1. 2008 Health Reform Law: Minnesotas Vision

2. Certification as HCH is Voluntary Certification requirements are met at certification, at the end of year one and annually thereafter. A certified HCH meets all recertification requirements or applies for a variance for superior outcomes. A variance may be granted for good cause or when failure to grant a variance would result in hardship.

3. Certification details There is no fee to apply for MDH HCH certification. MDH is the organization that will facilitate the certification process. All application forms are submitted electronically through the MDH HCH portal. Documents are also submitted through the portal, however there is a limit on document size and no graphics such as logos are accepted.

4. Certification details There is no deadline for applications, clinics apply when they meet the standards and criteria and are ready for a successful certification process. A clinic may apply in the manner that works out best for them, by clinician, department, clinic, organization. As HCH spread occurs and all clinicians are certified, the certified status for the clinic will be declared at annual recertification. When a previously certified clinician leaves a clinic and goes to work at a non-certified clinic, that clinician will need to apply as a brand new clinician along with their clinic.

5. Clinics in border states? Can they apply for certification? YES Subp. 24. Local trade area clinician. Local trade area clinician means a physician, physician assistant, or advanced practice registered nurse who provides primary care services outside of Minnesota in the local trade area of a state health care program recipient and maintains compliance with the licensing and certification requirements of the state where the clinician is located. For purposes of this subpart, local trade area has the meaning given in part 9505.0175, subpart 22.

6. Only providers who provide care that meets these requirements are certified. An eligible provider is a physician, nurse practitioner or physician assistant that works as part of a team that takes responsibility for the patients care and provides the full range of primary care services including: first point of contact acute care preventive care chronic care Providers are certified. A clinic is certified when all the clinics providers meet the requirements for certification.

7. Primary Care / Clinician Definition Subpart 16. Eligible provider. Eligible provider means a personal clinician or clinic that provides primary care services. Subp. 30. Primary care. Primary care means overall and ongoing medical responsibility for a patients comprehensive care for preventive care and a full range of acute and chronic conditions, including end-of-life care when appropriate. Subp. 27. Personal clinician. Personal clinician means a physician licensed under Minnesota Statutes, chapter 147, a physician assistant licensed and practicing under Minnesota Statutes, chapter 147A, or an advanced practice nurse licensed and registered to practice under Minnesota statutes, chapter 148.

8. Access and Communication Standards At Certification: 0040 subp 1A The HCH must be available to patients who have or are at risk of developing or have complex or chronic conditions are interested in participation There is a system in place to tell them about the services of the health care home. Participation is voluntary.

9. Clinics seeking both NCQA Recognition and Health Care Home Certification Are required to participate fully in the MDH certification process and meet the standards for Health Care Homes. Where in the MDH cross walk those standards and the intent of those standards are aligned between the NCQA recognition and the HCH standards the State will accept the documentation that has been submitted to the NCQA for verification when the applicant seeks HCH certification within one year and there are not substantial changes in operations. These standards / criteria are not exempt from the full decision making process and site visit by MDH. All other standards / criteria that are identified as different or the intent has variation from the MN HCH standards, are subject to the full certification process.

10. Certification Steps Optional pre-application activities STEP 1: Letter of intent STEP 2: Application and certification assessment tool STEP 3: Site visit STEP 4: MDH Review and Notification STEP 5: Recertification Optional: Variance requests, Appeal Process

11. Step 2 A: Certification Assessment Tool, Structure This is the self certification assessment form that HCH applicants should use to determine if they meet the requirements for HCH certification. Applicants will also submit their HCH Certification Assessment tool to MDH with their application prior to the certification site visit. Site evaluators will also use this same tool at site visits.

12. Certification Assessment Tool, Structure This is the self-assessment form that HCH applicants should use to determine if they meet the requirements for HCH certification. Applicants will also submit their HCH Self- Assessment form to MDH with their application prior to the certification site visit. Column one is the standard or criteria as stated in the HCH Rules 4764.0010- 0070, Column two the intent of the standard Column three the verification requirements and supporting data sources or documentation Column four, for your use: (applicant meets requirements yes/no)

13. Certification Assessment Tool, Structure, column 5 HCH progress HCH Progress column is for the applicant to use during the self assessment phase to communicate a brief description of how the applicant meets the requirements when they submit the assessment form to MDH Applicants will submit a limited number of documents to MDH prior to the site review and those are noted as submit at application.

14. Certification Assessment Tool, Instructions Standards are designated as must pass at initial certification or recertification at the end of year one. End of year one recertification standards gives the applicant additional time to implement standards that are more difficult to implement. Documentation sources are generally not proscriptive except in the circumstance where meeting the standard specifically requires a policy or protocol in the HCH rules

15. Certification Assessment Tool, Documentation data sources Documentation data sources: are types of documentation that clinics need to have in place to demonstrate performance Data sources include written policies, procedures, workflows, protocols, guidelines, documents that describe or support processes such as, forms, flowsheets, EMR screen shots, patient education materials, prepared resources, and pamphlets or reports such as meeting minutes, registry documents, patient medical records, records or files of HCH activities. Supporting document forms such as EMR screen shots, flowsheet or patient records should not be blank but include blinded information so the Evaluator can clearly see how the form is used.

16. Certification Assessment Tool, Submit at Application: Only documents that say, submit at application will be uploaded into the Web portal and submitted in advance of the certification site visit to MDH. Other documents or data sources will be reviewed either electronically or on paper at the site visit during the interview process. Administrative Burden: It is MDHs intent to limit the number of new documents that applicants need to prepare in advance of the site visit. MDH has limited the number of standards / criteria that require a specific policy. MDH will place emphasis on applicants brief description of how the applicant meets the requirements in the self- assessment and on how MDH site evaluators observe the work in conjunction with the supporting documents at the site visit

17. Application Process is complete when: Required letter of intent, application and certification 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.

18. 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

19. STEP 4: MDH Review and Notification For those applicants who do not meet 100% of the standards there are options: Submit a request for a variance. Request support from MDH or the learning collaborative for technical assistance. Develop a plan for remedy and reapply for those areas not met. File an appeal. The applicant has 30 days from the date of receiving denial notice to appeal the decision.

20. Are you ready for health care homes: pre- application activities

21. Ways for clinics to get started with certification Assemble a group of key stakeholders. Include interdisciplinary team members, leadership and patients Use the HCH certification assessment tool as a guide and complete an analysis for each criteria Develop a plan based on where the gaps are. Prioritize planning steps and identify responsible persons for action steps and timelines. Join the learning collaborative and seek resources from other groups and clinics. See the MDH web site for resources.

22. Ways for clinics to get started with certification Develop PDSA cycles where appropriate (works for quality and planning.) Measure progress frequently and celebrate steps. Identify areas where the clinic may need to submit a variance. Determine implementation plan, number of clinicians that will become certified the first time and future plan for spread. Determine timeline for certification application and meet regularly to update the group and certification assessment tool. Identify when the clinic is ready to submit their letter of intent.

23. 2008 Health Reform Law: Minnesotas Vision health.healthcarehomes@state.mn.us http://www.health.state.mn.us/healthreform/homes/index.html