MSHO/MSC+ Care Coordination Meeting

June 17, 2020 – Recorded WebEx

Agenda

• Pharmacy Updates – Adam Nelson

• Medication Adherence Kits Updates – Erika Bower

• PCA/EW Updates – Esther Versalles-Hester

• Assessment Reporting – Cindy Radke

• Advanced Directives – Dawn Sulland

• Care Coordination Updates – Dawn Sulland

Pharmacy Updates

June 17, 2020

Agenda

• COVID-19 Impacts

• Mail Order Pharmacy and 90 Day Supply

• Medication Recalls

• Health Connect 360 Review

Pharmacy Updates 5

COVID-19 Impacts

• Early Refills: Early refills are allowed for all members if the pharmacy submits a claim with a clarification code 13 for “disaster override”

– Override is only allowed once per month per drug per member

• Drug shortages: UCare is monitoring drug shortage due to supply chain disruptions

– UCare expanded coverage to all different albuterol inhalers as a result of possible shortages

• Extending Prior Authorizations: All pharmacy prior authorizations in place as of 5/19/20 were extended by 90 days

• Encouraging Mail Order and 90 Day Supply

– MSHO and MSC+ members able to fill chronic medications for 90 day supply with some limitations

– Additionally, some pharmacies are offering free home delivery services

Pharmacy Updates 6

Mail Order and 90 Day Supply

• MSHO Members

– MSHO members are able to fill for 90 day supply and use Express Scripts mail order pharmacy.

– Some MSHO members may realize a co-pay reduction for utilizing a 90 day supply and/or mail-order

• MSC+ Members

– During the pandemic emergency time period, MSC+ members are able to fill 90 day supply for chronic medications which are not considered specialty drugs or controlled substances

– MSC+ members are not able to use mail order due to regulatory restrictions

Pharmacy Updates 7

Mail Order and 90 Day Supply

• 90 day supply process

– Ask their pharmacist

• Can change themselves in specific situations or fax provider to change to 90 days

– Ask their provider for a new prescription allowing a 90 day supply per fill.

• Mail order process

– Prescribers e-prescribe though Express Scripts Home Delivery pharmacy

– Existing prescriptions would need to be transferred from current pharmacy

Pharmacy Updates 8

Mail Order Pharmacy Details

• Members may contact Express Scripts mail order by phone at 1-877-567-6320

• Also members can login to the ESI member portal at express-scripts.com

• Free standard shipping right to the members door

• Order tracking and more with the Express Scripts mobile app or online tools

• Access to a pharmacist by phone 24/7 from the privacy of your home

• Best used for chronic medications and filling for a 90 day supply

• Short term medications, such as antibiotics, are best filled at local pharmacy

Pharmacy Updates 9

Medication Recalls

• Ranitidine

– All strengths and formulation of ranitidine were recalled on 4/1

– The most commonly used alternatives that are available on all formularies are the following: Famotidine, Cimetidine, Nizatidine.

– Other formulary alternatives include Omeprazole, Pantoprazole, and Lansoprazole.

• Metformin Extended Release

– June 1 – Amneal and Apotex recalled all lots/batches of their Metformin Extended Release Products

– June 5 – Actavis (Teva) and Marksans Pharma Limited (Time Cap Labs) recalled certain impacted lots/batches of their Metformin Extended Release Products

– Alternatives include metformin extended release from manufacturers which have not been recalled or metformin immediate release

Pharmacy Updates 10

Health Connect 360 Overview

• Clinical program offered by Express Scripts

– Contracted pharmacy benefit manager (PBM) for UCare

• Available for members enrolled in MSHO or Connect + Medicare plans

• Integrates pharmacy, medical and member engagement data to

– identify gaps

– personalize outreach

– coordinate care

• Clinical support programs available for referral

11Pharmacy Updates

Clinical support programs

• Specialist pharmacist educational counseling

• Diabetes remote monitoring

• Weight loss remote monitoring

• Hypertension remote monitoring

• Pulmonary remote monitoring

• Drug deactivation and disposal bags

Pharmacy Updates 12

Referral process

• Referral form will be available on the UCare Care Management page on the UCare website

– https://home.ucare.org/en-us/providers/care-managers/

– Form will be in the resources section

• Referral form will be a fillable PDF to provide the member information, reason for referral, and program(s) for referral

• Email the completed form to pharmacyliaison@ucare.org

• Email notification will be sent back once the referral process is completed

Pharmacy Updates 13

Questions?

Please send questions to pharmacyintake@ucare.org

Medication Adherence Kit Updates

Erika Bower, PharmD, BCACP

NEW for 2020!!

• Medication Adherence Toolkits (MSHO and Connect + Medicare)

– Four time per day pillbox (2)

– Pill splitter

– Pillbox alarm

– Medicine tracker with marker

– Medication Record Pad

– Medication Bag

– Deterra Pouch Order Form

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Kit Distribution (Through 6/5/20)

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Row Labels February March April May JuneGrand Total

MED_ADHERENCE 41 76 36 89 11 253

Grand Total 41 76 36 89 11 253

Kit Distribution Breakdown

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PDC_Indicator Count of MEMBER_NBR

1 71

0 55

Grand Total 126

Measure CountAverage Rate Minimum Maximum

DIAB 14 0.866 0.386 1

RAS 50 0.924 0.516 1

CHOL 58 0.918 0.562 1

How can I order this?

• Currently available for MSHO and Connect + Medicare members only

• Find the order form online at: https://home.ucare.org/en-us/providers/care-managers/

• Select MSHO or Connect + Medicare

• Drop down “Forms”

• Select “Medication Toolkit Order Form”

• Fax completed form to the number listed

• Member will receive kit in the mail

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PCA/EW Updates

Presented by: Esther Versalles-Hester

Reminders regarding PCA Assessments

Applying DHS Guidelines

– When assessing dependencies for PCA, please reference the DHS instructions and guidelines document that is adjacent to the DHS 3428D supplemental waiver assessment and service plan form.

– Questions or clarifications regarding dependencies are addressed in the DHS PCA assessment video – see links below.

– https://www.youtube.com/playlist?list=PL6_zMEWPk7PlgpWE9tewalGuWSEo0WJCw

– Discrepancies on completed PCA assessments will be addressed with the care coordinator who performed the assessment.

– Reminder to document in the assessment if and why the member no longer meets a previous dependency.

Remote Delivery and Increased Billable Hours for PCA Services

Two temporary modifications to PCA services are:

• Allow remote delivery of qualified professional (QP) services for all people who receive PCA services.

• Remote delivery of qualified professional services

This policy modification allows:

• QPs to provide in-person oversight via two-way remote delivery (for example, phone or internet technology)

• QPs to provide services remotely to people who are new to receiving PCA services or are transferring to the agency.

• Remote service delivery for supervisory visits was approved retroactively to May 12, 2020, through the duration of the COVID-19 peacetime emergency for members in the PCA Choice model.

• The PCA traditional model was approved for remote supervisory visits retroactively to Mar. 19, 2020, through the duration of theCOVID-19 peacetime emergency.• Increase billable monthly work hours of individual PCA workers.

Increased billable monthly hours of PCA workers

• PCA provider agencies may bill up to a maximum of 310 hours per month, per individual worker, for the services an individual worker provides to a person who receives PCA services beginning May 1, 2020. This increase will help alleviate workforce shortages and allow more consistent care for people receiving services.

• This increase does not change the scope of PCA services listed on PCA Manual – Covered services or the individual PCA worker requirements listed on PCA Manual – PCA criteria.

• Note to CM that members could exhaust PCA prior to the service agreement/authorization expiration date to due flexible use ofPCA.

Elderly Waiver Reminders

• No need for add rates to the WSAF for home delivered meals services unless you are approving a negotiated rate.

• Homemaking providers bill the approved services weekly i.e. 2 days per week. We are asking/reminding CM’s to submit homemaking services based on number of hours per week vs. approved hours per month.

• Reminder to submit EW DTR’s timely. UCare is required to issue a 14 day notice which includes continuation of services.

• Timely LTCC’s – We have seen a spike in Benefit Exceptions to approve EW services ( gap in eligibility) due to late assessments which results in EW span/eligibility termination. Reminder to conduct assessment timely and prior to the waiver span expiration.

Questions?

Case managers can contact the CLS Intake team at: 612 676-6705, press option 2, then option 5 to speak to a Intake Authorization Coordinator.

Thank you!

Assessment Reporting • Update to the log this year:

– Streamlined the log to only have 3 choices for Type of Activity

• Assessment

• Refusal

• Unable to reach

– Assessments include:

• 3428, 3428H, 3427T, MnCHOICES, THRA, ICCD. Same as previous years, when a member has an initial, annual, product change, Significant Health Change and THRA.

• DO NOT include 6 month assessments.

• DO NOT include any MSC+ members.

– Providing a Tip sheet for working assessment reporting logs.

GridLiving Status Type of Activity

Community Assessment

Institutionalized Refusal

Unable to reach

Assessment Reporting Issues

• Seeing high volume of MSC+ members added to reporting.

• Logs not complete, missing assessment dates.

• Adding in Activity information other than –Assessment-Refusal-Unable to reach.

• Member ID column not formatted to text.

• Logs being sent long after the due date of the 10th of the month.

• Label your assessment logs: delegate/month/year. Example: HoustonJune2020

Advance Directives

Why Are Advance Directives Needed?

• Population is aging.

• Seeking health care alone.

• Health crises are unpredictable.

• Not appropriate to discuss advanced directives in midst of crisis.

• Eases burden for family members/providers.

• Reduces fear and worry about health care decisions.

• Communicates your wishes when you are not able to.

Defining Advance Directives

• Legal documents that allow patients to put healthcare wishes in writing, or to appoint someone they trust to make decisions for them, if they become incapacitated.

• Two types –

– Living will

– Durable power of attorney for healthcare.

• In Minnesota, an Advance Directive is called a Health Care Directive.

– Combines living will (medical instructions) and durable power of attorney for health care (someone to act as your agent).

Why Don’t People Have Advance Directives

• Only 18-32% complete the form.

– Low health literacy rates.

– Language barriers.

– Healthy people don’t see the need.

– Discomfort/superstition with discussion.

– Just don’t get around to it.

Did You Know?

• It is just as important for individual who wants to initiate or continue treatment to leave written instructions, as it is for those who have other preferences.

• A health care directive does not require an attorney to complete.

• Once written, a health care directive can be changed or revoked as long as you have the capacity to do so.

– Advanced directives are valid until is updated or canceled.

Required Elements of Health Care Directives

• Must be in writing.

• Must be dated.

• Must state person’s name.

• Must be executed by a person with capacity to do so.

• Must be signed by you or someone authorized to sign for you, when you can understand and communicate your health care wishes.

• Must be verified by a notary or two witnesses.

• Must include either health instructions OR a health care power of attorney, or both.

What to Do with a Health Care Directive

Inform others that it exists.

• Inform others of the content, who the decision makers are, etc.

• Give others a copy, especially health care providers, keep record of who has copies.

• Review and update as health care needs change.

• Keep in a safe place, where easily found, not in safe deposit box.

• Copies of the form are valid.

What to Do with a Health Care Directive

Review and update it when there are changes in:

• Health status.

• State of residence.

– An advance directive from another state must meet requirements of each state.

– Requests for assisted suicide will not be followed- regardless of state.

• The availability of individuals named as health care agent or alternative agents.

Care Coordinator’s Role• If member wishes to discuss advance directive:

– Describe advance directive.

– Ask if they want help completing one- locate forms, etc.

– Give ideas or suggestions for talking with family, etc.

– Support their ideas or wishes.

– Follow up on any planned discussion.

– Give resources for advance directives.

• If member does NOT wish to discuss advance directive:

– Document that the member does not want to discuss.

– Assure members that they will still have coverage if they choose to have an advance directive, or not.

• Address advance directives annually with all members, and document.

• May assist member in filling out advance directive.

• May not act as witness or authorized agent.

Cultural Considerations

• Approach carefully.

• Respect cultural beliefs about death and dying.

• Do not require member to discuss.

• Document if member does not want to discuss.

• Act as a resource when possible.

For More Information• The Minnesota Health Care Directive:

– Available in English and Large Print

– Minnesota Health Care Directive Planning Toolkit can be printed online at: http://z.umn.edu/mnhcdirective/.

• Five Wishes- U.S. Advance Directive

– Created by Aging with Dignity.

– Document available in other languages.

– Available online at https://fivewishes.org/

• Honoring Choices

– Advance Care Planning initiative led by Twin Cities Medical Society

– Available in Arabic, Chinese, English, Hmong, Russian, Somali, Spanish

– Available online at www.ucare.org/advanced-directives

Questions?

• Direct questions to: clinicalliaison@ucare.org

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Care Coordination Updates

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Care Coordination Enrollment Rosters

In the upcoming months those of you who receive the Care Coordination Enrollment Roster will begin to receive 2 Care Coordination Enrollment Rosters per month:

– First enrollment roster will be received within the first few days of the month and will contain:

• New members to UCare

• Members who had changes after the 15th of the previous month

– The second enrollment roster will be received around the 15th of the month and will contain:

• Members who had a PCC/Change form submitted prior to the 15th of the current month

• DHS additional enrollments

The second enrollment roster is to be considered your FINAL roster for the month and the one you would want to reconcile.

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Care Coordination Enrollment Roster Enhancements

The look and feel of the spreadsheet will remain the same and contain the:

• “Changes” tab-any members who have had a change i.e. product, care coordinator or are new to UCare

• “All” tab-all of the members assigned to you for care coordination including the ones indicated on the “Changes” tab

• “Definitions” tab-definitions of the changes indicated on the “Changes” tab

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COVID-19 Updates

• Current DHS Waivers and Modifications

– Allowing phone or video visits for waiver programs (CV15)

• Assessments for needs can be done by phone or online connection and care coordinators can conduct phone or video visits.

• This change is effective through the last day of the quarter in which the federal public health emergency ends.

– Allowing remote delivery of adult day services

• This change means:

– Adult day services can be delivered remotely, via 2-way interactive video or audio communication.

– Providers may deliver in-person services to people in their own homes or residences.

– Providers may deliver in-person services to one person at a time in their licensed setting, such as to receive a bath

• Providers can deliver the following services in alternative ways:

– Wellness checks and health-related services, including medication set-up and administration overseen by a nurse;

– Socialization/companionship;

– Activities;

– Meals, delivered to participants’ homes;

– Assistance with Activities of Daily Living (ADLs), including bathing; and

– Individual support to family caregivers.

• This will end when the peacetime emergency is over.

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COVID-19 Updates Continued

• Expanding remote Home and Community Based Services waiver services for people with disabilities

– The commissioner temporarily waived requirements to allow remote services by phone and other interactive technologies for people living in their own homes. This flexibility was needed to help combat isolation and strengthen the health and safety of older adults and people with disabilities who used to have daily contact in day services facilities.

– More information can be found in Bulletin #20-48-01.

– This expires at the end of the peacetime emergency.

• Customized living rate add-on payments for settings with confirmed cases of COVID-19

– People who receive customized living services are especially vulnerable to COVID-19 because of their age,underlying health conditions and their proximity to other COVID-19 susceptible people. The state’s goal is to support providers to ensure the health and safety of people who receive customized liv ing services, during this emergency period.

– DHS will provide a 50% rate add-on for customized living services for 45 days, beginning the date the provider setting had at least one COVID-19 exposure, as determined by the Minnesota Department of Health (MDH). This rate add-on is available to providers delivering services in a setting that has had at least one confirmed COVID-19 case among its residents or staff between March 13, 2020 and June 30, 2020.

– No required tasks for a care coordinator in regards to this.

– More information can be found in Bulletin #20-25-02

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Care Coordination Reminders

• When a member enrolls in UCare from FFS and you are in need of the DHS-6037 Transfer Form, please reach out to CMIntake@ucare.org to see if UCare has the documents before reaching out to the County.

• For metro area delegates

– If you are assigned a member and the member is transferred to another delegate due to the member’s PCC please ensure you are forwarding the transfer paperwork to the new care coordination delegate.

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Be Considerate When Sending Emails

When sending a communications please:

• Be clear in the message you are trying to convey

• Provide enough information

– Member name

– UCare ID

– DOB

– What the concern is, provide dates, names, and phone numbers

We are ALL WORKING TOGETHER and should treat others with dignity and respect.

Clinical Liaison Contact

• Email

– Clinicalliaison@ucare.org

• Phone number & toll-free phone number

– 612-294-5045

– 866-613-1395 toll-free.

• When calling please supply the following

– Contact person’s name, phone, and email.

– A detailed description, including:

• Member’s name and date of birth.

• Member’s UCare ID# or PMI #.

• UCare product (MSHO, MSC+, Connect or Connect + Medicare).

• Question pertaining to care coordination.

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Thank you!