DOH Health Home Program Office Hours Q&A POC

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September 6, 2023

Q:DOH hears two related concerns from the Health Home Community. Given the availability of the specification file only in early August 2023, there is concern that EHRs will not complete their builds in time for Health Homes to be submitting Plans of Care (POC) for 50% of their enrolled members by October 2023.

A: DOH recognizes that EHRs need a reasonable timeframe to build out the technology required to submit POC. The DOH expectation that 50% of POCs are submitted by October 2023 is intended as an intermediate process metric to ensure that HH’s are fully capable of submitting POCs before the end of 2023 so that when they are required for billing (January 2024), all Health Homes are in compliance. Accordingly, DOH can clarify that there is no adverse consequence if Health Homes have not submitted 50% of their POCs by October 2023. Over the coming weeks the DOH team will collect status reports from each HH to verify that the POC upload functionality is active and working by December 2023 so Health Homes have at least one month of full scale POC transmission experience in advance of the activation of the billing requirement 1/1/2024.

CES Tool:

Q:Can you please provide the HH community with the skip logic associated with the CES Tool?

A: The narrative of the skip logic is embedded in the headers of each section of the CES Tool which was shared on 8/30/23. We are sharing out again to the community a slightly improved Word version, as well as an Excel version that includes macros and can be used by all HH’s to complete CES Tools outside of their EHRs.

Q:DOH hears several concerns related to the tight timeframes associated with CES Tool implementation. Concerns relate to: the ability of EHRs to build out both the technology to upload the CES Tool determination (specifications presented 9/6/23 and distributed 9/13/23) to the MAPP-HHTS; the ability of EHRs to build out the CES Tool (released 8/30/2023) itself; the need to develop and roll out training session state-wide in advance of go-live.

A: DOH recognizes the tight timeframes associated with the rollout and implementation of the CES Tool. The initial required timeframes were as follows: HH’s start to implement the CES Tool in October 2023, and start to upload CES Tool Determinations in December 2023. In order to facilitate training, DOH is delaying the required implementation of the tool by 1 month. The training will be developed in September 2023 (by DOH and the CES Tool Workgroup). Training will be implemented state-wide in October 2023. In October 2023 Webex training sessions will be offered at varying times of day and on varying days of the week. In November of 2023 CMs start using the tool with all members whose Reassessments are due in November 2023 (On average, Care Managers {CMs} will have to complete the CES Tool for 1/12 of their members; a CM with a caseload of 60 will have to – on average – complete 5 CES Tools in November 2023). If EHRs have completed their builds by then, they may use the internal tools. Otherwise CMs will use a stand-alone tool Excel Tool which is being provided. Submission of determinations to the MAPP-HHTS will start in December 2023 as planned, including the results obtained in November.

Q:Can DOH please provide direction to EHR providers to ensure that they build out a mechanism to allow HHs to track/flag due dates of CES Tools at 6 month intervals after the first year (12 months).

A: In the context of the MAPP/IT Subcommittee DOH will assist HH’s and their EHRs in problem-solving to develop appropriate tracking systems to minimize the additional tracking burden that would exist starting in May 2024 if the EHRs do not integrate an alert system associated with CES Tools by that time.

Initial Appropriateness:

Q:Clarify the timing and rollout of the Initial Appropriateness collection and reporting requirements

A: Health Homes will be required to transition to the updated Initial Appropriateness Criteria for all new enrolled segments effective 12/1/23. The specifications for submission of Initial Appropriateness were presented on at the 9/6/23 DOH Office Hours, and distributed 9/14/2023. The Initial Appropriateness/Need functionality will be part of the MAPP 4.4 release on 12/9/23, and the reporting requirement will be in effect on that date. CMs will be required to record the specific Initial Appropriateness criteria as described in a location in the case record that can be reported up to MAPP-HHTS via the Consent and Member Program Status Upload file. Health Homes are encouraged to adjust policy so that they no longer need to record the information where they currently record it (For example, if at present, Health Homes require appropriateness to be documented in an enrollment note, the Health Home may change policy to remove that requirement).

Specifications for both CES Tool reporting and Initial Appropriateness Reporting via the Consent and Member Program Status Upload file

Consent and Member Program Status Upload
Field # Field Name Start Pos Length scope="col" End Pos Format
14 CEST Outcome 74 1 74 Alphanumeric (C, E, M)
15 CEST Start Date 75 8 82 MMDDYYYY, Numeric
16 CEST End Date 83 8 90 MMDDYYYY, Numeric
17 Appropriateness Category 91 2 92 Alphanumeric
18 Appropriateness Detail 93 250 342 Alphanumeric