New York State DOH Health Home Care Management Reporting Tool (HH-CMART) Support Calls – Session #7 April 3,2013 1

 Q+A Themes from Previous Calls  FACTGP + HH-Functional Assessments  HH-CMART Reports  Questions and Comments  Feedback, Help, and Ongoing Support 2

 Please submit your questions in writing to the webinar  If you would like to ask your questions, raise your hand (making sure you have entered your audio pin code) and we will unmute the call one at a time  We are working on a Question and Answer document that will be posted on the Health Home website under the HH-CMART section 3

Question and Answer Themes 4  How do I count for Care Management elements #21- 23, ‘CountMail’,’CountPhone’, ‘CountPerson’?  Elements 21, 22, and 23 capture counts of intervention conducted for or with the member during the reporting period. Count includes interventions conducted by CM & staff with or on behalf of the member/legal representative/ family. Count does not include interventions conducted by health care providers, other organizations or health plans. Each intervention should be assigned to one of the three following categories  21 – CountMail: Individualized letters or s sent during reporting period. Mailings or message or ONLY pre-written materials not specific to individual should not be included  22 – CountPhone: Count phone call interactions or texting made during reporting period.  Both incoming and outgoing phone call interactions count  Automated voice messages, attempted phone calls or texting, or leaving voice mail messages should not be counted  23 – CountPerson: Count each in-person interaction during the reporting period

 Fact GP & Functional Questionnaire scoring sheet influence on acuity score – The results of the FACT-GP and HH Functional Assessment will not directly impact the acuity score of the member. We are collecting this information and will be using it to get a more global sense of the population, including understanding the overall health of the population. We will be evaluating the data to determine its future utility in evaluating our members.  Homelessness scoring on the FactGP/HH Functional Assessment – Homelessness is scored on a Yes and No basis. A higher score represents better health, a score of “0” indicates that the member was homeless in the last 7 days; if they are housed, the score is “8”.  8 points for NO  0 for YES 5

 If the Care Management Program has converted to Health Home rate codes, the FACT GP and HH Functional Assessments are required to be completed on all active clients. If you have not submitted information to the Health Home you must do so immediately.  If you completed the assessments in 2012, then those scores should be put on the partial spreadsheet template and submitted to the Lead Health Home to which the clients have been assigned. ( see Webinar Session #4, Slide 6, 3/13/13)  If you did not complete them in 2012, you should be completing them on all active clients (Legacy or Health Home) from here on out and report those scores with the rest of the HH-CMART data for 2013 using the method agreed upon with the Lead Health Home 6

Question and Answer Themes 7  Care Management Programs lacking agreements with Lead Health Homes – Care Management Programs that do not have agreements with a Health Home, but have “converting TCM to Health Home members” should collect & keep the FACT GP and HH Functional Assessments to send to HH after an agreement is in place.  Fact GP / HH Functional Assessments on clients that are ‘case closed’ – If a case has been closed and you have the data collected, then submit the assessment data on all former and currently active Health Home members (i.e. case re-opened) to the assigned Lead Health Home Examples:  If a FACT GP and HH Functional Assessments are completed by the member, and later in the quarter the case is closed, report the scores to the Lead Health Home. Submit also if case had been closed and is now re- opened.  If the case is closed before the member completes the FACT GP and HH Functional Assessments, then the scores cannot be reported.

FACT GP/HH Functional Assessments 8  The Health Home FACT-GP / HH Functional Assessments should be collected to assess every member upon engagement, annually and at discharge.  The scores are tabulated using the FACT GP and Health Home Questionnaire Scoring Sheet.  The scoring sheet scores are entered into the HH CMART tool or whatever agreed upon method between the Lead HH & CM Program  Data Vs. Billing - The HH-CMART tool is for data submission purposes only and is not to be intended to be used for billing purposes.  HH CMART completion & Member Tracking System - Data must be sent in on the Member Tracking System in order for the HH- CMART data to be complete.  See elements represented as blue font and descriptions in Technical Specifications document.

HH-CMART Reports 9  The first report will only require data collected by the FACT-GP and Health Home Functional Assessment  This data will NOT be entered into the HH-CMART tool. This data will be entered into an excel document and submitted via the HCS system by the Health Home ( see Webinar Session #4, Slide 6, 3/13/13)  The date for submission of 2012 FACT GP / HH Functional Assessments data has NOT changed. Calendar year 2012 data is still due Monday, May 13, 2013, & is submitted by HH to DOH  All other reports containing ALL HH-CMART are due no later than the first Monday of the second month following the end of the reporting period. The schedule is on the Health Home website here:  dicaid_health_homes/assessment_quality_measures/reporting _periods_and_file_submission_dates.htm

Health Home CMART RESOURCES 10  Slides from all webinars can be accessed by visiting the Health Home website at: m/medicaid_health_homes/meetings_webinars.htm  We encourage your feedback  Case Scenario development  Clarify fields so that the thinking behind how a question is answered in the HH-CMART is the same across the board

HH-CMART ASSESSMENTS Resources 11  The FACT GP and Health Home Functional Assessments Questionnaires are on the Health Home website under the Assessments and Quality Metrics HH-CMART menu at this location: dicaid_health_homes/assessment_quality_measures/index.ht m  The FACT GP Scoring and Health Home Questionnaire Scoring Sheet is located on the same page, or directly at this location: dicaid_health_homes/assessment_quality_measures/docs/fact -gp_sccoring_sheet_hh_locked_mod.xls

Announcement of Upcoming Webinars 12  Health Home Bi-Weekly Policy Implementation Webinar Series Session 14 – Wednesday, April at 1:00 PM-2:30 PM Topic: Data Exchange Presentor: Caryl Shakshober & DOH legal Registration Link:  All Previous Webinars can be found here: mes/meetings_webinars.htm

 the Health Home Team at with the Subject : HH-CMART Or Call the Health Home provider line –  Health Home website, Assessment and Quality Metrics menu, Process Measures section: m/medicaid_health_homes/assessment_quality_measur es/process_measures.htm 13

 Weekly call every Wednesday from 10 a.m. to 11 a.m. ◦ The next call for April 10 th, 2013 will be announced via and information will be posted on the Health Home Website under “What’s New” menu 14