning and Uploading to a Progress Note
3. Click on “Add Progress Note”
4. Fill out the “Subject” of the Progress Note and write note in documentation box. Must start with “HH:”
HH Consent Information Sharing Scanning and Uploading to a Progress Note
5. Once a Progress Note is opened, find the Browse Button. Scanning and Uploading to a Progress Note
6. Click into the Browse Button and locate document saved on your Desktop Once it’s located, click on the document and then select open. 1
2
7. The uploaded document will fill in the box next to the Browse button: Before: After: 1. Confirm Upload Scanning and Uploading to a Progress Note
8. It is not required to fill out any other information. Once the subject line is filled in, press Save.
9. You must delete this item off of your Desktop once you have uploaded into CCA. This step is to eliminate the risk of uploading a document in the future into the wrong member file Viewing an Uploaded Document in CCA Once you have scanned and uploaded a document in CCA, you can view the document by doing the following: 1. Click once on the progress note that you just attached a document to. Hint: it will have a paperclip next to the entry
2. Once you have clicked on the appropriate entry, click on “More information” Viewing an Uploaded Document in CCA cont. 3. Click on “download file”, which is located at the bottom of your screen Viewing an Uploaded Document in CCA cont. 4. A yellow box will appear at the bottom of your page. It will ask you to “Open” or “Save” the document. Select “Open.” Transitions of Care
Transitions of Care When a member is admitted to an inpatient setting the care coordinator must document the required contacts for ToC. All contacts must be completed in a Contact Note. The difference between a ToC Contact note and a general contact note is the “Purpose of the Contact”
Care Coordinator must select “Transition of Care” Transitions of Care con’t Once transitions of care is complete, the care coordinator must complete a “ToC Wrap-up Form”
1. Select “Add Progress Note”
2. Click on the magnify glass next to Select Template. Transitions of Care con’t
3. Click the plus sign next to Member Contact Records. Under this drop down select “ToC Wrap-Up Form”. Then click “select”. Transitions of Care con’t
4. Fill out the “Created by”, “Title” and “Date of Admission” field Transitions of Care con’t
5. Complete the ToC Wrap-up form using the Molina DAR format. DAR stands for Data, Action, Response. Data= What information was gathered? Action= What Actions did the staff take? Response = What was the response to the above action?
Tasks
Tasks Tasks will show up on the My Task list with the following icons: Task (cont’d)
Tasks will appear for any member assigned to you or any task given to you for unassigned members.
My Tasks defaults to 3 days before and 3 days after today (moving current week) How to Create a Task 1. Title the task appropriately and verify it is associated to the correct member 2. Enter the time period the 4-mos HAP is due in the due date section Marking a Task Complete 1. Get into Tasks
2. Locate the scrolling bar on top and find Mark Complete. Marking a Task Complete ***All Tasks must be marked complete
When a task has been accomplished: 1. Add a Progress Note describing what was done to complete the task (if applicable) a) Member call, resources, follow up, etc 2. Mark the task complete (from scrolling tool bar) a) Select the task b) Select mark complete If a member is no longer in Health Homes and still has some tasks on the task list:
NOTE: Mark Complete is the only option. 1. Create a progress note – explaining member off plan etc… a) “Please disregard all tasks after this date” 2. Use the advanced filter to push out the date into the future 3. Locate all future tasks on a member 4. Mark them all complete a) Note: this has to be done one at a time Task Scroll Bar Options
Patient Tasks: an option to see all open tasks Mark Complete: to mark your task as complete Open Entry: To open Task More Information: To see a read-only version of task Add Reminder or Task: to add a new task Forward Task: to forward an existing task to another user Snooze: to pause or redefine the due date for a task Add Progress Note: to add a progress note based on an existing task Assignment: to check on your personal work assignments within CCA Letters: N/A to Health Homes Task (cont’d) If you cannot see your tasks you may need to: 1) Clear your filters • Go to My Work My Work Assignments in the Standard Tools options. • Click Clear Filters
2) Apply appropriate filter, which can be found at the bottom of your task page. It provides several options: Forwarding Tasks Forward a task: Use forward a task if: Task created to the wrong user Mistake made on a task (able to change the task while forwarding)
Process: Select a task Select Forward Task (from scrolling tool bar) At this point can change your task > Title > Due date > Must change user (may be the current user) Save Note: original task will still be on the task list and needs to be marked complete, you must enter a progress note of who you forwarded it to. Forward Task
Address Book & Healthwise Knowledge Base
Address Book User has the ability to ADD, EDIT or DELETE Contact information. *Member information cannot be updated. Any edited member information will be overridden by state populated contact information every month. To update member information, have member contact HCA* The information labeled “My Information” and “Mailing” for the member in the address book are both being over ridden by the state every month. To Update Contact Information (not for members) Process to Add New Contact Info: When using “Create New Contact”, those contacts will not change until updated by user Bring the member into focus Select Address Book Select “Create New Contact” Select Contact type from drop down Menu Complete with the Contact information section with the new information as applicable If adding a contact with new phone or address info for the member, add the word “MEMBER” to the last name Select “Save” Address Book Select Create New Contact Resources Healthwise Knowledgebase Health Home Forms
Telephonic Interpreter Services Molina Healthcare What language do you need?
SPANISH ALL OTHER LANGUAGES 1 DIAL EXTENSION DIAL NUMBER 762139 (844) 311-9777 844-885-3950 external line for Case Mgrs.
ENTER MEMBER’S STATE CODE 2 CA - 1011 NY - 1032 VA - 1060 FL - 1015 OH - 1035 WA - 1050 IL - 1018 SC - 1037 WI - 1055 MI - 1020 TX - 1040 NM - 1030 UT - 1045 3 ENTER YOUR DEPT. CODE Healthcare Services / Case Mgt. “088” must enter 3 digits 4 ENTER LANGUAGE CODE Spanish Line GLOBO Line Not Applicable See Language Code List
Molina Healthcare Interperter and Translation Servvices
® Language Codes List | Molina 1
To connect to an interpreter, select the required language by dialing its corresponding 3-digit language code and the pound sign (#). If you do not see the required language, or if you need assistance identifying the language, you may press 0 at any time to speak to an operator.
Remember to dial # after the 3-digit language code.
Commonly Requested Languages
090 Arabic 035 Mandarin 031 Cantonese 078 Russian 107 Farsi 142 Somali 129 Haitian Creole 060 Spanish 041 Korean 049 Vietnamese
265 Afghan 403 Chamorro 127 Fijian 016 Akan 038 Chao Chow 395 Filipino 418 Akateko 378 Chin 052 Finnish 070 Albanian 405 Chin (Falam) 227 Flemish 027 Amharic 406 Chin (Hakha) 276 Foochow 090 Arabic 408 Chin (Tedim) 058 French 072 Armenian 407 Chin (Zophei) 383 French Canadian 420 Armenian (Eastern) 030 Chinese 217 French Creole 421 Armenian (Western) 346 Chui Chow (Teochow) 032 Fukienese 365 Ashanti 034 Chungshan 014 Fulani 139 Assyrian 316 Chuukese 229 Fuzhou 109 Azerbaijani Crioulo (Portuguese 230 Ga 341 Creole) 019 Bambara 388 Garri (Garre) 067 Croatian 225 Belorusian 216 Georgian 063 Czech 084 Bengali 057 German 055 Danish 391 Bhutanese 071 Greek 111 Dari 263 Bosnian 125 Guamanian 131 Dinka 270 Brazil-Portuguese 083 Gujarati 056 Dutch 069 Bulgarian 401 Gulf Arabic 392 Dzongkha (Bhutanese) 042 Burmese 129 Haitian Creole 272 Ebon (Marshallese) 048 Cambodian 039 Hakka 273 Edo 031 Cantonese 396 Hamer-Bana 398 Egyptian Arabic 013 Cape Verdean 022 Hausa 321 Ewe 122 Cebuano 106 Hebrew 074 Fanti 138 Chaldean 082 Hindi 107 Farsi
GLOBO Customer Support: 1-866-252-3883 | [email protected] ® Language Codes List | Molina 2
319 Hindustani 329 Luo 333 Sichuan/Szechuan 046 Hmong 315 Maay Somali 256 Sicilian 286 Hokkien 068 Macedonian 089 Sinhala 147 Hunanese 051 Malay 064 Slovak 065 Hungarian 088 Malayalam 301 Slovakian 218 Ibo 354 Malinke 142 Somali 113 Ilocano 035 Mandarin 337 Soninke 121 Ilonggo 015 Mandingo 413 Soninke (Maraka) 050 Indonesian 246 Mandinka 312 Soninke (Sarahuleh) 399 Iraqi Arabic 205 Marathi 419 Soninke (Sarakole) 059 Italian 291 Marshallese 060 Spanish 235 Jakartanese 045 Mien 258 Suchown Jamaican English 423 Mina 357 311 Sudanese Arabic Creole (Patois) 373 Mirpuri 026 Swahili 040 Japanese 292 Mixteco 422 Swahili (Kibajuni) 411 Jarai 415 Mixteco Alto 053 Swedish 379 Jingpho (Kachin) 416 Mixteco Bajo 377 Sylheti 328 Jula 340 Moldovan (Romanian) 302 Taechew 412 Kamba (Kikamba) 150 Mongolian 117 Tagalog 288 Kanjobal 339 Montenegrin 033 Taiwanese 369 Karen 381 Moroccan Arabic 137 Tamil 384 Karenni 144 Navajo 303 Telegu 384 Kayah 249 Neapolitan 047 Thai 238 Kazakh 081 Nepali 105 Tibetan 023 Khmer 363 Nigerian English Pidgin 028 Tigrigna 239 Kikuyu 054 Norwegian 305 Toisan 366 Kinyarwanda 294 Nuer 036 Toishanese 240 Kirghiz 251 Oromo 128 Tongan 338 Kirundi 386 Ouatchi 342 Trukese 424 Kiswahili 110 Pashto 112 Turkish 425 Kizigua 297 Persian (Farsi) 095 Twi 376 Kongo 062 Polish 076 Ukrainian 041 Korean 061 Portuguese 079 Urdu 320 Krahn 141 Portuguese Creole 336 Uzbek 364 Kru/Krumen 409 Pulaar 049 Vietnamese 370 Kunama 080 Punjabi 308 Visayan 140 Kurdish 066 Romanian 119 Waray-Waray 414 Kurdish (Badini) 078 Russian 020 Wolof 372 Kurdish (Kurmanji) 126 Samoan 260 Wuxinese 375 Kurdish (Sorani) 426 Sango 387 Yemeni Arabic 043 Lao 400 Saudi Arabic 135 Yiddish 402 Levantine Arabic 148 Serbian 021 Yoruba 024 Lingala 299 Serbo-Croatian 115 Zambal 075 Lithuanian 037 Shanghainese
GLOBO Customer Support: 1-866-252-3883 | [email protected]
Health Home Participation Authorization and Information Sharing Consent Participation Authorization
I, ______, agree to participate in the Health Home program with ______Print name of beneficiary Print name of Health Home Lead
Signature of beneficiary or beneficiary’s legal representative Date
Information Sharing Consent Your health information is private and cannot be given to other people unless you agree or applicable Washington State or federal laws allow the information to be shared. The providers/partners that can get and see your health information must obey all these laws. This is true if your health information is on a computer system or on paper. In addition to laws that apply to all types of health information, specific laws provide greater protection of information related to sexually transmitted diseases, mental health treatment, and substance use disorder.
I agree that my Health Home can obtain all of my health information from the providers/partners listed on this form to coordinate my care. I also agree that the Health Home and the providers/partners listed on this form may share my health information with each other, and other providers/partners involved in managing my care. I understand this form takes the place of any other Health Home Participation Authorization and Information Sharing Consent forms I may have signed before. I can change my mind and take back my consent at any time by signing a Health Home Participation - Opt-Out/Decline Services form and giving it to my Health Home.
PLEASE NOTE: If your health records include any of the following information, you must also complete this section to include these records.
I give my permission to disclose information about (please put initials next to all that apply): _ _ Mental health _ _ HIV/AIDS and STD test results, diagnosis, or treatment
Note: To give consent for the release of confidential alcohol or drug treatment information you must complete a separate Release of Information (ROI) for Substance Use Disorder (SUD) Services form.
Please initial the appropriate choice below. This consent is valid: _ as long as my Health Home needs my records for this program; or
_ until ______date or event
______
I may revoke or withdraw this consent at any time in writing, but that will not affect any information already shared. A copy of this form provides my permission to share records.
Print name of beneficiary Beneficiary’s date of birth
Signature of beneficiary or beneficiary’s legal representative Date
Print name of legal representative (if applicable) Relationship of legal representative to beneficiary List your providers/partners on page two.
HCA 22-852 (12/17) page 1 of 3 Print name of Health Home beneficiary:
List the name of participating providers/partners Beneficiary Beneficiary Withdraws Gives Consent Consent Date Initials Date Initials Past Care Coordination Org. (CCO)/Lead Past CCO/Lead
This release of information should include page 1 of the Health Home Participation Authorization and Information Sharing Consent form in order to provide the legal authority to release information for the beneficiary listed above.
Page 2 of 3 Details about the beneficiary information sharing and consent process:
1. How will providers/partners use my information? Providers/partners will use your health information to coordinate and help you manage your health care.
2. Where does my health information come from? Your health information comes from places and people that gave you health care or health insurance in the past. These may include hospitals, doctors, pharmacies, laboratories, health plans, the Washington Apple Health (Medicaid) program, and other groups that share health information. You can get a list of all the places and people by calling your care coordinator.
3. What laws and rules cover how my health information can be shared? The laws and regulations that protect your health information include Chapter 70.02 RCW in Washington statute, the federal Health Insurance Portability and Accountability Act (“HIPAA”), and federal regulation 42 CFR Part 2.
4. If I agree, who can obtain and see my information? Your information may be obtained or seen by the providers/partners you agree can obtain and see it. Information can also be obtained or seen when allowed by applicable laws. For example, when you get care from a person who is not your usual doctor or provider, such as a new pharmacy, hospital, or other provider, some information, such as what your health plan pays for or the name of your Health Home provider, may be given to them or seen by them. For more information on who can get information, see our Notice of Privacy Practices.
5. What if a person uses my information and I did not agree to let them use it? If you think a person inappropriately used your information, call your case coordinator or call the HCA Medical Assistance Customer Service Center (MACSC) toll-free line at 1-800-562-3022 (TRS: 711).
6. How do I make changes to the list of providers/partners on the form? You can add new names to the list at any time by adding the provider/partner information and filling out the “Beneficiary Gives Consent” columns next to the addition. You can delete someone you no longer wish to include by filling out the “Beneficiary Withdraws Consent” columns next to the previously added provider/partner.
7. What if I change my mind later and want to take back my consent? You can cancel your consent at any time by signing a Health Home Participation - Opt-Out/Decline Services form and giving it to your Care Coordinator. You get this form online or by calling the HCA Medical Assistance Customer Service Center (MACSC) toll- free line at 1-800-562-3022 (TRS: 711). Your care coordinator will help you fill out this form if you want.
Note: If you decide to cancel your consent, providers who already have your information do not have to give your information back to you or take it out of their records.
8. When do I get a copy of this Health Home Participation Authorization and Information Sharing Consent form? You can have a copy of the form after you sign it.
Page 3 of 3
Health Home — Adolescent Information-Sharing Consent You have been enrolled into Health Homes. Your health care providers and others involved in your care need to be able to talk to each other about your health needs and care. At times, your health records may include information about:
Family planning services, such as birth control and abortion HIV/AIDS Sexually transmitted diseases (diseases you can get from having sex) Mental health medications and services Chemical dependency services
Since this type of health information is private, the health care providers and others who have your health information cannot give it to anyone unless you agree or the law allows it. This is true whether your health information is on a computer system or on paper. By signing this consent, you are agreeing that the people you have identified on this form have permission to view your private confidential medical information and may consult with one another to help you manage your health care. This health information may be from before or after the date you sign this form. Your health records may have information about illnesses or injuries you have or may have had before; test results, such as x-rays or blood tests; and the medicines you are taking now or have taken before. If you are age 13 years and older and have been referred to Health Homes, you will be asked to sign this form, whether or not this type of health information applies to you. If you do not sign this form, you will still be able to get Health Home services.
The laws that apply to these health records include: Sexually transmitted diseases: Revised Code of Washington (RCW) 70.24.105 Mental health records: Revised Code of Washington (RCW) 71.05.620 Chemical dependency: 42 Code of Federal Regulations (CFR) Part 2 I agree to allow Health Homes to receive and share my health information with the health care providers and others listed on this form as it applies to: All my client records, including reproductive health (i.e., birth control, pregnancy, abortion); HIV/AIDS and sexually transmitted disease (STD) test results, diagnosis, or treatment; mental health; and chemical dependency. OR Only the following records (check all that apply): HIV/AIDS and STD test results, diagnosis, or treatment Reproductive health Mental health Chemical dependency Other (list): I also agree that the health care providers and others listed on this form may share my health information with each other, and cannot share it with anyone who is not listed on this form. I can change my mind and take back my consent at any time by updating page 2 of this form and giving it to my Health Home care coordinator. This will not affect any information already shared. Initials: Unless previously revoked by me, the specific information above is valid until: I am no longer participating in Health Homes. Or until ______(enter expiration date).
Print name of client Client’s date of birth
Client or legal representative’s signature Date
Print name of legal representative Relationship of legal representative to client
HCA 22-855 (6/15)
If you think someone used your information and you did not agree to give the person your information, call your care coordinator or the Medical Assistance Customer Services Center (MACSC) toll-free line at 1-800-562-3022 (TTY: 1-800-848-5429).
Print name of client Client gives Client withdraws consent consent List the names of participating health care providers and others Client’s Client’s Date Date initials initials Children’s Administration social worker
Natural parent, adoptive parent, foster parent
Primary care provider
Managed care organization
Past managed care organization
Health Home care coordinator/lead
Past Health Home care coordinator/lead
Tribal social worker/director
Family planning provider
Chemical dependency provider
Mental health provider
Additional care providers
NOTICE: PROHIBITING REDISCLOSURE OF CONFIDENTIAL ALCOHOL- OR DRUG-TREATMENT INFORMATION This notice accompanies a disclosure of information concerning a client in alcohol/drug treatment, made to you with the consent of such client. This information has been disclosed to you from records protected by federal confidentiality rules, 42 Code of Federal Regulations (CFR), Part 2. The federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR, Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The federal rules restrict any use of the information to criminally investigate or prosecute any alcohol- or drug-abuse patient.
Health Home Participation (Opt-Out/Decline Services) Name of Medicaid Beneficiary Birth Date Beneficiary’s ProviderOne Number
Qualified Health Home Lead Care Coordination Organization Managed Care Organization (MCO) if applicable
I have completed a Health Action Plan (HAP) I have not completed a Health Action Plan (HAP) I talked with a Care Coordinator who explained the Health Home program and the care coordination services I could get. I have decided not to participate. I understand that I will continue to get my other Medicaid health care services. If I want Health Home services in the future, I can call: 1-800-562-3022 (TTY/TDD: 711 or 1-800-848-5429) I am declining services because: I am happy with my current providers or I do not need any help with my medical and health health care systems. care needs. I am not comfortable with using this new Other – Explain benefit or program. Details about Protecting your Health Information When you opt out of Health Home Services the following information is important for you to understand: Any previously signed Health Home Information Sharing Consent Forms are no longer valid. Your health information will be kept by providers/partners who already have your information. They do not have to give it back to you or take it out of their records. Your personal health information will still be protected under Washington State and Federal laws and rules. These laws and regulations include Washington State and federal confidentiality rules, RCW 71.05.630, RCW 70.24.105, RCW 70.02, the Uniform Health Care Information Act, 42 CFR 2.31(a)(5), and include 45 CFR Parts 160 and 164, which are the rules referred to as “HIPAA,” and 42 CFR Part 2. No one can obtain any new health information about you. Information already shared with others will not be given back. If you think a person used your information and you did not agree to give the person permission to use your information, call your Care Coordinator or call the Medicaid Assistance Customer Service Center toll free line at 1-800-562-3022 (TTY/TDD: 711 or 1-800-848-5429). Beneficiary’s Signature or Legal Guardian (if applicable) Date Signed If Legal Guardian’s Signature, print name
I discussed the Health Home program with the Beneficiary. The benefits were explained; however, they decided not to participate or to end their participation in Health Home. Signature of the HH Care Coordinator or Allied Staff Name of HH Care Coordinator or Allied Staff Date Signed
Care Coordinator Instructions The Care Coordinator or Allied Staff is responsible to: Document the beneficiary’s request to opt-out or decline services, on this form. Sign on the Signature of the HH Care Coordinator or Allied Staff line after the form has been completed. If the beneficiary’s request to opt-out or declines services is made over the phone, the beneficiary does not need to sign this form, however the Care Coordinator must document the request, on this form Provide the Beneficiary with a copy of the form, either in person or by mail. Insure that the Qualified Health Home Lead/MCO is provided with a copy of the form. Qualified Health Home / MCO Instructions Qualified Health Home Lead/MCO must Maintain the form and document it on the Health Home Opt-Out Form Registry, for monthly submission to HCA.
HCA 22-853 (12/16)
Health Home Assessments