ATT021_TGD-009-MonthlyReport.pdf

Contractor Technical Guidance Document

TGD #009

Essential Elements of a Monthly Report

Issue Date: February 28, 2020 Effective Date: April 1, 2020

Purpose The purpose of this Technical Guidance Document is to provide more detailed instruction as to what is expected in the Monthly Report, as well as to improve consistency in reporting, documenting, monitoring, and evaluating performance and levels of effort, and providing more efficient review and feedback by World Trade Center (WTC) Health Program Contracting Officer’s Representatives (CORs) across the Clinical Centers for Excellence (CCEs) and the National Provider Network (NPN).

Stakeholders affected Clinical Centers of Excellence and National Provider Network

Background The July 2019 Contract Modification focusing on the Performance Work Statement (PWS) was issued to all CCEs with various actions including administrative changes and new deliverable requirements. One of the changes to the new PWS includes updated requirements for the CCE Monthly Report (see section C.3.13.1 Monthly Reports). In order to achieve consistency across CCEs, and more efficient review and feedback by WTCHP CORs, the WTC Health Program is providing a template to be used by CCEs to report all elements of the Monthly Report.

Technical Guidance The contractor should use the attached Monthly Report Template which includes the exact elements outlined in the newly adopted PWS. The WTC Health Program CORs will use this new template to review the monthly report and provide feedback to the contractor. At least once a month, the COR will provide monthly report feedback and use this same template for documentation.

The CCE Monthly Report should provide correlating evidence to support the levels of effort on submitted invoices. Additionally, the reports should be succinct, and not include superfluous information that is not relevant to the reporting period, or to the elements required in the monthly report. It is acceptable to include supplemental documentation where indicated on the Monthly Report template.

Clinical Services vs. Non-Clinical Services Clarification

To clarify some of the terminology used in the Monthly Report Template, clinical services may include services such as treatment, diagnostic, and intensive case management services. Clinical services are any services that require a clinical staff member to complete. Non-clinical services may include services such as benefits counseling, social services, and member services. Non-clinical services do not require a clinical staff member to complete them. Additionally, we will continue to work with the CCEs and NPN as we implement this template and clarify any questions and provide feedback as to whether the information provided is adequate to justify effort.

Clarification on Reporting CLIN 3 Items (Case Management):

Case Volume and Case Mix:

In effort to promote consistency in reporting structures, the following case management (CM) elements should be incorporated into your November monthly report which is due on December 15, 2019.

• Caseload per Case Manager (Member to Case Manager ratio)

• CM volume by acuity level

• Total volume of members in CM

• Change in members from previous month to current month (number)

• Total members in ICM more than 6 months

Additionally, monthly reporting should also include member count by category. Because members may fall into different categories, it is important to report by unique member count only, based on the following elements:

• Cancer

• Transplant

• Complex Medical

• Behavioral Health

• Other

CCEs/NPN should notify the COR team if they have changes in operational activities that may affect their reporting process.

Format:

Reporting formats may vary among the sites due to variances in software or tracking systems used by each CCE/NPN. Template examples are provided as reference below (for current and future reporting information). Use of the table is optional; each CCE/NPN may choose to utilize the table(s) and/or customize the table(s) to the specifics of the individual site. The information may also be reported in your current format if the above elements are provided. This will allow for accurate tracking and trending of data and comparison across all sites.

Template Examples:

Case Manager Name Acuity Level (acuity levels may vary)

Total Members in CM Current

Month

Total Members in CM Previous

Month

Change From Previous Month

(Number) 1 2 3

Total Members in CM Number of Members in ICM More than 6 Months

Supplemental Material(s) PWS Section C.3.13.1 Monthly Reports Monthly Report Template

Revision History Rev # Changes Made to Document Point of Contact Date

1 New Technical Guidance COR 2/28/2020

Category

Total Members Current Month

Total Members Previous Month

Change From Previous Month

(Number)

Cancer Transplant Complex Medical

Behavioral Health Other

Total Members in CM Number of Members in ICM More than 6 Months

Monthly Report Template

Clinical Center of Excellence:

Reporting Month and Year:

Contract #:

Contract POC:

Submission Date:

FOR NIOSH USE ONLY

COR:

Review Date (3rd week of month):

Please complete each element of the Monthly Report Template. The purpose of the monthly report is to capture the contractor’s operational status and progress on implementing contract requirements. The CCE shall ensure level of effort and approved budget is only for costs incurred in carrying out the activities. Administrative records justifying staffing and costs for performance shall be documented and available for audit by CLIN. Please do not exceed 500 words per narrative.

Section/CLIN Description Guiding Questions & Instructions NIOSH USE ONLY Feedback for CCE

1. Deliverables

a. Operations

Manual and Required Plans

i. Brief update of major revisions and new processes that may result in cost reduction, increased or improved efficiency, and how that was determined.

Are there any major revisions of the Operations Manual or other Plans to report?

Yes ☐ No ☐ If yes, complete narrative.

Narrative:

ii. Major challenges and accomplishments in operation that may result in changes to costs and/or efficiency.

Are there any major challenges or accomplishments in operation to report?

b. Status of deliverables

i. Brief update of standing and ad hoc reports, inquiries, and new policy or technical guidance implementation Are there any updates regarding deliverables or implementation of policy and/or Technical Guidance to report?

2. Operations and Management (CLIN 1)

a. Operational status change notification in timely manner

i. Notify the Program of any disruption (planned or unplanned) to services within 24 hours or as soon as possible

Were there any disruptions to services during the reporting period?

ii. Changes to key staffing and staffing plan.

(Only report any changes, including who is new or leaving. Continue to provide staffing list on the invoice and quarterly reconciled report)

Were there any changes to staffing or the staffing plan during the reporting period?

b. Initial health evaluation, monitoring examination, and treatment

i. Provide numbers and types of visits and explanation for any major change in service.

Report numbers and types of visits in narrative.

Were there any major changes in service?

If yes, complete additional narrative.

VISIT TYPE AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL Initial Health Evals

Monitoring Exams

Treatment

TOTAL

c. Pharmacy benefit management

(PBM)

i. Brief update of major event(s) outside of Operations Manual that may positively or negatively impact the contractor, member(s), and cost that may result in revision to the PBM program activities.

Were there any major events that may result in revision to the PBM program activities during the reporting period?

ii. Brief update describing any significant change in technical approach and how the change is expected to improve cost control or efficiencies.

Were there any major changes in technical approach during the reporting period?

d. HIPAA Compliance

i. Brief update of HIPAA compliance activities. Were there any updates to HIPAA compliance activities during the reporting period?

ii. Brief update of any HIPAA violation activities and quality improvement and/or corrective actions.

Were there any HIPAA violations, QI, or corrective actions to report during the reporting period?

e. Program wide meetings and training related to implementation of contract requirements

i. Brief update of all significant outside meetings, events, and conferences that are directly related to implementation of the contract requirements.

Were any significant outside meetings, event, or conferences attended during the reporting period?

ii. Training organized by the Program, such as forums and PBM training.

• Description of the training

• Objectives/purpose

• Outcomes after the training

• Names of staff members who attended

• Necessary travel (beyond local transit), and duration of travel

Were any trainings attended by staff during the reporting period?

Yes ☐ No ☐ If yes, complete narrative, and address all bulleted items.

f. Change control and change request

i. Brief status update for new and recently implemented change requests. Report any substantial barrier and level of effort to implement the change.

Were there any newly implemented change requests during the reporting period?

ii. Track timeliness in submitting and/or responding to change request.

Were responses to or submissions of change requests delayed for any reason during the reporting period?

g. Claims process oversight

i. Brief update of any major issues and corresponding actions that may impact operating cost, treatment cost and/or deficiency in meeting this requirement.

Were there any major issues with the claims process during the reporting period?

Yes ☐ No ☐ If yes, complete narrative, including any corresponding actions.

ii. Brief description of findings and improvement plan from Program’s provided monthly claims dashboard

Were there any findings or improvement plans from the monthly claims dashboard during the reporting period?

h. Mass communication, and press and media releases

i. Communication with Program on major upcoming activities and mass communication

Are there any major upcoming communication activities to report?

ii. Drafts of co-branded materials provided in advance to Program for review and approval Were any co-branded materials not provided to the program for review and approval?

If yes, complete narrative with explanation.

i. Budget projection

i. Provide a budget snapshot including projection through the end of the performance period, and including invoicing and payment received status.

Please provide budget snapshot as a separate attachment.

j. Invoicing and supportive documentation

i. Brief update on any invoice-related issues and rejection that may have caused substantial administrative burden on government with any quality improvement activities and/or corrective action

Were there any invoice related issues, or rejections, during this reporting period?

ii. Ensure transparency and accountability, and CO concurrence for any desired changes to the established and approved sub-contracting plan.

Were there any changes to the sub-contracting plan during the reporting period?

k. Fraud, Waste and

Abuse Report

This report shall be submitted to the Program when FWA cases are confirmed, and shall be reviewed and signed by an executive officer of the CCE Contractor prior to submission. Provide the number of fraud, waste, or abuse (FWA) complaints made to the CCE Contractor during the reporting period related to covered services that warrant preliminary investigation by the CCE contractor.

The CCE Contractor shall also submit to the WTC Health Program the following on an ongoing basis for each confirmed FWA case it identifies through complaints, organizational monitoring, contractors, subcontractors, providers, and members, or other means related to covered services. Attach any FWA Reports as a separate attachment:

• The name of the individual or entity that committed the fraud, waste, or abuse;

• The source that identified the fraud, waste, or abuse;

• The type of provider, entity, or organization that committed the fraud, waste, or abuse;

• A description of the fraud, waste, or abuse;

• The approximate dollar amount of the fraud, waste, or abuse;

• The legal and administrative disposition of the case including actions taken by law enforcement officials to whom the case has been referred; and

• Other data/information as prescribed by the WTC Health Program.

3. Member Services (CLIN 2)

a. Monitoring and Initial Health Evaluations

i. Brief update on changes or issues with workflow oversight activities.

Were there any changes or issues with workflow oversight activities related to monitoring and initial health evaluations during the reporting period?

ii. Report numbers (monthly and cumulative) of services provided, by type, and by trends with a short summary of analysis.

Provide numbers and short summary of analysis in narrative.

SERVICE TYPE AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL

b. Medical services

i. Brief update on changes or issues with workflow oversight activities.

(This is different from 3.a. above, this may include PBM, Mental Health and other medical related services)

Were there any changes or issues with workflow oversight activities related to medical services during the reporting period?

ii. Report monthly and cumulative number of medical services provided, by type, and by trends with a short summary of analysis

MEDICAL

SERVICE TYPE

AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL

c. Non-medical Services

i. Brief update on changes or issues with workflow oversight and member retention activities.

Were there any changes or issues with workflow oversight activities related to non-medical services during the reporting period?

ii. Report numbers (monthly and cumulative) of non-medical services provided, by type, and by trends with a short summary of analysis.

NON-

MEDICAL

SERVICE TYPE

AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL

d. Member Complaints

i. Brief update on changes or issues with the process of reporting and addressing member complaints.

Were there any changes or issues with the process of reporting and addressing member complaints during the reporting period?

ii. Report number and nature of valid complaints, including those that affect service delivery, ethical issues, etc.

Provide number and short summary of complaints in narrative.

# COMPLAINTS AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL

iii. Provide quality improvement and/or corrective activities

Were there any QI or corrective activities regarding member complaints during the reporting period?

e. Regarding

Transfer Policy

i. Total number of members transferred in and out

• Number of members’ transfers not completed within the required 30-day timeframe and reason for delay

• What quality improvement have you conducted?

Provide numbers of transfers in and out.

Were any transfers not completed in 30 days?

Yes ☐ No ☐ If yes, complete narrative, and explain any QI activities conducted.

TRANSFERS AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL

IN

OUT

NET

f. Retention and Benefits Counseling

i. Brief update on retention rate and efforts to meet Program’s benchmarks

Are there any updates to retention rates and efforts to meet benchmark?

ii. Brief update on Benefits Counseling Eligibility

Assessment and Screening Tool (BEAST) implementation

Are there any updates on BEAST implementation?

4. Case Management (CLIN 3)

a. Case and staffing workload

i. Case management activities to justify staffing levels.

(Staffing workload and level should clearly reconcile with the details on the invoice)

Provide case management activities to justify staffing level.

ii. Total number of Members currently enrolled in ICM and how many are more than six (6) months.

Provide number of members in ICM and how many have been in ICM for more than 6 months.

b. Member complaints-outline of number of valid complaints and core issues

i. What are the trends in the complaints related to case management services and what quality improvement have you conducted?

Provide any trends in member complaints related to case management services and any QI that has been conducted.

5. Quality Improvement Activities

a. Quality Improvement Activities

i. Brief update on efforts to correct, improve or enhance efficiency, cost control and operational challenges.

Are there any updates on QI activities?

For NIOSH Use Only Date Feedback Sent:

COR Summary (by end of month):

(Major developments either negative or positive and actions items for either Units, Teams or contractors, progress update by COR. Include notes from Monthly Call with Contractor to address feedback.)