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ForwardPCMH PNC Learning Session - 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
Additional Information
| Attachment | Size |
|---|---|
 Audience Disclosure slides (001)_17.pptx | 460.09 KB |
 PCMH PNC September 5 2024 Learning Session Agenda.docx | 48.06 KB |
 Pediatric Shift Care Training FAQ FINAL.pdf | 331.3 KB |
| Pediatric Shift Care Training -Distribution copy.pdf | 712.72 KB |
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)
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 ANCCUPMC 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