Healthy Start Risk Appropriate Care and

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• Healthy Start Risk Appropriate Care and
• Healthy Start Coding
• http//www.floridacharts.com/hs/Hslogon.asp

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What is a Risk??

• Risk-probability of a certain event.
• Risk Factor-something which increases risk or
  susceptibility to an undesired outcome.
• Risk ratio-occurrence of an outcome in a
  population exposed to a risk factor compared to
  the occurrence of the outcome in a non-exposed
  population.

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Health Clinic Management System

• The Health Management Component (HMC) of the
  Health Clinic Management System (HCMS) is used to
  collect public health service data at the program
  component level for reporting to the Health
  Management Component Reporting System (HCMRS).

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WHY CODING IS IMPORTANT

• Coding data collected from the HMC is used to
  support departmental planning, budgeting,
  management and administration.
• Coding data is used to report to the state
  legislature and Medicaid on the Healthy Start
  Program.
• Coding data provides information on the types and
  quantities of services at the county and state
  level.
• Coding data is used to monitor the Healthy Start
  Program for performance and quality improvement.

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Why Coding is Important (cont.)

• Coding service reports help business managers,
  program supervisors, and contract managers.
• Coding data is used to draw down Medicaid
  reimbursement for services provided to Medicaid
  recipients.
• Provides a picture of the most effective
  packages of services that affect a participants
  outcomes.

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HEALTHY START ENCOUNTER FORM

• Your Encounter/Data Form is the Invoice for the
  Healthy Start services you provide.
• This form captures the data that is entered into
  the HCMS and becomes the data that provides the
  information needed for reporting to our coalition
  members and stakeholders, monitoring expenditures
  per participant, and program services per
  participant and level.

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Client Demographic Information

• Section A(Participant)
• Name
• Address
• Social Security or ID number
• Medicaid Number
• Date of Birth

• Section B(Provider)
• Service Unit
• Location
• Date
• Special Group 19

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19 Special Group

• Must enter a 2 when completing an encounter
  form when you have provided a service to a
  substance exposed infant or substance using
  pregnant woman.
• Prenatal Once the pregnancy is completed remove
  the 2 from the service record.

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Section C.
Service Codes
Healthy Start Services are identified by
numbers called Program Components

• Non-CHD
• 26 Prenatal
• 30 Infant

• CHD and
• CHD Contractors
• 27 Prenatal
• 31 Infant

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Initial Contact

• After screening, Initial Contact is the
  point-of-entry into Healthy Start care
  coordination.
• The Initial Contact is an evaluation of service
  needs.
• The Initial Contact or an attempt to contact must
  occur within 5 working days of the receipt of the
  Healthy Start screen/referral.
• The second attempt to contact must occur within
  10 working days of the first attempt to contact.

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Attempt to Contact 3103

• Attempt to contact or Initial Contact must be
  made within 5 days of receipt of screen.
• At a minimum, 3 attempts must be made before
  discontinuing follow up and coding the closure
  code unable to locate (3114).
• At least one attempt to contact the participant
  must be face-to-face.

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Attempts may be made by

• 1. Telephone call
• 2. Face-to-face
• 3. Letter

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Required Components Of An Initial Contact

• Explaining the meaning of the positive
• Healthy Start risk screen and referral.
• 2. Determining the participants ability to
  access comprehensive prenatal services/child
  health care services.
• Evaluating the participants service needs using
  risk appropriate care principles, and initiating
  an individualized plan of care.
• Providing information about how risk factors can
  be addressed and types of services available in
  the community.

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Initial Contact (continued)

• Providing referrals to community resources.
• Providing the name and phone number of a Healthy
  Start staff contact.
• Assigning a level of care based on the Healthy
  Start leveling system.
• Providing follow-up with the prenatal or child
  health provider within 30 days.

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Outcomes/Decisions
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Outcomes/Decisions

• 3101 Tracking Only
• Tracking involves only follow-up of referrals and
  other services to determine that the participant
  continues to be able to access services. It can
  be face- to-face or non face-to-face.

• 3102 Participant Needs Assessment
• The care coordinator determines the participant
  needs a face-to-face assessment, quickly, at
  least within 10 working days. Not every
  participant needs to receive an in-depth
  assessment within this time frame. If it is
  determined the participant does not need an IA
  this quickly, the 3200 series of codes may be
  bypassed.

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Initial Contact Closure

• 3110 Declines Services
• Used when the participant verbally declines
  additional services after the IC service has been
  provided, even though the care coordinator may
  believe further services are warranted.

• 3111 No Further Services Needed
• Used when the participant and the care
  coordinator collaboratively agree that no further
  services are needed.

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Initial Contact Closure

• 3112 Receiving or Will Receive Care Coord. from
  CMS/EIP
• Used when the care coordination is (or will be)
  adequately provided by CMS/EIP (Early Steps).

• 3113 Receiving or Will Receive Care Coord. from
  Another Provider, not CMS/EIP
• Used when the care coordination is (or will be)
  adequately provided by another provider, but not
  CMS/EIP (Early Steps).

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Initial Contact Closure Codes

• 3119 Unable to Provide Completed Initial Contact
• An Initial Contact has not been
  provided.
• Participant scored less than 4, is referred for
  factors other than score, and does not have
  safety concerns or immediate needs. Close after
  30 days if participant has not made contact with
  coordinator.
• Participant refuses the initial contact before
  all components of the initial contact have been
  completed.

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Initial Contact Closure

• 3114 Unable to Locate
• An Initial Contact has not been provided.
• Participant covertly declines services by not
  responding to attempts to contact.
• At least three attempts have been made and
  documented.

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3115 Initial ContactService Units

• This code is used to account for time spent
  providing an initial contact outcome beyond the
  one service unit recorded for the initial contact
  outcome code. Include the time spent providing
  the evaluation of service needs, documentation,
  travel, and any referral/telephone calls.

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Case Study

• What are the risk appropriate services for this
  case study?
• Risk appropriate care is the provision of
  services that directly address risk factors that
  participants are unable to solve by themselves
• What services need to be coded on the encounter
  form?

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Initial Contact Rules to Remember

• 3101, 3102, 3110, 3111, 3112, 3113, 3114, and
  3119 should be coded one time for each
  participant.
• The one time only use of these codes provides
  data on the number of Healthy Start participants.
• 3115 should always be used to capture any amount
  of time over one service unit for initial contact
  outcomes.
• 3203 (Attempt to Contact) can be coded more than
  one time for each participant.
• Time spent providing an Initial Contact is coded
  in 15 minute blocks of time.

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Initial Contact Rules (cont.)

• If an attempt to contact is made, code at least
  one service, even if it took less than 15 minutes
  to provide the service (e.g., an attempt to
  contact took 5 minutes, code one service).
• For services of more than 15 minutes, round the
  time to the nearest 15 minutes (7 minutes or less
  round down, more than 7 minutes round up).

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Initial Assessment

• Initial Assessment of service needs is a
• face-to-face evaluation.
• Done in collaboration with the participant and/or
  family, if participant is a child.
• Done within 10 working days of the Initial
  Contact.

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Initial Assessment Includes

• Face-to-face interview/assessment with pregnant
  participant or childs parents/caregivers
  includes a home evaluation.
• 2. Completion of an authorization for release
  of medical information, as appropriate.
• 3. Joint determination of participant and
  family service needs.
• 4. Evaluation of the individualized plan of care
  for continuing or modifying services based on the
  assessment.
• 5. Evaluation of assigned level and
  documentation of changes as needed.
• 6. A phone call or written notice to prenatal
  care provider or childs primary care provider
  within 30 calendar days of assessment regarding
  progression of Healthy Start care coordination
  service delivery.
• (Choose one code to describe the outcome and code
  any time over one service unit spent providing
  the Initial Assessment to 3215)

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Initial Assessment

• Initial Assessment must be face-to-face
• Home
• Community Setting
• Clinic
• Initial Assessment may be made during the same
  encounter as an Initial Contact if the Initial
  Contact was made face-to-face.
• (Code outcome of IC and outcome of IA
  Split any time over those two service units
  between 3115 and 3215.)

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Attempt to Contact 3203

• The Initial Assessment, or an attempted Initial
  Assessment must be made within 10 working days of
  the Initial Contact.
• At least 3 attempts must be made before
  discontinuing follow-up and coding unable to
  locate (3214).
• One attempt must be face-to-face.

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Attempts may be made by

• 1. Face-to-face
• 2. Letter
• 3. Telephone call

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Outcomes/Decisions
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Decision Point

• 3201 Needs Tracking Only
• Used when the participant needs less intensive
  care coordination services.

• 3202 Plan Ongoing Care Coordination
• Used when the IA results in a determination that
  the participant needs more follow-up than would
  be provided by tracking alone.

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Initial Assessment Closure Codes

• 3210 Declines Services
• Used when the participant verbally declines
  additional services after the IA has been
  provided, even though the care coordinator may
  believe further services are warranted.

• 3211 No Further Services Needed
• Used when the participant and the care
  coordinator collaboratively agree that no further
  services are needed.

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Initial Assessment Closure

• 3212 Receiving or Will Receive Care Coordination
  from CMS/EIP (Early Steps)
• Used when the care coordination is (or will be)
  adequately provided by CMS/EIP.

• 3213 Receiving or Will Receive Care Coordination
  from Another Provider, not CMS/EIP (Early Steps)
• Used when the care coordination is (or will be)
  adequately provided by another source, not
  CMS/EIP.

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Initial Assessment Closure

• 3219 Unable to Provide Completed Initial
  Assessment
• An Initial Assessment has not been provided.
• The participant refuses the initial assessment
  before all components of the initial assessment
  have been completed.

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Initial Assessment Closure

• 3214 Unable to Locate
• An Initial Assessment has not been provided.
• Participant covertly declines services by not
  responding to attempts to contact.
• At least three attempts have been made and
  documented, including one face to face attempt.

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3215 Initial AssessmentService Units

• Used to account for time spent providing an
  initial assessment outcome beyond the one service
  unit recorded for the outcome code. Include the
  time spent providing the assessment,
  documentation, travel, and referral/telephone
  calls.

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Case Study

• What are the risk appropriate services for this
  case study?
• Risk appropriate care is an individualized
  approach of service delivery all participants do
  not get the same set of services services are
  targeted to improve outcome.
• What services need to be coded on the encounter
  form?

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Initial Assessment Rules to Remember

• It is not always clear if a participant will need
  an assessment within the 10 day time frame.
• If in doubt, schedule and provide an assessment.
• 3201, 3202, 3210, 3211, 3212, 3213, 3214, and
  3219 can only be coded 1 time for each
  participant.
• The one time only use of the code provides data
  on the number of participants.
• 3215 should always be used to capture any amount
  of time over one service unit for initial
  assessment outcomes.
• 3203 can be coded more than one time for each
  participant.

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On Going Care Coordination

• Tracking the participants receipt of services.
• On going systematic assessment of participant,
  parent/caregiver, or family concerns, priorities,
  strengths, and resources.
• Planning with the family on how to address their
  concerns, priorities and resources.

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On Going Care Coordination (cont.)

• Developing a family support plan.
• Providing referrals and follow-up for services.
• Coordinating services with other
  providers/agencies/programs.
• Reinforcing the health care regimen.
• Providing anticipatory guidance and
• health related counseling.

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On Going Care Coordination (cont.)

• Advocating on behalf of the participant and
  family.
• Monitoring effectiveness of the services provided
  and adjusting the plan for services.
• Care Coordination transition to other providers.
• Maintaining on going communication with other
  providers, especially the prenatal or child
  health care provider.

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On Going Care Coordination (cont.)

• Ongoing systematic assessment of participant, or
  family assets, risks, concerns, and priorities.
• Ongoing evaluation of the individualized plan of
  care.
• Ongoing evaluation of the participants level of
  care.

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Attempt to Contact

• Used when an attempt to provide a care
  coordination service has been unsuccessful.
• At a minimum, 3 attempts must be made before
  discontinuing follow-up and coding as unable to
  locate, 3314.
• One attempt must be face-to-face.

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Attempts may be made by

• 1. Face-to-face
• 2. Letter
• 3. Telephone call

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Outcomes/Decisions

• 3320
• C.C. Face-to-Face
• 3321
• C.C. Tracking or not face-to-face
• 3322
• Initial Family Support Plan Meeting
• 3323
• Update Family Support Plan
• 3310
• Declines Services

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Outcomes/Decisions

• 3311
• No Further Services Needed
• 3312
• Receiving or will Receive Care Coordination from
  CMS/EIP
• 3313
• Receiving or will Receive Care Coordination
• from another Provider not CMS/EIP
• 3314
• Unable to Locate
• 3315
• Ineligible for Services

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Ongoing Care Coordination Services

• 3320 -Care Coordination Face-to-Face-Used when
  the care coordination activity is provided
  face-to-face with the participant.
• 3321 -Care Coordination
• Tracking or not Face-to-Face-Used when tracking
  activities either face-to-face or non
  face-to-face, or when providing ongoing care
  coordination that is non face-to-face.

• 3322 Initial Family Support Plan Meeting-Used at
  the time the FSP is written (face-to-face). It
  is required for all level 3 participants. If
  participant refuses to sign, still code and
  document the refusal to sign.
• 3323 Update Family Support Plan-Used when the FSP
  is updated (face-to-face). Minimally, this must
  be done every 3 months.

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Care Coordination Closure

• 3310 Declines Services
• Used when the participant declines or
  refuses services, in spite of the fact that the
  care coordinator believes services are needed.
• 3311 No Further Services Needed
• Used when the participant and the care
  coordinator collaboratively agree that no further
  services are needed.
• 3312 Rec.or Will Rec. C.C.from CMS/EIP
• Used when the ongoing care coordination is (or
  will be) adequately provided by CMS/EIP (Early
  Steps).

• 3313 Rec. or Will Rec. C.C.from Another Provider
  not CMS/EIP
• Used when the ongoing care coordination is (or
  will be) adequately provided by another provider,
  not CMS/EIP.
• 3314 Unable to Locate
• Used when a participant can not be located after
  3 attempts have been made and documented.
• 3315 Ineligible for Services
• Used when a participant has completed her
  postpartum and family planning appointment or
  eight weeks after delivery or when a child
  reaches three years of age or the participant
  moves out of state.

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Care Coordination Rules to Remember

• Not all participants will receive ongoing care
  coordination.
• Unlike Initial Contact and Initial Assessment
  codes, Ongoing Care Coordination Codes may be
  used more than once.
• Care Coordination Closure Codes can only be used
  once.

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Other Healthy Start Services
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Other Healthy Start Services

• 4501 Nutrition Assessment
• Provider must meet Qualifications in Chapter 7
• Code to participants identification number

• 8002 Psychosocial Counseling
• Provider must meet Qualification in Chapter 9
• Code to participants identification number

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Other Healthy Start Services

• 8004 Parenting Support and Education
• Qualification in Chapter 8
• Code to participants identification number

• 8008 Breast Feeding Education and Support
• Qualification in Chapter Chapter 5
• Code to participants identification number

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Other Healthy Start Services

• 8006 Childbirth Education
• Must meet provider qualifications in Chapter
  6
• Code to participant identification number

• 8026 Smoking Cessation Counseling
• Must meet provider qualification in Chapter
  10
• Code to participant identification number

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8013-Interconceptional Education and Counseling

• Activities that educate and inform the Healthy
  Start woman about health behaviors that will help
  to reduce risk and improve subsequent birth
  outcomes.
• Provider must meet qualification in Chapter 21
• Code is open to program component
• 26, 27, 30 and 31. Code to participants I.D.

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Interconceptional Education and Counseling

• Who can provide and code this other Healthy
  Start service?
• trained and qualified Healthy Start providers
• Coalition approved curriculum is used
• may be provided individually or in classes
• one unit of service 15 minutes

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Administration/Special Services
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3950 Participant Identification

• Outreach activities that identify specific
  individuals and groups who are in need of
  prenatal and child health care
• Health fairs
• Soup kitchens
• Neighborhood centers
• Door to door
• Chapter 2 for more information
• (Code service units and participant ID number if
  applicable)

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3951 Participant Related Activities

• Administrative activities related to screening
  and care coordination for Healthy Start
  participants
• Screening infrastructure
• Administrative functions that assure the Healthy
  Start process
• Healthy Start quality improvement functions
• Letters written to participants/families and
  providers.
• (Code service units and participant ID number if
  applicable)

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3952 Community Activities

• Providing information to the community related to
  the Healthy Start initiative and collaboration
  with other community groups
• Sharing with community agency representatives
• Presenting
• local places of worship
• business organizations
• community groups
• recruitment of public and
• private providers
• (Code service units )

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COUNTY HEALTH DEPARTMENT CODING TOOL Purpose To
Assist the County Health Department Employee in
Completing EARS When The Employee is a Healthy
Start Employee.
HEALTHY START SERVICE CODES (HSSG) EARS
(DHP 50-20)
Note When a H.S. service code listed above is
used code 0000 on the EARS form. In most
instances during a days time, an employee can
code 0000 on the EARS form, because his/her
responsibilities are usually direct or indirect
services for the client or on behalf of the
client. Example I have provided H.S. services
all day to both prenatal and infant participants.
I have 5 infant encounter forms and 5 prenatal
and have coded services. How do I code my EAR
form? Answer Code to program 27 and 31, code
0000 and split 480 minutes between the 2 program
components as appropriate.
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COUNTY HEALTH DEPARTMENT CODING TOOL
The Table Below outlines HS Employee Activities
that do not Need to be Captured on a H.S. Service
Encounter Form
EMPLOYEE ACTIVITY EARS CODE
The Table Below Outlines Employee Who is
Providing MomCare Services in the Role of the
MomCare Advisor EMPLOYEE ACTIVITY
EARS CODE
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COUNTY HEALTH DEPARTMENT CODING TOOL Purpose
To Assist the County Health Department Employee
in Completing EARS When The Employee is a Healthy
Start Employee.
Healthy Start Encounter Forms Administration
Special Services When Coded to a Participant ID
Number EARS (DHP 50-20)
Note Healthy Start Administrative codes should
only be used when a service is being provided
that otherwise cannot be captured under ongoing
care coordination HS service codes. Refer to the
HSSG for definitions of service codes. When
coding an Administration Special Services Code
the time on the HS encounter form and the EAR
code must match. When coding H.S.
Administrative codes 3950, 3951 and 3952, on a
H.S encounter form do not use these codes on an
EARS forms.
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H E A L T H Y S T A R T
Making a Difference