Division of Medicaid Welcomes Hospice Providers Hospice Care and Mississippi Medicaid Beneficiaries Monday November 15, 2010 10A-12PM

Hospice Care & Medicaid Beneficiaries An Overview

Introduction HealthSystems of Mississippi (HSM) is the Utilization Management and Quality Improvement Organization (QIO) contracted to perform certification and quality review for the Division of Medicaid (DOM). 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Who are we? We are doctors, nurses, social workers, physical therapist, occupational therapist, speech and language pathologist & other professionals with a broad spectrum of healthcare backgrounds. 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Upcoming Changes On January 1, 2011 DOM will require providers of hospice services to prior authorize any new admission or continuation of hospice services during any enrollment period before payment can be made by the fiscal agent, ACS. 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Upcoming Changes HSM will provide educational opportunities to assist providers in learning about the new prior authorization requirements. 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Upcoming Changes Effective Jan 1, 2011, The Patient Protection and Affordable Care Act, Section 3132, “requires a hospice physician to have a face-to-face encounter with the individual to determine continued eligibility for hospice care prior to the 180th day recertification and each subsequent recertification and attest that such visit took place.” * Source CMS website, www.cms.gov 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Upcoming Changes If the beneficiary is no longer certified for a continued stay in Hospice, you may contact the Long Term Care Bureau at the MS Division of Medicaid to discuss possible Long Term Care options. The number is 601-359-6141 or toll free at 1-800-421-2408. 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

What happens next? Following this session each participant will be emailed an informational packet to review. Liaison contact sheet. Education calendar. Review process diagram. List of required documents for Web review submission. 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Educational Opportunities HSM will contact each hospice provider to identify hospice liaisons to schedule trainings. 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Educational Opportunities There are four recommended training modules to complete: Review process. Review Building Tools System process. Hands on training and practice for Web portal. (How to submit a review) 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Educational Opportunities 1. Review Process DOM Policy & HSM Procedures. Required documentation; Election Statement. Enrollment Forms. Physician’s Certification. History & Physical. 180 Day face-to-face evaluation. Review work flow and timelines. Transition of information from assessment to successful Web review submission. 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Educational Opportunities 2. Review Building Tools Evidence based clinical guidelines. Palmetto & Cahaba national & local coverage determinations (NCD/LCD). Milliman Care Guidelines® . Louisiana – Mississippi Hospice and Palliative Care Organization. Accuracy in Diagnosis ICD-9 CM. Primary. Secondary. Performance Scale. Karnofsky Scale. Palliative Performance Scale v2. FAST Scale. NYHA Scale. Reporting Clinical Information. 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Educational Opportunities 3. System Process Detailed tour of the Web portal for electronic review submission. Web Administration & Security “Go Green” – accessing communications online. 4. Web Portal Process Hands-on training of the Web portal. Training sessions will be held across the state. These sessions incorporates information learned from the other training sessions. 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Educational Opportunities 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Educational Opportunities 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Educational Opportunities 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Contact Information To register for prior authorization readiness training: Visit the HSM Website at www.hsom.org. Call the HSM helpline at 1-866-740-2221 or (601) 360-4949. E-mail the HSM education department at education@hsom.org. 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

QUESTIONS 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY

Thank you! 1/3/2019 HSM CONFIDENTIAL AND PROPRIETARY