PCMH PNC Learning Session - September 5, 2024

September 5, 2024

This session will provide an overview of the Office of Medical Assistance Programs' focus on person-centered care, determining medical necessity, and appropriate vs. inappropriate denials, with a focus on Pediatric Shift Care medical necessity criteria for authorizing shift care services and the factors affecting medical necessity determinations.

Agenda

9:00 a.m. to 9:02 a.m. – Welcome and Overview – Robert Ferguson, MPH, Chief Policy Officer, Pittsburgh Regional Health Initiative (PRHI)

9:02 a.m. to 9:10 a.m. –Overview of the HealthChoices PCMH-PNC Program – Latesia Sease, HSPS Supervisor-Process Management Unit, Division of Quality and Special Needs Coordination, Department of Human Services - Bureau of Managed Care, Office of Medical Assistance Programs      

9:10 a.m. to 9:45 a.m. –PCMH Medical Necessity Criteria for Authorizing Shift Care Services - Donald Quigley RN, Clinical Quality Supervisor, Division of Quality and Special Needs Coordination, Department of Human Services - Bureau of Managed Care, Office of Medical Assistance Programs

9:45 a.m. to 10:00 a.m. – Q&A and Discussion – Carol Frazer, Pittsburgh Regional Health Initiative (PRHI)

 

Target Audience

Nurse

Physician

Social Worker

Learning Objectives

Describe the goals of the HealthChoices PCMH Pediatric Nursing Care program

Describe the Pediatric Shift Care medical necessity criteria for authorizing shift care services and the available resources

Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
    The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
  • 1.00 ANCC
    UPMC Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation
  • 1.00 ASWB
  • 1.00 Attendance
Course opens: 
09/05/2024
Course expires: 
12/31/2024
Event starts: 
09/05/2024 - 9:00am EDT
Event ends: 
09/05/2024 - 10:00am EDT

This session will provide an overview of the Office of Medical Assistance Programs' focus on person-centered care, determining medical necessity, and appropriate vs. inappropriate denials, with a focus on Pediatric Shift Care medical necessity criteria for authorizing shift care services and the factors affecting medical necessity determinations.

Agenda

9:00 a.m. to 9:02 a.m. – Welcome and Overview – Robert Ferguson, MPH, Chief Policy Officer, Pittsburgh Regional Health Initiative (PRHI)

9:02 a.m. to 9:10 a.m. –Overview of the HealthChoices PCMH-PNC Program – Latesia Sease, HSPS Supervisor-Process Management Unit, Division of Quality and Special Needs Coordination, Department of Human Services - Bureau of Managed Care, Office of Medical Assistance Programs      

9:10 a.m. to 9:45 a.m. –PCMH Medical Necessity Criteria for Authorizing Shift Care Services - Donald Quigley RN, Clinical Quality Supervisor, Division of Quality and Special Needs Coordination, Department of Human Services - Bureau of Managed Care, Office of Medical Assistance Programs

9:45 a.m. to 10:00 a.m. – Q&A and Discussion – Carol Frazer, Pittsburgh Regional Health Initiative (PRHI)

Zoom Meeting
Pittsburgh, PA
United States

Robert Ferguson, MPH, Chief Policy Officer, Pittsburgh Regional Health Initiative (PRHI)

Latesia Sease, HSPS Supervisor-Process Management Unit, Division of Quality and Special Needs Coordination, Department of Human Services - Bureau of Managed Care, Office of Medical Assistance Programs      

Donald Quigley RN, Clinical Quality Supervisor, Division of Quality and Special Needs Coordination, Department of Human Services - Bureau of Managed Care, Office of Medical Assistance Programs

Carol Frazer, Pittsburgh Regional Health Initiative (PRHI)

 

 

 

 

 

 

In support of improving patient care, this activity has been planned and implemented by the University of Pittsburgh and The Jewish Healthcare Foundation. The University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

As a Jointly Accredited Organization, University of Pittsburgh is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. University of Pittsburgh maintains responsibility for this course. Social workers completing this course receive  1.0 continuing education credits.

Physician (CME)
The University of Pittsburgh designates this live activity for a maximum of 1.0  AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing (CNE)
The maximum number of hours awarded for this Continuing Nursing Education activity is 1.0 contact hours.

Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
    The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
  • 1.00 ANCC
    UPMC Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation
  • 1.00 ASWB
  • 1.00 Attendance
Please login or register to take this course.