New York State DOH
Health Home Care Management
Reporting Tool (HH-CMART)
Support Calls – Session #3
March 6,2013
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Technical Specifications Update
Q+A Themes from February 27th Call
Reminder: 2012 Data Submission Requirements
Reporting Schedule
Introduction of 2012 Data Excel Template
Definitions of Elements 19-23
Questions and Comments
Feedback, Help, and Ongoing Support
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Please submit your questions in writing to the
webinar
 If you would like to ask your questions, raise
your hand (making sure you have entered
your audio pin code) and we will unmute the
call one at a time
 We are working on a Question and Answer
document that will be posted on the HH
website under the HH CMART section
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The first bullet defining AbleContact is now on top of Page 9 and
revised to read:
 Contact for ‘AbleContact’ is defined as a verbal interchange
between member/legal representative/family and Health
Home staff. Letters sent to members should not be counted
as contact, nor should leaving messages for members.
 AbleContact indicates whether the HH was able to contact the
member successfully or not
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Page 9 , 4th bullet revised also
◦ First sentence , from the previous version, on page 9 has been moved to note
on 12 OutreachEffort: Page 8
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Mailing and outreach/Mass mailings
 12 OutreachEffort: Page 8
◦ This count includes all attempts to contact the member to
engage them in participating in the Health Home for the
reporting period.
◦ Included are counts of in-person ( street level ) , phone contacts,
and individualized mailings to attempt to locate and interact
with the member PRIOR to the member or legal representative
agreeing to participate in the Health Home .
◦ The interaction where the member/ legal representative agrees
to participate should not be included in the count
◦ This does include all attempts regardless of whether the member
agreed to participate or not, once contact was made
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Mentioned on February 27th call (slide 15, element
#13 – AppropriateCM)
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Page 9 will reflect a change below.
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Multiple Health Homes Submission – For any entity using
the HH-CMART for two or more health homes, make a copy
of the HH-CMART Tool to use for each of the health homes
separately prior to entering any data.
◦ You should not use the same HH CMART Tool for entering more than
one Health Home’s data.
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Tracking Sheet and C-MART Connection –
The Patient Tracking System (PTS) is used to collect
enrollment information. This will auto populate some
fields (BLUE) of the HH CMART file.
The HH CMART collects individual level ‘care management’
data. ( outreach, engagement, assessment, Care plan, and
specific types of interventions)
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Fact GP on clients that are ‘case closed’ – HH’s are
required to submit 2012 FACT GP and HH Functional
Assessment data on all enrollees;
◦ Exception Retracted – see slide 6 from 3/20/13 webinar for
clarification
Data cannot be shared with a Health Home if the case has
been closed case and member has signed the withdrawal of
consent
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FACT GP on TCM Legacy Clients – Clients that did not
have a FACT-GP / HH Functional Assessment in 2012.
There should be an initial assessment done now and
submitted for 2013 first & second quarter data (part of
the August 5th, submission date)
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The first report will only require data collected by the FACTGP and Health Home Functional Assessment
This data will NOT be entered into the HH-CMART tool. This
data will be entered into an excel document and submitted
via the HCS system.
The date for submission of this data has NOT changed. Data
from Calendar year 2012 is still due Monday, May 13, 2013
All other reports are due no later than the first Monday of
the second month following the end of the reporting
period. The schedule is on the Health Home website here:
http://www.health.ny.gov/health_care/medicaid/program/
medicaid_health_homes/assessment_quality_measures/re
porting_periods_and_file_submission_dates.htm
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Reporting Period
Report Date
Element
HH-CMART File Submission
Date
FACT-GP and Health Home
Functional Initial Assessment
all enrollees (Jan-Dec 2012)
Excel template Monday, May 13, 2013
First Two Quarters 2013 (JanJune 2013)
2/2013
Monday, Aug 5, 2013
Third Quarter 2013
(July-Sep 2013)
3/2013
Monday, November 4, 2013
Fourth Quarter 2013
(Oct-Dec 2013)
4/2013
Monday, February 3, 2014
For each file submission, use a copy of the original version of the HH-CMART
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The first report will only require data collected by the FACT-GP and
Health Home Functional Assessment
◦ Specifications document required data are elements 2, 4, 7, and 35-49
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Below is an example of the FACT-GP data as it is seen from the excel
template.
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Additional Information about the FACT-GP is available on the Health
Home website here:
http://www.health.ny.gov/health_care/medicaid/program/medicaid_h
ealth_homes/assessment_quality_measures/index.htm#func_quest
Completed files are sent through the Health Commerce System (HCS)
using the ‘Secure File Transfer Application’ from the Applications tab.
Name the file with the Health Home name and upload the file (ie.
CapitalHealth.mdb). Send the file to ‘Laura Morris’ .
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Each element is color coded by data collection needs for each
element by reporting period
◦ Green = changes each reporting period
◦ Red = Once in, remains the same always
◦ Orange = Needs to be reviewed for new information
each report
◦ Blue = DOH will fill in
* Color Coding See slides from Feb. 20, 2013 Webinar
power point:
http://www.health.ny.gov/health_care/medicaid/progra
m/medicaid_health_homes/meetings_webinars.htm
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19 – ConsentDate: Equivalent to the ‘Consent Date’ on the
Health Home Patient Tracking System.
◦ Date that the member/legal representative signed appropriate
consent for data sharing among Health Home partners and includes
the signing of a valid consent for data collection from the RHIO/HIE
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20 – LevelOfIntensity: The frequency of interventions
conducted by the Health Home care management staff.
◦ Reported as:
High – CM staff intervention needed more than weekly
Medium – CM staff intervention needed weekly to every other week
Low – CM staff intervention needed less than every other week
 Interventions are interacting with member/legal representative/family and health
care providers and community based programs to arrange or monitor services and
progress.
 Does not include interventions conducted by providers, other organizations, or
health plans
◦ If frequency of intervention varies during reporting period, the
maximum level of intensity should be reported
 Example: First two months intensity is LOW but remainder of reporting period the
intensity is HIGH, element should be reported as HIGH
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Defining Interventions (Elements 21, 22 and 23)
◦ Interventions conducted as part of outreach (prior to engagement in care
management) should be excluded. This will be reported in element # 11.
◦ Interventions should be specific to the individual member’s care or care
management needs.
◦ Include interventions conducted by Health Home care management staff
and support staff or care management contracted providers
◦ Do not include interventions conducted by health care providers, other
organizations, or health plans
◦ Only interventions that were conducted should be counted, attempts
should not be counted
◦ Counts of interventions are not cumulative from start of care management
– when a new reporting period begins a new count begins
◦ Each separate intervention should be counted once in the appropriate
category of mode
◦ Include interventions involving the member/ family/ legal representative,
health care provider, or other organizations involved in the care plan
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Elements 21, 22, and 23 capture counts of intervention
conducted for or with the member during the reporting
period. Each intervention should be assigned to one of the
three following categories
21 – CountMail: Individualized letters or emails sent
during reporting period. Mailings or email message or
ONLY pre-written materials not specific to individual
should not be included
22 – CountPhone: Count phone call interactions made
during reporting period.
◦ Both incoming and outgoing phone call interactions count
◦ Automated voice messages, attempted phone calls, or leaving voice
mail messages should not be counted
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23 – CountPerson: Count each in-person interaction
during the reporting period
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We encourage your feedback
◦ Case Scenario development
◦ Clarify fields so that the thinking behind how a question is answered in
the HH-CMART is the same across the board
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Email the Health Home Team at
[email protected]
with the Subject : HH CMART
Or Call the Health Home provider line – 518.473.5569
Health
Home website, Assessment and Quality Metrics menu, Process
Measures section:
http://www.health.ny.gov/health_care/medicaid/program/medicaid
_health_homes/assessment_quality_measures/process_measures.ht
m
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Weekly call every Wednesday from 10 a.m. to 11 a.m.
◦ The next call will be March 13th
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Slides from all webinars can be accessed by visiting
the Health Home website at:
http://www.health.ny.gov/health_care/medicaid/program/me
dicaid_health_homes/meetings_webinars.htm
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