SOUTH COUNTRY • 1

 SOUTH COUNTRY connection

SOUTH COUNTRY • 1

Keeping County Staff Informed

calendar of events

February 2014

links:

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connectionCLICKHERE

As we entered 2014, South Country Health Alliance had significant enrollment changes resulting from the Affordable Care Act and MNsure. All of our counties saw an increase in membership, bringing in a total of 4,873 new Medical Assistance and MinnesotaCare members. Here was the breakdown in January:

County New Members County New MembersBrown 306 Steele 570Dodge 48 Todd 873Goodhue 555 Wabasha 56Kanabec 498 Wadena 436Morrison 972 Waseca 271Sibley 288

Because of the increase in enrollment, we’ve received a high volume of calls to the Member Services call center in the last month. Inquiries have covered several areas, including questions about member ID cards, eligibility, benefits, primary care clinic changes (members should let us know if the PCC on their ID card is not the clinic they go to), prescriptions (when transferring to a new health plan or product, members are eligible for a transition fill for medications under current prescriptions; new prescriptions do not qualify for a transition fill), and prior authorizations (members should notify South Country of any upcoming procedures that received approval by a former health plan).As new members have questions, please continue directing calls to Member Services at 1-866-567-7242 (TTY 711). n

DHS is mailing a letter in February to potential members of Special Needs BasicCare (SNBC), explaining that people with disabilities currently in Medical Assistance will be enrolled in SNBC by April 2014 unless they decide to opt out of the program. This is part of an ongoing expansion as individuals on Medical Assistance become eligible for SNBC. n

Potential Enrollees for April Enrollment by County

County Potential New Members County Potential New

MembersBrown 187 Steele 322Dodge 110 Todd 291Goodhue 287 Wabasha 136Kanabec 210 Wadena 189Morrison 364 Waseca 165Sibley 79

Figures based on Mayo Clinic Health Solutions Data Warehouse eligibility tables as of 12-11-13

Member ID Card Updates

CAHPS Surveys Coming

Mental/Chemical Health

County Satisfaction Survey

2014 Medicare Star Ratings

Susan Branstad Retires

Med. Therapy Management

Model of Care

Mission Statement & Values

Marketing DOs and DON’Ts

SBIRT Screening Tool

New Promotional Items

Feb 10 Service Enhancement Committee, MCIT, St. Paul, 10 a.m.-2 p.m.

Feb 13 Public Relations Committee, 2300 Park Dr., ITV, 1-3 p.m.

Feb 14 County Supervisor Meeting, 2300 Park Dr., ITV, 9 a.m.-noon

Feb 24 Joint Powers Board, 2300 Park Dr., 9 a.m.-noonFeb 24 Health Outcomes Committee, 2300 Park Dr., ITV, 2-4 p.m.

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MNsure & New Members

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 SOUTH COUNTRY connectionContinued from page 1

calendar of eventsMarch 3 PH/HS Directors Meeting, MCIT, St. Paul, 10 a.m.-2 p.m.March 7 Quality Committee, 2300 Park Dr., noon-2 p.m.March 24 Joint Powers Board, 2300 Park Dr., 9 a.m.-noon

March 27 County Connector Meeting, 2300 Park Dr., ITV, 9 a.m.-noon

Satisfaction SurveyLet us know

what you think!Your feedback helps us improve our service to you and our members.Click here to take our County Satisfaction

Survey today!

The annual DHS and CMS CAHPS surveys, or Consumer Assessment of Health Providers and Systems surveys, are going out to members in February. These surveys help measure member satisfaction with health plan performance, quality of care issues, and overall satisfaction with physicians and the health plan in the last year. Members affected:

• DHS CAHPS surveys target all members age 18 and older living in the community.• CMS CAHPS surveys target SeniorCare Complete (MSHO) members living in the

community.Member participation matters! The results to several questions in the CMS CAHPS survey are used as HEDIS and Star Ratings measures. Encourage South Country members to take the survey! If members have questions about the survey, they should call Member Services at 1-866-567-7242 (TTY 711).For more information, visit the Medicare Advantage and Prescription Drug Plan CAHPS Survey website. n

South Country Member Services can take enrollment applications over the phone if a member requests it. A Member Services Specialist helps the member fill out an application. The completed application is then mailed to the member, along with a stamped, addressed envelope. The member or his/her authorized representative must sign and return the application to South Country, and it will be processed. n

CAHPS Surveys Coming Soon

Taking Applications by Phone

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South Country has issued new member ID cards to all members for 2014, updating the look and information on the cards. Here’s what you need to know:

Card Issue DateThe Issue Date tells members when the card was issued to them. Members should always keep and use the most current version of the card. Providers should use the information on the most current version of the card.

Member & Provider ContactsOn the back of the ID cards, contacts for members are listed in the top section, while contacts for providers are on the bottom.

Additional ContactsThere are additional pharmacy help desk phone numbers on ID cards for members of SeniorCare Complete (MSHO) and AbilityCare (SNBC).

Updated Claims Submission AddressThe address to submit paper medical claims has been updated.

See member ID card examples for all of our programs on our website. n

ID Card Updates

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2014 Health & Wellness CalendarSouth Country created a new health and wellness calendar for 2014 and sent it to SeniorCare Complete (MSHO) and AbilityCare (SNBC) members living in the community. The calendar features several health topics and preventative services that help inform members about health issues and remind them to take care of their health all year. Through short articles, helpful reminders, and daily tips, important actions of care are put in front of members in a timely fashion. The calendar also includes general information for members, such as information about CAHPS surveys, tips for what to do when hospitalized, important phone numbers for emergencies, other South Country contacts, and so on. We hope this calendar will help remind members stay active, keep up with important check-ups, and make good life choices. Several calendars will be mailed to county supervisors the first week of February. If you would like to request a calendar, please contact Lori Nelson, HEDIS/Star Ratings manager, at 1-507-431-6597 or lnelson@mnscha.org. n

South Country is sending dental floss for our counties to give to the children you serve during the month of February. Floss is important to add to everyone’s daily dental routine to maintain a clean, healthy smile. Thank you for your assistance in promoting good dental care for children! n

Children’s Dental Health Month

South Country is offering 100 travel kits to each member county’s Public Health and Social Service departments, arriving early February.The travel kit includes basic hygiene products, including shampoo, conditioner, soap, disposable razors, toothpaste, and tooth brushes. They also contain basic information about South Country Health Alliance and our programs.These kits are intended for South Country members, potential members, and other people in need. Thank you for your partnership! We are happy to make this contribution back to your county. n

Personal Care Travel Kits

During the Communications Department’s visits with county staff last fall, we left complimentary brochure holders and member materials for each county office to use in their lobbies. To request a brochure rack or more materials, contact Communications Administrative Assistant Dana Holmes at marketing@mnscha.org or 1-507-431-6589. n

Refilling Your Brochure Racks

New Promotional Items

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 SOUTH COUNTRY connection

Mental Health Updates

Chemical Health Updates

Transition to ICD-10

Minnesota Uniform Companion Guides V8.0

New and revised Mental Health prior authorization and notification forms are located on South Country’s Mental Health Web page. If you haven’t already, please begin using these forms and discontinue using previous versions. We’ve also added short descriptions explaining the use of each form. n

New Forms

Revised Forms

The Rule 25 Assessment form (DHS-5204-ENG) and Rule 25 Assessment and Placement Summary form (DHS-2794-ENG) have been updated by DHS and posted to e-docs, incorporating DSM V/ICD-10 Substance Use Disorders diagnosis. n

The US health care industry is transitioning from ICD-9 to ICD-10 (ICD-10-CM/PCS), scheduled for implementation on October 1, 2014. Though the implementation date is still several months away, you should be preparing for your ICD-10 transition now.ICD-10 is the disease-classification system currently being used by the majority of the world. It will improve the detail of data captured through coding and facilitate patient care coordination across clinical settings. ICD-10 will provide the following:

• Greater coding accuracy and specificity

• Higher-quality information for measuring health care service quality, safety, and security

• Improved efficiencies and lower costs

• Reduced coding errors• Enhanced ability to conduct public

health surveillanceThis transition will be a significant undertaking for providers, payers, and other health care entities, requiring organization-wide planning and preparation. Any delay in adoption of ICD-10 will increase future implementation costs, as management of health information becomes more electronic and costs of implementing new coding systems increase.Early preparation, adequate education, and proper testing may reduce problems during the transition. South Country Health Alliance is continuing its in-depth training and education for staff members, county partners, providers, and enrollees to make a smooth transition. By communicating and working together, we can move toward a successful transition to ICD-10.For more information, visit the World Health Organization or the American Health Information Management Association. n

Effective January 31, 2014, the Minnesota Department of Health has adopted into rule version 8.0 of the Minnesota Uniform Companion Guides (MUCGs) for these transactions:

• ASC X12/005010X222A1 Health Care Claim: Professional (837)• ASC X12/005010X223A2 Health Care Claim: Institutional (837)• ASC X12/005010X224A2 Health Care Claim: Dental (837)• ASC X12/005010X221A1 Health Care Claim Payment Advice (835)• ASC X12/005010X279A1 Health Care Eligibility Benefit Inquiry and Response

(270/271)The companion guides help determine the most appropriate practices for your facility. You should discontinue using all previous versions. You can find all Minnesota Uniform Companion Guides on the Administrative Uniformity Committee website. n

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Latest Updates from Mental & Chemical Health

• 2286 CTSS Authorization Form• 2287 Initial Dialectical Behavior Therapy (DBT) Authorization Form• 2288 Additional Dialectical Behavior Therapy (DBT) Authorization Form• 2289 Diagnostic Assessment Authorization• 2290 Eating Disorder Inpatient/Outpatient Review Form

• 1690 v2 MH-TCM Authorization to Release Protected Health Information to SCHA• 1796 v3 MH-TCM Eligibility Determination Notification Form• 1922 v2 MH-TCM DTR Recommendation for Action Form• 2281 Mental Health Notification• 2284 MH-TCM Universal Transfer Form• 2285 Outpatient Mental Health Authorization Form• 2292 Preauthorization Request for Psychological Testing Form• 2324 MH Admission Worksheet

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 SOUTH COUNTRY connection

The Medicare Program rates all health and prescription drug plans each year, based on a plan’s quality and performance. Medicare Star Ratings help you know how well our plan is doing. You can use these Star Ratings to compare our plan’s performance to other plans. Star Ratings are assessed each year and may change from one year to the next.The two main types of Star Ratings are:

1. An Overall Star Rating that combines all of our plan’s scores.

2. Summary Star Rating that focuses on our medical or our prescription drug services.

Some of the areas Medicare reviews for these ratings include:• How our members rate our plan’s services and care;• How well our doctors detect illnesses and keep members

healthy; and• How well our plan helps our members use recommended

and safe prescription medications.

For 2014, South Country Health Alliance received the following Overall Star Rating from Medicare.

We received the following Summary Star Rating for South Country Health Alliance’s health/drug plan services: Health Plan Services: Drug Plan Services: The number of stars shows how well our plan performs. excellent above average average below average poorLearn more about our plan and how we are different from other plans at www.medicare.gov. You may also contact us seven days a week, 8 a.m.-8 p.m., at 1-866-567-7242 (TTY 711). n

Susan Branstad has recently retired from her position as Disease Management coordinator. Susan completed nearly 39 years working as a Registered Nurse, the last six of which were spent here at South Country Health Alliance. Susan was hired in 2008 when South Country decided to bring its Disease Management program in-house. She worked to create the program and helped it adapt to the needs of South Country members.“My time at South Country went fast, and there were always changes, but my favorite thing was talking with members every day and helping them complete their health goals,” said Susan. “Even if they just made small changes, it felt really good knowing we made a difference in their lives.”Susan is looking forward to spending time with her family, especially her granddaughter, and enjoying time at her cabin Up North.From everyone at South Country, we thank Susan for her excellent work with our members and wish her the very best in her retirement. Good luck! n

South Country’s website has a Care Coordination Web Manual for county staff and care coordinators to access forms, processes, and other information needed for managing members’ care.Our Care Coordination Web Manual pages will always have the most current documents. We continuously work to make sure the content is up-to-date. Bookmark these Web pages, and make sure you’re using the most current forms and processes.For questions or comments about the Care Coordination Web Manual, contact South Country Clinical Facilitators Stephanie Bartelt (sbartelt@mnscha.org, 1-507-431-6572) or Staci DeBus (sdebus@mnscha.org, 1-507-431-6574). n

The updated 2014 Prior Authorization and Notification Grid is on our website, located under the Providers tab on our Prior Authorization & Notification Grid Web page. Please use this document to determine if a prior authorization is required for certain health care services and what authorization form(s) to use. n

2014 Medicare Star Ratings

Susan Branstad RetiresCare Coordination Website

2014 PA Grid

3.5 Stars

4 Stars

3.5 Stars

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 SOUTH COUNTRY connection

DOexplain the benefits someone might obtain as a South Country member, including health promotion programs, Disease Management services, Connector and care coordination services, and so on.

DON’T make any written or verbal assertion that an individual must enroll with South Country to obtain Medical Assistance and covered benefits or that South Country is endorsed by CMS, Medicare, the State of Minnesota, or the federal government.

DOdirectly market to eligible individuals who are already South Country members. For example, you can introduce a South Country member on MSC+ to the benefits for SeniorCare Complete and give them materials about the program. This applies to all South Country products.

DON’T conduct direct or indirect cold-call marketing activities to potential members on behalf of South Country.

DO compare South Country to other health plans when there is equivalent and factual information given about each plan, including benefits, statistics, health promotions, and so on. Comparisons cannot be inaccurate, misleading, or otherwise misrepresent South Country or other plans.

DON’T compare South Country to other health plans if there is not equivalent and factual information given about each plan.

DOdistribute South Country marketing materials to inform eligible people about South Country, our programs, business hours, and other information. Counties must do the same for other plans if requested.

DON’T distribute or collect South Country enrollment forms or hold any marketing events on behalf of South Country unless it is an approved marketing activity and a South Country licensed representative is present. Meals may not be provided to prospective members at these events.

DOdisplay brochures, posters, or signs at provider offices and clinics informing patients that the provider is part of South Country’s network.

DON’T distribute South Country marketing materials that have not received approval from the Department of Human Services and the Center for Medicare and Medicaid Services.

DOcheck the South Country website at www.mnscha.org for updates, materials, and forms. For more information about marketing regulations and other South Country 411 information sheets, visit the South Country 411 Web page. n

South Country 411

DOs and DON’Ts of Marketing for Counties Mission & ValuesMission StatementSouth Country Health Alliance’s mission is to empower and engage our members to be as healthy as they can be, build connections with local agencies and providers who deliver quality services, and be an accountable partner to the Counties we serve.To accomplish this, South Country implements a care coordination model that incorporates both medical and social services, and enables South Country’s enrollees to receive services in a comprehensive and cohesive manner.

Diamond Values• Collaboration

We value the contributions of many individuals, partners, and agencies in helping meet the needs of our members.

• Stewardship We responsibly manage our resources, using them in the best way possible for our members.

• Communication We communicate openly, honestly, and frequently, responsibly sharing information and ideas in all areas of our business.

• Excellence We provide quality through our programs and services that make a difference in people’s lives.

Our mission and values are at the center of South Country Health Alliance. They are a reflection of who we are, where we have been, and where we want to go. Every day we strive to carry out our mission and values in all that we do. n

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 SOUTH COUNTRY connectionModel of Care

Special Needs Plans Provide Coordination & Continuity of CareSouth Country Health Alliance offers two fully-integrated Medicare Advantage Special Needs Plans for persons who are eligible for both Medicare and Medical Assistance. These plans are SeniorCare Complete (MSHO) and Special Needs BasicCare: AbilityCare (HMO SNP). Both plans integrate the two benefit sets from Medicare and Medical Assistance. The model of care for SeniorCare Complete and AbilityCare offers the opportunity to improve care for members through the coordination and continuity of care. South Country works to assure that each member has the following:

• A primary care clinic • Assistance in navigating the health

care system through care coordination so the member receives the right service at the right time with no duplication

• A system that integrates the medical and social services, along with complex medical case management so that service is seamless

• Care management to help members achieve the highest level of health by providing integrated care coordination and promoting service accessibility

South Country is a county-owned health plan that has a unique relationship with counties, offering a local care team model. South Country utilizes county-based case managers to provide the overall care coordination of members’ needs. Local care coordination ensures access to all benefits including Medicare, Medical Assistance, Home and Community-Based Waivers, and other county services. The Interdisciplinary Care Teams are developed at the local level with the Care Coordinator leading the interdisciplinary care team.

Care Coordinators Care Coordinators work with all identified providers, including primary care, specialty care, home care, and other community support and human service providers to ensure that care is provided at the right time and not duplicated.

South Country Clinical Staff and Utilization Management South Country provides clinical staff to assist the interdisciplinary care team by providing consultation for members with complex and chronic conditions. South Country also provides utilization management through prospective and retrospective utilization review, prior authorization, and clinical case management.

CCM (Client Contact Manager) An electronic case management web-based computer program is accessible to the interdisciplinary care team in order to provide immediate shared access to members’ information. Under this model of care, all members are offered the following:

• A face-to-face visit within 30 days of enrollment.

• An initial health assessment which reviews and identifies physical, psychosocial, and functional areas of concern. The health assessment is completed on an annual basis.

• A comprehensive care plan is developed from the needs and areas of concern that were identified from the health assessment. The Care

Coordinator works with members in the development of the care plan ensuring coordination of the members’ Medicare, Medical Assistance, Home and Community-Based Waivers, and other services.

• Contact with a Care Coordinator which includes, at a minimum, quarterly communication and annual face-to-face visits to monitor the progress and re-evaluation of the member’s care plan. The Care Coordinator and member can revise the care plan as needed.

The care plan is holistic and crosses all domains of medical and social services and guides the Care Coordinator to reduce service fragmentation, improve clinical outcomes, and assist with access to care. South Country assures access to care by developing and working with provider networks that have targeted clinical expertise for the target population. Providers are accredited by nationally-recognized quality and health care safety accreditation organizations whose standards assure evidence-based practice. South Country provides trainings for providers through online manuals, electronic newsletters, bulletins, mailings, and specialized annual trainings (in-person, web-based, interactive television). Maintaining regular communication is vital among all providers, care managers, Care Coordinators, and South Country staff. South Country evaluates the model of care through the Plan-Do-Act-Check cycle. Results are documented and preserved as evidence of the effectiveness of the model of care. South Country communicates the outcomes and improvement initiatives to all stakeholders through multiple methods including, but not limited to, Web page announcements, newsletters, bulletins, and trainings. By doing so, South Country works to improve care for members through the coordination and continuity of care as outlined in the model of care. n

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 SOUTH COUNTRY connection

SCHA believes it is the responsibility of everyone to report suspected

fraud, waste, or abuse. You can report anonymously

through our REPORT-IT hot line by calling 1-877-778-5463.

You can also make a report at www.reportit.net. Username: SCHA,

Password: Owatonna

REPORTING: Fraud, Waste and Abuse

South Country Health Alliance (SCHA) is a county-based

purchasing health plan providing coverage for Minnesota Health

Care programs in Brown, Dodge, Freeborn, Goodhue, Kanabec,

Morrison, Sibley, Steele, Todd, Wabasha, Wadena,

and Waseca Counties.

Copyright © 2014 by South Country Health Alliance.

The County Connection is a bimonthly publication of

South Country Health Alliance. For submission information or re-

print permission, please contact:

SCHA, 2300 Park Drive, Suite 100, Owatonna, MN 55060

Email: marketing@mnscha.org Website: www.mnscha.org

Have an idea for what you’d like to see in the next County Connection newsletter? Send us your requests

at marketing@mnscha.org.

SBIRT Screening ToolSouth Country’s Provider Network will be looking for a completed SBIRT (Screening, Brief Intervention, and Referral to Treatment) screening tool at the annual 2014 Medical Record Review.

SBIRT is a program developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the US Department of Health and Human Services to provide screening, intervention, and referrals intended to stop alcohol and substance abuse before they become serious problems. Conducting an annual SBIRT on members ages 13 and older became a DHS requirement for managed care organizations and their providers.

The approved SBIRT screening tools are short and simple to administer. Instructions for conducting the screening and intervention strategies are included. n

Medication Therapy ManagementSouth Country Health Alliance offers Medication Therapy Management (MTM) programs to members at no additional cost. These programs help provide better prescription drug coverage for members by making sure they are using appropriate drugs to treat their medical conditions. A team of pharmacists, doctors, and nurses can answer questions about prescription medicines and over-the-counter products. MTM services include the following:

• a review of medications• personalized medicine lists• help in understanding how medications work and their side effects• educational materials

Members are automatically enrolled in an MTM program if they have multiple medical conditions, are taking many prescription drugs, and have high drug costs (see eligibility criteria below). South Country may notify members of enrollment into the program. If a member is selected as an eligible participant for an MTM program, we will send information about the program in the mail, including information on how to disenroll if the member chooses not to participate. Remember: There is no added cost for MTM programs and members may leave the program at any time.

Eligibility Criteria• Have 3 or more of the following chronic conditions:

• Benign Prostatic Hyperplasia (BPH)• Chronic Heart Failure• Chronic Kidney Disease (CKD)• Diabetes• Dyslipidemia• Osteoporosis• Asthma• Rheumatoid Arthritis (RA)• Chronic Obstructive Pulmonary Disease (COPD)

• Take 6 or more prescriptions• Spend more than $754.00 in the previous quarter on your medications n

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