Excel Sample Sheet 33672 | Care Coordination Report Template

Partial file snippet.

Sheet 1: CCO Info

	
	
	
	
	
		

		

		

		

	
	
		CCO Name & Contract #
		

		< == please select from dropdown list
	
	
		

		

		

		

	
	
		Reporting Period
		Q2 - Apr-Jun 2021
		< == please select from dropdown list
		

	
	
		

		

		

		

	
	
		CCO Contact Person for this Report
		

		

		

	
	
		Name
		 
		

	
	
		

		

		

		

	
	
		Email
		 
		

	
	
		

		

		

		

	
	
		

		

		

		

	
	
		Please also identify your CCO and the last day of the reporting period in the filename (e.g., ABCCCO_06302021). 
		

		

		

	



Sheet 2: Guidance

	
	
	
	
	
	
		
 
		
		

		

		

	
	
		

		

		

	
	
		

		

		

	
	
		Guidance for CCO Care Coordination Report 
		

		

		

		

	
	
		

		

		

		

		

	
	
		Purpose
		

		

		

		

	
	
		This document provides guidance to Coordinated Care Organizations (CCOs) on the biannual Care Coordination Report (CCR) referenced in Exhibit B, Part 4, Section 7 h. of the 2021 CCO contract and described in detail in OAR 410-141-3860(19). 
		
	
		

		

		

		

		

	
	
		Instructions 
		

		

		

		

	
	
		The CCR consists of two components: Data and Narrative. They are reported using the worksheets of the same names in the CCO Care Coordination Report template provided on the CCO Contract Forms webpage.
		
	
		

		

		

		

		

	
	
		Timeline & Submission Process 
		

		

		

		

	
	
		Each CCO will submit its completed biannual CCR to CCO.MCODeliverableReports@dhsoha.state.or.us on the following revised schedule for 2021.  Due date is 45 60 (per revised rule) days after the end of the reporting period:
		
	
		QTR
		Reporting Period
		

		Due Date
		

	
	
		Q1
		January 1-March 31, 2021
		

		No report due
		

	
	
		Q2
		April 1-June 30, 2021
		

		Saturday, August 14, 2021
		Changed to 8/29/2021 per revised rule
	
	
		Q3
		July 1-September 30, 2021
		

		Sunday, November 14, 2021
		Changed to 11/29/2021 per revised rule
	
	
		Q4
		October 1-December 31, 2021
		

		No report due
		

	
	
		

		

		

		

		

	
	
		Each submitted report must have the CCO name and the last day of the reporting period in the filename (e.g., ABCCCO_06302021). The “CCO Info” worksheet  in the report template must be completed.
		
	
		

		

		

		

		

	
	
		Technical Specifications
		

		

		

		

	
	
		Technical specifications for the CCR are provided on the worksheet of the same name in the reporting template.
		



Sheet 3: Report 1 of 3 (Data)

	
	
	
		Terminology 
(use hyperlinks to navigate to Tech Specs tab)
		Data
	
	
		CCO lives
		

	
	
		Member eligible for care coordination by REALD
		Use Report 2 of 3 (REALD)
	
	
		Member receiving care coordination by REALD
		
	
		Member eligible for ICC services by REALD
		
	
		Member receiving ICC services by REALD
		
	
		Member eligible for ICC services (%)
		

	
	
		Member receiving ICC services (%)
		

	
	
		Member assessed for ICC services who declined or refused
		

	
	
		Reason for refusal
		

	
	
		Not Interested
		

	
	
		Did not Respond to Outreach
		

	
	
		Lack of Understanding of ICC Program
		

	
	
		Other - please define
		

	
	
		Member screened within required time frames (%)
		

	
	
		Member in Prioritized Population assessed for ICC within 10 days (%)
		

	
	
		Other Member assessed for ICC within 30 days (%)
		

	
	
		ICC assessment Referral - Response within one business day (%)
		

	
	
		ICC assessment completed within 30 days (%)
		

	
	
		Member given a health risk re-screening (%)
		

	
	
		Member rescreened based on triggers within 7 days (%)
		

	
	
		Care coordinator assignments within 3 business days (%)
		

	
	
		ICC services by CCO staff (%)
		

	
	
		Member progress on goals (%)
		

	
	
		all identified care plan goals fully met
		

	
	
		all identified care plan goals partially met
		

	
	
		at least half of identified care plan goals fully met
		

	
	
		 at least one identified care plan goal fully met
		

	
	
		none of the identified care plan goals met
		

	
	
		Type of reassessment trigger that led to reassessment
		

	
	
		New hospital visit (%)
		

	
	
		New high-risk pregnancy (%)
		

	
	
		New chronic disease (%)
		

	
	
		New behavioral health (%)
		

	
	
		Opioid drug use (%)
		

	
	
		IV drug use (%)
		

	
	
		Suicide attempt, ideation, or planning (%)
		

	
	
		New I/DD diagnosis (%)
		

	
	
		Adverse child experiences (%)
		

	
	
		Homelessness (%)
		

	
	
		Z code diagnoses within one month (%)
		

	
	
		Caregiver placements within 6 months (%)
		

	
	
		Exclusionary practice (%)
		

	
	
		New/ongoing behavioral health needs (%)
		

	
	
		Discharge from residential setting (%)
		

	
	
		Severe alcohol or benzodiazepine usage (%)
		

	
	
		Readmissions to acute care psychiatric hospital (%)
		

	
	
		Readmissions for emergency department for psychiatric reason (%)
		

	
	
		Type of sentinel event that led to reassessment
		

	
	
		Sentinel event - please define (%)
		

	
	
		Sentinel event - please define (%)
		

	
	
		Members with MA or DSNP plans and LTSS

The words contained in this file might help you see if this file matches what you are looking for:

...Sheet cco info name amp contract lt please select from dropdown list reporting period q aprjun contact person for this report nbsp email also identify your and the last day of in filename eg abccco guidance care coordination purpose document provides to coordinated organizations ccos on biannual ccr referenced exhibit b part section h described detail oar instructions consists two components data narrative they are reported using worksheets same names template provided forms webpage timeline submission process each will submit its completed ccomcodeliverablereports dhsohastateorus following revised schedule due date is per rule days after end qtr january march no april june saturday august changed july september sunday november october december submitted must have ldquo rdquo worksheet be technical specifications terminology use hyperlinks navigate tech specs tab lives member eligible by reald receiving icc services assessed who declined or refused reason refusal not interested did res...


CCO Name & Contract #			< == please select from dropdown list

Reporting Period	Q2 - Apr-Jun 2021	< == please select from dropdown list

*CCO Contact Person for this Report*
Name

Email


*Please also identify your CCO and the last day of the reporting period in the filename (e.g., ABCCCO_06302021).*

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Guidance for CCO Care Coordination Report

*Purpose*
This document provides guidance to Coordinated Care Organizations (CCOs) on the biannual Care Coordination Report (CCR) referenced in Exhibit B, Part 4, Section 7 h. of the 2021 CCO contract and described in detail in OAR 410-141-3860(19).

*Instructions*
The CCR consists of two components: Data and Narrative. They are reported using the worksheets of the same names in the CCO Care Coordination Report template provided on the CCO Contract Forms webpage.

*Timeline & Submission Process*
Each CCO will submit its completed biannual CCR to CCO.MCODeliverableReports@dhsoha.state.or.us on the following revised schedule for 2021. Due date is 45 60 (per revised rule) days after the end of the reporting period:
QTR	Reporting Period	Due Date
Q1	January 1-March 31, 2021	No report due
Q2	April 1-June 30, 2021	~~Saturday, August 14, 2021~~	Changed to 8/29/2021 per revised rule
Q3	July 1-September 30, 2021	~~Sunday, November 14, 2021~~	Changed to 11/29/2021 per revised rule
Q4	October 1-December 31, 2021	No report due

Each submitted report must have the CCO name and the last day of the reporting period in the filename (e.g., ABCCCO_06302021). The “CCO Info” worksheet in the report template must be completed.

*Technical Specifications*
Technical specifications for the CCR are provided on the worksheet of the same name in the reporting template.

Terminology (use hyperlinks to navigate to Tech Specs tab)	Data
CCO lives
Member eligible for care coordination by REALD	Use Report 2 of 3 (REALD)
Member receiving care coordination by REALD
Member eligible for ICC services by REALD
Member receiving ICC services by REALD
Member eligible for ICC services (%)
Member receiving ICC services (%)
Member assessed for ICC services who declined or refused
Reason for refusal
Not Interested
Did not Respond to Outreach
Lack of Understanding of ICC Program
Other - please define
Member screened within required time frames (%)
Member in Prioritized Population assessed for ICC within 10 days (%)
Other Member assessed for ICC within 30 days (%)
ICC assessment Referral - Response within one business day (%)
ICC assessment completed within 30 days (%)
Member given a health risk re-screening (%)
Member rescreened based on triggers within 7 days (%)
Care coordinator assignments within 3 business days (%)
ICC services by CCO staff (%)
Member progress on goals (%)
all identified care plan goals fully met
all identified care plan goals partially met
at least half of identified care plan goals fully met
at least one identified care plan goal fully met
none of the identified care plan goals met
Type of reassessment trigger that led to reassessment
New hospital visit (%)
New high-risk pregnancy (%)
New chronic disease (%)
New behavioral health (%)
Opioid drug use (%)
IV drug use (%)
Suicide attempt, ideation, or planning (%)
New I/DD diagnosis (%)
Adverse child experiences (%)
Homelessness (%)
Z code diagnoses within one month (%)
Caregiver placements within 6 months (%)
Exclusionary practice (%)
New/ongoing behavioral health needs (%)
Discharge from residential setting (%)
Severe alcohol or benzodiazepine usage (%)
Readmissions to acute care psychiatric hospital (%)
Readmissions for emergency department for psychiatric reason (%)
Type of sentinel event that led to reassessment
Sentinel event - please define (%)
Sentinel event - please define (%)
Members with MA or DSNP plans and LTSS

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