Maternal Infant Health Program Community of Practice Webinar January 25, 2018
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Maternal Infant Health Program Community of Practice Webinar
January 25, 2018
AgendaRemaining question and answer from October
Coordinator Trainings IT UpdatesPolicy UpdatesForms UpdatesCertification Cycle 7 ReviewsHome Visiting Continuous Quality Improvement 2018
focusOverview of the Pregnancy Risk Assessment Monitoring
System (PRAMS) in Michigan with a focus on breastfeeding data
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Forms Updates
Final batch to MDHHS Forms Team for editing and formatting
Weekly update sent on 1-19-18Another weekly update will be sent this weekUse forms dated 4/1/18. All previously dated
forms are invalid. These forms should be utilized with all beneficiaries enrolled on 4/1/18 or after.
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Communication – Medicaid Health Plan
MIHP agencies are required to communicate beneficiary information to the beneficiary’s Medicaid Health Plan (MHPs), at a minimum, when one of their members has: Enrolled in your MIHP Transferred to your MIHP agency from another
MIHP agencyEmergency interventions implementedHas been discharged from your MIHP
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Communication
MIHP providers must report all new MHP enrollees or the status of the MHP referral to the appropriate MHP on a monthly basis or as agreed to in the Care Coordination Agreement or MHP Contract
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Common Acronyms Used in this Presentation
EMR – Electronic Medical Record FFS – Fee For Service (Straight Medicaid) IMHS – Infant Mental Health Specialist IRI – Infant Risk Identifier IT – Information Technology LSW – Licensed Social Worker MHP – Medicaid Health Plan MIHP – Maternal Infant Health Program MRI – Maternal Risk Identifier NICU – Neonatal Intensive Care Unit POC – Plan of Care PVPN – Professional Visit Progress Note RD – Registered Dietician RN – Registered Nurse SEI – Substance Exposed Infant
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Q & A 2017 October Coordinator Training POC2
Q. 1 – New Maternal POC2 – are dates to be filled in for communication with health plan or health care provider only if beyond original date put on the checklist for communication?
A. Fill in the dates on the POC2 for communications sent if they are sent for reasons other than those listed on the Beneficiary Status Notification documents. Only document on POC2 for communication other than the referral communication listed on the Beneficiary Status Notification.
Q. 2 – Where would we document the Quitline on the care plan? A. The Tobacco POC2 Resource-Referral-Communication column has a check box for the Quitline. Please document the Tobacco POC2, intervention #9, on the PVPN in the domain addressed section on Page 1 of PVPN and document Tobacco referral on Page 2 of PVPN.
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Q & A 2017 October Coordinator Training POC2
Q. 3 – Were the new Plans of Care 2 developed taking EMR into consideration?
A. Yes, given the variation in EMR software, we recommend contacting the software vendor and/or agency IT for assistance.
Q. 4 – If a client begins a domain at a low risk level, increases to a higher risk level, then ends services at a lower level, would risk be changed back and re-dated again on the POC2?
A. Utilize professional judgement to determine which risk level and corresponding interventions are most appropriate. Sustaining the high risk level for this situation may be preferable, as relapse may be frequent with this specific beneficiary and may require more intensive interventions to assure success.
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Q & A 2017 October Coordinator Training POC2
Q. 5 – Is the box on the POC2 required to be checked if a RD referral is made outside of the MIHP?
A. Yes, when a nutrition risk is identified a referral should be made.
Q. 6 – Is there a box to document quit date and amount on the Tobacco POC2?
A. No, please document additional information in the PVPN.
Q. 7 – Will you put something in writing to clarify the “Beneficiary entered treatment” box?
A. This box should be utilized to document whether through the course of care in MIHP, the beneficiary entered treatment for substance misuse or alcohol. The purpose of this box is to document the success of the intervention.
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Q & A 2017 October Coordinator Training Communication
Q. 8 – The initial communication with the doctors addresses all risks. Is this the date that is documented on the new POC2?
A. No. Document the enrollment and discharge communication dates on the checklist.
Q. 9 – Clarify when to let MHP know about a referral; when utilizing tools; writing safety/action plans; when asked to talk to a doctor.
A. Use professional judgement in determining what information should be shared with MHP and/or Medical Care Provider. Guidance is also available in the MIHP policy, operation guide, and certification tool.
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Q & A 2017 October Coordinator Training Communication
Q. 10 – Sending/informing MHPs about beneficiary risks?A. The Prenatal and Infant Communication forms that are required to be faxed to the MHPs should have the risks listed. This is one way the plan can identify a high-risk mother, who may need case management services and coordination of benefits. This is clarified on the new Beneficiary Status Notification instructions.
Q. 11 – Should copies of letters sent to Medical Providers and MHPs both be in beneficiary chart?
A. The Beneficiary Status Notification form indicates both the MHP and the Medical Care Provider. If both are indicated on the form, one form will suffice.
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Q & A 2017 October Coordinator Training Transportation
Q. 12 – Clarification on transportation reimbursement for parents whose infant is in NICU. The infant is not yet enrolled in the program but mother is enrolled.
A. Section 2.10 of the MIHP policy in the Michigan Medicaid Provider Manual, allows for transportation services to help MIHP enrolled pregnant and infant beneficiaries access to their health care and pregnancy-related appointments and for a mother to visit her hospitalized infant. Please have the beneficiary contact their MHP regarding transportation coverage.
Q. 13 – MHP transportation questions regarding MHP beneficiaries.A. Please follow the guidelines of the beneficiaries Medicaid Health Plan regarding transportation.
Q. 14 – Can agencies bill FFS for a client’s bus tickets?A. Yes, if client is a FFS beneficiary. Please see the Medicaid Transportation Policy.
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Q & A 2017 October Coordinator Training Professional Visit Progress Notes
Q. 15 – Beneficiary feedback – Already doing this in the reaction to intervention section on page 1. What is the difference?
A. The narrative about mother/caregiver’s reaction to interventions provided is required for each domain addressed at the visit and documented on page 1.
The revised fields on the PVPN, page 2, includes separate feedback fields for:
“Outcome of Previous Referrals” - A brief description of the outcome of referrals made at previous visits.
“Beneficiary or Caregiver asked for feedback on today’s visit” – yes/no and then briefly explain in the feedback section below this question.
“Specific plan for next visit” beneficiary/caregiver and staff –A brief description of the plan for the next MIHP visit, identifying the staff’s priority and the beneficiary’s priority.
“Beneficiary or Caregiver’s feedback regarding today’s referral” – A brief description of how beneficiary/caregiver responded to the referrals made during current visit.
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Q & A 2017 October Coordinator Training Postpartum visits
Q. 16 – Must a postpartum visit be done for mom before the IRI for the infant?
A. The Medicaid Provider Manual MIHP policy, section 2.9.A. states a second home visit must be made after the birth of the infant to observe bonding, infant care and nutrition, and discuss family planning. Please read the MIHP policy for further information.
Q. 17 – Clarify if agencies may bill and use maternal visits beyond the one postpartum visit.
A. After the postpartum visit, visits should be billed under the infant. Please remember that the intent of the MIHP policy is that one postpartum visit occur and then the infant should be enrolled in MIHP as soon as possible. If more postpartum visits are necessary, the rationale for additional maternal visits should be well documented.
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Q & A 2017 October Coordinator Training Referrals
Q. 18 – Definition difference between a referral vs. resource/educational material?Educational materials and resources are risk domain specific documents and/or
links to websites shared with beneficiaries.
A referral is any risk domain specific suggestions; information; or assistance in obtaining services from an outside entity for an identified need and/or risk. However, referring a beneficiary to an agency may result in obtaining resources (i.e., baby items, food, clothing, etc.).
Q. 19 – Do referrals have to be documented on the new POC2s and PVPN?A. Risk domain specific referrals listed on the POC2s should be documented on the POC2 in addition to the referral section of the PVPN. The detailed referral documentation on the POC2s is designed to capture exactly where beneficiaries are being referred and the outcome of the referral. This duplicate documentation will be addressed as more POC2s are updated and align with the new format.
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Q & A 2017 October Coordinator Training Referrals
Q. 20 – Clarify “Did the beneficiary access referral”?A. Accessing a referral would be defined as the beneficiary contacting the referred entity. For example, a beneficiary making an appointment at an agency she was referred would be accessing the referral.
Q. 21 – When are MIHP staff required to make a RD referral?A. When a nutrition risk is identified. Agencies must indicate how nutrition counseling services were provided by a RD; or that a referral was offered or made, as documented on a Professional Visit Progress Note.
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Q & A 2017 October Coordinator Training FORMS
Q. 22 – Can “contact the MHP” be added to the MIHP Recipient Rights Form?
A. This has been done and is included on the revised form effective 4/1/18.
Q. 23 – Can we add additional lines, boxes and spaces to EMR forms?
A. Additional space for documentation is allowable when converting hard copy forms to an EMR.
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Q & A 2017 October Coordinator Training Action/Safety Plans
Q. 24 – Is there research and evidence to show that creating an action plan moves clients forward? Is this evidence-based?
A. Action planning has been derived from the patient-centered model of care, which is evidence-based. This model of care is based on the premise that two-way communication needs to occur for effective and optimal health of the patient. Action planning is embedded in the Michigan Quality Improvement Consortium Guidelines for Patients with Substance Use Disorder or Risky Substance Use “Create an action plan identifying patient strengths and supports.” Access at http://www.mqic.org/pdf/mqic_screening_diagnosis_and_referral_for_substance_use_disorders_cpg.pdf
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Q & A 2017 October Coordinator Training Action/Safety Plans
Q. 25 – Are the safety plans still required to be completed within three visits?
A. Safety plans should be developed as soon as possible for all beneficiaries. However, they are required before the completion of services when the beneficiary scores out as high risk on the depression, domestic violence, infant safety or substance abuse domain (infants only) unless the MIHP professional documents that the beneficiary did not wish to develop a safety plan.
Q. 26 – Are MIHP professionals required to write out what the safety and action plans were about?
A. It is recommended per your professional judgement.
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Q & A 2017 October Coordinator Training Breastfeeding
Q. 27 – Request for Breastfeeding and Methadone Information.A. The decision is always determined by the beneficiary under the medical guidance of her physician. For the American Congress of Obstetricians and Gynecologists Guidance visit: https://www.acog.org/-/media/committee-Opinions/committee-on-Obstetric-Practice/co711.pdf?dmc=1&ts=20170906T2058260281
Q. 28 – Will breastfeeding score out for maternal and infant clients in the revised MRI and IRI?
A. Yes, breastfeeding will score out on the revised risk identifiers.
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Q & A 2017 October Coordinator Training Other
Q. 29 – Would like reconsideration of one visit per month.A. The expectation is one visit per month. Visit frequency can be greater or less than once per month if rationale for visit spacing is documented in the PVPN and contact log.
Q. 30 – Would like access to MIHP database for MHPs. It would be beneficial to allow for better communication and case management.
A. This has been discussed but is not planned at this time
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Q & A 2017 October Coordinator Training Other
Q. 31 – Can the same standing order be documentation for RD and High Risk or SEI?
A. The standing order must clearly indicate the approved reasons for ordering additional visit. One physician order can state multiple reasons for the order.
Q. 32 – Can you provide a list of SCRIPT program providers in Michigan?
A. A Michigan list of SCRIPT program providers is not available, however, some regions have regional lists, such as Northern Michigan. Contacting the local health departments in your service area is recommended.
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Q & A 2017 October Coordinator Training Other
Q. 33 – Is there specific guidance as to when the second discipline should do their visits?
A. The second discipline visit should occur as indicated by the needs of the beneficiaries based on the risk identifier.
Q. 34 – How can MIHP staff obtain more training on Motivational Interviewing?
The Motivational Interviewing training that occurred during the October Coordinator training was recorded and is available on the MIHP website.
Motivation Interview education can also be found at: https://www.improvingmipractices.org/
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Certification Cycle 7
Certification Cycle 7 – General Information
The February and March reviews will be scheduled for cycle 6 if:
The last review was Cycle 5The last review was conditionalThe last review was a 12 month full
If your certification was due in February or March and you do not meet the above criteria, your review will be scheduled after April 1, 2018.
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Certification Cycle 7 – General Information26
• Met (100-90%)• Met with Conditions (89-80%)• Not Met(<80%)
• Combined and separated indicators for ease of use
• Re-numbered indicators• Deleted “placeholder” numbers• Grouped “like” items together• Added section titles
Certification Cycle 7 Indicator 1 – Pre-review Materials
PRE-REVIEW MATERIALS Provider sends all requested certification documentation to
the reviewer by mail only, (not via fax or email). All pre-review documents requested are received by the
reviewer no later than 14 calendar days before the onsite review, no exceptions.
All documents submitted are legible.
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Certification Cycle 7Indicator 2 & 7
Indicator 2 – Requested Medical Records 100% of requested billing and program records are made available by 10:00am on the first day of the review, contain all applicable MIHP forms and are accessible to all agency, state and federal government staff.
Indicator 7 – Training Requirements and CertificatesA. Course completion certificates for online trainings and additional required trainings for the program coordinator and all new professional staff hired/contracted since the last review.
B. Signed Notice of New Professional Staff Training Completion for all staff hired/contracted since the previous review.
C. MDHHS attendance certificates that indicate coordinator or designee attended all required state coordinator trainings and the Michigan Home Visiting Conference since previous review.
D. Course completion certificates of the Overview of the Maternal Infant Health Program Training Course for all administrative staff who enter data into the MIHP database.
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Certification Cycle 7Indicator 8 – Disseminating Information
PRE-REVIEW MATERIALSProtocol describes:
Process for sharing program information with all staff members:Coordinator emails
Regional coordinator meeting program updates and training content
MIHP Alerts
MIHP Consultant correspondence
Great Start Collaborative correspondence
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Certification Cycle 7Indicator 9 – Professional Staff
Pre-review Materials:A. Protocol Describes
3) How the provider arranges for International Board Certified Lactation Consultant® (IBCLC®) services if provider does not have an IBCLC® on staff, identifies the IBCLC® provider, and specifies how and under what conditions the referral to the IBCLC® is made.
C. Documentation from personnel files and MIHP Personnel Roster indicates that:The MDHHS waiver approval letter and Notice of Waiver Completion is on file
for all staff waived since the previous review.
The Professional Staff Waiver Training Matrix is also on file for all staff waived since the previous review.
D. Written verification that staffing back up arrangements are agreed on by the providing professional or MIHP provider
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Certification Cycle 7Indicator 10 – after hours AccessPRE-REVIEW MATERIALS:
A.) Protocol Describes 1) How beneficiaries are informed about accessing emergency services when the agency
phone is not answered immediately. Directions should include calling 9-1-1 or going to the ER.
4) How the provider ensures that the agency phone is not accessible to family members or others who are not authorized to handle PHI.
5) Written material used to inform all beneficiaries how to access services if they have an emergency during the work day, on the weekend or after hours.
AGENCY OBSERVATION
F.) There is evidence that the agency has a business phone which is answered professionally and includes the MIHP provider name.
G.) There is evidence that the phone message includes directions for leaving a call-back number with a statement indicating when the caller may expect a return call.
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Certification Cycle 7Indicator 15 and 16
15 – Respond to Referrals PROGRAM CHART REVIEW:The MIHP must respond to referrals promptly to meet the beneficiary’s needs (within a maximum of 7 calendar days for the infant and 14 calendar days for the pregnant woman). Respond to referrals received prior to the infant's discharge from the inpatient setting within 2 business days of hospital discharge.
16 – Consent FormsPROGRAM and BILLING CHART REVIEWa. 100% of charts reviewed have consent forms that were signed and dated before the Risk Identifier was administered
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Certification Cycle 7Indicator 17 and 18
17 – Handling Beneficiary GrievancesPRE-REVIEW MATERIALSa. Protocol describes:
2.) How beneficiary is notified of the MDHHS and MHP grievance procedures.
18 – BillingSTATE MIHP STAFF ADMINISTRATIVE REVIEW
4.) No more than18 professional visits for an infant using Code 99402 are billed and paid.
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Certification Cycle 7Indicator 20 & 21
20 – Lactation SupportPOLICY UPDATE
Medicaid will reimburse for evidence-based lactation support services provided to post-partum women in the outpatient setting up to and through 60 days post-delivery when services are provided by a qualified licensed MIHP registered nurse or licensed social worker in possession of a valid and current IBCLC certification. A maximum of two visits per pregnancy will be reimbursed for either a single or multiple gestation pregnancy. One visit is reimbursable per date of service. (Section 2.13, Lactation Support and Counseling Services, MIHP, Medicaid Provider Manual)
21 – BillingBILLING CHART REVIEW
5) The correct place of service code used for billing matches the Risk Identifier or Professional Visit Progress Note.
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Certification Cycle 7Indicator 25 & 26
25 – Great Start/Early OnPRE-REVIEW MATERIALS
Email documentation indicates that provider receives regular written communications, at a minimum quarterly, from the Great Start Collaborative (GSC) in each county served by the MIHP.
STAFF INTERVIEW
Staff describes how referrals are made to Early On.
26 – Referral ResourcesPRE-REVIEW MATERIALS
Protocol describes:
How referral resources are communicated to the beneficiaries in each county served.
How the staff have access to and are aware of resources in each county served.
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Certification Cycle 7Indicator 29 – New – Physician Orders
PROGRAM and BILLING CHART REVIEWAt least 90% of all program and billing charts reviewed requiring a
physician order indicate that:A physician order is in the chart. The reason for and purpose of services requiring a physician order is
well documented in the beneficiary chart. The physician orders include the following elements: printed MIHP
provider name; printed medical provider name, address, and phone number; medical provider signature and credentials; (MD, DO, FNP, PA), and date of signature (for all physician orders signed after 4/1/2018).
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Certification Cycle 7Indicator 32 – Medical Provider Communication
Combined two Cycle 6 Indicators, added a protocol, and reworded requirementsPRE-REVIEW MATERIALS Protocol describes:
How required written communication is provided to the medical care provider.
How and when additional communication (telephone, fax, etc.) with medical care provider is provided.
PROGRAM CHART REVIEW – rewrite of original language At least 90% of charts reviewed indicate that the medical care provider was notified through
sending a complete and accurate Beneficiary Status Notification form at a minimum when: The beneficiary is enrolled in MIHP (within 14 calendar days, unless the MIHP is part of an OB or pediatric
practice and the MIHP provider has a signed statement indicating that notification is not necessary).
A significant change occurs (domain added to POC 2; beneficiary transfer received by MIHP provider; beneficiary changed medical care provider).
The beneficiary has had emergency interventions implemented (fax form within 24 hours)
The beneficiary is discharged in addition to sending the Discharge Summary (within 14 calendar days of entering the Discharge Summary into the MDHHS database, unless the MIHP is part of an OB or pediatric practice and the MIHP provider has a signed statement indicating that notification is not necessary).
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Certification Cycle 7New Indicator 33 Medicaid Health Plan Communication
PRE-REVIEW MATERIALSProtocol describes:
How required written communication is provided to the Medicaid Health Plan. How and when additional communication (telephone, fax, etc.) with the Medicaid
Health Plan is provided.
PROGRAM CHART REVIEWAt least 90% of charts reviewed indicate that the Medicaid Health Plan was notified through sending a complete and accurate Beneficiary Status Notification form at a minimum when:
The beneficiary is enrolled in MIHP (within 14 calendar days or within 14 days after beneficiary is enrolled in a Medicaid Health Plan)
The beneficiary has had emergency interventions implemented (fax form within 24 hours) A beneficiary is transferred to your MIHP. The beneficiary is discharged (within 14 calendar days of entering the Discharge
Summary into the MDHHS database)
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Certification Cycle 7 Indicator 36 & 39
Indicator 36 – Accurate and Appropriately Altered FormsPROGRAM CHART REVIEW
C.) 100% of charts reviewed have forms on which data entries have been appropriately altered (e.g., single-line through error, initials of person responsible for the error, alteration is visible-no whiteout, permanent marker or scribbling; or data additions are initialed).
Indicator 39 – ImmunizationsPROGRAM CHART REVIEWMaternal Beneficiaries
Provider printed the maternal Michigan Care Improvement Registry (MCIR) Immunization Record or screenshot of attempt to locate in MCIR, reviewed immunization status with the beneficiary and placed the record in chart (on closed maternal charts with visits occurring after 4/1/2018).
Infant Beneficiaries Provider printed the infant Michigan Care Improvement Registry (MCIR) Immunization
Record or screenshot of attempt to locate in MCIR, reviewed the immunization status with the caregiver (at a minimum during the next visit after 4 months, 6 months and 12 months and placed the record in chart (on all infant charts opened after 4/1/2018
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Certification Cycle 7 Indicator 40 & 41
Indicator 40 - ASQPROGRAM CHART REVIEW
Part 2: Denominator will now be number of ASQ-3 and ASQ: SE-2 Information Summary Sheets
reviewed rather than number of charts reviewed.
Part 3: At least 90% of infant charts document that learning activities were shared with the family
when an ASQ-3 or an ASQ: SE-2 scored close to the cutoff (in the gray area) in one or more domains.
Indicator 41 – Nutrition CounselingPROGRAM CHART REVIEW
At least 90% of closed program charts reviewed with a visit on or after 4/1/2018 in which a nutrition risk is identified, indicate how nutrition counseling services were provided by a RD; or that a referral was offered or made, as documented on a Professional Visit Progress Note
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Certification Cycle 7 –Indicator 42 – Plan of Care
Plan of Care Part 1STAFF INTERVIEW
Staff can describe the following POC 1 protocols: The information that must be given to the beneficiary in writing.
Whether or not it is adequate to just give the beneficiary information on signing up for text4baby
PROGRAM CHART REVIEW
Signature of professional who administered the Risk Identifier.
Plan of Care Part 2 In which a risk level change has been documented, indicate that the risk level increase or
decrease is based on the criteria in POC 2, that the date of the change is noted in Column 1 and the reason behind the risk level change is documented on the PVPN or Contact Log.
Plan of Care Part 3STAFF INTERVIEW
Discussion with staff indicates they can describe how many days the second discipline has to sign the POC3.
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Certification Cycle 7 –Indicator 44 – Implementing the Care Plan - NEW
A professional visit is a face-to-face encounter with a beneficiary conducted by a licensed professional (i.e., licensed social worker, registered nurse, or infant mental health specialist) for the specific purpose of implementing the beneficiary's plan of care. (Section 2.7, MIHP, Medicaid Provider Manual)To fully meet this indicator: PROGRAM CHART REVIEWAt least 90% of Professional Visit Progress Notes reviewed indicate that:
Plan of Care risk domains; beneficiary identified needs; or issues identified through professional judgement of provider were addressed at every visit.
If no risk was assessed, include documentation related to the rationale for services.
Infant charts document the Substance Exposed Infant (SEI) Plan of Care is added to the POC 2as soon as the SEI risk is identified and interventions began to be implemented as soon as the plan of care is pulled.
Infant Professional Visit Progress Notes document substance-exposed infant interventions are implemented at every visit after visit 18 or documentation as to why substance-exposed interventions were not implemented.
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Certification Cycle 7 Indicator 45 & 48
Indicator 45 – Addressing Risk Domainsc.) At least 90% of closed charts and charts that should have been closed reviewed indicate that staff addressed all risk domains included in the POC 2 or there is documentation as to why risk domains were not addressed on the Professional Visit Progress Note, Contact Log or Discharge Summary.Indicator 48 – Case ManagementPRE-REVIEW MATERIALS Protocol describes:
The case manager’s process for conducting quarterly chart reviews to determine:Whether or not the beneficiary has been seen monthly (once in a
given month).
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Certification Cycle 7 Indicator 51 & 59
Indicator 51 – Discharge SummaryPROGRAM CHART REVIEW
At least 90% of closed charts reviewed include a Maternal or Infant Discharge Summary that is complete and accurate with respect to each data field.
Indicator 59 – Maternal OnlyPRE-REVIEW MATERIALS
Each signed agreement between the maternal only provider and an infant provider meets the Guidelines for Maternal Only MIHP Providers.
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IT Updates
Reminder
Agencies may now correct
MRI, IRI—if completed within last 30 days—as long as a discharge has not been started
MDS or IDS—if completed within the last 30 days
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Reminder
If corrected—please note field(s) corrected –in the comments section on the submission page (e.g. corrected DOB, changed response to CPS history, etc.)
May only “update” once
47
48
49
Reminder
Must wait one day before an agency completes a discharge summary—after a risk identifier has been deleted and re-entered.
Discharge Summary must be dated at least one day after last date of service
If specific problems arise, contact a State MIHP Consultant for assistance
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New messaging coming soon!
When entering an IRI—the system will note that a MRI was completed for this mom—for this pregnancy—by X agency—and will recommend follow up with that agency for coordination of care.
If an agency chooses to continue, once they receive the “MRI was completed by” message—the entry will be followed by a 2nd
message—if an IRI has been completed for this baby.
Stronger “2nd pregnancy in one year” message for MRI . Warns that an agency may have to repay Medicaid if this is a duplicate.
51
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Coming Soon!
Abbreviated discharge summaries for :
Beneficiaries who have completed a Risk identifier only—without additional billable MIHP services
2nd, 3rd, etc. child in a set of multiples
Will have a button for full discharge required? Yes, NoWill click Yes or NoWill only be able to click this button one time.
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State Home Visitation Initiative-CQI project update
Tobacco Cessation
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State Home Visitation Initiative-CQI project update HV CQI team undertakes quality improvement projects
around topic areas that impact the entire system of home visiting.
For this CQI cycle, Tobacco Use by Pregnant Women was selected.
As tobacco use is a leading cause of low-birth weight and other complications, the goal of this project is to decrease the rate of pregnant and mothering women who use tobacco.
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State Home Visitation Initiative-CQI project update
Gathered responses from all home visitation models (2017 HV Conference)
Current tobacco screening practices Cessation education/assistance provided by each of the models
January 2018—follow up survey with a sample of agencies from around the state
ModelRegionAgency typePopulation served
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Which evidence based home visiting model are you implementing in your community? (n=61)
17
16
10
6
6
4
1
1
Maternal Infant Health Program (MIHP)
Infant Mental Health (IMH)
Healthy Start
Family Spirit
Nurse Family Partnership (NFP)
Early Head Start (EHS)
Healthy Families America (HFA)
Parents as Teachers (PAT)
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How comfortable are you…
66%
24%
8%
2%
Asking clients about their tobacco use? (n=62)
Very comfortable Comfortable Somewhat comfortable Not at all comfortable
58
How comfortable are you…
42%
42%
11%
5%
Advising clients to quit using tobacco? (n=62)
Very comfortable Comfortable Somewhat comfortable Not at all comfortable
59
How comfortable are you…
55%39%
6%
Providing clients with information to quit using tobacco? (n=62)
Very comfortable Comfortable Somewhat comfortable Not at all comfortable
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How comfortable are you…
55%35%
8%2%
Referring clients to quit using tobacco? (n=62)
Very comfortable Comfortable Somewhat comfortable Not at all comfortable
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What would increase your comfort level when referring clients to resources to quit using tobacco? (Each participant selected up to three responses)
40
34
20
17
17
15
15
13
13
12
10
10
7
7
1
Brochures to provide clients
List of local tobacco dependence treatment resources to provide to clients
Webinars on tobacco dependence treatment
In person training on how to talk to clients about tobacco
Webinars on how to talk to clients about tobacco
In person training on tobacco dependence treatment
Webinars on medications to treat tobacco dependence
In person training on medications to treat tobacco dependence
Webinars on Motivational Interviewing
Material to read on tobacco dependence treatment
In person training on motivational interviewing
Material to read on how to talk to clients about tobacco
Material to read on motivational interviewing
Material to read on medications to treat tobacco dependence
Other*
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Are you aware that as of January 2016, both Medicaid and Healthy Michigan Plan cover all seven FDA approved medications for quitting smoking without prior authorization, step therapy, or annual lifetime quantity limits? (n=62)
No69%
Yes31%
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7 FDA approved medications
Bupropion SR (Zyban, Wellbutrin)—Prescription only Varenicline (Chantix)—Prescription only Nicotine gum (Nicorette Nicorette) –OTC only Nicotine inhaler—Prescription only Nicotine lozenges –OTC only Nicotine nasal spray (Nicotrol NS)— Prescription only Nicotine patch (Nicoderm CQ, Nicotrol) –OTC or
Prescription
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State Home Visitation Initiative-CQI project update
Evaluate resultsDetermine next stepsIf agency was sent the survey and
hasn’t yet responded, please respond by January 31, 2018
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