The Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS) provides health insurance coverage of up to Rs. 1 lakh annually for families earning less than Rs. 72,000 in Tamil Nadu. Over 1.57 crore families have benefited from the scheme so far, with 17.30 lakh beneficiaries receiving Rs. 3398.66 crore in insurance coverage for medical procedures between 2012-2017. High-end surgeries are covered up to Rs. 2 lakh through private hospitals participating in the program.
The document describes a shared care planning program in New Zealand that aims to improve health outcomes through integrated care, shared access to patient information, and the use of technology. The program provides a shared care record and communication tools to enable coordinated care across providers. Early results show increased communication and task coordination among care teams, as well as improved care plan development. Recommendations include establishing clear governance, understanding funding models, and taking an iterative approach to technology and workflow refinements.
Health and wellness center by Dr. Jitender, MD PGIMERYogesh Arora
Health and wellness center is one of the two component of Ayushmann Bharat. HWC ensures comprehensive, quality, and affordable care to be achieved by all.
This document discusses pathways to strengthening integrated health systems with a focus on palliative care. It outlines current health system challenges including multiple disease burdens, health inequalities, and weak infrastructure. The document proposes principles of participation, preparedness, and partnerships to guide health system strengthening efforts. It also summarizes work done in several countries to advocate for palliative care, strengthen staff capacity through training, and improve palliative care service delivery through integration into national health systems and strategies. Key achievements include inclusion of palliative care in national plans and budgets, training of over 600 health professionals, and improved access to palliative medications.
Office-Based Opioid Treatment: What You Need to Know: Trends in Behavioral He...Epstein Becker Green
Presented by David Shillcutt (Associate, Epstein Becker Green) and Kristina Sherry (Attorney, Nelson Hardiman) on April 4, 2019.
Office-based opioid treatment providers are on the front lines of the response to the opioid epidemic, but recent developments in federal and state legislation have significant implications for provider business models and service delivery strategies.
This webinar will examine provider capacity issues for medication assisted treatment, the opportunities and challenges of telemedicine for addiction services, and the expansion of innovative service delivery networks including the “Hub and Spoke” system and related models.
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/office-based-opioid-treatment-what-you-need-to-know-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
The document summarizes the organization of health care delivery in the United States at the federal, state, and local levels. At the federal level, health care is overseen by the Department of Health and Human Services (HHS) which contains 11 operating divisions that focus on various health issues. States each operate their own health care departments and access services locally through private practices, clinics, and hospitals. The overall goal is to ensure all Americans have access to health care.
The Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS) provides health insurance coverage of up to Rs. 1 lakh annually for families earning less than Rs. 72,000 in Tamil Nadu. Over 1.57 crore families have benefited from the scheme so far, with 17.30 lakh beneficiaries receiving Rs. 3398.66 crore in insurance coverage for medical procedures between 2012-2017. High-end surgeries are covered up to Rs. 2 lakh through private hospitals participating in the program.
The document describes a shared care planning program in New Zealand that aims to improve health outcomes through integrated care, shared access to patient information, and the use of technology. The program provides a shared care record and communication tools to enable coordinated care across providers. Early results show increased communication and task coordination among care teams, as well as improved care plan development. Recommendations include establishing clear governance, understanding funding models, and taking an iterative approach to technology and workflow refinements.
Health and wellness center by Dr. Jitender, MD PGIMERYogesh Arora
Health and wellness center is one of the two component of Ayushmann Bharat. HWC ensures comprehensive, quality, and affordable care to be achieved by all.
This document discusses pathways to strengthening integrated health systems with a focus on palliative care. It outlines current health system challenges including multiple disease burdens, health inequalities, and weak infrastructure. The document proposes principles of participation, preparedness, and partnerships to guide health system strengthening efforts. It also summarizes work done in several countries to advocate for palliative care, strengthen staff capacity through training, and improve palliative care service delivery through integration into national health systems and strategies. Key achievements include inclusion of palliative care in national plans and budgets, training of over 600 health professionals, and improved access to palliative medications.
Office-Based Opioid Treatment: What You Need to Know: Trends in Behavioral He...Epstein Becker Green
Presented by David Shillcutt (Associate, Epstein Becker Green) and Kristina Sherry (Attorney, Nelson Hardiman) on April 4, 2019.
Office-based opioid treatment providers are on the front lines of the response to the opioid epidemic, but recent developments in federal and state legislation have significant implications for provider business models and service delivery strategies.
This webinar will examine provider capacity issues for medication assisted treatment, the opportunities and challenges of telemedicine for addiction services, and the expansion of innovative service delivery networks including the “Hub and Spoke” system and related models.
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/office-based-opioid-treatment-what-you-need-to-know-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
The document summarizes the organization of health care delivery in the United States at the federal, state, and local levels. At the federal level, health care is overseen by the Department of Health and Human Services (HHS) which contains 11 operating divisions that focus on various health issues. States each operate their own health care departments and access services locally through private practices, clinics, and hospitals. The overall goal is to ensure all Americans have access to health care.
Ayushman Bharat is India's flagship public health insurance scheme launched by the government. It has two major components - Health and Wellness Centers and Pradhan Mantri Jan Arogya Yojana (PM-JAY). PM-JAY provides health insurance coverage of Rs. 500,000 per family per year for secondary and tertiary care hospitalization to over 100 million poor and vulnerable families. It covers pre-existing diseases, hospitalization costs, and post-hospitalization expenses. States implement PM-JAY through either an assurance model run directly by the state or an insurance model where an insurer manages the scheme. Hospitals empanelled under PM-JAY provide cashless services to beneficiaries
The document discusses emerging thinking on the long term design of the UK's national payment system for mental health services. It aims to support improved patient outcomes, efficient use of resources, and appropriate allocation of risk. The payment system should incentivize integrated care, especially for those with long term conditions or multiple needs. Several regulatory levers are proposed to guide behavior change, including improving data quality, introducing different payment approaches for different types of care, and allowing local innovation. Next steps include publishing a long term strategy and supporting documents on specific areas like enabling long term condition coordination and mental health.
The document discusses guidelines for diagnosing and classifying diabetes from the Standards of Medical Care in Diabetes - 2018. It covers:
1. Classifying diabetes into type 1, type 2, gestational diabetes, and other specific types.
2. Diagnostic tests for diabetes including hemoglobin A1c (A1c), fasting plasma glucose, and oral glucose tolerance tests.
3. Categories of increased risk for diabetes (prediabetes) defined as A1c of 5.7-6.4%, fasting plasma glucose of 100-125 mg/dL, or 2-hour plasma glucose of 140-199 mg/dL during an oral glucose tolerance test.
This document discusses health information systems. It notes that health information is integral to national health systems and is a basic management tool. A health information system involves collecting, processing, analyzing and transmitting health data to organize services, conduct research, and train medical professionals. The goals of such a system are to provide relevant data to health managers at all levels to assist in planning and evaluating performance. Components of an information system include demographics, health resources, service utilization statistics, and financial data. Surveillance is also discussed as an important part of monitoring health status and making decisions about service delivery.
This document outlines the Duterte administration's health agenda to achieve universal health coverage in the Philippines. The key goals are to:
1) Establish functional service delivery networks to ensure access to quality health services.
2) Attain and sustain universal health insurance to protect Filipinos from health-related financial risks.
3) Protect Filipinos from the triple burden of disease through guaranteed health services and community interventions.
Dr Aillen Keel CBE (Deputy CMO)'s keynote speech 'Better Health After Cancer,' at the SCPN's 'Be Active Against Cancer Conference,' Tuesday 4th February 2014.
This document summarizes key points of a new 5-year GP contract framework agreement in the UK. It covers addressing workforce shortages through recruitment and retention programs, solving indemnity costs by establishing a new clinical negligence scheme, improving quality measures, establishing primary care networks to integrate services, investing in digital technologies, and guaranteeing funding stability over 5 years. The agreement aims to improve health outcomes, care quality for patients with multiple conditions, and long-term sustainability of the NHS.
Community diagnosis is defined as determining the pattern of health problems in a community and the factors influencing this pattern. It involves comprehensively assessing the community's social, political, economic, physical and biological environment. The purposes of community diagnosis include identifying health problems and those at risk, determining community needs, and developing strategies for community involvement. It involves collecting both measurable health data like disease prevalence and age distribution as well as soft factors like customs and beliefs. The process involves defining the community, identifying needs, prioritizing health issues, assessing resources, and setting priorities for action.
Department of Health Program Directions and Priorities Towards MDGs 4 and 5Michelle Avelino
The document outlines the Department of Health's (DOH) current efforts, status, and directions regarding achieving Millennium Development Goals 4 and 5 in the Philippines. It discusses programs established to improve maternal and child health, including emergency obstetric care facilities, integrated service packages, training programs, and monitoring systems. It notes accomplishments, ongoing challenges, and a proposed approach to scaling up family planning and maternal, newborn and child health programs through collaboration with partners.
This document discusses managed care plans and integrated delivery systems. It defines managed care and explains the origins and characteristics of managed care plans, including their use of tools like primary care physicians, guidelines, utilization review, and financial incentives to manage costs and quality. The document also describes different types of managed care plans along a continuum and their use in government programs. Finally, it defines integrated delivery systems and types of system integration and consolidation in healthcare.
The document discusses the roles and functions of subcentres and primary health centres in India's public health system. Subcentres are the most peripheral unit and aim to provide basic primary healthcare services to populations of 3,000-5,000 through a female health worker and male multipurpose worker. Primary health centres serve larger populations of 20,000-30,000 and provide outpatient and inpatient services through medical officers and staff. Both play key roles in maternal and child health, family planning, immunization, disease control programs and acting as first referrals in rural areas. The document outlines the comprehensive services expected at each level according to Indian public health standards.
This document discusses legal and ethical ways for dentists in India to market their dental practices. It begins by providing context on the controversy around healthcare professionals advertising in India. It then outlines specific ethical and unethical marketing acts according to regulations. Unethical acts include false promises, demeaning solicitation, and misleading advertisements. Acceptable marketing includes formal announcements of new practices or services without exaggerated claims. The document concludes by noting debate around the necessity of advertising for dental practices to compete and attract patients.
Human Genomics and Public Health in a Global World: Challenges for Low & Midd...Human Variome Project
This document discusses challenges for low and middle income countries regarding human genomics and public health in a global context. It notes that while genomics activity is increasing in about 50 countries, it remains fragmented without systematic monitoring or links to health policymakers. Five priorities for international genomics are identified: building an evidence base for genomic medicine, addressing health disparities, managing diverse patient populations, implications for medical education, and coordination across diseases. The document argues for greater global collaboration to improve access, establish standards, and promote equity and justice.
The document discusses Catalonia's transition from a chronic care program to an integrated health and social care model. It describes Catalonia's healthcare system and the aging population it serves. It outlines strategic projects from the 2011-2015 Health Plan including developing integrated care pathways and classifying complex chronic patients. The chronic care program aims to identify these complex patients and develop shared intervention plans incorporating health and social needs. Risk stratification tools are used to segment the population and identify those at high risk of hospitalization. [/SUMMARY]
This presentation was presented online by Dr.Vinothini as a part of PG Seminar Presentation and the full video presentation can be found in official YouTube channel of IAPSM eConnect
Link for the video: https://www.youtube.com/watch?v=eqR1J9jjCgs
This document provides an overview of Ayushman Bharat, India's national health protection scheme. It discusses the rationale for the scheme due to issues with access to healthcare and rising costs pushing families into poverty. The key components of Ayushman Bharat are the creation of 150,000 Health and Wellness Centers to deliver comprehensive primary healthcare and the Pradhan Mantri Jan Arogya Yojana, which provides health insurance coverage to poor families. The document outlines the initiatives, organization of primary healthcare services, and key features of Ayushman Bharat.
The National Mental Health Program (NMHP) was launched in India in 1982 to address the high burden of mental illness and lack of infrastructure to support mental healthcare. The NMHP aimed to prevent mental illness, promote recovery, reduce stigma, and ensure socioeconomic inclusion of those with mental illness. It emphasized integrating mental healthcare into primary healthcare using a community-based approach. The NMHP established treatment programs at village, primary health center, and district hospital levels using a multidisciplinary team including a psychiatrist, nurse, social worker and therapist. The program focused more on treatment than prevention and did not adequately address the role of family support. It outlined short-term over long-term goals and lacked a clear administrative structure.
The document discusses various aspects of health policy in the Philippines, including its history, goals, and strategies. It outlines the country's epidemiological transition over time from communicable to non-communicable diseases. It also summarizes the government's plans to achieve universal health care through expanding PhilHealth coverage, improving health facilities, deploying more health workers, and ensuring financial protection for citizens' health needs. The ultimate goals are to achieve public health targets while providing accessible, quality care and minimizing out-of-pocket costs.
Michigan's plan integrates Medicare and Medicaid financing and services for people eligible for both programs. It transitions coverage from fee-for-service to managed care through Integrated Care Organizations and Prepaid Inpatient Health Plans. The goals are more coordinated, higher quality care at lower cost. People will be enrolled in phases by region and needs starting in 2013. Community health centers expect their roles serving dual eligibles to continue and require maintaining Medicaid policies supporting safety net providers.
The Accountable Health Communities Model team hosted a webinar to provide an overview of the new funding opportunity and application requirements for Track 1 on Wednesday, September 14, 2016 from 2:00p.m. – 3:00p.m. EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Ayushman Bharat is India's flagship public health insurance scheme launched by the government. It has two major components - Health and Wellness Centers and Pradhan Mantri Jan Arogya Yojana (PM-JAY). PM-JAY provides health insurance coverage of Rs. 500,000 per family per year for secondary and tertiary care hospitalization to over 100 million poor and vulnerable families. It covers pre-existing diseases, hospitalization costs, and post-hospitalization expenses. States implement PM-JAY through either an assurance model run directly by the state or an insurance model where an insurer manages the scheme. Hospitals empanelled under PM-JAY provide cashless services to beneficiaries
The document discusses emerging thinking on the long term design of the UK's national payment system for mental health services. It aims to support improved patient outcomes, efficient use of resources, and appropriate allocation of risk. The payment system should incentivize integrated care, especially for those with long term conditions or multiple needs. Several regulatory levers are proposed to guide behavior change, including improving data quality, introducing different payment approaches for different types of care, and allowing local innovation. Next steps include publishing a long term strategy and supporting documents on specific areas like enabling long term condition coordination and mental health.
The document discusses guidelines for diagnosing and classifying diabetes from the Standards of Medical Care in Diabetes - 2018. It covers:
1. Classifying diabetes into type 1, type 2, gestational diabetes, and other specific types.
2. Diagnostic tests for diabetes including hemoglobin A1c (A1c), fasting plasma glucose, and oral glucose tolerance tests.
3. Categories of increased risk for diabetes (prediabetes) defined as A1c of 5.7-6.4%, fasting plasma glucose of 100-125 mg/dL, or 2-hour plasma glucose of 140-199 mg/dL during an oral glucose tolerance test.
This document discusses health information systems. It notes that health information is integral to national health systems and is a basic management tool. A health information system involves collecting, processing, analyzing and transmitting health data to organize services, conduct research, and train medical professionals. The goals of such a system are to provide relevant data to health managers at all levels to assist in planning and evaluating performance. Components of an information system include demographics, health resources, service utilization statistics, and financial data. Surveillance is also discussed as an important part of monitoring health status and making decisions about service delivery.
This document outlines the Duterte administration's health agenda to achieve universal health coverage in the Philippines. The key goals are to:
1) Establish functional service delivery networks to ensure access to quality health services.
2) Attain and sustain universal health insurance to protect Filipinos from health-related financial risks.
3) Protect Filipinos from the triple burden of disease through guaranteed health services and community interventions.
Dr Aillen Keel CBE (Deputy CMO)'s keynote speech 'Better Health After Cancer,' at the SCPN's 'Be Active Against Cancer Conference,' Tuesday 4th February 2014.
This document summarizes key points of a new 5-year GP contract framework agreement in the UK. It covers addressing workforce shortages through recruitment and retention programs, solving indemnity costs by establishing a new clinical negligence scheme, improving quality measures, establishing primary care networks to integrate services, investing in digital technologies, and guaranteeing funding stability over 5 years. The agreement aims to improve health outcomes, care quality for patients with multiple conditions, and long-term sustainability of the NHS.
Community diagnosis is defined as determining the pattern of health problems in a community and the factors influencing this pattern. It involves comprehensively assessing the community's social, political, economic, physical and biological environment. The purposes of community diagnosis include identifying health problems and those at risk, determining community needs, and developing strategies for community involvement. It involves collecting both measurable health data like disease prevalence and age distribution as well as soft factors like customs and beliefs. The process involves defining the community, identifying needs, prioritizing health issues, assessing resources, and setting priorities for action.
Department of Health Program Directions and Priorities Towards MDGs 4 and 5Michelle Avelino
The document outlines the Department of Health's (DOH) current efforts, status, and directions regarding achieving Millennium Development Goals 4 and 5 in the Philippines. It discusses programs established to improve maternal and child health, including emergency obstetric care facilities, integrated service packages, training programs, and monitoring systems. It notes accomplishments, ongoing challenges, and a proposed approach to scaling up family planning and maternal, newborn and child health programs through collaboration with partners.
This document discusses managed care plans and integrated delivery systems. It defines managed care and explains the origins and characteristics of managed care plans, including their use of tools like primary care physicians, guidelines, utilization review, and financial incentives to manage costs and quality. The document also describes different types of managed care plans along a continuum and their use in government programs. Finally, it defines integrated delivery systems and types of system integration and consolidation in healthcare.
The document discusses the roles and functions of subcentres and primary health centres in India's public health system. Subcentres are the most peripheral unit and aim to provide basic primary healthcare services to populations of 3,000-5,000 through a female health worker and male multipurpose worker. Primary health centres serve larger populations of 20,000-30,000 and provide outpatient and inpatient services through medical officers and staff. Both play key roles in maternal and child health, family planning, immunization, disease control programs and acting as first referrals in rural areas. The document outlines the comprehensive services expected at each level according to Indian public health standards.
This document discusses legal and ethical ways for dentists in India to market their dental practices. It begins by providing context on the controversy around healthcare professionals advertising in India. It then outlines specific ethical and unethical marketing acts according to regulations. Unethical acts include false promises, demeaning solicitation, and misleading advertisements. Acceptable marketing includes formal announcements of new practices or services without exaggerated claims. The document concludes by noting debate around the necessity of advertising for dental practices to compete and attract patients.
Human Genomics and Public Health in a Global World: Challenges for Low & Midd...Human Variome Project
This document discusses challenges for low and middle income countries regarding human genomics and public health in a global context. It notes that while genomics activity is increasing in about 50 countries, it remains fragmented without systematic monitoring or links to health policymakers. Five priorities for international genomics are identified: building an evidence base for genomic medicine, addressing health disparities, managing diverse patient populations, implications for medical education, and coordination across diseases. The document argues for greater global collaboration to improve access, establish standards, and promote equity and justice.
The document discusses Catalonia's transition from a chronic care program to an integrated health and social care model. It describes Catalonia's healthcare system and the aging population it serves. It outlines strategic projects from the 2011-2015 Health Plan including developing integrated care pathways and classifying complex chronic patients. The chronic care program aims to identify these complex patients and develop shared intervention plans incorporating health and social needs. Risk stratification tools are used to segment the population and identify those at high risk of hospitalization. [/SUMMARY]
This presentation was presented online by Dr.Vinothini as a part of PG Seminar Presentation and the full video presentation can be found in official YouTube channel of IAPSM eConnect
Link for the video: https://www.youtube.com/watch?v=eqR1J9jjCgs
This document provides an overview of Ayushman Bharat, India's national health protection scheme. It discusses the rationale for the scheme due to issues with access to healthcare and rising costs pushing families into poverty. The key components of Ayushman Bharat are the creation of 150,000 Health and Wellness Centers to deliver comprehensive primary healthcare and the Pradhan Mantri Jan Arogya Yojana, which provides health insurance coverage to poor families. The document outlines the initiatives, organization of primary healthcare services, and key features of Ayushman Bharat.
The National Mental Health Program (NMHP) was launched in India in 1982 to address the high burden of mental illness and lack of infrastructure to support mental healthcare. The NMHP aimed to prevent mental illness, promote recovery, reduce stigma, and ensure socioeconomic inclusion of those with mental illness. It emphasized integrating mental healthcare into primary healthcare using a community-based approach. The NMHP established treatment programs at village, primary health center, and district hospital levels using a multidisciplinary team including a psychiatrist, nurse, social worker and therapist. The program focused more on treatment than prevention and did not adequately address the role of family support. It outlined short-term over long-term goals and lacked a clear administrative structure.
The document discusses various aspects of health policy in the Philippines, including its history, goals, and strategies. It outlines the country's epidemiological transition over time from communicable to non-communicable diseases. It also summarizes the government's plans to achieve universal health care through expanding PhilHealth coverage, improving health facilities, deploying more health workers, and ensuring financial protection for citizens' health needs. The ultimate goals are to achieve public health targets while providing accessible, quality care and minimizing out-of-pocket costs.
Michigan's plan integrates Medicare and Medicaid financing and services for people eligible for both programs. It transitions coverage from fee-for-service to managed care through Integrated Care Organizations and Prepaid Inpatient Health Plans. The goals are more coordinated, higher quality care at lower cost. People will be enrolled in phases by region and needs starting in 2013. Community health centers expect their roles serving dual eligibles to continue and require maintaining Medicaid policies supporting safety net providers.
The Accountable Health Communities Model team hosted a webinar to provide an overview of the new funding opportunity and application requirements for Track 1 on Wednesday, September 14, 2016 from 2:00p.m. – 3:00p.m. EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
While at Good Shepherd Fairview Home my final project for my internship was to make a presentation to give to leadership about the Medicaid Redesign in New York State. I did research about Governor Cuomo and the Medicaid redesign team that he instated to redesign New York’s Medicaid program in January 2011 to ensure that it was sustainable. The main goal of the presentation was to inform the staff about how things will change when managed care organizations will be present.
Supercharge Crisis Services - Gabriella Guerra (Natcon15)David Covington
As health care continues to focus on accountability for improved clinical outcomes, usage of lower cost services, improved public safety and a demand for positive client experiences, the importance of crisis services grows. With increasing attention to the value of crisis services, how do we support excellence? Financing, collaborative partnerships, standard operating procedures, current research, use of data and innovative technology are cornerstones of effective intervention delivery for hotlines, mobile teams and crisis stabilization. Come take an in-depth look into the tools and solutions available to quickly build the clinical, administration and financial supports to keep track with the new national focus.
Well Care Health Plans, Inc.
Presentation to Georgia House Children's Mental Health Study Committee
October 20, 2015
Dauda Griffin, MD
Behavioral Health Medical Director
Remedios Roderiguez, Senior Director
Behavioral Health Operations
Carisa Magee, Manager, Medicaid/CHIP Program Policy Texas Health and Human Services Commission, presented an overview of Medicaid at the "Designing Healthcare in Texas" conference hosted by One Voice Texas, Harris County Healthcare Alliance and Kinder Institute on June 3, 2014.
The first in a series of Accountable Health Communities Model webinars was held on Thursday, January 21, 2016 from 2:00 – 3:30pm EST. The webinar focused on an overview of the model and application requirements. A repeat of the webinar covering the same topic was held Wednesday, January 27, 2016 from 3:00– 4:30pm EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Thursday, January 30, 2020 to provide information and answer questions about the hospice benefit component recently added to the Value Based Insurance Design (VBID) Model. The Centers for Medicare & Medicaid Services announced in January 2019 that beginning in calendar year 2021, the VBID Model will test including the Medicare hospice benefit in Medicare Advantage.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document discusses building community health worker programs. It begins with objectives to describe the value of CHWs to healthcare executives and boards, how to integrate a CHW program cost-effectively, and tools for implementation. It then discusses the history and role of CHWs, how their interventions can produce cost savings, and strategies for formulating the CHW role within an organization. The document outlines considerations for implementation including stakeholder engagement and best practices. It presents two case studies of CHW programs at Wooster Community Hospital and Parkview Health.
Health insurance in the US has evolved from primarily covering catastrophic illness to also covering preventative care and services. There are various types of health insurance plans including HMOs, PPOs, and consumer-driven plans. Government plans like Medicare and Medicaid provide coverage for specific groups. Providers must verify a patient's insurance coverage and submit claims according to the insurer's requirements to receive reimbursement.
This document discusses strategies for hospital partnerships and care coordination. It describes approaches to more effectively serve populations outside hospitals, including bringing together treatment providers, community groups, and others. One model mentioned is Health Enterprise Zones (HEZs). The document outlines characteristics of today's healthcare system and drivers transforming it, including new models of coordinated and population-based care. It provides examples of partnerships and programs at Carroll Hospital and Access Carroll, a community health center, to integrate services and coordinate care for low-income populations.
The document provides an overview of government-funded health insurance programs in the United States, including Medicare, Medicaid, CHIP, and Workers' Compensation. It describes how Medicare has different parts that cover various services, and how eligibility and coverage can differ between Medicaid programs in different states. The document also discusses fraud and abuse issues across government health programs, and how agencies work to address these challenges through education and legislation.
The Medicare Care Choices Model aims to expand access to concurrent palliative and curative care for Medicare beneficiaries with serious illnesses. It will test allowing participating hospices to provide supplemental palliative care services to eligible beneficiaries, while receiving curative treatment, in return for a $400 per beneficiary per month fee. Hospices must be Medicare-certified and able to coordinate care. Eligible beneficiaries have advanced cancers, lung disease, heart failure or HIV/AIDS. The model seeks to improve pain and symptom management through 24/7 access to hospice professionals and care coordination over three years. CMS implementation contractors will provide technical support to participating hospices.
CMS hosted an open door forum (ODF) call on Wednesday, April 16, 2014 to allow providers, beneficiary advocacy groups, and other interested parties to learn more about the Medicare Care Choices Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The documents discuss changes in the US healthcare system focusing on quality improvement initiatives. It summarizes frameworks from the Institute for Clinical Systems Improvement (ICSI) and Regional Health Improvement Collaboratives (RHIC) that provide guidelines and coordinate multi-stakeholder efforts to reform payment systems, improve care delivery, and increase community health. It also describes the Quality Alliance Steering Committee's (QASC) work measuring healthcare quality nationally through organizations like MN Community Measurement. The overall goal is to shift focus from sickness to prevention by increasing access to high-quality, coordinated care.
This SMMC provider webinar talks about the implications for recipients who are eligible for both the Long-term Care and Managed Medical Assistance programs.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
2. Today’s Agenda
• MI Health Link Overview
• Eligibility Criteria
• Benefits of MI Health Link
• Covered Services
• Enrollee Protections
• What to Consider
• Enrollment and Beyond
4. MI Health Link
A new program that joins Medicare
and Medicaid benefits, rules and
payments into one coordinated
delivery system called MI Health Link
4
5. MI Health Link
• Three year program beginning no earlier than
March 1, 2015
• Three-way contract between Center for Medicare
and Medicaid Services (CMS), Michigan
Department of Community Health (MDCH) and MI
Health Link health plan
– The health plan contracts with Pre-paid Inpatient Health
Plan (PIHP) to deliver behavioral health services
• Provided in four regions in the state
6. Four Regions
• Region 1 - Entire Upper Peninsula
• Region 4 - Southwest Michigan (Barry, Berrien,
Branch, Calhoun, Cass, Kalamazoo, St. Joseph
and Van Buren counties)
• Region 7 - Wayne County
• Region 9 - Macomb County
6
7. Region 1 – Upper Peninsula
7
• MI Health Link health plan
– Upper Peninsula Health Plan
• Pre-Paid Inpatient Health Plan
– NorthCare Network
8. Region 4 – Southwest Michigan
8
• MI Health Link health plan options
– Aetna Better Health of Michigan
– Meridian Health Plan
• Pre-Paid Inpatient Health Plan
– Southwest Michigan Behavioral Health
9. Region 7 – Wayne County
9
• MI Health Link health plan options
– Aetna Better Health of Michigan
– AmeriHealth
– Fidelis SecureCare
– HAP Midwest Health Plan
– Molina Healthcare
• Pre-Paid Inpatient Health Plan
– Detroit-Wayne Mental Health Authority
10. Region 9 - Macomb County
10
• MI Health Link health plan options
– Aetna Better Health of Michigan
– AmeriHealth
– Fidelis SecureCare
– HAP Midwest Health Plan
– Molina Healthcare
• Pre-Paid Inpatient Health Plan
– Macomb PIHP
12. Eligibility Criteria
People may be eligible for MI Health Link if
they:
• Live in one of the four regions
• Are age 21 or over (CSHCS exluded)
• Are eligible for full benefits under both
Medicare and Medicaid and
• Are not enrolled in hospice
12
13. Eligibility Criteria
• People enrolled in PACE and MI Choice are
eligible, but must leave their programs before
joining MI Health Link
• People with a deductible are not eligible for
MI Health Link
• People in a nursing home are eligible and
must continue to pay their patient pay
amount to the nursing home
13
15. Benefits of MI Health Link
• No co-payments or deductibles for in-
network services, including medications
– Note that nursing home Patient Pay Amounts
will still apply
• One health plan to manage all Medicare
and Medicaid covered services
• One card to access all services
15
16. Benefits of MI Health Link
• Person-centered care with a focus on
supports for community living, not just
doctor-driven medicine
• Access to a 24/7 Nurse Advice Line to
answer questions
16
17. Benefits of MI Health Link
• Each enrollee will have a care coordinator
who will
–work with the enrollee to create a personal
care plan based on the enrollee’s goals
–answer questions and make sure that the
enrollee’s health care issues get the attention
they deserve
–connect the enrollee to supports and services
needed to be healthy and live where they
want
17
18. Benefits of MI Health Link
• Each enrollee will have access to an
Integrated Care Team that will
–include the enrollee’s doctors, providers,
and anyone else the enrollee would like to
include
–work with the enrollee to identify their
goals and preferences for care and services
18
20. Covered Services
• All health care covered by Medicare and
Medicaid
–Medications
–Dental and vision services
–Equipment and medical supplies
–Physicians and specialists
–Emergency and urgent care
20
21. Covered Services
• All health care covered by Medicare and
Medicaid (cont.)
–Hospital stays and surgeries
–Diagnostic testing and lab services
–Nursing home services
–Home health services
–Transportation for medical emergencies and
medical appointments
21
22. Covered Services
• Long Term Supports and Services (LTSS)
–Personal care
–Equipment to help with activities of daily
living
–Chore services
–Home modifications
–Adult day program
–Private duty nursing
22
23. Covered Services
• Long Term Supports and Services (LTSS) (cont.)
–Preventive nursing services
–Respite
–Home delivered meals
–Community transition services
–Fiscal intermediary services
–Personal emergency response system
–Nursing home care
23
24. Covered Services
• Behavioral Health Services
–Behavioral health services are those that
are provided to individuals who have a
mental illness, intellectual/developmental
disability or substance use disorder.
24
25. Covered Services
• Behavioral Health Services (cont.)
–Behavioral Health services are accessed
through the Health plan, PIHP or local
Community Mental Health Service Provider
(CMHSP)
–If currently receiving services through the
CMHSP, services will not change or be
interrupted
25
26. Covered Services
Behavioral health services are medically
necessary services. Examples of behavioral health
services may include:
–Individual, group and/or family therapy
–Medication review
–Supported employment
–Community living supports (meal preparation,
laundry, chores, food shopping)
–Substance abuse treatment services
(assessment, treatment planning, stage-based
interventions, referral and placement)
26
27. Covered Services
• Additional services offered by the plan
–Health plans can offer services not covered
by Medicare and Medicaid
–Plans can enhance Medicaid and Medicare
services
• May cover supplies or services more often
• May cover a higher dollar amount when there
is a dollar limit on a service
–Check Plan finder for enhanced services
27
29. Enrollee Protections
• MI Health Link follows the current
grievance and appeal processes for
Medicare and Medicaid services
• Enrollees will be offered appropriate
appeals rights and directed through the
notice letters which entity they should
contact if they wish to appeal an action
30
30. Enrollee Protections
• A MI Health Link Ombudsman Program will be
available to help enrollees resolve problems
and answer questions
• Health plans must offer a choice of providers
and care coordinators
• Health plans must honor the continuity of
care requirements
31
31. Enrollee Protections
• Each MI Health Link health plan is
required to have a separate Advisory
Council specific to the program
–1/3 of the Advisory Council must be
enrollees
–The majority of members must be
enrollees, family members of enrollees and
advocates
32
32. Enrollee Protections
• The State will form a MI Health Link Advisory
Committee for enrollees, allies, and advocates
to give input and suggestions to help improve
MI Health Link
– Organized by MDCH
– Provides a way for enrollees and stakeholders to
offer suggestions and feedback
– Membership will represent the diverse interests of
stakeholders, especially enrollees
33
33. Enrollee Protections
• Application forms for the MDCH Advisory
Committee can be found here:
http://www.Michigan.gov/MIHealthLink
– Call 517-241-4293 if you need the form mailed to you
• A completed application form is required for
consideration; a letter of reference is optional
• Completed applications can be sent to MDCH by
email, fax or regular mail
– Email: IntegratedCare@michigan.gov
34
34. Enrollee Protections
Continuity of Care
The health plan must
• Allow enrollees to continue to see current doctors and
providers during the transition period
• Pay out-of-network doctors and providers during the
transition period at no cost to the enrollee
• Allow choice of personal care service providers
including paying family members or friends to provide
the service
• Work to bring providers into the health plan’s network
• Cover current medications 35
35. The health plan must
• Honor current authorizations for services
– These could be reported to the plan by the
enrollee
– Personal Care authorization information is
provided to the plan by MDCH
36
Enrollee Protections
Continuity of Care
36. • Those who want to join MI Health Link and are
already in nursing homes are not required to
move to a different nursing home in the
health plan’s network
• The health plan must enter into single-case
agreements for enrollees currently residing in
out-of-network nursing homes
37
Enrollee Protections
Continuity of Care
37. • Enrollees have the right to live in an out-of-
network nursing home for the life of the
program if the enrollee:
– Resides in the nursing home at the time of
enrollment;
– Has a family member or spouse that resides in the
nursing home; or
– Requires nursing home care and resides in a
retirement community that includes a nursing
home.
38
Enrollee Protections
Continuity of Care
38. • Timeframes
– Scheduled Surgeries
• The health plan must honor specified provider
and prior authorizations for surgeries scheduled
within one hundred eighty (180) calendar days of
enrollment
– Dialysis
• The health plan must maintain current level of
service and same provider at the time of
enrollment for one hundred eighty (180) calendar
days
39
Enrollee Protections
Continuity of Care
39. • Timeframes
– Chemotherapy and Radiation
• Treatment initiated prior to enrollment must be
authorized by the plan through the course of
treatment with the specified provider
– Organ, Bone Marrow, Hematopoietic Stem Cell
Transplant
• The health plan must honor specified provider,
prior authorizations and plans of care
40
Enrollee Protections
Continuity of Care
40. • Timeframes
–Durable Medical Equipment
• The plan must honor prior authorizations
when the item has not been delivered and
must review ongoing prior authorizations
for medical necessity
–Dental and Vision
• The health plan must honor prior
authorization when an item has not been
delivered
41
Enrollee Protections
Continuity of Care
41. • Timeframes
–Home Health, Personal Care and
Physician/Practitioners
• For people receiving services from the PIHP
specialty services and supports program or
HAB supports waiver, the health plan must
maintain current provider and level of
services at the time of enrollment for one
hundred eighty (180) calendar days
42
Enrollee Protections
Continuity of Care
42. • Timeframes
–Home Health, Personal Care and
Physician/Practitioners
• For all other enrollees, the health plan
must maintain current provider and level
of services at the time of enrollment for
ninety (90) calendar days
43
Enrollee Protections
Continuity of Care
43. • Timeframes
– MI Choice (HCBS) Waiver services
• For enrollees previously participating in
the MI Choice HCBS waiver, the health
plan must maintain the providers and
level of services at the time of Enrollment
for ninety (90) calendar days
44
Enrollee Protections
Continuity of Care
45. What to Consider
• Do current doctors and other providers
participate in the MI Health Link plan?
• If not, would the provider consider
joining the MI Health Link plan?
• Are current medications covered by
the MI Health Link plan?
• Each plan offers its own list of covered
medications
46. What to Consider
• Participants of PACE or MI Choice
have to leave that program to join
MI Health Link
–People may have to wait for an
opening if they choose to return to
MI Choice
47
47. What to Consider
• MI Choice services are different than the MI
Health Link waiver services
– Private duty nursing (maximum hours vary)
– Personal care (eligibility differences)
– Personal emergency response system (eligibility
differences)
• These are important considerations if you are
in an expanded eligibility category and do not
need waiver services under MI Health Link
48
48. What to Consider
• For MI Choice participants living in an
adult foster care home or a home for
aged
–this setting may not be approved under
the new rules for the MI Health Link
waiver
–discuss this issue with your current
MI Choice supports coordinator
49
49. What to Consider - PACE
• PACE integrates all Medicare and Medicaid
services
- Services are primarily provided in the PACE
Center
- Participants must use the PACE primary care
physicians in the PACE centers and other
providers like hospitals that are contracted with
the PACE organization
- PACE provides social interaction for in the PACE
Center for its participants
50
50. What to Consider – Home Help
• Personal care services in MI Health Link will be
provided through the health plans and not
DHS
• MI Health Link enrollees can have the same
providers they had in Home Help
• The same plan of care (time and task) will be
provided until a new assessment is performed
51
51. What to Consider
• People with employer or union sponsored
insurance plans who join MI Health Link
may not be able to return to those
insurance plans
– check with your retiree benefits management
system/human resources
• letters sent to potential enrollees will warn
those in employer or union sponsored plans
not to enroll unless they meet with retiree
benefits manager and are prepared to lose plan
52
52. What to Consider
• Most people eligible for both Medicare and
Medicaid who are enrolled in a Medicaid
managed care plan and opt-out of MI Health
Link will receive Medicaid services through
original Medicaid
• Only people with Medicare employer or union
sponsored health plans may continue to
receive Medicaid services through a Medicaid
managed care plan if they don’t participate in
MI Health Link
53
54. Enrollment Periods
UP and Southwest Michigan
• Opt-in enrollment
– People can enroll no earlier than February 1, 2015
– Services start no earlier than March 1, 2015
• Passive enrollment of eligible individuals if
they do not opt-out
– People will receive notices 60 days and 30 days
before they are passively enrolled
– Services start no earlier than May 1, 2015
55
55. Enrollment Periods
Wayne and Macomb counties
• Opt-in enrollment
– People can enroll no earlier than April 1, 2015
– Services start no earlier than May 1, 2015
• Passive enrollment of eligible individuals if
they do not opt-out
– People will receive notices 60 days and 30 days
before they are passively enrolled
– Services start no earlier than July 1, 2015
56. Enrollment
People eligible for MI Health Link will
receive a letter explaining:
• How to enroll in a MI Health Link plan
• Whom to contact for help
• How to opt-out if they don’t want to be part
of MI Health Link
57
57. Enrollment
• People may change plans or opt out at
any time
• If people opt-out, the state may not
automatically enroll them into a plan
–These people are still eligible to enroll if
they wish
58
59. What Happens after Enrollment?
• Enrollees receive a member packet from
the health plan including
–A new MI Health Link card
–Provider directory
–Summary of benefits
–Member handbook
60
60. What Happens after Enrollment?
• Enrollees will receive an initial screening
• Enrollees will receive a Level I Assessment
• If needed, enrollees will also receive a Level II
Assessment
• Each enrollee will help develop his or her own
Individual Integrated Care and Supports Plan
(IICSP)
61
62. Initial Screening
• Nine “yes” or “no” questions to
–Identify current services
–Identify immediate or unmet needs
• People calling to enroll will be asked these
simple questions during the call
• For people choosing not to answer on the
phone, the plan will work with the person to
complete the questions
63
63. Level I Assessment
• A broad assessment used to identify and
evaluate current health and functional needs
• Completed within 45 days of enrollment start
date
• Serves as the basis for further assessment
64
64. Level II Assessment
• Completed within 15 days of the Level I
Assessment for people identified with
– Behavioral Health needs
– Intellectual developmental disabilities (I/DD) needs
– Long term supports and services (LTSS) needs
• Health plans will collaborate with PIHPs and LTSS
agencies
• Additional supports and services will be
coordinated to meet the needs identified
65
65. Level II Assessment
For people needing nursing home or waiver
services
• The Nursing Facility Level of Care
Determination tool will be completed to
determine if the enrollee meets the
requirements for these services
• The health plan will coordinate with long term
supports and services providers to meet the
enrollee’s needs
66
66. Level II Assessment
For people identified with a behavioral health
need
• the health plan will make a referral to the
PIHP
• the PIHP will complete a telephonic screen to
determine mental health service need and
referral to a provider.
67
68. Individual Integrated Care and
Supports Plan (IICSP)
• Each enrollee will help develop their own care
and supports plan with his care coordinator
and will choose the people to participate in
the process
– Selected family, friends and providers
– Invited integrated care team members
69
69. Individual Integrated Care and
Supports Plan (IICSP)
• Follows a person-centered planning process
• Is completed within 90 days of enrollment
start date
• Is the single plan that coordinates care for all
services and providers and includes the PIHP
and LTSS service plans
70
70. Individual Integrated Care and
Supports Plan (IICSP)
• Contains plan for addressing concerns and
goals, as well as measures for achieving them
• Identifies specific providers, supports and
services including amount, scope and duration
• Lists the person responsible and time lines for
specific interventions, monitoring and
reassessment
71
71. Individual Integrated Care and
Supports Plan (IICSP)
The IICSP contains
• Enrollee’s preferences for care, support and
services
• Enrollee’s prioritized list of concerns, goals,
objectives and strengths
• Screening and assessment results
72
72. Ongoing Coordination
Care coordinators will maintain ongoing
relationships with enrollees to assure
• assessments and care plans are revisited and
updated periodically
• questions and concerns are answered and
addressed
• health issues get the attention they deserve
• the enrollee is satisfied with MI Health Link
73
74. Reporting requirements
75
These 9 Special Use Fields to
be used by states approved for
data collection for Integrated
Care in NPR ShipTalk.
75. Reporting Requirements
What is the source of this referral into the Duals
Program? (Select One):
1. Referred from State Medicaid Office
2. Referred from Enrollment Broker (Michigan ENROLLS)
3. Referred from 1-800-MEDICARE
4. Referred from CMS Federal Coordinated Health Care Office
(FCHCO)
5. Referred from the Appeals Process
6. Self referred
7. Other
76
82. Reporting Requirements
Was the duals client referred out and if so, to
where?
1. Referred to State Medicaid Office
2. Referred to enrollment broker
3. Referred to 1-800-MEDICARE
4. Referred to CMS Federal Coordinated Health
Care Office (FCHCO)
83
84. Reporting Requirements
Beneficiary Disposition
1. Beneficiary decided to opt out of the duals
program
2. Beneficiary enrolled in the program, but
enrolled in a different managed care plan
instead of the one to which they were
assigned
85
85. Reporting Requirements
3. Beneficiary actively enrolled in program and
managed care plan of their choice
4. Beneficiary chose to remain enrolled in the
program and managed care plan to which
they were assigned
5. Beneficiary decision in progress
86
New health plans and current Michigan Pre-paid Inpatient Health Plans (PIHPs) receive payments to provide covered services
5
Adults 21 or over enrolled in the Children’s Special Health Care Services program are not eligible for MI Health Link. They should not receive any enrollment notices. People enrolled in Hospice should not receive any enrollment notices as they are also not eligible for MI Health Link.
NOTE: If people leave PACE or MI Choice to join MI Health Link and would later like to return to PACE or MI Choice, their spot is not guaranteed. If there are no spots available under the MIHealth Link waiver, they will need to go on the waiting list.
For those over 100% of FPL, those with full Medicaid, i.e. PACE, Waiver and LTC will protect the Medicaid eligibility.
NOTE: DO NOT LOSE OR DISCARD RED, WHITE, and BLUE MEDICARE CARD OR GREEN MEDICAID CARD. (In the event eligibility status changes, the beneficiary will still need these other cards to access services.
Translation services for care coordinator and nurse advise line. HP required to have line for Multilanguage use.
Dental services include preventive visits to the dentist for cleanings and restorative covered services like fillings. Dentures (full and partial) are also a covered benefit. Each health plan is required to have a choice of dental providers for enrollees. Your care coordinator can help you get access to a dentist if this has been a problem in the past.
Plans must cover emergency services when people travel out of state and outside of demonstration regions in the state.
Transportation for routine medical care as well as dental, vision and mental health; any medical care provider. No limits on the number of medical transportations provided.
Non-medical transportation is part of the waiver within MHL adult care program, i.e. religious services, etc.
Personal Care – hands on assistance with activities of daily living (eating, dressing, bathing, grooming, etc) and IADLs (shopping, cooking, laundry, light housecleaning, etc.)
Equipment – shower chairs, grabbers, medication boxes, adaptive eating utensils or weighted bowls, etc.
Home modifications – widening doorways, ramps, etc.
NOTE: some LTSS services are covered only if individuals meet the necessity requirements, meaning they qualify for the MI Health Link HCBS waiver and are determined to have need for a service via assessment.
Fiscal intermediary services – for using self-directed care and will be working with care coordinator.
Medicare mental health benefit will be delivered under PIHP.
CMHSP = Community Mental Health Services Provider
Additional Services might be hearing aids, gym memberships, dental partials and OTC supplies.
In general if it was a Medicaid benefit, they would request the hearing through DCH and if a Medicare benefit, they would request a hearing through Medicare. Process still waiting approval from CMS.
Enrollees will be offered appropriate appeals rights and directed through the notice letters the entity they should contact if they wish to appeal an action. If the ICO takes an action they are required to send the action notice and it will tell the individual where they can file appeals. They can also contact the MI Health Link Ombudsman (once it is implemented) if they seek assistance in understanding appeal rights.
The Ombudsman Program will likely be implemented around the same time as MI Health Link. The Ombudsman toll-free telephone number will be made available to MMAP as soon as the entity is selected and the number is known.
Advocacy group and legal aid services my contact the DCH or DHS helpline or contact MMAP.
Health plans are required to include MI Health Link enrollees on their advisory councils to give program feedback to the plan
Grant funding to support transportation
Personal Care: Changes in state regulation or law regarding requirements for personal care providers will apply to MI Health Link.
Dental coverage is equal to current Medicaid dental coverage. Crowns not included.
HAB = habilitation
Home and Community Based Services = MiChoice
Formularies vary the same as it does with Part D drug plans. Information is on Plan Finder
MI Choice has a waiting list in some areas of the state.
There are openings for PACE in all the regions in which MI Health Link is being implemented (except there is no PACE organization in the UP)
Suggest that PACE and MI Choice folks compare current benefits to what’s available in MI Health Link since they are different. May have to be reassessed if enrollee wishes to return to one of these programs.
Private duty nursing is limited to 16 hours per day under MI Health Link. MI Choice offers 24 hours per day of PDN.
Hands on person-care is not a waiver service. It is provided as a state plan benefit under MI Health Link.
Personal Emergency Response Systems are a supplemental benefit under MI Health Link and needing this services doesn’t qualify someone for a waiver slot. Doesn’t need waiver slot to receive.
For example:
Waiver differences: Private Duty Nursing in MI Choice can be up to 24 hours a day while Private Duty Nursing for MI Health Link is limited to 16 hours a day. If you receive PDN for more than 16 hours a day, you may not want to leave MI Choice.
People in MI Choice cannot receive the state plan personal care service (currently provided through the Home Help program administered by DHS). Under MI Health Link, people can receive state plan personal care (hands-on care) and be on the waiver if they have need for a waiver service. People requiring prompting and cueing to complete personal care tasks would receive this service as the expanded community living supports waiver service under MI Health Link.
If a person receives hands-on care through MI Choice Community Living Supports, the person would receive this service through MI Health Link under the personal care benefit without using a waiver slot. People need to consider the current waiver services they receive to determine if they are a basic benefit or waiver service under MI Health Link. Being in MI Choice does not ensure the person will be approved for a MI Health Link waiver slot.
The new Home and Community Based Rules require persons on a waiver to live in an independent setting. Some AFCs and HFA facilities may not meet these new requirements. For people in the MI Health Link waiver, these settings must be in compliance with this new setting rule. For people in the MI Choice Waiver program, these settings are allowed a 5 year transition period to come into compliance with the rules for the person to continue to receive services in these settings. There is no transition period for the MI Health Link waiver, so a person currently on MI Choice living in one of these settings that doesn’t meet the new rule requirements could not receive waiver services in this setting if they joined MI Health Link and needed waiver services. Their options would be to stay in that setting and continue with MI Choice or enroll in MI Health Link and not receive waiver services or move to another setting that is in compliance with the new rule.
PACE
Individual Home Help providers would have to meet the same policy requirements that have been established for background checks for personal care providers in Home Help. Enrollees need to inform their Care Coordinators who their Home Help providers are if they want to have them continue as their providers. The providers will need to have a provider agreement with the MI Health Link plan.
If the person has this type of insurance and calls the enrollment broker to enroll, the enrollment broker will confirm that the person understands that by enrolling in MI Health Link, he and anyone on his insurance plan may not return to the employer/union sponsored insurance.
Enrollment broker = Michigan Enrolls
Note for MMAP: This is the duals lite issue.
People in these regions will receive an introductory letter in telling them their options and how to opt-in or opt-out. Enrollees will be advised to contact MMAP for additional information.
Phase 1 will receive letters informing them of enrollment options in late January 2015. Individuals will be able to enroll beginning February, with services beginning no sooner than March 1, 2015, with passive enrollment for those that do not opt out, beginning May 1, 2015.
Phase 2 implementation timeline will not change, with the program running through December 2018 instead of December 2017,
If these people don’t opt-in or opt-out and are eligible for passive enrollment (to be assigned to a health plan), they will receive the 60 day letter which will include information on how to enroll or opt-out as well as the plan they will be assigned to. If they don’t take any action, they will receive a reminder letter 30 days prior to passive enrollment with the same information reminding them of their options. If no action is taken to opt-out, enrollment will be effective April 1, the first day they can receive services.
No change to Phase 2 implementation timeline.
There will be three waves of passive enrollment in Macomb and Wayne counties- July, August and September.
MMAP will be included in the letter as a contact for help.
Passive enrollment – If a person was passively enrolled into a Medicare or Medicaid plan during the current calendar year, he is excluded from passive enrollment until the beginning of the next calendar year. This person is still eligible for MI Health Link and would receive the introductory letter.
Enrollees should keep their Medicare and Medicaid cards even though they are not needed for the MI Health Link services.
Enrollees can use the welcome letter to receive services for scheduled appointments or emergency services before the new MI Health Link card is received. Take the Medicare and Medicaid cards to the appointment until you receive the MI Health Link card as these cards contain information that will help the provider confirm enrollment in MI Health Link.
Initial screen consists of 9 yes or no questions done when the call into Michigan Enrolls
Level I assessment can be done by phone or in person.
Level II is with care coordinator.
Should be done by care coordinator or other medically trained staff person.
Level I assessment may be done after client is passively enrolled.
Existing assessments may be adopted if they are still current (not due for reassessment). This will help reduce the assessments for the enrollee. This assessment will be used during the development of the Individual Integrated Care and Supports Plan.
Care Coordinators will be collaborating with PIHPS and LTSS to coordinate care.
I/DD = Intellectual developmental disabilities.
BH = Behavioral Health
LTSS = Long term supports and services
Initial assessment done by Michigan Enrolls
Everyone gets a Level I assessment
Depending on Level I assessment, they would get level II assessment for LTSS or Level II for PIHP and then yet another level of assessment for mental health services referral.
LOCD tool = 7 doors of need for care
Door One (1) - 87% qualify through door 1 based on four (4) activities of daily living. Client requires six (6) points to come through door one (1). Provider would need to score manually.
Door Two (2) – Addresses cognitive issues. There are three (3) qualifiers for clients to come through this door. It is the second most probable door of eligibility (10% of clients come through this door) Individuals that are severely impaired in decision making, have memory issues and trouble making themselves understood.
Door Three (3) – Physician Involvement (visits and orders). Necessary to make sure and count the number of days in which the order was changed and number of days in which an exam was done by the physician. (not the amount of exams or changes, but the DAYS these were done) An emergency exam must not be counted and is not inclusive on this assessment. Scoring - To qualify through door three (3), there are two (2) ways in which the client can qualify. FIRST - Beneficiary must have one (1) physician exam and four (4) days in which the orders were changed. SECOND – Physician must have examined the client twice (2 days) and that the physician ordered changes in the last fourteen (14) day timeframe.
Door Four (4) - Treatments and conditions. One (1) area is needed to qualify for entrance through this door.
Door Five (5) -– Skilled rehabilitation therapies. The individual must have required at least 45 minutes of active PT, OT or ST (scheduled or delivered) in the last 7 days and continues to require rehabilitation therapies to qualify under door 5.
Door Six (6) – Behavioral Issues (2% qualify through this door). This door covers wandering, verbally/physically abusive, resisting care, etc.
Scoring – 2 options to qualify.
Door Seven (7) - Service Dependency. The applicant is currently being served by either the MI Choice Program, PACE program or Medicaid reimbursed nursing facility.
Scoring – Applicant must be a current participant and demonstrate service dependency to quality under Door 7.
Enrollees must be reassessed at least annually, at a change in condition or at the request of the enrollee or enrollee’s representative (family, friend, guardian, POA, DPOA, provider, etc.)