2016 ucare connect bi-annual training...agenda welcome/introductions ucare connect health...
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2016 UCARE CONNECT BI-ANNUAL TRAINING
RECORDED WEBEX-NOVEMBER 2016
AGENDA
Welcome/Introductions
UCare Connect Health Promotions-Nicole Lier
Non-Discrimination and Grievances-Nancy Molenda
UCare Connect 2017 Benefits Overview-Rob Burkhardt
UCare Connect + Medicare Product Training-Rob Burkhardt
Follow-up After Hospitalization Performance Improvement Project Update-Annie Halland
UCare Connect Case Management Updates-Bobbi Jo Glood & Jennifer Andersen
UCare ConnectNovember 2016
Health Promotion
Programs
UCare Connect
Health and WellnessUCare’s Health Promotion team’s focus is on prevention
Fitness
Community Education discounts
MOMS Program
Preventive Rewards and Incentives
Tobacco Cessation
Mobile Dental Clinic
UCare Connect Fitness:
SilverSneakers
SilverSneakers provides:
Basic club membership at no cost to
members
Flex classes outside of gym – assisted
living, community centers, etc.
At home kit options – 1 per year
Online resources, including classes
and nutrition advice
NEW!Fitness Icons on
member ID Cards
SilverSneakers
Current club listings:
www.silversneakers.com• All YMCA Twin Cities
branches
• Courage Center
• Curves
• Anytime
• Snap Fitness
•Access to multiple clubs
•13,000 clubs nationwide;
500 in Minnesota
•No visit requirement
•Caregivers can attend
with member as helper
SilverSneakers
Members receive a SilverSneakers card via US
All new members get cards in their first month
OR Print card on demand at silversneakers.com
SilverSneakers
Connect to Wellness Kit
Choice of 4 kits:
Kit A: Stress Relief with a meditative coloring book and DVD
Kit B: Tai Chi with a Tai Chi DVD and mat
Kit C: Sit & Be Fit with a seated fitness DVD and fitness towel
Kit D: Latin Dance with a Latin dance DVD and fitness towel
One kit per member per calendar year
Members call Customer Service to order; an order form is
also included in the New Member packet
Community Education
Discounts
Community Education classes in School Districts:
Exercise and Nutrition
Defensive Driving
Computer Skills
Not for private lessons or high risk activities.
Up to $15 discount per class.
Members give UCare ID when registering.
Management of Maternity
Services (MOMS)
Any/all pregnant members eligible:
Pregnant members are auto enrolled
Members self enroll
Incentives for pregnant members:
$75 gift card after first trimester prenatal visit
$75 gift card for post-partum visit
$25 tobacco incentive
MOMS Prenatal Handbook
Automatically mailed to any member
identified as pregnant
Members can request a booklet
Topics include:
Post-partum depression
Nutrition
UCare resources
Pregnancy book and DVD vouchers
Available in English
Somali DVD with English booklet
Pregnancy Nurse Advisor
Members identified as pregnant are called via a
pregnancy nurse
Early prenatal care
Smoking
Depression
Chemical use
Nutrition
Postpartum visit
Pregnancy Nurse Advisor
Members can self enroll
Inbound option for Pregnancy Advisor
Nurses:
888-778-8205*
*WATCH FOR NEW NUMBER in 2016
Pregnant Smokers
$25 gift card incentive
Tobacco Quitline assessment with health coach via the
Tobacco Cessation program
Incentive can be printed from UCare website
Quit Smoking Handbook
Breast Pumps
Breast pumps at no cost
to members
Baby must be delivered
for free pump
Limit one pump every 3
years
Durable Medical
Equipment vendors
Child Birth and Pregnancy
Classes
Members can attend classes
at a clinic, hospital, or public
health agency at no charge
Seats, Education, and Travel Safety
(SEATS)
Car seats for pregnant members
UCare Connect members need to obtain the seat while pregnant –not after delivery.
Seats given by partner agencies via home visits or group classes.
Car seat education required.
Parents’ Guide
Reference for new parents
Mailed to members 0 - 6 months
Focus on well child visits
Home-safety checklist
Nutrition information
Common medical issues
Parenting survival skills
Mammogram Reward
Eligible ages 50 – 74 years
$50 incentive to complete mammogram screening
Noncompliant outreach mailings
Child and Teen Check up
Eligible ages 12-21 years(Connect - 18-21 years)
$25 incentive to complete annual preventive checkup
Mailings sent to noncompliant members
Help to Stop Using Tobacco
Mayo Clinic Tobacco Quitline:
1-888-642-5566
No cost for all members.
Nicotine replacement therapy (patches, gum, lozenges) available at no cost.
Personalized coaching helps increase quit rate.
Mobile Dental Clinic
https://ucare.org/HealthPlans/dentalcareforu/Pages/
MobileDentalClinicSchedule.aspx
Mobile Dental Clinic Schedule
Appointment line:
1-866-451-1555 toll free
TTY: 1-800-627-3529 toll free
Greater MN location once/month
Metro locations
Health Promotion Contacts
Nicole Lier
Health Promotion Supervisor
612-676-3281
Amy Bender
Health Promotion Specialist Senior
612-676-3351
Kristen Ophaug
Health Promotion Specialist
612-676-3355
www.ucare.org/healthwellness
NON-DISCRIMINATION AND GRIEVANCES
Section 1557 of the Affordable Care Act
November 2016
Training Objectives
During this training, participants will learn:
Overview of Section 1557 and
nondiscrimination requirements
How nondiscrimination requirements apply at
UCare
Grievance rights and internal procedures
SECTION 1557 OVERVIEW
What is Section 1557?
Section 1557 is the nondiscrimination law in the
Affordable Care Act (ACA).
Section 1557 is important to achieving the ACA’s goals
of expanding access to health care and coverage,
eliminating barriers, and reducing health disparities.
Section 1557 prohibits discrimination on the basis of
race, color, national origin, sex, age, or disability in
certain health programs and activities.
Section 1557 builds upon longstanding
nondiscrimination laws and provides new civil rights
protections.
What are some of the notable provisions
of Section 1557?
Section 1557 is the FIRST Federal civil rights law to broadly prohibit sex
discrimination in health programs and activities.
– Sex discrimination includes, but is not limited to, discrimination based
on an individual’s sex, including pregnancy, related medical
conditions, termination of pregnancy, gender identity and sex
stereotypes. Gender identity means an individual's internal sense of
gender, which may be male, female, neither, or a combination of male
and female.
– Sex stereotypes means stereotypical notions of masculinity or
femininity.
Section 1557 applies to the Health Insurance Marketplaces and to all health
plans offered by health insurance companies that participate in the
Marketplaces.
What is the scope of Section 1557?
All health programs and activities that receive Federal financial assistance
from HHS, including Medicaid, Medicare, and APTC/CSR. This includes:
– Hospitals, health clinics, physicians’ practices, community health
centers, nursing homes, rehabilitation centers, health insurance
issuers, State Medicaid agencies, etc.
– All health programs and activities administered by entities created
under Title I of the ACA (i.e., MNsure).
– All health programs and activities administered by HHS (e.g.,
Medicare Program, Federally-facilitated Marketplaces).
– These are known as “covered entities” in the rule.
Where an entity is principally engaged in health services or health
coverage, ALL of the entity’s operations are considered part of the health
program or activity, and must be in compliance with Section 1557 (e.g., a
hospital’s medical departments, as well as its cafeteria and gift shop).
UCare Actions to Comply with Section 1557
Identified Civil Rights Coordinator
Implemented notices and statements – see link on ucare.org
homepage
Developed new corporate policy – GOV011 UCare
Nondiscrimination Policy (link)
Developed new corporate procedure – GOV0044
Nondiscrimination Grievance Procedure (in progress)
Completed training on Section 1557
– Department mtgs for those with direct interaction
– Included in annual compliance training beginning in 2017
Analyzed system edits related to gender or age (in progress)
Developing medical policy regarding transgendered services (in
progress)
Communicated availability of auxiliary aids and translation services
timely and at no cost to the individual
Nondiscrimination notice
This is one of the two versions of
the notice and taglines.
WHAT IS DISCRIMINATION
IN SECTION 1557
Discrimination based on an individual’s race, color or national
origin is prohibited
A covered entity (UCare) may not:
Segregate, delay or deny services or benefits based on
an individual’s race, color or national origin.
Delay or deny effective language assistance services to
individuals with limited English proficiency (LEP). The
term “national origin” includes, but is not limited to, an
individual’s, or his or her ancestor’s, place of origin
(such as a country), or physical, cultural, or linguistic
characteristics of a national origin group.
Section 1557 protects individuals in the United States,
whether lawfully or not, who experience discrimination
based on any of Section 1557’s prohibited bases.
Requirements for communicating with LEP individuals
A covered entity must:
Take reasonable steps to provide meaningful access to each
individual with LEP eligible to be served or likely to be
encountered in its health programs and activities. This may include
language assistance services, such as oral language assistance or
written translations.
Publish taglines in non-English languages to notify the individual
about the availability of language assistance services.
Notification of availability of language assistance services must be
in significant publications, prominent physical location, and on its
website.
Offer a qualified interpreter when oral interpretation is a reasonable
step to provide an individual with meaningful access.
Provide language assistance free of charge and in a timely manner.
Requirements for communicating with LEP individuals
A covered entity may not:
Require an individual to provide his or her own
interpreter.
Rely on a minor child to interpret, except in a life
threatening emergency where there is no qualified
interpreter immediately available.
Rely on interpreters that the individual prefers when
there are competency, confidentiality or other concerns.
Rely on unqualified bilingual or multilingual staff.
Use low-quality video remote interpreting services.
Discrimination based on an individual’s sex is prohibited
Covered entities must:
Provide equal access to health care, health insurance coverage, and other
health programs without discrimination based on sex, including pregnancy,
gender identity, or sex stereotypes.
Treat individuals consistent with their gender identity, including with
respect to access to facilities, such as bathrooms and patient rooms.
Providers cannot deny or limit sex-specific health services based solely on
the fact that the gender identity or gender recorded for an individual does
not align with the sex of individuals who usually receive those types of sex-
specific services (e.g., denying a transgender male a pap smear or denying
a transgender woman a prostate exam).
Sex specific programs are allowed only if a covered entity can show an
exceedingly persuasive justification for the program. That means the sex-
specific nature of the program must be substantially related to an important
health-related or scientific objective.
Discrimination based on an individual’s age is prohibited
A covered entity may:
Base its actions on age when it is a factor necessary to the normal
operation, or achievement of a statutory objective of a program. Therefore,
this standard does not apply to any age distinction that is authorized under
Federal, State, or local law.
Provide different treatment based on age when the treatment is justified by
scientific or medical evidence or based on a specialty (e.g., pediatricians
are not required to treat adults and gerontologists not required to treat
children).
A covered entity may not exclude, deny or limit benefits and services based on
an individual’s age (e.g., a physician’s practice may not deny a 62-year-old
man health services because it only accepts patients under age 60).
Discrimination based on an individual’s disability is prohibited
A covered entities must take the following steps, unless
they would result in an undue financial burden or would
fundamentally alter the program:
Make reasonable changes to policies, procedures and practices to
provide equal access for individuals with disabilities.
Make all health programs and activities provided electronically
accessible.
Ensure newly constructed and altered facilities are physically
accessible.
Provide effective communication with individuals with disabilities,
including patients and their companions.
Provide auxiliary aids and services to individuals with disabilities
free of charge and in a timely manner. Auxiliary aids and services
include, but are not limited to, large print materials and TTY.
Discrimination based on an individual’s disability is prohibited
A covered entities may not:
Require an individual to provide his or her own interpreter.
Rely on a minor child to interpret, except in a life threatening
emergency where there is no qualified interpreter immediately
available.
Rely on interpreters that the individual prefers when there are
competency, confidentiality or other concerns.
Rely on unqualified staff interpreters.
Use low-quality video remote interpreting services.
Discrimination in health insurance or other health coverage is
prohibited
Covered entities that provide or administer health-related insurance or
coverage may not discriminate on the basis of race, color, national origin, sex,
age, or disability. This means we may not do the following based on race,
color, national origin, sex, age, or disability:
Deny, cancel, limit or refuse to issue or renew a health insurance plan or
other health coverage.
Deny or limit coverage of a claim.
Impose additional cost sharing or other limitations or restrictions on
coverage.
Use discriminatory marketing practices or benefit designs (e.g., plan covers
treatment for eating disorders in women but not men).
Have categorical exclusions or limitations in coverage for all health care
services related to gender transition.
Covered entities may determine whether a particular health service is
medically necessary or otherwise meets applicable coverage requirements in
any individual case.
GRIEVANCE RIGHTS AND
PROCESSES
What rights does someone have who feels discriminated against
by UCare?
Individuals have the right to file a grievance with the
following entities:
UCare
Federal Office of Civil Rights (OCR)
In addition, SPP members may file a grievance with
DHS or the Minnesota Department of Human Rights
What rights does someone have who feels discriminated against
by UCare?
Beginning in October 2016, individuals are notified of
these rights and the procedures to file a grievance through
required notices in significant publications, our website,
and in our physical location. If you receive a grievance,
follow existing procedures to ensure the grievance is
filed.
Oral grievances by current members go to Customer
Services
Written grievances go to Complaints, Appeals, and
Grievances
What happens if a grievance is filed with OCR?
OCR is a neutral, fact-finding agency that receives, investigates and
resolves thousands of complaints from the public alleging discrimination in
health services and health coverage.
When OCR finds violations, a covered entity will be required to take
corrective actions, which may include revising policies and procedures, and
implementing training and monitoring programs. Covered entities may also
be required to pay compensatory damages.
When a covered entity refuses to take corrective actions, OCR may
undertake proceedings to suspend or terminate Federal financial assistance
from HHS. OCR may also refer the matter to the U.S. Department of
Justice for possible enforcement proceedings.
Section 1557 also provides individuals the right to sue covered entities in
court for discrimination if the program or activity receives Federal financial
assistance from HHS or is a State-based Marketplace℠.
What happens if a oral grievance is filed with UCare?
Individual calls UCare and indicates
discrimination
Is the discrimination
related to transportation?
Follow existing procedures to
resolve
Does member want to file an oral grievance?
yes
noProduct #
Did member call # on back of card or general
UCare number?
Transfer to applicable CS team for the member’s
product
General UCare
Offer member the right to file a written
grievance and to go to OCR. Document
complaint in FUSE and follow workflow for “serious allegation”
through U360.
Enter into EXP form. Note: form being
updated for nondiscrimination –
field TBD
no
Customer Service Specialist (CSS) researches and
initiates email to designated grievance staff in applicable business area.
Title of email includes “PRIORITY Discrimination
grievance”
Designated grievance staff reviews and responds to
CSS within 5 calendar days.
After receiving response from designated grievance
staff, CSS verbally communicates outcome to
member. Outcome is documented in EXP. If CSS cannot reach member after three attempts, resolution
letter is sent.
Designated grievance staff based on the type of issue are (copy bold on all):GR/Civil Rights Coordinator – Nancy MolendaLegal – TBDProvider/contracting issue – Carolyn LynkBenefit issue – Liz ConwayDelegate issue – Brenda McIlveen, Pat MitschInterpreter issue – Monica HartDisability issue – Nancy MolendaUCare employee issue – Jamie StevensonEnrollment issue – Tami Messbarger, Sue Wooldridge
Did call come through Sales department?
Does individual want to file a
grievance?
Does individual want to file an oral or
written grievance?
Enter into CRM and submit incident in U360. Enter into
title of U360 incident
“Discrimination grievance.”
member
Is individual a member/member representative or
non-member?
noDid member call
sales?
Transfer to Customer Service Line or forward email to
yes
yesNon-member
yes
no
yes
Advise individual that concern will be shared
with Sales Director. Document in CRM if
individual is willing to share first and last
name.
no
oral
Compliance reviews incident and
coordinates with designated staff as
needed.
Monthly report generated from U360 for
all items related to discrimination. Sent to Civil Rights Coordinator
and Sr. Leadership.
All member oral
grievances are manually entered into
CAG database.
Go to A
written
Does member want to file a
written grievance?
no
Go to A
yes
Go to B
Sales will complete communication with individual regarding the outcome of the
grievance.
Individual
Customer Service
Sales
CAG
CIA
Other/varies
Key
What happens if a written grievance is filed with UCare?
Color Key
Individual or someone on behalf of individual submits written grievance (may be
result of initial oral grievance)
Is it a nondiscrimination grievance and an
appeal?
Two cases get opened – one for grievance and one for appeal. These
are worked separately. Resolve at the same time when able and
required by product. If the grievance is addressed first, the letter states
the appeal outcome will be coming.
yes
nono
Is it a grievance related to
discrimination and Quality of Care (QOC)?
Follow existing procedures for QOC.
yes
memberIs individual a
member or non-member?
CAG enters into database and
identifies as related to discrimination using cheat sheet
Non-member
CAG will follow process and timelines to resolve, but will
not log in CAG database. CAG will load as U360 incident.
Enter into title of U360 incident “Discrimination grievance.”
A
Is additional information needed
from external individuals?
Individual
Customer Service
Sales
CAG
CIA
Other/varies
Key
Send grievance acknowledgement letter to member
within 10 calendar days.
CAG team researches and initiates email to
designated grievance staff in applicable business area.
Title of email includes “PRIORITY Discrimination
grievance”
Designated grievance staff reviews and responds
within 5 calendar days.
After receiving response from designated grievance staff, CAG communicates
outcome to member through a letter. Outcome
is documented in CAG database.
no
CAG will follow procedure for 14 day extension as
applicable.
yes
B
Member oral grievances and Delta member
grievances are added to CAG database. CAG
receives excel document and manually enters into
CAG database.
CAG database reporting includes member written
and oral grievances. Report sent to Civil Rights Coordinator.
Compliance reviews incident and
coordinates with designated staff as
needed.
Sales will complete communication with individual regarding the outcome of the
grievance.
Monthly report generated from U360 for all items
related to nondiscrimination. Sent to Civil Rights Coordinator and
Sr Leadership.
Designated grievance staff based on the type of issue are (copy bold on all):GR/Civil Rights Coordinator – Nancy MolendaLegal – TBDProvider/contracting issue – Carolyn LynkBenefit issue – Liz ConwayDelegate issue – Brenda McIlveen, Pat MitschInterpreter issue – Monica HartDisability issue – Nancy MolendaUCare employee issue – Jamie StevensonEnrollment issue – Tami Messbarger, Sue Wooldridge
Go to C
Conclusion
This work is never done…
– Additional guidance is ongoing and expected to continue
– Medical care and standards continue to evolve
– We will continue to learn how to be better
Resources available to you
– OCR’s Section 1557 site (link)
– UCare’s internal nondiscrimination site (link)
– Civil Rights Officer/Coordinator
UCare Connect
2017 Benefit Changes
Changes - All State Products
Community Emergency Medical Technician
(EMT) (pending federal approval)
Gender Confirmation Surgery (formerly non-
covered service known as Sex Reassignment
Surgery)
MCO must use DHS-preferred drugs,
authorization criteria for Hepatitis C
Adults Ages 21-64
Institution for Mental Disease (IMD) now covered
in lieu of other covered services, e.g., inpatient
psychiatric services often used for CD.
Children (Under age 21)
Psychiatric Residential Treatment Facility (PRTF)
for children with severe aggression who can be a
harm to themselves or others. Effective 7/1/17,
DHS workgroup
Changes - All State Products
MHCP Specialty Pharmacy
1/1/2017: All specialty pharmacy for UCare state
programs through Fairview Specialty Pharmacy
Members currently using Accredo Pharmacy will
be contacted by Fairview Specialty Pharmacy
before 1/1/17 (letters late November)
Prescriptions automatically transferred from
Accredo to Fairview Specialty
Around 200-250 members will be affected by the
change
MHCP Formulary Changes
Additions are made throughout the year as:
• drugs are reviewed by P&T Committee
• new generics come to market
• treatment guidelines are updated
Medicaid Class review – Rheumatoid Arthritis and
Hepatitis C at November P&T
UCare Pharmacy Management evaluates
• therapeutic classes of drugs
• current clinical guidelines
• current formulary alternatives
• DHS requirements and state statutes
• Minnesota Medicaid MCO market formularies
MHCP Formulary Changes
A number of brand name products have been
removed if the generic or an equally effective
alternative is represented on the formulary.
UCare Connect + MedicareProduct Training
What Is Connect + Medicare?
UCare Connect + Medicare – fully integrated Medicare and Medicaid coverage for dual-eligible Special Needs Basic Care (SNBC) enrollees ages 18-64.
In contrast to:
UCare Connect - non-integrated Medicaid-only product serving dual-eligible and non-dual-eligible SNBC enrollees ages 18-64.
UCare Connect + Medicare Product Launch
SNBC product implementation project
Potential Enrollee outreach underway (Stuffer in Annual Health Plan Selection letter, UCare brochure
Potential Enrollees can apply now, DHS will hold applications until December
Product / enrollment effective January 1, 2017
Enrollment projected to be 1,000 on 1/1/17, reaching 2,000 by 12/31/17
Expecting many current UCare Connect enrollees to transfer to UCare Connect + Medicare
Service Area
UCare Connect + Medicare
Anoka, Carver, Dakota, Hennepin, Olmsted, Ramsey, Scott, Sherburne,
Stearns, Wright, Washington
UCare Connect
Aitkin, Anoka, Becker, Benton, Blue Earth, Carlton, Carver, Cass, Chippewa, Chisago,
Clay, Cook, Cottonwood, Crow Wing, Dakota, Faribault, Fillmore, Hennepin, Houston,
Isanti, Itasca, Jackson, Kandiyohi, Kittson, Lac Qui Parle, Lake, Lake of the Woods, Le Sueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, Mille Lacs, Mower, Murray, Nicollet, Nobles,
Norman, Olmsted, Otter Tail, Pennington, Pine, Polk, Ramsey, Red Lake, Redwood, Rice,
Rock, Roseau, Scott, Sherburne, St. Louis, Stearns, Swift, Washington, Watonwan,
Wilkin, Winona, Wright, Yellow Medicine
How is UCare Connect + Medicare different?Feature UCare Connect UCare Connect + Medicare
Medical Assistance benefits X X
Medicare A & B benefits X
Prescription drugs Medicaid only (duals have external Part D plan)
Part D + Medicaid wrap-around
PCA, Home Care Nursing, HCBS (disability waiver)
Carved out (covered by Fee For Service Medical
Assistance)
Carved out (covered by Fee ForService Medical Assistance)
Service area 62 counties 11 counties
Care Navigators, need-based Care Coordination,
X X
Passive enrollment X (can apply as well) Must apply through Sales
Cost Sharing None Part D only for some
Retention Specialists X X
Transition Prescription Fill 30 days 90 days
Health Promotion Silver Sneakers, Wellness kits, Community Ed, Tobacco
Cessation, MOMs/SEATS, incentives
Silver Sneakers, Wellness kits, Community Ed, Tobacco Cessation,
MOMs/SEATS, incentives
How is UCare Connect + Medicare similar to MSHO?
Medicaid, Medicare, Part D integrated coverage
Both regulated through CMS Special Needs Plan rules, (MSHO demo slightly different), have annual CMS bids
Shared formulary
Only Part D cost sharing
Enrollees have 90 day Medical Assistance grace period
DHS processes enrollment for UCare
Enrollees actively enroll through Sales (MSHO can enroll through county too)
Care coordination
Home & Community Based Services available to enrollees (MSHO = EW through UCare, Connect + = disability waiver through county)
Questions?
Contact UCare Customer Service
UCare Connect
(612)676-3395 / (877)903-0061
2015 Performance
Improvement Program
(PIP)
Follow Up After Hospitalization
PIP Overview
Overview: Performance Improvement Projects (PIPs)
are required as part of the DHS contract:
Interventions 2015-2017
Collaborative PIP with Medica
Why is this important?
Appropriate follow-up care after discharge
from a psychiatric hospitalization is vital.
It can help reduce the risk of repeat
hospitalization and identify patients in need
of additional interventions before they
reach a crisis point
Low scores for SNBC
Why is this important?
Goal: to increase UCare’s Follow-Up after
Hospitalization (FUH) rate of the SNBC
population in the next 3 years (2015-2017)
• Increase 7 day rate by 7 points
• Increase 30 day rate by 6 points
HEDIS 2014 (2013
DOS)Baseline
HEDIS 2015 Rate (2014
DOS) Year 1
HEDIS 2016 Rate (2015
DOS)Year 2
HEDIS 2017 Rate (2016
DOS)Year 3
7 Days 41.40% 43.87% 43.50% N/A
30 Days 67.63% 69.66% 69.59% N/A
HEDIS Measure
The Healthcare Effectiveness Data and
Information Set (HEDIS) standard measures
from National Committee for Quality Assurance
(NCQA)
Follow-up After Hospitalization (FUH) measures
% of members who see a mental health
practitioner after psychiatric hospitalization
• Within 7 days of d/c
• Within 30 days of d/c
HEDIS Measure
Types of mental health professionals that
“count”:
• Psychiatrists and psychologists
• Clinical social worker
• Clinical nurse specialist
• Advance Practice Nurses (NPs)
• Licensed therapists and counselors
• TCM and ARMHS – as long as one of the
above practitioners provides the service and if
the primary dx is a mental health dx
What can you do?
When calling member post-discharge, help
them arrange an appt with a MH
practitioner within 7 (or 30) days
• Transportation set up?
• Interpreter needed?
Call member or provider to verify if
member attended appt.
• If not, set up additional appt within 30 days
Resource
Handout updated with provider
information, and types of visits
that “count”:
Other Interventions
2015-2017: Provider education
• Webinars, toolkit, newsletter articles
Potentially in 2017: Share information on
mental health provider availability
Questions?
Please call or email with any questions:
Annie Halland, Quality Improvement Specialist
Ph: 612-676-3317
Email: [email protected]
UCARE CONNECT CASE MANAGEMENT
UPDATES
MONTHLY RECONCILIATION OF MEMBERS
All UCare Connect delegates should complete a monthly reconciliation of members on your enrollment rosters.
It is important to be sure that members you work with are assigned to you for care coordination.
You will only receive payment for members who are showing on your enrollment rosters.
This reconciliation of members will help reduce enrollment and payment issues.
If you find a discrepancy, contact [email protected]
ACTIONS FOR WHEN A UCARE CONNECT/SNBC MEMBER TERMS
ON ENROLLMENT ROSTERS
When a UCare Connect member is showing as TERMED in the status column on the changes tab of the monthly
enrollment roster, the care coordinator should:
Make a case note stating the member has termed and close the member to care coordination.
Check the member’s status on the following months enrollment roster:
If the member is not listed, do not provide care coordination services.
If the member is listed as active on the following month’s enrollment roster, pick up services where they
were left off.
If you are contacted by a termed member who wants to restore eligibility, please refer the member to UCare’s
Retention Specialist, Hli Xiong at 612.676.3438 or toll free at 1.855.307.6978 for assistance.
UCare will respond to enrollment inquires related to case transfers sent to the UCare Connect Intake email-
[email protected] by month-end.
Do not send inquiries about each termed member on your enrollment roster, you should follow the members
status on the current months roster.
UCARE TRANSPORTATION DEPARTMENT
UCare’s Transportation Department has a new email address
that Care Coordinators can use to schedule rides for members
or send transportation related questions.
Care Coordinators can:
Call 612.676.6830 or toll free at 800.864.2157 to schedule
rides from 6:00 AM-10:00 PM Monday thru Friday.
Complete the MHCP Care Coordinator Ride Entry form
located on the UCare website and fax it to 612.884.2400 or
email it.
The email address is [email protected]
TRANSPORTATION QUESTIONS & ANSWERS
Responding to emails:
Transportation reps working the requests received through the [email protected] in box will respond once the entire request is completed.
MHCP Care Coordinator Ride Entry Form requests:
It is best to email the MHCP Care Coordinator Ride Entry form to [email protected](rather than using fax)
Care Coordinators should indicate they would like a response and include their email address in the body of the email.
Due to the volume and resources, Transportation reps are not able to make phone calls or look for email address (if not provided on the form) to respond to all requests.
Escalated Issues:
Care Coordinators should:
Send an email to [email protected] and indicate in the subject line that it is an “escalated issue”
Emails will be reviewed and handled accordingly and, if needed, sent to a supervisor for a response.
Call the Transportation department at 612.676.6830 and ask to speak to a supervisor.
Callers will be transferred to the Customer Service Rapid Response team, which is trained to handle escalated issues.
UCARE CONNECT CARE COORDINATION TIPS
Home Care Authorizations:
UCare Connect covers skilled nursing visits (SNV) and home health aide (HHA) services
for members (regardless of their waiver eligibility) when they are prior-authorized by
UCare (or Mayo Clinic Health Solutions for member with a Mayo Clinic for their PCC)
Providers are responsible for contacting UCare to obtain authorizations, starting with the first
visit.
UCare Connect does NOT cover home care nursing (formally known as private duty
nursing), PCA, or home and community based waiver services.
UCARE CONNECT CARE COORDINATION TIPS
CONTINUED
Care Coordination Resources
Please remember that there are two different sets of SNBC resources on UCare’s website for SNBC.
If you are providing SNBC care coordination in an expansion county (Aitkin, Becker, Cass, Clay, Cook, Crow Wing, Itasca, Kittson, Koochiching, Lake, Lake of the Woods, Mahnomen, Marshall, Norman, Ottertail, Pennington, Polk, Red Lake, Roseau, Wilkin), remember to use only the resources listed under the UCare Connect Expansion Counties link on our website.
If you are providing SNBC care coordination in any other county, use only the resources listed under the UCare Connect link on the website.
If you are a delegate who also does MSHO/MSC+ care coordination, remember not to use these forms/resources for UCare Connect Care Coordination.
UCARE CONNECT CARE COORDINATION TIPS
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Members Moving to Other Counties/Delegates:
When a member moves to another county, the care coordinator should:
Update the member’s address in the state system by sending the DHS 5181 form to a county financial worker.
Prepare transfer paperwork to share with the new delegate (agency or county).
Transfer paperwork includes: DHS Case Management Transfer and Communication Form #6037, Copy of the most recent
assessment, care plan, and any pertinent case notes.
Members will be moved to the next delegate’s UCare enrollment roster when UCare receives
confirmation of the new county from DHS.
This process can occasionally take more than one month, the member will show as a “care coordinator change” in
the Status column of the UCare enrollment roster. The new delegate may contact the prior delegate to request
transfer paperwork.
Unless the new delegate contacts the prior delegate in advance to request the transfer paperwork, do not
send any transfer paperwork until the transfer is confirmed on your enrollment roster to avoid confusion.
UCARE CONNECT/SNBC MEMBERS 65+
Effective January 1st. 2017, SNBC will be a program for members ages 18-64.
SNBC members who will be turning 65 will be required to change to a seniors product (MSC+ or MSHO).
Members can choose an MCO, if they do not choose an MCO they will be assigned.
Members that were previously with an MCO will be assigned to that MCO unless they choose a different one.
QUESTIONS
If you have questions please contact
THANK YOU!!