SNC
How many outreaches does a supportive member receive in the initial outreach process
What is 5
What is a CCSO
Care Coordination and Support Organization - the agency that manages a members pathways to success
How long do we have to outreach the member from the MCR report?
SAME DAY
5 outreaches (call, call, letter, call, call/letter/email) before date it is due
What BH provider takes the youngest child referrals?
Backpack health
How often do we offer F2F for each (supportive and intensive) SNC/YIC/FYIC member
What is every 90 days for intensive - every 180 days for supportive
True or false: every CCSO is also a MCR provider
FALSE - we have 3 new ccsos that do not provide MCR
When does a member need an IDCT
within 7 days of community stabilization, 7 days of discharge - AND if they have been IP 21 days (in addition to the post discharge idct)
CM will contact guardian within 30 days via phone
CM will contact guardian on 10/23 at 3pm
CM will follow up with guardian via phone in 30 days or sooner if needed.
CM will follow up with guardian via phone in 30 days or sooner if needed.
Tell me the reassessment outreach process.
Reassessment must be completed BEFORE day 365 of CM. 5 attempt should be made to complete (following IC process - so member should be in PO if annual was UTR as you also should not have been able to complete IC)
When do you put a member in pop health
After 5 initial outreaches (PO process if intensive)- or after they have successfully completed care management
How does a member become pathways to success eligible?
They have an IM CANS completed by a QMHP
True or False: We outreach our MCR providers for any member on the MCR list
False - we should be checking Profax for the imcat and safety plan
True or False - If we change an intervention, we should not send a care plan
False - any change to the care plan other than progress against goal or a date change requires a letter be sent
What does a member need to have completed to get ABA therapy
Comprehensive dx testing (ex: CARS or ADOS)
What members that do not have a 7007, 7600, 7601 are treated as SNC?
All children with sickle cell disease
DOUBLE JEOPARDY:
How long does a member stay pathways to success eligible
180 days after their NB rate code expires
Also accepted: when they turn 22
What should be included in the idct template?
Presenting Problem
Member F/U with BH w/ in 7 days
Med Changes
PCP notification / follow up
Safety Plan Evaluation
F2F offered (within 7 days)
USE THE TEMPLATE PLEASE
How long do we have to follow up on a CRD?
Within 30 days of initial CRD referral and then every ic following
If a member is housing insecure - give me an example of 1 goal, 2 interventions, and 2 referrals that could be made
Ex: I will have stable housing. I will work with my CM to apply for SSI for income for housing. I will apply for SRN list. Referrals: Centauri, SRN, Public Housing, Modivcare (will transport to housing appointments 4x/year)
What are the required assessments and timeframes for SNC members
Intensive: Pediatric supplemental assessment and PSC-17 at least annually or with change in condition (must be documented within 24 hours of onboarding)
Supportive: PSC-17 and CSA as applicable (must be completed at least annually - preferably every 6 months) and documented within 24 hours of onboarding
the SFTP Prior Auth File
what is the difference between the IMCAT, Safety plan, and IM CANS
IMCAT - assessment for crisis stabilization - brief intervention
Safety Plan - what the member/family agree to in order to be safe in the community
IMCANS - a comprehensive assessment of BH Risk and needs
RAP score: 51.2 member is IP for 14 days. How many RAP notes do you have entered 24 hours after discharge if you followed the whole process?
Every 2 days + 1 after discharge (6-7 acceptable if you charted day after IP alert)
DOUBLE JEOPARDY
Name me at least 5 tools we use for data mining and how we use them
PCC
QNXT
Medcompass
Case Assistant
Peoplesafe/COS/CAS
CEC Snapshot