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

2. Hospice Care & Medicaid Beneficiaries An Overview

3. 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).
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HSM CONFIDENTIAL AND PROPRIETARY

4. 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.
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5. 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.
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6. Upcoming Changes
HSM will provide educational opportunities to assist providers in learning about the new prior authorization requirements.
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7. 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,
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8. 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 or toll free at
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9. What happens next?
Following this session each participant will be ed an informational packet to review.
Liaison contact sheet.
Education calendar.
Review process diagram.
List of required documents for Web review submission.
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10. Educational Opportunities
HSM will contact each hospice provider to identify hospice liaisons to schedule trainings.
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11. 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)
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12. 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.
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13. 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.
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14. 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.
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15. Educational Opportunities
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16. Educational Opportunities
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17. Educational Opportunities
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18. Contact Information
To register for prior authorization
readiness training:
Visit the HSM Website at
Call the HSM helpline at
or (601)
the HSM education department at
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19. QUESTIONS
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20. Thank you!
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