ࡱ> q` 8WbjbjqPqP y::LFW^^^^6 6 6 $Z ^3^3^3P34Z j:5:5(b5b5b5N8N DNjjjjjjj$_lhnt:j6 ;P IM@;P;P:j^^b5b5OjXXX;P^^ b56 b5jX;PjXXehj 6 |fb5.5 b^3P6fjej0j$fX;oQ;o |f;o6 |fLNhNJXN<:OLNLNLN:j:juX^LNLNLNj;P;P;P;PZ Z Z )^3Z Z Z ^3Z Z Z ^^^^^^ TABLE OF CONTENTS PAGE 1.01 INTRODUCTION 1 1.02 STATEMENT OF PURPOSE 1 1.03 DEFINITIONS 1  1.03-1 Authorized Agent 1 1.03-2 Educational Opportunities 1 1.03-3 Health Care Provider 1 1.03-4 Health Care Services 1 1.03-5 Lock-In 2 1.03-6 fb88 Integrated Health Management Solution (MIMHS) 2 1.03-7 Medical Necessity 2 1.03-8 Member 3 1.03-9 Member Review Team 3 1.03-10 Over-Utilization 3 1.03-11 Primary Care Provider 3 1.03-12 Program Integrity Unit 3 1.03-13 Prescriber 3 1.04 ENROLLMENT OF MEMBERS IN RESTRICTION PLAN 3 1.04-1 Identification of Members 3 1.04-2 Member Review Team - Case Evaluation 4 1.04-3 Member Review Team - Plan Criteria 5 1.04-4 Member Notification 5 1.04-5 Provider Notification 6 1.05 EMERGENCY HEALTH CARE SERVICES AND NON-PRIMARY CARE PROVIDERS 6 1.06 PLAN MONITORING 7 1.07 CHANGE IN HEALTH CARE PROVIDERS 7 1.08 CHANGE IN MEMBER STATUS IN RESTRICTION PLAN 7 1.09 MEMBER RIGHTS 8 INTRODUCTION  The Restriction Plan is an administrative procedure where certain fb88Care members who have a history of over-utilizing fb88Care benefits must receive their primary medical care from one health care provider, and when indicated, one hospital, one pharmacy and specified additional providers, (such as a behavioral health provider, dentist, eye care provider). The Department of Health and Human Services anticipates that restricting members who over-utilize services to a single primary care provider will result in better health care management and the reduction of the total cost of care. 1.02 STATEMENT OF PURPOSE 1.02-1 The purposes of the Restriction Plan are: A. To decrease and control over-utilization and/or abuse of fb88Care covered health care services and/or benefits, and to minimize medically unnecessary and addictive drug usage; B. To establish a method of monitoring non-emergency health care  services for fb88Care members who have utilized fb88Care health care services or benefits at a frequency or in an amount that is not medically necessary; and C. To assist members through education and referral towards appropriate health care service and benefit use. 1.03 DEFINITIONS For purposes of this Section, the following definitions shall apply:  1.03-1 Authorized Agent is the organization authorized by the Department of Health and Human Services (DHHS) to perform specified functions pursuant to a signed contract or other approved signed agreement. 1.03-2 Educational Opportunities means the opportunities provided by DHHS or its Authorized Agent to discuss the members pattern of health care utilization, in which discussion the member receives information on how to obtain or use appropriate health care services or receives a referral to an appropriate agency to obtain services for the identified utilization problem. 1.03-3 Health Care Provider is an individual or entity that furnishes health care services or benefits to persons for which payment is reimbursable through the fb88Care Program. 1.03-4 Health Care Services are all services covered under the fb88 Medical Assistance Program. These services include, but are not limited to, primary care provider, pharmacy and hospital services. 1.03 DEFINITIONS (cont) 1.03-5 Lock-In is a federally authorized program specified in the Code of Federal Regulations (42 CFR ( 431.54 (e)) that provides that a fb88Care member who has utilized fb88Care services at a frequency or amount that is not medically necessary may be restricted to designated health care providers that are enrolled as fb88Care providers. Lock-In will only be deemed necessary once the Member Review Team has determined that the member has exhausted all Educational Opportunities. The Team may enroll a member in a Lock-In corresponding to the type of Over-Utilization by the member. A member may be enrolled in more than one type of Lock-In. A Lock-In is a basis of denial for a claim for payment of services outside the terms of the Lock-In. Lock-In restrictions do not apply to emergency services, that is, stabilization of an emergency medical condition as defined in Section 1.02-4.B. &C. of Chapter I of the fb88Care Benefits Manual. There are four types of Lock-in: A. Full Restriction (Lock-In type 1) - This Lock-In type requires a member to be restricted to the core providers of a Primary Care Physician, a Hospital, a Pharmacy and may include restrictions within additional provider types. Full restriction will occur when clinical review has identified Over-Utilization in any two of the core provider types. Partial Lock-In (Lock-In type 2) This Lock-In type restricts the member to a provider in one or multiple types of health care providers when clinical review has identified Over-Utilization in one or more types of health care providers but the standard of a Full restriction is not met. Prescriber Lock-In (Lock-In type 3) This Lock-In type restricts the member to one or more specific Prescribers for prescriptions when clinical review has indentified Over-Utilization in one or more types of prescriptions. The Member Review Team may designate multiple Prescribers for the member for differing types of prescriptions. Pharmaceutical Restriction (Lock-In type 4) This Lock-In type restricts the member from being able to obtain one or more specific drug categories (classes) when clinical review has identified Over-Utilization in one or more drug categories. 1.03-6 fb88 Integrated Health Management Solution (MIMHS) is the computer system that fb88Care Services of The Department of Health and Human Services (DHHS) uses to process provider claims for reimbursement as of March 2010. 1.03-7 Medical Necessity is the use of health care services or benefits that are appropriate to, and not in excess of, the health care needs of the member, as determined by the Member Review Team through investigation and analysis of the medical record and claims history. Potential indicators of the lack of medical necessity include but are not limited to: 1.03 DEFINITIONS (cont) A. unusually frequent utilization of health care services; B. inappropriate or excessive acquisition of drugs, especially drugs with addictive properties such as: tranquilizers, psychostimulants, narcotic analgesics, non-narcotic analgesics, sedative barbiturates and sedative non-barbiturates; and C. duplicated services or prescriptions for the same or similar conditions.  1.03-8 Members are recipients of fb88Care services.  1.03-9 Member Review Team (the Team) is the Department of Health and Human Services (DHHS) multidisciplinary team that participates in the surveillance of health care services and benefit utilization by fb88Care members and determines the existence of over-utilization and/or misuse. The Team shall consist of, at a minimum, a physician; a registered nurse or social worker; and a representative of Program Integrity. The Team may also include other consultants, such as a pharmacist and/or a representative from the Health Care Management unit of fb88Care services. 1.03-10 Over-Utilization is the use of health care services and benefits in excess of medical necessity, as determined by the Member Review Team. 1.03-11 Primary Care Provider (PCP) is a physician or other provider who practices primary care. 1.03-12 Program Integrity Unit is the unit responsible for conducting a federally required monitoring plan that reviews all fb88Care services and expenditures. 1.03-13 Prescriber is an M.D., D.O., nurse practitioner, physician assistant or resident in training who possesses a valid DEA number.  1.04 ENROLLMENT OF MEMBERS IN THE RESTRICTION PLAN 1.04-1 Identification of Members A. The Program Integrity Unit will identify members who appear to be obtaining health care services that are not medically necessary. Members who are suspected of obtaining health care services that are not medically necessary may be identified by the following sources: 1. Referrals or complaints from members, providers, professional associations, health care professionals and other citizens; 2. Referrals from the Department of Health and Human Services (DHHS), Office of fb88Care Services, Fraud Investigation and Recovery Unit, the Department of Attorney General, Health Care Crimes Unit, third party payers, State of fb88 Board of Pharmacy, 1.04 ENROLLMENT OF MEMBERS IN THE RESTRICTION PLAN (cont)   the Health and Human Services Office of Inspector General (OIG), Center for Medicare and Medicaid Services (CMS), State and local law enforcement agencies, and any other State or Federal agency; 3. Computer generated reports that identify members who may be over-utilizing or inappropriately using health care services.  B. Following the identification of members who appear to utilize health care services that are not medically necessary, the Program Integrity Unit may: 1. Analyze the computer-generated profiles of the members reimbursed health care services for the previous six (6) months, or longer if indicated; 2. Review the members clinical records to document the medical necessity as well as the frequency of services billed, and if necessary; 3. Communicate with the key providers to determine if over-utilization is occurring.  C. Upon completion of the initial review process, DHHS or its Authorized Agent may contact the member who appears to have over-utilized health care services, to discuss the members pattern of utilization of health care services. During the contact, the DHHS or its Authorized Agent shall review a summary of the members primary care provider, pharmacy and hospitalization or other service usage and the member shall be given an opportunity to explain his or her utilization pattern. In addition to explaining the Restriction Plans, DHHS or its Authorized Agent may also provide information on how to obtain appropriate health care services or refer the member to an appropriate agency to obtain services for an identified problem. D. DHHS or its Authorized Agent shall make notes to document the content of the contact, member responses and any referrals. DHHS or its Authorized Agent shall provide the member with a contact name and office telephone number as resources. E. DHHS or its Authorized Agent shall refer the case to the Member Review Team for evaluation in cases where no apparent medical necessity for the health care services exists and/or over-utilization continues. 1.04-2 Member Review Team - Case Evaluation The Member Review Team shall review cases referred under the 1.04 ENROLLMENT OF MEMBERS IN THE RESTRICTION PLAN (cont) preceding Section to evaluate the utilization and medical necessity of the health care services rendered to members. The Member Review Team shall summarize its findings and recommendations in writing. The Team may recommend: A. That the member be monitored by DHHS or its Authorized Agent until more documentation and information is available. B. That DHHS or its Authorized Agent contact the member to discuss, verbally or through written communication, the members health care utilization and concerns. The DHHS or its Authorized Agent will inform the member of the benefits of proper health care utilization and assist the member, if necessary, in securing a health care provider. The Unit representative will also explain the Restriction Plans that could be implemented should the current pattern of utilization continue  C. That the member be enrolled in one or more of the four types of Lock-In of the Restriction Plan for restriction to a health care provider, pharmacy, hospital and/or other provider as necessary in order to improve the members health care benefits usage. The Team may recommend an initial enrollment in the Restriction Plan for a period not to exceed twenty-four (24) months. Subsequent re-enrollment periods, if necessary, are limited to twelve (12) month periods. 1.04-3 Member Review Team Plan Criteria A. Restriction Plan Criteria The Team may elect to enroll the member into the Restriction Plan if the member has exceeded medically necessary utilization of medical services or benefits. The Team determines over-utilization on a case-by-case basis that includes an evaluation of the members medical condition and need for services as determined using relevant information including but not limited to the medical record, claims data and national standards for best practices. The member must retain reasonable access to fb88Care services of adequate quality, including consideration for geographic location and reasonable travel time.  1.04-4 Member Notification If the Member Review Teams decision is to enroll the member in the Restriction Plan, the Program Integrity Unit shall mail a Notice of Decision to the member and provide the member with: 1. The Teams decision, 2. A summary of the evidence upon which the Teams decision was based, 1.04 ENROLLMENT OF MEMBERS IN THE RESTRICTION PLAN (cont) 3. The effective date of the restriction and/or enrollment into the Plan, 4. Citation of the rules supporting the Teams decision,  5. A health care provider and/or prescriber designation form, and 6. Notice of the members right to request an administrative hearing and appeal the Teams determination in accordance with the fb88 Medical Assistance Manual, Chapter I, and Chapter IV.  B. The member shall have thirty (30) days from the receipt of the Notice of Decision to complete the health care provider and/or prescriber designation form and return it to the Team. If the member fails to return the completed health care provider and/or prescriber designation form or otherwise notify the Program Integrity Unit of his/her designation of health care providers and/or prescriber, staff of the Program Integrity Unit shall select the members health care providers and/or prescriber based on the members medical needs and geographic location. C. Selection of the health care provider(s) and/or prescriber by the Program Integrity Unit staff or through oral notice by the member shall be so documented in the members file. Enrollment in the Restriction Plan shall not begin until after the member has had an opportunity for an administrative hearing, if requested. If a hearing is not requested by the member within thirty (30) days of the date of the Notice of Decision, then the members enrollment in the Restriction Plan shall become effective immediately upon confirmation with the participating health care providers. 1.04-5 Provider Notification The Program Integrity Unit will contact by telephone each health care provider and/or prescriber selected, to explain the Restriction Plan and solicit the providers participation and cooperation. If the provider agrees to participate as the health care provider and/or prescriber for the member, a follow-up letter shall be sent by the Program Integrity Unit to the provider confirming his/her participation and the date on which the restriction shall begin. 1.05 EMERGENCY HEALTH CARE SERVICES AND NON-PRIMARY CARE PROVIDERS Non-primary care providers shall be reimbursed for health care services only in the following circumstances:  A. When the need to stabilize an emergency medical condition (as defined in Section 1.02-4.B. & C., Chapter I of the fb88Care Benefits Manual, also refer to Chapter IV, Section 1.03-5) exists. Reimbursement is subject to the providers later written or verbal verification of that need when requested by the Program Integrity Unit; B. When the member has been referred by the primary care provider; and C. When the member has received services without a referral from providers whose category of service is not covered by the restriction plan, i.e., x-ray, laboratory, and optometrists.  1.06 PLAN MONITORING During the period of enrollment in the Restriction Plan, the Program Integrity Unit will supervise and monitor utilization patterns of restricted members and analyze computer-generated profiles of the members health care services reimbursed under fb88Care. The member will be contacted by the Program Integrity Unit periodically to verify that his or her medical needs are being met. The member shall receive the Program Integrity Units toll-free telephone number, to clarify questions regarding restriction, seek assistance if access problems arise, and report complaints. 1.07 CHANGE IN HEALTH CARE PROVIDER At the time the member is notified of his/her enrollment in the Restriction Plan, the member shall be advised that he/she may change his/her health care provider for any reasonable cause at a later date, by notifying the Program Integrity Unit. Program Integrity Unit Staff shall contact the proposed health care provider and arrange his/her participation in this members restriction plan. If the member, or health care provider, believes a second opinion is warranted or desirable, the second opinion provider payment may be authorized by contacting the Program Integrity Unit staff in advance of the second opinion. 1.08 CHANGE IN MEMBER STATUS IN RESTRICTION PLAN 1.08-1 Continuation of restriction, or modification of enrollment into another Lock-In type, beyond the initial period will be recommended when subsequent annual reviews of the members records, claims data and national standards, in accordance with the fb88Care Benefits Manual, Chapter IV, by the Member Review Team indicate one or more of the following: A. Evidence of members failure to comply with the recommended plan of management from the health care providers; B. Evidence of members continued over-utilization of services without medical necessity, which includes services where payments were denied by fb88Care because the Restriction Plan protocols were not followed; or C. Members voluntary request to continue the restriction.  1.08-2 In cases where the Member Review Team determines that the enrollment in the Restriction Plan should continue beyond the initial period, the member shall be notified in writing by a Notice of Decision. The Notice of Decision shall include the evidence used in the determination and members right to request an administrative hearing in accordance with the fb88Care Benefits Manual, Chapter I, and Chapter IV.  1.08 CHANGE IN MEMBER STATUS IN RESTRICTION PLAN (cont)  1.8-3 When the Member Review Team determines that the members utilization practices have significantly improved, the health care provider restriction shall be terminated on a date designated by the Member Review Team. The member shall be notified by mail of the termination of restriction and the effective date of termination. The Program Integrity Unit shall notify the member that his/her fb88Care utilization shall be monitored to insure that the improved utilization pattern is maintained. Should previously observed over-utilization practices become evident during the monitoring period, the members case shall be reviewed in accordance with Chapter IV, Section I. 1.09 MEMBER RIGHTS A. A member who disagrees with the determination that he/she be enrolled in the Restriction Plan, or a member who is aggrieved by an action or policy relating to his/her involvement or continued reenrollment in the Restriction Plan is entitled to oppose the action. He/she shall be informed of his/her rights to appeal. 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