Complete FIDA Provider Training 10.9.2014

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Fully Integrated Duals Advantage (FIDA)

Provider Education and Training


Who is required to take this training?

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The state of New York requires all FIDA contracted providers to take this one-time training

If you have completed FIDA training through another plan, please send a copy of your attestation to: [email protected]

Who is required: • Individual and Group Providers

All contracted practitioners with an NPI number

• Facilities A responsible party is required to complete and

provide subsequent training to providers within the facility

mailto:[email protected]


Fully Integrated Duals Advantage (FIDA): Background

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Purpose: To integrate care management for dually eligible

participants (people who have both Medicare and Medicaid in NY) who may require home and / or community-based Long-Term Care Support Services (LTSS) such as: • Social Services • Mental Health and / or substance abuse services

To coordinate all LTSS necessary To incorporate physical and behavioral health with

independent living and reduce healthcare fragmentation


FIDA: Participants

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Age 21 or older, residing in NYC, Long Island, or Westchester who: • Receive or need community-based long term care services • Receive or need managed long term care • Live in nursing homes or who come to be permanently placed

in nursing homes and are both Medicare and Medicaid eligible

Exclusions: people in the Office for People with Developmental Disabilities, Traumatic Brain Injury, and Nursing Home Transition & Diversion Waivers who receive hospice services or live in a Medicaid Assisted Living Program.


The New FIDA Plans

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The following plans will combine under one managed care plan to encompass FIDA:

1. Medicare Advantage plan 2. Part D prescription drug plan 3. Medicaid Managed Long Term Care (LTCS) plan 4. Regular Medicaid care covering all other Medicaid

services

FIDA plans will cover Medicaid LTCS as well as ALL other medical care covered by Medicare and Medicaid.


FIDA: Participant Enrollment

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Voluntary Enrollment Passive Enrollment

As of 1/1/2015, participants can enroll voluntarily

As of 4/1/2015, eligible participants will be assigned a FIDA Plan by NYSDOH if/or: Plan is not selected

after 60 day min. advance notification

Declined enrollment

Participant does not opt out


Provider Requirements

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Some participating provider requirements include: Training: must meet applicable State minimum training requirements,

including minimum hours and topics of training.

No Balance Billing: may not balance bill participants for covered services rendered.

HIPAA: compliance with applicable federal and state privacy,

confidentiality and security laws, rules and/or regulations, including without limitation, the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA)

For more information regarding contractual obligations, see the

ValueOptions Provider Handbook

http://www.valueoptions.com/providers/Handbook/ValueOptions_Provider_Handbook.pdf


FIDA Covered Behavioral Health Services

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OMH licensed community residences

Substance abuse (SA) programs

Peer-delivered services

Intensive psychiatric rehabilitation treatment programs

Opioid treatment services – SA

Mobile mental health treatment

Day treatment Assertive community treatment (ACT) MI

Outpatient- medically supervised withdrawal – SA

Continuing day treatment

Inpatient hospital psychiatric/impatient mental health over 190-day lifetime Limit

Peer mentoring Personalized recovery oriented services (PROS)

Outpatient mental health

Inpatient hospital care acute – including substance abuse and rehab services

Outpatient substance Abuse

Community integration counseling

Structured day program


Module 1 Quiz: Introduction to FIDA Requirements

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True/False 1. The FIDA plan combines several current Medicare and Medicaid programs into one full-service plan. (Answer: TRUE ) As a participating provider, you should utilize

balance billing when rendering covered services to a member.

(Answer: FALSE: The FIDA Plan prohibits the act of balance billing participants for provided services.)


Module 1 Quiz Answers

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1. True 2. False - The FIDA Plan prohibits the act of balance billing participants for provided services.)


Cultural Competency & Disability Training

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Learning Objectives

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Define Cultural Competency 1:

Comprehend laws and regulations 2:

Recognize importance and integration into daily practice 3:

Identify Person-Centered Service Planning (PCSP) Models 4:


Defining Cultural Competency

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“ Cultural competence in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs.” Betancourt, Green, & Carillo, 2002


National Standards on Culturally and Linguistically Appropriate Services (CLAS)

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Enacted through a Presidential Executive Order Provide effective, equitable, understandable and

respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs. (HHS, 2013)

Standards cover Governance, Leadership and Workforce; Communication and Language Assistance; Engagement, Continuous Improvement and Accountability


The Americans with Disabilities Act (ADA) requires that health care providers offer individuals with disabilities:

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• Full and equal access to their health care services and facilities. • Reasonable modifications to policies, practices, and procedures when

necessary to make health care services fully available to individuals with disabilities (including hearing, vision, cognitive, and psychiatric disabilities), unless the modifications would fundamentally alter the nature of the services.

• Flexibility in scheduling and appointment processes. • Communication with participants in a manner that accommodates

their individual needs, including: • Alternative communication or formats for those who are deaf or

hard of hearing • Specialized care for individuals with cognitive limitations • Interpreters for those who have limited English proficiency

• All care must be provided in accordance and compliance with the ADA, as specified by the Olmstead decision.


Federal Legislation

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The American with Disabilities Act And Title II

There can be no discrimination on the basis of disability by public entities in civic life.

The Olmstead Decision Supreme Court decision (1999) that affirmed persons with mental disabilities must be accommodated in

community rather than institutional settings.


Federal Legislation: ADA Components for Providers

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To be considered ADA compliant, the following access requirements are necessary:

• Transportation and parking • Clear signage and way finding throughout

facilities • Waiting areas and examination space • Diagnostic equipment • Bathroom facilities

Please note all medical, behavioral, community-based, and facility-based LTSS Participating Providers must receive training in physical accessibility in accordance with the US Department of Justice ADA guidance for Providers. Full ADA compliance is not required to participate in the FIDA Plan but is subject to change.


Transportation & Parking

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To be considered ADA compliant, your office must be accessible along public transportation routes and/or with accessible parking close to entrances. There must also be an accessible front entrance with a ramp and curb cut at appropriate grades and surfaces.

http://www.ada.gov/adata1.pdf


Accessibility: Visually Impaired

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For visually impaired members, you will need: • Alternative formats for communicating instructions

and other health care information (e.g., explanations of informed consent) • Alternative formats include Braille, large print, audio

recording, and e-mail or digital documents (which are accessible using a personal computer equipped with “screen reading” software)

• Clear and consistent signage (e.g., color and symbol signage) throughout facilities

• Raised lettering and Braille on selected signs such as room and elevator controls


Waiting Rooms

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For members with mobility disabilities, ADA compliance includes:

• Accessible routes to and through the room • Entry doors with adequate clear width, maneuvering

clearance, and accessible hardware • Adequate clear floor space inside the room for side

transfers and use of lift equipment


Bathroom Facilities

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• Clear floor space to a single wheelchair of at least 30”x48”

• Features such as grab bars, enlarged toilet stalls, insulating pipes, or accessible faucet controls

• Accessible door handles, pulls, latches, locks, and other operable parts must have a shape that is easy to operate with one hand

For members with mobility disabilities, ADA compliance includes:


ADA Resources

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Access To Medical Care For Individuals With Mobility Disabilities • Includes an overview of

general ADA requirements and illustrated examples of accessible facilities, examination rooms, and medical equipment

2010 ADA Standards for Accessible Design • Standards for new

construction and alterations

Note: This list of requirements is not exhaustive. At this time, full ADA compliance is not required for providers to participate in the FIDA program.

http://www.ada.gov/medcare_mobility_ta/medcare_ta.pdf



http://www.ada.gov/2010ADAstandards_index.htm

http://www.ada.gov/2010ADAstandards_index.htm


Federal Legislation

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Title VI of the

Civil Rights Act of 1964 “No person shall be subjected to discrimination on

the basis of race, color, or national origin under any program or activity that receives federal financial

assistance.”


People with Disabilities May Experience Barriers

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Serious mental illness Dementia / Alzheimer’s Developmental disabilities Dual diagnosis of mental

health and substance abuse Dual diagnosis of intellectual

disabilities and mental health

Disabilities with multiple chronic illnesses or functional or cognitive limitations

Substance abuse disorders

Homeless with a disability Intellectual disabilities Stereotypes influence the

way they are treated Difficulty navigating the

healthcare system Under-utilization of

healthcare services Lack of health insurance Limited access to health

information


Chronic Conditions Prevalent Within FIDA Eligible Population

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Top 10 Diagnoses for FIDA Eligible Population

Hypertension Hypertension NOS/NEC Diabetes Hyperlipidemia Osteoarthritis Minor Mental Health

Acute Joint and Musculoskeletal Diagnoses

Coronary Atherosclerosis Chronic Joint and

Musculoskeletal Diagnoses Acute Gastrointestinal

Diagnoses and Symptoms

Physical Health Mental Health Status Daily Living Urinary Incontinence 75.4% Confusion 62.7% Grooming 79.7%

Dyspnea 73.3% Daily Anxiety 22.2% Dressing Upper Body 89.8%

Chronic Pain 80.6% Depressive Feelings 23.3% Dressing Lower Body 95.1%

Medication Non-Adherence 27.0% Impaired Decision

Making 26.7% Bathing 98.9%

Therapy Non-Adherence 31.5% Memory Deficient 26.3%


People with Disabilities May Experience Inequality

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Income Co

Stigma

Paternalism Income Communication Style

Education and Literacy Level

Institutionalization Access to appropriate services


Communication

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Communication can be spoken, written or through sign language.

Tone is communicated by gestures, eye contact, voice inflection and can mean different things in different cultures.

Its important to consider your communication style when treating patients with impairments: • Visual • Hearing • Speech • Mobility • Cognitive


Use People-First Language

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Say: Instead of:

People with disabilities Handicapped, crippled, disabled

He has a cognitive disability He’s mentally retarded

She has autism She’s autistic

He has a physical disability He’s a quad or cripple

She uses a wheelchair She’s wheelchair-bound

He has an emotional disability He’s emotionally disturbed

Accessible parking Handicapped parking


Communication: Interpreter Services

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The FIDA plan makes resources available to participants who require culturally, linguistically, and/or disability competent care such as, but not limited to, disability and language lines.

For assistance obtaining Interpreter or Language Line resources, visit the NYS Office of Mental Health.

https://www.omh.ny.gov/omhweb/cultural_competence/translation/


Influential Models – Person-Centered Service Planning

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Social Model of Disability

Independent Living Philosophy Recovery Model


The Social Model of Disability

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The Social Model of Disability: empowers individuals with

disabilities to define themselves as whole members of society and

makes a clear distinction between one’s disability and the more limiting effects of society’s treatment of that disability

Example: Needing a wheelchair isn’t a problem; it’s a problem when a building doesn’t include ramps.


Independent Living Philosophy

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The Independent Living Philosophy builds on the Social Model of Disability by affirming that individuals with disabilities have the right to self-determination, self-respect, and equal opportunities.

This philosophy emphasizes the importance of supporting and empowering the individual to take an active role in accessing services.


Recovery Model

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The Recovery Model: is a treatment concept wherein

consumers have primary control over decisions about their own care, and recovery is viewed as a journey rather than an outcome

argues that if individuals with mental illnesses have greater control and choice in their treatment, they will be able to take increased control in their lives


Wellness Principles

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Physical Spiritual Social Intellectual Emotional / Mental Occupational Environmental Financial


Crisis Prevention and Levels of Treatment

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Emergency: In an emergency situation, the Participant should be seen in person immediately or referred to appropriate emergency service providers. Participating providers who do not maintain twenty-four (24) hour coverage must maintain a system for referring members to a source of emergency assistance during non-business hours. See Provider Handbook for more details.

Emergent: In an emergent situation, the Participant should be seen within six (6) hours of the request for an appointment or referred to appropriate emergency service providers.

Urgent: In an urgent situation, the Participant must be offered the opportunity to be seen within forty-eight (48) hours of a request for an appointment.

http://www.valueoptions.com/providers/Handbook/ValueOptions_Provider_Handbook.pdf


Module 2 Quiz: Cultural Competency & Disability

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True/False 1. The Americans with Disabilities Act (ADA) requires health care providers offer equal access to services and provide reasonable accommodations to ensure services are accessible to individuals with disabilities. 2. The 3 influential models of person-centered service delivery include: Social Model of Disability, Independent Living Philosophy, and the Recovery Model.



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1. True 2. True


Interdisciplinary Care Team (IDT)

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Learning Objectives

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1:

2:

3:

4

Understand Person-Centered Service Plan (PCSP)

Describe Health Assessments in IDT Context

Outline Interdisciplinary Team (IDT) Purpose & Roles

3:

4:


Interdisciplinary Team (IDT): Composition

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Definition: • Professionals from different medical and behavioral health

disciplines working toward a common goal and responsibility of the group effort

Must include: • Participant • Behavioral Health Professional • Primary Care Provider (PCP) or clinical designee from practice • Primary Care Manager – IDT Lead

Can Include: • Participant’s designee (i.e., caregiver, family) • Home Care Aide(s) • Nursing Facility Representative • Other Providers


Interdisciplinary Team (IDT): Roles

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The IDT is led by an assigned Care Manager at the FIDA Plan

Under the FIDA Program, the IDT:

• Writes, monitors and participates in a person-centered health service plan (PCSP)

• Contributes to ongoing care management activities • Authorizes FIDA covered health services • Reviews participant health care plan at least every six

(6) months or whenever a significant change occurs


Interdisciplinary Team (IDT): Roles cont’d.

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Highly encouraged to work collaboratively • The goal is for consensus with treatment decisions while

keeping participant’s specific needs and preferences in consideration

If conflict with Treatment Decision(s): • For care decisions requiring a provider with a specific

licensure and / or certification, decision always rests with appropriately licensed and / or certified treating member(s) of the IDT


IDT: Role of Participating Provider

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As a ValueOptions provider, you play an integral role for the FIDA plan in that you provide the expertise to assess, evaluate, and provide services related to mental health and / or substance abuse deemed necessary to meet the requirements set forth by the Interdisciplinary Care Team’s (IDT) Person-Centered Service Plan (PCSP).

• To support the PCSP, the following must be made available to all IDT members, including, but not limited to: Documentation of all care and services rendered to the

Participant Current and past assessments, reassessments and any file

notes that include the Participant’s response to treatment Medication records A signed release permitting disclosure of personal information

http://www.valueoptions.com/providers/Forms/Administrative/Coordination_of_Care_Authorization_Form.pdf


FIDA Model of Care: Overview

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RN-assessor conducts initial assessment

IDT meets/ develops the PCSP/authorizes services

PCM coordinates authorized services

Services

Reassessment


IDT: Initial Comprehensive Health Assessment

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Comprehensive Assessment New York State Uniform Assessment System (UAS-

NY) • The UAS-NY uses 22 items and sub-items from the

UAS-NY community assessment including: Cognition and communication Mood and behavior Functional status (activities of daily living

performance) Nutritional status


IDT: Review of Assessments

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After each participant assessment: • The IDT meets (within 30 days) to review results,

authorize needed services and coordinate health care for participant

Primary Care Manager (PCM) facilitates meetings of the IDT and discussion of person-centered service plan (PCSP)

PCM sends PCSP to IDT members for signatures after each meeting

PCM sends participant hard copy of PCSP signed by all IDT members


IDT: Comprehensive Health Assessment

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Reassessment: Every 6 months - or -

When change in health status: • Within 48-hr period prior to transition or • Within 30-day period after discharge

Following the reassessment, the IDT meets to make necessary updates to the PCSP. PCSP meeting should be attended by the participant and all IDT members.


Person-Centered Service Plan (PCSP)

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Personal Health Care Service Plan document: • Prepared during IDT meeting no later than 30-days of

assessment • Reviewed and / or amended within 30-days of

comprehensive reassessment

Components of the PCSP: • Results of health risk assessment(s) • Goals, interventions, health services, benefits and

preferences for care

Identifies: • Personalized medical, behavioral and mental health needs • Cultural, linguistic, special needs services, and other health

needs and goals


IDT: Purpose of PCSP

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Identifies who is responsible for implementation of each portion of care plan

Determines clear communication for IDT members for six(6) month duration of plan

Informs / offers health service alternatives such as: • Home • Institutional • Community-based services

Discusses related obligations


IDT: Purpose of PCSP cont’d

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Evaluates effectiveness of current plan of care

and reevaluates or modifies as needed Discusses problems, concerns or interventions

raised at last care planning Determines care or service(s) for the six(6) month

care-plan duration • Amount of time services are authorized • Integration of technology into care plan


The IDT must:

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Educate, empower and facilitate the Participant to make choices within the parameters of the FIDA Demonstration and to exercise his or her rights and responsibilities, including the opportunity to participate in Consumer Directed Personal Assistance Services;

Involve the Participant as an active team member, including providing information and explanations using plain language understandable to the Participant and/or caregiver, and stress Participant-centered collaborative goal setting;

Arrange the supports necessary for the Participant to keep doing things he or she enjoys, to follow through on prescribed treatments, and to remain physically active;

Establish a set of guidelines or care responsibilities for the entire team and distribute these to Participant;

Provide education to the Participants and families regarding health and social needs;


The IDT must (cont’d):

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Identify the Participant’s informal support systems/networks in relationship to his or her functional and safety needs;

Assess and assist the Participant in identifying and addressing quality of life issues;

Deliver coordination with care providers across settings; Assist the Participant in accessing reasonable accommodation

and accessible providers; Offer information about and assist Participant in maintaining and

establishing community links; Supply information about services available through the Area

Agency on Aging to adults age 60 and older; Provide information about and assist Participant with housing and

transportation issues; and Support the Participant and/or designated representative in

understanding the disease process, chronic illness, and/or disability and realizing his/her role as the daily self-manager.


Resources

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Provider Connect Provider Handbook FIDA Training Provider Webinar Calendar For additional information regarding the FIDA

Plan, please visit the New York State Department of Health

*For a list of references, please send requests to: [email protected]

http://www.valueoptions.com/providers/Providers.htm

http://www.valueoptions.com/providers/Handbook.htm

http://www.valueoptions.com/providers/Network/Fully-Integrated-Duals-Advantage-FIDA.htm

http://www.valueoptions.com/providers/Webinars.htm

https://www.health.ny.gov/health_care/medicaid/redesign/mrt_101.htm

https://www.health.ny.gov/health_care/medicaid/redesign/mrt_101.htm



Module 3 Quiz: IDT

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True/False 1. The Interdisciplinary Team (IDT) must include the participant/patient only during the initial meeting. 2. A Person-Centered Service Plan is created as a result of the health risk assessment(s) to identify treatment goals and interventions that align with the individual’s specified treatment needs.



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1. False: The participant/patient is a vital piece of the IDT and should always be a part of creating their Person-Centered Service Plan.

2. True

Attestation of Completion FIDA Provider Training

By signing this form, I confirm that I have completed the FIDA Provider Training as mandated by the State of New York and agree to abide by all standards and guidelines set forth by the FIDA Plan. I understand that I may contact ValueOptions at [email protected] with any questions. ______________________________________________________________________ Provider Name (printed) _______________________________________________________________________ Facility or Group Name if applicable _______________________________________________________________________ Practice Address _______________________________________________________________________ City State Zip code __________________________________ NPI Number __________________________________ Tax ID Number __________________________________ ________________________ Signature Date Please send completed attestation form to [email protected] or fax attention to PR FIDA: (855)215-0917.



Complete FIDA Provider Training 10.9.2014

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Transcript of Complete FIDA Provider Training 10.9.2014