08-10-15
Q & A
MIHP Regional Coordinator Meetings
March, 2015
Risk Identifiers
1. Pregnancy health does not score out if she did not have a problem getting into care once, even if she entered after 20 weeks. There is not always a barrier to getting in – sometimes she just didn’t want to. It should not be dependent on a specific reason – LPNC (late prenatal care) should be enough.
Internet Explorer (IE) 9 and IE 10 can cause problems with the algorithm and risk level scores. Use IE 8 or IE 11.
2. On the IRI under Family Support, there is no option under “who spends the most time with your baby” for a family member (grandparent, aunt, etc.) but it lists “neighbor.” Please add family/other with option to list specifically. Thank you.
We will make this change.
3. On the MRI there is no specific and separate question asking if mom is enrolled in WIC – it is embedded in a question asking about food assistance with the state and food pantries. If receiving one of the programs listed, mom will answer Yes, even if not receiving WIC, so “food” is not flagged as a risk on the Risk Scoring page. Are you currently enrolled in WIC should be a separate question and if “No” should show as a risk through SSO!
On the MRI, we are determining if she has food. You would document WIC enrollment on the Professional Visit Progress Note.
4. For Family Planning – low risk is being assigned for moms who say “I wanted to be pregnant now” and “No, I was not using birth control.”
5. Family Planning Algorithm: Intermittent – wants to be pregnant now – should not score out, but it does.
(This response applies to questions #4 through #5 above.) Correct. This is the current design of the tool; however, we are looking at ways to capture whether or not a pregnancy is planned.
6. Can we get an opportunity to add in missing Medicaid ID for not completed infant RIs behind the scenes?
This will be done behind the scenes by mid-May. See IT alert sent 03/25/15 which explains how this will be done.
7. Is there a way to cross-reference for maternal or infant RIs (i.e., can you get a flag that this mother was screened by another agency for their infant or maternal case)?
There is a way and we’re hoping we will be able to do this. Stay tuned.
8. When are we going to be able to download our RI data? This was supposed to happen at least 2 years ago. Not aggregate reports but the actual client-level data. We need it for our internal QA, program monitoring and reporting.
We continue to work on this. We have encountered multiple unforeseen IT barriers.
9. If a client doesn’t have a MCD RID number on IA, we have been checking CHAMPS 2x/day till they have a number before completing the RI in system – preventing algorithm and pulling POC 2s. If we complete it without a MCD ID, when we do the Discharge Summary, it won’t transfer or if we go back and try to put it in, we have to have the whole thing deleted and re-entered. What is the best way to handle this so we:
a. Can continue service
b. Stay within guidelines for timely entry
c. Reduce paperwork/time on re-entries
We understand that this is happening intermittently. Please provide your consultant with the details so she can investigate the situation. Keep documentation that you have notified your consultant so that your certification reviewer will know you had a valid reason for not entering the Discharge Summary.
10. Please consider allowing effective date in 2 weeks to allow staff training/roll- out.
When we make major changes to the forms, our typical process is to issue them 3 months prior to the effective date (the date when they must be used). It is our expectation that agencies will disseminate all state-provided training information to their staff well before the new forms become effective.
11. Maternal: High risk is only PICA.
Should be eating disorder
Category 1 & 2
Infant: High risk is only:
No age appropriate food for infant.
Cereal in bottle: does not (circle with slash) screen out for infants with reflux.
Neither maternal nor infant uses any criteria used by WIC to determine risk.
The algorithm scores out based on the literature around care coordination and incorporates WIC screening criteria where appropriate.
12. IRI question: How many children do you have? Does it include new baby?
13. The IRI that asks how many children you have – are you supposed to include the newborn?
(This response applies to questions #12 through #13 above.) The IRI asks: Are you a first-time parent? If No, how many sibling children are there? This is the total number of children in the household for whom the mother is responsible. It includes the infant beneficiary, full siblings, half siblings, step children and foster children. If the mother shares a home with other adults who have children, do not count the children of the other adults in the total if the mother isn’t responsible for the children.
14. Please consider allowing agencies to reactivate Risk Identifiers that are “complete.” Many times during our review process we identify errors (simple typos) that require us to have the entire RI deleted and then re-entered.
15. I’m wondering if MIHP coordinators can receive rights to delete or reactivate Risk Identifiers. It is difficult for staff to fax the correct form, wait for a reply, and then re-enter info. Also, it would help if corrections to RIs could be done immediately after submitting – sometimes we don’t know we entered incorrect DOB or middle initial until RI is printed. Coordinators could do this.
(This response applies to questions #14 through #15 above.) We have discussed it with IT and we are not able to permit this due to data integrity issues. Risk Identifiers may not be altered once they are complete in the SSO system. In order to correct errors after that point proceed as follows:
1) IRI - If it’s within 30 days of entry, you may delete the screen yourself and re-enter all of the data.
2) MRI and Discharge Summaries – you must submit a deletion request to the state. After it’s deleted, you may re-enter the data. (We have submitted a service request to allow the 30-day self-deletion window for the MRI.)
We suggest that you implement an internal QA process to correct errors before you “press the button.” For example, have another individual review the data you have entered or walk away from your computer and come back and look at your data entries again with fresh eyes.
16. Please add a box (or something) to the MRI to indicate when a risk screen is done but the client refuses ongoing MIHP services (RI only).
We are working on this.
17. Sometimes the RI pulls an inappropriate risk. Ex: Housing - if client answers she is homeless, but answers “yes” to “has regular nighttime, temporary housing”, it still pulls a high risk. However, the risk information matches moderate.
If you have an example of this, please contact your consultant with the details.
18. Please consider spacing out the MRI/IRI. It’s a little overwhelming and easy to miss questions with the material being so condensed. We would rather have more pages and have more room.
The majority of people in the field requested that we have fewer pages.
19. It would be nice if the MRI/IRI had lines to write on, rather than boxes. Our area doesn’t have the ability for wireless internet, so all our charting is done on paper.
We are not able to do this.
20. Please consider adding an option for Abuse/Violence on MRI/IRI that shows we were unable to ask/review due to having partner/other person present – can’t complete online and we want to start services with intention of asking ASAP when able to be alone with client.
If a woman does not answer these questions for any reason whatsoever (including that you did not ask them because her partner was present), she will score out as “unknown,” in which case you would implement the highest level of interventions. You may note the reason you did not ask the questions in the comments section.
21. Please consider reviewing questions that may or may not have “don’t know” as an option. For example, many parents are unsure when they’ll start solids or take child to the dentist but there’s no option for unsure, whereas there is a “don’t know” option for asking mom if she had a C-section/vaginal delivery or if baby stayed in hospital after delivery.
The Risk Identifier is an evidence-based maternal/infant health and psychosocial assessment. It is standardized in order to guide appropriate services based on a beneficiary’s needs and risks, no matter the location within the state, which contributes to the fidelity of the MIHP model. A question that does not have an “unknown” option provides additional information you may need in delivering care as well as an opportunity to provide education related to that question.
POC 2
1. POCs do not capture risk appropriate referral data. Referrals to RDs are likely being missed.
We capture information about RD referrals on the maternal nutrition and the infant feeding and nutrition POCs. WIC enrollment status is documented on every progress note – all WIC offices have RDs on staff. Referral to an RD is also captured on the progress note under “referrals” and “outcome of previous referrals.”
2. If an RD identifies a new risk during a visit, especially when it relates to nutrition (Diabetes, Food, Infant Feeding and Nutrition), it seems to be very confusing that the RD could not pull the appropriate POC 2 and document as a risk on the visit note and indicate the date intervention is achieved as she is likely going to address the concerns with interventions on that same date. If the POC 2 has to be pulled by the RN or SW, the RD may never see the client again to mark that the interventions she provided (at the visit she identified the risk) as being achieved.
RDs are not licensed in the State of Michigan and are therefore unable to perform the duties of care coordinator for MIHP.
3. Can staff list multiple dates on the POC2s when addressing interventions or should only the 1st date addressed/achieved be indicated?
You are required only to list the date the intervention was first implemented, but there is no prohibition against entering additional dates as well.
4. Confusion with boxes/no boxes with POC 2s risk information. When can we use professional judgment if SSO/RI does not identify a specific risk? When can we pull PO2s if not on Risk Scoring page?
If, and only if, the beneficiary’s risk information matches the criteria in Column 2, you can pull the POC 2 based on professional judgment. It does not matter if a particular criterion has a box in front of it or not. We will remove the boxes when we revise the POC 2s.
5. Many risks identified from the RIs are not matching the risk info listed on the POC 2s and sometimes not the algorithms. This is very confusing (sad face). Examples include Abuse/Violence, Family Support (CPS hx), Family Planning and Stress/Discipline.
POC 2s are not designed to include all of the items from the algorithm. Column 2 incorporates both risk information from the algorithm and characteristics you would identify by professional observation; it does not include every item from the algorithm or every observation you possibly could make as a professional. The only purpose of Column 2 is to assist you if you are considering adding a domain or changing the risk level for an existing domain based on professional judgment. If, and only if, the beneficiary’s risk information matches the criteria in Column 2, you can add a domain or change the risk level. We will remove the boxes from Column 2 when we revise the POC 2s.
6. Am I ok in dating the POC 2 at moderate risk for the same date as the RI? High box would be marked, but moderate would be marked and dated.
No, you cannot change the initial risk level on the same date that the RI was administered. You have to wait until the first professional visit to change the risk level based on professional judgment.
7. Do you note an intervention on the care plan that was done during the assessment visit?
Yes.
8. When noting dates and N/A on care plan, are both the date and initials and credentials needed?
No, initials and credentials are not needed when you document the date that an intervention was implemented on the POC 2. You are not required to write “NA” on the
POC 2, although you may choose to do so. Your signature and credentials are required on the POC 1 and the POC 2.
9. When noting N/A on care plans at discharge, do we do that on all domain levels (low, high) or just the level the patient was at?
You are not required to write N/A on POC 2s at all. You may leave it blank.
10. Infant and Maternal POC 2 – breastfeeding domain. Moderate level 6th bullet currently reads: Is experiencing a lack of support or discouragement to breastfeed her partner or family. Grammar correction?
Thank you for catching this.
11. If we are taking the dates of outcomes from Progress Notes, then why place dates on the POC 2?
This is because of numerous requests from the field.
12. POC Pregnancy Health: High will never score out for chronic medical condition, so need a box in front of risk information.