Advocate Notes

Committee: Medical Care Advisory

Location: DHSS Campus

Presentation Topic- Electronic Visit Verification (EVV)

Directors Update: Stephen Groff opens 

He begins with going over legislation

Long term Health Care Issues and people felt cornered.

The importance of Fertility Insurance coverage and economic growth

SB 227 Primary Care Services

Create Primary Care Reimbursement for preventative services. 

Encourage value-based service and move towards more innovative ways to pay for these services

SB 230 Mental Health and Substance Abuse Parity

Next legislation concepts he discussed was about people with mental health disabilities and their need for long-term care. Some individuals are living totally out of the Managed Care System. They need their health care through managed care but not other services they receive 

Thought discussion: May put unintended burden making it unrealistic to perform and achieve expectations

Medicaid study group:  

Senate Concurrent Res. No. 70-   There with be an option for buy-in and potention for Waiver and subsidies for certain services. 

* Not only of healthy life but healthy economy and middle class

* 24,000 Delawareans are enrolled in Marketplace plans via ChooseHealthDE.com or Healthcare.gov

* health insurance premiums on an average “ Silver” level Marketplace in Delaware increased by 25%

* Urban Instititute has shown that per-enrollee healthcare spending  is 22% less under Medicaid than under private insurance.

* also Medicaid  expansion, Delawareans making 138% or less of the Federal Poverty (FPL) are eligablible for Medicaid

* Congress enacted the Medicaid Buy-In option for states in the alanced Budget Act of 1997 and enhanced the option in the Ticket to Work Incentive Improvement Act of 1999

* Continued with “Medicaid for Workers with Disabilities” (MWD) and Buy-In availability. 

* Goes on to state that Delaware’s small size gives it a unique opportunity for innovation in public policy, including health care policy

This brought on much discussion about the lack of Primary Care in the state of Delaware from Doctors sitting around the table. 

 

Deputy Director- Lisa Zimmerman Update:  

DMMA works with DDDS.  Discussing the Lifespan Waiver and Child Medical Needs.  They are currently working on a Charter and everyone is welcome to come.

 

Medical Director- Dr Liz Brown- Family Physician- DMMA: 

She discussed National Governors’ Association (NGA)  - “Harnessing the Power of Data” pilot-  use a data in our Medicaid Program

- We must be careful how we use the data

- analyze the gaps

- maximizing the data

- transform data

- this will be a 16 month project

- includes: eligibility, claims, data warehouse

- Multi-state collaboration, but not sharing personal member data. Will be sharing best practices. Purpose will be to Learn from each other

- CMS alignment

- reporting is a really important part and she wants it to be done easily

- for healthcare data based based out of DHIN

- thinking about sustainability and appropriately getting matching funds

 

Pharmacy Update- Cindy Denemark-  

1) Opioid talk will be postponed

- discussed Naloxone and the Pharmacists

2) Time line for Prescription Assistance Program

- reaching out to people previously enrolled before part D is due. Oct and December processing claims for January 1st

 

PRESENTATION: Electronic Visit Verification By: Glynn Williams and Laura Hendrick

21st Century Cures Act and Parity Based

The following Must be present to comply with law: 

* Seamlessly transmit info

* accommodate multiple forms of data collection

* protect information (privacy and HIPAA) 

* provide support for users (provide training) 

 

STATES CAN LOSE PRIVLEDGES, but must provide they made good effort to comply

Must be able to collect:    ( 6 items)

* Type of Service

* Individual receiving service

* Date of Service

* Location of Service Delivered

* Individual providing the service

* Time the service begins and ends

 

SERVICES Subject to EVV: 

* Personal Care

* Attendant Care

* Habilitation

* Respite

* Chore

* Home Health Nursing

* pt/ot/st  under Home Health Benefit

* Home Health Aide

* Private Duty Nursing

 

DMMA proposes to use an open model system: 

* One statewide EVV system and aggregation

* interfacing capabilities with state data aggregator

 

ACROSS THE BOARD DATA COLLECTION:  

PRIOR APPROVAL: 

* Initial Health Information Technology (HIT) 

SERVICE VERIFICATION:

* Member and direct care worker will verify services at the end of each shift/visit

System will include:

* List of tasks  ( from which the DSW can choose that have been completed during shift)

*  “ Exceptions” - permits providers to correct mistakes ( state prescribed time frames)

MEMBER/ FAMILY PORTAL:

* member/family can access data and information

REPORTING AND DASHBOARDS: 

* reporting and dashboard functionality at various user levels (State, MCO, Provider) 

OTHER FUNCTIONALITY:  

* Capability to track Direct Service Worker (DSW) qualifications and trainings

* Generate Unique DSW Identifier to be tracked across providers

* Payroll (potentially) 

* DMMA will explore functionality for a member/family satisfaction and care experience surveys