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Idaho Medicaid Primary Care Programs

Primary Care Programs ◦ Healthy Connections ◦ Idaho Medicaid Health Home Patient centered model of care with a focus on comprehensive care coordination

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Page 1: Primary Care Programs ◦ Healthy Connections ◦ Idaho Medicaid Health Home Patient centered model of care with a focus on comprehensive care coordination

Idaho Medicaid Primary Care Programs

Page 2: Primary Care Programs ◦ Healthy Connections ◦ Idaho Medicaid Health Home Patient centered model of care with a focus on comprehensive care coordination

Primary Care Programs◦ Healthy Connections◦ Idaho Medicaid Health Home

Patient centered model of care with a focus on comprehensive care coordination for participants with complex or chronic diseases

All Healthy Connections policies, procedures and requirements, including referrals, apply to Health Home providers and participants

Idaho Medicaid

Page 3: Primary Care Programs ◦ Healthy Connections ◦ Idaho Medicaid Health Home Patient centered model of care with a focus on comprehensive care coordination

Method of referral:

Electronic On-Line through Trading Partner Access

◦ www.idmedicaid.com Referral Form

◦ HC Referral Form ◦ Prescription Pad ◦ Admit orders, etc.

Verbal ◦ Calling orders to a specialist

Documented in both the referred from and referred to patient records or entered online

Referrals

http://www.idmedicaid.com/
Page 4: Primary Care Programs ◦ Healthy Connections ◦ Idaho Medicaid Health Home Patient centered model of care with a focus on comprehensive care coordination

Name of the PCP granting the referral Date referral issued Duration of referral-best practice not to

exceed 1 year Number of visits Specific scope of services being referred Reason for referral Diagnosis or condition

Referral Requirements

Page 5: Primary Care Programs ◦ Healthy Connections ◦ Idaho Medicaid Health Home Patient centered model of care with a focus on comprehensive care coordination

A referral may be passed on by a specialist to other providers to treat the condition indicated in the original referral under the following referral approval reasons:

Diagnose and Treat Diagnose and Treat to include surgery Diagnose, Treat and Forward to specialty provider

for this condition Follow patient jointly Assume Care

Referral Requirements

Page 6: Primary Care Programs ◦ Healthy Connections ◦ Idaho Medicaid Health Home Patient centered model of care with a focus on comprehensive care coordination

Referrals remain active for duration of referral and do not expire if participant changes HC PCP

Referral not required: Emergency medical services when condition meets

emergency definition ◦ Acute symptoms of sufficient severity, including severe pain

that could result in placing the health of the individual in serious jeopardy, impairment of bodily functions or dysfunction of any body parts, if left untreated

Pregnancy related services Provided by an OB/GYN-to include hospital based services when directed by an OB/GYN specialist

Hospital Admissions ◦ Subsequent to an Emergency Room visit ◦ Discharge in coordination with PCP

HC Policies

Page 7: Primary Care Programs ◦ Healthy Connections ◦ Idaho Medicaid Health Home Patient centered model of care with a focus on comprehensive care coordination

Is the Patient Accounting System considered to be part of the records?

Screening procedure that does not require referral, condition then found that requires a referral?

Patient comes in with order from specialist, patient has not established care with PCP?

Questions

Page 8: Primary Care Programs ◦ Healthy Connections ◦ Idaho Medicaid Health Home Patient centered model of care with a focus on comprehensive care coordination

H208-666-6766800-299-6766

208-799-5088800-799-5088

515 N 16th 208-642-7006Payette, ID 83661 800-494-4133

208-334-4676800-354-2574

208-736-4793800-897-4929

208-235-2927800-284-7857

208-528-5786800-919-9945

Spanish Line800-378-3385

208-455-7244800-494-4133

Email: [email protected]

Email: [email protected]

Email: [email protected] Shoup Avenue, Suite 4Idaho Falls, ID 83402

Phone: 888-528-5861Fax: 888-532-0014Email: [email protected]

Email: [email protected] Poleline, Suite 3Twin Falls, ID 83301Email: [email protected] Hiline Rd, Suite 202Pocatello, ID 83201

3402 Franklin RdCaldwell, ID 83605Email: [email protected] Westgate, Suite BBoise, ID 83704Email: [email protected]

Healthy ConnectionsCustomer Service

1120 Ironwood, Suite 102Coeur d'Alene, ID 83814Email: [email protected] F Street, P. O. Drawer BLewiston, ID 83501Email: [email protected]

Region 6Deborah Jorgensen

Region 7Julie Adams

Region 4Paula Faulkner &Julie Colleran

Region 5Clint Fullmer

Region 2Denise Walk

Region 3Rosie Lupercio &Joy Longstreet

Region Contact InformationRegion 1Jennifer Kaufman


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