SOM - State of Michigan
Q & AMIHP Regional Coordinator MeetingsMarch, 2015Risk IdentifiersPregnancy health does not score out if she did not have a problem getting into care once, even if she entered after 20 weeks. There is not always a barrier to getting in – sometimes she just didn’t want to. It should not be dependent on a specific reason – LPNC (late prenatal care) should be enough.Internet Explorer (IE) 9 and IE 10 can cause problems with the algorithm and risk level scores. Use IE 8 or IE 11. On the IRI under Family Support, there is no option under “who spends the most time with your baby” for a family member (grandparent, aunt, etc.) but it lists “neighbor.” Please add family/other with option to list specifically. Thank you.We will make this change.On the MRI there is no specific and separate question asking if mom is enrolled in WIC – it is embedded in a question asking about food assistance with the state and food pantries. If receiving one of the programs listed, mom will answer Yes, even if not receiving WIC, so “food” is not flagged as a risk on the Risk Scoring page. Are you currently enrolled in WIC should be a separate question and if “No” should show as a risk through SSO!On the MRI, we are determining if she has food. You would document WIC enrollment on the Professional Visit Progress Note.For Family Planning – low risk is being assigned for moms who say “I wanted to be pregnant now” and “No, I was not using birth control.”Family Planning Algorithm: Intermittent – wants to be pregnant now – should not score out, but it does.(This response applies to questions #4 through #5 above.) Correct. This is the current design of the tool; however, we are looking at ways to capture whether or not a pregnancy is planned.Can we get an opportunity to add in missing Medicaid ID for not completed infant RIs behind the scenes?This will be done behind the scenes by mid-May. See IT alert sent 03/25/15 which explains how this will be done.Is there a way to cross-reference for maternal or infant RIs (i.e., can you get a flag that this mother was screened by another agency for their infant or maternal case)?There is a way and we’re hoping we will be able to do this. Stay tuned.When are we going to be able to download our RI data? This was supposed to happen at least 2 years ago. Not aggregate reports but the actual client-level data. We need it for our internal QA, program monitoring and reporting. We continue to work on this. We have encountered multiple unforeseen IT barriers. If a client doesn’t have a MCD RID number on IA, we have been checking CHAMPS 2x/day till they have a number before completing the RI in system – preventing algorithm and pulling POC 2s. If we complete it without a MCD ID, when we do the Discharge Summary, it won’t transfer or if we go back and try to put it in, we have to have the whole thing deleted and re-entered. What is the best way to handle this so we:Can continue serviceStay within guidelines for timely entry Reduce paperwork/time on re-entriesWe understand that this is happening intermittently. Please provide your consultant with the details so she can investigate the situation. Keep documentation that you have notified your consultant so that your certification reviewer will know you had a valid reason for not entering the Discharge Summary. Please consider allowing effective date in 2 weeks to allow staff training/roll- out. When we make major changes to the forms, our typical process is to issue them 3 months prior to the effective date (the date when they must be used). It is our expectation that agencies will disseminate all state-provided training information to their staff well before the new forms become effective. Maternal: High risk is only PICA. Should be eating disorderCategory 1 & 2Infant: High risk is only:No age appropriate food for infant.Cereal in bottle: does not (circle with slash) screen out for infants with reflux.Neither maternal nor infant uses any criteria used by WIC to determine risk.The algorithm scores out based on the literature around care coordination and incorporates WIC screening criteria where appropriate.IRI question: How many children do you have? Does it include new baby?The IRI that asks how many children you have – are you supposed to include the newborn?(This response applies to questions #12 through #13 above.) The IRI asks: Are you a first-time parent? If No, how many sibling children are there? This is the total number of children in the household for whom the mother is responsible. It includes the infant beneficiary, full siblings, half siblings, step children and foster children. If the mother shares a home with other adults who have children, do not count the children of the other adults in the total if the mother isn’t responsible for the children.Please consider allowing agencies to reactivate Risk Identifiers that are “complete.” Many times during our review process we identify errors (simple typos) that require us to have the entire RI deleted and then re-entered.I’m wondering if MIHP coordinators can receive rights to delete or reactivate Risk Identifiers. It is difficult for staff to fax the correct form, wait for a reply, and then re-enter info. Also, it would help if corrections to RIs could be done immediately after submitting – sometimes we don’t know we entered incorrect DOB or middle initial until RI is printed. Coordinators could do this.(This response applies to questions #14 through #15 above.) We have discussed it with IT and we are not able to permit this due to data integrity issues. Risk Identifiers may not be altered once they are complete in the SSO system. In order to correct errors after that point proceed as follows:1) IRI - If it’s within 30 days of entry, you may delete the screen yourself and re-enter all of the data.2) MRI and Discharge Summaries – you must submit a deletion request to the state. After it’s deleted, you may re-enter the data. (We have submitted a service request to allow the 30-day self-deletion window for the MRI.)We suggest that you implement an internal QA process to correct errors before you “press the button.” For example, have another individual review the data you have entered or walk away from your computer and come back and look at your data entries again with fresh eyes.Please add a box (or something) to the MRI to indicate when a risk screen is done but the client refuses ongoing MIHP services (RI only).We are working on this.Sometimes the RI pulls an inappropriate risk. Ex: Housing - if client answers she is homeless, but answers “yes” to “has regular nighttime, temporary housing”, it still pulls a high risk. However, the risk information matches moderate.If you have an example of this, please contact your consultant with the details.Please consider spacing out the MRI/IRI. It’s a little overwhelming and easy to miss questions with the material being so condensed. We would rather have more pages and have more room.The majority of people in the field requested that we have fewer pages.It would be nice if the MRI/IRI had lines to write on, rather than boxes. Our area doesn’t have the ability for wireless internet, so all our charting is done on paper.We are not able to do this.Please consider adding an option for Abuse/Violence on MRI/IRI that shows we were unable to ask/review due to having partner/other person present – can’t complete online and we want to start services with intention of asking ASAP when able to be alone with client.If a woman does not answer these questions for any reason whatsoever (including that you did not ask them because her partner was present), she will score out as “unknown,” in which case you would implement the highest level of interventions. You may note the reason you did not ask the questions in the comments section.Please consider reviewing questions that may or may not have “don’t know” as an option. For example, many parents are unsure when they’ll start solids or take child to the dentist but there’s no option for unsure, whereas there is a “don’t know” option for asking mom if she had a C-section/vaginal delivery or if baby stayed in hospital after delivery. The Risk Identifier is an evidence-based maternal/infant health and psychosocial assessment. It is standardized in order to guide appropriate services based on a beneficiary’s needs and risks, no matter the location within the state, which contributes to the fidelity of the MIHP model. A question that does not have an “unknown” option provides additional information you may need in delivering care as well as an opportunity to provide education related to that question.POC 2POCs do not capture risk appropriate referral data. Referrals to RDs are likely being missed.We capture information about RD referrals on the maternal nutrition and the infant feeding and nutrition POCs. WIC enrollment status is documented on every progress note – all WIC offices have RDs on staff. Referral to an RD is also captured on the progress note under “referrals” and “outcome of previous referrals.”If an RD identifies a new risk during a visit, especially when it relates to nutrition (Diabetes, Food, Infant Feeding and Nutrition), it seems to be very confusing that the RD could not pull the appropriate POC 2 and document as a risk on the visit note and indicate the date intervention is achieved as she is likely going to address the concerns with interventions on that same date. If the POC 2 has to be pulled by the RN or SW, the RD may never see the client again to mark that the interventions she provided (at the visit she identified the risk) as being achieved.RDs are not licensed in the State of Michigan and are therefore unable to perform the duties of care coordinator for MIHP.Can staff list multiple dates on the POC2s when addressing interventions or should only the 1st date addressed/achieved be indicated?You are required only to list the date the intervention was first implemented, but there is no prohibition against entering additional dates as well.Confusion with boxes/no boxes with POC 2s risk information. When can we use professional judgment if SSO/RI does not identify a specific risk? When can we pull PO2s if not on Risk Scoring page? If, and only if, the beneficiary’s risk information matches the criteria in Column 2, you can pull the POC 2 based on professional judgment. It does not matter if a particular criterion has a box in front of it or not. We will remove the boxes when we revise the POC 2s. Many risks identified from the RIs are not matching the risk info listed on the POC 2s and sometimes not the algorithms. This is very confusing (sad face). Examples include Abuse/Violence, Family Support (CPS hx), Family Planning and Stress/Discipline.POC 2s are not designed to include all of the items from the algorithm. Column 2 incorporates both risk information from the algorithm and characteristics you would identify by professional observation; it does not include every item from the algorithm or every observation you possibly could make as a professional. The only purpose of Column 2 is to assist you if you are considering adding a domain or changing the risk level for an existing domain based on professional judgment. If, and only if, the beneficiary’s risk information matches the criteria in Column 2, you can add a domain or change the risk level. We will remove the boxes from Column 2 when we revise the POC 2s. Am I ok in dating the POC 2 at moderate risk for the same date as the RI? High box would be marked, but moderate would be marked and dated.No, you cannot change the initial risk level on the same date that the RI was administered. You have to wait until the first professional visit to change the risk level based on professional judgment.Do you note an intervention on the care plan that was done during the assessment visit?Yes.When noting dates and N/A on care plan, are both the date and initials and credentials needed?No, initials and credentials are not needed when you document the date that an intervention was implemented on the POC 2. You are not required to write “NA” on the POC 2, although you may choose to do so. Your signature and credentials are required on the POC 1 and the POC 2.When noting N/A on care plans at discharge, do we do that on all domain levels (low, high) or just the level the patient was at?You are not required to write N/A on POC 2s at all. You may leave it blank.Infant and Maternal POC 2 – breastfeeding domain. Moderate level 6th bullet currently reads: Is experiencing a lack of support or discouragement to breastfeed her partner or family. Grammar correction?Thank you for catching this. If we are taking the dates of outcomes from Progress Notes, then why place dates on the POC 2?This is because of numerous requests from the field.POC Pregnancy Health: High will never score out for chronic medical condition, so need a box in front of risk information.We will remove all boxes when we revise the POC 2s.Nutrition care plan – unable to type in date on computer.We will look into this.Progress NoteOn the Prof Visit Progress Note, what is (RN/SW/IMH) meant for after “Standing order in place for RD services question? Should the non-RD disciplines circle their disciplines here?This used to say “RD order in place: Y, N or NA.” People were confused by this, so we added the non-RD disciplines in order to clarify it. Starting Oct. 1, 2015, you will need to circle your discipline. Electronic signatures in an EHR system generally cannot be modified, which means the signature date may not match the date of the visit (i.e., if documentation is completed 2 to 3 days later). Is this a problem?Please check with your programmer to see if it’s possible to modify this. The dates do need to match.Blended visits: If we close an infant case and open a maternal case because mom is pregnant again, do we mark the Progress Note as a blended visit, or is blended visit only used when both the infant and maternal cases are open?The blended visit box is marked only when both cases are open. Once a Discharge Summary is completed on one of the cases, the visit is no longer blended. Forms ChecklistsMaternal Forms Checklist still has boxes after the date. Is it mandatory to check these boxes?No. We will remove these boxes.Please give specific instructions for each entry in writing. Clarify and include information when forms are faxed on a different day than the field staff fills out the form.We are working on improving the form and providing written instructions. The date you would document is the date that the communication form is faxed to the medical care provider.Contact LogIf using the MIHP Contact Log, is it mandatory to fill in the Medicaid # at the top right corner of the page?No, we will remove this from the form.Discharge SummaryCan you change the level on the POC 2 on the discharge date?If we are not supposed to adjust the risk level at discharge, why is there an option to change risk on the Discharge Summary at all?(This response applies to questions #1 through #2 above.) Yes, you can change the risk level on the POC 2 on the discharge date, as long as the beneficiary meets the meets the risk criteria in Column 2.So you are saying we can if we want to, but we don’t have to change the risk levels up and down if we don’t want to during the course of care and at discharge. We can just document them on the Discharge Summary at the same level they were initially and we will be in compliance and make it very simple for our staff. Is this correct? Yes, by current standards, you will be in compliance; however, to provide the best care, it may be necessary to change the risk level in order to implement higher level interventions. Why don’t you delete “none” box on the Discharge Summary when it’s not an appropriate option?Those that cannot be “none” on Discharge Summary should be grayed out.If we cannot mark “no,” can we please not have the option on the risk summary or have it appear in gray?(This response applies to questions #4 through #6 above.) We explored this and determined that it’s too costly. Please refer to #9 MIHP Coordinator Email FY 14-15 regarding Answering “None” – Discharge Summary. The whole discussion on changing risk levels at discharge is very confusing and is clear as mud. If you want us to mark the boxes a certain way, we will, but it’s hard to train staff on something like this when it doesn’t make sense.You say pregnancy health cannot be “none” but then said if she was moderate because of prenatal access concerns and then she got into care and this is not a problem you said she can be a “none” so which one is it? Can pregnancy health be none?Pregnancy health: no could be an option if access concerns were the reason for active and has resolved on discharge.Please specify when infant safety can be marked “none” once it was marked high on the initial:Infant now has a crib but mom has the basic need food care plan and isn’t handling food properly or housing is unstable still and safety of home. Can you mark “none” for infant safety?Family Planning @ low – if indicator for level was NOT hx of intermittent contraception use, then can risk level at Discharge Summary be “none”?Depression risk levels (or risk levels in general) – if I didn’t change the level during the visit, but I change it at discharge, is that ok? Or should I keep it at the highest level?Stress/Depression @ low – if indicator for level was ONLY “reports experiencing stress” and resolved (EPDS low score, has support, and states not experiencing stress, then can risk level be “none” at discharge? (This response applies to questions #7 through #13 above.) Due to the dialogue generated regarding the discharge summary and all of the important questions raised, we are in the process of re-evaluating the discharge summary. At this time, you are advised to use the last risk level reflected on the Plan of Care 2 as your discharge summary risk level. You may only indicate “none” if there was no risk in a particular domain throughout the course of care.If there is a question that is answered incorrectly on the RI, such as Abuse/Violence, can we submit “none” on the Discharge Summary? Abuse/Neglect is a risk that is frequently mistakenly scored.Correct the Risk Identifier. The Risk Identifier information must be accurate.General development moderate. @ RI does indicator “Risk Info.” ASQ-3 results in gray. Please clarify that this is a history as opposed to last screening.We’re not certain that we understand this question, but Bright Futures is the screening tool embedded in the Infant Risk Identifier that leads to a “score” and the requirement to use the General Development POC 2. The General Infant Development POC 2 is also appropriate if there are concerns identified on the ASQ-3 or the ASQ: SE at ANY screening. You may also pull it if you, as a professional, are concerned about the caregiver’s understanding of infant development. We have had risks auto-populate on a Discharge Summary that were not identified on the RI Risk Scoring Sheet. We were using IE8.Please contact your consultant about this and be prepared to provide details.Often we are getting the message on SSO that “No beneficiary is found” when attempting to complete a new Discharge Summary despite having entered complete Risk Identifiers (including Medicaid IDs).We’re aware of this issue and it will be fixed soon.Also having problems with the SSO deleting out Medicaid numbers. MRI entered and completed with Medicaid number. At time of discharge, the Medicaid # is not populating on summary because it is no longer in the MRI. Very time consuming to have MRI deleted and re-enter just to complete summary. We’re aware of this issue and it will be fixed soon.I keep noticing on Discharges that even though an individual risks out for asthma on the electronic discharge (MRI,) asthma always risks out as “none.” Is anything being done to change this?This has been fixed.If your agency is able to provide visits after you “run out” of billable visits, should you immediately do the D/C summary? We don’t want documentation on services that you provide that will not be billed to Medicaid. Complete the Discharge Summary soon after your last billable visit.Please give us written instructions on how to discharge twins.The information in the MIHP Operations Guide on discharging twins is being updated and we are drafting written instructions on how to discharge twins. We also are looking for ways to adapt the electronic Discharge Summary to make it more user-friendly.Maternal discharge - clarify how to answer question relating to length of breastfeeding when mother continues breastfeeding at the time of discharge.Count the number of months from the date the baby was born until the last billable visit.Relating to the Discharge Summary discussion, I appreciate that you are not requiring us to change the level of risk on the POC2, but it seems to me that we are possibly reporting inaccurate information to the health care provider.We’re continuing to work on improving the data collection process.If you complete an MRI and enrollment for a mother who does not have Medicaid and does not get approved for Medicaid, what do you do to close out the record? We cannot do a discharge? We do not get paid for any portion of the enrollment.You are correct. The State does not require you to maintain this beneficiary’s records but you will want to look to your own agency’s record retention schedule. Be sure to delete the MRI from the MIHP database.Do when the discharge summary is entered into the database and the date it is sent to the physician need to be the same date? The manual says they have to coincide but do they need to be the exact same date? For example, the D/C summary is entered on the afternoon of 3/16/15 but letter is sent on 3/17/15.No, they do not have to be the exact same date. The Operations Guide will be changed to indicate that you have 14 days after entering the Discharge Summary into the database to notify the physician of the discharge. We note this this on the Forms Checklist.D/C could be changed to an updated D/C or the previous one. So that the documentation is still there. We do not understand this comment.With discharges that are completed and then the client requests a transfer, could a box be added to transfer request that notes if electronic D/C completed, please request it to be deleted.Yes, we can make this change.Forms in GeneralCan you provide forms to us in enough time to update all EMR forms? I am getting frustrated being dinged on audits because of date changes only that were not communicated to us.What is the rationale for changing dates on all forms when one significant change is made? It puts a significant burden on the programs. They either have to copy all new forms or do program changes in an EMR. The level of burden on programs and providers does not seem to be a consideration when decisions are made.(This response applies to questions #1 through #2 above.) When forms are changed on an annual basis, they are all re-dated with the same new date, even if they were not otherwise modified in any way. This is in order to have consistent records in all charts for certification review purposes. Agencies have three months to incorporate the new forms before they become effective (required).Please review all the MIHP forms and remove/correct all the mistakes.We’re in the process of doing this.Do agencies have to keep a copy of the electronic record in the chart or can it be printed on a “need to know” basis?Agencies can maintain an all-electronic chart and print documents out on a need-to-know basis.When testing new forms would be nice to offer testing in the UP. Our site cannot afford to go to Lansing and we have many comments and suggestions each time new MRI or IRI comes out.We will be offering testing opportunities for providers in the UP in the future.Quality ImprovementNOTE: All of the recommendations below have been provided to the MIHP Quality Improvement Coordinator for consideration as she develops the MIHP QI plan.Quality ImprovementThere is no excuse for not having the new IRI ready for preview at this coordinator meeting, along with the instructions.Another mistake is on page 14 of March Coordinator training under IT updates. Ingrid said the new IRI would be available to go live on 3/27/15 @ 7 pm. That’s not what the paper says.Reduce constant changes in process and paperwork.All consultants should say the same thing.Too many little rules allow the big picture to get lost.Let the free market reduce the # of MIHPs and make recertification a reasonable process. Your own operations would never meet any reasonable review – you guys at the state level are constantly making errors and issuing corrections. Very, very frustrating.Make the coordinator’s meetings all program info and not CEU credits. Some program coordinators are not even SWs or RNs.Review changes for each cycle (i.e., 4 to 5) at the Program Coordinator meetings…Duh!QI SuggestionsExtend recertification timelines to longer than 18 months.Put communications in writing – especially policy-related.Decrease # of changes/revisions made to forms after released 10-01-14, etc.Please date all new forms.Let us know when you change forms. NOTE: We do notify you when we change forms. We request feedback from the field for the first month after the forms are issued and use it to revise and finalize them. Don’t make too many copies of the first set of forms. Wait for the final versions.Please communicate with coordinators when things are added to the web site (trainings, resources, etc.).Please communicate with coordinators when forms are revised on the web site. Otherwise, how do we know changers were made? Forms do not have revision dates.Form an Advisory Committee with coordinators.QI suggestion: Stricter requirements on becoming a new MIHP provider.QI: More ability for SSO to transfer information from one form to another automatically. Too many repetitive questions.QI:Include client interviews in the review process.Risk domain levels can be very confusing. Would it be possible to have just identified risks rather than risks with multiple levels? Sometimes the interventions at the appropriate level don’t’ fit the client situation and home visitors think they are helping the family and it can make reviews and coordinating with the doctors difficult.Please take a statewide survey gathering info about FTEs, caseloads, productivity goals, ROI. Thanks. Not to create standards but for benchmarking (great MPH intern project!). Developing best practice recommendations.QI recommendation: Electronic records for all MIHP forms – web-based – every program on one software system or ability to download into state system (similar to MI-WIC) ASAP.Any consideration for moving MIHP to web-based documentation?Is there a future plan for MIHP programs to submit materials electronically prior to review?Quality: Cert Tool for Cycle 6 – require chart review tools for chart review for each agency to be seen at cert review. In other words, require MIHP providers to show proof of chart reviews.Are there any tools for beneficiary evaluations? What do other MIHP providers use/ask? Part of QI in future?Software that promotes quality. For example, domains and risk levels that are recorded on MRI & IRI should auto-populate discharge summary.Long-term: Web-based programs for total record documentation. This would also ensure all interventions could auto-populate.Is there a plan to change certificates required for certification? If an agency has 0 unmet re: certificate requirement for immediate past review, can a change be made so only new staffing certificates need to be sent? NOTE: For a brief period of time we experimented with allowing agencies that had a conditional 6th - month review to provide less documentation but we determined that it compromised the quality of the review. Medicaid Breast PumpsI was told by a local DME provider that they could ONLY provide breast pumps to:A woman who is NOW working after having a baby orA diagnosis that warrants use of pump only if diagnosis supports it – being pregnant/having a baby is NOT considered a “need”Breast pumps are available to Medicaid-eligible beneficiaries (MSA Bulletin 14-60). A diagnosis is required and documentation of intent to breastfeed is an acceptable diagnosis.Are we concerned that providing breast pumps will cause unintended consequence of decreasing the # of woman who actually put baby to breast (which decreases milk supply and length of breastfeeding)? Will MDCH be keeping stats on this?No, the intent is to encourage breastfeeding. MDHHS currently assesses breastfeeding rates and will continue to do so.ReimbursementWould Medicaid consider reimbursing visits at a higher rate when serving non-English speaking families with an interpreter? We pay for both MIHP staff and interpreter. Visits are most often lengthy due to the need to interpret both MIHP provider and client. Or would Medicaid health plan cover these services?No, there are no plans to change reimbursement rates based on client needs at this time. All Medicaid providers are required to have a means for providing services to non-English speaking families. If serving a baby with visits usually completed with MOB, are we able to bill for complete services if MOB is not home when we go for the visit and dad (FOB) or grandma is there and they request the visit be completed with them? Do we need MOB consent to complete the visit?At this time, you are not allowed to bill for services if the caregiver is not present. Mechanism for reimbursement for providing reflective supervision.No, there is no mechanism at this time.Will Medicaid ever increase the amount of payment of MIHP assessments (RI) and visits?Medicaid will continue to evaluate reimbursement rates for providers. No changes in reimbursement rates will be made at this time.When will Medicaid start reimbursing for MIHP discharge summaries? Staff spends a significant amount of time completing these very long summaries with no reimbursement for this time. This is a financial strain on the providers of this program. It can take 30-45 minutes to complete a d/c summary and should be reimbursed similar to that for conducting a RI.Payment for the development of Discharge Summaries is currently incorporated into the design of the program.Increase the number of home visits to high-risk mothers.Consideration is being given to the number of allowable visits within the program.Same-day visit, increase to two disciplines, ex: SW visit and RD visit.As discussed in the provider newsletter dated 12-13, The Center for Medicaid Services does not allow providers to bill for two disciplines on the same date of service utilizing 99402. For this reason, Medicaid will not reimburse for two professional visits on the same date of service.Can MIHP providers bill for ASQ & SE assessments? Will Medicaid consider this option?No, not at this time.TransportationAre MHPs required to provide “emergency” transportation, i.e. same day?If a client has an urgent appt w/in the notice period, too short for a health plan to respond, what can we do? Are you saying that we cannot arrange transportation for her, no matter how sick her baby is and no matter that the doctor said to come in IMMEDIATELY?If the MCO refuses urgent transportation for a beneficiary, are we able to provide that service (e.g., taxi) and bill for it?(This response applies to questions #11 through #13 above.) The Bridges Administrative Manual BAM 825 states that Medicaid Health Plans are required to assure that the need for transportation to medical services is met. Please refer to the beneficiary’s MHP for specific guidelines related to emergency transportation services.Could you please clarify transportation that is ok to provide for parenting classes? Can parenting classes be for a first-time mom during pregnancy? It was recently explained to us we should not have provided transportation to a mother going to parenting classes during pregnancy.MIHP may provide transportation to attend CBE classes and parenting classes. Childbirth education classes are intended for the pregnant beneficiary. Parenting education classes are intended for the parent of an infant beneficiary. Transportation issue – there is no centralized phone center for non-English patients which makes it difficult/impossible to arrange transportation over the phone.MIHP providers can assist the beneficiary with contacting the Medicaid Health Plan to arrange transportation services. There is no centralized phone center at this time. We have contracts with health plans to provide services. They receive a large amount of funding to meet their client’s needs. Why is it so hard then, to get them to make needed changes (i.e., transportation glitches) that we need them to make to better serve families?We encourage you to communicate with a MHP when barriers arise and to contact your consultant with the details if the barriers are not resolved.Eligibility ProblemsWe are still having problems getting infants on Medicaid. Some of our infants are dropped off Medicaid during their first year of life.Infants born to Medicaid-eligible moms are automatically Medicaid-eligible at the time of birth. When eligibility concerns arise, the beneficiary should contact her caseworker at the local MDHHS office, with your assistance, if needed. If the issue is not resolved, please contact your consultant and provide her with the necessary details (caseworker and beneficiary ID#) to follow up with an investigation.Since DCH and DHS became one (MDHHS), can we work together to solve Medicaid eligibility problems for our Medicaid patients so no one will be cut off at middle of pregnancy? Please.MDHHS looks forward to working together as a team to decrease barriers for all Medicaid-eligible individuals in the state.OtherWhat is the avenue for receiving referrals for MIHP services for the Healthy Michigan Plan?Referrals come from MHPs.Training and TAWeb SiteIs information/teaching/instructions going to be available on the Discharge Summary and POC 2 levels on the website?We are in the process of updating the instructions and will post them on the web site.Can there be a “search” button on the web site?There is a search bar on the web site on the upper right side of the page.Online TrainingFor the state-created webinars, it would be really nice to have highlights from it in writing as well as an outline. It is difficult to go back to reference a 2+ hour webinar.We are developing forms instructions for all of the MIHP forms and will post them on the web site.Have folks be able to pay for CEUs if desired thru the web site rather than eliminating them We will continue to offer CEs for some online trainings free of charge.The training videos are not very clear to understand.The new online staff training videos:Slides do not match what’s being discussedThe SSO portion is too hard/small to seeThe volume is too lowLeaves staff with more questions than answers(This response applies to questions #5 through #6 above.) We are working to improve training videos.Will staff be expected to complete the updated Smoke Free Baby and Me course if they completed the original course?No, only new staff will be required to take the updated course.PowerPoints at Coordinator MeetingsFor the printouts of the presentations – can they be printed in a way that is easy to be read? Black background with yellow text is very difficult to read. Same with graphs that print out to grey and are intangible on the printout.Use bigger print on slides both on screen and in print. Important more so in print as very hard to read which limits chance of referencing materials or sharing with colleagues.(This response applies to questions #8 through #9 above.) We are working on this.Can the PowerPoints be sent to us after the meetings so that we can read them and used data points to educate staff?Yes, they will be posted on the web site.Coordinator MeetingsThese meetings should be open to staff in addition to coordinators.Is it possible to have virtual coordinator meetings online (raise “hands” for questions) but still pay $25 to enter the room? MORE STAFF COULD ATTEND. It is very expensive to travel 2 times per year.It’s not realistic to think coordinators can pass on everything that gets stated at these meetings to their staff.(This response applies to questions #11 through #13 above.) We are restructuring our coordinator training format. Starting in 2016, all staff will be able to access two live webinars each year. These webinars will replace one of the two face-to-face coordinator meetings we have been facilitating annually. We will still facilitate one face-to-face coordinator meeting each year (in June), to which each agency may send two staff.The timeframe for these meetings is TOO LONG. Planning a day this long is truly disrespectful to BOTH participants and presenters. It is not possible to keep focused for this amount of time. Many/all participants have to drive a minimum of 1 hour each way with some driving 2+ hours each way. This concern has been voiced multiple times with no change. PLEASE reconsider as the day loses its value.We have heard you and we will be ending the meetings at 4:00 ics for Future MeetingsSpecific information on ICD-10 codes for MIHP visits is needed for the program to direct staff on what codes they should be choosing. When will MIHP receive training?Can you provide a list of the ICD-10 codes that will be applicable to MIHP services?Can you send an email reminding us which workshop covered ICD 10 last year so we can review soon? We need this info before Sept 2015.ICD-10 coding – will there be a listing available to providers for MIHP? Before the Sept training?(This response applies to questions #15 through #18 above.) As a Medicaid provider, it is your responsibility to acquire coding information. You are encouraged to go to the ICD-10 section on the CHAMPS web site for ICD-10 online training, documents and other resources. There will not be an ICD-10 training session at the September coordinator meetings. You will need to gear up ASAP so you are ready to go on Oct. 1, 2015.NOTE: We will consider the topics listed in #19 - #24 below as we plan future coordinator ics for future (MB – caring & sharing):Trauma and Chronic Stress (Great Start Collaborative focusing on this and asking us what we do in MIHP with moms and babies)WIC (qualifiers/packages/eligibility/RD breastfeeding liaison)Children’s Special Health Care Services (qualifiers/what they do). Early Head Start (Are they the same in every county across the state? Maybe a speaker about what they do? Curriculum/evidence-based? Referrals? Waiting lists?)DHS & Medicaid (How do caseworkers know a woman is pregnant so she doesn’t cancel the pregnant woman’s Medicaid? Maybe a speaker on that – still a problem, even though we meet with DHS locally.) QI?Supports/Billing Q&A session for our person who does our billing. A chance to meet with someone else who does the billing in a similar county.Suggestions for training topicsLeadershipMarketingQuality AssuranceHelping Workers Get in the DoorTraining suggestion: suicide/self-harmBilling person specifically versed in MIHP (codes & stuff) to answer questions.Not just housing but specifics: how Section 8 works, how homeless vouchers work, specific income limit limits, etc.Realistic housing resources.Educational Materials and Guidelines NeededIdentified a need for more educational materials for nutrition.Is the patient ed packet going to be updated soon?(This response applies to questions #25 through #26 above.) We are reviewing the potential of revising/updating the MIHP educational packet.It would be very helpful to have specific nutrition education materials and breastfeeding education materials.The American Academy of Pediatrics at and the United States Department of Agriculture at are both sources of current and relevant information and resources related to nutrition, including breastfeeding. Information on breastfeeding for African-American women is available at itsonlynatural/.Also, there are breastfeeding materials on the MIHP web site and MDHHS is developing a breastfeeding web site. Additional information on breastfeeding will be provided at the September, 2015 coordinator meetings.Clients continue to become pregnant again, even though birth control is addressed at every visit. Suggestions please.One suggestion would be a referral to a family planning clinic for contraceptive services and excellent information and education. See MIHP web site for directory of Title X clinics around the state. As presented at the March 2015 coordinator training, another suggestion would be to encourage LARC (Long Acting Reversible Contraceptive) methods (Quess Derman, Reproductive & Preconception Health, MDHHS). For more information, access the MDHHS Family Planning web site at familyplanning.How are challenges of professional boundaries of staff being addressed? Are there written guidelines?We suggest you look to your own professional code of conduct.Can you mention now that you will give us a fact sheet for our website?The MIHP fact sheet is posted on the web site. However, it is currently being updated. Please clearly identify the expectations for completing both MIHP consents (Participation in MIHP and Release of PHI). Mom open in pregnancy and baby open at birth (family chart).MultiplesWhen opening infant (not open to mom prenatally).There is a # of differing recommendations in print (Ops Guide, Forms Instruction Sheet, etc.).Forms instructions are in revision and will address consents.Personnel Roster Guidelines DO NOT specify which form is to be used – or that it will only be accepted if you use the right form!We’re looking at the feasibility of revising the Personnel Roster to make it more user-friendly.ALL MIHP requirements should be in writing. It is fine that you give us verbal instructions but it is really important to have all instructions/requirements in the Operations Guide.It is our plan to update the Operations Guide on an annual basis.Do updates like Medicaid – have policy out there, then when you update it, highlight that and date it! Don’t make changes so often!Coordinator emails function as notification of changes that will be documented in the Operations Guide the next time it is revised. The effective date of a particular change is as stated in the coordinator email. We will add a heading to coordinator emails to clearly designate operational changes with effective dates. Other Training & TAWhen we do the RI in Sept, may be a good time to collate all real and/or perceived problems and take that opportunity to update literature and algorithm.We’re looking into the feasibility of conducting another literature review which may result in changes to the Risk Identifier.Is MIHP staff eligible to come to the Home Visiting Conference? When? Where?Yes, MIHP coordinators and staff are eligible to participate in the Michigan Home Visiting Initiative Conference on Aug 6-7, 2015, at the Detroit Marriott at the Renaissance Center. This year, there will be a $25 fee per person, which covers both days of the conference.Conference registration information was included in a coordinator email.FYI: Many programs can only attend one conference this summer. It would be nice if Joni’s Postpartum Support International Conference presentation, she would also present at the home visitation conference.We’re considering ways this presentation may be provided.Please consider allowing coordinators to post questions to and then consultants review and answer/post questions/answers in coordinator emails.This is under consideration.ASQ – please clarify if we are supposed to age-adjust if an infant is born at 37 weeks. If so, please change language in Operations Guide.For the ASQ-3, adjusting the age for prematurity is necessary if a child was born more than three weeks before his or her due date (at or below 37 weeks gestation) and is chronologically under two years of age. An easy way to adjust for prematurity is to use the ASQ-3 Age Calculator at . OtherThere needs to be an MIHP Advisory Group! Please work on this.The new Maternal Health Unit Manager is taking this under consideration for the future.Interconception Care: When counseling women after a loss or poor outcome, what words do you use so as not to imply blame for the loss or poor outcome?There are online resources to help with this. We suggest the March of Dimes at # and Tomorrow’s Child at .Appoint a designated physician (per county) to support MIHP with standing order signature.Each MIHP provider is responsible for obtaining any orders required by Medicaid policy.When is MIHP initiating the promotional media blitz?There are various projects in process, including a press release on the next MIHP research article that being published by MSU.What about vapor cigarettes?Go to The American Academy of Pediatrics (AAP) web site at and type“e cigarettes” in the search bar for a wealth of information on this topic.Are agencies required to have interpreters for non-English speaking clients?What if no other local MIHP agencies serve non-English speaking clients?Per Cert Tool #19, agencies can refer to other programs & Op Guide pg. 53.They would have the same access to interpreter services as we would.You must serve beneficiaries in one of the three ways specified in the Cert Tool, #19. If you don’t have staff who speak the beneficiary’s language, you may refer to another MIHP agency that specializes in serving beneficiaries who speak that language – make sure you arrange the referral – don’t just hand the beneficiary a phone number. If you don’t have staff who speak the language and there is no other MIHP that specializes in serving beneficiaries who speak that language, then you are absolutely required to arrange for interpreter services. We discuss immunizations at visits but how do we know if infant/child is up to date? Is it possible for MIHP to get MCIR access in the future? QI?Only entities that give immunizations or pay for immunizations (e.g., Medicaid Health Plans) can have access to MCIR. You can contact the beneficiary’s medical care provider for info about the immunizations that the beneficiary has received to date.Walk for MIHP around Zoo for moms & babies/families. This sounds like a wonderful idea for a local coalition of MIHPs to raise awareness of the program. Ask questions and answer pg #s picsWe don’t know what this means. ................
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