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Health Home Implementation Webinars

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In this case the RHIO must sign a BAA with the lead Health Home and therefore will become a Heath ... Care management ... subcontractor packets and Business ... – PowerPoint PPT presentation

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Title: Health Home Implementation Webinars


1
Health Home Implementation Webinars
  • Session 14 April 10, 2013
  • Data Exchange Application Agreements

2
What is a DEAA? What data exchange is and is not
allowed?
  • The DEAA allows the DOH to exchange lists of
    Health Home members with the lead Health Home.
  • The lead Health Home then completes subcontractor
    packets with network partners, permitting the
    lead Health Home to share lists and demographic
    data with their partners prior to member consent.

3
What is a DEAA? What data exchange is and is not
allowed?
  • The DEAA does not permit
  • Data exchange between other lead Health Homes
    without a subcontractor packet (a lead to lead
    packet is being developed).
  • Data exchange with local social service districts
    without a subcontractor packet. (Comment Local
    Districts have valuable information that can aid
    in identifying members. Subcontractor packets
    are an easy and recommended solution to permit
    data exchange to assist the local districts in
    updating data while providing Health Homes with
    valuable information.

4
What is a subcontractor packet and when is it
used? What is the process?
  • The subcontractor (aka downstream or network
    provider) packet is designed to allow the lead
    Health Home to share data with network partners,
    e.g., with those that provide case management
    services or other services (e.g., outreach) prior
    to obtaining member consent.
  • Subcontractors are engaged by the lead Health
    Home, not vice versa.
  • Subcontractors complete their portion of the
    packet and then return it to their lead Health
    Home (not DOH).

5
What is a subcontractor packet and when is it
used? What is the process?
  • The lead Health Home then authenticates the
    packet by signing the Executory Clause, BAA and
    Confidentiality Agreement.
  • The lead Health Home then submits the packet to
    DOH (Privacy Coordinator).
  • Once reviewed and approved, an Approval Letter is
    generated to the lead Health Home, permitting
    data sharing.
  • In order to permit data sharing between two
    network partners (subcontractors) a reciprocal
    subcontractor packet must be executed (this is
    being developed).

6
Is a DEAA needed for community referrals?
  • Members do not have to be on DOH lists or be
    approved by DOH in order to be accepted as a
    Health Home referral.
  • Health Homes, their partners, and MCPs are
    responsible for determining whether the
    individual presumptively meets Health Home
    criteria.
  • The State is not involved in the assignment of a
    community referral, hence a DEAA is not required
    for exchange of information about the prospective
    member.
  • EXAMPLE A member is seen in the ED , having
    signed the required ED Notice of Privacy, where
    the ED MD refers member to Health Home A. This is
    a community referral.

7
Can lead Health Homes refer or transfer members
to other lead Health Homes?
  • If the member has been assigned by the DOH, the
    Health Homes must have executed agreements with
    each other to share information about the member
    and arrange referrals or transfers. The transfer
    must be reported on the Health Home tracking
    system using the appropriate reason codes.
  • If a Health Home determines that it cannot meet
    the needs of an assigned member, and cannot refer
    or transfer him/her to another health home or
    partner then
  • If the member was assigned to the HH by DOH but
    has not received HH services, submit a rejection
    record to the tracking system.
  • If the member has received Health Home services,
    the members enrollment should be end dated by
    submitting a change record to the tracking system
    using the appropriate reason code.
  • DOH will reassign the member to another Health
    Home with the next list.

8
Data Sharing and Consent
  • Can a care management provider share data on a
    converting member with the lead Health Home?
  • A care management provider can share data on a
    converting member with the lead Health Home after
    the subcontractor packet /agreement is in place.
  • Care management providers can collect and manage
    converting Health Home members prior to the
    subcontractor packet/agreement is in place,
    including obtaining consent.
  • Once the subcontractor packet/agreement is in
    place, the members information can be
    communicated to the Health Home.

9
Data Sharing and Consent
  • Consent form
  • The Health Home consent allows sharing of health
    information with / from core health home partners
    involved in the members care that are listed on
    the consent form. It includes medical, behavioral
    health, SUD treatment providers and CM
    agencies others per the website
    http//www.health.ny.gov/health_care/medicaid/prog
    ram/medicaid_health_homes/form)
  • It includes Regional Health Information
    Organization ( RHIO) consent for Health Homes
    participating with RHIOs
  • The member does not need to sign the consent at
    the same time as he/she agrees to receive and
    participate in Health Home services as long as
    that member can still be effectively managed
    without sharing/ obtaining Health Information.

10
Opt Out and Withdrawal of Consent
  • Opt Out ( DOH-5059)
  • Health Home participation is not mandatory and
    individuals who do not want to participate can
    opt-out of the program prior to consenting. .
  • Signing the Opt-out form (DOH 5059) indicates
    they do not want to participate or receive Health
    Home services
  • Health Home Patient Information Sharing
    Withdrawal of Consent Form- (DOH-5058)
  • For a Health Home member that has already
    consented and the member decides at any time to
    discontinue receiving Health Home services
  • The member/ legal representative should be
    filled out and sign Health Home Patient
    Information Sharing Withdrawal of Consent Form-
    (DOH-5058)
  • If the member cannot be located, disenroll the
    member according to Health Home policies/
    procedures, and information sharing should be
    discontinued upon disenrollment.

11
Questions, Comments, or Concerns?
  • Questions on the DEAA process, subcontractor
    packets and Business Associate Agreements
    (BAAs)regarding sharing Medicaid data should be
    directed to
  • Caryl Shakshober OHIP Privacy Coordinator
  • cxs15_at_health.state.ny.us
  • 518-486-5771

12
Alert Use Cases
  • Eric Weiskopf, M.Ed OHITT
  • Ellen Flink OHITT

13
Fully Operational Health Home with Embedded or
Subcontracted Care Manager
  • Health Home Consent signed
  • Single-Entity RHIO Consent signed in ED

14
HH Partner
RHIO Consent
Subcontractor packet
All American Hospital Health Home with Embedded
Care Manager
Alert
RHIO
Care Management Application
Health Home Consent
RHIO Consent
Subcontractor packet
Alert
Subcontracted Care Manager
All American Hospital
HH Member enters All American Hospital Emergency
Department
15
Fully Operational Health Home with Embedded or
Subcontracted Care Manager
  • Health Home Consent signed
  • Multi-Entity RHIO Consent signed in ED

16
HH Partner
Subcontractor packet
All American Hospital Health Home with Embedded
Care Manager
RHIO with Multi-Entity Consent
Alert
Care Management Application
Health Home Consent
Alert
Subcontractor packet
Subcontracted Care Manager
All American Hospital
HH Member enters All American Hospital Emergency
Department
17
Health Home Member Enters Emergency Department of
Health Home with Embedded Care Manager
  • Health Home Consent not signed
  • Single-Entity Consent signed in ED

18
All American Hospital - Lead HH with Embedded
Care Manager
RHIO
Alert
No Health Home Consent
RHIO Consent
All American Hospital Emergency Department
HH Member enters All American Hospital Emergency
Department
19
Scenario Health Home wishes to send member
tracking file to local RHIO RHIO uses
information to match patient to appropriate
Health Home and sends alerts to care
manager. Prerequisite To share information
that comes directly from Medicaid, a RHIO must
sign a subcontractor packet with the lead Health
Home to become a Heath Home sub-contractor. Previ
ously signed BAA that existed between RHIO/Health
Home as a part of a RHIO participation agreement
is not enough to allow Health Homes to send
information gleaned directly from Medicaid to the
RHIO.
20
Health Home Member Enters Emergency Department
of Health Home with Embedded Care Manager
  • Health Home Consent not signed
  • Single-Entity RHIO Consent signed
  • Health Home has an approved subcontractor packet
    with RHIO

21
Subcontractor packet
All American Hospital - Lead HH with Embedded
Care Manager
Demographic Alert
RHIO
No Health Home Consent
RHIO Consent
All American Hospital Emergency Department
HH Member enters All American Hospital Emergency
Department
22
Health Home Member Enters Emergency Department
of Health Home with Sub-Contracted Care Manager
  • Health Home Consent not signed
  • Single-Entity RHIO Consent signed at ED
  • Health Home has an approved subcontractor packet
    with both RHIO and Sub-Contracted Care Manager

23
Subcontractor packet
Demographic Alert
All American Hospital Lead HH
RHIO
No Health Home Consent
Demographic Alert
RHIO Consent
Demographic Alert
Subcontractor packet
Subcontracted Care Manager
All American Hospital Emergency Department
HH Member enters All American Hospital Emergency
Department
24
Health Home Member Enters Emergency Department
of Health Home with Sub-Contracted Care Manager
  • Health Home Consent not signed
  • Single-Entity RHIO Consent signed for
    Sub-Contracted Care Manager
  • Health Home has an approved subcontractor packet
    with both RHIO and Sub-Contracted Care Manager

25
Subcontractor packet
All American Hospital Lead HH
Demographic Alert
RHIO
No Health Home Consent
Demographic Alert
RHIO Consent
RHIO Consent
Demographic Alert
Subcontractor packet
Subcontracted Care Manager
All American Hospital Emergency Department
HH Member enters All American Hospital Emergency
Department
26
Health Home Member Enters an Emergency Department
of a Different Health Home
  • Health Home Consent not signed

27
HH Member assigned to All American Hospital
Health Home enters New York Hospital Emergency
Department
New York Hospital
RHIO Consent
Demographic Alert
RHIO
All American Hospital Health Home with Embedded
Care Manager
No Health Home Consent
RHIO Consent
Subcontractor packet
Demographic Alert
Subcontracted Care Manager
All American Hospital Emergency Department
28
Health Home Member Enters an Emergency Department
of a Different Health Home
  • Health Home Consent not signed
  • Health Home has an approved subcontractor packet
    with RHIO and Sub-Contracted Care Manager
  • Sub-Contracted Care Manager has RHIO consent

29
New York Hospital
HH Member assigned to All American Hospital
Health Home enters New York Hospital Emergency
Department
RHIO Consent
Subcontractor packet
Demographic Alert
RHIO
All American Hospital Lead HH with Embedded
Care Manager
No Health Home Consent
Demographic Alert
RHIO Consent
Subcontractor packet
RHIO Consent
Subcontracted Care Manager
All American Hospital Emergency Department
30
Health Home Member Enters an Emergency Department
of a Different Health Home
  • Health Home Consent not signed
  • Health Home has an approved subcontractor packet
    with RHIO, Sub-Contracted Care Manager, and a 2nd
    Health Home
  • Sub-Contracted Care Manager has RHIO consent

31
New York Hospital
New York Hospital Health Home
RHIO Consent
Subcontractor packet
Subcontractor packet
Demographic Alert
RHIO
All American Hospital Health Home with Embedded
Care Manager
No Health Home Consent
Demographic Alert
RHIO Consent
Subcontractor packet
RHIO Consent
Subcontracted Care Manager
All American Hospital Emergency Department
32
Questions, Comments, or Concerns?
  • Contact
  • Eric Weiskopf
  • esw01_at_health.state.ny.us
  • 518 473 7960

33
Webinar Questions
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