Presentation on theme: "Participants in HCH conference call 6-29-10 Marie Maes-Voreis, MDH Ross Owen, DHS Amy Johnson, Medica representative Becky Walsh, Prime West representative."— Presentation transcript:
Participants in HCH conference call Marie Maes-Voreis, MDH Ross Owen, DHS Amy Johnson, Medica representative Becky Walsh, Prime West representative UCARE has provided a statement Health Partners has provided a statement
Two foundational pieces of legislation First “medical home” legislation- Provider Directed Care Coordination for patients with complex illness in the Medicaid FFS population (now Primary Care Coordination) PCC Health Care reform legislations requires “health care homes” for all Medicaid/ SCHIP/ state employees/ fully-insured privately insured in Minnesota, Health Care Homes, HCH
Participants in Minnesota Health Care Home (HCH) training, surveys, and mini-grants by zip code of participant (when available), March 2009 to June 2010 Primary Care Clinics from throughout Minnesota have participated in HCH planning and implementation (Data provided under contract from MDH to the Primary Care Coalition including MN Academy of Family Practice, MN Chapter of the American Academy of Pediatrics and the MN Chapter of the American College of Physicians)
Certification Steps Optional pre-application activities STEP 1: Letter of intent, letter to applicants with instructions on site visit and payment methods STEP 2: Application and pre-certification assessment form STEP 3: Site visit STEP 4: MDH Review and Notification STEP 5: Recertification Optional: Variance requests, Appeal Process
Application Process is complete when : Required letter of intent, application and self assessment has been submitted. Required documents have been submitted and reviewed. Site visit has been completed. The “90 day waiting period” begins when these steps are completed.
STEP 4: MDH Review and Notification MDH will notify the applicant within 90 days of certification status. The report will identify all standards that are met and not met. Those applicants meeting 100% of the standards required at initial certification will achieve certification. Celebrate! Public recognition Payer notification
Notification of HCH Certification Notification to payers by clinicians through MCC (Minnesota Credentialing Collaborative Web Tool) OR Through normal channels for communication to payers Web report on MDH web site for clinics and consumers site Clinician NameOrganization Clinic / Address (searchable by zip code) Certification Date Anniversary Date Dr. Tim Jones MDH Health SystemNorth31-Oct-0931-Oct-10
Payer Secure Certification Site Payers may verify certification information at MDH payer web site. Clinician Name NPI and certificatio n numbersOrg Clinic Name Address Certification Date Anniversary Date Janice James, NP NPI and MDH Health SystemNorth31-July-1031-July-11
Rate Negotiation Considerations
Care Coordination Task / Function List Task/Function List: (Items marked with a “ ” were identified as likely to require considerably more time and resources for more complex patients.) Telephone and e-communication with patients and with caregivers Visit time not currently reimbursable (scheduling blocks to meet access requirements for health care home certification. Establishing patient/family partnerships, recruitment/outreach, education (including enrollment and ongoing engagement) required for certification. Travel for care that must take place outside of the usual clinic location, e.g. house calls for home bound frail elderly Registry and panel management Patient-centered care: tools, resources and time necessary to ensure that decision-making and care are consistent with patients’ culture, values, and preferences
Care Coordination Task / Function List Continued
DHS Fee-for-Service Care Coordination rate assumptions DHS began with the current reimbursement for a minute evaluation and management (E&M) visit (CPT code = $65.92) as the base value for one hour of physician work. Because the work of care coordination in a HCH is divided between the physician and other members of the care team, DHS assumed the following distribution of work in an optimally-functioning practice: 20% Physician 50% Care Coordinator 30% Office/Clerical After discounting for this work distribution over time (care coordinator time at 65% of the physician rate and office/clerical time at 30%), the MHCP fee-for-service rate for one hour of care coordination in a HCH is $ Assumptions were made about the average amount of care coordination needed per month for each complexity tier, resulting in rates ranging from $10-$60 PMPM for eligible patients.
Certification details: Your questions As new clinicians are certified in a clinic or organization, the certification anniversary date will change over time so there is one anniversary date. MDH and the certified clinic will determine that date together. All questions submitted to MDH to
A clinic is certified only if all of the clinic's clinicians meet HCH requirements. It is the clinic's responsibility to notify MDH when a new clinician joins a certified clinic and intends to become a certified clinician The clinic has 90 days from the date of hiring the new clinician or until its next annual recertification to apply for this new clinician, whichever is sooner A clinic may continue to operate as a certified clinic until the new clinician is certified If the clinician chooses not to be certified, the clinic will no longer be certified, but the clinicians who were previously certified automatically will continue their individual certification
Health Care Homes Contacts : Marie Maes-Voreis, RN MA HCH Program Director
HCH Health Plan Contracting Contacts :
Medica- contracting for HCH When HCH certification is achieved, contact your Medica contract manager Medica will consider your existing contract & product portfolio to determine reimbursement method If provider is not currently in an alternative payment arrangement, Medica will follow DHS tiering and reimbursement structure Allow days for operational set up Medica will honor payment for care coordination from the date of HCH certification
PrimeWest- contracting for HCH PrimeWest Health requires clinics/clinicians to be certified before we will proceed with contracting. To inquire about Health Care Home contracting, please call our Provider Services line: ; and select option 2 (Contracting). Lisa Kamrowski, our Provider Relations Specialist will be able to assist you with your contracting questions. Currently, we have not made a decision on whether we will go retroactive to certification date on claims payment. We are currently seeking input from MDH on this issue.
UCARE- contracting for HCH “To inform UCare of your interest in a Health Care Home contract, your clinic contact information to UCare will consider requests individually, based upon DHS standards and existing UCare products and contracts. UCare will follow the DHS tiered model for reimbursement. UCare does not intend to be in a retroactive contract situation. Thank you.”
Health Partners- contracting for HCH For Health Care Home contracting questions, please contact Chuck Abrahamson, Vice President of Network Management and Provider Relations. His contact information is below: