Health Home Implementation Webinars

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Health Home Implementation Webinars

• Session 14 April 10, 2013
• Data Exchange Application Agreements

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What is a DEAA? What data exchange is and is not
allowed?

• The DEAA allows the DOH to exchange lists of
  Health Home members with the lead Health Home.
• The lead Health Home then completes subcontractor
  packets with network partners, permitting the
  lead Health Home to share lists and demographic
  data with their partners prior to member consent.

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What is a DEAA? What data exchange is and is not
allowed?

• The DEAA does not permit
• Data exchange between other lead Health Homes
  without a subcontractor packet (a lead to lead
  packet is being developed).
• Data exchange with local social service districts
  without a subcontractor packet. (Comment Local
  Districts have valuable information that can aid
  in identifying members. Subcontractor packets
  are an easy and recommended solution to permit
  data exchange to assist the local districts in
  updating data while providing Health Homes with
  valuable information.

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What is a subcontractor packet and when is it
used? What is the process?

• The subcontractor (aka downstream or network
  provider) packet is designed to allow the lead
  Health Home to share data with network partners,
  e.g., with those that provide case management
  services or other services (e.g., outreach) prior
  to obtaining member consent.
• Subcontractors are engaged by the lead Health
  Home, not vice versa.
• Subcontractors complete their portion of the
  packet and then return it to their lead Health
  Home (not DOH).

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What is a subcontractor packet and when is it
used? What is the process?

• The lead Health Home then authenticates the
  packet by signing the Executory Clause, BAA and
  Confidentiality Agreement.
• The lead Health Home then submits the packet to
  DOH (Privacy Coordinator).
• Once reviewed and approved, an Approval Letter is
  generated to the lead Health Home, permitting
  data sharing.
• In order to permit data sharing between two
  network partners (subcontractors) a reciprocal
  subcontractor packet must be executed (this is
  being developed).

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Is a DEAA needed for community referrals?

• Members do not have to be on DOH lists or be
  approved by DOH in order to be accepted as a
  Health Home referral.
• Health Homes, their partners, and MCPs are
  responsible for determining whether the
  individual presumptively meets Health Home
  criteria.
• The State is not involved in the assignment of a
  community referral, hence a DEAA is not required
  for exchange of information about the prospective
  member.
• EXAMPLE A member is seen in the ED , having
  signed the required ED Notice of Privacy, where
  the ED MD refers member to Health Home A. This is
  a community referral.

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Can lead Health Homes refer or transfer members
to other lead Health Homes?

• If the member has been assigned by the DOH, the
  Health Homes must have executed agreements with
  each other to share information about the member
  and arrange referrals or transfers. The transfer
  must be reported on the Health Home tracking
  system using the appropriate reason codes.
• If a Health Home determines that it cannot meet
  the needs of an assigned member, and cannot refer
  or transfer him/her to another health home or
  partner then
• If the member was assigned to the HH by DOH but
  has not received HH services, submit a rejection
  record to the tracking system.
• If the member has received Health Home services,
  the members enrollment should be end dated by
  submitting a change record to the tracking system
  using the appropriate reason code.
• DOH will reassign the member to another Health
  Home with the next list.

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Data Sharing and Consent

• Can a care management provider share data on a
  converting member with the lead Health Home?
• A care management provider can share data on a
  converting member with the lead Health Home after
  the subcontractor packet /agreement is in place.
• Care management providers can collect and manage
  converting Health Home members prior to the
  subcontractor packet/agreement is in place,
  including obtaining consent.
• Once the subcontractor packet/agreement is in
  place, the members information can be
  communicated to the Health Home.

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Data Sharing and Consent

• Consent form
• The Health Home consent allows sharing of health
  information with / from core health home partners
  involved in the members care that are listed on
  the consent form. It includes medical, behavioral
  health, SUD treatment providers and CM
  agencies others per the website
  http//www.health.ny.gov/health_care/medicaid/prog
  ram/medicaid_health_homes/form)
• It includes Regional Health Information
  Organization ( RHIO) consent for Health Homes
  participating with RHIOs
• The member does not need to sign the consent at
  the same time as he/she agrees to receive and
  participate in Health Home services as long as
  that member can still be effectively managed
  without sharing/ obtaining Health Information.

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Opt Out and Withdrawal of Consent

• Opt Out ( DOH-5059)
• Health Home participation is not mandatory and
  individuals who do not want to participate can
  opt-out of the program prior to consenting. .
• Signing the Opt-out form (DOH 5059) indicates
  they do not want to participate or receive Health
  Home services
• Health Home Patient Information Sharing
  Withdrawal of Consent Form- (DOH-5058)
• For a Health Home member that has already
  consented and the member decides at any time to
  discontinue receiving Health Home services
• The member/ legal representative should be
  filled out and sign Health Home Patient
  Information Sharing Withdrawal of Consent Form-
  (DOH-5058)
• If the member cannot be located, disenroll the
  member according to Health Home policies/
  procedures, and information sharing should be
  discontinued upon disenrollment.

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Questions, Comments, or Concerns?

• Questions on the DEAA process, subcontractor
  packets and Business Associate Agreements
  (BAAs)regarding sharing Medicaid data should be
  directed to
• Caryl Shakshober OHIP Privacy Coordinator
• cxs15_at_health.state.ny.us
• 518-486-5771

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Alert Use Cases

• Eric Weiskopf, M.Ed OHITT
• Ellen Flink OHITT

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Fully Operational Health Home with Embedded or
Subcontracted Care Manager

• Health Home Consent signed
• Single-Entity RHIO Consent signed in ED

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HH Partner
RHIO Consent
Subcontractor packet
All American Hospital Health Home with Embedded
Care Manager
Alert
RHIO
Care Management Application
Health Home Consent
RHIO Consent
Subcontractor packet
Alert
Subcontracted Care Manager
All American Hospital
HH Member enters All American Hospital Emergency
Department
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Fully Operational Health Home with Embedded or
Subcontracted Care Manager

• Health Home Consent signed
• Multi-Entity RHIO Consent signed in ED

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HH Partner
Subcontractor packet
All American Hospital Health Home with Embedded
Care Manager
RHIO with Multi-Entity Consent
Alert
Care Management Application
Health Home Consent
Alert
Subcontractor packet
Subcontracted Care Manager
All American Hospital
HH Member enters All American Hospital Emergency
Department
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Health Home Member Enters Emergency Department of
Health Home with Embedded Care Manager

• Health Home Consent not signed
• Single-Entity Consent signed in ED

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All American Hospital - Lead HH with Embedded
Care Manager
RHIO
Alert
No Health Home Consent
RHIO Consent
All American Hospital Emergency Department
HH Member enters All American Hospital Emergency
Department
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Scenario Health Home wishes to send member
tracking file to local RHIO RHIO uses
information to match patient to appropriate
Health Home and sends alerts to care
manager. Prerequisite To share information
that comes directly from Medicaid, a RHIO must
sign a subcontractor packet with the lead Health
Home to become a Heath Home sub-contractor. Previ
ously signed BAA that existed between RHIO/Health
Home as a part of a RHIO participation agreement
is not enough to allow Health Homes to send
information gleaned directly from Medicaid to the
RHIO.
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Health Home Member Enters Emergency Department
of Health Home with Embedded Care Manager

• Health Home Consent not signed
• Single-Entity RHIO Consent signed
• Health Home has an approved subcontractor packet
  with RHIO

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Subcontractor packet
All American Hospital - Lead HH with Embedded
Care Manager
Demographic Alert
RHIO
No Health Home Consent
RHIO Consent
All American Hospital Emergency Department
HH Member enters All American Hospital Emergency
Department
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Health Home Member Enters Emergency Department
of Health Home with Sub-Contracted Care Manager

• Health Home Consent not signed
• Single-Entity RHIO Consent signed at ED
• Health Home has an approved subcontractor packet
  with both RHIO and Sub-Contracted Care Manager

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Subcontractor packet
Demographic Alert
All American Hospital Lead HH
RHIO
No Health Home Consent
Demographic Alert
RHIO Consent
Demographic Alert
Subcontractor packet
Subcontracted Care Manager
All American Hospital Emergency Department
HH Member enters All American Hospital Emergency
Department
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Health Home Member Enters Emergency Department
of Health Home with Sub-Contracted Care Manager

• Health Home Consent not signed
• Single-Entity RHIO Consent signed for
  Sub-Contracted Care Manager
• Health Home has an approved subcontractor packet
  with both RHIO and Sub-Contracted Care Manager

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Subcontractor packet
All American Hospital Lead HH
Demographic Alert
RHIO
No Health Home Consent
Demographic Alert
RHIO Consent
RHIO Consent
Demographic Alert
Subcontractor packet
Subcontracted Care Manager
All American Hospital Emergency Department
HH Member enters All American Hospital Emergency
Department
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Health Home Member Enters an Emergency Department
of a Different Health Home

• Health Home Consent not signed

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HH Member assigned to All American Hospital
Health Home enters New York Hospital Emergency
Department
New York Hospital
RHIO Consent
Demographic Alert
RHIO
All American Hospital Health Home with Embedded
Care Manager
No Health Home Consent
RHIO Consent
Subcontractor packet
Demographic Alert
Subcontracted Care Manager
All American Hospital Emergency Department
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Health Home Member Enters an Emergency Department
of a Different Health Home

• Health Home Consent not signed
• Health Home has an approved subcontractor packet
  with RHIO and Sub-Contracted Care Manager
• Sub-Contracted Care Manager has RHIO consent

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New York Hospital
HH Member assigned to All American Hospital
Health Home enters New York Hospital Emergency
Department
RHIO Consent
Subcontractor packet
Demographic Alert
RHIO
All American Hospital Lead HH with Embedded
Care Manager
No Health Home Consent
Demographic Alert
RHIO Consent
Subcontractor packet
RHIO Consent
Subcontracted Care Manager
All American Hospital Emergency Department
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Health Home Member Enters an Emergency Department
of a Different Health Home

• Health Home Consent not signed
• Health Home has an approved subcontractor packet
  with RHIO, Sub-Contracted Care Manager, and a 2nd
  Health Home
• Sub-Contracted Care Manager has RHIO consent

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New York Hospital
New York Hospital Health Home
RHIO Consent
Subcontractor packet
Subcontractor packet
Demographic Alert
RHIO
All American Hospital Health Home with Embedded
Care Manager
No Health Home Consent
Demographic Alert
RHIO Consent
Subcontractor packet
RHIO Consent
Subcontracted Care Manager
All American Hospital Emergency Department
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Questions, Comments, or Concerns?

• Contact
• Eric Weiskopf
• esw01_at_health.state.ny.us
• 518 473 7960

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Webinar Questions