healthy moms healthy babies care coordination (pilot) instructions

Michigan Department of Health and Human Services

Maternal Infant Health Program

MDHHS-5957-Instructions (5-21)

This form is intended to document care coordination activities conducted on behalf of beneficiaries eligible to participate in the Healthy Moms, Healthy Babies pilot. Billable care coordination activities must be completed by home visitors and/or MIHP Coordinators. Other administrative staff activities and time are not eligible for reimbursement. Documentation of cumulative time on this form attests to the compliance for reimbursement. This form is only required for agencies selected in the ‘Treatment’ group of the pilot. Form requirements: Completed once per calendar month. Include every beneficiary whose Medicaid ID will be billed with the Enhanced Care Coordination (T2022) code. At least one care coordination activity and topic addressed category must be checked per beneficiary. Care Coordination activity(ies) must account for at least 30 minutes of cumulative time spent by home visitor(s) and/or MIHP Coordinator. Agency – Input the MIHP provider name. Month/Year – Input the month and year (MM/YYYY) which the documentation will support. Beneficiary – Input the beneficiary’s first and last name. Medicaid ID – Input the beneficiary’s Medicaid ID. Time – Input the cumulative amount of time home visitors and/or MIHP Coordinator spent on care coordination activities for each beneficiary listed. Care Coordination Activity – At least one care coordination activity must be checked Communication with Medical Care Provider Communication with Medicaid Health Plan Communication with Community Resource Communication with Other – Specify the entity. Reflective Supervision Case Conference Coordination to support plan/care Non-billable contact – Designated to refer to non-billable communication with the beneficiary/ caregiver. Topic Addressed – This section is designed to capture information regarding the topic(s) addressed during the care coordination activity(ies). This information should be associated with the Z-code assigned to the Enhanced Care Coordination code each month. This documentation is not required in a specific location but there must be a clear linkage between the Z-code chosen and documentation in the chart or on this form. Documented in chart – Check this box if the care coordination activity is associated with documentation in the beneficiary chart. •• For example: Housing was a domain addressed during a professional visit on a given month and a home visitor/MIHP Coordinator called local homeless shelter to find housing resources for the beneficiary/caregiver. Documentation on the Risk Identifier and PVPN support the care coordination activity and the appropriate Z-code will be billed. Examples of appropriate Z-codes: Z59.0 Homelessness Z59.1 Inadequate housing Additional topics – Check this box and specify the topic addressed in the text box below if the care coordination activity is not associated with documentation in the beneficiary chart. •• For example: A beneficiary (maternal) mentions they would like to start working once the baby is born. This information is not documented in the chart. A home visitor/MIHP Coordinator reaches out to local employers and gathers career resources to share with the beneficiary. Documentation on this form should include checking “Additional topics” and writing “job resources” or “unemployed” in the text box provided. Example of appropriate Z-codes: Z56.0 Unemployment, unspecified