Health Home Application Provider Training

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Health Home ApplicationProvider Training

Ohio Department of Mental Health14 June 2013

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• Who Must Use This Application▫ Phase 1 providers that had not submitted an application to ODMH by

June 4, 2013▫ All Phase 2 providers

• What this Training Will Cover▫ How to fill out & submit an application to provide health home service

• What this Training Will NOT Cover▫ What is a Health Home▫ How to develop health home service for your agency

• HOWEVER▫ The application was designed to guide an agency through the

requirements to develop a health home service▫ Agency needs to individualize the sections to describe its own model for

health home service

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Proposed Revised Rule 5122-29-33

•Currently in Common Sense Initiative comment period

•Application is based upon proposed rule•Comment until June 19, 2013

▫http://mentalhealth.ohio.gov/what-we-do/protect-and-monitor/licensure-and-certification/rules/draft-rules.shtml

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When is the Application Due?• The Office of Licensure and Certification will appreciate it if Phase

2 applications are submitted by August 1, 2013▫ This is not a deadline, but will help the process d/t the anticipated large

number of applications▫ However, L/C is committed to doing everything possible to ensure that

all applications received are processed in a timely manner before October 1st

• August 1st time frame should allow the Department enough time to review the application and gain additional information from the provider if there are missing elements from the application

• ODMH cannot guarantee Certification will be granted by October 1, regardless of when an application is received – an incomplete (missing documents or information) or non-compliant (not in compliance with the rules) application can delay the effective date▫ Effective date of certification is date agency submits a complete and

compliant application, and will be on or after October 1 (Phase 2) Effective date for Medicaid billing may be later than date of

certification

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Why is the Application So Detailed?

• Normal process to add non-deemed Medicaid billable service includes ODMH conducting an on-site survey AFTER provider has begun to provide services so that ODMH can review clinical records

• This application allows ODMH to certify service without requiring provider to first provide health home service for a month or longer (without ability to bill), then have ODMH conduct an on-site survey▫Under this scenario, if on-site resulted in Plan of

Correction (POC), provider would not be eligible to bill Medicaid for services provided prior to on-site and date of approved POC

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Throughout the application, providers will be asked to:

•Provide data (name, addresses, etc.)•Answer checkbox questions•Describe or explain

▫Use Narrative•Attach

▫Include agency documentation, e.g. policies and procedures, with application

▫Please label all attachments submitted with this application with the appropriate application section title and number/letter

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Provider Eligibility to Apply

(D) ODMH certified for each of the following services:(1) Behavioral health counseling and therapy;(2) Mental health assessment;(3) Pharmacological management; and (4) Community psychiatric support treatment.

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Suggested Steps to Design Health Home Service

• Describe population to be served (target population)▫Physical health needs/chronic medical conditions,

behavioral health needs, utilization, age, etc.• Decide on integrated care model – how will primary

care be delivered▫If not using ownership/membership, enter into

agreements• Determine capacity – how many persons meet your

agency’s target population• Develop policies and procedures for health home

service, including delivery of primary care• Should be based upon the target population needs, and not be

generic or “cookie-cutter”• Develop form templates

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Tasks to Design Health Home Service

•Identify needed partners, i.e. providers/entities with whom the agency will develop working relationships▫Based upon the needs of the target population▫Define roles in coordinating and managing care▫How will data be exchanged▫On-going – update as needs of target population

change•Develop job descriptions and identify staff who

will fill each role on the health home team ▫Within the four positions, what competencies are

needed to meet the target population needs

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Remember the 6 Components of Health Home Service. Include in development of health home program description & policies and procedures [See 5122-29-33 (C) for detailed information on activities]:

1. Comprehensive Care Management2. Care Coordination3. Health Promotion4. Comprehensive Transitional Care and Follow-up5. Individual & Family Supports

1. Includes expanded access6. Referral to Community and Social Support

Services

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• Develop tools/templates for health home service delivery▫ Comprehensive assessment▫ Comprehensive assessment update▫ Integrated care plan▫ Communication plan – routine exchange of information with

consumer, family/significant others, health home team, primary care providers, specialist, partners, managed care plans

▫ Crisis management and contingency plan▫ Clinical summary report

• Develop procedures/protocols for information exchange & coordination of care with consumer, family/significant others

• Develop policies, procedures, protocols on Comprehensive Care Management & Care coordination▫ Communication, exchange of data, assist consumer in accessing

needed services, medication management including med reconciliation, track tests, make referrals and follow-up as necessary.

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• Health Promotion activities. Preventative and Disease Management. Two levels:▫ Individual specific, e.g. John needs to quit smoking

Different for each consumer▫ Target population, e.g. Offering smoking cessation classes

On-going. Will change over time as assessed needs change, e.g. initially may develop smoking cessation and exercise programs, & nutrition classes. In one year, number of individuals on health home with diabetes increases from 15% to 45%, so agency adds diabetes specific classes specific to managing chronic diabetes – teaching individuals to track blood pressure; check their feet for cuts, blisters, etc. and to notify health home team & primary care doctor of sores that do not go away, etc.

Use evidenced-based, informed, best, emerging and/or promising practices/

• Transitional care▫ Work with partners and others to prevent adverse outcomes

Having partnerships in place will ▫ Post-discharge services & follow-up

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• Develop Outreach Plan• Data Sharing & Information Management

▫Develop capacity and strategies▫Used to inform care management and care

coordination• Electronic Health Record

▫Certified by national Coordinator for Health Information Technology

▫If agency does not have one, develop plan to acquire within 12 months of certification Staff and financial resources needed

• Health Information Exchange▫If not participating, develop plan

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Please Note

•Task list is not exhaustive•Please consult rule 5122-29-33 and other

training resources

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Now the Application…

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Agency Profile DataPage 1

•Remember to list all anticipated sites and the information for each

•Health home sites must be certified by ODMH▫Same requirement as for other certified services▫Routine locations where providing the service▫Do not need to certify primary care locations

(unless co-located with agency) or community locations

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Health Home Service PopulationPage 2

•Applicant must demonstrate an understanding of the eligible populations to be serves in the Health Home by addressing key characteristics, including: chronic medical conditions; SPMI/SMI/SED; utilization, rates; locations; age; and culture.

•References data that will soon be available for applicants.

•This data is not currently available, but will be shared in the near future.

•Will be available on the web, by county and provider•Future webinars will be scheduled

Target PopulationHealth Home Service Requirements

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• Health Home Service Providers are required to:▫ Ensure capacity to serve all eligible consumers within the

designated service area

▫ Provide health home service to ONLY eligible consumers

▫ Use the criteria for serious and persistent mental illness (SPMI), serious mental illness (SMI) and serious emotional disturbance (SED) as described in the rule when identifying eligible consumers

▫ Determine the eligibility of consumers for the health home service

Target PopulationMethodology for Identifying Eligible

Consumers

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▫ODMH does not prescribe a specific format or methodology

▫Health home providers are not required to show proof or documentation of the methodology used for determining consumer’s eligibility

▫Health Home providers may use a combination of approaches when identifying eligible consumers such as: EHR based identification Medical Record Review by Group or Individual Staff Standardized Form

Target PopulationManaging Referrals to Health Home Service

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• Referral Sources for Health Home Service may include:▫ Hospital Emergency Departments (mandatory referral source)▫ Hospital Inpatient Psychiatric Units ▫ Managed Care Plans▫ Mental health treatment providers▫ Specialty providers▫ County children services▫ Self-referrals▫ Other community providers

• Health Home Provider should:▫ Inform potential referral sources about referral process and capacity▫ Train intake staff regarding health home service referrals▫ Respond and accept referrals in a timely manner▫ Track number and type of referrals, and wait time▫ Follow up with the referral sources on the outcome of the referrals and▫ Provide an explanation of the reasons for denial of the health home

service as appropriate

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Behavioral and Physical Health IntegrationPage 2

A. List Integrated Care Accreditation or Certification

▫If agency does not currently have, list anticipated date by which you expect to obtain

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5122-29-33 (F)(F) A health home provider shall demonstrate integration of physical and behavioral health care by achieving one of the following:

(1) Successful implementation of accrediting body integrated physical health/primary care standards during the next accreditation survey process following Ohio department of mental health certification as a health home provider in which the provider is eligible in accordance with its accrediting body policies and procedures to undergo a review of its integrated physical health/primary care services:(a) Integrated behavioral health/primary care or health home core program accreditation by the commission on accreditation of rehabilitative facilities; or

(b) Primary physical health care standards by the joint commission behavioral health care accreditation program; or(c) Integrated behavioral health and primary care supplement standards by the council on accreditation; or(d) Equivalent accreditation or certification approved by the Ohio department of mental health; or

(2) Within eighteen months:(a) Level one patient-centered medical home recognition by the national committee for quality assurance; or(b) Patient-centered specialty practice recognition by the national committee for quality assurance; or(b) (c) Equivalent accreditation, certification or recognition approved by the Ohio department of mental health.

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B. Integrated Care Model, Health Home and Primary Care

▫Describe your behavioral health and primary care integration model and how your model addresses how, where, when and what primary care is provided, how the primary care and health home provider collaborate in areas such as referrals, communication, information sharing and medical record management, staffing arrangements and supervision, and financial arrangements. How will your agency provide integrated care and

incorporate the use of data in health home service in order to achieve positive consumer outcomes

Reference SAMHSA Six Levels of Collaboration How does your model fit population and capacity needs

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• Attach a copy of your primary care service plan.▫Oops, should say “Applicants with Ownership/▫Membership” in providing primary care (See bottom

Page 3)• Applicants with health home coordinated and co-

located care integration models▫Attach a copy of your agreements with primary care

providers. Agreements must include the following: educational materials/training that will engage providers; information that will be exchanged between the health home and provider; and role of providers in coordinating and managing care, including integrated care plan development and updates, team meetings and communication protocols.

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Table APage 3

• Another “oops” in column (E)▫Fill out if providing primary care via

ownership/membership• Health Home Site(s), Integrated Care Model(s),

Primary Care Capacity and Expanded Access▫Checkboxes and simple descriptions▫Allows for potential of different models of

integration at different locations▫Demonstrate expanded access (check all that apply)▫Identify capacity▫Location(s) of primary care provider(s)▫Use as many copies as needed for site/model

combinations

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Primary Care Screening Assurance ChecklistPage 4

• Checkboxes for provider to attest to the ability to ensure primary care screening and treatment services

• Utilized to monitor physical health status, monitor outcomes, and quality measures

• Health home will need to collect vital signs (pulse, respiratory rate, temperature and blood pressure), height, weight and BMI on a quarterly basis either through primary care provider visit records (annual health checks, acute illness or follow-up visits etc.) and/or appointments with the health home provider (nurse health assessment visit, pharmacological management visits etc.).

• Oxygen saturation level is not a quarterly requirement and it should only be measured as appropriate or needed by the primary care provider or pediatrician.▫ Example: Patient has an acute or chronic respiratory disease such as

asthma, emphysema, COPD or pneumonia, and the primary care doctor is concerned about the low oxygen saturation level.

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Partner/Provider Outreach and EngagementPage 4

1. Attach a copy of your provider outreach plan that you follow to communicate with and engage providers and entities with whom you do not have formal agreements, but with whom you need to develop effective working relationships to serve clients in the health home.

▫ Outreach plan shall address how the health home will educate providers about the health home service, goals and the value of the relationship or collaboration in the delivery of service components, and how and what type of information will be exchanged between the health home provider and the non-health home provider.

▫ Outreach plan shall describe the role of the non-health home provider in coordinating and managing care to the consumer including but not limited to integrated care plan development and revisions and participation in meetings.

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• (Continued) Attach provider outreach plan. Applicant’s outreach plan must include:▫Defined accountabilities for provider outreach and

engagement. ▫Dedicated education and outreach processes and

materials.▫An accurate and comprehensive description for providers

about participating as part of a health home in Ohio: Reference key components that are included in the planned

care model. Reference goals for integration of physical and behavioral

health care. Acknowledge requirements of the Ohio Rule.

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2. Referencing Table B, applicant should address why and how it will facilitate working relationships with entities listed to ensure that necessary services will be available and/or coordinated for its health home clients as part of their integrated care management.

3. When you identify a gap in your health home network relationships, describe your strategy to engage and establish effective working relationships.

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•Table B: Health Home Network Relationships▫Please identify those providers that you

have or will have relationships, collaborations or partnerships.

▫Describe how those entities identified are appropriate to serve your health home population (This is answered in # 2 above).

▫Check all that apply.

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Consumer Informed Consent and OrientationPage 5

A. Attach a copy of your consumer informed consent form and related policies and procedures.

• Proposed 5122-29-33 (C)(1)(b)• Document consumer's informed consent specific to

enrollment in the health home service prior to enrollment. Informed consent shall include:▫ Description of the health home service, benefits and

drawbacks of enrollment in the health home service, including the relationship between the health home service and other services, particularly other care coordination services (e.g. CPST, MCP care management, AOD case management)

▫ Consumer's ability to opt out of enrollment in the health home service

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Health Home ConsumersInformed Consent

• ODMH OAC - 5122-27-04 Consent for treatment still applies, and requires agencies to have in place policies and procedures for obtaining written informed consent for treatment.

• Health Home provider must have documentation of informed consent.

• It is recommended that the informed consent for the health home service include:▫ The diagnosis and the other eligibility criteria ▫ The nature and purpose of the health home service ▫ The risks and benefits of the health home service▫ Alternatives to the health home service▫ The risks and benefits of not receiving the health home service

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Consumer Informed Consent and OrientationPage 5

B. Attach a copy of your written health home service orientation informational materials. Materials must describe and confirm the process to orient and inform consumers including discussing the benefits of active participation in the health home service.

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Health Home Orientation

• The health home provider must provide the health home member and/or guardian with an orientation that is appropriate for the health home member’s needs and includes the following:▫ An overview of health home service▫ The general nature and goals of health home service▫ An explanation of the consumer’s right to decline services▫ Information about the hours during which the services are

available and how the consumer, family and caregivers may participate in the delivery of health home service

• Health home provider must demonstrate orientation of consumers to health home service

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Comprehensive AssessmentPage 6

A. Attach a copy of your health home comprehensive assessment tool(s) [form/template] used to assess an individual’s

▫ physical health▫ behavioral health (i.e., mental health disorders, substance

abuse disorders, and developmental disabilities)▫ long-term care (e.g., assistance with activities of daily

living, functional status, self-care capability), social service needs (e.g., financial assistance, housing, family or support system dynamics).

• Refer to the health home application resource document for a list of assessment and planning domains you may use as guidance.

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A. Comprehensive Assessment Domains: The assessment and planning domains listed in the table below are provided as a resource to assist in the comprehensive assessment process. Applicants may crosswalk any of these domains with their health home comprehensive assessme nt tool(s); however, use of these domains is not a requirement of the health home application.

Client demographics or identifying Information;

Family environment/ relationships;

Strengths/capabilities; Meaningful activities; Cultural/ethnic issues/

information/concerns; History of learning

difficulties/barriers to learning;

Special communication needs;

History of abuse, neglect and violence;

Risk assessment; Mental status

examination; Current discharge and

transition plans; Client/family/guardian

expression of preferences and goals;

Level of involvement in the care planning process;

Presenting problem including referral source and reason for referral;

Primary/family/marital significant other support systems;

Limitations of activities of daily living including instrumental activities of daily living and/or self-care;

Mental health treatment history;

Alcohol/drug/tobacco use treatment history;

Past and current medications including OTC and herbal;

Medication allergies or adverse reactions to medications;

Transportation capabilities and constraints;

Living situation/housing status including any environmental and safety concerns;

Pertinent family history;

Friendship/social peer support/relationships;

Religion/spirituality; School functioning/

education history; Employment history; Income/financial

Status including ability to manage own finances;

Community supports/ self-help groups;

Sexual history/concerns;

Military history; Legal history; Physical health

history; Advance directives

when applicable.

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Comprehensive AssessmentPage 6

• Attach relevant portions of your policies and procedures that demonstrate you have a plan to initiate assessment and routine updates. This should include such elements as: changes in health status, needs, significant events, system supports and flags for routine updates, i.e., at least every 90 days and annual reassessment. Your response should include the following:▫ Describe data sources that will be used to complete the

comprehensive assessment. ▫ Describe how information from the assessment is used to

stratify individuals by categories of risk to develop behavioral, physical and other appropriate health interventions.

▫ Describe your time frames for completing the comprehensive assessment.

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Care Planning

Page 6

B. 1. Attach your integrated care plan template. Care plan components should include:

▫identification of measurable goals and objectives interventions with specific time frames for completion

▫provisions for acknowledging client and relevant others’ (i.e., family, guardians, significant others) input, preferences, and level of involvement in the care plan.

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Care Planning

Page 6

B. 2. Attach your policies and procedures which should include:

▫process for development, review (at least every 90 days) and updating of the integrated care plan

▫how the care plan addresses and coordinates an individual’s clinical and nonclinical needs.

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Comprehensive Assessment, Care Planning Dates

•Comprehensive Assessment completed within 30 days of enrollment in health home service

•Re-assessment at least every 90 days•Integrated Care Plan completed within 60

days of enrollment▫Based on results of the comprehensive

assessment▫Include consumer and family participation▫Reviewed at least every 90 days and

updated as needed

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Care CoordinationPage 6

C. 1. Describe how you will coordinate with consumer, consumer’s family members and care givers, team members, PCP, specialists, social service and other providers (i.e. tracking tests, referrals, scheduled appointments, follow-up, etc.) in implementing the care plan. Provide the following supporting documents:

▫Attach your communication protocols or policy that describe information exchange between consumer, consumer’s family members and care givers, team members, PCP, specialists, and other providers.

▫Attach communication plan to address routine information exchange, ensure that collaboration and communication occurs between consumer, consumer’s family members and care givers, team members, PCP, specialists, other providers and payors.

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Care Coordination (C)Page 6

2. Attach your Crisis Management and Contingency Plan.

3. Attach your Clinical Summary Report template.

4. Describe how you will coordinate care (e.g., assist consumer in obtaining health care, including primary, acute and specialty medical care, mental health, substance abuse services and developmental disability services, long-term care and ancillary services; perform medication management, including medication reconciliation; track tests, referrals and follow-up as necessary, etc.)

Health Home Service ComponentsComprehensive Care

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• Comprehensive Assessment should include;▫ Medical, behavioral, long-term care and social service needs▫ Reassessment of the consumer and review of the existing assessment at least every 90 days▫ Updates as needed

ODMH Mental Health Assessment service standards still apply.

• Single Integrated Care Plan should:▫ Be based on the results of the comprehensive assessment▫ Include consumer and family participation▫ Reviewed at least every 90 days▫ Updated as needed

ODMH Individualized treatment plan standards still apply.

• Crisis and Contingency Plan should:▫ Be reflective of assessed clinical need

• Communication Plan should:▫ Be developed for all consumers ▫ Include and be shared with family, significant others, other service and treatment providers

Health Home Service Components: Care Coordination

▫ Implementation of integrated care plan; ▫ Assist consumer in obtaining health care, including mental

health, substance abuse services and developmental disabilities services, ancillary services and supports;

▫ Medication management, including medication reconciliation; ▫ Track tests and referrals and follow-up as necessary; ▫ Coordinate, facilitate and collaborate with consumer, family, team

of health care professionals, providers; ▫ Monitor care plan and the individual’s status in relation to his or

her care plan goals; ▫ Provide clinical summaries and consumer information along with

routine reports of treatment plan compliance to the team of health care professionals, including consumer/family.

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Health Home Service Components:Care Coordination Highlights

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•Health home service provider should share with other providers and implement the following: ▫Integrated Care Plan ▫Communication Plan ▫Crisis and Contingency Plan ▫Monthly clinical summary reports

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Health PromotionPage 7

• Based on the assessed needs of your health home population, describe the following:1. How you plan to use consumer-level clinical data to

address health promotion programming for an individual’s specific health promotion, self-monitoring and self-care needs and goals (e.g., working with a consumer on his/her individual health promotion goals)

2. Your systematic strategies to address health promotion for your health home population through programs or initiatives (e.g., evidence-based, evidence-informed, best, emerging and/or promising practices related to smoking cessation, nutrition, chronic disease management, etc.)

Health Home Service Components Health Promotion

• Provide education to the consumer and his or her family /guardian/significant other that is specific to his/her needs as identified in the assessment;

• Assist the consumer to acquire symptom self-monitoring and management skills so that the consumer learns to identify and minimize the negative effects of the chronic illness that interests with his/her daily functioning;

• Provide or connect the consumer with the services that promote healthy lifestyle and wellness and are evidence based;

• Actively engage the consumer in developing and monitoring the care plan;• Connect consumer with peer supports including self-help/self-management

and advocacy groups; • Develop consumer specific self-management plan anticipating possible

occurrence or re-occurrences of situations requiring an unscheduled visit to health home or emergency assistance in a crisis;

• Population management through use of clinical and consumer data to remind consumers about services need for preventive/chronic care;

• Promote behavioral health and good lifestyle choices; • Educate consumer about accessing care in appropriate settings.

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Health Home Service Components:Health Promotion Highlights

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•Chronic disease self-management•Tobacco cessation •Weight management•Nutritional counseling•Exercise and fitness •Preventive services and screenings

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Comprehensive Transitional CarePage 7

• Describe how you will facilitate and manage comprehensive transitional care and follow up (e.g., inpatient-to-inpatient, residential, community settings to prevent unnecessary inpatient admissions, inappropriate emergency department use and other adverse outcomes). The applicant should describe processes for :▫ Receiving timely notifications of admissions/discharges as well as

receiving discharge records.▫ Proactive development of transition/discharge plans.▫ Ensure the timely provision of post-discharge services including

short and long term follow-up.▫ Follow up with primary care, specialists, social services.▫ Medication review and reconciliation.▫ Risk assessment (e.g., potential for re-admission/re-

institutionalization, non-adherence to care plan.▫ Revisions to comprehensive care plan to integrate

transition/discharge plan.

Health Home Service Components Comprehensive Transitional Care and Follow-

up▫Facilitate and manage care transitions (inpatient to

inpatient, residential, community settings, pediatric to adult) to prevent unnecessary inpatient admissions, inappropriate emergency department use and other adverse outcomes such as homelessness;

▫Develop a comprehensive discharge and/or transition plan with short-term and long-term follow-up;

▫Conduct or facilitate clinical hand-offs as face-to-face interactions between providers to exchange information and ask questions;

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Health Home Service Components: Comprehensive Transitional Care and Follow-

up Highlights

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•Discharge/Transition Planning•Warm Clinical Hand-off

▫Face-to-face introduction•Medication Reconciliation•Timely Transmission of Discharge Record•Timely follow-up by a mental health

treatment provider after hospital discharge

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Culturally & Linguistically Appropriate ServicesPage 7

•Describe how your agency will ensure that the health home service is delivered in a manner that is culturally and linguistically appropriate, including how you will address:▫Staff education▫Staff training▫Staff recruitment▫Provisions for communication modalities

(e.g., hearing or visual impairment).

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Data Sharing & Information Management for Care Management &

CoordinationPage 8

1. Describe your capacity and strategies for using data from a variety of sources to inform and support comprehensive and timely care management and care coordination. Address the sources and types of health data that you currently do or expect to receive as a health home, including from Medicaid and ODMHAS and other state agencies; behavioral, primary care and specialty providers; inpatient facilities; long term support service and social service agencies, and managed care organizations (MCOs).

2. Describe your ability to integrate hospital admission, discharge, utilization and other data into routine health home operations.

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Data Sharing & Information Management for Care Management &

CoordinationPage 8

3. Describe your systematic processes for following up on tests, treatments, services and referrals and incorporating them into client’s plan of care.

4. Describe the relevant health record solutions, databases, and data management protocols for documentation and bi-directional information sharing among providers, team members and agencies as part of ongoing care planning and coordination.

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Team CompositionPage 8

1. Applicant should complete Table C to describe its staffing model.

2. Explain how the professional competencies and expertise of the health home team will align with serving the needs of the identified health home service population.

3. Attach position descriptions for each of the four required health home team members (i.e., team leader, embedded primary care clinician, care manager, and qualified health home specialist).

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Table CPage 9

•Please provide team compositions and descriptions in the table below.▫A health home service provider shall utilize

an integrated, multidisciplinary team to deliver health home service.

•See health home application resource document for additional team descriptions.

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How to Fill Out Table C• “Please complete the table below for number of teams, estimated caseloads,

health home team members, staff credentials, and staffing ratios:”▫ Provide brief description of how caseload estimates and staffing ratios were

determined.▫ Provide detailed information about proposed Health Home team members,

including credentials, total team FTEs and staffing ratios using the following table.

• Team Description – For each Health Home team, CMHAs should describe

any additional characteristics of individuals who will receive the Health Home service (e.g., SMI Adult, SED Child, Homeless, etc.).

• Client Need/Risk or Level of Care – CMHAs are encouraged to develop caseloads based on client acuity, complexity or level of care. Please provide a brief description (no more than 100 characters) of the clinical/functional status of each caseload.

• Estimated Caseload [column (a)] – The total number of SPMI individuals to be served by a health home team.

• Staffing Credentials (Cred.) – The professional qualifications of Health Home team members (e.g., licensure, certification, degree, etc.).

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How to Fill Out Table C(Continued)

• Ratio [column (b1)] – The number of SPMI individuals to which a member of the team of healthcare professionals is assigned. Each CMHA must develop ratios based on the clinical acuity or complexity of individuals with SPMI.

• FTE [column (b2) ] – The proportion of a health team member’s time associated with the delivery of the Health Home service. FTE does not refer to the person’s full- or part-time employment with the agency; rather, FTE amounts reflect the percentage of the health home team member’s time devoted to the Health Home service. FTE (columns b2, c2, d2, e2) is calculated by dividing the Estimated Caseload (column a) by the relevant Ratio (columns b1, c1, d1, e1).

• Total Team FTEs [column (f)] – The total number of FTEs for a team. Calculated by summing each FTE (columns b2, c2, d2, e2).

• Total Team Ratio [column (g)] – Provides the total staff-to-client ratio for a team. Calculated by dividing Estimated Caseload (column a) by Total Team FTEs (column f).

• CMHAs must also provide an agency total and summarize across all teams the Estimated Caseload (column a), total FTE by team member (columns b2, c2, d2, e2), Total Team FTEs (column f) and Total Team Ratio (column g).

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Quality Improvement/Performance Measures & Outcomes

Page 10

1. Attach your quality improvement program description/plan.

2. Describe how you have incorporated health home services into this plan.

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Quality Improvement/Performance Measures & Outcomes

Page 10

3. Describe your readiness to collect, monitor and report the health home performance measures as identified by the state. Include the job title of the staff person responsible for oversight of performance measures and quality improvement.

4. Attach a sample of your performance monitoring report.

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Health Information TechnologyPage 10

A. Electronic Health Record•If you currently have an electronic health

record (EHR) product that is certified by the Office of the National Coordinator for Health Information Technology:

1. Describe the extent to which the health home and its various sites share a common electronic record system.

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•Electronic Health Record2. At the time of application, if you are not

utilizing a certified EHR, demonstrate progress in the acquisition and implementation of an EHR, such as providing evidence of engagement in a procurement process to acquire an EHR, development of an implementation plan and time frame, including a budget and commitment of staff or contractor resources

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B. Health Information Exchange1. Describe if and how the health home

participates in a Health Information Exchange (HIE) network e.g., direct exchange or bi-directional query based exchange;

If not currently participating in HIE, what plans are being developed to participate in HIE?

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Health Home Service AttestationPage 11

•Sign and Date•Congratulations, you are finished!

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What about those “Oops”•ODMH will release an updated application

after today’s training•Providers who have started working on an

application do not need to change▫Take note of the items to which you do not need

to respond (it is not “wrong” if you do anyway) Attach primary care service plan only if providing

primary care services through ownership/membership

Table A, Column (E) – only fill out if agency’s integrated care model is ownership/membership

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Health Home Application and Resource Document

• http://1.usa.gov/11fMhT0

•Health Home Service Certification Supplemental Application

•Health Home Service Certification Supplemental Application Resource Document▫Resource document includes a checklist of

all needed attachments & other reference materials

http://1.usa.gov/11fMhT0

http://1.usa.gov/11fMhT0

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ODMHAS Office of Licensure and Certification

• Janel M. Pequignot, Chief• Denise Cole, Manager• Rob Nugen, Manager• Calvin Daniels, MH Standards Surveyor• Barbara Dietz, Alcohol & Drug Program Specialist• Teri Hill, MH Standards Surveyor• Nick Humenay, Alcohol & Drug Program Specialist• Leeann Kapp, MH Standards Surveyor• Rose Lester, MH Standards Surveyor• Greg Lewis, Program Administrator• Lataunia Pitts-Wilson, MH Standards Surveyor• Susan Sekely, MH Standards Surveyor• Kisha Stewart, Database Administrator• Holly Stone, MH Standards Surveyor• Kathy Yokum, MH Standards Surveyor

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Who is My L/C Contact for Health Home Questions?

• Your usual agency lead surveyor may or may not be the surveyor assigned to review your health home application

• Until application is received and agency is contacted by surveyor, Rob Nugen is the L/C point of contact for health home questions▫[email protected] or

[email protected] (beginning 6/21)▫614-466-9074

• Rob is the L/C lead for health homes, so feel free to contact him anytime, even after your agency is assigned a health home surveyor

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Application Technical Assistance Mondays1:30 – 2:30 pm

• Beginning Monday, June 24• Office of Licensure & Certification health home application

technical assistance webinar sessions• Participate to ask questions and/or listen to other questions

• Attendees may attend more than one, but will need to register for individual sessions. Dates and registration links: ▫ June 24: https://www2.gotomeeting.com/register/767440546 ▫ July 1: https://www2.gotomeeting.com/register/335363258 ▫ July 8: https://www2.gotomeeting.com/register/543210858 ▫ July 15: https://www2.gotomeeting.com/register/481220042 ▫ July 22: https://www2.gotomeeting.com/register/399891802

• Frequency of additional Monday TA sessions will be announced later

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Health Home Resources

•Remember to participate in learning communities

•ODMH Health Home website▫http://mentalhealth.ohio.gov/what-we-do/

protect-and-monitor/medicaid/health-home-committees.shtml

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Questions???Janel M. Pequignot

▫[email protected] [email protected] (effective 21

June)▫614-466-9065

Documents

Health Home Application Provider Training