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Transcript Welcome [www.mnaap.org]

Participants in HCH conference call
Marie Maes-Voreis, MDH
Ross Owen, DHS
Amy Johnson, Medica representative
Becky Walsh, Prime West representative
UCARE has provided a statement
Health Partners has provided a statement
Two foundational pieces of
• 2007- First “medical home” legislation- Provider
Directed Care Coordination for patients with
complex illness in the Medicaid FFS population
(now Primary Care Coordination) PCC
• 2008- Health Care reform legislations requires
“health care homes” for all Medicaid/ SCHIP/
state employees/ fully-insured privately insured
in Minnesota, Health Care Homes, HCH
Primary Care Clinics from throughout Minnesota have
participated in HCH planning and implementation
(Data provided under contract from MDH to the Primary Care Coalition including MN Academy of Family Practice,
MN Chapter of the American Academy of Pediatrics and the MN Chapter of the American College of Physicians)
Participants in Minnesota
Health Care Home (HCH)
training, surveys, and
mini-grants by zip code of
participant (when
March 2009 to June 2010
Certification Steps
• Optional pre-application activities
• STEP 1: Letter of intent, letter to applicants with
instructions on site visit and payment methods
• STEP 2: Application and pre-certification
assessment form
• STEP 3: Site visit
• STEP 4: MDH Review and Notification
• STEP 5: Recertification
• Optional: Variance requests, Appeal Process
Application Process is complete when:
• Required letter of intent, application and self
assessment has been submitted.
• Required documents have been submitted and
• Site visit has been completed.
• The “90 day waiting period” begins when these
steps are completed.
STEP 4: MDH Review and Notification
MDH will notify the applicant within 90 days of
certification status.
• The report will identify all standards that are met and
not met.
• Those applicants meeting 100% of the standards
required at initial certification will achieve
• Celebrate! Public recognition
• Payer notification
Notification of HCH Certification
• Notification to payers by clinicians through MCC
(Minnesota Credentialing Collaborative Web Tool)
• Through normal channels for communication to payers
Web report on MDH web site for clinics and consumers site
Clinician Name
Clinic / Address
(searchable by
zip code)
Dr. Tim Jones
MDH Health
Payer Secure Certification Site
• Payers may verify certification information at
MDH payer web site.
Clinician Name
Janice James,
NPI and
n numbers
NPI and
Rate Negotiation Considerations
General Considerations: The work group recommended that the following
overarching issues be taken into consideration in the development of care
coordination rates.
Fixed Costs. The work group recognized there are two main categories of fixed
costs related to operating a health care home: start-up costs and maintenance
fixed costs. Examples of these include the time and resources to develop a patient
registry, and the ongoing costs of keeping the software current and maintaining
the tools. The work group recommended that specific strategies be developed to
address these fixed costs and that they be considered in the development of the
care coordination rates.
Overlap with Currently Reimbursed Services. The work group recognized that the
task/function list above contains a number of items that may already be separately
coded and reimbursed in current fee-for-service arrangements. The work group
recommended that the care coordination rates reflect only those services listed
above that are not reimbursed separately elsewhere.
Care Coordination Task / Function List
Task/Function List: (Items marked with a “” were identified as likely to
require considerably more time and resources for more complex patients.)
 Telephone and e-communication with patients and with caregivers
Visit time not currently reimbursable (scheduling blocks to meet access
requirements for health care home certification.
Establishing patient/family partnerships, recruitment/outreach, education
(including enrollment and ongoing engagement) required for certification.
Travel for care that must take place outside of the usual clinic location, e.g.
house calls for home bound frail elderly
Registry and panel management
Patient-centered care: tools, resources and time necessary to ensure that
decision-making and care are consistent with patients’ culture, values, and
Care Coordination Task / Function List
 Coverage and insurance coordination, including time spent filling out
forms and documents required for coverage.
 Pre-visit planning
 Family conferences
 Care team conferences
 Transition planning and management
 Medication reconciliation
 Behavior change coaching
 Care planning, integration of specialty care and coordination with
community resources
 Initial and periodic risk screening
 Measurement, analysis and submission of quality indicators as
required for health care home certification
 Learning collaborative participation as required for HCH certification
DHS Fee-for-Service Care Coordination
rate assumptions
DHS began with the current reimbursement for a 40-60 minute evaluation
and management (E&M) visit (CPT code 99215 = $65.92) as the base
value for one hour of physician work. Because the work of care
coordination in a HCH is divided between the physician and other members
of the care team, DHS assumed the following distribution of work in an
optimally-functioning practice:
20% Physician
50% Care Coordinator
30% Office/Clerical
After discounting for this work distribution over time (care coordinator time
at 65% of the physician rate and office/clerical time at 30%), the MHCP
fee-for-service rate for one hour of care coordination in a HCH is $40.54.
Assumptions were made about the average amount of care coordination
needed per month for each complexity tier, resulting in rates ranging from
$10-$60 PMPM for eligible patients.
Certification details: Your questions
• As new clinicians are certified in a clinic or
organization, the certification anniversary date
will change over time so there is one anniversary
• MDH and the certified clinic will determine that
date together.
• All questions submitted to MDH to
[email protected]
A clinic is certified only if all of the clinic's
clinicians meet HCH requirements.
• It is the clinic's responsibility to notify MDH when a new clinician
joins a certified clinic and intends to become a certified clinician
• The clinic has 90 days from the date of hiring the new clinician or
until its next annual recertification to apply for this new clinician,
whichever is sooner
• A clinic may continue to operate as a certified clinic until the new
clinician is certified
• If the clinician chooses not to be certified, the clinic will no longer
be certified, but the clinicians who were previously certified
automatically will continue their individual certification
Health Care Homes Contacts:
[email protected]
Marie Maes-Voreis, RN MA
HCH Program Director
[email protected]
HCH Health Plan Contracting Contacts:
Medica- contracting for HCH
• When HCH certification is achieved, contact your Medica
contract manager
• Medica will consider your existing contract & product portfolio
to determine reimbursement method
• If provider is not currently in an alternative payment
arrangement, Medica will follow DHS tiering and reimbursement
• Allow 60-90 days for operational set up
• Medica will honor payment for care coordination from the date
of HCH certification
PrimeWest- contracting for HCH
PrimeWest Health requires clinics/clinicians to be certified
before we will proceed with contracting.
To inquire about Health Care Home contracting, please call
our Provider Services line: 866-431-0802; and select option 2
Lisa Kamrowski, our Provider Relations Specialist will be
able to assist you with your contracting questions.
Currently, we have not made a decision on whether we will
go retroactive to certification date on claims payment. We
are currently seeking input from MDH on this issue.
UCARE- contracting for HCH
“To inform UCare of your interest in a Health Care
Home contract, email your clinic contact information
to [email protected] UCare will consider
requests individually, based upon DHS standards
and existing UCare products and contracts.
UCare will follow the DHS tiered model for
reimbursement. UCare does not intend to be in a
retroactive contract situation. Thank you.”
Health Partners- contracting for HCH
For Health Care Home contracting questions, please contact
Chuck Abrahamson, Vice President of Network Management
and Provider Relations.
His contact information is below:
[email protected]