Session 14– April 10, 2013
Data Exchange Application Agreements
1
•
The DEAA allows the DOH to exchange lists of Health
Home members with the lead Health Home.
•
The lead Health Home then completes subcontractor
packets with network partners, permitting the lead
Health Home to share lists and demographic data with
their partners prior to member consent.
2
The DEAA does not permit:
• Data exchange between other lead Health Homes without a
subcontractor packet (a lead to lead packet is being
developed).
• Data exchange with local social service districts without a
subcontractor packet. (Comment: Local Districts have valuable
information that can aid in identifying members. Subcontractor packets
are an easy and recommended solution to permit data exchange to assist
the local districts in updating data while providing Health Homes with
valuable information.
3
•
The subcontractor (aka downstream or network provider)
packet is designed to allow the lead Health Home to
share data with network partners, e.g., with those that
provide case management services or other services (e.g.,
outreach) prior to obtaining member consent.
•
Subcontractors are engaged by the lead Health Home, not
vice versa.
•
Subcontractors complete their portion of the packet and
then return it to their lead Health Home (not DOH).
4
•
The lead Health Home then authenticates the packet by
signing the Executory Clause, BAA and Confidentiality
Agreement.
•
The lead Health Home then submits the packet to DOH
(Privacy Coordinator).
•
Once reviewed and approved, an Approval Letter is generated
to the lead Health Home, permitting data sharing.
•
In order to permit data sharing between two network
partners (subcontractors) a reciprocal subcontractor packet
must be executed (this is being developed).
5
•
Members do not have to be on DOH lists or be approved by DOH
in order to be accepted as a Health Home referral.
•
Health Homes, their partners, and MCPs are responsible for
determining whether the individual presumptively meets Health
Home criteria.
•
The State is not involved in the assignment of a community
referral, hence a DEAA is not required for exchange of
information about the prospective member.
EXAMPLE: A member is seen in the ED , having signed the
required ED Notice of Privacy, where the ED MD refers member to
Health Home A. This is a community referral.
6

If the member has been assigned by the DOH, the Health Homes
must have executed agreements with each other to share
information about the member and arrange referrals or transfers.
The transfer must be reported on the Health Home tracking system
using the appropriate reason codes.

If a Health Home determines that it cannot meet the needs of an
assigned member, and cannot refer or transfer him/her to another
health home or partner then:
◦ If the member was assigned to the HH by DOH but has not received HH
services, submit a rejection record to the tracking system.
◦ If the member has received Health Home services, the member’s
enrollment should be end dated by submitting a change record to the
tracking system using the appropriate reason code.
◦ DOH will reassign the member to another Health Home with the next list.
7
Can a care management provider share data on a
converting member with the lead Health Home?
• A care management provider can share data on a converting
member with the lead Health Home after the subcontractor
packet /agreement is in place.
• Care management providers can collect and manage
converting Health Home members prior to the subcontractor
packet/agreement is in place, including obtaining consent.
• Once the subcontractor packet/agreement is in place, the
member’s information can be communicated to the Health
Home.
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Consent form
• The Health Home consent allows sharing of health
information with / from core health home partners involved in
the members care that are listed on the consent form. It
includes medical, behavioral health, & SUD treatment
providers and CM agencies; & others per the website :
http://www.health.ny.gov/health_care/medicaid/program/me
dicaid_health_homes/form)
• It includes Regional Health Information Organization ( RHIO)
consent for Health Homes participating with RHIOs
• The member does not need to sign the consent at the same
time as he/she agrees to receive and participate in Health
Home services as long as that member can still be effectively
managed without sharing/ obtaining Health Information.
9

Opt Out ( DOH-5059)
◦ Health Home participation is not mandatory and individuals who do not
want to participate can “opt-out” of the program prior to consenting. .
◦ Signing the Opt-out form (DOH 5059) indicates they do not want to
participate or receive Health Home services

Health Home Patient Information Sharing Withdrawal of Consent Form(DOH-5058)
◦ For a Health Home member that has already consented and the member
decides at any time to discontinue receiving Health Home services
◦ The member/ legal representative should be filled out and sign Health
Home Patient Information Sharing Withdrawal of Consent Form- (DOH5058)
◦ If the member cannot be located, disenroll the member according to
Health Home policies/ procedures, and information sharing should be
discontinued upon disenrollment.
10

Questions on the DEAA process, subcontractor
packets and Business Associate Agreements
(BAAs)regarding sharing Medicaid data should be
directed to:
◦ Caryl Shakshober – OHIP Privacy Coordinator
[email protected]
518-486-5771
11
Eric Weiskopf, M.Ed – OHITT
Ellen Flink – OHITT
12


Health Home Consent signed
Single-Entity RHIO Consent signed in ED
13
HH Partner
RHIO
Consent
Subcontractor
packet
Care
Management
Application
Subcontractor
packet
Subcontracted
Care Manager
All American
Hospital
Health Home
with
Embedded
Care Manager
Alert
Health Home
Consent
Alert
HH Member enters
All American Hospital
Emergency Department
RHIO
RHIO
Consent
All American
Hospital
14


Health Home Consent signed
Multi-Entity RHIO Consent signed in ED
15
HH Partner
Subcontractor
packet
All American
Hospital
Health Home
with
Embedded
Care Manager
Care
Management
Application
Subcontractor
packet
Subcontracted
Care Manager
Alert
Health Home
Consent
RHIO with
MultiEntity
Consent
Alert
HH Member enters
All American Hospital
Emergency Department
All American
Hospital
16

Health Home Consent not signed

Single-Entity Consent signed in ED
17
All American Hospital Lead HH with
Embedded Care
Manager
Alert
No Health
Home Consent
RHIO
RHIO
Consent
HH Member enters All
American Hospital
Emergency Department
All American
Hospital
Emergency
Department
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Scenario:
Health Home wishes to send member tracking file to local RHIO
RHIO uses information to match patient to appropriate Health
Home and sends alerts to care manager.
Prerequisite: To share information that comes directly from
Medicaid, a RHIO must sign a subcontractor packet with the lead
Health Home to become a Heath Home sub-contractor.
Previously signed BAA that existed between RHIO/Health Home
as a part of a RHIO participation agreement is not enough to
allow Health Homes to send information gleaned directly from
Medicaid to the RHIO.
19

Health Home Consent not signed

Single-Entity RHIO Consent signed

Health Home has an approved subcontractor packet with
RHIO
20
Subcontractor
packet
All American Hospital Lead HH with
Embedded Care
Manager
Demographic
Alert
No Health
Home Consent
RHIO
RHIO
Consent
HH Member enters All
American Hospital
Emergency Department
All American
Hospital
Emergency
Department
21

Health Home Consent not signed

Single-Entity RHIO Consent signed at ED

Health Home has an approved subcontractor packet with
both RHIO and Sub-Contracted Care Manager
22
Subcontractor
packet
All American
Hospital – Lead
HH
Demographic
Alert
No Health
Home Consent
RHIO
Demographic
Alert
Subcontractor
packet
Subcontracted
Care Manager
Demographic
Alert
HH Member enters All
American Hospital
Emergency Department
RHIO
Consent
All American
Hospital
Emergency
Department
23

Health Home Consent not signed

Single-Entity RHIO Consent signed for Sub-Contracted Care
Manager

Health Home has an approved subcontractor packet with
both RHIO and Sub-Contracted Care Manager
24
Subcontractor
packet
All American
Hospital – Lead
HH
Demographic
Alert
No Health
Home Consent
Demographic
Alert
RHIO
RHIO
Consent
Subcontractor
packet
Subcontracted
Care Manager
Demographic
Alert
HH Member enters All
American Hospital
Emergency Department
RHIO
Consent
All American
Hospital
Emergency
Department
25

Health Home Consent not signed
26
HH Member assigned to All
American Hospital Health
Home enters New York
Hospital Emergency
Department
New York
Hospital
All American
Hospital Health
Home with
Embedded Care
Manager
Subcontractor
packet
Subcontracted
Care Manager
RHIO
Consent
Demographic
Alert
No Health
Home Consent
Demographic
Alert
RHIO
RHIO
Consent
All American
Hospital
Emergency
Department
27

Health Home Consent not signed

Health Home has an approved subcontractor packet with
RHIO and Sub-Contracted Care Manager

Sub-Contracted Care Manager has RHIO consent
28
HH Member assigned to All
American Hospital Health
Home enters New York
Hospital Emergency
Department
New York
Hospital
RHIO
Consent
Subcontractor
packet
All American
Hospital – Lead
HH with
Embedded
Care Manager
Subcontractor
packet
Demographic
Alert
No Health
Home Consent
Demographic
Alert
RHIO
RHIO
Consent
RHIO
Consent
Subcontracted
Care Manager
All American
Hospital
Emergency
Department
29

Health Home Consent not signed

Health Home has an approved subcontractor packet with
RHIO, Sub-Contracted Care Manager, and a 2nd Health Home

Sub-Contracted Care Manager has RHIO consent
30
New York Hospital Health
Home
New York
Hospital
RHIO
Consent
Subcontractor
packet
Subcontractor
packet
All American
Hospital Health
Home with
Embedded
Care Manager
Demographic
Alert
No Health
Home Consent
Demographic
Alert
Subcontractor
packet
RHIO
RHIO
Consent
RHIO
Consent
Subcontracted
Care Manager
All American
Hospital
Emergency
Department
31
Contact:
Eric Weiskopf
[email protected]
518 473 7960
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