blue plus care coordination training 2016 … caregiver coaching and counseling with caregiver...

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.Confidential and proprietary.

BLUE PLUS CARE COORDINATION TRAINING2016 WINTER WEBINAR

February 2016

Partner Relations Team

Today’s Presenters

• Stormy Church, Partner Relations Consultant

• Kim Flom-Brooks, Partner Relations Consultant

• Katie Gumtow, Manager- Partner Relations

• Special Guests: • Lisa Benrud, Sr. Clinical Project Manager

• Erika Bradseth, Sr. Clinical Project Manager

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Housekeeping Items

• Purpose is to provide Care Coordinators with process and general updates, including revisions to the guidelines, forms and resources

• Questions may be submitted at any time. We will answer them at the end as time permits. Q & A Summary will be emailed to all participants after the presentation

• Attendance Log: Sign in and return via e-mail to: [email protected]

• Survey will be sent to all participants following presentation

• Webinar will be available to view for one year. We will include the link with the final Q&A

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mailto:[email protected]

Agenda

• 2016 Blue Plus and Partner Relations Updates

• 2016 Supplemental MSHO Benefits

• New Service Under Family Care Giver Benefit and Resources

• Transitions of Care (TOC) Process Updates

• Bridgeview Enhancements Review

• 2016 Quality Improvement Project Updates

• 2016 MSHO STAR Rating Activities

• Guidelines and Other Updates

• MMIS Entry of Screening Documents

• Moving Home Minnesota

• General Reminders & Upcoming Events

• Questions & Answers

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Blue Plus General Updates

• Division name change—Government Market Solutions

• New Program Manager—Sandy DelCastillo

Back row: Karla Kosel, Melinda Heaser,

Jenna Rangel, Stormy Church, Ashley Berg

Middle row: Melissa Rakow-Paré, Ricky Vang,

Amy Wald

Front row: Sandy DelCastillo, Nissa Roberts,

Kim Flom-Brooks, Katie Gumtow

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2016 Blue Plus Service area map

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PMAP, MNCare, MSC+ and

Secure Blue (MSHO)

PMAP, MNCare

MNCare

PMAP, MNCare, MSC+

Secure Blue (MSHO),

MSC+

No Products in County

County Totals by Product

PMAP- 65 Counties

MinnesotaCare- 69 Counties

Secure Blue (MSHO)- 62 Counties

MSC+- 63 CountiesRock Nobles Jackson Martin Faribault Freeborn FillmoreMower

Pipestone Murray

WatonwanCottonwood

Waseca Steele Dodge

Olmsted

Rice

LincolnLyon

McLeod

Meeker

KandiyohiSwift

Stevens Pope

Grant Douglas

Todd

Otter Tail

Isanti

Mille

Lacs

Ka

nab

ec

Aitkin

Carlton

Becker

Mahnomen

Hubbard

Norman

Red Lake

Pennington

Kittson Roseau

Lake

of the

Woods

Beltrami

Marshall

Polk

Clay

Wilkin

Traverse

Big Stone

Yellow Medicine

Lac qui Parle

Chippewa

Blue Earth

Redwood

Brown

NicolletLe Sueur

Sibley

Renville

Houston

Winona

Wabasha

Goodhue

Carver

Scott

Dakota

Wa

sh

ing

ton

Ra

ms

ey

Hennepin

Wright

Stearns

Sherburne

Anoka Ch

isag

oBenton

Morrison

Pine

Crow

Wing

Wadena

Cass

Itasca

Koochiching

St. Louis

LakeCook

HUBBARD

RED

LAKE

MAHNOMEN

STEELE

GRANT

MCLEOD

SHERBURNE

BENTON

December 2015

Government Market Solutions

Partner Relations Contacts

Nissa Roberts (651) 662-7613 [email protected]

Stormy Church (651) 662-1040 [email protected]

Melissa Rakow-Paré (651) 662-7872

[email protected]

Poua Ricky Vang (651) 662-4523 [email protected]

Jenna Rangel (651) 662-4529 [email protected]

Kim Flom-Brooks (651) 662-9647

[email protected]

Melinda Heaser (651) 662-1815 [email protected]

• Essentia West & East

• Geriatric Services Minnesota

• Thomas Allen, Inc.

• Meridian Services

• Health East

• Bluestone Physicians

• Fairview Partners

Cook

ST LOUIS

KOOCHICHING

ITASCA

CARLTON

PINE

AITKIN

CROW WING

CASS

BELTRAMI

WADENA

MILLE

LACS

BECKER

LAKE OF THE

WOODS

CLAY

NORMAN

PENNINGTON

MARSHALL

ROSEAUKITTSON

POLK

MORRISON

TODD

OTTER TAIL

DOUGLAS

POPESTEVENS

STEARNS

CHISAGO

ISANTI

WASHINGTON

WRIGHT

KA

ND

IYO

HI

ANOKA

HENNEPIN

SWIFT

BIG STONE

TRAVERSE

WILKIN

KANABEC

LAC QUI

PARLE

YELLOW MEDICINE

LYONREDWOOD

RENVILLE

MEEKER

CHIPPEWA

LINCOLN

MURRAYCOTTONWOOD

WATONWAN

NOBLES JACKSONROCK

PIPE-

STONE

BROWN

NICOLLET

LE

SUEUR

MARTIN FARIBAULT

SIBLEY

RICE

BLUE EARTH WASECA

FREEBORN

MOWER

GOODHUE

DODGEOLMSTED

RAMSEYCARVER

SCOTTDAKOTA

WABASHA

WINONA

FILLMORE HOUSTON

COOK

LAKE

CLE

AR

WA

TER

Gov Prog Manager Katie Gumtow(651)662.2297

Gov Prog Manager Sandy DelCastillo(651)662.7657

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Blue Plus DHS Contract Updates

Blue Plus 2016 MSHO and MSC+ Contract with DHS

New:• Telehealth available for MSHO and MSC+ members

• Annual dental visit withhold inserted into the contract. More information to come regarding incentives for members to get regular dental care

• DHS increased dental rates for dental providers in greater Minnesota by 9.65%

Proposed:• DHS intends to revise MMIS to require screening document entry for Health Risk Assessments (HRA)

for members who are already on another Waiver (e.g. CADI, DD, BI, CAC). The timeline for this change is not yet determined

• Pending Federal approval, EW home/vehicle modification limits will be raised from $10,000 to $20,000

A Communique will be issued when more information is available on these topics

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2016 MSHO UPDATES

MSHO Supplemental Benefits for 2016

• Continuation of Benefit

• *New BlueRide Transportation to qualifying fitness centers:• Round trip transportation up to 12 times per month

• Transportation is arranged by BlueRide 1-866-340-8648 (TTY 711)

• A same day ride option is available

• *New Additional Podiatry Services:• Routine foot care for members that do not have a Medicare-covered condition

• Up to 10 routine podiatry visits per calendar year at $0 copay

• Must be provided by a podiatrist or MD

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MSHO Supplemental Benefits for 2016 (cont’d)

• * New $750 Bathroom Safety items benefit• Benefit is per member per year. May include, but is not limited to, grab bars, shower

bench, bath mat, and toilet safety rails

• Available to all MSHO members

• Member must have exhausted their medical and waiver benefits. If on EW this benefit can be used only when waiver budget is exhausted

• This benefit must be directly approved by Clinical Guides 1-866-518-8447

• Must use an in-network Durable Medical Equipment (DME) provider

• Refer to Communique dated 1/4/2016

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• *New 90-Day Prescription Fill

• Members can get a 90-day fill of certain medications including;

• Medications other than Insulin for diabetes

• Certain blood pressure and heart medications

• Medications for managing cholesterol

• Members on these medications were sent letters about the new 90 day fill option in December 2015

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• *Two New Additional Dental Benefits

• One additional preventive exam for a total of two exams per calendar year with $0 copay

• Two perio-maintenance dental visits (max of 2 per year) with $0 copay

Questions about dental benefits:• Members call Delta Dental at 1-800-774-9049

• Care Coordinators call Delta Dental Liaison at 1-866-303-8138

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NEW SERVICES & RESOURCES

New Family Caregiver Service –AC and EW

Family Caregiver Services for Families of Older Adults

Three service categories to support family caregivers1. Family Caregiver Training and Education

2. Family Caregiver Coaching and Counseling with Caregiver Assessment

3. *Family Memory Care—New service effective Nov 1st 2015

DHS Bulletin #15-25-12

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http://www.dhs.state.mn.us/main/groups/publications/documents/pub/dhs16_198588.pdf

New Family Caregiver Service –AC and EW (cont’d)

1. Family Caregiver Training and Education

• Individual or group sessions

• Instructions on treatment, disease management, direct care skills, using equipment and technology, etc.

• Education about caregiving roles, managing stress, family dynamics, dealing with difficult behaviors

• Powerful Tools for Caregivers® is an example of a self-care education program that equips caregivers with tools and strategies

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https://www.powerfultoolsforcaregivers.org/

New Family Caregiver Service –AC and EW (cont’d)

2. Family Caregiver Coaching and Counseling with Caregiver Assessment

• Individualized support for caregivers

• Equipping the caregiver with knowledge, skills, and tools for providing self-directed care.

• Caregiver assessment to identify needs and strengths, a person-centered plan with goals, coaching, and follow-up on established goals

3. Family Memory Care (FMC)—new service effective Nov 1st 2015

• Coaching and counseling to support family caregivers of persons with Alzheimer’s disease and related dementias (PWD)

• Improve caregivers’ ability to withstand the difficulties of caregiving by improving social support and minimizing conflict.

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New Family Caregiver Blue Cross Resource

Visit the new Caregiver

Resources webpage

for health plan information

and helpful resources at:

bluecrossmn.com/caregiver

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https://www.bluecrossmn.com/healthy/public/personal/home/footer/help-faqs/caregiver-resources


TRANSITION OF CARE UPDATES

Transitions of Care Log and Process Updates

Refer to Communique Transition of Care Log update 12-18-15

What was changed?

• Changed language from “Transition Description” to “Reason for Admission”

• Continue to document the reason the member was initially hospitalized in this section

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Transitions of Care Log and Process Updates (cont’d)

Up to three transitions can be documented on one log

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Usual Care Setting

• Adding to the definition of “usual care setting”—includes “new” usual care setting, (i.e., a community member who decides upon permanent nursing home placement after a hospitalization)

• Complete tasks related to member returning to usual care setting as outlined in the upcoming slides

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Contacting the member/member’s representative during transitions

Member is Admitted to New Care Setting—not required to contact the member/member’s representative unless Care Coordinator feels it is necessary

Member Returns to Usual Care Setting—is required to contact the member/member’s representative

New

Not new

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Member is admitted to new care setting

For each transition the CC must do the following within 24 hours of notification (these are not new requirements):

• Communicate with the receiving setting (CC contact info, care plan/services)

• Notify primary physician of the transition

• Document admission on the TOC log

New: No need to contact the member or member’s rep during these phases of the transitions unless CC feels necessary

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Member returns to usual care setting

• Communicate with the receiving setting (CC contact info, care plan/services)

• Notify primary physician of the transition

• Contact the member or authorized representative and discuss the following:• Care transition process

• Changes to health status

• Changes to care plan

• Provide education to prevent readmission/future unplanned admissions

• Discuss the four pillars

• Update the care plan, if applicable

• Do this within one day of discharge or one day after notification of discharge, whichever is sooner

• Document on the TOC log

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Transitions of Care Log and Process updates (cont’d)

TOC log was updated to separate tasks that should be completed when the member returns home

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If Care Coordinator finds out about all the transition(s) 15 days or more after the member has returned to their usual care setting

• No TOC log will be required

• Contact the member to discuss the care transition process, any changes to their health status and plan of care, and provide education about how to prevent readmission

• Document this discussion in case notes

New

New

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Caution: This applies only if the CC learns about all of the transitions 15 days after the member has returned to the usual care setting

• Example: If the CC learns of a transition while the member is still in any phase of the transition process, CC TOC activities and completed TOC log(s) are still required

• Example: If CC begins TOC interventions/log, they should complete the process through to discharge back to usual care setting even if the CC learns of the discharge back to the usual care setting 15 days or more after it occurred

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Transitions of Care Log and NF Members

Why do nursing home care coordinators need to intervene during Transition when the facility normally takes care of the communications?

Example:

• 83 y/o MSHO member admitted to GeriPsych unit for sudden increase in dementia related behaviors. Upon admission, CC contacted hospital care manager and informed them of her role. She also confirmed they had the member’s medical records from the Nursing Facility (NF) and POA/family contact information

• Hospital Care Manager then notified the CC of member’s return to the NF and updated her on member’s medication changes and follow up appointments needed

• This allowed the CC to assist the NF team with finding an ongoing psychiatric provider to monitor medications and reduce chance of another psychiatric admission

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• Audits of TOC logs and/or case note documentation will continue

• The Transitions of Care section of all four guidelines have been revised

• The two TOC documents have been updated and are available on our Care Coordination Portal:

• 6.22- Transition of Care Log

• 6.22.01- Transition Log Instructions

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BRIDGEVIEW ENHANCEMENTS

Bridgeview Updates

New enhancements to the Bridgeview web tool for 2016

• Training documents available on Care Coordination Portal under Access Training section

• Webinar recording and demonstration in the Access Training section

Highlights

• Before entering HRA data all members must be assigned to a Care Coordinator

• HRAs for EVERY member in MSHO and MSC+ in all rate cells (A,B and D) to be entered following

the new instructions (effective January 2016)

• No change to the EWSA tool portion – all service agreements for EW members entered same

• “Past due” reminder will disappear when most recent assessment/HRA entered

• Continue to follow the process for transferring members if change in CC Delegation

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Bridgeview Reminders

Provider Payment Inquiries: Defer providers to Bridgeview directly for any billing issues, including payments

Residential Absence Days: Enter a new service agreement with the prorated days and rate during the absence. This will provide an updated service agreement; providers should not be guessing the amount to bill

Service Codes with Correct Units: Be sure to calculate the appropriate units based on your service code within the “To” and “From” dates. Many claims reject when an incorrect number of units are entered

Provider NPI/UMPI: Verify with the provider the appropriate NPI or UMPI based on the services authorized

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2016 QUALITY IMPROVEMENT

PROJECT (QIP)

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• Goal: Improve depression management, including medication adherence, among MSHO & MSC+ members

• Timing: Three year project (2016 – 2018)

• Multiple Interventions: Care Coordinator, Member, Provider

• QIP Collaborative with other Health Plans: Blue Plus, HealthPartners, Medica & UCare

Depression Quality Improvement Project (QIP)

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• One of the most common mental health conditions among older adults

• Often undiagnosed and undertreated

• Care Coordinators can play important role in addressing barriers to effective treatment

Why Depression?

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• Training and resources on identification and management of depression in seniors under development

• Depression screening during member’s annual assessment (LTCC)

• Baseline data collection during annual Care Plan audit

• Positive depression screen or documented depression diagnosis on LTCC?

• If yes → review for goal addressing depression or indication that depression well-managed by current provider team

Planned Interventions: Care Coordinator Education & Data Collection

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• Blue Plus provides a monthly report identifying MSHO members with gap in antidepressant refills starting March 2016

• Care Coordinator outreach

• Educate about medication adherence (talking points on back of report)

• Address barriers to adherence

• Document call outcomes on simple tracker (return to BluePlus quarterly)

Planned interventions: Care Coordinator Outreach

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• MSHO members with initial fill of an antidepressant receive mailing:

• Cover letter highlighting Blue Plus resources

• Antidepressant medication “Tip Sheet”

Planned Interventions: Member Mailing

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• Monthly report to prescribers identifying MSHO members with gap in antidepressant refills

Planned Interventions: Provider Outreach


2 0 1 6 S TA R R AT I N G A C T I V I T I E S

( M S H O O N LY )

Confidential and proprietary.

Interim Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey

• Monthly survey being mailed to roughly 500 Secure Blue members (July-January)

• Similar to the annual CMS CAHPS survey asking members about their experiences

with their health plan

• Non-responders will receive a phone call (1 attempt w/message if no answer)

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2016 MSHO STAR Ratings Activities



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Comprehensive Medication Review

• Beginning March, 2016: Care Coordinators will receive quarterly lists of Medication Therapy Management (MTM) eligible members

• Encourage members to complete a Comprehensive Medicare Review (CMR) and, if requested, help member to schedule the CMR by calling 1-866-686-2223

MTM Welcome Calls

• January, 2016: Around 2,000 eligible members received a call from PRIME encouraging them to schedule a Comprehensive Medication Review and allowing them to “opt out” if desired

Pharmacy Related Communications

• High Risk Medication communication



Pharmacy Case Management

• Eligible members receive welcome letter and call from pharmacist inviting them to participate

• Opt-in program for qualified members to work with PRIME pharmacist to address adherence to medications related to diabetes, statins, and high blood pressure

• The pharmacist and member work together to determine timetable of regular adherence check-ins (such as once a month or once every 3 months)

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2016 MSHO STARS Communications

Members will be receiving the following STARS related communications throughout 2016:

• STARS quarterly newsletter: thrive.

• 15 month member calendar (annually in October)

• Preventive screening reminders, including flu shot

• Educational materials (falls prevention/staying physically active + others to be determined)


2016 STAR Activities Under Consideration

Member voucher/rewards for closing gaps in care

• Currently evaluating effectiveness

• Communication will be sent if offered again in 2016

In-home member screenings

• Colon Cancer Fit Kits

• May consider Osteoporosis Bone Density Screenings

Also under consideration

• CVS Health tag messaging

• Guided Health letters

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GUIDELINES UPDATES

Guidelines Updates

Updates to the Nursing Home Guidelines only

Discharge Planning

• Care Coordinator and the Assessor work together to complete all discharge planning. The primary responsibilities of the Assessor are:

• Complete the LTCC and determining EW eligibility

• Develop the Collaborative Care Plan

• Coordinate any home care and EW services

• Nursing Home Care Coordinator should complete TOC activities, TOC log and may assist the Assessor with the following tasks, if applicable:

• Locate another living arrangement

• Coordinate any physician discharge orders including medical supply or equipment needs

• Assure member’s pharmacy needs are in place post discharge

• Arrange transportation for day of discharge

• Coordinate any post discharge follow up appointments

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Guideline Updates (cont’d)

Updates to the Community Guidelines only

PCA Authorization Process– New Blue Plus Members Transferring with Existing PCA Authorizations

• If the PCA provider is in Blue Plus network, the CC can fax copy of the previous PCA authorization to Blue Plus Utilization Management

• If the PCA provider is not in the Blue Plus network, the CC can fax a copy of the previous PCA authorization to Blue Plus Utilization Management for temporaryauthorization up to 120 days. It is expected that the member’s PCA services transition to an in network provider before the temporary authorization expires

Blue Plus UM fax # 651-662-4022 or 1-866-800-1665

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Community Guidelines

Case Closure Process—Section updated

If applicable, send the 6.25- HCBS Waiver, AC, and ECS Case Management Transfer and Communication Form (DHS 61037) to the county to determine eligibility for other programs or services

EW reassessments during 90-day MA term rule—New section added

• For Elderly Waiver members (both MSHO and MSC+) who lose MA eligibility for up to 90 days when it is expected that the member’s MA will be reinstated during the 90 day period. If the member’s annual EW reassessment is due during the 90 day term window, the care coordinator must complete the reassessment

• This requirement does not apply to those who lose eligibility for moves out of state, who exceed asset limits or for whom MA is not expected to be reinstated within 90 days

90-day grace period for MSHO—New section added

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Community Guidelines

Prior Authorization Process for Lift Chair and Mechanism

Section updated to better delineate what should be done, by whom, and when, related to both pieces of the chair—the lift mechanism and the chair (furniture) portion:

• DME provider responsible to submit requests for the lift portion. If approved, the authorization is entered into Blue Plus claims system

• CC authorizes chair portion (if under $800) and enters Service Agreement

Clarification added regarding:• When lift is denied under the medical benefit and both portions considered for coverage

under EW

• When the chair portion is over $800 must be sent to UM for authorization

• Who is responsible to send the DTR and when

• Who enters a service agreement and when

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Community Guidelines only

Care Planning

• Disease Management updates

• Health Coaches—New name• Assist with short-term case management services in complex situations involving

catastrophic illness, high medical costs, frequent hospitalizations, out-of-state providers, or when additional education or support is requested by a member’s caregiver

• Also provides Disease Management for the following conditions: Asthma, Diabetes, Coronary Artery Disease (CAD), Heart Failure, Chronic Obstructive Pulmonary Disease, Chronic Kidney Disease, Hypertension, Hyperlipidemia, Musculoskeletal Pain, Depression, Pediatric Obesity, Metabolic Syndrome

• Make a referral to these programs using 6.09-Medical Management Referral form

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Transfers of Care Coordination

• Confirm the current and/or new PCC with the member, authorized rep, or facility• Care Coordinators may also fax in the 6.03-Notification of PCC Change to 651-662-6439

• Complete DHS-6037: HCBS Waiver, AC, and ECS Case Management Transfer and Communication Form

• If services will continue with same provider, keep all active service agreement(s) in Bridgeview open. Be sure to share this information with the new delegate

• Close service agreement(s) that are no longer applicable

• Refer to DHS Bulletin 15-25-10 for complete details

Important: If it is known the member’s MA is terming and the member will not be reinstated, do not transfer the case. The current care coordinator should continue to follow the member until the member’s coverage terminates

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http://www.dhs.state.mn.us/main/groups/publications/documents/pub/dhs16_195967.pdf


Assessment and Refusal Tracking Process

• Enter all Assessment data into the Bridgeview web tool

• Note: When entering Refusals—Unable to Reach: Before entering a Refusal—Unable to Reach, the Care Coordinator must: • Attempt three phone contacts, then

• Mail an 8.40-Unable to Contact Letter to the member, and

• Document these attempts in Bridgeview

• Details and instructions can be found on the Blue Plus Care Coordination Portal www.bluecrossmn.com/carecoordination. Click on Access Trainings and select, January 2016 Bridgeview Enhancements Training

If you have any questions, contact your Partner Relations Consultant

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http://www.bluecrossmn.com/carecoordination

Forms, Resources, Letters Updates

Form Updates

• Removed 6.07- Notification of Care Coordinator Assigned

• Added 6.09- Medical Management Referral- Telephonic Health Coach program for disease or short term case management

• Added 6.24- LTC Communication Form DHS 5181 to Portal

• Updated all checklists with Care Coordinator assignment in Bridgeview

Letter UpdatesAll letters will be reposted soon with updated language block. Always download your letters directly from the Portal to assure current version

Resource Updates• 9.03- Immunizations Guidelines

• 9.21- STARS Engagement Prevent Falls

• 9.22- STARS Engagement Physical Activity

• 9.15.01- SecureBlue Advantages Compared to MSC+ (Member Approved version)

• 9.14- Key Contact Phone Numbers

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SCREENING DOCUMENTS

When to Enter a Screening Document in MMIS

The Care Coordinator/Support Staff should enter a screening documents into MMIS (with exception of members on CADI/DD/BI/CAC waivers, receiving DD case management or in a NH) for the following activities:

• New members including product changes (MSC+ to MSHO, MSHO to MSC+)• Initial HRA

• Transitional HRA

• Reassessments

• Change in condition assessments

• Change in Care Coordinator

• Change in programs (CADI to EW, exiting EW)

*Enter MMIS screening documents prior to the capitation dates located in the Guidelines

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Capitation Dates for MMIS Screening Document Entries

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When the First Month of the Eligibility Span: Last Day to Enter Screening Document timely:

January 12/22/15

February 1/21/16

March 2/19/16

April 3/23/16

May 4/21/16

June 5/20/16

July 6/22/16

August 7/21/16

September 8/23/16

October 9/22/16

November 10/21/16

December 11/18/16

January 2017 12/21/16

MMIS Entry of Transitional HRAs

How to enter a Transitional HRA Screening document into MMIS• Use Activity Type: 05-Document Change

• Use Assessment Result: 98-Other

• Document “Transitional HRA” in the comments section (optional)

Reminders• The activity date and effective date will be the date you complete the Transitional HRA,

not the date of enrollment

• The annual HRA is due within 365 days from the date of the original LTCC/MnCHOICES assessment (not the date of the transitional HRA)

*Please refer to Guidelines regarding when to use a Transitional HRA

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MMIS Screening Document Examples

Scenario Activity Type Assessment Result Program Type

Community member, new to BP, had an assessment within 365 days, transitional HRA completedORChange in CC

05 98 Field cannot be changed

Nursing home member (30 days or greater), face to face visit, opening to EW for the very first time

04 01 03/04

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MMIS Screening Document Examples

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Scenario ActivityType

Assessment Result

ProgramType

Community member, face to face visit, opening to EW for the very first time

02 01 03

Community member, face to face visit at reassessment, continuing EW for the next consecutive year

06 13 03


MOVING HOME MINNESOTA

Moving Home Minnesota (MHM)

What is MHM? • MHM is a federally funded program that assists people with transitions from

nursing homes and other qualified institutions to community living

What are MHM eligibility requirements (must meet all of these)?

• On Medical Assistance

• Eligible for MA payment of at least one day of institutional care

• Reside in a qualified institution(s) for 90 or more consecutive days (Medicare rehab days are not included in the 90 day count)

• People age 65 and older need to use EW upon discharge from an institution

Why would a Care Coordinator use MHM?

• May be helpful in complex situations

• Can be used concurrently with EW funds• There are specific services that MHM will fund

• Services cannot be duplicated

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Elderly Waiver Transitional Services (allotment of $3,000)• Lease and rental deposits

• Essential furniture, basic household items and personal items

• One time pest and allergen treatment of setting

• Utility set up fees and deposits

• Personal supports to help locate and transition to the community based housing

• Window coverings

MHM includes• Transition Coordination

• Supplemental and demonstration services

For complete list of Supplemental and Demonstration Services: http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_180320#

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http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_180320


How long can a participant be on MHM?

• Up to 180 days for Transition Planning prior to discharge to the community

• Once in the community a participant may receive service for up to one year

Reminder – Providers must be enrolled with DHS to provide any MHM services

Please consult with your Partner Relations Consultant at Blue Plus when considering a member for Moving Home Minnesota.

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Moving Home Minnesota (MHM)Contact Information

How do I sign an individual up for MHM?

• Recipients can enroll by:1) Completing MHM intake form #5032 found on the DHS eDocs website

• Can be completed by the client, a family member, social worker, case manager, care coordinator, or any other invested caregiver acting with permission of the client

2) By calling Senior Linkage Line/Disability Linkage Line

• Claims for MHM services are billed to BCBS, not Bridgeview

• Refer to DHS Bulletin #14-69-02 for details

For questions regarding MHM: [email protected]

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REMINDERS

Elderly Waiver Reminders

Reminder: EW is designed to offer Home & Community Based Services that go beyond what is available through the member’s medical benefit

Examples of supplies that could be covered under medical benefit:

• Lift Chair motor portion

• Nutritional supplements

• Gloves

For assistance, refer to the T2029 grid located on the Bridgeview Site or

call the Clinical Guide Team at 1-866-518-8447

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Elderly Waiver Reminders

Reminder: A member eligible for EW must choose and receive at least one waiver service in addition to Care Coordination

Waiver eligibility criteria: All must be met before opening/continuing (reassessment) EW:

• The member requires one or more AC, ECS or waiver service to delay or prevent institutionalization

• The member’s needs can be met in the community in a satisfactorily safe and cost effective manner

• It has been determined that the waiver, ECS or AC program is the appropriate payer for these services

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Transfers of Care Coordination Delegation Reminders:

Prior to transferring, confirm correct PCC with member, authorized rep, or customized living/nursing facility. This is especially important if the transfer is to one of our care systems who provide Care Coordination as the PCC determines assignment

• Change the PCC by calling member services or faxing form 6.03- Notification of Primary Care Clinic Change Form• Blue Plus requires the PCC Provider ID on this form—PCC change will NOT be processed if

this field is blank

• Locate this ID in the directory on the Care Coordination Portal

• Changing the PCC alone does not transfer the member. Follow the transfer process by sending in 6.08- Transfers in Care Coordination Delegation to notify Blue Plus

• *New* If it is known the member’s MA is terming and coverage will not be reinstated, do not transfer the case. Current Care Coordinator should continue to follow the member until coverage terms

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Reminders (cont’d)

• 2016 is a leap year- Annual HRAs still due within 365 days of the previous assessment

• Example: HRA was completed March 15, 2015. Annual HRA will be due by March 13, 2016

• Annually send or give the member a copy of their Blue Cross Member Rights along with a copy of the 6.02.03-Collaborative Care Plan

• 6.02.03 Medicare-Medicaid Member Rights for MSHO members

• 6.02.04 Medicaid-Only Member Rights for MSC+ members

• Care Coordinator CMS Fraud, Waste and Abuse Training• Blue Cross does not require care coordinators to complete the Medicare FWA

training on an annual basis

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Reminders (cont’d)

Residential Services (RS) Tool reminders

• The Partner Relations team sends out Missing RS Tool reminders regularly

• Reports come from DHS

• Please upload any missing RS Tools identified on the report in MN-ITS

Foster Care placements

• DHS includes members in foster care on the report (even if the member was in the placement prior to the requirement to use the RS tool for foster care)

• Inform the Partner Relations team if your report includes a member in foster care prior to 7/1/15. This member will be removed from future reports. No other action is required from the Care Coordinator

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Upcoming Events

• 123rd MSSA Conference : Recognizing Our Responsibility for ChangeMarch 16-18, 2016 • Early Bird Registration by Feb. 22

• Discounted hotel rooms at the Hilton by March 15th

• DHS Care Coordination Conference: Sept 2016• Have ideas for workshops or speakers? Send to [email protected]

• Care Coordination Delegate Audits: Spring 2016

• MN CHOICES: Projected for August 2016 (at the earliest)

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Questions & Answers

Follow up:

Q & A Summary will be emailed to all participants after presentation

Webinar slides available to view for one year online. Instructions for viewing will arrive with the Q & A Summary

Survey will be sent to participants for feedback following the webinar

Attendance Log: Sign in and return via e-mail to [email protected]

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RESOURCES

Website Resources

BCBS MN Website:Care Coordination Portal

Care Coordination Guidelines

Care Coordination Resources (Resource Management page)

BluePlus Government Programs Information

MN DHS Provider Manual:CBSM Manual- Care Coordination/Case Management

CBSM Manual- EW and AC Program

CBSM Manual- Equipment and Supplies

CBSM Manual-Home Care Services

CBSM Manual- PCA Services

Other:MinnesotaHelp.info

Senior Linkage Line

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https://www.bluecrossmn.com/carecoordination/public/msho_index.html

https://www.bluecrossmn.com/carecoordination/public/msho_blue_advantage.html

https://www.bluecrossmn.com/carecoordination/public/msho_resource_management.html

https://www.bluecrossmn.com/healthy/public/personal/home/shopplans/shop-mn-health-care-programs

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_000815

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_056766

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=ID_008993

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=ID_000822

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_137828

https://www.minnesotahelp.info/

http://metroaging.org/help-information/senior-linkage-line/

Important Phone Numbers

Resource Phone Number

Senior Linkage Line 1-800-333-2433

Medicare 1-800-MEDICARE (633-4277)

BluePlus- Blue Advantage (MSC+) Member Services

651-662-5545 or 1-800-711-9862

BluePlus- SecureBlue (MSHO) Member Services

651-662-6013 or 1-888-740-6013

BlueRide 651-662-8648 or 1-866-340-8648

BluePlus Interpreters 651-662-5545 or 1-800-711-9862

Delta Dental 651-406-5907 or 1-800-774-9049

Nurse Line (24/7) 1-800-622-9524

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QUESTIONS AND ANSWERS


THANK YOU!