New York State DOHHealth Home C-MART

Support Calls-Session #2February 27,2013

1

Technical Specifications Update Change in 2012 Submission Data Requirement Q+A Themes from February 13th and 20th Definitions of Elements 1-18 Questions and Comments Feedback, Help, and Ongoing Support

2

Please submit your questions in writing to the webinar

If you would like to ask your questions, raise your hand (making sure you have entered your audio pin code) and we will unmute the call one at a time

3

Change for PlanID field on bottom of page 6 and top of page 20. FFS members field will be filled in with ‘8888888’ not ‘99999999’. New Specifications are available on Health Home Website

Page 6 changed ‘99999999’ to ‘8888888’

Page 20 – Changed ‘99999999’ to ‘8888888’

4

We have received a lot of feedback about the first file submission and have decided to reduce the amount of data for the first reporting period.

The first report will only require data collected by the FACT-GP and Health Home Functional Assessment

This data will NOT be entered into the HH-CMART tool. This data will be entered into an excel document and submitted via the HCS system. A template will be introduced next week.

The date for submission of this data has NOT changed. Data from Calendar year 2012 is still due Monday, May 13, 2013

All other reports are due no later than the first Monday of the second month following the end of the reporting period (see updated deadlines on table in next slide)

5

6

For each file submission, use a copy of the original version of the HH-CMART

FACT-GP - For a member entering a Health Home, a FACT-GP and Health Home Functional Assessment must be completed at 1) enrollment, 2) annually and 3) at disenrollment. ◦ The results of these assessments are used to adjust the risk

scoring for members and applicable rates. ◦ These tools do not take the place of the comprehensive

assessment needed to develop a care management plan for the member.

◦ The care manager should use all resources available for each member to ensure an appropriate care management plan is formulated.

7

Field#1, PlanID and Members switching plans – If a member switches plans in the middle of a reporting period, the HH-CMART data should report where that person is at the end of that reporting period.

Switching Health Home within a Reporting Period- Each Health Home should have HH-CMART data to report

Data Vs. Billing - The HH-CMART tool is for data submission purposes only and is not to be intended to be used for billing purposes.

Phase 3 Health Homes-CMART Submission – Phase 3 Health Homes that have not started providing Health Home services should be reporting data starting from when they received the first assignment file and started active outreach and engagement.

8

How to submit data/who submits data - Data reporting process should be determined between the Health Home and the downstream providers. The Health Home is responsible to collect all the data and submit to NYS DOH

Resources – Lead Health Homes should have passed all HH-CMART files and documents to their downstream providers. If this has not occurred, contact your lead Health Home and the Department of Health.◦ Previous Webinars are located under the February 2013 tab here:

http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/meetings_webinars.htm

◦ Updated Specifications Manual and User’s Guide can be found here: http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/assessment_quality_measures/process_measures.htm

◦ Today’s power point slides and webinar audio file will be on the Health Home website by early next week.

9

Q: AIRS system and HH-CMART – Conduct a Gap Analysis/Mapping◦What is the element definition?◦Do I have it in my system?◦ If I do, where is it? And how do I extract it to the HH-CMART?

EXAMPLE: Is there something currently being captured or documented that provides that element’s information?◦ Yes, data is captured. Is there any reformatting or mapping that

needs to be done from it’s current form to the formats specified for collection?

◦ No, there is a gap. If the information is not currently captured, how could systems change and staff trained to capture for future?

10

Each element is color coded by data collection needs for each element by reporting period◦Green = changes each reporting period◦Red = Once in, remains the same always◦Orange = Needs to be reviewed for new information

each report◦Blue = DOH will fill in* Color Coding See slides from Feb. 20, 2013 Webinar

power point: http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/meetings_webinars.htm

11

1 – PlanID: The organization’s OMC Plan ID. FFS members should be filled in with ‘8888888’ If a member changes health plans during a reporting period, use the PlanID for the member at the end of the reporting period. HH-CMART User Manual Appendix has a list of PlanIDs.

2 – HHID: This is the MMIS number and will be the same for all members in the Health Home’s file. ◦ More than one Care Management Provider - If a member changes care management

providers during the reporting period, the Health Home will need to combine the data for the member for the reporting period. For example, if the member is with agency A for one month and Agency B for the next two months, the data will be combined by the Health Home to one row for the member for the reporting period.

◦ More than one Health Home - If the member changes Health Homes, report the data connected with each Health Home for the partial period. Member may be in more than one Health Home file for a CM provider. HH-CMART has HHIDs in drop down on the main menu screen. * see below.

3 – Report Date: Should reflect the quarter for the end reporting period, Q/YYYY

12

HHID ReportDate CIN DOB ProgramType AbleContact ContactDate OutreachEffort2202501 2/2013 AB12345C 1/18/1978 HH Behavioral Health Yes 12/14/2012 74208471 2/2013 AB12345C 1/18/1978 HH Behavioral Health Yes 2/21/2013 12

4 – CIN: Medicaid Client ID Number. Valid CIN must be provided for every record and should be the CIN from the reporting period.

5/6 – Last/First Name of member 7 – Date of Birth of member 8 – TriggerDate: Imported as MM/DD/YYYY. This is the same thing

as the “Begin Date” on the Health Home Patient Tracking System for the first record submission for the member. ◦ It is the first day of the month when outreach and engagement began.

9 – ProgramType: Members should be placed in a category based on the primary issue for care management. Members may have conditions for more than one category; select the category based on the member’s primary focus for care management.◦ Categories are – HH Behavioral health, HH Chronic Adult, HH Children,

HH Developmentally Disabled, HH LTC, and Missing◦ We use Program Type in analyses to subset populations when analyzing

outcomes. This allows more focused evaluation of impact for people with similar conditions.

13

10 – AbleContact: Indicates if Health Home was able to contact member regarding participation in care management. ◦ Contact is defined as a verbal interchange (phone or in-person) between member/ legal

representative/ family and Health Home staff. Contact does not include mailings or attempts to contact (voice message or unsuccessful in-person attempt to locate member).

◦ Hiatus Period – A hiatus period is a three month span during which the Health Home cannot bill for outreach efforts for any member who has not be able to be engaged in the Health Home in the previous three months. Ongoing outreach efforts can be undertaken during the hiatus period; hiatus period signifies the billing status for the member.

11- ContactDate: Completed for those who were contacted (AbleContact = ‘YES) and left blank for those not contacted. This is the date of initial contact or verbal interchange between member/legal representative/family and Health Home staff. ◦ ‘Missing’ should be used for members who were contacted but the date is not known

12 – OutreachEffort: Count of in-person or phone contacts or attempts to locate and interact with the member during the reporting period. ◦ The count includes interactions or attempts prior to the member’s agreement to participate in the

Health Home. The interaction where the member agrees to participate in the Health Home is not counted.

◦ Outreach contacts are reported for all members even if the member did not agree to participate in the Health Home. Efforts made during hiatus period should be included in counts even if not billing for outreach.

14

15

16

16 – OptOut: Indicates if member/legal representative/family refused to participate in the Health Home. ◦ Foe members offered participate, the response should be either

‘OPTED OUT’ or ‘DID NOT OPT OUT’.◦ For members who were not offered participation because the member

was not able to be contacted or was not appropriate for participation, the response should be ‘NOT APPROPRIATE HH’.

17- EngagedCM: Indicates if the member agreed to participate in the Health Home. ◦ Engagement is the agreement of the member/ legal rep/ family and

care manager that there is a need for care management and the member is willing to participate .

18 –EngagedCMDate: This is the date when the member agrees to participate in the Health Home.◦ It is the ‘Begin Date’ in the PTS for the first record submission for

the member with the Outreach/Engagement code = ‘E’.◦ If the member does not engage in CM (EngagedCM = ‘NO’), this

element through #34 will be blank.

We encourage your feedback◦ Case Scenario development◦ Clarify fields so that the thinking behind how a question is answered in

the HH-CMART is the same across the board

Email the Health Home Team atHH2011@health.state.ny.us

with the Subject : HH CMARTOr Call the Health Home provider line – 518.473.5569

Health Home website, Assessment and Quality Metrics menu, Process Measures section:

http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/assessment_quality_measures/process_measures.htm

17

Weekly call every Wednesday from 10 a.m. to 11 a.m.◦The next call will be March 6th

Slides from all webinars be accessed by visiting the

Health Home website at:http://www.health.ny.gov/health_care/medicaid/program/

medicaid_health_homes/meetings_webinars.htm

18