04-28-17

Q & A

MIHP Provider Webcast

February 16, 2017

MHP – MIHP Collaboration

  1. Will the MIHP – MHP meeting on 3/20/17 be presented as a webcast?

No.

  1. Will there be a call in option for the collaborative meeting on 3/20/17?

Yes.

  1. MHP report – why do we need to send enrollment info at the time of enrollment but also must send the same info on the monthly report?
  2. Do we have to send notification of enrollment to the MHP every time we enroll a client in addition to the list we send monthly?

Yes, at this time you must notify the MHP of enrollment using both methods. We will send out additional guidance on reporting MIHP beneficiary enrollment to MHPs.

  1. Can we use the same communication form for the provider and the HMO, and can we fax it to the HMO?

Yes, the communication form is designed to be faxed to both the medical care provider and the MHP, unless otherwise instructed by the MHP.

  1. Regarding MHP monthly reports. The Operations Guide states that the only notification needed is the prenatal/infant communication form. Today you stated that the enrollment letter must also be sent. Please clarify.

The MIHP Operations Guide (page 8.25) states: Use the revised Prenatal and Infant Care Communications forms to notify the MHP that one of their members has enrolled in your MIHP. These are the same forms you use to notify the medical care provider about beneficiary enrollment. Medical care provider communications have always been sent with Cover Letter A (at enrollment) or B(notification of change in risk factors)and we wrongly assumed we didn’t need to restate it here.

  1. Elizabeth, the billing code is T1023 that needs prior authorization because it’s also being used with behavioral health services and we use it with an assessment for an infant.
  2. T1023 code is coming back to billing needing a prior authorization because it is also used in Behavioral Health Services but we use it for Infant Assessment in the office.

Policy Bulletin 16-33 states “MHPs may not require authorization for the Initial Risk Assessment visit, professional visits, drug-exposed infant visits, MIHP lactation support visits, childbirth education classes, or parenting education classes when provided within the criteria and limits established in Medicaid policy.”

If an MHP is requiring prior authorization, contact your consultant with the specific details (names, dates, etc.).

  1. One MHP is requiring prior authorization for the initial 9 visits and the additional 9 infant visits.
  2. At least one MHP is requiring prior authorization for the additional 9 ISS visits. OG says we only need MD approval or standing order. What is our response to this?

Policy Bulletin 16-33 states “MHPs may not require authorization for the Initial Risk Assessment visit, professional visits, drug-exposed infant visits, MIHP lactation support visits, childbirth education classes, or parenting education classes when provided within the criteria and limits established in Medicaid policy.”

If an MHP is requiring prior authorization, contact your consultant with the specific details (names, dates, etc.). Medical care provider authorization is required for the additional 9 infant visits and must be in the chart.

  1. Regarding Op Guide Notify Provider/MHP ER interventions. Webinar only referenced enrollment & discharge notification. Please advise.

See the MIHP Operations Guide (page 8.25 – 8.26) for details on your responsibilities regarding coordination with the MHP, including notifying the MHP within 24 hours when emergency interventions are implemented. Also, note that all of the POC 2 risk domains that include emergency interventions state that you are to inform the MHP when the interventions are implemented.

  1. MO22. If a client declines for her physician to get communication, can we still send the prenatal communication to the MHP? In addition, do we need to add the MHP name to the ROI in the “other” section?

If the beneficiary does not consent to sharing communications with her medical care provider, complete the relevant form and keep it in her chart. Do not send it to her medical care provider. You do not need the beneficiary’s consent to share communications with her MHP. As the payer, the MHP has the authority to see the beneficiary’s health information without her consent.

  1. Is there anything that can be done to help the MIHPs get the Care Coordination Agreements back in a timely fashion?

If an MHP is not getting the CCA back to you in a timely fashion, contact your consultant with the specific details (names, dates, etc.).

Multiples

  1. Multiples ASQ Tracker and Checklist. Duplication of ASQs on these forms. Please advise.

The ASQ screenings that are conducted with the billable infant are tracked on the Infant Forms Checklist (I001). The ASQ screenings that are conducted with the non-billable infants are tracked on the ASQ-3 and ASQ: SE-2 Tracking for Multiples (MIHP 520) form.

  1. Are you saying the checklists are not required for non-billable multiples?

Yes, that’s what we are saying. The Forms Checklist is only completed for the infant whose Medicaid ID is used to bill blended visits.

  1. The Operations Guide says to put the ASQ tracker for multiples in the chart that you are NOT billing for, but Joni just stated to put it in the chart you are billing. Please clarify!

Thanks for bringing this to our attention. We will include clarification in the next coordinator email. The MIHP Operations Guide states (page 8.61):When you are serving multiples, you track ASQ-3 and ASQ: SE-2 screening dates on the Infant Forms Checklist for the infant whose Medicaid ID is used to bill blended visits. The ASQ-3 and ASQ: SE-2 Tracking for Multiples form is used to track screening dates for the other multiples in the family. File the Tracking for Multiples form in the chart of the infant whose Medicaid ID is not used to bill blended visits or in the family chart.However, please disregard this instruction and file the ASQ-3 and ASQ: SE-2 Tracking for Multiples form in the chart of the infant whose Medicaid ID is being used to bill blended visits.

  1. The unbillable blended PVPN is not to be used for a mom - baby combo. Correct?
  2. Is the non-billable PVPN used when we have a blended visit and are using infant’s MCD ID# and we cover a domain on the newly pregnant mom’s POC 2?
  3. F/u is the reverse of your example mom is billable and baby is new.

Use of the non-billable beneficiary PVPN is currently on pause. Document all activity that takes place at a blended visit on a single standard PVPN, as previously required.

  1. You mentioned not to chart the non-billed multiple on the POC or Discharge Summary. I thought we had to keep 2 POCs for each twin, we did an IRI for each one, so we had to do a Discharge Summary for both also. Wouldn’t we document the interventions on BOTH POCs and BOTH Discharge Summaries? Thank you.

The MIHP Operations Guide (pages 5.13 and 5.14) states:

In the case of multiple births, the following documents are to be completed separately for each infant:

1. Consent to Participate in Risk Identifier Interview/Participate in MIHP

2. Consent to Release Protected Health Information

3. Risk Identifier

4. Plan of Care

5. ASQ-3 and ASQ: SE-2 Information Summary Sheets

6. Discharge Summaries

Although Discharge Summaries are completed for all multiples, only the Discharge Summary for the infant whose Medicaid ID number is being used for billing purposes is completed in its entirety, and only the interventions provided for the infant being billed are reflected on this Discharge Summary. For the other multiples, do not document any interventions on the Discharge Summary.Please see Discharge Summary Forms Instructions at the MIHP website for details.

PVPNs

  1. Are we ever going to have the progress notes and POCs on the computer? Is there a timeline available?

We’ve had many competing priorities and our IT resources are limited. We do not have a timeline at this point.

  1. How can I obtain progress notes that my staff can type into, please?
  2. Please fix problems with the new forms. For example, when typing on the Communication Form, there are not available characters to complete an address. In addition, there are only enough characters on the bottom for a few sentences. Other forms also have issues. ALL continue to push information down on to a second unnecessary page.

You can download the form or if you have an EMR system, you can request an unprotected forms disc from MDHHS. However, please understand that certain fields are limited on purpose.

  1. Are there any abbreviations we can use in progress notes? My staff has a tendency to use things like FOB, BCP, L&D, and S&S.

It’s preferred that your staff use full words but industry standard abbreviations are acceptable: Dx, Tx, DOB, EDC, etc.It is recommended that you keep a master list of abbreviations so all staff are using them in the same way.

Billing

  1. No insurance pays for MIHP except Medicaid. When a patient has a primary insurance like BCBS and an HMO secondary. We cannot bill the primary and always put a rejection on and bill over to the Medicaid. There is no EOB. Is that acceptable for them?

Because Medicaid is the only insurer that covers MIHP, you are not required to bill other insurances. Go to MIHP Medicaid Health Plans Frequently Asked Questions (FAQ) and see questions B8 and BA8.

  1. Is MOMS ever going to cover post-partum MIHP visits?

This is not under discussion. At birth, the infant becomes eligible for MIHP and the dyad/family unit may continue to receive MIHP services.

Diabetes

  1. Is peanut butter considered a carb or a protein?

Peanut butter has a variable amount of carbs depending on the type purchased, so label reading is essential to knowing. Reduced fat peanut butter tends to be higher in carbs than regular peanut butter. Read the label.

  1. Are there income guidelines for Diabetes Self-Management Education (DMSE)?

There are no income guidelines for DMSE. Michigan Medicaid and most private and commercial insurances cover DMSE.

Transfers

  1. What about when a patient transfers? How do we discharge that patient from our program?

The transferring agency sends the required documents to the receiving agency and does not do a Discharge Summary. The receiving agency does the Discharge Summary when services are concluded.

  1. On occasion, when a client transfers, we need to do a paper discharge when an IT issue has not been resolved. How would we discharge them?

Paper Discharge Summaries are not acceptable. If you have problems with an electronic Discharge Summary, contact your consultant ASAP so she can tell the IT team about it.

Other

  1. Would like more guidance on how consultants would like communication to take place when it comes to infants who are enrolled and IRI do not pull risk factors or for infants over 18 months of age in order to complete services and document in chart. There are no forms on website but have seen the guidelines online. Please clarify. Thank you!

There are no forms for this purpose. If you would like to request permission to enroll a FFS beneficiary with no scored risks, or to enroll a FFS infant over the age of 12 months, or to continue to serve a FFS infant who reaches 18 months, contact your consultant to request prior approval. If your request is approved, the consultant will put it in writing. If the beneficiary is in an MHP, contact the MHP to request prior approval in these three instances. Each MHP will have its own process for requesting prior approval. If the MHP does not provide prior approval, contact your consultant with the specific details (names, dates, etc.).

  1. Cycle 6 audit requirements are 10% of charts and minimum of quarterly, yet presentation reflected no requirements. Please advise.

The MIHP Operations Guide (page 8.22) states: It is suggested that care coordination chart reviews are conducted on at least 10% of charts at least quarterly. It is a suggestion in Cycle 6, but may become a requirement in Cycle 7.

  1. Cycle 6 Cert Tool #29, monthly visits. #29g states: indicate that visits are conducted at least monthly unless there is documentation as to why this wasn’t done. Is it correct to assume that case planning in order to spread out visits based on client needs? For example, a baby who was seen by both professionals in the first two months and then the plan is to spread out the remaining visits over the 12 months of age. (Without other needs that would allow an order for extra visits. Also the same situation can occur with a pregnant woman).

Spreading out the visits over the anticipated length of service is an important consideration, although so much depends on the particular beneficiary’s circumstances. Just as we don’t want you to see beneficiaries every week as a standard practice, there may be rare circumstances under which weekly visits are indicated.In the situation you describe, you would simply need to document that the beneficiary wasn’t seen in a particular month because you are intentionally spreading out the allotted number of visits according to plan. The intent of requiring documentation that a beneficiary was or wasn’t seen in a given month is to prevent long gaps in service when the care coordinator (or other staff) does not look at the chart for several months and the agency does not have a systematic process for tracking the time between visits.

  1. How long are standing orders in place for how often do they need to be signed?

The standing order needs to be updated and signed annually.

  1. I’ve send a request to delete a record twice within 2 weeks and it has not been completed. How do we follow up?

Please contact your consultant.

  1. Regarding sign-in sheets for certificates. Groups who have sign-in sheets, how do we get individual certificates for all those attending?

The sign-in sheet takes the place of individual training certificates.

  1. Is WIC the only place we can get Coffective breastfeeding resources?

You can get free Coffective breastfeeding resources at the MIHP web siteor you may go toto access all of the resources available from Coffective.

  1. Will this webcast be archived and will the PPT slides be available?

Yes, at .

  1. GREAT JOB!!! THANK YOU!!!
  2. Thanks, Joni for doing a great job!

Thank you for the positive feedback.

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