Embed Size (px)
Citation preview
Medicaid Service Coordination (MSC)
E-VISORY The MSC E-VISORY is an electronic publication which provides information on policies, guidance, available programs and services and training opportunities related to MSC. In order to receive an email notification when a new MSC E-Visory is posted, or to view past issues visit the following link: MSC E-Visory
ISSUE # 16-18 June 15, 2018
Materials for the June 20, 2018 MSC Supervisors Conference The MSC Supervisors Conference is being held on June 20, 2018 via videoconference and WebEx from 9:30am-12:30pm. The conference agenda is as follows:
• Care Coordination Organization Implementation Update
• Review of the Life Plan
• Care Coordination Organization Enrollment Update
• Review of Administrative Memorandums related to CCO NOTE: The materials that will be referenced during this conference are attached to this MSC E-Visory. There will not be any materials distributed on the day of the conference. Registration can be accessed at: http://www.opwdd.ny.gov/opwdd_careers_training/training_opportunities/slms. Existing users can log into SLMS from the page listed above. New users can follow the instructions to become SLMS users and log in. To search this conference simply enter “MSC” into the Find Learning search bar in the Quick Links. If you have any issues with registration or logging on the day of the conference please contact Talent and Development by email at [email protected] or by phone at 518-473-1190 Completion Required for All Care CCO Enrollments– CCO CHOICES Selection Screen As outlined in the MSC Resource Guide each MSC must complete the CCO CHOICES Selection screen after consent forms are completed. This selection screen must be completed no later than June 30, 2018 and the form will not be available after June 30. Directions on how to complete the form in CHOICES can found at the following link: https://opwdd.ny.gov/opwdd_login/choices/ccoselectionform.
6/15/2018
1
Welcome to the Quarterly
Medicaid Service Coordination Supervisors Conference
June 20, 2018
Angie Francis
MSC and NY START Statewide Coordinator [email protected]
Amanda Harper
Assistant Statewide MSC Coordinator and
CCO Implementation Team
Welcome
InformationMaterials can be found in the MSC E-visory at:
https://opwdd.ny.gov/opwdd_services_supports/service_coordination/medicaid_service_coordination/msc_e-visories
Certificates will not be issued to those attending by WebEx. Please use your confirmation email and document attendance on your MSC Training record to receive credit towards professional development hours.
3
6/15/2018
2
AgendaWelcome
Hot Topics
Care Coordination Organization (CCO) Readiness
Policy Guidance on Individualized Service Plan (ISPs) and
Life Plans
CCO Enrollment Update
Office for People With Developmental Disabilities (OPWDD)
Administrative Memorandums (ADMs) Update
Closing
4
Hot Topics• People First Care Coordination MSC
Webinars https://opwdd.ny.gov/opwdd_services_supports/care_coordination_organizations/msc_webinars
• Enrollment and Consent Resource Guide
• Conferences post 7/1/18• CHOICES Care Coordination Organization
(CCO) Selection form must be submitted by 6/30/18
• E-Visory email addresses • CCO transition for Non-Medicaid Care
Management
5
Medicaid Service Coordination Supervisor Conference
Care Coordination Organization (CCO) Readiness
6
6/15/2018
3
Ongoing CCO Readiness
Review ScheduleReadiness Activity Date
Readiness Review Letters to Initially
Designated CCO
March 2018
Desk Review April 2018
On-Site Visit and CCO Certification of
Meeting Requirements of Designation
May 2018
CCO Formal Designation Letters Issued June 2018
Formally Designated CCO Begin Operations
(pending State and Federal Approvals)
July 1, 2018
7
Readiness Review Activities
There are two phases to the CCO
Readiness Review Activities:
1. Formal Designation
o Off-Site Desk Review
o On-Site Readiness Review
2. Ongoing Activities
8
Off-Site Desk Review Requested Documents
• CCO Policies and Procedureso Health Home Core Services and Requirements, including
Other health Home Standards and Requirements
o Payments and Billing Standards
o Enrollment and Consento Communicating and Sharing Protected Health Information
• Training Schedules and Modules / Curriculum for Care Managers
• Organizational Charto Board and Executive Management Structure
o Roles and Responsibilities of Key Personnel
9
6/15/2018
4
On-Site Readiness Review Expectations
• Demonstrate progress in meeting NYS
Health Home Standards and Centers for Medicare and Medicaid Services (CMS)
Health Home Program functional
requirements
• Present information to demonstrate
understanding of the CCO Care Management programs
10
On-Site Readiness Review Expectations (Con’t)
• Provide all CCO Policies and Procedures
o Including updates to previously submitted versions
oProtocol for distributing policies and procedures to CCO personnel including Care Managers
• Demonstrate Care Management capabilities using CCO Health Information
Technology (HIT)11
Formal Designation
• CCOs who successfully complete the
State’s readiness review process will be formally designated by the State to begin
CCO operations
• CCOs will be required to certify continued
compliance with current and future Federal
and State requirements related to the operation of a CCO in New York State
12
6/15/2018
5
Ongoing Activities
• Ongoing review of specific readiness areas include:oRegional Health Information Organization
(RHIO) Connectivity
oHIT Systems Interoperability
oData Analytics
oNetwork Development
oQuality Assurance/Performance Improvement
oAdministrative Services Agreements
13
Thank you – [email protected]
14
Policy Guidance on ISPs and Life Plans
15
6/15/2018
6
Purpose
• To clarify that the Draft CCO/HH Policy
Manual, shared in March 2018, is the living document that defines the CCOs
operational guidelines and will continue to
be updated as the program evolves
• A final version will be shared prior to July
1st
16
Policy Guidance on the Completion of ISPs and Life Plans
17
• Refer to the 1115 Waiver Transition Plan, available at https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/idd/draft_idd_1115_waiver.htm , and
• The Draft CCO/HH Policy Manual document sent to CCOs and once finalized, published on the Department Of Health (DOH) webpage
Policy Guidance on the Completion of ISPs and Life PlansTransition Plan:
• Pg. 29 - the individual, family and Care Manager may convene the Inter Disciplinary Team (IDT) and transition the current ISP to a Life Plan between the dates of July 1, 2018 to July 1, 2019
• Pg. 11 - In recognition of the transition activities underway in spring of 2018, the Transition Plan includes a temporary extension for the completion of the annual Level of Care (LOC) redeterminations that are due in May and July 2018 and will be extended and must be completed no later than September 30, 2018.
18
6/15/2018
7
Policy Guidance on the Completion of ISPs and Life Plans
DRAFT CCO/HH Policy Manual:
• Pg. 48-49 - “For individuals who had previously received Medicaid Service Coordination (MSC) or Plan of Care Support Services (PCSS) and who enrolled on 7/1/18, the timeline will follow, in most cases, the person’s established schedule for care planning meetings (i.e. the twice annual required ISP review). For CCO/HH enrollees in Tier 4, the highest payment Tier (Tier 4 includes all Willowbrook Class Members), the Care Manager shall conduct a face-to-face meeting with the individual, their family/ representative, convene the care planning team, review the State approved functional needs assessment, complete the comprehensive assessment process, and develop the individual’s Life Plan using a person-centered planning process at the next review meeting, but no later than December 30, 2018 (six (6) months following the July 1, 2018 start of CCO/HH services).”
19
Policy Guidance on the Completion of ISPs and Life Plans
DRAFT CCO/HH Policy Manual:
• Pg. 48-49 - “For CCO/HH enrollees in Tiers 1, 2 or 3, the Care Manager shall conduct a face-to-face meeting with the individual, their family/representative,
convene the care planning team, review the State approved functional needs assessment, complete the comprehensive assessment process, and develop the Life Plan using a person-centered planning process at the next “annual” review meeting, but no later than June 30, 2019 (twelve (12) months following the July
1, 2018 start of CCO/HH services).”
20
• There is no relief to the requirement for completion of the annual or semi-annual ISP reviews that are due in the months preceding July 1, 2018
• Unless the person requests the change or there is some other reason that a change in schedule is required, ISP six month or annual reviews due prior to 7/1/18 must occur on schedule. During this time of change, the MSC agency will need to do all that they can to ensure that these MSC activities are as complete as they possibly can be
• There may be instances where things will need to be completed after the transition to CCO, such as distribution of the ISP. However, in alignment with the expectations currently in place, the service coordinator should keep records that are clear and comprehensive enough to enable effective transition of service coordination services to the CCO
21
Policy Guidance on the Completion of ISPs and Life Plans
6/15/2018
8
The Life Plan and How it Will Interface with
Services
Transitioning to the Life Plan
ISP – Current Format
• OPWDD Suggested template with required elements
• Typically a typed paper plan with variation on level of detail
• Attachments are stapled paper to ISP– Hab plans
– Individualized Plan of Protective Oversight and Safeguards (IPOPs)
Life Plan – Future Format
• Integrated plan with
consistent data set built into
an Information Technology (IT) system
• Desired outcomes and
habilitative goals and
safeguards within the Life Plan
• Staff Actions with detail on
how to support a person detailed by the provider
Life Plan Considerations
• Same building blocks in place – Life Plan
integrates the habilitation goals and safeguards rather than attaching them
• Life Plan defines what the person wants and needs
• Staff Action Plans define how the goals and safeguards will be achieved
6/15/2018
9
Habilitation Plans Outcomes
and Support Strategies
• Section II of the Life Plan identifies the
Outcomes and Support Strategies
– This, along with section III (Health and safety supports) is where the habilitative goals are established
• Goals must relate to the areas of interest
that the person and/or their support givers
identify in the planning process
Habilitation Plans Outcomes
and Support Strategies The Life Plan identities:
• Council on Quality Leadership/Personal Outcome Measures (CQL/POM) valued outcome
• CCO Goal Valued outcome – person desired goal related support
• Provider assigned goal – activities, general, that provider will complete
• Location• Service type
• Frequency
• Quantity
• Time frame
• Special considerations
Habilitation Plans Outcomes
and Support Strategies
• Serves to define the habilitative goals for the person and creates an integrated Life Plan with defined service goals and anticipated outcomes
• Meets requirements for an integrated Hab Plan
• Provider of services will develop a Staff Action Plan to describe how the outcomes will be achieved
• Sharing of the Staff Action Plans can be completed through any manner agreed to between the CCO and the provider– E.g., Data sharing in an IT system or through e-mail,
regular mail, or fax
6/15/2018
10
Plan for Protective Oversight
Safeguards/Plan for Protective Oversight
• Section 3 of the Life Plan is the safeguard section
• The safeguard plan of support will replace the required Plan for Protective Oversight for certified settings
• Completed during the person-centered planning meeting – Informed by the person, their support team (including residential
provider), and any assessment information that is pertinent to the safeguard domain areas
Plan for Protective Oversight Safeguards
• Must serve as the current and active guidance for the safeguards needed for a person
• Programs must communicate any changes to the Care Manager so that the plan can be updated
• In an emergency, immediate action and education of staff supports can be implemented with follow up to the Care Manager so that the plan can be updated
Plan for Protective Oversight Safeguards
• Used as the required documentation of safeguards in any review/survey activity
• Care Manager is responsible to gather/obtain information, update the plan, and share plan (via the Portal) with service providers who need to implement it
• Service providers need to ensure prompt communication of changes and to have more detailed plans as appropriate
6/15/2018
11
The Life Plan – POMs and Plan for
Protective Oversight
The Life Plan – POMs and Plan for Protective Oversight
Assignments
The Life Plan – POMs and Plan for
Protective Oversight Assignments
6/15/2018
12
The Life Plan – Section II
The Life Plan – Section III
The Life Plan – Sections IV and V
6/15/2018
13
Life Plan Considerations • The Life Plan is an integrated document
– Houses the Habilitative Plans and the Safeguard needs
– More detail for how the plans will be achieved are maintained by and the responsibility of the service provider
• Safeguards are not program specific but are centered on the person’s interests and needs
– The coordination of the Life Plan is the responsibility of the Care Manager but notification of changed needs and implementation of the safeguards is the responsibility of the service provider/support giver
Life Plan Considerations
• The development of the Staff Action Plan must be sent to the CCO in an agreed to form and
format within 60 days of the Life Plan meeting
• These requirements are not significantly
different than the expectations in the current system; they are the same building blocks with changed language and format
Thank you – [email protected]
39
6/15/2018
14
Care Coordination Organization (CCO)
Enrollment Update
40
Status of Enrollment
Current Enrollment Percentages as of June,14 2018
41
70,256, 68%
32,939, 32%
Count and Percent of Total Enrollees that Provided
Consent
Consent Provided
Consent/Choice Not
Been Made
Service Selection
• Most people that have made a CCO
selection are choosing the CCO Health Home Service
42
66%2%
32%
CCO SERVICE SELECTION
Health Home HCBS Basice Plan support Has not yet made a choice
6/15/2018
15
Importance of Enrollment
• It is important to ensure an individual or
other decision maker understands that enrollment in a CCO and selection of
either the Health Home Care Management
Service or Basic Home and Community Based Services (HCBS) Plan Support is
necessary in order to maintain eligibility for
OPWDD HCBSs
43
Resources for Service
Coordinators• Training - “Transitioning to CCOs - What MSCs Need to Know
and Do” – on the Statewide Learning Management System (SLMS)
• MediSked Coordinate Modules - SLMS
• MSC Toolkit: • Brochure
• CCO Coverage Chart• Example Script and Guidance
• FAQs for Individuals and Families
• FAQs for MSCs• Health Home Services Care Manager Checklist
• MSC Resource Guide
• Sample Letter• Video: Care Coordination Sample Information Session
44
CHOICES Selection Form • Must be entered in CHOICES no later than June 30, 2018
• This form will not be available after this date
• If there is an error when entering the CCO Selection form in CHOICES please follow the process below:
Send an email to the CCO Project Mailbox
Be sure to include the following information so that we may assist you appropriately:
• Individual’s First and Last Name;
• Individual’s TAB ID;
• Exact Wording of Error Message Received; and
• The following as they appear in CHOICES or TABS:
– Full MSC Agency Name
– MSC Agency Program Code
– Program Name
Once the CCO Project Mailbox has received this information and evaluated the cause of the error message, you will receive additional direction to resolve the issue
45
6/15/2018
16
Decision-Making Process
• On May 4, 2018 OPWDD sent an e-mail to the field that outlined the steps in the decision-making process for enrollment in CCOs
• The email included:
• Decision-making memo;
• MSC tracker for enrollment;
• Developmental Disabilities Regional Office (DDRO)/Developmental Disabilities State Operations Office (DDSOO) contact information; and
• CCO contact information
46
Process for Individuals Not Able to
Make Decisions for Themselves
If an individual lacks the ability to choose a CCO and does not have a guardian lawfully empowered to enroll him or her in a CCO, then any of the following parties may, in the order listed:
• An actively involved spouse• An actively involved parent• An actively involved adult child• An actively involved adult sibling• An actively involved adult family member• The Consumer Advisory Board (CAB) for the
Willowbrook Class members, but only for members of the Willowbrook Class
47
Question: Can an individual’s advocate
sign the required consent for CCO
enrollment and care management service
option?
Answer: If an individual’s advocate is not
one of the parties listed who are able to
make decisions, the advocate may not be the decision-maker
48
6/15/2018
17
Process for Consent When a
Decision-Maker is Unavailable
If an individual lacks the ability to make a choice, does not have a guardian lawfully empowered to enroll him or her in a CCO and select a service, and there are no parties available to make timely decisions:
• The chief executive officer (CEO) of the agency operating the individual’s residential facility or sponsoring the Family Care home, or a designee of the CEO, may make enrollment decisions
49
Process for Consent When a
Decision-Maker is Unavailable
• If the individual’s residential facility is operated by OPWDD (DDSOO), the CEO of the agency is the director of the DDSOO that operates the residential facility
• If the individual does not reside in a certified residential setting, the DDRO director for the region encompassing the individual’s residence may make enrollment decisions
50
When to Utilize a
CEO/Director Decision-Maker• After a minimum of three attempts to contact the
individual, guardian or other authorized decision-maker have been made and documented
• Documentation
• Must be submitted to the decision-maker with the individual’s packet of information
• The contact attempts have been documented in notes or an agency developed form by the Medicaid Service Coordinator
51
6/15/2018
18
Submission to Decision-Maker
• Required documents for submission
• The person’s current ISP
• The individualized information letter
• Consent forms (for both the Health Home and Basic HCBS Plan support)
• Documentation of efforts to obtain a decision from the appropriate decision-maker (where appropriate)
52
Loss of Contact
• Please speak with your DDRO MSC
Regional Coordinator if there is someone that is on your roster that you have not
been in contact with for over a year
• Provide completed Individual Withdraw from Medicaid Service Coordination (MSC3) form
• Supporting documentation of attempts to contact the person and their family/advocate
53
New Enrollees
• People who are new to OPWDD Care Management post July 1,
2018
• CCOs will continue to work with people to complete the necessary eligibility processes and documentation as MSC
Agencies do today
• CCOs have to engage early in the process prior to enrollment
• OPWDDs Front Door will refer individuals to the CCOs in the region
in which they reside or an individual could already be connected
• The CCO will provide assistance when needed:
• Eligibility
• Level of Care Eligibility Determination
• Medicaid
54
6/15/2018
19
Thank you – Questions?
55
Medicaid Service Coordination
Administrative Memorandum (ADM) Update
56
Administrative Memorandums
Related to Medicaid Service
Coordination and Plan of Care
Support Services
MSC and PCSS sunset June 30, 2018
ISP and Habilitation Plan ADMs will remain in effect through June 30, 2019, until the full transition to Life Plan’s
are complete
The CCO/HH Provider Policy Guidance and
Manual will serve as the guiding document for
CCOs and Care Managers
57
6/15/2018
20
CCO/HH Provider Policy and
Guidance Manual
• CCO/HHs will be governed by the CCO/HH Provider Manual
• Outlines all requirements for Health Home Care Management and Health Home Services
• Maintains existing functions of the Medicaid Service Coordination program:
o Advocacy
o Incident Reporting
o Care Plan Development
o Benefit and Entitlement
58
Development of New ADMs
• ADMs for HCBS will continue
• Updates to existing ADMs to reflect CCO
language (i.e. ISP to Life Plan)
• Habilitation Plans will be included as part
of the Life Plan
59
Thank you – Questions?
60
6/15/2018
21
Join the Conversation:
Visit www.opwdd.ny.gov today to sign up!
61
Thank you
for attending, the next Conference is scheduled for
September 12, 2018
Registration for these conferences can be done through SLMS for either the WebEx or VC, please check the SLMS website to register.
https://opwdd.ny.gov/opwdd_careers_training/training_opportunities/slms
62
