Enrollment/Disenrollment
Once a family agrees to outreach for Health Home services, what information should you obtain at your first outreach visit?
1.) CIN Number (FSS to verify in EPACES)
2.) HealthELink Consent (System Generated)
3.) Individual ROI's for all providers and school
What are the two requirements to eligible for Health Homes?
1.) Medicaid
2.) Qualifying Condition (Two Chronic or one qualifying single condition)
What are the four single qualifying conditions that will make you eligible for Health Homes?
1.) HIV/AIDS
2.) Sickle Cell Disease
3.) Serious Emotional Disorder (SED)
4.) Complex Trauma
What consent for enrollment do you complete for a member under the age of 18?
DOH 5201 and 5203
What needs to be completed in Netsmart prior to your eligibility screening?
Problem Chart
When is it appropriate to send a NOD for disenrollment?
Anytime a member is disenrolled other than member request.
What would make a child not qualify for Health Home services, even if they have Medicaid and qualifying chronic conditions?
They do not fit the appropriateness criteria
The chronic conditions used at enrollment to complete your eligibility screening.
Who should complete the DOH 5055 form?
A member over 18, or a minor who is pregnant, parenting or married.
When do you have to upload your enrollment packet, qualifying conditions?
10 days after enrollment
How many days do you need to send the NOD and disenrollment letter prior to disenrollment?
You need at least a 10 day notice before disenrollment.
How many months can a member stay enrolled while in an excluded setting? Give an example of an excluded setting
6 months
Residential Facility, Jail, inpatient stay
What codes are needed when determining eligibility from providers?
ICD-10 Codes
At age can a member consent to share or withhold information regarding protected services such as family planning, abortion, HIV testing/treatment, STD/STI testing, drug and alcohol treatment, sexual assault, prenatal care, labor/delivery, and contraception.
Age 10
Once a Care Manager is aware that a child does not qualify for Health Home Services, what two documents should you send?
1.) SYB Denial Letter
2.) DOH 5236/NOD for denial of enrollment
What letter should be sent if there has been no communication from the parent/member and it has been decided the member should be disenrolled?
SYB 30 day notification letter
By the end of the enrollment month
True or False: Developmental disorder of scholastic skill or motor function is a qualifying conditions?
False
What two consents are required to be completed in the consent tab?
1.) CHUNNY Consent
2.) 5201/5055 Consents
What is the name of the form for a member under the age of 18 who is homeless or considered a runaway youth.
Homeless youth attestation form
When can you place a member in diligent search efforts?
After 30 days of no contact
Name a category that falls under the appropriateness criteria within the children's eligibility screening?
- Social Determinate Risk
-Treatment non adherence risk
-Direct referral from MCO
-Adverse Event Risk
-Health Care Risk
Name at least three qualifying conditions that fit the SED Criteria?
Schizophrenia Spectrum and Other Psychotic Disorders. • Bipolar and Related Disorders • Depressive Disorders • Anxiety Disorders • Obsessive-Compulsive and related Disorders. • Trauma and Stressor Related Disorders. • Dissociative Disorders • Somatic Symptom and Related Disorders. • Feeding and Eating Disorders • Gender Dysphoria • Disruptive, Impulse-Control, and Conduct Disorders. CHHUNY Eligibility Policy Page 3 • Personality Disorders • Paraphilic Disorders • ADHD* • Elimination Disorders* • Sleep Wake Disorders* • Sexual Dysfunctions* • Medication Induced Movement Disorders* • Tic Disorder
Once a year
Who should be listed within the care coordination tab?
All providers, social supports, and care team members.