Community healthchoices direct service provider online ...



Community HealthChoices Direct Service Provider ModuleTable of Contents TOC \o "1-3" \h \z \u Welcome PAGEREF _Toc16231690 \h 1Resources PAGEREF _Toc16231691 \h 1CHC Direct Service Providers PAGEREF _Toc16231692 \h 1Overview PAGEREF _Toc16231693 \h 1Course Objectives PAGEREF _Toc16231694 \h 1Key Concepts PAGEREF _Toc16231695 \h 1Program Goals PAGEREF _Toc16231696 \h 1MCOs PAGEREF _Toc16231697 \h 2Selection and Transition PAGEREF _Toc16231698 \h 2Participant Transition PAGEREF _Toc16231699 \h 3Who enrolls in CHC? PAGEREF _Toc16231700 \h 3The LIFE Program PAGEREF _Toc16231701 \h 3Who is not eligible? PAGEREF _Toc16231702 \h 3Enrollment Process PAGEREF _Toc16231703 \h 4Knowledge Check One PAGEREF _Toc16231704 \h 4Roles and Implementation PAGEREF _Toc16231705 \h 5Provider’s Role PAGEREF _Toc16231706 \h 5Implementation Timeline PAGEREF _Toc16231707 \h 5Implementation Sequence PAGEREF _Toc16231708 \h 5DHS Role PAGEREF _Toc16231709 \h 6MCO Role PAGEREF _Toc16231710 \h 6MCO Provider Manual PAGEREF _Toc16231711 \h 6MCO Training PAGEREF _Toc16231712 \h 7SC Role Moving Forward PAGEREF _Toc16231713 \h 8What’s Included? PAGEREF _Toc16231714 \h 8Needs Assessment Process PAGEREF _Toc16231715 \h 8Requests for Comprehensive Assessments PAGEREF _Toc16231716 \h 9Person-Centered Service Plan PAGEREF _Toc16231717 \h 9What about NHT? PAGEREF _Toc16231718 \h 9First Time LTSS Enrollment PAGEREF _Toc16231719 \h 10Provider Enrollment and Contracting PAGEREF _Toc16231720 \h 10Providers and Participants PAGEREF _Toc16231721 \h 10EVS PAGEREF _Toc16231722 \h 10Issue Resolution PAGEREF _Toc16231723 \h 11Communication PAGEREF _Toc16231724 \h 11Services beyond PAS and Home Healthcare PAGEREF _Toc16231725 \h 11Knowledge Check Two PAGEREF _Toc16231726 \h 12Maintaining Standards and Safety PAGEREF _Toc16231727 \h 13Quality PAGEREF _Toc16231728 \h 13Incident Management PAGEREF _Toc16231729 \h 14EVV PAGEREF _Toc16231730 \h 14Handling Disputes PAGEREF _Toc16231731 \h 14Knowledge Check Three PAGEREF _Toc16231732 \h 15Summary and Next Steps PAGEREF _Toc16231733 \h 16Providers PAGEREF _Toc16231734 \h 16Final Thoughts PAGEREF _Toc16231735 \h 16Register Completion PAGEREF _Toc16231736 \h 16WelcomeResourcesMany website links are mentioned in this module. To ensure that the links remain accurate and active, we have placed them in a separate document on this website.Whenever a link is available in the Resources Document, the following bar will be displayed in the training module, usually at the bottom of your screen.CHC Direct Service ProvidersWelcome to Community HealthChoices direct service provider training.OverviewThe Department of Human Services developed this training to prepare HCBS (home and community-based) Waiver direct service providers for the transition to managed care for long-term services and supports. If you have not had a chance to complete the Community HealthChoices Overview online module, please do so. The overview module focuses on the Community HealthChoices (CHC) program’s goals and benefits from the participant and stakeholder standpoint. Those elements are essential to your ability to prepare for and work within a managed care approach.Course ObjectivesIn this training, we’ll focus on roles of providers during the transition and after implementation and on how providers can help prepare participants during the transition and implementation of CHC, and to successfully participate in the managed care approach. To do this, you’ll review the role of providers in the transition period, the ongoing role of providers, new elements in enrollment, services, support, and monitoring, responsibilities of managed care organizations (MCOs), and next steps for providers.Key ConceptsBefore we dive in, let’s review key concepts of managed care from the CHC Overview module.Program GoalsThe program enrolls adults who are eligible for both Medicare and Medicaid, or currently live in a nursing facility paid by Medicaid, or are receiving long-term service and support through OLTL Medicaid home and community-based waiver programs and are not enrolled in the LIFE program.Specific goals of the program are to:Enhance opportunities for community-based services,Strengthen healthcare and long-term service and support delivery systems,Allow for new innovations,Promote the health, safety, and well-being of enrolled participants, andEnsure transparency, accountability, effectiveness, and efficiency of the program.MCOsTo achieve these goals, the managed care organization (MCO) is a central point of administration, coordination, and accountability. There are three Community HealthChoices MCOs in Pennsylvania:AmeriHealth Caritas, which is called Keystone First in the Southeast,Pennsylvania Health and Wellness, andUPMC Community HealthChoices.If you’d like to learn more about the individual MCOs, please check out the CHC Resources Document. The Resources Document has contact information, emails, and websites for the MCOs.Selection and TransitionAll eligible individuals will be asked to select one MCO when they enroll. Each MCO is accountable for having an adequate network of providers.In addition, during a 180-day transition period, MCOs must contract with all qualified and willing providers. (The choice of the 180-day transition period was based on best practices discovered by the 22 other states that have implemented managed care for long-term services and supports, or MLTSS.)The 180-day transition ensures that participants can keep their current service coordinators and HCBS providers to give continuity of care during the transition. In order for waiver participants to keep their existing service coordinators and providers, those organizations must contract with the MCOs.If your organization has not already contracted with one or more MCOs, a key next step for providers is to contact the MCOs to start the contracting process.Waiver participants’ service plans will remain in place during the transition unless there is a change in their condition, environment, or set of assessed needs. Service coordination will become an administrative function of the MCO. MCOs may contract with service coordination entities to provide these services, or they may hire service coordinators directly.If you’d like to learn more about the individual MCOs, please check out the CHC Resources Document. The Resources Document has contact information, emails, and websites for the MCOs.Participant TransitionYou might be wondering who of your participants are going into CHC. We’ll take a look at that next.Who enrolls in CHC?Who can enroll in CHC?Individuals who are 21 years old or over, are enrolled in Community HealthChoices if they are receiving:Both Medicare and Medicaid. This is called dual eligible.Long-term services and supports, known as LTSS, through the Attendant Care, Independence, COMMCARE, or Aging waivers,Services through the OBRA Waiver and are nursing facility clinically eligible, orCare in a nursing home paid for by Medicaid.Eligible individuals age 55 and older may choose to enroll in CHC or they may choose to enroll or remain in a Living Independence for the Elderly (LIFE) program. The LIFE program features a managed care approach as well.The LIFE ProgramThe LIFE program is a capitated managed care model that fully integrates comprehensive long-term care services and supports, behavioral health, and physical health services to Medicare or Medicaid participants.To be eligible for LIFE you must:Be age 55 or older,Be nursing facility clinically eligible,Live in an area served by the LIFE program, andBe able to be safely served in the community.The program is based on a national program called the Program of All-Inclusive Care for the Elderly. The program focuses on individuals living independently in their home and communities for as long as possible. LIFE will continue to remain an option for eligible individuals alongside CHC.Who is not eligible?Individuals are NOT eligible for Community HealthChoices if they are:Receiving long-term services and supports in the OBRA waiver and are not nursing facility clinically eligible,A person with an intellectual or developmental disability who is receiving services beyond supports coordination through the Department of Human Services’ Office of Developmental Programs, orA resident in a state-operated nursing facility, including the state veterans’ homes.Enrollment ProcessTo start the CHC enrollment process with participants, the Department of Human Services (DHS) will send a letter to them within 90 days of implementation in each zone. The letter will outline the transition process. Participants (and nursing home residents) will be contacted by Pennsylvania’s independent enrollment broker (IEB). The IEB will step individuals through the process of selecting an MCO. The decision tree is based on what the participant’s priorities are in terms of services, preferred providers, current needs, and others.MCOs will be accountable for services and coordination as of the implementation date. If participants do not select an MCO, an MCO will be selected for them based on their current needs, providers, and services. Participants may change their MCO at any time.Knowledge Check OneNow check your understanding of what’s been covered so far by answering these review questions.1. True or False? Participants who are currently enrolled in LIFE must move to CHC.Please pause.The correct answer is False. LIFE participants may opt to stay in the LIFE program or move to CHC.2. True or False? Participants must determine if they are affected by CHC.Please pause.The correct answer is False. DHS will notify individuals who will transition into CHC. In addition, the IEB will follow up with eligible individuals.3. True or False? CHC-MCOs are required to contract with all qualified and willing HCBS providers during the transition period.Please pause.The correct answer is True. CHC-MCOs are required to contract with all qualified and willing HCBS providers during the transition period.4. True or False? Once a participant selects an MCO, the participant cannot change the MCO until the next annual reassessment.Please pause.The correct answer is False. Participants can change MCOs at will. MCOs manage that process.Roles and ImplementationSo, what is the role of providers in the transition process? Let’s talk more about that next.Provider’s RoleYour role is to educate participants about the program and processes, answer questions, and encourage participants to make an informed choice of MCOs— essentially demystifying the process. Changes like this can be daunting. Service providers have regular interactions and solid relationships with waiver participants. This puts you in a great position to help educate participants about the process and discuss the transition in your daily conversations.You can let them know when CHC will begin, that they’ll receive a letter from DHS, the role of the IEB, the importance of their choices, new services available to them, and everyone’s commitment to continuity of care.Another role of providers is to contract with the MCOs. MCOs are required to contract with all qualified and willing providers for the transition period. To ensure that waiver participants can continue to receive services from you, please be proactive in contacting and contracting with the MCOs. The Resources Document has contact information, emails, and websites for the MCOs.Implementation TimelineLet’s review the timeline from the CHC Overview online training.Pennsylvania is rolling out the program in stages. The Southwest zone was first with an implementation date of January 2018, followed by the Southeast zone in January 2019, and finally by the Northwest, Northeast, and Lehigh/Capital zones in January 2020. This allows adequate time for individuals, families, nursing facilities, service coordinators, and service providers to prepare for the change.Implementation SequenceDHS will provide training and outreach to educate participants prior to transition. The training and outreach is multi-modal, including local events, online training, educational materials, and webinars. People will need to hear about this process more than once.Let’s look at the process steps.Awareness FlyerThe sequence starts with awareness flyers sent to participants. The flyers include contact information for a dedicated CHC participant hotline.Local EventsNext, local events are scheduled 2-3 months prior to implementation to educate participants.Separate educational events will be scheduled for service coordination entities, direct service providers, and nursing facilities.Pre-Transition Notice & Pre-Enrollment PackageThen, DHS will send a pre-transition notice that informs participants that they will transition to CHC and that the independent enrollment broker (IEB) will send them a pre-enrollment package.MCO SelectionNext, the IEB will work with the participant to identify the MCO that best meets their needs. They will also receive information about the LIFE program.MCO Participant MaterialsOnce the participant selects an MCO (or is assigned an MCO if no selection is made), the MCO will send the participant a package with their participant identification card and information about next steps.DHS RoleDHS’s priorities through implementation and transition are:No interruption in participant services, andNo interruptions in provider payments.DHS has engaged with MCOs in rigorous readiness reviews that included a focus on having enough providers and having information technology systems in place to ensure service tracking and payments. MCOs are responsible for providing training on systems and processes.Throughout the transition period, DHS will monitor closely for continuity of participant services and continuity of provider payments.MCO RoleMCOs have specific roles in the transition period as well. In addition to being the single point of accountability for services, MCOs are required to:Perform participant assessments, including assessments for those who do not currently receive long-term services and supports,Contract with all willing and qualified providers,Provide training to providers in terms of how to use their billing and monitoring systems, andReport to DHS on continuity of care and provider payment outcome measures.MCO Provider ManualMCOs must keep its network providers informed and up-to-date with the latest policy and procedures, as they affect the MA Program. MCOs must develop and maintain a provider manual. The provider manual must be distributed in a manner that is easily accessible to all network providers. MCOs may specifically delegate this responsibility to large providers in its provider contract. The Provider Manual must be updated annually. The Department may grant an exception to this annual requirement upon written request from the MCO provided there are no major changes to the manual.The MCO must submit its Provider Manual and annual updates to the Department for review and prior approval.MCO TrainingMCOs must develop and maintain a provider network that is knowledgeable and experienced in treating and supporting participants in CHC. Training is a key element of meeting these requirements.The MCOs must submit and obtain prior approval from the Department of an annual provider education and training work plan. The work plan must outline its methods to educate and train network providers, including its process for measuring outcomes, tracking schedules and documenting attendance.MCO Training AreasMCOs must conduct training in the following areas.Needs screening, comprehensive needs assessment and reassessment, and service planning system and protocols and a description of the provider’s role in service planning and service coordinationService coordination and how providers fit into the person-centered planning approachPopulation being servedAccessibility requirementsApplication of the definition of medically necessaryInformation about Alzheimer’s disease and related dementiasIdentification and referrals for mental health and drug and alcohol/substance abuse servicesDiverse needs of persons with disabilities (e.g., how to work with sign language interpreters)Policy against discriminationCultural, linguistic, and disability competency & special needsAdministrative processesIssues identified by provider relationsQuality management processes and issuesProcess to submit materials to the CHC-MCO for utilization review and Prior Authorization reviewComplaint, grievance, and DHS Fair Hearing and Appeals processPerformance Improvement Projects (PIP) and how providers benefit Dual eligibility for Medicare and Medicaid and coordination of services for eligible participantsSC Role Moving ForwardOk, so we’ve covered the provider, DHS, and MCO roles in transition. What about service coordination moving forward beyond transition?The basic tasks and goals of service coordination remain the same: assisting participants in accessing needed long-term services and supports. Moving forward, the role and scope expand. The objective of service coordination is support for CHC program participants, specifically those individuals in need of long-term services and supports, and those with unmet needs, in the following ways:The identification of needed services through the comprehensive needs assessment process.The assurance of appropriate service delivery. Service delivery must support both a participant’s needs and their preferences. This is accomplished through the management of the person-centered planning process and the development and implementation of the participant’s person-centered service plan. The coordination of the participant’s long-term care services with all of their other services including those provided by Medicare, Medicaid physical health, and behavioral health.What’s Included?Under CHC, service coordination includes: activities to identify, coordinate, and assist participants in obtaining access to needed health services and in-home supports, as well as social and housing services needed to help participants live in their communities. In terms of housing, SCs will oversee pre-tenancy and transition services for housing, and will assist in obtaining and retaining housing. Pest eradication, a barrier to retaining housing currently, is included in the CHC program.Under CHC, a service coordinator (SC) is the MCO’s designated, accountable point-of-contact for each participant receiving long-term care services. This is a benefit to participants and their families. There is a single “one call” approach to all physical, cognitive, and long-term services and supports.Needs Assessment ProcessMuch like the current process though, service coordination, planning, and delivery is based on health screenings and the comprehensive needs assessment. There are several elements to the process under CHC. First, let’s look at individuals who are dually eligible for Medicare and Medicaid but do not currently receive long-term services in a facility or through waiver services. Within 90 days, MCOs will conduct health screenings of these individuals. If the MCO believes that the individual needs LTSS, the MCO will refer the individual for a functional evaluation to determine if the person is nursing facility clinically eligible, NFCE. This “functional eligibility determination,” or FED, fulfills the same role as the current level of care determination, or LCD. Current waiver service participants are already NFCE and will not need to be screened for this.Requests for Comprehensive AssessmentsFor participants receiving waiver services or residing in a nursing facility, the MCOs will perform comprehensive needs assessments. The MCOs are required to perform reassessments annually to inform the person-centered service plan.Participants can also request one based on their self-identifying needs or if they experience a change in condition or environment. MCOs can perform one when their team observes changes in a participant’s needs, conditions, or environment. As always, it is important for participants to take as active a role in the process as possible and work with MCOs and assessors to ensure that all needs and preferences are identified accurately. The assessment process lays the foundation for effective service planning and delivery.Person-Centered Service PlanOnce needs are assessed and identified, the MCO is accountable for planning services. Each CHC participant will have a person-centered service plan, PCSP. This plan may include both care management and long-term service and support, LTSS. (Remember, not all CHC participants need long-term services and supports. Current waiver participants will have both.)PCSPs must be developed by the service coordinator, the participant, the participant’s representative, and the person-centered planning team.The planning team may include providers, caregivers, family members, physical health providers, primary care physicians, specialists, behavioral health providers, direct care workers, and others as needed.What about NHT?What about CHC participants in nursing facilities who want to move into the community?Nursing home transition, known as NHT, is an administrative role for the CHC-MCOs. This will work to close current gaps between NHT and service coordination functions. MCOs provide NHT activities to participants residing in nursing facilities who express a desire to move back to their homes or other community-based settings and cannot do so through the normal discharge process because of identified barriers.First Time LTSS EnrollmentWhat about participants enrolling for the first time to receive LTSS through CHC? The LTSS enrollment process will still be managed by the independent enrollment broker, or IEB. The requirements are similar. Let’s review the requirements.Physician’s CertificationThere is a need for a physician’s certification of a medical condition or disability and a physician's determination of level of care.Functional Eligibility Determination (FED)There is a functional assessment to determine whether the applicant meets nursing facility level of care or is nursing facility ineligible. This is called the functional eligibility determination.Financial EligibilityThe County Assistance Office (CAO) still determines financial eligibility.Enrollment and SelectionOnce an individual meets the eligibility requirements (clinical-including the physician’s certification and FED assessment, and financial) the person is enrolled in CHC. The person selects an MCO during the enrollment process. CHC and MCO support starts the day after the participant has been determined to be eligible for the program.SummaryIn addition, moving forward, the IEB will manage intercounty transfers, waiver program transfers (such as OBRA to CHC), MCO transfers, and disenrollment.Provider Enrollment and ContractingWhat is the process to enroll with MCOs?First, providers must be enrolled with Medicaid for all services that they wish to provide under CHC. Next, providers contract with MCOs. Please note that MCOs must be enrolled with Medicaid as well.The Resources Document has contact information, emails, and websites for the MCOs.Providers and ParticipantsDoes the provider role with participants change? Not really.EVSThe Eligibility Verification System, otherwise known as EVS, will stay in place with CHC implementation. Providers are required to ensure that participants are eligible before rendering services. EVS methods, inquiry, and response formats will not change. EVS will display the MCO, plan code information, third party liability and the participant’s primary care physician. For more information, please reference the Provider Quick Tip #11. The Resources Document has a link for the Quick Tips.Issue ResolutionLines of communication for participants are the same. Participants are encouraged to discuss and resolve issues locally with providers and service coordinators first. MCOs are required to have complaint and grievance processes that include tracking and reporting. MCOs must support the Medicaid fair hearing process. Participants will still be able to call the participant hotline for unresolved municationPAS and home healthcare providers have the most contact with participants. You can help participants adjust to the change.Encourage them to participate in stakeholder engagements in meetings and online.Give them reminders about CHC information that will be coming in the mail.Encourage them to read materials and field questions as you can. Note hotline numbers that they can call for more information.Encourage them to make informed decisions and select an MCO by the deadline in their area.Services beyond PAS and Home HealthcareMCOs must cover services beyond PAS and home healthcare. The following are some services the MCO covers. PERSMCOs are required to cover Personal Emergency Response Systems (PERS) and the systems are subject to the continuity of care provision.After the continuity of care period, MCOs can determine their PERS provider networks. PERS providers must enroll with Medicaid/MA and contract with MCOs.Home modificationsMCOs must cover home modifications. Home modifications are also subject to the continuity of care provision.After the transition period, MCOs can determine their home modification provider networks.Other vendor servicesMCOs are required to cover vendor services and are subject to the continuity of care provision.Services include:Home-delivered mealsVehicle modificationsNon-medical transportationCommunity transition servicesAssistive technologySpecialized medical equipmentAfter the continuity of care period, MCOs can determine their provider networks. Providers must enroll with Medicaid/MA and contract with MCOs.Participant-directedParticipant-directed services, including Services My Way, will continue and MCOs will offer the option to participants.The MCO service coordinators will perform the same tasks as they do under the current system.Identifying the type, scope, amount, frequency, and duration of servicesMonitoring services to ensure health and welfareFMSFinancial Management Services (FMS) will continue as it does today.MCO service coordinators will work with FMS and the participant to ensure:The plan is fulfilledDirect care workers are paid and managed according to regulationsThe participant’s health and welfare are maintainedKnowledge Check TwoNow check your understanding of what’s been covered so far by answering these review questions.1. True or False? DHS must approve each CHC-MCO’s provider education and training plan.Please pause.The correct answer is True. MCOs are required to train providers in a number of subject areas. The plan is part of the initial readiness review. It must be updated and submitted annually.2. True or False? The entire commonwealth switched to CHC on January 1, 2018.Please pause.The correct answer is False. The Southwest Zone was first; followed by the Southeast Zone in January 2019; and finally the Northwest, Northeast, and Lehigh/Capital zones in January 2020.3. Which of the following are DHS’s priorities through implementation and transition? (Select all that apply.)Containing costs of services.No interruption in participant services.Implementing new service plans as soon as possible.No interruption in provider payments.Please pause.The correct answer is that DHS's priorities through implementation and transition are:No interruption in participant services, andNo interruption in provider payments.4. True or False? Providers contact the MCOs to determine if participants are eligible before providing services.Please pause.The correct answer is False. Providers will continue to use the Eligibility Verification System (EVS) to determine eligibility.5. True or False? Once providers are enrolled with Medicaid, they are automatically available to provide services to CHC participants.Please pause.The correct answer is False. Providers must enroll with Medicaid for all services that they wish to provide under CHC and they must contract with the MCO.6. True or False? Pest eradication is a new service under CHC.Please pause.The correct answer is True. Pest eradication is a new service under CHC.7. True or False? Waiver participants will need to have a new CHC care plan in place by the implementation date in each area.Please pause.The correct answer is False. Existing service plans will remain in place for 180 days after implementation or until a new service plan is created - whichever is later.Maintaining Standards and SafetyEnhancing quality is a key CHC goal. Let’s learn about maintaining standards and safety next.QualityMoving forward, MCOs will ensure quality of service coordination and provider services. Each MCO has a quality plan and quality measures that have been approved by DHS. Quality Management Efficiency Teams (QMETs) will continue to monitor providers in fee-for-service, OBRA, and Act 150 programs.In addition to monitoring at the local level, there are national and state proposed metrics to measure quality. At the state level, Pennsylvania will assess:Community services,Service and care coordination,Grievances,Appeals,Critical incidents,Rebalancing among facility-based and community-based settings, andAdherence to CMS waiver assurances.In the short-term, Pennsylvania will also monitor key program launch indicators including continuity of service and provider participation.Incident ManagementService coordinators have played a central role in incident management. That will not change. All CHC providers will report incidents using the Enterprise Incident Management (or EIM) system in HCSIS. (This will be a new process for Aging waiver providers and service coordinators.) MCOs must develop policies and procedures for providers to contact service coordinators to investigate incidents and must train providers on the procedures. Reporting to adult and older adult protective services remains the same as it is today.EVVIn addition to learning the MCOs billing system, visit verification will be another new element. Initially, methods for time and work reporting will be part of the contract with the MCOs. Moving forward, Electronic Visit Verification (EVV) will be required of all MCOs by January 2020. EVV is used to verify and record the type of service performed, who performed it, the date, service location and beginning and end times. Many providers currently use similar systems for their own organizations. DHS is looking for a department-wide approach and is soliciting input on best practices. Input can be sent to the email address found in the Resources Document.Handling DisputesSo what if my provider organization contracts with an MCO and has issues with how things work? Where does my organization go? Provider contracts are with the MCO, so that is where disputes are resolved.MCO ProcessMCOs must develop, implement, and maintain a provider dispute resolution process, which provides for informal resolution of provider disputes at the lowest level and a formal process for provider appeals. DHS must approve the process and will receive reports on disputes and outcomes.Provider Appeal CommitteeEach MCO must establish a Provider Appeal Committee, which providers can use to appeal decisions. At least 25% of the membership of the Committee must be composed of providers and/or peers.Interpretation/ Resolution of Provider AgreementsThe MCO and the provider must handle the resolution of all issues regarding the interpretation of provider agreements. This process does not involve DHS and provider appeals are not within the jurisdiction of the Department’s Bureau of Hearings and Appeals.Knowledge Check ThreeNow check your understanding of what’s been covered so far by answering these review questions.1. True or False? DHS no longer monitors quality.Please pause.The correct answer is False. CHC-MCOs monitor provider quality and are required to submit quality plans and measures. DHS monitors the MCOs for quality. OLTL QMET teams will continue to monitor fee-for-service, OBRA, and Act 150 programs.2. True or False? Incidents will be reported through the Enterprise Incident Management (EIM) system in HCSIS.Please pause.The correct answer is True. All incidents will be reported in EIM. Additionally, reporting to adult and older adult protective services remains the same as it is today.3. True or False? Electronic Visit Verification will be implemented immediately in each CHC zone.Please pause.The correct answer is False. EVV will be required by January 2019. DHS is soliciting input on best practices.4. True or False? If providers have issues with how things are working with an MCO, they report this to DHS immediately.Please pause.The correct answer is False. Disputes are resolved between providers and MCOs, not DHS. Each MCO must have a complaint and issue resolution process approved by DHS.Summary and Next StepsWhat are the next steps for providers?ProvidersFirst, contact the MCOs to discuss contracting. Each MCO’s contact information is included in the Resources Document for this training.Participate in CHC Third Thursday webinars to learn more about CHC and how it may affect your organization.Participate in stakeholder engagement meetings and events.Read and share within your organization any CHC-related information sent to you by DHS.Participate in upcoming provider educational sessions hosted by DHS and the MCOs.Get on the LISTSERV to keep current with updates about CHC. Directions to access the LISTSERV are noted in the Resources Document.Visit the HealthChoices website.Final ThoughtsMost importantly, providers play a vital role in managing this change with participants. You can help reduce the fear and anxiety associated with change by proactively talking with participants about the process, new features, continuity of care, and resources to encourage participants to make informed choices under CHC.Register CompletionCongratulations! You have completed this module.If you have read the contents of the entire module, register your completion of this module by going to the appropriate webpage.If you are an enrolled provider, go to this webpage.If you are not an enrolled provider, go to this webpage. ................
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