Dec 012014
 

This message is to remind you that HNE will honor any approved, existing Prior Authorizations for care for members reassigned to HNE Be Healthy, as long as the authorization is for a covered benefit. This notification applies to the medical necessity approvals. Any previously negotiated contractual agreements will not apply. HNE will reimburse at Massachusetts Medicaid rates for all out-of-network services.

The process for honoring pre-existing Prior Authorizations for care is as follows:

 Please fax the Standard Prior Authorization Form, along with a copy of the approval letter issued by the prior Managed Care Organization (MCO), to 413.233.2700. Health Services representatives are available to assist you Monday through Friday, between the hours of 8:00 a.m. and 5:00 p.m., at 413.787.4000 x 5027.

Dec 012014
 

This message is to remind you that HNE will honor any approved, existing Prior Authorizations for care for members reassigned to HNE Be Healthy, as long as the authorization is for a covered benefit. This notification applies to the medical necessity approvals. Any previously negotiated contractual agreements will not apply. HNE will reimburse at Massachusetts Medicaid rates for all out-of-network services.

The process for honoring pre-existing Prior Authorizations for care is as follows:

Please fax the Standard Prior Authorization Form, along with a copy of the approval letter issued by the prior Managed Care Organization (MCO), to 413.233.2700. Health Services representatives are available to assist you Monday through Friday, between the hours of 8:00 a.m. and 5:00 p.m., at 413.787.4000 x 5027.

Dec 012014
 

With the impact of new Medicaid members joining HNE Be Healthy, we understand that you may have questions about how to become credentialed with MBHP, our vendor for the behavioral health benefits for these members. The process is outlined below.

In order to become credentialed with MBHP, behavioral health providers are being asked to send a letter of intent to the following e-mail address: MBHPNetworkManagement@valueoptions.com. In your letter of intent, please highlight that you have clients whom you are currently seeing who have recently switched to HNE Be Healthy, and in an effort to avoid a disruption in services, you are requesting to join their network ASAP. It may be helpful to expedite the process by attaching your most current CV or resume’ along with your letter of intent.

If you have any further questions or concerns please feel free to call the network operations department at MBHP at 800-495-0086

Robert Azeez, M.Ed., CADC II, CRC, LADC-I

Medicaid Behavioral Health Manager

Health New England

razeez@hne.com

413-233-3438

Nov 262014
 

 

HNE Be Healthy Behavioral Health Providers please be aware of a new “BH transitional visit”, being introduced by MBHP for our members that is now effective. The transition visit aims to improve Health New England (HNE) Be Healthy Members’ connectedness to their aftercare services upon discharge from adult inpatient facilities by promoting adherence to discharge, medication, and risk management plan(s).  The purpose of the transition visit is to reduce readmission to inpatient facilities and increase community tenure by providing aftercare supports and resources upon discharge. Attached are transitional visit forms to utilize for this service.

 

 MBHP-HNE Be Healthy Transition Visit Form 11-25-14

Nov 262014
 

There was a recent  mailing that was sent to providers who currently have patients that are utilizing prescription NEXIUM®, Kapidex™, Dexilant, Prevacid® Solutab™, omeprazole sodium bicarbonate (generic Zegerid®), or rabeprazole. Effective January 1, 2015, HNE will no longer cover prescription NEXIUM®. HNE will instead cover the over-the-counter (OTC) version: Nexium® 24HR.

Below is an example of which Nexium selection you should choose when you electronically prescribe (E-prescribe) or write your Nexium 24HR prescription:

Nexium 24HR                                                 20mgCPDR                                                                   Oral

Nexium® 24HR is available in 14, 28, and 42 count packages. The new prescription will need to be written for one of these listed quantities, as Nexium® 24HR is not available in the standard 30 count package.

For ease of transition we are asking HNE providers to proactively apply the following changes when prescribing Nexium® 24HR:

  • Change prescriptions for 30 NEXIUM® 20 mg to 28 Nexium® 24HR capsules per month.
  • Change prescriptions for 30 NEXIUM® 40 mg to 56 Nexium® 24HR capsules per month.

Members and pharmacies have already been made aware of this change.

The reject messaging on the claim at point of service will reflect the bullets above. Pharmacies will be asked to contact the prescribing physician for verbal authorization to switch.

Additionally, since the cost of OTC Nexium ®24HR product is considerably lower than other brand name and some generic proton pump inhibitors (PPIs), HNE will now require Nexium ® 24HR (OTC) as a step therapy requirement for the following PPIs effective January 2015:

  • Kapidex
  • Dexilant
  • Prevacid® Solutab
  • Omeprazole sodium bicarbonate (generic Zegerid®)
  • Rabeprazole

For HNE to cover the Step Therapy drugs listed above, the member must try all of the corresponding First Line drugs, which include omeprazole, pantoprazole, and Nexium ®24HR (OTC).

Should you have any questions, please feel free to contact our Provider Relations at 413.233.3313 or 800.842.4464, extension 5000.

Nov 202014
 

 

Results from the survey to PCPs on communication with BH providers who are treating your patients

HNE is committed to supplying our providers with the information they need to deliver high quality care to our members. As part of that commitment, we asked you to participate in a survey to assess your experience with communications from behavioral health providers who are treating your patients. The results from the survey are as follows:

 

                                             Do you receive reports?       Are they timely?             Are they helpful?

Almost always (>80%) 10% 18% 18%
Most of the time (60-80%) 0% 4% 35%
Half of the time (50%) 12% 12% 0%
Some of the time (20-40%) 18% 18% 17%
Few times (<20%) 30% 18% 6%
Never 30% 30% 24%

 

This information will help us develop methods to improve the continuity and coordination of treatment of our members. Thank you for taking the time to fill out the survey and returning it to HNE.

 

 

 

 

Oct 212014
 

Helpful ADHD Materials:

Below is a link to additional information and the ADHD toolkit created conjointly by the National Initiative for Children’s Healthcare Quality and the American Academy of Pediatrics. Through this link you can access the ADHD Toolkit. Simply click on the link below then go to the final version of the ADHD Toolkit. The toolkit is introduced as a Practitioner’s Toolkit but we have found that it has resources and information that are very user-friendly for parents. http://www.nichq.org/childrens-health/adhd/resources/adhd-toolkit

Oct 012014
 

A reminder that HNE is proud to announce that we will be co-sponsoring and subsidizing a Continuing Medical Education (CME) event on behavioral health integration in the primary care setting. CMEs will be provided in the area of risk management. Please see the attached brochure for information and how to register for this event. The cost of the event, if you register before October 6th is $25.00. The cost of the event after October 6 is $35.00.

 Practical Strategies flyer 2014

Sep 302014
 

Two different patient satisfaction surveys impact CMS Star ratings:

  1. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, typically mailed to the Plan members from March–June.
  2. The Health Outcomes Survey (HOS), typically mailed to members April–July.

HNE has compiled a list of some of the questions from both surveys. You can see exactly the questions your patients are answering. We’ve also included recommendations to efficiently address these metrics. These guidelines have been compiled from various organizations including the Centers for Disease Control and Prevention (CDC), The Mayo Clinic, and Medscape Medical News.

5-Star Metric: Care Coordination

Recommendations for Physicians:

  • You probably know all relevant information about your patient’s medical history—but does your patient know you know? Make sure they do — it’s a quick way to improve patient satisfaction with doctor-patient communication.
  • Ask if the patient has seen any other providers—and if you are aware specialty care has occurred, mention it and discuss as needed.
  • Tell your patients when they should expect test results (“by the end of next week”) and who will give them the results – a staff member, your medical assistant, you?
  • Do you let patients know when test results are normal? If not, be sure they know that—but that they can call your office if they still want to check results.

5-Star Metric: Getting Care Quickly:

Recommendations for Your Staff:

  • Ensure a few appointments each day are available to accommodate urgent visits.
  • Maintain an effective triage system to ensure that frail and/or very sick patients are seen right away.
  • Offer appointments with a nurse practitioner or physician’s assistant to patients who want to be seen on short notice but cannot be seen by their doctor.
  • Encourage patients to make their routine appointments for checkups or follow-up visits as soon as they can—weeks or even months in advance.
  • Be proactive and call patients months before their tests, screenings, or physicals are due and get them scheduled. Don’t wait for the patient to call.

5-Star Metric: Monitoring Physical Activity

Recommendations:

• Have medical assistants assess patient’s physical activity level.

• Review and address the assessment results as needed.

• Utilize appropriate educational materials and suggest community resources, such as gyms or fitness programs.

• Consider referral to physical therapy so patients with limited mobility can learn safe and effective exercise.

5-Star Metric: Urinary Incontinence

Recommendations for Physicians:

  • Encourage nursing staff and medical assistants to ask patients about any incidents of urinary incontinence in the last 6 months. Patients are often too embarrassed to initiate the discussion.
  • Educate patients about noninvasive behavioral interventions for UI; when necessary, refer for appropriate treatment.

5-Star Metric: Reducing Risk of Falling

Recommendations for Physicians:

  • Conduct a Medication Review with patients. Some medications or combinations of medications can have side effects like dizziness or drowsiness, increasing fall risk.
  • Consider gradually withdrawing psychotropic medication and modifying other prescriptions, as appropriate, to reduce fall risk.
  • Encourage annual eye exams and regular prescription updates for glasses/contact lenses.
  • Consider referral to an occupational therapist for home safety evaluation* and modification.
  • Encourage exercise, specifically those that increase leg strength and balance.

And, General Tips for Providers:

  • Encourage patients to obtain preventive screenings annually or when recommended.
  • Create office practices to identify noncompliant patients at the time of their appointment.
  • Submit complete and correct encounters/claims with appropriate codes.
  • Submit clinical data such as lab results to HNE.
  • Communicate clearly and thoroughly; ask, “Do you have any questions?”
  • Understand each measure you impact.
  • Incorporate Health Outcomes Survey (HOS) questions into each visit. Find out more about HOS at http://www.hosonline.org/Content/SurveyInstruments.aspx .
  • Review the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey to identify opportunities for you or your office to have an impact: http://ma-pdpcahps.org/content/surveyinstruments.aspx.