HEALTH RISK ASSESSMENTS (HRA’S)...HEALTH RISK ASSESSMENTS (HRA’S) Blue Plus Government Markets -...
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Blue Cross ® and Blue Shield ® of Minnesota and Blue Plus ® are nonprofit independent licensees of the Blue Cross and Blue Shield Association. Confidential and proprietary. HEALTH RISK ASSESSMENTS (HRA’S) Blue Plus Government Markets - Partner Relations Team Date recorded: 12/26/2019
HEALTH RISK ASSESSMENTS (HRA’S)...HEALTH RISK ASSESSMENTS (HRA’S) Blue Plus Government Markets - Partner Relations Team Date recorded: 12/26/2019 Hello, this presentation is revolving
Confidential and proprietary. Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.Confidential and proprietary.
HEALTH RISK ASSESSMENTS (HRA’S)
Blue Plus Government Markets - Partner Relations TeamDate recorded: 12/26/2019
Presenter
Presentation Notes
Hello, this presentation is revolving around the various Health Risk assessments. What they are and when you would use them when working with Blue Plus members. I will be reviewing the LTCC, 6.28 transitional HRA and 3428H forms. I will also review the refusals and unable to reach.
Confidential and proprietary.
HEALTH RISK ASSESSMENT TIMELINES
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Presenter
Presentation Notes
Before we go into the types of assessments, we wanted to review the timeline for completion of health risk assessments. When completing an initial assessment, pay attention to the timeframe for completion. For all members, except MSC+ community well, you need to complete the face to face assessment within 30 days. For MSC+ members, you need to complete the assessment within 60 days. If a member is Community well and refuses a face to face and will complete a telephonic (3428H) assessment, this also needs to be completed within 30 days for MSHO and 60 days for MSC+ community well members. Transitional HRA’s need to follow the requirements of the initial assessments and be completed within the same time frames. For all reassessments, the assessment needs to be completed within 365 days of the previous assessment.
Confidential and proprietary.
LONG-TERM CARE CONSULTATION (LTCC) DHS 3428
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Presenter
Presentation Notes
We will start with the LTCC (DHS 3428) Health Risk Assessment tool for initial and annual assessments. When a member enrolls with Blue Plus, this is the form that is used for the initial assessments. This is also the form that is used for the annual assessments for Blue Plus members. As a Care Coordinator you need to thoroughly complete all sections. Once completed, then you develop a care plan for the member using the collaborative care plan. As a result of the LTCC Assessment, if the member is determined to be at risk, or needs referrals for specialty care, other home care services or assessments, the Care Coordinator will make all appropriate referrals. For example, if the member is at risk for falls, a PT referral can be completed. If the member experiences incontinence, a referral to their primary physician should be completed. If you are unable to schedule the assessment within the time frame needed, then please document the reason for these delays in the member’s case notes, this includes any delays in enrollment notification Enter the assessment type and date into Bridgeview by the 10th of the following month that the assessment was completed. Enter an LTC Screening Document in MMIS. Reassessment s are due within 365 days of the date of the last HRA. If a re-assessment is late, then document well in the member’s case notes as to the reason for the delay. All DHS documents are updated periodically. Please pay attention to the dates and make sure you are using the most current, up to date document.
Confidential and proprietary.
6.28 TRANSITIONAL HRA (THRA)
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Presenter
Presentation Notes
Now let’s talk about the 6.28 Transitional HRA. This is an optional HRA tool for newly enrolled members or members that have had a product change that have had an LTCC , MNCHOICES or 3428H Assessment and care plan done within the last 365 days. If the member is experiencing a significant change at the same time, do not use this form. You will then want to complete a full LTCC. This form was developed in order to assist when a member has a product change or is new to Blue Plus who has had a previous assessment within 365 days without the care coordinator having to complete a full assessment. The Transitional HRA must be accompanied by a previous assessment and care plan being attached to it. � Therefore, Care Coordinator’s need to obtain and review the previous assessment/care plan (LTCC/MNCHOICES/3428H) . If you are unable to obtain the previous assessment, then a full LTCC needs to be completed.
Confidential and proprietary.
6.28 TRANSITIONAL HRA (THRA)
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Presenter
Presentation Notes
On the second page of the transitional HRA, there is a section regarding goals. Make sure you review the previous care plan and the goals. If there are no new goals, you do not need to add any in this section. After reviewing the previous goals, if there are new goals, please include them here. When monitoring notes between this assessment and the next one due, make sure to make you updates on both the previous care plan and this one. The previous assessments/care plans can be reviewed either telephonically or in person to ensure the information has not changed and the care plan is addressing the member’s needs. If any portion of the paired documents is missing or unsigned, the Care Coordinator is responsible for obtaining the missing information. If unable to obtain the missing information, the Care Coordinator must complete a new assessment and care plan. The next reassessment is due within 365 days of the previous LTCC/MNCHOICES/3428H assessment and not the date of the Transitional HRA.
Confidential and proprietary.
DHS 3428H
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Presenter
Presentation Notes
This next form is the Minnesota Health Risk Assessment Form known as DHS 3428H. This form is the HRA option for members who are community well and refuse a face to face. It should be offered to complete telephonically. This form is also the required HRA form for members who are open to a non-EW waiver such as DD, CAC, CADI or BI, are living in an ICF/DD or a DD member living in the community. This form has two care plans associated with it. For a community well member, you use the MN My Care Plan- Telephonic: care plan with the 3428H telephonic HRA. For the member on a non-EW waiver, you use the 6.17 Care plan ICF/DD and HCBS waiver care plan. Make sure that you document in the members case notes that the member refused the face to face full LTCC assessment.
Confidential and proprietary.
REFUSALS (CW ONLY)
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Community well Members only
• No home care or PCA• Non-EW waiver (DD,CAC,CADI or BI)
Does not have home care services
Not open to Elderly waiver
Only members or resp party can refuse
Care Coordination is still a requirement.
Presenter
Presentation Notes
Some members can refuse an assessment, but they need to not be open to a waiver nor have home care services. Basically, these members are community well with no services. Even though these member can refuse an assessment, care coordination is still a requirement. Refusals can only be made by the member or responsible party. If the member refuses a face to face HRA, offer to complete the 3428H in which can be done telephonically. Community well members receiving Home Care or PCA services cannot refuse the HRA and continue to receive services. If the member refuses both telephonic and face-to-face assessment, then it is considered a refusal. Care Coordinators need to state the refusal in the members case notes. Continue to reach out to the member at least every 6 months either by phone or email.
Confidential and proprietary.
UNABLE TO REACH (CW ONLY)
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Care Coordinators must make a total of four attempts
to contact the member
Presenter
Presentation Notes
Members that are community well may not be able to be reached for an assessment. Care Coordinators must make a total of four attempts to contact the member to offer the HRA. The 4 attempts can be obtained via phone, e-mail, letter, or reaching out to the financial worker/DHS or anyone else you think may have information to reach the member. The fourth and final attempt must be mailing the 8.40 Unable to Contact Letter to the member.
Confidential and proprietary.
NURSING HOME ASSESSMENT
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Initial assessment and reassessment:
New members to Blue Plusor,
➢ Within 45 days of notification of long-term placement; or,
➢ Within 45 days of the transfer effective date if the long-term placement results in a transfer of Care Coordination Delegation; or
➢ Within 365 days of the previous assessment, whichever is sooner.
Presenter
Presentation Notes
We are going to switch gears now to the nursing home assessments. There are different times that you need to complete a nursing home assessment. If a member is new to Blue Plus, the care coordinator is notified that the member is long term placement, or if the member transfers to a new delegate due to long term placement. With all of these cases, the nursing home assessment needs to be completed within 45 days or 365 days from the previous assessment which ever is sooner. . For reassessments, the nursing home assessment needs to be completed within 365 days.
Confidential and proprietary.
NURSING HOME ASSESSMENT
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Presenter
Presentation Notes
All nursing home assessments need to be completed face to face. Although the majority of the assessment is a chart and care plan review, it is still required to physically visit with the nursing home member. The assessment is not complete until you have seen the member. When you are completing the initial assessment, please be aware that a member may not be able to fully participate and in these cases reach out at a minimum of one time to the guardian, POA or their responsible party. The CC should also review o their role , the Supplemental Benefits or discuss MSHO enrollment for MSC+ members. The CC is to document this discussion on the checklist(s) or in the case notes. Part of the process of completing the nursing home assessment is to also interview the facility staff and address any needs identified with the member’s care.
Confidential and proprietary.
NURSING HOME TRANSITIONAL HRA
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Presenter
Presentation Notes
There is a THRA nursing home option that is available to use only for product changes and not new enrollees to Blue Plus. This page is located at the end of the nursing home assessment for convenience. This option requires a review of the current MN NH Member Annual Assessment done in the last 365 days. In addition, the Care Coordinator must document any updates to the care plan and discussions with member and/or Responsible Party. After completion, then the CC enters the THRA information into Bridgeview. The next annual assessment is due 365 days from the last full assessment date.
Confidential and proprietary. Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.Confidential and proprietary.
THANK YOU. Any questions?Contact your Partner Relations Consultant or email [email protected].
