The intent is as follows:

• All patients selected for the ACC will be assigned only to ACC contracted practices and only to the practice that has been determined to be their “Medical Home”.  
• Patients that have a “Medical Home” with a non-ACC contracted practice should not be enrolled in the ACC.
• Practices contracted for the ACC initial phase will most likely have both ACC and regular fee-for service Medicaid patients.
• Practices, not contracted for the pilot phase of the ACC, should not have any ACC patients assigned to them.

Practice staff need to be knowledgeable about the letter that will be mailed to patients so that you can help explain the importance of this letter and counsel your patients appropriately, should they desire to make any changes. Here are some possible strategies:

• Proactively educate your patients about this letter using one or more of these methods :
  
  • In person when the patient is in the office
  • A posted notice in the office where patients can see it
  • When parents of children on Medicaid call the office
  • A handout
• Explain the Health Colorado letter to the patient:
  
  • “You may get enrolled in a new Medicaid health plan”
  • “If so, you may get a letter in the mail that looks like this (show them the template)”
  • Explain to the patients that “If you do not wish to participate in this plan, call 303-839-2120 immediately.  Participation in this plan or not participating in this plan in no way effects your Medicaid benefits.”
  • “If you receive this letter, make sure that our office is listed as the Primary Care Medical Provider in the letter”
  • “If we are, you need not do anything else”
  • “If another practice/physician is listed in the letter as the PCMP, make sure you call 303-839-2120 immediately to have that changed to our practice/physician”
• Encourage your patients to call your office if they need help with the letter.
• Remember, not all of your patients will receive this letter!

As always, CCHAP is here to help you with information and support.  Feel free to contact Kevin Heckman, heckman.kevin@tchden.org, 720-777-6309 or Anita Rich, rich.anita@tchden.org, 720-777-5495 with any questions that you or your staff may have.

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WHAT DO PRACTICES NEED TO KNOW ABOUT MAXIMUS?

Who is MAXIMUS?
MAXIMUS is a vendor that partners with state, federal, and local governments to provide assistance with enrolling eligible Coloradans into an appropriate Medical Assistance Program. Currently Maximus is contracted to enroll clients into CHP+, CHP+ Prenatal and Family Medicaid.
 
The Medicaid application form is intended to help determine eligibility for both Medicaid and CHP+ programs. Maximus is only available to answer eligibility and enrollment questions for Medical Assistance Programs that they are processing. MAXIMUS will refer inquiries on applications that are being processed by the State or County to those agencies. For example: If a family applied at the Department of Human Services office, families would need to contact this entity for status of their application rather than MAXIMUS.

What does MAXIMUS DO?
MAXIMUS will process new enrollment applications and renewals of enrollment for medical assistance programs for Medicaid and CHP+. You can contact MAXIMUS for things like: Questions, issues and status updates for applications that are on file with MAXIMUS.

• EXAMPLES: Checking eligibility, getting status, status on what’s missing and needed to complete the application, adding a member to the household, Add a Baby, research to get file sent to HMO, request of an expedite for an application on file.

Who do I contact once the application is determined to be Medical Assistance Program eligible?
If the family becomes Medicaid eligible, you can continue to contact MAXIMUS with questions.

If the family becomes CHP+ eligible, the file is sent over to the appropriate HMO (Colorado Access, Rocky Mountain Health Plans, etc.) and it is that HMO that can then answer any questions. If you cannot get the answers you need from the HMO feel free to call MAXIMUS for help.

PROVIDERS and members should first call 1-800-359-1991. There is an IVR (interactive voice response) option on this line that may be helpful for PROVIDERS and members to use to check on eligibility status. There is a NEW TOLL FREE NUMBER DEDICATED TO PROVIDERS and community based organizations. Please note that this is not an interactive voice response line and has limited resources available to answer your calls: 1-877-311-4540.

When do I contact the HMO verses MAXIMUS?
When the family has been determined eligible for CHP+, you may contact the HMO for questions.  If the HMO does not have the file loaded with their system, you may ask them to request this family file from MAXIMUS.

What is MOVEit? “MOVEit” is a web based application implemented by MAXIMUS to help providers communicate with MAXIMUS and get updates and issues resolution. MOVEit uses email-like communications, referred to as “packages” that are encrypted during delivery to safely and securely transmit protected health information e.g. ID and social security numbers, names, etc…

How do I sign up for MOVEit access?

1. Send a request to eemapsupport@maximus.com
2. A user will be verified, authorized and an account will be created within 3 business days.
3. The user will receive an email with instructions. Within instructions there is notice that a package will be sent. Users must notify eemapsupport@maximus.com if they do not receive an email with notification of a package waiting. The initial package will contain a user manual to assist users with using MOVEit.

Should you need additional help, you may contact:

Jeff Gaskill
Communications Manager
MAXIMUS
4500 Cherry Creek Dr. South, Suite 200
Glendale, CO 80246
Office 303-217-4213
Fax 303-217-4154

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Practice Manager's Corner

Provider Payment Delay Update
The Long Bill has been sent to Governor Hickenlooper for signature. If the bill is signed in its current form, there will not be any Medicaid provider payment delays. HCPF will post an announcement upon signature on the HCPF Web site and on the Web Portal Message Center.

Accountable Care Collaborative
All seven Regional Care Collaborative Organizations’ contracts have been awarded and program implementation has begun. This map illustrates the RCCOs and their corresponding counties. The Department sent enrollment letters to 521 Medicaid clients in Weld County (RCCO 2- Colorado Access) in April notifying them of their enrollment in the ACC program effective May 1. Only five clients chose to opt-out of the program.

For a June start date, the Department will send letters to approximately 4,000 more clients living in Northeast Colorado (RCCO 2- Colorado Access); approximately 5,000 thousand clients on the Western Slope and in Larimer County (RCCO 1- Rocky Mountain Health Plan); and approximately 5,900 clients in Southern Colorado, including Pueblo, Huerfano and Las Animas Counties (RCCO 4- Integrated Community Health Partners) will receive letters in May for a June start date. If you would like more information, please contact Sarah Roberts.

Code 96110 – Depression Screenings Clarification
Please be advised that providers are not to bill Common Procedural Terminology (CPT) code 96110 for depression screens. CPT code 96110 is to be billed only when developmental screens are provided. The Department of Health Care Policy and Financing is currently working on identifying an appropriate code and reimbursement for depression screens.

Prior Authorization Request (PAR) Change/Revision Reminder
All revised and pending PARs require a PAR form. When revising or sending in information, indicate the PAR number requiring a revision or waiting for additional information (pending) on the new PAR form. The original dates on a PAR cannot be revised.
If disputing a denied PAR, please submit a new PAR form with required attachments. Denied PARs are not revised, the PAR will be keyed as new.

Clinical Laboratory Improvement Amendments (CLIA) Update
Beginning on July 1, 2011, claims submitted for any dates of service for procedures covered by CLIA must have a CLIA number of the laboratory where the procedure was done on file or on the claim. The submitted CLIA number must certify the provider for the procedure(s) and the date(s) of service on the claim. Claims or claim lines without a valid CLIA number will be denied.
Please see the May 2011 Medicaid Provider Bulletin for details.

Medicaid Provider Service Centers
There are three distinct service centers that HCPF has made available to assist providers with the complex processes of: Enrolling as a provider with the State of Colorado, Serving Medicaid clients, and billing the Colorado Medical Assistance Program for services and receiving payment.

ACS Provider Services is a call center for providers, which is operated by the Department’s fiscal agent for the Medicaid Management Information System (MMIS). ACS Provider Services offers technical and user support to providers who have questions regarding Claims, Provider Enrollment, Prior Authorization Request (PAR) and Eligibility
Hours 8:00 A.M. to 5:00 P.M. MT, Monday through Friday
Phone 1-800-237-0757:
    Option 1 – Verify Client Eligibility
    Option 2 – Claim Status
    Option 3 – Warrant Information
    Option 4 – All other questions

ACS EDI Services is also a call center for providers that is operated by the Department’s Fiscal Agent for the MMIS, and this call center assists providers with enrolling to submit claims electronically (via the Web Portal) and electronically retrieving reports and statements.
Hours 8:00 A.M. to 5:00 P.M. MT, Monday through Friday
Phone 1-800-237-0757 or 1-800-237-0044.

CGI Help Desk is a call center and e-mail support desk for providers, which is operated by the Department’s vendor (CGI) for the Web Portal. The Web Portal allows providers to interactively submit claims, prior authorization requests, and request client eligibility information online. The CGI Help Desk offers technical support to providers who have issues with navigation and use of the Web Portal.
Hour 7:00 A.M. to 7:00 P.M. MT, Monday through Friday
Phone 1-888-538-4275, option 1
Email HelpDesk.HCG.central.us@cgi.com

Customer Contact Center is a call center that responds to client issues and Web site e-mail inquiries. This call center assists Medicaid clients with questions regarding benefits and eligibility, obtaining Medicaid Identification Cards, assistance to clients receiving bills, locating area providers, and out-of-state providers.
Hours 7:30 A.M. to 5:30 P.M. MT, Monday through Friday (excluding State holidays)
Phone 303-866-3513 Denver Metro area
1-800-221-3943 Outside the Denver Metro area
Email Customer.Service@hcpf.state.co.us

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Health Care for African American Patients/Families

by Marcia Carteret M.Ed.

The following cultural patterns may represent many African Americans, but do not represent all people in a community. Families that have immigrated recently from Africa have very different cultures compared to families that have been in the US for many generations.  Get to know your patient and their families on an individual level. Not all patients from diverse populations conform to commonly known culture-specific behaviors, beliefs, and actions. Participation in cultural practices is a more useful indicator of health beliefs and behaviors than assumptions made about group affiliation.
 

The Diversity of "Black" Experience

It's helpful to make a distinction in terminology – "blacks" can be defined as all persons of African descent, whose genealogical connection is to Africa, and in particular West Africa. However, because skin color and culture are not the same thing, when discussing cultural beliefs and practices among this group, the term African American best refers to "blacks" in the United States, people whose sociocultural roots are in the North American experience, but who are of African descent. When applying this definition, it should become obvious that skin color is not the best indicator; people of African descent can have very light complexions. Many are of combined heritages. It is particularly important not to generalize about the African American experience when meeting with patients and families. Seeing the individual in each encounter is, as always, most important.

Social Structure
Many aspects of African American culture today reflect the culture of the general US population. However, the structure in African American families is often extended to include non-related “family” members or "fictive kin." The family may be matriarchal, although father or mother may take on the decision-making role. For African Americans, women more than men tend to remain unmarried, and more women have been educated at the college level.

Respect for Elders
In general, the older generation is more conservative, may have a more traditional view of gender roles, and may shun interracial dating and marriage. Elders are respected and often provide care for their grandchildren. Institutionalization of elders has historically been avoided, with sons and daughters taking on the family caretaker role.

Diet & Health Disparities
Studies in health disparities show residents of disadvantaged neighborhoods often have little to no environmental support for healthy behaviors which increases their risk for health disparities. For most African Americans and others residing in low-income neighborhoods, the abundance of fast food chains (fast foot companies have specifically targeted African American communities as a growing market for their products), high-priced food marts, and a lack of access to healthy affordable foods contributes to the prevalence of obesity and chronic illness. Convenience and cost have an especially strong influence on low-income individuals' likelihood of adopting healthy dietary behaviors; fresh fruits and vegetables and lean meat are more expensive that packaged processed foods. Similarly, lack of transportation can be a pressing problem for low-income families, something middle class Americans of all ethnic groups are spared. If you have to take a bus to do real grocery shopping, it is more likely you will rely on the corner 7-11 for convenience food.

Obesity, especially in children, is an enormous problem across America. National programs to improve diet quality and the overall health, especially among African Americans and other minority groups, have been initiated. Body and Soul: A Celebration of Healthy Eating and Living for African Americans offers information targeted to African Americans on eating a healthy diet rich in fruits and vegetables. http://www.cdph.ca.gov/programs/cpns/Documents/body%20and%20soul%20manual.pdf (Body and Soul was a collaborative effort among two research universities, a national voluntary agency (American Cancer Society), and the National Institutes of Health to disseminate and evaluate under real-world conditions the impact of previously developed dietary interventions for African Americans.)

Religion
African Americans often have strong religious affiliations, especially with Christian denominations—notably Baptist and Church of God in Christ. However, many follow Islam. Maintaining good health is often correlated with good religious practice. Many churches maintain a health ministry through which congregations and parish nurses support good health with flu shots, blood pressure checks, and health education.1 Research has shown that the affluent among all social groups tend to move away from their communities of origin, and to become less traditional, whereas the poor are more likely to follow traditional cultural and religious practices.2,3

Asking About Religion and Spiritual Matters
According to Dr. Terri Richards, keynote speaker at a recent noon conference for medical residents at the Department of Community Pediatrics at the University of Colorado School of Medicine, it can be very important to find out about a patient's religion or faith. However, asking your patient directly "What religion do you practice?" or "What is the faith you follow?" is not as effective as asking more indirectly about where an individual turns for support in difficult times. Often times, the answer to this question among African Americans will be church. "I go to church every Sunday" or "My child wasn't feeling well enough to make it to church on Sunday." Encourage the patient to elaborate. This opens up an avenue for further exploration of how a person's faith informs their health beliefs and behaviors. Also, because our formative experiences are so long-lasting, it may be helpful to learn not just what the patient's religious and cultural affiliation is now, but what the beliefs of the family of origin were.

Trust & Medical Care
African Americans are becoming increasingly health conscious, seeking health screenings and treatments, although health literacy in this population tends to vary by generation. Older African Americans may be suspicious of clinicians, because of experiences of past generations of African Americans with health care.  Even African American parents today have heard about the Tuskegee experiments on African Americans, so they may be a little reserved or suspicious until it is apparent that their health care provider is friendly, wants to listen, and is interested in them.  There may be reluctance to share personal or family issues, so building a trusting relationship is absolutely crucial.

Child Rearing
African Americans describe their approach to child rearing as being less permissive than Americans of European descent. For example, telling a child that he is "in time out" may not seem as effective as giving a spanking, and culturally spanking is not frowned upon. The American Academy of Pediatrics suggests that parents be encouraged to develop methods other than spanking for managing undesirable behavior in their children. However, among African Americans studies show a preference for using "harsh" or "authoritarian" forms of discipline that include physical punishment. This does not mean to suggest that abuse is considered acceptable among African Americans. Culture must be taken into account in childrearing. "Because parenting occurs in a socio-cultural context, recommendations about what constitutes an effective approach to discipline may not be generalizable to all populations among or between similar cultures. 4,5

Death and Dying
When considering the ways different cultures respond to death and dying, it is important to look at three variables: heritage consistency (the extent to which a person's lifestyle identifies with traditional cultural values an reflects their cultural roots), social class, and spirituality.
Generally speaking, in the African American experience, spirituality is a fundamental part of how many people process and reconcile the experience of death.

African Americans tend to believe in the sanctity of life and rely on a strong sense of community and family at times of loss. Family-centered consensus is valued in decision-making and there's often a strong need for extended family to gather at a time of death; the family should be informed of an impending death so that extended family members who live out of state can be notified.

Many African Americans have a holistic view of death and dying so that birth and death are understood to be part of a cycle or continuum. At the same time, many older African Americans, who believe that death is God’s will, may also tend to believe that life support should be continued as long as necessary. Cremation is generally avoided in this community and organ donation may be viewed by some as a desecration of the body. 6


In medical settings, the spiritual aspects of caring for people who are dying have often been neglected. So much emphasis is placed on the physical care of the dying that spirituality is often overlooked, and health care providers do not always recognize that this should be an integral part of the continuum of care. In hospital settings, one way to accomplish this is to offer the support of the hospital chaplain. Naturally, it would be ideal to involve clergy from a person's own faith community, but if that is not possible, then certainly make sure that the hospital chaplain is available as an integral part of the care team.


Conclusions
Understanding a patient’s practice of cultural norms can allow providers to more quickly build rapport and ensure effective patient-provider communication. Efforts to reduce health disparities among African Americans must be holistic, addressing the physical, emotional, and spiritual health of individuals and families. Also important is making connections with community members and recognizing conditions in the community. Again, get to know your patients on an individual level. Generalizations in this material may not apply to your patients. Not all patients from diverse populations conform to commonly known culture-specific behaviors, beliefs, and actions.

 
References

1 www.stratishealth.org African American  cultural guide

2. Barrett RK. Sociocultural Considerations for Working with Blacks Experiencing Loss and Grief. In Living with Grief: How We Are—How We Grieve, K Doka (ed.). Washington DC: Taylor & Francis Publishers, Inc., 1998, 83-96.[Return to International Perspectives]

3. Perry H. Mourning and Funeral Customs of African Americans. In Ethnic Variations in Dying, Death, and Grief, DP Irish, KF Lundqust & VJ Nelson (eds.). Washington: Taylor & Francis Publishers, Inc., 1993, 51-65.[Return to International Perspectives]

4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2568462/pdf/jnma00178-0030.pdf

5. Larzelere RE. A review of the outcomes of parental use of nonabusive or customary physical punishment. Pediatrics. 1996 Oct;98(4 Pt 2):824–828. [PubMed]

 6. Barrett RK, Heller KS. Death and dying in the black experience: An interview with Ronald K. Barrett. Innovations in End-of-Life Care. 2001;3(5), www.edc.org/last acts

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Copyright 2011 Colorado Children's Healthcare Access Program and other entities as noted.

 CCHAP Home > Newsletter Articles > Newsletter 49, May 2011