This document provides training on new reporting requirements for Healthy Start providers regarding Medicaid managed care. It summarizes the key changes to Medicaid in Florida, including the transition to managed medical assistance and mandatory enrollment of pregnant women in Medicaid managed care plans. It then outlines the requirements, procedures, and billing codes for initial contact, assessment, care coordination, and other Healthy Start services providers must follow. It emphasizes the need to properly document and code services to draw Medicaid dollars and meet new monthly, quarterly, and annual reporting deadlines.

1. WELCOME

2. Purpose of this training
Train Healthy Start Providers
regarding new reporting
requirements in the Department
of Health and
Healthy Start MomCare Network

3. BACKGROUND AND HISTORY- MEDICAID
 Effective January 1, 2014 the 1915b Waiver
transitioned to the 1115 Managed Medical
Assistance (MMA) Waiver
 Florida’s plan for Medicaid Reform all waivers
moved to Agency for Health Care Administration
(AHCA)
 Florida’s 2005 Medicaid Reform Plan-all Medicaid
pregnant women moved from voluntary to
mandatory for Medicaid Managed Care in 2014.
 Rollout for MMA starts May, June, July or August
 Area physicians will need to join area Managed
Care Plan

4.  2011 Legislation mandated
 Formation of an Administrative Services Organization to
represent HSC in AHCA contract
 Healthy Start MomCare Network, Inc.
 Medicaid Managed Care (MCO) plans to have
agreements with their area HSC
 Evaluations of waiver program and quality measures of
MCO’s.

5. HEALTHY START PROGRAM DESCRIPTION
What do you see?

6. After completing the training the
participant will be able to:
 Define the requirements of the Customer
Service/Call Number
 Implement a Customer Service Complaints and
Grievances Tracking System
 Understand and be able to complete the steps for
verifying enrollee’s Medicaid status
 Demonstrate understanding of the Healthy Start
Coordinated System of Care Program

7. COMPLAINTS AND GRIEVANCES
 Both informal and formal steps to resolve
 All who are dissatisfied to appropriate staff for follow-up
 Maintain a log of all complaints and grievance files
 Report a quarterly summary of all complaints and
grievance
 Each enrollee is free to exercise his or her rights in
accordance with 42 CFR 438.100

8. HEALTHY START COORDINATED SYSTEM OF
CARE

9. INITIAL CONTACT
Point of entry into Healthy Start after screening
 Pregnant women score 6 or more
Children score 4 or more
Have been referred other then score
Tier 1

10. TIER 1
 Minimum of 3 attempts
 One MUST BE face to face
 Knowledge or suspicion of current:
 Domestic violence
 Sexual abuse
 Child abuse or neglect
 Diagnosed mental illness or substance abuse disorder
 HIV/AIDS diagnosis
 Hepatitis B diagnosis
 Inadequate growth and development
 Safety concerns noted by the health care provider on the HS Screening form
 Language barriers
 AHCA considers being on Medicaid a risk factor

11. INITIAL CONTACT IS AN EVALUATION OF NEEDS
 Initial Contact or 1st Attempt to Contact must be made
within 5 working days of receipt of screen/referral
 Telephone or face-to-face
 Second attempt to contact must be made within 10
working days of first attempt
 Telephone, face-to-face or letter
 Third attempt to contact must be made within 10 working
days from second attempt
 Telephone, face-to-face or letter

12. SUCCESSFUL INITIAL CONTACT
1. Provide information on the Healthy Start
program and reason for the referral
2. Prioritize severity of risk and determine the
ability to access health care through the
managed care plan
3. Evaluate service needs
4. Providing information on how to address risk
factors

13. 5. Providing referrals as needed
6. Providing name and phone number of Healthy Start
Care Coordinator.
7. Initiating the Healthy Start care coordination record
8. Initiating and complete the Plan of Care
9. Providing follow-up with the prenatal or child health
provider within 30 days of IC.

14. IF ALL STEPS ARE COMPLETED THEN
CODE THE APPROPRIATE MEDICAID
ALLOWABLE/BILLABLE HS CODE:
3101, 3102, 3110, 3111, 3113
THESE CODES PROMPT THE SYSTEM AND ALLOWS US TO
DRAW DOLLARS FOR THE MEDICAID CLIENT

15. LEVEL OF CARE
 Used to determine intensity and duration of services
– Level P: pending initial contact
– Level E: Enrollee require only the service components of an initial contact and closure
– Level 1: Enrollee require short term follow-up on the ability to successfully access
services
*after four months participant must be moved to another level or closed
– Level 2: Enrollees don’t function independently & don’t have adequate knowledge about
community services or may have additional barriers to accessing, participating in or
coordinating services for themselves/their child.
* can have a family support plan completed but not coded
– Level 3: Enrollees/families are experiencing multiple concerns and need frequent
service coordination. Safety concerns & crisis intervention are often characteristics of
enrollees in this level.
* face to face contact and family support plan coded
Proper coding details whether a client is receiving the appropriate level of care based
on their level

16. INITIAL ASSESSMENT
FACE-TO-FACE EVALUATION
Provided to all enrollees meeting certain criteria during the initial contact.
Must make 3 attempts to contact

17. SUCCESSFUL INITIAL ASSESSMENT
1. Initial assessment or an attempt at an initial
assessment will be done within 10 business days
after the initial contact has been completed and it
is determined that the enrollee meets the criteria
for the assessment.
2. Enrollees have an Individualized Plan of Care that
includes the identified needs, goals, interventions
and progress towards meeting the goal(s).
3. Enrollees are assigned a level of service delivery
based on their needs.
4. The IPC is initiated at the IC and re-evaluated at each
subsequent encounter.

18. SUCCESSFUL INITIAL ASSESSMENT
5. Need to take place face to face in the clinic, WIC, the
community or the home and documented in the IPC.
6. Every pregnant woman, infant or child in need of other
Healthy Start and/or community services is referred for
those services within 5 business days of completion of the
initial assessment.
7. A written report is provided to the prenatal care provider of the
infant’s or child’s primary care provider, within thirty
calendar days of the initial contact and the initial
assessment regarding findings, and plan for the disposition
of the case.

19.  IF ALL STEPS ARE COMPLETED THEN CODE
THE APPROPRIATE MEDICAID ALLOWABLE HS
CODE:
3201, 3202, 3210, 3211, 3213

20. CARE COORDINATION AND RISK
APPROPRIATE CARE
 The foundation for delivery of Healthy Start Services.
Enrollees receiving care coordination are contacted,
assess, provided with information, and referred for services.
Intensity and duration of care coordination services are
determined by:
Risk factors effecting enrollees
Family assets, strengths and resources to offset
risk factors
Enrollee and family desires, concerns, priorities
HS care coordination resources within community

21. CARE COORDINATION FACE TO FACE
3320
CARE COORDINATION TRACKING
OR
NON FACE TO FACE
3321

22. INCLUDES ANY OF THE FOLLOWING ACTIVITIES:
 Developing a caring and trusting relationship
 Tracking receipt of services
 Continuing assessment of
 Concerns, Priorities
 Strengths, Resources
 Plan with family how to address above issues
 Develop and Update a Family Support Plan
 Providing Resources
 Follow-up on referrals and services
 Coordinating services with other
providers/agencies/programs
 Empowering the participant and family toward self-
sufficiency and economic stability
 Promoting employability and life management skills
 Reinforcing the health care regimen
 Provide anticipatory guidance
 Advocating on behalf of the participant and family for
needed services
 Monitoring effectiveness of services provided and
adjusting the plan for services as appropriate
 Care coordination transition to other providers
 Maintaining ongoing communication with other
providers
 Evaluation and update of the Individualized Plan of
Care
 Evaluation and update of level of care

23. FAMILY SUPPORT PLANNING
LEVEL 3 PARTICIPANTS (HISTORY OF SUBSTANCE
ABUSE AND OTHER HIGH-RISK ENROLLEES)
 3322 Initial Family Support Plan Meeting
 Must be face-to-face
 It is not a plan of care
 If participant refuses to sign place in chart and
document refusal
 3323 Update Family Support Plan
 Modified as needed
 Updated every 3 months
 Must be face-to-face

24. CARE COORDINATION CLOSURE
 3310 Declines Services
 3311 No Further Services
 3313 Receive or Will receive C.C. from Another Provider
not CMS/Early Steps

25. OTHER HEALTHY START SERVICES
Must be face to face
 4501 Nutrition Counseling
 8004 Parenting Education and Support
 8006 Childbirth Education
 8008 Breastfeeding Education and Support
 8026 Tobacco Cessation Counseling

26. FINANCIAL CONSEQUENCES
 Page 31-Performance Standards and Liquidated
Damages
 May be imposed
 Per calendar day
 Per reporting period
 Per incident

27. REPORTING REQUIREMENTS DUE
 These requirements apply for both the Medicaid
and DOH reporting
 Monthly Reports 15 calendar days
 Quarterly Reports 15 calendar days
 Annual Reports 15 calendar days
 The Network has a 20 day reporting requirement for
the Coalition.

28. “CHANGE BRINGS OPPORTUNITY”
-NIDO QUBEIN
 What opportunities do you see with these changes