MHM - Healthy Michigan Plan

Transcription

1 MHM - Healthy Michigan Plan

2 What is Healthy Michigan Plan? The Healthy Michigan Plan is a new category of eligibility authorized under the Patient Protection and Affordable Care Act and Michigan Public Act 107 of 2013 that began in April 1, The benefit design of the Healthy Michigan Plan ensures beneficiary access to quality health care, encourages utilization of high-value services, and promotes adoption of health behaviors. Currently enrolled providers are automatically providers for the Healthy Michigan Plan.

3 Who Does it Provide For? The Healthy Michigan Plan provides health care coverage for individuals who: Are age years Have income at or below 133% of the federal poverty level under the Modified Adjusted Gross Income methodology Do not qualify for or are not enrolled in Medicare or other Medicaid programs Are not pregnant at the time of application Are residents of the State of Michigan

4 Eligible Individuals Access Per federal requirement, individuals eligible for services under the Healthy MI Plan must have access to the following 10 Essential Health Benefits: Ambulatory patient services Emergency Services Hospitalization Maternity and newborn care Mental health and substance use disorder treatment services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventative and wellness services and chronic disease management Pediatric services, including oral and vision care

5 Health Risk Assessments For Healthy MI Plan beneficiaries enrolled in a health plan, the Michigan Department of Community Health has developed a standard Health Risk Assessment (HRA) to be completed annually, based on the enrollment date. The beneficiary and provider each have separate sections to fill out. The purpose of HRA is to provide a systematic approach to collect information from members that identifies risk factors, provides feedback, and links the person with at least one intervention to promote health, sustain functions, and prevent disease. The HRA is designed to identify health behavior goals and is intended to be completed during annual well care visits. Each health plan providing services to Healthy MI Plan members has an incentive for providers who complete and return the HRA form for their HMP (Healthy Michigan Plan) patients.

6 HRA Form - Incentives All areas of section #4 are to be completed in full to receive incentive: Blood Pressure BMI address weight management questions Cholesterol if known, please include levels Blood sugar Influenza Vaccine Sign and attest on page 5 of form Provider will receive $25.00 for new members with a completed HRA Provider will receive $50.00 for completion of HRA and if the visit was within 150 days of enrollment If it s a 2 nd annual patient visit the provider will receive only $25.00 for completion of HRA Remember: the HRA impacts your patient s benefits, coinsurance and member gift card incentive

7 The HRA Form Annual Process The information for the annual assessment will be utilized to assist the provider, and member, for tracking and assessing progress toward meeting individualized targets/goals, recognizing that addressing and maintaining healthy lifestyle changes is a long-term process. After members are enrolled, they should receive a welcome packet, which includes an HRA form. The members are asked to fill their portion of the HRA (first two pages) and provide the form to their PCP on their first visit so the provider can fill out their part (last two pages). If the member forgets their form, they have the option to fill out another one at the provider s office. The HRA form can be mailed or faxed to Quality Management Department by the provider or member. In this case, it s the provider who usually sends the assessment.

8 Processing the HRA The HRA s are received via mail and fax transmittal. Each HRA is reviewed to see if it is compliant or non-compliant Compliant and Non-Compliant HRA s are determined by whether the provider s section is complete or not. If all areas are completed by the provider on the last two pages, the HRA is considered compliant.

9 Processing the HRA A fax request regarding an incomplete HRA will be sent to provider if: The provider pages are missing The provider s section is incomplete The member pages are missing Note: Although member s section is voluntary, please provide both pages whether the member completed part or none of their section Even if the member left their entire section blank, please send their two pages, filling out the patient demographic area on the first page. It is very important that the member s name, DOB, phone number, and especially, the member s MI Health id# is included on the HRA in order to initiate the HRA process If the provider s two pages are the only part of the HRA received, it is considered incomplete and the member pages will be requested

10 Processing the HRA Main Areas That Are Commonly Overlooked Missing member pages (first two pages) Section 4 (Provider section) most common missing areas for member results: Blood Pressure Height and Weight - the ht and wt are two separate lines but sometimes providers will enter the inch of the height on the weight line and won t include the weight (i.e., if the member s height is 5 6, pcp will enter Ht5 Wt6 ) BMI indicate need for weight management? Patient diagnosed with HTN? Patient diagnosed with High Cholesterol? Patient diagnosed with diabetes? Influenza vaccine - providers will sometimes write NA or Not Flu Season instead of entering the required information; even if it s not flu season, providers are still required to answer if the flu shot is recommended or not Healthy Behaviors - only one answer should be checked but sometimes check more than one answer is checked, which may be direct conflict (i.e., checking off 1 and 4 will make the difference if a member receives an incentive or not) Attestation Page sometimes the member prints and signs on the provider s line *Attachment: Instructions on how to properly fill out an HRA Double click on attachment

11 Information Fax completed HRA s to our secured fax line at (855) Mail completed HRA s to: Molina Healthcare of Michigan 880 W Long Lake Rd, Suite 600 Troy, MI Attn: Quality Management Department *Note: highlight link right click click on Open Hyperlink Providers may contact the provider helpline at MDCH for billing and coverage questions at: or providersupport@michigan.gov or healthymichiganplan@michigan.gov Providers may also want to check out the Provider Outreach Toolkit on the MDCH Website at Provider Outreach Toolkit or follow these manual steps at type in search tool Health Michigan Plan click on link (MDCH - Healthy Michigan Plan - SOM - State of Michigan) Healthy Michigan Plan Provider Information Provider Outreach Toolkit Member information: Double click on attachment

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