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FALL 2016

H S C S NN E T W O R K

C O N N E C T O RThe quarterly provider newsletter for Health Services for Children with Special Needs, Inc.

fall 2016ISSUE 3

inside this issue

2 HSCSN Transition Care Management

3 Member Connection: Meet Zhane (update)

4 Provider Connection: National Youth Transitions Center

6 Case Study Connection: Jalan W.Burton, MD, MPH

8 Reminders and Resources

CAN OUR MEMBERS COUNT ON YOU OR YOUR REPRESENTATIVE TO BE THERE ON

THURSDAY,DECEMBER 15?

RSVP TODAY AT CSMITH@HSCSN.ORG

2 | HSCSN Network Connector HSCSN Network Connector | 3

published by

Health Servicesfor Children with Special Needs, Inc.

1101 Vermont Avenue, NWSuite 1201

Washington, DC 20005www.hscsn-net.org

Danny BellamyChief Operating Officer

Khalil BouharounChief Information Officer (HSC System) Chief Administrative Officer (HSCSN)

Rhonique Shields, MD, MHA, FAAPChief Medical Officer

Vice President, Medical Affairs

Robin Pirtle, RN, BSN, MHSMVice President, Care Management

Sherron BowersDirector, Provider Operations and Contracting

Chawleen SmithSr. Provider Services Coordinator

Newsletter Editor

Tyhisia Thompson, CPCSCredentials Coordinator

TRANSITION CAREMANAGEMENT

Transitioning from pediatric to adult care is a process that starts during early to mid-adolescence. Each Care Manager assists assigned members with identifying adult providers by the time they turn 18 years and no later than age 21. Within the Care Management Department there is a Transition Team consisting of six (6) Care Managers who provide care coordination services to members aged 23 ½ to 26 years old. On assignment to the team the member’s current needs and transition readiness are assessed. At age 26, all members age out of the HSCSN plan and transition into the District of Columbia’s Fee-For-Service Medicaid program. The Transition Care Manager maintains frequent contact, at least monthly six months prior to aging out, with the member to provide hands on support as necessary to assist members in navigating the health care system. The goals of the Transition Team are to ensure a smooth transition from HSCSN to Medicaid, ensure each member is educated and knowledgeable of their medical condition, he/she is able to manage their condition, understands triggers, medication management, where applicable, and to foster independence in members to become more comfortable about making informed health decisions for themselves. For members who are unable to manage their health independently caregivers are provided with the resources required to make decisions for and speak on behalf of their loved one.

The Care Managers work with the Utilization Management Department and Primary Care Providers (PCP) to ensure members receiving home care services, medical supplies and/or equipment are coordinated with vendors serving the Fee-For-Service population prior to the disenrollment from HSCSN to limit any disruption in service. This is especially important for members receiving Personal Care Aide and Skilled Nursing services. A new order for services is required by DC Medicaid for services to continue. The PCP must submit a new order for Skilled Nursing on a DC Medicaid Order Form to Delmarva (external review agency for DC Medicaid) and on receipt Delmarva will have a nurse perform an assessment prior to approving services. In addition, the Transition Care Manager identifies and connects members to agencies such as Rehabilitation Services Administration (RSA), Department of Disability Services (DDS), Metro Access and other community-based organizations providing supportive services, based on the member needs.

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Meet Zhane

TRANSITIONING FROM HIGH SCHOOL TO COLLEGE

Congratulations to Zhane for graduating from high school!Zhane is now a freshman at one of the local colleges.

To Read Zhane’s Story Refer To The Network Connector Spring Issue 2016 On The Website Of HSCSN

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4 | HSCSN Network Connector HSCSN Network Connector | 5

The Youth Transitions Collaborative (YTC) is a community of organizations that share the goal of empowering youth and young people with disabilities to create a self-directed path to adulthood and employment, and to participate in and contribute to society. The National Youth Transitions Center (NYTC) provides a single location in the nation’s capital for modeling cross-systems collaboration and improving the transitions services available to youth and young people, their families and communities. Existing as an innovative “collaborative community,” the NYTC provides opportunities for nonprofits serving youth and young people to build capacity, create new partnerships, and benefit from its national agenda. This national agenda is comprised of policy and advocacy efforts, innovative research, and cross-sector collaborations that stimulate new thinking and learning across the country.

Health care providers can provide support to transitioning youth with disabilities and chronic health conditions by encouraging them to take charge of planning and managing their own health and career goals!

The NYTC is the focal point of the Youth Transitions Collaborative’s community. This by-invitation-only membership group, facilitated by The HSC Foundation, is comprised of over 50 regional and national organizations with a commitment to serving youth and young people with disabilities. These organizations are united by shared values and a desire to be stronger together, providing direct services, expertise and guidance for the Center. The Collaborative also serves as the basis for The HSC Foundation’s efforts to build the capacity of nonprofit organizations serving the disability and youth communities as well as create a cohesive community among these organizations. They also participate in a variety

of programming initiatives that provide further opportunities to partner on a variety of topics, including advocacy, career preparation and employment.

Currently, only 20.5% of youth and young adults with disabilities participate in the labor force compared to 68.4% of individuals without disabilities. (ODEP, 2016)

PROGRAMMING INITIATIVES

Work Early, Work Often“Work Early, Work Often” is a video-based campaign created by the Youth Transitions Collaborative’s career preparation and management working group. Together, the three-part video campaign highlights the importance of work and work-based experiences in an individual’s transition to adulthood, particularly for young people with disabilities. Each storyline focuses on a different subject and narrative, told from the perspective of key audiences that are part of the transition journey.

To watch the videos individually or as a series, visit thenytc.org/workearly or youtube.com/thenytc. Please also follow us on social media, facebook.com/thenytc and twitter.com/The_NYTC.

ADVOCATES IN DISABILITY AWARD

The Advocates in Disability Award program honors a young person with a disability between the ages of 14 and 26 who is dedicated to positively affecting the lives of people with disabilities and their families in the United States. The program also supports an innovative project developed by the award recipient that benefits the U.S. disability community. The selected recipient is awarded $3,000 in recognition of past disability advocacy and will receive up to $7,000 in additional

a collabor ative learning communityto benefit youth and young people with disabilities

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funding for a proposed project to benefit the disability community. The Advocates in Disability Award is presented annually by The HSC Foundation and the Mitsubishi Electric America Foundation.

Career development is a critical step as we think about employment for youth with disabilities, which addresses how youth prepare for going to work and having careers. Many young people, particularly youth with disabilities and chronic health conditions, do not have the opportunity to gain work skills and practice work. (National Collaborative on Workforce and Development, 2015)

FEDERAL ALLIANCE

The Alliance between ODEP, Youth Transitions Collaborative (the Collaborative), and Maternal and Child Health Bureau’s (MCHB) The National Alliance to Advance Adolescent

Health (Got Transition) has focused on improving health care transition and employment of youth and young people with disabilities. The Alliance Partners have created a career and health checklist for youth and young people with disabilities that was released in July 2015 in coordination with the 25th Anniversary of the Americans with Disabilities Act.The Office of Disability Employment Policy (ODEP) provides national leadership by developing and influencing disability employment-related policies and practices affecting an increase in the employment of people with disabilities. A sub-cabinet level policy agency within the Department of Labor, ODEP recognizes the need for a national policy to ensure that people with disabilities are fully integrated into the 21st Century workforce.

HEATH RESOURCE CENTER

The HEATH Resource Center, managed by The George Washington University Graduate School of Education and Human Development, is an online clearinghouse of postsecondary education resources for people with disabilities. It serves as the NYTC’s official resource site and can be accessed at heath.gwu.edu. HEATH gathers, develops, and disseminates information such as self-directed learning modules (e.g., stress management, food & nutrition), quarterly newsletters highlighting latest research, guidance on financial aid for students with disabilities, and many more up-to-date resources.

BECAUSE THE FUTURE NEEDS EVERYONE

Youth and young people with disabilities often confront severe obstacles as they transition from adolescence to adulthood and from school to work. By having timely interventions and supportive services, these challenges can be transformed into moments of opportunity. The National Youth Transitions Center is committed to helping young people with disabilities achieve their greatest level of independence and accomplishment. Developed by The HSC Foundation, the Center brings together the resources of multiple organizations to provide transitions-related services, research, evaluation, best practices, public policy guidance, and innovative projects. The success of their collaboration is measured in young lives empowered to thrive in the workplace and within their community.

If you have any questions about the NYTC and/or the YTC, please contact Jessica Queener at jqueener@cscn.org.

THE 2016 ADA AWARD RECIPIENTDiagnosed with autism and partial blindness, Sara Luterman’s advocacy work began after graduating from Johns Hopkins University and the University of Maryland in creative writing. In addition to creating NOS Magazine, a blog about neurodiversity news, culture and representation, she currently works as a program assistant at the Association of University Centers on Disabilities, sits on the board for the Association for Autistic Community and acts as a part of the Individual Advocacy Group to help protect the rights of adults who need assistance in living independently. Her writing has also been featured in The Guardian and The Atlantic and she has served as an expert on a HuffPost Live segment about Hillary Clinton’s autism policy.

Left to right - Kevin Webb, Senior Director, Mitsubishi Electric America Foundation, Jessie MacKinnon, Vice-President, Programs and Partnerships, The HSC Foundation, Sara Luterman, 2016 ADA Recipient, Dr. Thomas Chapman, President and CEO, The HSC Foundation

PROV IDER CONNECTION

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C ASE STUDY CONNECTION

8 | HSCSN Network Connector HSCSN Network Connector | 9

PROV IDER R ESOURCES & R EMINDER S

DISAGREE WITH A CLAIM PAYMENT OR DENIAL?It can be appealed in writing within 90 days of the denial or payment.

HSCSN Claims Appeals Attn: D. HawkinsP.O. Box 29055 Washington, DC 20017

Send a letter with all supporting documentation requesting an adjustment of payment and the reason the payment is not correct. If a claim was incorrectly sent to DC Medicaid and now we are denying it for timely (late) filing, please include a copy of the letter from DC Medicaid.

APPEALS SHOULD BE SUBMITTED IN WRITING WITHIN 90 DAYS OF PROCESSING

CLAIMS SUBMISSION CLAIMS PAYMENT ADDRESS:

HSCSN CLAIMS Electronic Payor ID # 37290P.O. Box 29055 EMDEON is clearinghouse Washington, DC 20017

NPI NUMBERNPI should be on each claim. If NPI number is not included on your claim, it will be denied. The name and NPI of each Personal Care Aid (PCA) are required for claims submission.

NO BALANCE BILLINGAll members of Health Services for Children with Special Needs, Inc. are Medicaid members and cannot be billed for balances over HSCSN’s paid amount. When accepting our members as patients, you agree to accept our payment as payment in full.

ELECTRONIC PAYMENT

ATTENTION PRIMARY CARE PROVIDERS!As a requirement of our contract with DC Department of Health Care Finance (DHCF) Medicaid, HSCSN must ensure that each of our network primary care providers receive EPSDT/HealthCheck training once every 2 years. Please assist HSCSN in meeting our contractual obligation.

HealthCheck and Fluoride Varnish Trainings are both available online.The trainings are free. HealthCheck training provides 5 CME credits. It fulfills the Medicaid’s training requirement for all Medicaid Managed Care Organizations (MCOs) with which you are paneled. Fluoride Varnish training will fulfill your obligations to provide and bill for fluoride varnish application in the District. NOTE: You must compete the HealthCheck training

GO TO: http://dchealthcheck.net (YOUR NPI# IS NEEDED)

PLEASE COMPLETE YOUR TRAINING TODAY!

VISIT:DC Medicaid Web Portal - Department of Health Care Finance

https://www.dc-medicaid.com

Office of the State Superintendent of Education (OSSE)

http://osse.dc.gov

The HSC Health Care System

http://hschealth.org

Emdeon is a leading provider of revenue and payment cycle solutions that connect payers, providers and patients to improve healthcare business processes.

To learn more about our company, our services and our commitment to improving healthcare, visit our website at www.emdeon.com.

Attention: HSCSN Providers

Switch from PAPER to ELECTRONIC payment.

Enroll today with Emdeon ePayment •  Enroll online at emdeon.com/eft

•  To enroll by fax or by mail, you can download the enrollment form atemdeon.com/epayment/enrollment.

•  Fax completed form to 615.238.9615.

•  Mail completed form to: •  Emdeon (Attention: Emdeon Electronic Payment Service Enrollment)

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Helpful Hints for a Emdeon ePayment Enrollment •  Supply your NPI and Tax ID Numbers•  Review all terms and authorization forms prior to submitting them to Emdeon

•  EFT Provider Enrollment Support 866-506-2830 Option 1 for enrollment; Option 2 for EFT/Payment Manager

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