RHODY HEALTH OPTIONS (RHO) IMPLEMENTATION Nursing Homes Wave 1 and 2 October 18, 2013

1. RHODY HEALTH OPTIONS (RHO) IMPLEMENTATION Nursing Homes Wave 1 and 2 October 18, 2013

2. RhodyHealth Options (RHO) Agenda Implementation Timelines How to determine eligibility Case Management Claims Submission and Payment Ongoing communication Q&A

3. Implementation Timelines Enrollment Waves 1 and 2 Wave 1 letters sent 9/1 effective 11/1 Wave 2 letters sent 10/1 effective 12/1 NHPRI received 11/1 enrollment file on 10/12 Total 3489 members; 568 in nursing homes ID cards will be mailed by 10/25

4. Eligibility Several ways to check eligibility: DHS website= https://www.eohhs.ri.gov Navinet= https://navinet.navimedix.com Call NHPRI Member Services at 401-459-6601

5. Case Management Collaboration • Neighborhood to send each facility a monthly roster of members • Neighborhood to obtain copies of recent MDS forms, review for discharge opportunities, and consult with nursing home staff • Identified Lead Care Manager contacts: • Lea Doiron 427-8202 • Paula Giroud 427-8261 • Utilization Department 459-6060

6. Case Management Role • LTSS Waiver application assistance • Develop and monitor individualized Plan of Care • Collaborate to assess for safe discharge plan to the community when appropriate • Participate in discharge planning meetings with members and caregivers • Facilitate referrals to community services to ensure safe transition plan • Follow member, post discharge, to ensure needs continue to be met in the community

7. Nursing Home Requirements Reconcile monthly admissions roster Provide access for case managers to meet member and review medical record, including MDS Provide supportive clinical information for those receiving skilled services Collaborate in identification of those with potential discharge plan Collaborate in ensuring a safe transition to the community when applicable

8. Claims Submission If you have not already done so, contact your software vendor to obtain their established clearinghouse connections. Neighborhood presently trades with these clearinghouses: • Emdeon– Professional & Institutional claims • Navicure – Professional claims • Relay Health – Professional & Institutional claims • SSI Group – Professional & Institutional claims • Viatrack – Professional claims Contact Mary Harnedy at mharnedy@nhpri.org(401) 459-6659

9. Claims Submission • Patient share • Timing of claims payments • Claims testing- to begin 10/25/13; test claims may be forwarded; feed back on results provided to ensure clean claim submission

10. Ongoing Communications RHO detail on the web by end of month Provider Manual posted on web by month end Email updates-via distribution list Nursing Home workgroup biweekly meetings State updates on this Integrated Care Initiative (ICI) project can be found at: http://www.ohhs.ri.gov/integratedcare/newsandupdates/

11. Contacts at Neighborhood Medical Management Michelle Lupoli, Director of Medical Management, 459-6035 Kathy Ullrich, Manager of Care Management, Duals 427-6526 Claims Production Meghan Ruane, Director of Operations, 459-6606 Provider Engagement and Contracting Pat Huschle, Director of Provider Engagement and Contracting,459-6012 Maureen Brousseau, Manager of Ancillary Network,459-6033 Paula Lea, Contract Consultant, 459-6037 Production Support & EDI • Mary Harnedy, Specialist, 459-6659

12. Questions?