Monthly Children's Medicaid Transformation Webinar

  • Presentation also available in Portable Document Format (PDF)

October 11, 2017

Agenda

1915(c) Transitioning Waiver Providers Status of Readiness Activities

Health Home System Readiness Activities

  • 7/26/17 – Email to 1915c providers to submit a Single Point of Contact (SPOC) to NYS DOH for communication of readiness activities relating to waiver providers transition to Health Home Care Management
  • 8/29/17 – Second email sent to 1915c providers – submission of a Single Point of Contact (SPOC) for readiness activities relating to 1915c providers transition to Health Home Care Management
    • If a provider had already identified a SPOC during the launch of Health Homes, the provider still needs to respond to the email to identify a SPOC. The staff that was previously identified can continue to be that contact.
  • 9/15/17 – Communication to 1915c providers without a Business Associate Agreement (BAA) with a Health Home Serving Children (HHSC) and not in the Health Commerce System with the organization type, "Health Home CMA" – steps relating to obtaining a BAA and gaining access to the Health Commerce System as a "Health Home CMA"
  • 9/29/17 – Communication to 1915c providers with multiple Medicaid Management Information System (MMIS) IDs. Requesting 1915c providers confirmation of the MMIS ID that should be utilized for children´s Health Home with MAPP HHTS
  • NYS DOH Staff Continue to work with 1915c providers and provide education on the process of becoming a Health Home Care Management Agency
    • Individual calls have been held with 1915c providers that are working to obtain a Business Associate Agreement (BAA) with a Health Home Serving Children and are not yet in the Health Commerce System as a "Health Home CMA"

Waiver Providers Status Report – Department of Health (DOH) Care at Home (CAH) I/II

29 Total CAH I & II Providers that will transition to Health Home Care Management

  • 20 CAH I & II Providers have a Business Associate Agreement (BAA) with a Health Home Serving Children
    • 9 CAH I & II Providers are working to obtain Business Associate Agreement (BAA) with a Health Home Serving Children
  • 26 CAH I & II Providers are in the Health Commerce System (HCS)
    • 3 CAH I & II Providers do not have a Health Commerce System (HCS)
    • 7 CAH I & II Providers are in the Health Commerce System (HCS) without the proper organization type, "Health Home CMA"

Waiver Providers Status Report – Office for People With Developmental Disabilities (OPWDD) Care At Home (CAH)

24 Total OPWDD CAH Providers that will transition Health Home Care Management

  • 19 OPWDD CAH Providers have a Business Associate Agreement (BAA) with a Health Home Serving Children
    • 5 OPWDD CAH Providers are working to obtain Business Associate Agreement (BAA) with a Health Home Serving Children
  • 23 OPWDD CAH Providers are in the Health Commerce System (HCS)
    • 1 OPWDD CAH Provider does not have a Health Commerce System (HCS)
    • 5 OPWDD CAH Providers are in the Health Commerce System (HCS) without the proper organization type, "Health Home CMA"

Waiver Providers Status Report – Office of Children and Families (OCFS) Bridges to Health (B2H)

17 Total OCFS B2H Providers that will transition to Health Home Care Management (2 of these providers are also OMH HCBS Providers)

  • All 17 OCFS B2H Providers have a BAA with a Health Home Serving Children
  • All 17 OCFS B2H Providers are in the Health Commerce System (HCS) with a proper HCS organization type, "Health Home CMA"

Waiver Providers Status Report – Office of Mental Health (OMH) Serious Emotional Disturbance (SED) HCBS

28 Total OMH HCBS Providers that will transition to Health Home Care Management (2 of these providers are also OCFS B2H Providers)

  • 27 OMH HCBS Providers have a BAA with a Health Home Serving Children
    • 1 OMH HCBS Provider is working to obtain Business Associate Agreement (BAA) with a Health Home Serving Children
  • 26 OMH HCBS Providers are in the Health Commerce System (HCS)
    • 2 OMH HCBS Providers are in the Health Commerce System (HCS) without the proper organization type, "Health Home CMA"

Next Steps for 1915(c) Transitioning Waiver Providers

  1. Ensure all 1915c waiver providers are connected by HCS and have a BAA with a Health Home Serving Children
  2. Each 1915c waiver providers will need to identify a MAPP HHTS Gatekeeper by November 17, 2017 – announcement forthcoming
  3. Connect all 1915c waiver provider´s staff to roles within the MAPP HHTS and UAS–NY
  4. Health Homes to connect with 1915c waiver providers to determine a training schedule for staff regarding HIT systems and policy/procedures

Reminder – UAS and MAPP Training is Available Now

Training has already begun!!

DOH Health Home Children´s team is currently working with 1915(c) providers to ensure system access and connectivity to Health Homes

By November 2017 – 1915(c) waiver providers should complete activities that will provide access to required Health Home systems

  • Organizations need access to the Health Commerce System (HCS) and a role type of Health Home Care Management Agency (CMA)
    • All staff who will be working within MAPP HHTS and the UAS–NY MUST have active HCS accounts
MAPP HHTS
  • The Organization will then be entered into MAPP HHTS
  • The Organization assigned Gate Keeper will receive an email for training on MAPP roles
  • The Gate Keeper will assign staff roles within MAPP
  • Staff will then receive an email regarding on–line MAPP HHTS training – you can begin training now
UAS–NY
  • The designated HCS Coordinators can assign staff roles within the UAS–NY
  • When staff have an active HCS account and an assigned a role within the UAS–NY, staff will receive an email regarding access to online training – you can begin training now

Additional in–person trainings will be available 2017–2018 for CANS–NY tool

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Provider Designation

Psychosocial Rehabilitation (PSR)

  • Rehabilitation Service under the State Plan
  • Medical Necessity Requirements
  • Intent is to restore, rehabilitate and support the child´s functional level
  • Can be delivered to a group of children or one on one
  • Can occur in a variety of settings, e.g., home, community
  • Recommended by an Licensed Practitioner of the Healing Arts (LPHA)

Habilitation

  • 1115 HCBS benefit
  • Intended for children who are acquiring a skill they did not previously have
  • Can be delivered to a group of children or one to one
  • Community Habilitation setting–in the child´s home or community
  • Day Habilitation setting–provider owned day habilitation facility serving children

Palliative Care

  • To assist the State in its review of applications from providers that have applied for palliative care designation, such providers will receive email seeking additional information about the services they intend to provide
  • Provider designations will be specific to each palliative care service
    • Bereavement
    • Pain and Symptom Management
    • Massage Therapy
    • Expressive Therapy (art, music, play)

Palliative care service descriptions

Bereavement Service – Help for participants and their families to cope with grief related to the participant´s end–of–life experience. Bereavement counseling services are inclusive for those participants in receipt of hospice care through a hospice provider.

Pain and Symptom Management – Relief and/or control of the child´s suffering related to their illness or condition.

Expressive Therapy (art, music and play) – Help children better understand and express their reactions through creative and kinesthetic treatment.

Massage Therapy – To improve muscle tone, circulation, range of motion and address physical symptoms related to their illness.

Palliative Care Provider Qualifications

Bereavement Service A Licensed Clinical Social Worker (LCSW), a Licensed Master Social Worker (LMSW), a Licensed Psychologist or a Licensed Mental Health Counselor, that meet current NYS licensing

Pain and Symptom Management Pediatrician or Family Medicine Physician, board certified in Pediatrics or Family Medicine licensed by the State of New York, a Nurse Practitioner licensed by the State of New York ( Pain and Symptom Management)

Expressive Therapy (art, music and play) Child Life Specialist with certification through the Child Life Council a Creative Arts Therapist licensed by the State of New York ,a Music Therapist with a Bachelor´s Degree from a program recognized by the NYS Education Department, or a Play Therapist with Master´s Degree, from a program recognized by the New York State Education Department and a current Play Therapist Registration conferred by the Association for Play Therapy (Expressive Therapy (Art, Music and Play).

Massage Therapy Massage Therapist currently licensed by the State of New York.

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Billing and Rates

Billing and Rates: Next Steps

  • Webinar was held on October 10, 2017 to discuss overview of rate methodology
  • Slides will be posted to ctacny.org in the next day or so
  • Work with DOH and sister agencies to finalize all outstanding internal questions, as well as any stakeholder feedback/questions from the 10/10 meeting
  • Make final adjustments to rates for outstanding questions
  • Review rates with DOH and sister agencies to determine if additional adjustments are required
  • Communicate rates on 10/24/17

Community First Choice Option Services

  • Some CFCO services overlap with HCBS
    • Environmental Modifications
    • Vehicle Modifications
    • Assistive Technology
    • Community Habilitation
  • CFCO will be billed first when applicable
  • State working on guidance for accessing and billing CFCO and HCBS

Topics for future webinar discussion

Please submit suggestions for upcoming Transformation Webinar discussions

  • Chat box function
  • Email: BH.Transition@Health.NY.GOV

Monthly Children´s Medicaid Transformation Webinar

  • November 8, 2017 – 3–5 pm
  • December 13, 2017 – 3–5 pm

Additional information and webinars can be found at: Webinars and Important Information for the Children´s Medicaid System Transformation

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Upcoming Training

10/24/17 Part 2: Children´s SPA and HCBS Draft Rates, Codes and Modifiers Webinar

November: MCO Contracting Fairs

  • 11/6 Albany
  • 11/8 NYC
  • 11/16 Rochester
  • Registration Information Coming Soon

December: Revenue Cycle Management Training

  • 12/6 Rochester
  • 12/12 Albany
  • 12/15 NYC
  • Registration Information Coming Soon
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Resources to Keep Informed

DOH Transition Mail Log
BH.Transition@health.ny.gov

Health Home Bureau Mail Log
https://apps.health.ny.gov/pubdoh/health_care/medicaid/program/medicaid_health_homes/emailHealthHome.action

OMH Managed Care Mail Log
BHO@omh.ny.gov

Children´s Designation Mail Log
OMH–Childrens–Designation@omh.ny.gov

Subscribe to DOH Health Home listserv
http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/listserv.htm

Subscribe to children´s managed care listserv
http://www.omh.ny.gov/omhweb/childservice/

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