New York State DOH Health Home Care Management Reporting Tool (HH-CMART) Support Calls – Session #3 March 6,2013 1

 Technical Specifications Update  Q+A Themes from February 27 th Call  Reminder: 2012 Data Submission Requirements  Reporting Schedule  Introduction of 2012 Data Excel Template  Definitions of Elements  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 HH website under the HH CMART section 3

The first bullet defining AbleContact is now on top of Page 9 and revised to read:  Contact for ‘AbleContact’ is defined as a verbal interchange between member/legal representative/family and Health Home staff. Letters sent to members should not be counted as contact, nor should leaving messages for members.  AbleContact indicates whether the HH was able to contact the member successfully or not 4

 Page 9, 4 th bullet revised also ◦ First sentence, from the previous version, on page 9 has been moved to note on 12 OutreachEffort: Page 8 5

Mailing and outreach/Mass mailings  12 OutreachEffort: Page 8 ◦ This count includes all attempts to contact the member to engage them in participating in the Health Home for the reporting period. ◦ Included are counts of in-person ( street level ), phone contacts, and individualized mailings to attempt to locate and interact with the member PRIOR to the member or legal representative agreeing to participate in the Health Home. ◦ The interaction where the member/ legal representative agrees to participate should not be included in the count ◦ This does include all attempts regardless of whether the member agreed to participate or not, once contact was made 6

 Mentioned on February 27 th call (slide 15, element #13 – AppropriateCM)  Page 9 will reflect a change below. 7

 Multiple Health Homes Submission – For any entity using the HH-CMART for two or more health homes, make a copy of the HH-CMART Tool to use for each of the health homes separately prior to entering any data. ◦ You should not use the same HH CMART Tool for entering more than one Health Home’s data.  Tracking Sheet and C-MART Connection – The Patient Tracking System (PTS) is used to collect enrollment information. This will auto populate some fields (BLUE) of the HH CMART file. The HH CMART collects individual level ‘care management’ data. ( outreach, engagement, assessment, Care plan, and specific types of interventions) 8

 Fact GP on clients that are ‘case closed’ – HH’s are required to submit 2012 FACT GP and HH Functional Assessment data on all enrollees; ◦ Exception Retracted – see slide 6 from 3/20/13 webinar for clarification Data cannot be shared with a Health Home if the case has been closed case and member has signed the withdrawal of consent  FACT GP on TCM Legacy Clients – Clients that did not have a FACT-GP / HH Functional Assessment in There should be an initial assessment done now and submitted for 2013 first & second quarter data (part of the August 5 th, submission date) 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.  The date for submission of this data has NOT changed. Data from Calendar year 2012 is still due Monday, May 13, 2013  All other reports 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: medicaid_health_homes/assessment_quality_measures/re porting_periods_and_file_submission_dates.htm 10

11 For each file submission, use a copy of the original version of the HH-CMART

 The first report will only require data collected by the FACT-GP and Health Home Functional Assessment ◦ Specifications document required data are elements 2, 4, 7, and  Below is an example of the FACT-GP data as it is seen from the excel template.  Additional Information about the FACT-GP is available on the Health Home website here: ealth_homes/assessment_quality_measures/index.htm#func_quest ealth_homes/assessment_quality_measures/index.htm#func_quest  Completed files are sent through the Health Commerce System (HCS) using the ‘Secure File Transfer Application’ from the Applications tab. Name the file with the Health Home name and upload the file (ie. CapitalHealth.mdb). Send the file to ‘Laura Morris’. 12

Each element is color coded by data collection needs for each element by reporting period ◦ Green = changes each reporting period ◦ Red = Once in, remains the same always ◦ Orange = Needs to be reviewed for new information each report ◦ Blue = DOH will fill in * Color Coding See slides from Feb. 20, 2013 Webinar power point: m/medicaid_health_homes/meetings_webinars.htm 13

 19 – ConsentDate: Equivalent to the ‘Consent Date’ on the Health Home Patient Tracking System. ◦ Date that the member/legal representative signed appropriate consent for data sharing among Health Home partners and includes the signing of a valid consent for data collection from the RHIO/HIE  20 – LevelOfIntensity: The frequency of interventions conducted by the Health Home care management staff. ◦ Reported as: High – CM staff intervention needed more than weekly Medium – CM staff intervention needed weekly to every other week Low – CM staff intervention needed less than every other week  Interventions are interacting with member/legal representative/family and health care providers and community based programs to arrange or monitor services and progress.  Does not include interventions conducted by providers, other organizations, or health plans ◦ If frequency of intervention varies during reporting period, the maximum level of intensity should be reported  Example: First two months intensity is LOW but remainder of reporting period the intensity is HIGH, element should be reported as HIGH 14

 Defining Interventions (Elements 21, 22 and 23) ◦ Interventions conducted as part of outreach (prior to engagement in care management) should be excluded. This will be reported in element # 11. ◦ Interventions should be specific to the individual member’s care or care management needs. ◦ Include interventions conducted by Health Home care management staff and support staff or care management contracted providers ◦ Do not include interventions conducted by health care providers, other organizations, or health plans ◦ Only interventions that were conducted should be counted, attempts should not be counted ◦ Counts of interventions are not cumulative from start of care management – when a new reporting period begins a new count begins ◦ Each separate intervention should be counted once in the appropriate category of mode ◦ Include interventions involving the member/ family/ legal representative, health care provider, or other organizations involved in the care plan 15

 Elements 21, 22, and 23 capture counts of intervention conducted for or with the member during the reporting period. 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 made during reporting period. ◦ Both incoming and outgoing phone call interactions count ◦ Automated voice messages, attempted phone calls, or leaving voice mail messages should not be counted  23 – CountPerson: Count each in-person interaction during the reporting period 16

 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  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: _health_homes/assessment_quality_measures/process_measures.ht m 17

 Weekly call every Wednesday from 10 a.m. to 11 a.m. ◦ The next call will be March 13 th  Slides from all webinars can be accessed by visiting the Health Home website at: dicaid_health_homes/meetings_webinars.htm 18