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[]
[]
["Audit Tool #","Care Manager Name  ","Member Name","Member CIN#","Qualifying Diagnoses","Medicaid","Significant Risk","General Risk","Stability","Skills","Engagement","CES Review Recommendation","Comments on CES Review Recommendation"]
[1,{"$f":"'CES Tool 1'!$C$3","v":0},{"$f":"'CES Tool 1'!$A$3","v":0},{"$f":"'CES Tool 1'!$B$3","v":0},{"$f":"'CES Tool 1'!$C$9","v":"Yes"},{"$f":"'CES Tool 1'!$C$11","v":"Yes"},{"$f":"'CES Tool 1'!$C$14","v":"PROCEED TO ADDITIONAL RISK FACTORS"},{"$f":"'CES Tool 1'!$C$18","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"},{"$f":"'CES Tool 1'!$C$23","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"},{"$f":"'CES Tool 1'!$C$29","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"},{"$f":"'CES Tool 1'!$C$36","v":"More Information Needed"},{"$f":"'CES Tool 1'!$A$48","v":"MORE INFORMATION NEEDED"},{"$f":"'CES Tool 1'!$A$41","v":0}]
[2,{"$f":"'CES Tool 2'!$C$3","v":0},{"$f":"'CES Tool 2'!$A$3","v":0},{"$f":"'CES Tool 2'!$B$3","v":0},{"$f":"'CES Tool 2'!$C$9","v":"No"},{"$f":"'CES Tool 2'!$C$11","v":0},{"$f":"'CES Tool 2'!$C$14","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"},{"$f":"'CES Tool 2'!$C$18","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"},{"$f":"'CES Tool 2'!$C$23","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"},{"$f":"'CES Tool 2'!$C$29","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"},{"$f":"'CES Tool 2'!$C$36","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"},{"$f":"'CES Tool 2'!$A$48","v":"RECOMMEND DISENROLLMENT"},{"$f":"'CES Tool 2'!$A$41","v":0}]
[3,{"$f":"'CES Tool 3'!$C$3","v":0},{"$f":"'CES Tool 3'!$A$3","v":0},{"$f":"'CES Tool 3'!$B$3","v":0},{"$f":"'CES Tool 3'!$C$9","v":0},{"$f":"'CES Tool 3'!$C$11","v":0},{"$f":"'CES Tool 3'!$C$14","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"},{"$f":"'CES Tool 3'!$C$18","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"},{"$f":"'CES Tool 3'!$C$23","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"},{"$f":"'CES Tool 3'!$C$29","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"},{"$f":"'CES Tool 3'!$C$36","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"},{"$f":"'CES Tool 3'!$A$48","v":"CES REVIEW INCOMPLETE"},{"$f":"'CES Tool 3'!$A$41","v":0}]
[4,{"$f":"'CES Tool 4'!$C$3","v":0},{"$f":"'CES Tool 4'!$A$3","v":0},{"$f":"'CES Tool 4'!$B$3","v":0},{"$f":"'CES Tool 4'!$C$9","v":0},{"$f":"'CES Tool 4'!$C$11","v":0},{"$f":"'CES Tool 4'!$C$14","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"},{"$f":"'CES Tool 4'!$C$18","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"},{"$f":"'CES Tool 4'!$C$23","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"},{"$f":"'CES Tool 4'!$C$29","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"},{"$f":"'CES Tool 4'!$C$36","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"},{"$f":"'CES Tool 4'!$A$48","v":"CES REVIEW INCOMPLETE"},{"$f":"'CES Tool 4'!$A$41","v":0}]
[5,{"$f":"'CES Tool 5'!$C$3","v":0},{"$f":"'CES Tool 5'!$A$3","v":0},{"$f":"'CES Tool 5'!$B$3","v":0},{"$f":"'CES Tool 5'!$C$9","v":0},{"$f":"'CES Tool 5'!$C$11","v":0},{"$f":"'CES Tool 5'!$C$14","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"},{"$f":"'CES Tool 5'!$C$18","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"},{"$f":"'CES Tool 5'!$C$23","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"},{"$f":"'CES Tool 5'!$C$29","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"},{"$f":"'CES Tool 5'!$C$36","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"},{"$f":"'CES Tool 5'!$A$48","v":"CES REVIEW INCOMPLETE"},{"$f":"'CES Tool 5'!$A$41","v":0}]
[6,{"$f":"'CES Tool 6'!$C$3","v":0},{"$f":"'CES Tool 6'!$A$3","v":0},{"$f":"'CES Tool 6'!$B$3","v":0},{"$f":"'CES Tool 6'!$C$9","v":0},{"$f":"'CES Tool 6'!$C$11","v":0},{"$f":"'CES Tool 6'!$C$14","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"},{"$f":"'CES Tool 6'!$C$18","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"},{"$f":"'CES Tool 6'!$C$23","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"},{"$f":"'CES Tool 6'!$C$29","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"},{"$f":"'CES Tool 6'!$C$36","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"},{"$f":"'CES Tool 6'!$A$48","v":"CES REVIEW INCOMPLETE"},{"$f":"'CES Tool 6'!$A$41","v":0}]
[7,{"$f":"'CES Tool 7'!$C$3","v":0},{"$f":"'CES Tool 7'!$A$3","v":0},{"$f":"'CES Tool 7'!$B$3","v":0},{"$f":"'CES Tool 7'!$C$9","v":0},{"$f":"'CES Tool 7'!$C$11","v":0},{"$f":"'CES Tool 7'!$C$14","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"},{"$f":"'CES Tool 7'!$C$18","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"},{"$f":"'CES Tool 7'!$C$23","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"},{"$f":"'CES Tool 7'!$C$29","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"},{"$f":"'CES Tool 7'!$C$36","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"},{"$f":"'CES Tool 7'!$A$48","v":"CES REVIEW INCOMPLETE"},{"$f":"'CES Tool 7'!$A$41","v":0}]
[8,{"$f":"'CES Tool 8'!$C$3","v":0},{"$f":"'CES Tool 8'!$A$3","v":0},{"$f":"'CES Tool 8'!$B$3","v":0},{"$f":"'CES Tool 8'!$C$9","v":0},{"$f":"'CES Tool 8'!$C$11","v":0},{"$f":"'CES Tool 8'!$C$14","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"},{"$f":"'CES Tool 8'!$C$18","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"},{"$f":"'CES Tool 8'!$C$23","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"},{"$f":"'CES Tool 8'!$C$29","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"},{"$f":"'CES Tool 8'!$C$36","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"},{"$f":"'CES Tool 8'!$A$48","v":"CES REVIEW INCOMPLETE"},{"$f":"'CES Tool 8'!$A$41","v":0}]
[9,{"$f":"'CES Tool 9'!$C$3","v":0},{"$f":"'CES Tool 9'!$A$3","v":0},{"$f":"'CES Tool 9'!$B$3","v":0},{"$f":"'CES Tool 9'!$C$9","v":0},{"$f":"'CES Tool 9'!$C$11","v":0},{"$f":"'CES Tool 9'!$C$14","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"},{"$f":"'CES Tool 9'!$C$18","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"},{"$f":"'CES Tool 9'!$C$23","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"},{"$f":"'CES Tool 9'!$C$29","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"},{"$f":"'CES Tool 9'!$C$36","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"},{"$f":"'CES Tool 9'!$A$48","v":"CES REVIEW INCOMPLETE"},{"$f":"'CES Tool 9'!$A$41","v":0}]
[10,{"$f":"'CES Tool 10'!$C$3","v":0},{"$f":"'CES Tool 10'!$A$3","v":0},{"$f":"'CES Tool 10'!$B$3","v":0},{"$f":"'CES Tool 10'!$C$9","v":0},{"$f":"'CES Tool 10'!$C$11","v":0},{"$f":"'CES Tool 10'!$C$14","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"},{"$f":"'CES Tool 10'!$C$18","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"},{"$f":"'CES Tool 10'!$C$23","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"},{"$f":"'CES Tool 10'!$C$29","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"},{"$f":"'CES Tool 10'!$C$36","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"},{"$f":"'CES Tool 10'!$A$48","v":"CES REVIEW INCOMPLETE"},{"$f":"'CES Tool 10'!$A$41","v":0}]
["TOTAL ROW","TOTAL ROW","TOTAL ROW","TOTAL ROW",{"$f":"COUNTIF(Table1[Qualifying Diagnoses],\"Yes\")","v":1},{"$f":"COUNTIF(Table1[Medicaid],\"Yes\")","v":1},{"$f":"COUNTIF(Table1[Significant Risk],\" PROCEED TO MEMBER ENGAGEMENT\")","v":0},{"$f":"COUNTIF(Table1[General Risk],\"MEMBER HAS GENERAL RISK FACTORS\")","v":0},{"$f":"COUNTIF(Table1[Stability],\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\")","v":0},{"$f":"COUNTIF(Table1[Skills],\"THEY DO NOT HAVE THE SKILLS YET\")","v":0},{"$f":"COUNTIF(Table1[Engagement],\"RECOMMEND CONTINUED SERVICES\")","v":0},{"$f":"COUNTIF(Table1[CES Review Recommendation],\"RECOMMEND CONTINUED SERVICES\")","v":0},"TOTAL ROW"]

{"sheet":"DropDowns","index":1,"n_rows":33,"n_cols":18,"rows_kept":33,"cut":false,"hidden":true,"merged":[]}
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Concrete Example"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ADVERSE EVENTS RISK: Current Quality flag in PSYCKES or equivalent from RHIO or MCO"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ADVERSE EVENTS RISK: Current POP flag in PSYCKES"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ADVERSE EVENTS RISK: Current H-code in EMEDNY (HARP Eligible/Enrolled) - Must specify H1, H2, H3, H4, H5, H6, H8, H9 (H7 NOT INCLUDED)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SOCIAL DETERMINANTS RISK: Currently homeless (HUD 1, 2, or 4)  "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SOCIAL DETERMINANTS RISK:Member has fewer than 2 people identified as a support by the member"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SOCIAL DETERMINANTS RISK:Member has had a recent change in guardianship"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SOCIAL DETERMINANTS RISK: Recent institutionalization or nursing home placement of member's primary support person"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SOCIAL DETERMINANTS RISK: Member does not have needed benefits (SSI, SNAP, etc.)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SOCIAL DETERMINANTS RISK:Currently can not access food due to financial limitations or ability to shop or access food site, dietary restrictions, etc. "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SOCIAL DETERMINANTS RISK: Current Intimate Partner Violence"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HEALTHCARE RISK: Member does not have a healthcare provider or specialist to treat a chronic health condition"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HEALTHCARE RISK: Member has not seen their provider (e.g., PCP, BH, etc.) in the last year"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HEALTHCARE RISK: Member (or guardian) is unable to appropriately navigate the healthcare system for the member's chronic conditions."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TREATMENT NON-ADHERANCE RISK: Member/care team member report of non-adherance…Must specify WHICH medication(s) and/or treatment(s) are involved."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TREATMENT NON-ADHERANCE RISK: PSYCKES flag related to non-adherance or equivalent from RHIO or MCO"]
["Yes   ",null,"Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"RE-ADMISSION/RECIDIVISM RISK: Released from inpatient Medical, Psych, or Detox within the last 90 days.  Must specify name of institution and date of release."]
["No",null,"No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"RE-ADMISSION/RECIDIVISM RISK:Released from Jail/Prison or other justice program within the last 90 days. Must specify name program and date of release."]
["Unclear",null,"Unclear",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NONE OF THE ABOVE - PROCEED TO ADDITIONAL RISK FACTORS"]
[null,null,"N/A"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,"12 month"]
["Care Manager",null,null,null,null,null,null,null,null,null,null,"18 month"]
["Supervisor",null,null,null,null,null,null,null,null,null,null,"24 month"]
["Quality Assurance",null,null,null,null,null,null,null,null,null,null,"30 month"]
[null,null,null,null,null,null,null,null,null,null,null,"36 month"]
[null,null,null,null,null,null,null,null,null,null,null,"42 month"]
[null,null,null,null,null,null,null,null,null,null,null,"48 month"]
[null,null,null,null,null,null,null,null,null,null,null,"54 month"]
["Yes - DO NOT PROCEED WITH THE CES REVIEW",null,null,null,null,null,null,null,null,null,null,"60 month"]
["No",null,null,null,null,null,null,null,null,null,null,"Off-Cycle"]

{"sheet":"CES Tool 1","index":2,"n_rows":58,"n_cols":5,"rows_kept":58,"cut":false,"hidden":false,"merged":[[17,0,17,1],[18,0,18,1],[19,0,19,1],[21,0,21,1],[22,0,22,1],[20,0,20,1],[27,0,27,1],[26,0,26,1],[23,0,23,1],[24,0,24,1],[25,0,25,1],[30,0,30,1],[31,0,31,1],[32,0,32,1],[33,0,33,1],[28,0,28,1],[29,0,29,1],[47,0,47,2],[35,0,35,1],[37,0,37,1],[34,0,34,1],[36,0,36,1],[49,2,57,2],[0,0,0,2],[7,0,7,1],[8,0,8,1],[9,0,9,1],[10,0,10,1],[14,0,14,1],[15,0,15,1],[16,0,16,1],[11,0,11,2],[13,0,13,1],[12,0,12,2],[38,0,38,1],[39,0,39,2],[40,0,45,2],[46,0,46,2]]}
["DOH CONTINUED ELIGIBILITY FOR SERVICES REVIEW TOOL \nUse with members enrolled for at least 1 year who are not pended, i.e. this should not be used on members who are Disengaged and in Diligent Search, or are Pended for any reason.                 \nDO NOT USE FOR ANY MEMBER THAT IS ELIGIBLE FOR HH+                                                                                                                                                                                                                               \n Look at CURRENT records.  That will generally mean documentation within the last 90 days, unless otherwise indicated. "]
["MEMBER NAME","MEMBER CIN","CARE MANAGER NAME"]
[]
["LAST IN PERSON CONTACT WITH MEMBER (DATE)","LAST CONTACT WITH AT LEAST ONE CARE TEAM MEMBER (DATE)","LAST COMPREHENSIVE REASSESSMENT (DATE)"]
[]
["ELIGIBLE FOR HH+ SMI OR HH+ HIV?","LENGTH OF STAY IN THEIR CURRENT HEALTH HOME PROGRAM (MONTHS) \n","TYPE OF REVIEW"]
["No"]
["BASIC ELIGIBILITY PRE-SCREEN  \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result.\nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.",null,{"$f":"IF(AND(C9=\"\",C11=\"\"),\"Is the Member Eligible for Health Home Services?\",IF(OR(C9=\"NO\",C11=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C9=\"UNCLEAR\",C11=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",IF(OR(C9=\"\",C11=\"\"),\"CONTINUE WITH THIS SECTION\",IF(AND(C9=\"Yes\",C11=\"Yes\"),\"PROCEED TO SIGNIFICANT RISK FACTORS\",\"Error\")))))","v":"PROCEED TO SIGNIFICANT RISK FACTORS"}]
["Does the member still have qualifying diagnoses for Health Home?",null,"Yes"]
["Which One(s)?"]
["Does the Member still have Active Medicaid, with no disqualifying R/E codes?\n\nRemember: Members can only be disenrolled due to inactive Medicaid if they are no longer eligible for Medicaid or if they have been refusing to take the necessary steps to fix the Medicaid case.  It is expected that HHCM’s will need to help members reactivate their Medicaid at times.",null,"Yes"]
[]
[]
["SIGNIFICANT RISK FACTORS \nSelection of at least one Concrete Example skips straight to Member Engagement \nSelection of “No Concrete Example of a Significant Risk Factor in record” skips straight to Additional Risk Factors. ",null,{"$f":"IF(C15=\"\",\"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?\",IF(C15=\"NONE OF THE ABOVE - PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO MEMBER ENGAGEMENT\"))","v":"PROCEED TO ADDITIONAL RISK FACTORS"}]
["Select a Concrete Example of a Significant Risk Factor:",null,"NONE OF THE ABOVE - PROCEED TO ADDITIONAL RISK FACTORS"]
["Description/Specifics if indicated:"]
["Additional Risk Factors\nQuestions in this section DO NOT have to be answered in order.  As soon as the tool skips to another section or generates a result, stop answering further questions in this section. ",null,{"$f":"IF(AND(C18=\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",C23=\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",C29=\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\"),\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\",IF(OR(C18=\"MEMBER HAS GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",C29=\"THEY DO NOT HAVE THE SKILLS YET\"),\"SKIP TO MEMBER ENGAGEMENT\",IF(AND(C18=\"NO GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE STABLE\",C29=\"THEY HAVE THE SKILLS\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C18=\"UNCLEAR\",C23=\"UNCLEAR\",C29=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\"))))","v":"REVIEW GENERAL RISK, STABILITY, AND SKILLS"}]
["General Risk Factors: \nAny “Yes” answer skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result \nIf all answers are “No”, proceed to Stability Risk Factors ",null,{"$f":"IF(AND(C19=\"\",C20=\"\",C21=\"\",C22=\"\"),\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",IF(OR(C19=\"YES\",C20=\"YES\",C21=\"YES\",C22=\"YES\"),\"MEMBER HAS GENERAL RISK FACTORS\",IF(AND(C19=\"NO\",C20=\"NO\",C21=\"NO\",C22=\"NO\"),\"NO GENERAL RISK FACTORS\",IF(COUNTIF(C19:C22,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING GENERAL RISK\"))))","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"}]
["Has member had preventable or unnecessary hospitalizations or ER visits over the last six months?  \n“Preventable” means they were directly attributable to their lack of adherence to or access to treatments, appointments, or understanding of their Chronic Diagnoses. \n“Unnecessary” means the health care need could or should have been met in an outpatient or urgent care setting instead. "]
["Is the member's current housing unsafe?"]
["The member has safety concerns in their environment or community, and the member has not been able to follow a safety plan."]
["Has member been a danger to themselves or others within the last six months?\nExamples: Suicidal or homicidal ideation or attempts, violence towards self or others, inclusive of self-harm or arson, subject of a temporary restraining order, etc.  "]
["Stability Risk Factors: \nAny \"Yes\" answer to the first question, or a \"No\" answer to the last four questions, skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result. \nIf there are no “Unclear” answers, and the tool did not skip to Member Engagement, proceed to Skills Based Risk Factors ",null,{"$f":"IF(AND(C24=\"\",C25=\"\",C26=\"\",C27=\"\",C28=\"\"),\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",IF(AND(C24=\"No\",C25=\"Yes\",C26=\"Yes\",C27=\"Yes\",C28=\"Yes\"),\"HEALTH AND SDOH CONDITIONS ARE STABLE\",IF(OR(C24=\"Yes\",C25=\"No\",C26=\"No\",C27=\"No\",C28=\"No\"),\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",IF(OR(C24=\"Unclear\",C25=\"Unclear\",C26=\"Unclear\",C27=\"Unclear\",C28=\"Unclear\"),\"UNCLEAR\",\"CONTINUE ASSESSING STABILITY\"))))","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"}]
["If the member has a mental health diagnosis, have they experienced an increase in symptoms, or the need for crisis management responses within the last six months? \nCrisis management could be provided through a formal crisis response team, or informally through their HHCM. "]
["If the member has a SUD diagnosis, has the member met and maintained their SUD goals over the last six months, such as Abstinence, Moderation, or Harm Reduction?\nSUD applies to legal and illegal drugs of abuse, alcohol, and/or tobacco if the member has identified a goal related to use of that substance."]
["Has the member had stable housing over the last six months?\n\"Stable\" means there have been no evictions, moves, or periods of homelessness."]
["If the member is in a relationship with chronic Intimate Partner Violence, have they been able to follow a Safety Plan over the last six months?"]
["If the member is involved in the Criminal Justice System, have they been following the requirements of their Parole/Probation over the last six months?"]
["SKILLS-BASED RISK FACTORS\nAny “No” answer skips straight to Member Engagement  \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nIf all answers are “Yes”, this ends the screening and generates a “Recommend Disenrollment” result.  \n\nThese questions should be answered as if the member did not have HHCM assistance. Some people may have assistance from someone else in their life such as family, home aides, or other types of case managers, which we are referring to collectively as “a caregiver”.  ",null,{"$f":"IF(AND(C30=\"\",C31=\"\",C32=\"\",C33=\"\",C34=\"\",C35=\"\"),\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\",IF(AND(C30=\"YES\",C31=\"YES\",C32=\"YES\",C33=\"YES\",C34=\"YES\",C35=\"YES\"),\"THEY HAVE THE SKILLS\",IF(COUNTIF(C30:C35,\"No\")>0,\"THEY DO NOT HAVE THE SKILLS YET\",IF(COUNTIF(C30:C35,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING SKILLS\"))))","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"}]
["Does the member or caregiver understand the frequency of outpatient follow up, schedule and keep their healthcare appointments, and have reliable transportation to get to their healthcare appointments without HHCM assistance? "]
["Does the member or caregiver understand who is on their Care Team and when/why/how to contact them without HHCM assistance? "]
["Does the member or caregiver maintain the member’s medication adherence without HHCM assistance? "]
["Is the member or caregiver aware of upcoming recertifications for benefits and can successfully recertify without HHCM assistance? \nThis could include Medicaid, SNAP, SSI, SSDI, Public Assistance, etc.  "]
["Does the member or caregiver manage the member’s day-to-day finances without HHCM assistance? \nThis could include paying rent, bills, budgeting, etc. "]
["Does the member or caregiver manage the member’s ADLs and IADLs without HHCM assistance? "]
["Member Engagement \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result. \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nA \"Yes\" answer for ALL THREE questions ends the screening and generates a “Recommend Continued Services” result. \n\nMembers with legal guardians may not be able to engage actively with the CM, and progress on HH POC goals may look different than for other members.  \nFor example:  A member with severe dementia may not be able to talk directly to the HHCM, and the HHCM's primary engagement may be with the member's son or daughter.  \nThe \"Member Engagement\" questions may be considered as \"Caregiver Engagement\" questions in these cases. ",null,{"$f":"IF(AND(C37=\"\",C38=\"\",C39=\"\"),\"IS MEMBER ENGAGED WITH HHCM SERVICES?\",IF(OR(C37=\"No\",C38=\"No\",C39=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C37=\"UNCLEAR\",C38=\"UNCLEAR\",C39=\"UNCLEAR\"),\"More Information Needed\",IF(AND(C37=\"Yes\",C38=\"Yes\",C39=\"Yes\"),\"Recommend Continued Services\",\"Continue Assessing Member Engagement\"))))","v":"More Information Needed"}]
["Does the member have non-maintenance goals left to accomplish on the POC?\n\nAn active (non-maintenance) goal is one that requires actions by the HHCM to elicit progress towards completion of the goal. The members' goal(s) would not be achieved without concrete interventions and support of the HHCM.\n\nMaintenance goals are goals that the member has met, and although ongoing, do not require any active assistance from the HHCM.  Example: “Member will continue to fill their medication monthly”.",null,"Yes"]
["Has the member been actively engaged and working with the CM on their HH POC Goals and Tasks in the last six months?\n\nA member is not actively engaged if they are only in touch with the HHCM to say they are busy, or will call them back, or if regularly, Core Services being provided are only being provided through the Care Team because the member is unavailable.  \n\nA member is not working with the HHCM on their HH POC Goals and Tasks if during their contacts they are solely updating the HHCM on their life or persistently addressing something not on the POC. ",null,"Yes"]
["Have the member and Care Manager been making progress on their HH POC Goals and Tasks in the last six months?\n\nA member and HHCM are not making progress on the HH POC Goals and Tasks if the same task is being attempted month after month and nothing changes or moves forward. ",null,"Unclear"]
["COMMENTS                                                                                                                                                                                                                                                                                                                                       "]
[]
[]
[]
[]
[]
[]
["RESULTS OF CONTINUED ELIGIBILITY FOR SERVICES REVIEW"]
[{"$f":"IF(OR(C8=\"Recommend Disenrollment\",C17=\"Recommend Disenrollment\",C36=\"Recommend Disenrollment\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C8=\"More Information Needed\",C17=\"More Information Needed\",C36=\"More Information Needed\"),\"MORE INFORMATION NEEDED\",IF(C36=\"Recommend Continued Services\",\"RECOMMEND CONTINUED SERVICES\",IF(A7=\"Yes - DO NOT PROCEED WITH THE CES REVIEW\",\"CES REVIEW NOT REQUIRED- MEMBER IS HH+ ELIGIBLE\",\"CES REVIEW INCOMPLETE\"))))","v":"MORE INFORMATION NEEDED"},null,null,null,{"$f":"A48","v":"MORE INFORMATION NEEDED"}]
["DATE OF CES REVIEW","DATE NEXT CES REVIEW DUE","Supervisor Response to Recommendation (optional)"]
["2023-10-02",{"$f":"IFERROR(_xlfn.IFS(A48=\"RECOMMEND CONTINUED SERVICES\", A50+180, A48=\"RECOMMEND DISENROLLMENT\", \"N/A\", A48=\"MORE INFORMATION NEEDED\", A50+60), \"\")","v":"2023-12-01"}]
["REVIEWER NAME","TYPE OF STAFF COMPLETING THE TOOL"]
[]
["DOCUMENTS REVIEWED (optional)","DATE(S) OF THE DOCUMENTS (optional)"]
["PSYCKES:"]
["Care Plan:"]
["Comprehensive Assessment(s):"]
["Encounter Notes:"]
["Billing Support Questionnairres:"]

{"sheet":"CES Tool 2","index":3,"n_rows":58,"n_cols":5,"rows_kept":58,"cut":false,"hidden":true,"merged":[[13,0,13,1],[0,0,0,2],[9,0,9,1],[10,0,10,1],[7,0,7,1],[8,0,8,1],[11,0,11,2],[12,0,12,2],[25,0,25,1],[14,0,14,1],[15,0,15,1],[16,0,16,1],[17,0,17,1],[18,0,18,1],[19,0,19,1],[20,0,20,1],[21,0,21,1],[22,0,22,1],[23,0,23,1],[24,0,24,1],[38,0,38,1],[26,0,26,1],[27,0,27,1],[28,0,28,1],[29,0,29,1],[30,0,30,1],[31,0,31,1],[32,0,32,1],[33,0,33,1],[34,0,34,1],[35,0,35,1],[36,0,36,1],[37,0,37,1],[39,0,39,2],[40,0,45,2],[46,0,46,2],[47,0,47,2],[49,2,57,2]]}
["DOH CONTINUED ELIGIBILITY FOR SERVICES REVIEW TOOL \nUse with members enrolled for at least 1 year who are not pended, i.e. this should not be used on members who are Disengaged and in Diligent Search, or are Pended for any reason.                 \nDO NOT USE FOR ANY MEMBER THAT IS ELIGIBLE FOR HH+                                                                                                                                                                                                                               \n Look at CURRENT records.  That will generally mean documentation within the last 90 days, unless otherwise indicated. "]
["MEMBER NAME","MEMBER CIN","CARE MANAGER NAME"]
[]
["LAST IN PERSON CONTACT WITH MEMBER (DATE)","LAST CONTACT WITH AT LEAST ONE CARE TEAM MEMBER (DATE)","LAST COMPREHENSIVE REASSESSMENT (DATE)"]
[]
["ELIGIBLE FOR HH+ SMI OR HH+ HIV?","LENGTH OF STAY IN THEIR CURRENT HEALTH HOME PROGRAM (MONTHS) \n","TYPE OF REVIEW"]
["No"]
["BASIC ELIGIBILITY PRE-SCREEN  \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result.\nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.",null,{"$f":"IF(AND(C9=\"\",C11=\"\"),\"Is the Member Eligible for Health Home Services?\",IF(OR(C9=\"NO\",C11=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C9=\"UNCLEAR\",C11=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",IF(OR(C9=\"\",C11=\"\"),\"CONTINUE WITH THIS SECTION\",IF(AND(C9=\"Yes\",C11=\"Yes\"),\"PROCEED TO SIGNIFICANT RISK FACTORS\",\"Error\")))))","v":"RECOMMEND DISENROLLMENT"}]
["Does the member still have qualifying diagnoses for Health Home?",null,"No"]
["Which One(s)?"]
["Does the Member still have Active Medicaid, with no disqualifying R/E codes?\n\nRemember: Members can only be disenrolled due to inactive Medicaid if they are no longer eligible for Medicaid or if they have been refusing to take the necessary steps to fix the Medicaid case.  It is expected that HHCM’s will need to help members reactivate their Medicaid at times."]
[]
[]
["SIGNIFICANT RISK FACTORS \nSelection of at least one Concrete Example skips straight to Member Engagement \nSelection of “No Concrete Example of a Significant Risk Factor in record” skips straight to Additional Risk Factors. ",null,{"$f":"IF(C15=\"\",\"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?\",IF(C15=\"NONE OF THE ABOVE - PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO MEMBER ENGAGEMENT\"))","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"}]
["Select a Concrete Example of a Significant Risk Factor:"]
["Description/Specifics if indicated:"]
["Additional Risk Factors\nQuestions in this section DO NOT have to be answered in order.  As soon as the tool skips to another section or generates a result, stop answering further questions in this section. ",null,{"$f":"IF(AND(C18=\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",C23=\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",C29=\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\"),\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\",IF(OR(C18=\"MEMBER HAS GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",C29=\"THEY DO NOT HAVE THE SKILLS YET\"),\"SKIP TO MEMBER ENGAGEMENT\",IF(AND(C18=\"NO GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE STABLE\",C29=\"THEY HAVE THE SKILLS\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C18=\"UNCLEAR\",C23=\"UNCLEAR\",C29=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\"))))","v":"REVIEW GENERAL RISK, STABILITY, AND SKILLS"}]
["General Risk Factors: \nAny “Yes” answer skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result \nIf all answers are “No”, proceed to Stability Risk Factors ",null,{"$f":"IF(AND(C19=\"\",C20=\"\",C21=\"\",C22=\"\"),\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",IF(OR(C19=\"YES\",C20=\"YES\",C21=\"YES\",C22=\"YES\"),\"MEMBER HAS GENERAL RISK FACTORS\",IF(AND(C19=\"NO\",C20=\"NO\",C21=\"NO\",C22=\"NO\"),\"NO GENERAL RISK FACTORS\",IF(COUNTIF(C19:C22,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING GENERAL RISK\"))))","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"}]
["Has member had preventable or unnecessary hospitalizations or ER visits over the last six months?  \n“Preventable” means they were directly attributable to their lack of adherence to or access to treatments, appointments, or understanding of their Chronic Diagnoses. \n“Unnecessary” means the health care need could or should have been met in an outpatient or urgent care setting instead. "]
["Is the member's current housing unsafe?"]
["Has the member reported any safety concerns in their environment or their community, have they been able to follow a Safety Plan over the last six months?"]
["Has member been a danger to themselves or others within the last six months?\nExamples: Suicidal or homicidal ideation or attempts, violence towards self or others, inclusive of self-harm or arson, subject of a temporary restraining order, etc.  "]
["Stability Risk Factors: \nAny \"Yes\" answer to the first question, or a \"No\" answer to the last four questions, skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result. \nIf there are no “Unclear” answers, and the tool did not skip to Member Engagement, proceed to Skills Based Risk Factors ",null,{"$f":"IF(AND(C24=\"\",C25=\"\",C26=\"\",C27=\"\",C28=\"\"),\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",IF(AND(C24=\"No\",C25=\"Yes\",C26=\"Yes\",C27=\"Yes\",C28=\"Yes\"),\"HEALTH AND SDOH CONDITIONS ARE STABLE\",IF(OR(C24=\"Yes\",C25=\"No\",C26=\"No\",C27=\"No\",C28=\"No\"),\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",IF(OR(C24=\"Unclear\",C25=\"Unclear\",C26=\"Unclear\",C27=\"Unclear\",C28=\"Unclear\"),\"UNCLEAR\",\"CONTINUE ASSESSING STABILITY\"))))","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"}]
["If the member has a mental health diagnosis, have they experienced an increase in symptoms, or the need for crisis management responses within the last six months? \nCrisis management could be provided through a formal crisis response team, or informally through their HHCM. "]
["If the member has a SUD diagnosis, has the member met and maintained their SUD goals over the last six months, such as Abstinence, Moderation, or Harm Reduction?\nSUD applies to legal and illegal drugs of abuse, alcohol, and/or tobacco if the member has identified a goal related to use of that substance."]
["Has the member had stable housing over the last six months?\n\"Stable\" means there have been no evictions, moves, or periods of homelessness."]
["If the member is in a relationship with chronic Intimate Partner Violence, have they been able to follow a Safety Plan over the last six months?"]
["If the member is involved in the Criminal Justice System, have they been following the requirements of their Parole/Probation over the last six months?"]
["SKILLS-BASED RISK FACTORS\nAny “No” answer skips straight to Member Engagement  \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nIf all answers are “Yes”, this ends the screening and generates a “Recommend Disenrollment” result.  \n\nThese questions should be answered as if the member did not have HHCM assistance. Some people may have assistance from someone else in their life such as family, home aides, or other types of case managers, which we are referring to collectively as “a caregiver”.  ",null,{"$f":"IF(AND(C30=\"\",C31=\"\",C32=\"\",C33=\"\",C34=\"\",C35=\"\"),\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\",IF(AND(C30=\"YES\",C31=\"YES\",C32=\"YES\",C33=\"YES\",C34=\"YES\",C35=\"YES\"),\"THEY HAVE THE SKILLS\",IF(COUNTIF(C30:C35,\"No\")>0,\"THEY DO NOT HAVE THE SKILLS YET\",IF(COUNTIF(C30:C35,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING SKILLS\"))))","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"}]
["Does the member or caregiver understand the frequency of outpatient follow up, schedule and keep their healthcare appointments, and have reliable transportation to get to their healthcare appointments without HHCM assistance? "]
["Does the member or caregiver understand who is on their Care Team and when/why/how to contact them without HHCM assistance? "]
["Does the member or caregiver maintain the member’s medication adherence without HHCM assistance? "]
["Is the member or caregiver aware of upcoming recertifications for benefits and can successfully recertify without HHCM assistance? \nThis could include Medicaid, SNAP, SSI, SSDI, Public Assistance, etc.  "]
["Does the member or caregiver manage the member’s day-to-day finances without HHCM assistance? \nThis could include paying rent, bills, budgeting, etc. "]
["Does the member or caregiver manage the member’s ADLs and IADLs without HHCM assistance? "]
["Member Engagement \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result. \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nA \"Yes\" answer for ALL THREE questions ends the screening and generates a “Recommend Continued Services” result. \n\nMembers with legal guardians may not be able to engage actively with the CM, and progress on HH POC goals may look different than for other members.  \nFor example:  A member with severe dementia may not be able to talk directly to the HHCM, and the HHCM's primary engagement may be with the member's son or daughter.  \nThe \"Member Engagement\" questions may be considered as \"Caregiver Engagement\" questions in these cases. ",null,{"$f":"IF(AND(C37=\"\",C38=\"\",C39=\"\"),\"IS MEMBER ENGAGED WITH HHCM SERVICES?\",IF(OR(C37=\"No\",C38=\"No\",C39=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C37=\"UNCLEAR\",C38=\"UNCLEAR\",C39=\"UNCLEAR\"),\"More Information Needed\",IF(AND(C37=\"Yes\",C38=\"Yes\",C39=\"Yes\"),\"Recommend Continued Services\",\"Continue Assessing Member Engagement\"))))","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"}]
["Does the member have non-maintenance goals left to accomplish on the POC?\n\nAn active (non-maintenance) goal is one that requires actions by the HHCM to elicit progress towards completion of the goal. The members' goal(s) would not be achieved without concrete interventions and support of the HHCM.\n\nMaintenance goals are goals that the member has met, and although ongoing, do not require any active assistance from the HHCM.  Example: “Member will continue to fill their medication monthly”."]
["Has the member been actively engaged and working with the CM on their HH POC Goals and Tasks in the last six months?\n\nA member is not actively engaged if they are only in touch with the HHCM to say they are busy, or will call them back, or if regularly, Core Services being provided are only being provided through the Care Team because the member is unavailable.  \n\nA member is not working with the HHCM on their HH POC Goals and Tasks if during their contacts they are solely updating the HHCM on their life or persistently addressing something not on the POC. "]
["Have the member and Care Manager been making progress on their HH POC Goals and Tasks in the last six months?\n\nA member and HHCM are not making progress on the HH POC Goals and Tasks if the same task is being attempted month after month and nothing changes or moves forward. "]
["COMMENTS                                                                                                                                                                                                                                                                                                                                       "]
[]
[]
[]
[]
[]
[]
["RESULTS OF CONTINUED ELIGIBILITY FOR SERVICES REVIEW"]
[{"$f":"IF(OR(C8=\"Recommend Disenrollment\",C17=\"Recommend Disenrollment\",C36=\"Recommend Disenrollment\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C8=\"More Information Needed\",C17=\"More Information Needed\",C36=\"More Information Needed\"),\"MORE INFORMATION NEEDED\",IF(C36=\"Recommend Continued Services\",\"RECOMMEND CONTINUED SERVICES\",IF(A7=\"Yes - DO NOT PROCEED WITH THE CES REVIEW\",\"CES REVIEW NOT REQUIRED- MEMBER IS HH+ ELIGIBLE\",\"CES REVIEW INCOMPLETE\"))))","v":"RECOMMEND DISENROLLMENT"},null,null,null,{"$f":"A48","v":"RECOMMEND DISENROLLMENT"}]
["DATE OF CES REVIEW","DATE NEXT CES REVIEW DUE","Supervisor Response to Recommendation (optional)"]
[null,{"$f":"IFERROR(_xlfn.IFS(A48=\"RECOMMEND CONTINUED SERVICES\", A50+180, A48=\"RECOMMEND DISENROLLMENT\", \"N/A\", A48=\"MORE INFORMATION NEEDED\", A50+60), \"\")","v":"N/A"}]
["REVIEWER NAME","TYPE OF STAFF COMPLETING THE TOOL"]
[]
["DOCUMENTS REVIEWED (optional)","DATE(S) OF THE DOCUMENTS (optional)"]
["PSYCKES:"]
["Care Plan:"]
["Comprehensive Assessment(s):"]
["Encounter Notes:"]
["Billing Support Questionnairres:"]

{"sheet":"CES Tool 3","index":4,"n_rows":58,"n_cols":5,"rows_kept":58,"cut":false,"hidden":true,"merged":[[13,0,13,1],[0,0,0,2],[9,0,9,1],[10,0,10,1],[7,0,7,1],[8,0,8,1],[11,0,11,2],[12,0,12,2],[25,0,25,1],[14,0,14,1],[15,0,15,1],[16,0,16,1],[17,0,17,1],[18,0,18,1],[19,0,19,1],[20,0,20,1],[21,0,21,1],[22,0,22,1],[23,0,23,1],[24,0,24,1],[38,0,38,1],[26,0,26,1],[27,0,27,1],[28,0,28,1],[29,0,29,1],[30,0,30,1],[31,0,31,1],[32,0,32,1],[33,0,33,1],[34,0,34,1],[35,0,35,1],[36,0,36,1],[37,0,37,1],[39,0,39,2],[40,0,45,2],[46,0,46,2],[47,0,47,2],[49,2,57,2]]}
["DOH CONTINUED ELIGIBILITY FOR SERVICES REVIEW TOOL \nUse with members enrolled for at least 1 year who are not pended, i.e. this should not be used on members who are Disengaged and in Diligent Search, or are Pended for any reason.                 \nDO NOT USE FOR ANY MEMBER THAT IS ELIGIBLE FOR HH+                                                                                                                                                                                                                               \n Look at CURRENT records.  That will generally mean documentation within the last 90 days, unless otherwise indicated. "]
["MEMBER NAME","MEMBER CIN","CARE MANAGER NAME"]
[]
["LAST IN PERSON CONTACT WITH MEMBER (DATE)","LAST CONTACT WITH AT LEAST ONE CARE TEAM MEMBER (DATE)","LAST COMPREHENSIVE REASSESSMENT (DATE)"]
[]
["ELIGIBLE FOR HH+ SMI OR HH+ HIV?","LENGTH OF STAY IN THEIR CURRENT HEALTH HOME PROGRAM (MONTHS) \n","TYPE OF REVIEW"]
[]
["BASIC ELIGIBILITY PRE-SCREEN  \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result.\nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.",null,{"$f":"IF(AND(C9=\"\",C11=\"\"),\"Is the Member Eligible for Health Home Services?\",IF(OR(C9=\"NO\",C11=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C9=\"UNCLEAR\",C11=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",IF(OR(C9=\"\",C11=\"\"),\"CONTINUE WITH THIS SECTION\",IF(AND(C9=\"Yes\",C11=\"Yes\"),\"PROCEED TO SIGNIFICANT RISK FACTORS\",\"Error\")))))","v":"Is the Member Eligible for Health Home Services?"}]
["Does the member still have qualifying diagnoses for Health Home?"]
["Which One(s)?"]
["Does the Member still have Active Medicaid, with no disqualifying R/E codes?\n\nRemember: Members can only be disenrolled due to inactive Medicaid if they are no longer eligible for Medicaid or if they have been refusing to take the necessary steps to fix the Medicaid case.  It is expected that HHCM’s will need to help members reactivate their Medicaid at times."]
[]
[]
["SIGNIFICANT RISK FACTORS \nSelection of at least one Concrete Example skips straight to Member Engagement \nSelection of “No Concrete Example of a Significant Risk Factor in record” skips straight to Additional Risk Factors. ",null,{"$f":"IF(C15=\"\",\"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?\",IF(C15=\"NONE OF THE ABOVE - PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO MEMBER ENGAGEMENT\"))","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"}]
["Select a Concrete Example of a Significant Risk Factor:"]
["Description/Specifics if indicated:"]
["Additional Risk Factors\nQuestions in this section DO NOT have to be answered in order.  As soon as the tool skips to another section or generates a result, stop answering further questions in this section. ",null,{"$f":"IF(AND(C18=\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",C23=\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",C29=\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\"),\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\",IF(OR(C18=\"MEMBER HAS GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",C29=\"THEY DO NOT HAVE THE SKILLS YET\"),\"SKIP TO MEMBER ENGAGEMENT\",IF(AND(C18=\"NO GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE STABLE\",C29=\"THEY HAVE THE SKILLS\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C18=\"UNCLEAR\",C23=\"UNCLEAR\",C29=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\"))))","v":"REVIEW GENERAL RISK, STABILITY, AND SKILLS"}]
["General Risk Factors: \nAny “Yes” answer skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result \nIf all answers are “No”, proceed to Stability Risk Factors ",null,{"$f":"IF(AND(C19=\"\",C20=\"\",C21=\"\",C22=\"\"),\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",IF(OR(C19=\"YES\",C20=\"YES\",C21=\"YES\",C22=\"YES\"),\"MEMBER HAS GENERAL RISK FACTORS\",IF(AND(C19=\"NO\",C20=\"NO\",C21=\"NO\",C22=\"NO\"),\"NO GENERAL RISK FACTORS\",IF(COUNTIF(C19:C22,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING GENERAL RISK\"))))","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"}]
["Has member had preventable or unnecessary hospitalizations or ER visits over the last six months?  \n“Preventable” means they were directly attributable to their lack of adherence to or access to treatments, appointments, or understanding of their Chronic Diagnoses. \n“Unnecessary” means the health care need could or should have been met in an outpatient or urgent care setting instead. "]
["Is the member's current housing unsafe?"]
["Has the member reported any safety concerns in their environment or their community, have they been able to follow a Safety Plan over the last six months?"]
["Has member been a danger to themselves or others within the last six months?\nExamples: Suicidal or homicidal ideation or attempts, violence towards self or others, inclusive of self-harm or arson, subject of a temporary restraining order, etc.  "]
["Stability Risk Factors: \nAny \"Yes\" answer to the first question, or a \"No\" answer to the last four questions, skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result. \nIf there are no “Unclear” answers, and the tool did not skip to Member Engagement, proceed to Skills Based Risk Factors ",null,{"$f":"IF(AND(C24=\"\",C25=\"\",C26=\"\",C27=\"\",C28=\"\"),\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",IF(AND(C24=\"No\",C25=\"Yes\",C26=\"Yes\",C27=\"Yes\",C28=\"Yes\"),\"HEALTH AND SDOH CONDITIONS ARE STABLE\",IF(OR(C24=\"Yes\",C25=\"No\",C26=\"No\",C27=\"No\",C28=\"No\"),\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",IF(OR(C24=\"Unclear\",C25=\"Unclear\",C26=\"Unclear\",C27=\"Unclear\",C28=\"Unclear\"),\"UNCLEAR\",\"CONTINUE ASSESSING STABILITY\"))))","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"}]
["If the member has a mental health diagnosis, have they experienced an increase in symptoms, or the need for crisis management responses within the last six months? \nCrisis management could be provided through a formal crisis response team, or informally through their HHCM. "]
["If the member has a SUD diagnosis, has the member met and maintained their SUD goals over the last six months, such as Abstinence, Moderation, or Harm Reduction?\nSUD applies to legal and illegal drugs of abuse, alcohol, and/or tobacco if the member has identified a goal related to use of that substance."]
["Has the member had stable housing over the last six months?\n\"Stable\" means there have been no evictions, moves, or periods of homelessness."]
["If the member is in a relationship with chronic Intimate Partner Violence, have they been able to follow a Safety Plan over the last six months?"]
["If the member is involved in the Criminal Justice System, have they been following the requirements of their Parole/Probation over the last six months?"]
["SKILLS-BASED RISK FACTORS\nAny “No” answer skips straight to Member Engagement  \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nIf all answers are “Yes”, this ends the screening and generates a “Recommend Disenrollment” result.  \n\nThese questions should be answered as if the member did not have HHCM assistance. Some people may have assistance from someone else in their life such as family, home aides, or other types of case managers, which we are referring to collectively as “a caregiver”.  ",null,{"$f":"IF(AND(C30=\"\",C31=\"\",C32=\"\",C33=\"\",C34=\"\",C35=\"\"),\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\",IF(AND(C30=\"YES\",C31=\"YES\",C32=\"YES\",C33=\"YES\",C34=\"YES\",C35=\"YES\"),\"THEY HAVE THE SKILLS\",IF(COUNTIF(C30:C35,\"No\")>0,\"THEY DO NOT HAVE THE SKILLS YET\",IF(COUNTIF(C30:C35,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING SKILLS\"))))","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"}]
["Does the member or caregiver understand the frequency of outpatient follow up, schedule and keep their healthcare appointments, and have reliable transportation to get to their healthcare appointments without HHCM assistance? "]
["Does the member or caregiver understand who is on their Care Team and when/why/how to contact them without HHCM assistance? "]
["Does the member or caregiver maintain the member’s medication adherence without HHCM assistance? "]
["Is the member or caregiver aware of upcoming recertifications for benefits and can successfully recertify without HHCM assistance? \nThis could include Medicaid, SNAP, SSI, SSDI, Public Assistance, etc.  "]
["Does the member or caregiver manage the member’s day-to-day finances without HHCM assistance? \nThis could include paying rent, bills, budgeting, etc. "]
["Does the member or caregiver manage the member’s ADLs and IADLs without HHCM assistance? "]
["Member Engagement \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result. \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nA \"Yes\" answer for ALL THREE questions ends the screening and generates a “Recommend Continued Services” result. \n\nMembers with legal guardians may not be able to engage actively with the CM, and progress on HH POC goals may look different than for other members.  \nFor example:  A member with severe dementia may not be able to talk directly to the HHCM, and the HHCM's primary engagement may be with the member's son or daughter.  \nThe \"Member Engagement\" questions may be considered as \"Caregiver Engagement\" questions in these cases. ",null,{"$f":"IF(AND(C37=\"\",C38=\"\",C39=\"\"),\"IS MEMBER ENGAGED WITH HHCM SERVICES?\",IF(OR(C37=\"No\",C38=\"No\",C39=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C37=\"UNCLEAR\",C38=\"UNCLEAR\",C39=\"UNCLEAR\"),\"More Information Needed\",IF(AND(C37=\"Yes\",C38=\"Yes\",C39=\"Yes\"),\"Recommend Continued Services\",\"Continue Assessing Member Engagement\"))))","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"}]
["Does the member have non-maintenance goals left to accomplish on the POC?\n\nAn active (non-maintenance) goal is one that requires actions by the HHCM to elicit progress towards completion of the goal. The members' goal(s) would not be achieved without concrete interventions and support of the HHCM.\n\nMaintenance goals are goals that the member has met, and although ongoing, do not require any active assistance from the HHCM.  Example: “Member will continue to fill their medication monthly”."]
["Has the member been actively engaged and working with the CM on their HH POC Goals and Tasks in the last six months?\n\nA member is not actively engaged if they are only in touch with the HHCM to say they are busy, or will call them back, or if regularly, Core Services being provided are only being provided through the Care Team because the member is unavailable.  \n\nA member is not working with the HHCM on their HH POC Goals and Tasks if during their contacts they are solely updating the HHCM on their life or persistently addressing something not on the POC. "]
["Have the member and Care Manager been making progress on their HH POC Goals and Tasks in the last six months?\n\nA member and HHCM are not making progress on the HH POC Goals and Tasks if the same task is being attempted month after month and nothing changes or moves forward. "]
["COMMENTS                                                                                                                                                                                                                                                                                                                                       "]
[]
[]
[]
[]
[]
[]
["RESULTS OF CONTINUED ELIGIBILITY FOR SERVICES REVIEW"]
[{"$f":"IF(OR(C8=\"Recommend Disenrollment\",C17=\"Recommend Disenrollment\",C36=\"Recommend Disenrollment\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C8=\"More Information Needed\",C17=\"More Information Needed\",C36=\"More Information Needed\"),\"MORE INFORMATION NEEDED\",IF(C36=\"Recommend Continued Services\",\"RECOMMEND CONTINUED SERVICES\",IF(A7=\"Yes - DO NOT PROCEED WITH THE CES REVIEW\",\"CES REVIEW NOT REQUIRED- MEMBER IS HH+ ELIGIBLE\",\"CES REVIEW INCOMPLETE\"))))","v":"CES REVIEW INCOMPLETE"},null,null,null,{"$f":"A48","v":"CES REVIEW INCOMPLETE"}]
["DATE OF CES REVIEW","DATE NEXT CES REVIEW DUE","Supervisor Response to Recommendation (optional)"]
[null,{"$f":"IFERROR(_xlfn.IFS(A48=\"RECOMMEND CONTINUED SERVICES\", A50+180, A48=\"RECOMMEND DISENROLLMENT\", \"N/A\", A48=\"MORE INFORMATION NEEDED\", A50+60), \"\")","v":""}]
["REVIEWER NAME","TYPE OF STAFF COMPLETING THE TOOL"]
[]
["DOCUMENTS REVIEWED (optional)","DATE(S) OF THE DOCUMENTS (optional)"]
["PSYCKES:"]
["Care Plan:"]
["Comprehensive Assessment(s):"]
["Encounter Notes:"]
["Billing Support Questionnairres:"]

{"sheet":"CES Tool 4","index":5,"n_rows":58,"n_cols":5,"rows_kept":58,"cut":false,"hidden":true,"merged":[[49,2,57,2],[34,0,34,1],[39,0,39,2],[40,0,45,2],[46,0,46,2],[47,0,47,2],[36,0,36,1],[37,0,37,1],[38,0,38,1],[35,0,35,1],[29,0,29,1],[30,0,30,1],[31,0,31,1],[32,0,32,1],[33,0,33,1],[24,0,24,1],[25,0,25,1],[26,0,26,1],[27,0,27,1],[28,0,28,1],[23,0,23,1],[12,0,12,2],[13,0,13,1],[14,0,14,1],[15,0,15,1],[16,0,16,1],[17,0,17,1],[18,0,18,1],[19,0,19,1],[20,0,20,1],[21,0,21,1],[22,0,22,1],[11,0,11,2],[0,0,0,2],[7,0,7,1],[8,0,8,1],[9,0,9,1],[10,0,10,1]]}
["DOH CONTINUED ELIGIBILITY FOR SERVICES REVIEW TOOL \nUse with members enrolled for at least 1 year who are not pended, i.e. this should not be used on members who are Disengaged and in Diligent Search, or are Pended for any reason.                 \nDO NOT USE FOR ANY MEMBER THAT IS ELIGIBLE FOR HH+                                                                                                                                                                                                                               \n Look at CURRENT records.  That will generally mean documentation within the last 90 days, unless otherwise indicated. "]
["MEMBER NAME","MEMBER CIN","CARE MANAGER NAME"]
[]
["LAST IN PERSON CONTACT WITH MEMBER (DATE)","LAST CONTACT WITH AT LEAST ONE CARE TEAM MEMBER (DATE)","LAST COMPREHENSIVE REASSESSMENT (DATE)"]
[]
["ELIGIBLE FOR HH+ SMI OR HH+ HIV?","LENGTH OF STAY IN THEIR CURRENT HEALTH HOME PROGRAM (MONTHS) \n","TYPE OF REVIEW"]
[]
["BASIC ELIGIBILITY PRE-SCREEN  \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result.\nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.",null,{"$f":"IF(AND(C9=\"\",C11=\"\"),\"Is the Member Eligible for Health Home Services?\",IF(OR(C9=\"NO\",C11=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C9=\"UNCLEAR\",C11=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",IF(OR(C9=\"\",C11=\"\"),\"CONTINUE WITH THIS SECTION\",IF(AND(C9=\"Yes\",C11=\"Yes\"),\"PROCEED TO SIGNIFICANT RISK FACTORS\",\"Error\")))))","v":"Is the Member Eligible for Health Home Services?"}]
["Does the member still have qualifying diagnoses for Health Home?"]
["Which One(s)?"]
["Does the Member still have Active Medicaid, with no disqualifying R/E codes?\n\nRemember: Members can only be disenrolled due to inactive Medicaid if they are no longer eligible for Medicaid or if they have been refusing to take the necessary steps to fix the Medicaid case.  It is expected that HHCM’s will need to help members reactivate their Medicaid at times."]
[]
[]
["SIGNIFICANT RISK FACTORS \nSelection of at least one Concrete Example skips straight to Member Engagement \nSelection of “No Concrete Example of a Significant Risk Factor in record” skips straight to Additional Risk Factors. ",null,{"$f":"IF(C15=\"\",\"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?\",IF(C15=\"NONE OF THE ABOVE - PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO MEMBER ENGAGEMENT\"))","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"}]
["Select a Concrete Example of a Significant Risk Factor:"]
["Description/Specifics if indicated:"]
["Additional Risk Factors\nQuestions in this section DO NOT have to be answered in order.  As soon as the tool skips to another section or generates a result, stop answering further questions in this section. ",null,{"$f":"IF(AND(C18=\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",C23=\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",C29=\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\"),\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\",IF(OR(C18=\"MEMBER HAS GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",C29=\"THEY DO NOT HAVE THE SKILLS YET\"),\"SKIP TO MEMBER ENGAGEMENT\",IF(AND(C18=\"NO GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE STABLE\",C29=\"THEY HAVE THE SKILLS\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C18=\"UNCLEAR\",C23=\"UNCLEAR\",C29=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\"))))","v":"REVIEW GENERAL RISK, STABILITY, AND SKILLS"}]
["General Risk Factors: \nAny “Yes” answer skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result \nIf all answers are “No”, proceed to Stability Risk Factors ",null,{"$f":"IF(AND(C19=\"\",C20=\"\",C21=\"\",C22=\"\"),\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",IF(OR(C19=\"YES\",C20=\"YES\",C21=\"YES\",C22=\"YES\"),\"MEMBER HAS GENERAL RISK FACTORS\",IF(AND(C19=\"NO\",C20=\"NO\",C21=\"NO\",C22=\"NO\"),\"NO GENERAL RISK FACTORS\",IF(COUNTIF(C19:C22,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING GENERAL RISK\"))))","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"}]
["Has member had preventable or unnecessary hospitalizations or ER visits over the last six months?  \n“Preventable” means they were directly attributable to their lack of adherence to or access to treatments, appointments, or understanding of their Chronic Diagnoses. \n“Unnecessary” means the health care need could or should have been met in an outpatient or urgent care setting instead. "]
["Is the member's current housing unsafe?"]
["Has the member reported any safety concerns in their environment or their community, have they been able to follow a Safety Plan over the last six months?"]
["Has member been a danger to themselves or others within the last six months?\nExamples: Suicidal or homicidal ideation or attempts, violence towards self or others, inclusive of self-harm or arson, subject of a temporary restraining order, etc.  "]
["Stability Risk Factors: \nAny \"Yes\" answer to the first question, or a \"No\" answer to the last four questions, skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result. \nIf there are no “Unclear” answers, and the tool did not skip to Member Engagement, proceed to Skills Based Risk Factors ",null,{"$f":"IF(AND(C24=\"\",C25=\"\",C26=\"\",C27=\"\",C28=\"\"),\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",IF(AND(C24=\"No\",C25=\"Yes\",C26=\"Yes\",C27=\"Yes\",C28=\"Yes\"),\"HEALTH AND SDOH CONDITIONS ARE STABLE\",IF(OR(C24=\"Yes\",C25=\"No\",C26=\"No\",C27=\"No\",C28=\"No\"),\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",IF(OR(C24=\"Unclear\",C25=\"Unclear\",C26=\"Unclear\",C27=\"Unclear\",C28=\"Unclear\"),\"UNCLEAR\",\"CONTINUE ASSESSING STABILITY\"))))","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"}]
["If the member has a mental health diagnosis, have they experienced an increase in symptoms, or the need for crisis management responses within the last six months? \nCrisis management could be provided through a formal crisis response team, or informally through their HHCM. "]
["If the member has a SUD diagnosis, has the member met and maintained their SUD goals over the last six months, such as Abstinence, Moderation, or Harm Reduction?\nSUD applies to legal and illegal drugs of abuse, alcohol, and/or tobacco if the member has identified a goal related to use of that substance."]
["Has the member had stable housing over the last six months?\n\"Stable\" means there have been no evictions, moves, or periods of homelessness."]
["If the member is in a relationship with chronic Intimate Partner Violence, have they been able to follow a Safety Plan over the last six months?"]
["If the member is involved in the Criminal Justice System, have they been following the requirements of their Parole/Probation over the last six months?"]
["SKILLS-BASED RISK FACTORS\nAny “No” answer skips straight to Member Engagement  \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nIf all answers are “Yes”, this ends the screening and generates a “Recommend Disenrollment” result.  \n\nThese questions should be answered as if the member did not have HHCM assistance. Some people may have assistance from someone else in their life such as family, home aides, or other types of case managers, which we are referring to collectively as “a caregiver”.  ",null,{"$f":"IF(AND(C30=\"\",C31=\"\",C32=\"\",C33=\"\",C34=\"\",C35=\"\"),\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\",IF(AND(C30=\"YES\",C31=\"YES\",C32=\"YES\",C33=\"YES\",C34=\"YES\",C35=\"YES\"),\"THEY HAVE THE SKILLS\",IF(COUNTIF(C30:C35,\"No\")>0,\"THEY DO NOT HAVE THE SKILLS YET\",IF(COUNTIF(C30:C35,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING SKILLS\"))))","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"}]
["Does the member or caregiver understand the frequency of outpatient follow up, schedule and keep their healthcare appointments, and have reliable transportation to get to their healthcare appointments without HHCM assistance? "]
["Does the member or caregiver understand who is on their Care Team and when/why/how to contact them without HHCM assistance? "]
["Does the member or caregiver maintain the member’s medication adherence without HHCM assistance? "]
["Is the member or caregiver aware of upcoming recertifications for benefits and can successfully recertify without HHCM assistance? \nThis could include Medicaid, SNAP, SSI, SSDI, Public Assistance, etc.  "]
["Does the member or caregiver manage the member’s day-to-day finances without HHCM assistance? \nThis could include paying rent, bills, budgeting, etc. "]
["Does the member or caregiver manage the member’s ADLs and IADLs without HHCM assistance? "]
["Member Engagement \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result. \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nA \"Yes\" answer for ALL THREE questions ends the screening and generates a “Recommend Continued Services” result. \n\nMembers with legal guardians may not be able to engage actively with the CM, and progress on HH POC goals may look different than for other members.  \nFor example:  A member with severe dementia may not be able to talk directly to the HHCM, and the HHCM's primary engagement may be with the member's son or daughter.  \nThe \"Member Engagement\" questions may be considered as \"Caregiver Engagement\" questions in these cases. ",null,{"$f":"IF(AND(C37=\"\",C38=\"\",C39=\"\"),\"IS MEMBER ENGAGED WITH HHCM SERVICES?\",IF(OR(C37=\"No\",C38=\"No\",C39=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C37=\"UNCLEAR\",C38=\"UNCLEAR\",C39=\"UNCLEAR\"),\"More Information Needed\",IF(AND(C37=\"Yes\",C38=\"Yes\",C39=\"Yes\"),\"Recommend Continued Services\",\"Continue Assessing Member Engagement\"))))","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"}]
["Does the member have non-maintenance goals left to accomplish on the POC?\n\nAn active (non-maintenance) goal is one that requires actions by the HHCM to elicit progress towards completion of the goal. The members' goal(s) would not be achieved without concrete interventions and support of the HHCM.\n\nMaintenance goals are goals that the member has met, and although ongoing, do not require any active assistance from the HHCM.  Example: “Member will continue to fill their medication monthly”."]
["Has the member been actively engaged and working with the CM on their HH POC Goals and Tasks in the last six months?\n\nA member is not actively engaged if they are only in touch with the HHCM to say they are busy, or will call them back, or if regularly, Core Services being provided are only being provided through the Care Team because the member is unavailable.  \n\nA member is not working with the HHCM on their HH POC Goals and Tasks if during their contacts they are solely updating the HHCM on their life or persistently addressing something not on the POC. "]
["Have the member and Care Manager been making progress on their HH POC Goals and Tasks in the last six months?\n\nA member and HHCM are not making progress on the HH POC Goals and Tasks if the same task is being attempted month after month and nothing changes or moves forward. "]
["COMMENTS                                                                                                                                                                                                                                                                                                                                       "]
[]
[]
[]
[]
[]
[]
["RESULTS OF CONTINUED ELIGIBILITY FOR SERVICES REVIEW"]
[{"$f":"IF(OR(C8=\"Recommend Disenrollment\",C17=\"Recommend Disenrollment\",C36=\"Recommend Disenrollment\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C8=\"More Information Needed\",C17=\"More Information Needed\",C36=\"More Information Needed\"),\"MORE INFORMATION NEEDED\",IF(C36=\"Recommend Continued Services\",\"RECOMMEND CONTINUED SERVICES\",IF(A7=\"Yes - DO NOT PROCEED WITH THE CES REVIEW\",\"CES REVIEW NOT REQUIRED- MEMBER IS HH+ ELIGIBLE\",\"CES REVIEW INCOMPLETE\"))))","v":"CES REVIEW INCOMPLETE"},null,null,null,{"$f":"A48","v":"CES REVIEW INCOMPLETE"}]
["DATE OF CES REVIEW","DATE NEXT CES REVIEW DUE","Supervisor Response to Recommendation (optional)"]
[null,{"$f":"IFERROR(_xlfn.IFS(A48=\"RECOMMEND CONTINUED SERVICES\", A50+180, A48=\"RECOMMEND DISENROLLMENT\", \"N/A\", A48=\"MORE INFORMATION NEEDED\", A50+60), \"\")","v":""}]
["REVIEWER NAME","TYPE OF STAFF COMPLETING THE TOOL"]
[]
["DOCUMENTS REVIEWED (optional)","DATE(S) OF THE DOCUMENTS (optional)"]
["PSYCKES:"]
["Care Plan:"]
["Comprehensive Assessment(s):"]
["Encounter Notes:"]
["Billing Support Questionnairres:"]

{"sheet":"CES Tool 5","index":6,"n_rows":58,"n_cols":5,"rows_kept":58,"cut":false,"hidden":true,"merged":[[13,0,13,1],[0,0,0,2],[9,0,9,1],[10,0,10,1],[7,0,7,1],[8,0,8,1],[11,0,11,2],[12,0,12,2],[25,0,25,1],[14,0,14,1],[15,0,15,1],[16,0,16,1],[17,0,17,1],[18,0,18,1],[19,0,19,1],[20,0,20,1],[21,0,21,1],[22,0,22,1],[23,0,23,1],[24,0,24,1],[38,0,38,1],[26,0,26,1],[27,0,27,1],[28,0,28,1],[29,0,29,1],[30,0,30,1],[31,0,31,1],[32,0,32,1],[33,0,33,1],[34,0,34,1],[35,0,35,1],[36,0,36,1],[37,0,37,1],[39,0,39,2],[40,0,45,2],[46,0,46,2],[47,0,47,2],[49,2,57,2]]}
["DOH CONTINUED ELIGIBILITY FOR SERVICES REVIEW TOOL \nUse with members enrolled for at least 1 year who are not pended, i.e. this should not be used on members who are Disengaged and in Diligent Search, or are Pended for any reason.                 \nDO NOT USE FOR ANY MEMBER THAT IS ELIGIBLE FOR HH+                                                                                                                                                                                                                               \n Look at CURRENT records.  That will generally mean documentation within the last 90 days, unless otherwise indicated. "]
["MEMBER NAME","MEMBER CIN","CARE MANAGER NAME"]
[]
["LAST IN PERSON CONTACT WITH MEMBER (DATE)","LAST CONTACT WITH AT LEAST ONE CARE TEAM MEMBER (DATE)","LAST COMPREHENSIVE REASSESSMENT (DATE)"]
[]
["ELIGIBLE FOR HH+ SMI OR HH+ HIV?","LENGTH OF STAY IN THEIR CURRENT HEALTH HOME PROGRAM (MONTHS) \n","TYPE OF REVIEW"]
[]
["BASIC ELIGIBILITY PRE-SCREEN  \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result.\nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.",null,{"$f":"IF(AND(C9=\"\",C11=\"\"),\"Is the Member Eligible for Health Home Services?\",IF(OR(C9=\"NO\",C11=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C9=\"UNCLEAR\",C11=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",IF(OR(C9=\"\",C11=\"\"),\"CONTINUE WITH THIS SECTION\",IF(AND(C9=\"Yes\",C11=\"Yes\"),\"PROCEED TO SIGNIFICANT RISK FACTORS\",\"Error\")))))","v":"Is the Member Eligible for Health Home Services?"}]
["Does the member still have qualifying diagnoses for Health Home?"]
["Which One(s)?"]
["Does the Member still have Active Medicaid, with no disqualifying R/E codes?\n\nRemember: Members can only be disenrolled due to inactive Medicaid if they are no longer eligible for Medicaid or if they have been refusing to take the necessary steps to fix the Medicaid case.  It is expected that HHCM’s will need to help members reactivate their Medicaid at times."]
[]
[]
["SIGNIFICANT RISK FACTORS \nSelection of at least one Concrete Example skips straight to Member Engagement \nSelection of “No Concrete Example of a Significant Risk Factor in record” skips straight to Additional Risk Factors. ",null,{"$f":"IF(C15=\"\",\"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?\",IF(C15=\"NONE OF THE ABOVE - PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO MEMBER ENGAGEMENT\"))","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"}]
["Select a Concrete Example of a Significant Risk Factor:"]
["Description/Specifics if indicated:"]
["Additional Risk Factors\nQuestions in this section DO NOT have to be answered in order.  As soon as the tool skips to another section or generates a result, stop answering further questions in this section. ",null,{"$f":"IF(AND(C18=\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",C23=\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",C29=\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\"),\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\",IF(OR(C18=\"MEMBER HAS GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",C29=\"THEY DO NOT HAVE THE SKILLS YET\"),\"SKIP TO MEMBER ENGAGEMENT\",IF(AND(C18=\"NO GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE STABLE\",C29=\"THEY HAVE THE SKILLS\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C18=\"UNCLEAR\",C23=\"UNCLEAR\",C29=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\"))))","v":"REVIEW GENERAL RISK, STABILITY, AND SKILLS"}]
["General Risk Factors: \nAny “Yes” answer skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result \nIf all answers are “No”, proceed to Stability Risk Factors ",null,{"$f":"IF(AND(C19=\"\",C20=\"\",C21=\"\",C22=\"\"),\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",IF(OR(C19=\"YES\",C20=\"YES\",C21=\"YES\",C22=\"YES\"),\"MEMBER HAS GENERAL RISK FACTORS\",IF(AND(C19=\"NO\",C20=\"NO\",C21=\"NO\",C22=\"NO\"),\"NO GENERAL RISK FACTORS\",IF(COUNTIF(C19:C22,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING GENERAL RISK\"))))","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"}]
["Has member had preventable or unnecessary hospitalizations or ER visits over the last six months?  \n“Preventable” means they were directly attributable to their lack of adherence to or access to treatments, appointments, or understanding of their Chronic Diagnoses. \n“Unnecessary” means the health care need could or should have been met in an outpatient or urgent care setting instead. "]
["Is the member's current housing unsafe?"]
["Has the member reported any safety concerns in their environment or their community, have they been able to follow a Safety Plan over the last six months?"]
["Has member been a danger to themselves or others within the last six months?\nExamples: Suicidal or homicidal ideation or attempts, violence towards self or others, inclusive of self-harm or arson, subject of a temporary restraining order, etc.  "]
["Stability Risk Factors: \nAny \"Yes\" answer to the first question, or a \"No\" answer to the last four questions, skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result. \nIf there are no “Unclear” answers, and the tool did not skip to Member Engagement, proceed to Skills Based Risk Factors ",null,{"$f":"IF(AND(C24=\"\",C25=\"\",C26=\"\",C27=\"\",C28=\"\"),\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",IF(AND(C24=\"No\",C25=\"Yes\",C26=\"Yes\",C27=\"Yes\",C28=\"Yes\"),\"HEALTH AND SDOH CONDITIONS ARE STABLE\",IF(OR(C24=\"Yes\",C25=\"No\",C26=\"No\",C27=\"No\",C28=\"No\"),\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",IF(OR(C24=\"Unclear\",C25=\"Unclear\",C26=\"Unclear\",C27=\"Unclear\",C28=\"Unclear\"),\"UNCLEAR\",\"CONTINUE ASSESSING STABILITY\"))))","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"}]
["If the member has a mental health diagnosis, have they experienced an increase in symptoms, or the need for crisis management responses within the last six months? \nCrisis management could be provided through a formal crisis response team, or informally through their HHCM. "]
["If the member has a SUD diagnosis, has the member met and maintained their SUD goals over the last six months, such as Abstinence, Moderation, or Harm Reduction?\nSUD applies to legal and illegal drugs of abuse, alcohol, and/or tobacco if the member has identified a goal related to use of that substance."]
["Has the member had stable housing over the last six months?\n\"Stable\" means there have been no evictions, moves, or periods of homelessness."]
["If the member is in a relationship with chronic Intimate Partner Violence, have they been able to follow a Safety Plan over the last six months?"]
["If the member is involved in the Criminal Justice System, have they been following the requirements of their Parole/Probation over the last six months?"]
["SKILLS-BASED RISK FACTORS\nAny “No” answer skips straight to Member Engagement  \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nIf all answers are “Yes”, this ends the screening and generates a “Recommend Disenrollment” result.  \n\nThese questions should be answered as if the member did not have HHCM assistance. Some people may have assistance from someone else in their life such as family, home aides, or other types of case managers, which we are referring to collectively as “a caregiver”.  ",null,{"$f":"IF(AND(C30=\"\",C31=\"\",C32=\"\",C33=\"\",C34=\"\",C35=\"\"),\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\",IF(AND(C30=\"YES\",C31=\"YES\",C32=\"YES\",C33=\"YES\",C34=\"YES\",C35=\"YES\"),\"THEY HAVE THE SKILLS\",IF(COUNTIF(C30:C35,\"No\")>0,\"THEY DO NOT HAVE THE SKILLS YET\",IF(COUNTIF(C30:C35,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING SKILLS\"))))","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"}]
["Does the member or caregiver understand the frequency of outpatient follow up, schedule and keep their healthcare appointments, and have reliable transportation to get to their healthcare appointments without HHCM assistance? "]
["Does the member or caregiver understand who is on their Care Team and when/why/how to contact them without HHCM assistance? "]
["Does the member or caregiver maintain the member’s medication adherence without HHCM assistance? "]
["Is the member or caregiver aware of upcoming recertifications for benefits and can successfully recertify without HHCM assistance? \nThis could include Medicaid, SNAP, SSI, SSDI, Public Assistance, etc.  "]
["Does the member or caregiver manage the member’s day-to-day finances without HHCM assistance? \nThis could include paying rent, bills, budgeting, etc. "]
["Does the member or caregiver manage the member’s ADLs and IADLs without HHCM assistance? "]
["Member Engagement \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result. \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nA \"Yes\" answer for ALL THREE questions ends the screening and generates a “Recommend Continued Services” result. \n\nMembers with legal guardians may not be able to engage actively with the CM, and progress on HH POC goals may look different than for other members.  \nFor example:  A member with severe dementia may not be able to talk directly to the HHCM, and the HHCM's primary engagement may be with the member's son or daughter.  \nThe \"Member Engagement\" questions may be considered as \"Caregiver Engagement\" questions in these cases. ",null,{"$f":"IF(AND(C37=\"\",C38=\"\",C39=\"\"),\"IS MEMBER ENGAGED WITH HHCM SERVICES?\",IF(OR(C37=\"No\",C38=\"No\",C39=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C37=\"UNCLEAR\",C38=\"UNCLEAR\",C39=\"UNCLEAR\"),\"More Information Needed\",IF(AND(C37=\"Yes\",C38=\"Yes\",C39=\"Yes\"),\"Recommend Continued Services\",\"Continue Assessing Member Engagement\"))))","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"}]
["Does the member have non-maintenance goals left to accomplish on the POC?\n\nAn active (non-maintenance) goal is one that requires actions by the HHCM to elicit progress towards completion of the goal. The members' goal(s) would not be achieved without concrete interventions and support of the HHCM.\n\nMaintenance goals are goals that the member has met, and although ongoing, do not require any active assistance from the HHCM.  Example: “Member will continue to fill their medication monthly”."]
["Has the member been actively engaged and working with the CM on their HH POC Goals and Tasks in the last six months?\n\nA member is not actively engaged if they are only in touch with the HHCM to say they are busy, or will call them back, or if regularly, Core Services being provided are only being provided through the Care Team because the member is unavailable.  \n\nA member is not working with the HHCM on their HH POC Goals and Tasks if during their contacts they are solely updating the HHCM on their life or persistently addressing something not on the POC. "]
["Have the member and Care Manager been making progress on their HH POC Goals and Tasks in the last six months?\n\nA member and HHCM are not making progress on the HH POC Goals and Tasks if the same task is being attempted month after month and nothing changes or moves forward. "]
["COMMENTS                                                                                                                                                                                                                                                                                                                                       "]
[]
[]
[]
[]
[]
[]
["RESULTS OF CONTINUED ELIGIBILITY FOR SERVICES REVIEW"]
[{"$f":"IF(OR(C8=\"Recommend Disenrollment\",C17=\"Recommend Disenrollment\",C36=\"Recommend Disenrollment\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C8=\"More Information Needed\",C17=\"More Information Needed\",C36=\"More Information Needed\"),\"MORE INFORMATION NEEDED\",IF(C36=\"Recommend Continued Services\",\"RECOMMEND CONTINUED SERVICES\",IF(A7=\"Yes - DO NOT PROCEED WITH THE CES REVIEW\",\"CES REVIEW NOT REQUIRED- MEMBER IS HH+ ELIGIBLE\",\"CES REVIEW INCOMPLETE\"))))","v":"CES REVIEW INCOMPLETE"},null,null,null,{"$f":"A48","v":"CES REVIEW INCOMPLETE"}]
["DATE OF CES REVIEW","DATE NEXT CES REVIEW DUE","Supervisor Response to Recommendation (optional)"]
[null,{"$f":"IFERROR(_xlfn.IFS(A48=\"RECOMMEND CONTINUED SERVICES\", A50+180, A48=\"RECOMMEND DISENROLLMENT\", \"N/A\", A48=\"MORE INFORMATION NEEDED\", A50+60), \"\")","v":""}]
["REVIEWER NAME","TYPE OF STAFF COMPLETING THE TOOL"]
[]
["DOCUMENTS REVIEWED (optional)","DATE(S) OF THE DOCUMENTS (optional)"]
["PSYCKES:"]
["Care Plan:"]
["Comprehensive Assessment(s):"]
["Encounter Notes:"]
["Billing Support Questionnairres:"]

{"sheet":"CES Tool 6","index":7,"n_rows":58,"n_cols":5,"rows_kept":58,"cut":false,"hidden":true,"merged":[[13,0,13,1],[0,0,0,2],[9,0,9,1],[10,0,10,1],[7,0,7,1],[8,0,8,1],[11,0,11,2],[12,0,12,2],[25,0,25,1],[14,0,14,1],[15,0,15,1],[16,0,16,1],[17,0,17,1],[18,0,18,1],[19,0,19,1],[20,0,20,1],[21,0,21,1],[22,0,22,1],[23,0,23,1],[24,0,24,1],[38,0,38,1],[26,0,26,1],[27,0,27,1],[28,0,28,1],[29,0,29,1],[30,0,30,1],[31,0,31,1],[32,0,32,1],[33,0,33,1],[34,0,34,1],[35,0,35,1],[36,0,36,1],[37,0,37,1],[39,0,39,2],[40,0,45,2],[46,0,46,2],[47,0,47,2],[49,2,57,2]]}
["DOH CONTINUED ELIGIBILITY FOR SERVICES REVIEW TOOL \nUse with members enrolled for at least 1 year who are not pended, i.e. this should not be used on members who are Disengaged and in Diligent Search, or are Pended for any reason.                 \nDO NOT USE FOR ANY MEMBER THAT IS ELIGIBLE FOR HH+                                                                                                                                                                                                                               \n Look at CURRENT records.  That will generally mean documentation within the last 90 days, unless otherwise indicated. "]
["MEMBER NAME","MEMBER CIN","CARE MANAGER NAME"]
[]
["LAST IN PERSON CONTACT WITH MEMBER (DATE)","LAST CONTACT WITH AT LEAST ONE CARE TEAM MEMBER (DATE)","LAST COMPREHENSIVE REASSESSMENT (DATE)"]
[]
["ELIGIBLE FOR HH+ SMI OR HH+ HIV?","LENGTH OF STAY IN THEIR CURRENT HEALTH HOME PROGRAM (MONTHS) \n","TYPE OF REVIEW"]
[]
["BASIC ELIGIBILITY PRE-SCREEN  \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result.\nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.",null,{"$f":"IF(AND(C9=\"\",C11=\"\"),\"Is the Member Eligible for Health Home Services?\",IF(OR(C9=\"NO\",C11=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C9=\"UNCLEAR\",C11=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",IF(OR(C9=\"\",C11=\"\"),\"CONTINUE WITH THIS SECTION\",IF(AND(C9=\"Yes\",C11=\"Yes\"),\"PROCEED TO SIGNIFICANT RISK FACTORS\",\"Error\")))))","v":"Is the Member Eligible for Health Home Services?"}]
["Does the member still have qualifying diagnoses for Health Home?"]
["Which One(s)?"]
["Does the Member still have Active Medicaid, with no disqualifying R/E codes?\n\nRemember: Members can only be disenrolled due to inactive Medicaid if they are no longer eligible for Medicaid or if they have been refusing to take the necessary steps to fix the Medicaid case.  It is expected that HHCM’s will need to help members reactivate their Medicaid at times."]
[]
[]
["SIGNIFICANT RISK FACTORS \nSelection of at least one Concrete Example skips straight to Member Engagement \nSelection of “No Concrete Example of a Significant Risk Factor in record” skips straight to Additional Risk Factors. ",null,{"$f":"IF(C15=\"\",\"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?\",IF(C15=\"NONE OF THE ABOVE - PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO MEMBER ENGAGEMENT\"))","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"}]
["Select a Concrete Example of a Significant Risk Factor:"]
["Description/Specifics if indicated:"]
["Additional Risk Factors\nQuestions in this section DO NOT have to be answered in order.  As soon as the tool skips to another section or generates a result, stop answering further questions in this section. ",null,{"$f":"IF(AND(C18=\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",C23=\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",C29=\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\"),\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\",IF(OR(C18=\"MEMBER HAS GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",C29=\"THEY DO NOT HAVE THE SKILLS YET\"),\"SKIP TO MEMBER ENGAGEMENT\",IF(AND(C18=\"NO GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE STABLE\",C29=\"THEY HAVE THE SKILLS\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C18=\"UNCLEAR\",C23=\"UNCLEAR\",C29=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\"))))","v":"REVIEW GENERAL RISK, STABILITY, AND SKILLS"}]
["General Risk Factors: \nAny “Yes” answer skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result \nIf all answers are “No”, proceed to Stability Risk Factors ",null,{"$f":"IF(AND(C19=\"\",C20=\"\",C21=\"\",C22=\"\"),\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",IF(OR(C19=\"YES\",C20=\"YES\",C21=\"YES\",C22=\"YES\"),\"MEMBER HAS GENERAL RISK FACTORS\",IF(AND(C19=\"NO\",C20=\"NO\",C21=\"NO\",C22=\"NO\"),\"NO GENERAL RISK FACTORS\",IF(COUNTIF(C19:C22,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING GENERAL RISK\"))))","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"}]
["Has member had preventable or unnecessary hospitalizations or ER visits over the last six months?  \n“Preventable” means they were directly attributable to their lack of adherence to or access to treatments, appointments, or understanding of their Chronic Diagnoses. \n“Unnecessary” means the health care need could or should have been met in an outpatient or urgent care setting instead. "]
["Is the member's current housing unsafe?"]
["Has the member reported any safety concerns in their environment or their community, have they been able to follow a Safety Plan over the last six months?"]
["Has member been a danger to themselves or others within the last six months?\nExamples: Suicidal or homicidal ideation or attempts, violence towards self or others, inclusive of self-harm or arson, subject of a temporary restraining order, etc.  "]
["Stability Risk Factors: \nAny \"Yes\" answer to the first question, or a \"No\" answer to the last four questions, skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result. \nIf there are no “Unclear” answers, and the tool did not skip to Member Engagement, proceed to Skills Based Risk Factors ",null,{"$f":"IF(AND(C24=\"\",C25=\"\",C26=\"\",C27=\"\",C28=\"\"),\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",IF(AND(C24=\"No\",C25=\"Yes\",C26=\"Yes\",C27=\"Yes\",C28=\"Yes\"),\"HEALTH AND SDOH CONDITIONS ARE STABLE\",IF(OR(C24=\"Yes\",C25=\"No\",C26=\"No\",C27=\"No\",C28=\"No\"),\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",IF(OR(C24=\"Unclear\",C25=\"Unclear\",C26=\"Unclear\",C27=\"Unclear\",C28=\"Unclear\"),\"UNCLEAR\",\"CONTINUE ASSESSING STABILITY\"))))","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"}]
["If the member has a mental health diagnosis, have they experienced an increase in symptoms, or the need for crisis management responses within the last six months? \nCrisis management could be provided through a formal crisis response team, or informally through their HHCM. "]
["If the member has a SUD diagnosis, has the member met and maintained their SUD goals over the last six months, such as Abstinence, Moderation, or Harm Reduction?\nSUD applies to legal and illegal drugs of abuse, alcohol, and/or tobacco if the member has identified a goal related to use of that substance."]
["Has the member had stable housing over the last six months?\n\"Stable\" means there have been no evictions, moves, or periods of homelessness."]
["If the member is in a relationship with chronic Intimate Partner Violence, have they been able to follow a Safety Plan over the last six months?"]
["If the member is involved in the Criminal Justice System, have they been following the requirements of their Parole/Probation over the last six months?"]
["SKILLS-BASED RISK FACTORS\nAny “No” answer skips straight to Member Engagement  \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nIf all answers are “Yes”, this ends the screening and generates a “Recommend Disenrollment” result.  \n\nThese questions should be answered as if the member did not have HHCM assistance. Some people may have assistance from someone else in their life such as family, home aides, or other types of case managers, which we are referring to collectively as “a caregiver”.  ",null,{"$f":"IF(AND(C30=\"\",C31=\"\",C32=\"\",C33=\"\",C34=\"\",C35=\"\"),\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\",IF(AND(C30=\"YES\",C31=\"YES\",C32=\"YES\",C33=\"YES\",C34=\"YES\",C35=\"YES\"),\"THEY HAVE THE SKILLS\",IF(COUNTIF(C30:C35,\"No\")>0,\"THEY DO NOT HAVE THE SKILLS YET\",IF(COUNTIF(C30:C35,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING SKILLS\"))))","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"}]
["Does the member or caregiver understand the frequency of outpatient follow up, schedule and keep their healthcare appointments, and have reliable transportation to get to their healthcare appointments without HHCM assistance? "]
["Does the member or caregiver understand who is on their Care Team and when/why/how to contact them without HHCM assistance? "]
["Does the member or caregiver maintain the member’s medication adherence without HHCM assistance? "]
["Is the member or caregiver aware of upcoming recertifications for benefits and can successfully recertify without HHCM assistance? \nThis could include Medicaid, SNAP, SSI, SSDI, Public Assistance, etc.  "]
["Does the member or caregiver manage the member’s day-to-day finances without HHCM assistance? \nThis could include paying rent, bills, budgeting, etc. "]
["Does the member or caregiver manage the member’s ADLs and IADLs without HHCM assistance? "]
["Member Engagement \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result. \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nA \"Yes\" answer for ALL THREE questions ends the screening and generates a “Recommend Continued Services” result. \n\nMembers with legal guardians may not be able to engage actively with the CM, and progress on HH POC goals may look different than for other members.  \nFor example:  A member with severe dementia may not be able to talk directly to the HHCM, and the HHCM's primary engagement may be with the member's son or daughter.  \nThe \"Member Engagement\" questions may be considered as \"Caregiver Engagement\" questions in these cases. ",null,{"$f":"IF(AND(C37=\"\",C38=\"\",C39=\"\"),\"IS MEMBER ENGAGED WITH HHCM SERVICES?\",IF(OR(C37=\"No\",C38=\"No\",C39=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C37=\"UNCLEAR\",C38=\"UNCLEAR\",C39=\"UNCLEAR\"),\"More Information Needed\",IF(AND(C37=\"Yes\",C38=\"Yes\",C39=\"Yes\"),\"Recommend Continued Services\",\"Continue Assessing Member Engagement\"))))","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"}]
["Does the member have non-maintenance goals left to accomplish on the POC?\n\nAn active (non-maintenance) goal is one that requires actions by the HHCM to elicit progress towards completion of the goal. The members' goal(s) would not be achieved without concrete interventions and support of the HHCM.\n\nMaintenance goals are goals that the member has met, and although ongoing, do not require any active assistance from the HHCM.  Example: “Member will continue to fill their medication monthly”."]
["Has the member been actively engaged and working with the CM on their HH POC Goals and Tasks in the last six months?\n\nA member is not actively engaged if they are only in touch with the HHCM to say they are busy, or will call them back, or if regularly, Core Services being provided are only being provided through the Care Team because the member is unavailable.  \n\nA member is not working with the HHCM on their HH POC Goals and Tasks if during their contacts they are solely updating the HHCM on their life or persistently addressing something not on the POC. "]
["Have the member and Care Manager been making progress on their HH POC Goals and Tasks in the last six months?\n\nA member and HHCM are not making progress on the HH POC Goals and Tasks if the same task is being attempted month after month and nothing changes or moves forward. "]
["COMMENTS                                                                                                                                                                                                                                                                                                                                       "]
[]
[]
[]
[]
[]
[]
["RESULTS OF CONTINUED ELIGIBILITY FOR SERVICES REVIEW"]
[{"$f":"IF(OR(C8=\"Recommend Disenrollment\",C17=\"Recommend Disenrollment\",C36=\"Recommend Disenrollment\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C8=\"More Information Needed\",C17=\"More Information Needed\",C36=\"More Information Needed\"),\"MORE INFORMATION NEEDED\",IF(C36=\"Recommend Continued Services\",\"RECOMMEND CONTINUED SERVICES\",IF(A7=\"Yes - DO NOT PROCEED WITH THE CES REVIEW\",\"CES REVIEW NOT REQUIRED- MEMBER IS HH+ ELIGIBLE\",\"CES REVIEW INCOMPLETE\"))))","v":"CES REVIEW INCOMPLETE"},null,null,null,{"$f":"A48","v":"CES REVIEW INCOMPLETE"}]
["DATE OF CES REVIEW","DATE NEXT CES REVIEW DUE","Supervisor Response to Recommendation (optional)"]
[null,{"$f":"IFERROR(_xlfn.IFS(A48=\"RECOMMEND CONTINUED SERVICES\", A50+180, A48=\"RECOMMEND DISENROLLMENT\", \"N/A\", A48=\"MORE INFORMATION NEEDED\", A50+60), \"\")","v":""}]
["REVIEWER NAME","TYPE OF STAFF COMPLETING THE TOOL"]
[]
["DOCUMENTS REVIEWED (optional)","DATE(S) OF THE DOCUMENTS (optional)"]
["PSYCKES:"]
["Care Plan:"]
["Comprehensive Assessment(s):"]
["Encounter Notes:"]
["Billing Support Questionnairres:"]

{"sheet":"CES Tool 7","index":8,"n_rows":58,"n_cols":5,"rows_kept":58,"cut":false,"hidden":true,"merged":[[13,0,13,1],[0,0,0,2],[9,0,9,1],[10,0,10,1],[7,0,7,1],[8,0,8,1],[11,0,11,2],[12,0,12,2],[25,0,25,1],[14,0,14,1],[15,0,15,1],[16,0,16,1],[17,0,17,1],[18,0,18,1],[19,0,19,1],[20,0,20,1],[21,0,21,1],[22,0,22,1],[23,0,23,1],[24,0,24,1],[38,0,38,1],[26,0,26,1],[27,0,27,1],[28,0,28,1],[29,0,29,1],[30,0,30,1],[31,0,31,1],[32,0,32,1],[33,0,33,1],[34,0,34,1],[35,0,35,1],[36,0,36,1],[37,0,37,1],[39,0,39,2],[40,0,45,2],[46,0,46,2],[47,0,47,2],[49,2,57,2]]}
["DOH CONTINUED ELIGIBILITY FOR SERVICES REVIEW TOOL \nUse with members enrolled for at least 1 year who are not pended, i.e. this should not be used on members who are Disengaged and in Diligent Search, or are Pended for any reason.                 \nDO NOT USE FOR ANY MEMBER THAT IS ELIGIBLE FOR HH+                                                                                                                                                                                                                               \n Look at CURRENT records.  That will generally mean documentation within the last 90 days, unless otherwise indicated. "]
["MEMBER NAME","MEMBER CIN","CARE MANAGER NAME"]
[]
["LAST IN PERSON CONTACT WITH MEMBER (DATE)","LAST CONTACT WITH AT LEAST ONE CARE TEAM MEMBER (DATE)","LAST COMPREHENSIVE REASSESSMENT (DATE)"]
[]
["ELIGIBLE FOR HH+ SMI OR HH+ HIV?","LENGTH OF STAY IN THEIR CURRENT HEALTH HOME PROGRAM (MONTHS) \n","TYPE OF REVIEW"]
[]
["BASIC ELIGIBILITY PRE-SCREEN  \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result.\nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.",null,{"$f":"IF(AND(C9=\"\",C11=\"\"),\"Is the Member Eligible for Health Home Services?\",IF(OR(C9=\"NO\",C11=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C9=\"UNCLEAR\",C11=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",IF(OR(C9=\"\",C11=\"\"),\"CONTINUE WITH THIS SECTION\",IF(AND(C9=\"Yes\",C11=\"Yes\"),\"PROCEED TO SIGNIFICANT RISK FACTORS\",\"Error\")))))","v":"Is the Member Eligible for Health Home Services?"}]
["Does the member still have qualifying diagnoses for Health Home?"]
["Which One(s)?"]
["Does the Member still have Active Medicaid, with no disqualifying R/E codes?\n\nRemember: Members can only be disenrolled due to inactive Medicaid if they are no longer eligible for Medicaid or if they have been refusing to take the necessary steps to fix the Medicaid case.  It is expected that HHCM’s will need to help members reactivate their Medicaid at times."]
[]
[]
["SIGNIFICANT RISK FACTORS \nSelection of at least one Concrete Example skips straight to Member Engagement \nSelection of “No Concrete Example of a Significant Risk Factor in record” skips straight to Additional Risk Factors. ",null,{"$f":"IF(C15=\"\",\"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?\",IF(C15=\"NONE OF THE ABOVE - PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO MEMBER ENGAGEMENT\"))","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"}]
["Select a Concrete Example of a Significant Risk Factor:"]
["Description/Specifics if indicated:"]
["Additional Risk Factors\nQuestions in this section DO NOT have to be answered in order.  As soon as the tool skips to another section or generates a result, stop answering further questions in this section. ",null,{"$f":"IF(AND(C18=\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",C23=\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",C29=\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\"),\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\",IF(OR(C18=\"MEMBER HAS GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",C29=\"THEY DO NOT HAVE THE SKILLS YET\"),\"SKIP TO MEMBER ENGAGEMENT\",IF(AND(C18=\"NO GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE STABLE\",C29=\"THEY HAVE THE SKILLS\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C18=\"UNCLEAR\",C23=\"UNCLEAR\",C29=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\"))))","v":"REVIEW GENERAL RISK, STABILITY, AND SKILLS"}]
["General Risk Factors: \nAny “Yes” answer skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result \nIf all answers are “No”, proceed to Stability Risk Factors ",null,{"$f":"IF(AND(C19=\"\",C20=\"\",C21=\"\",C22=\"\"),\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",IF(OR(C19=\"YES\",C20=\"YES\",C21=\"YES\",C22=\"YES\"),\"MEMBER HAS GENERAL RISK FACTORS\",IF(AND(C19=\"NO\",C20=\"NO\",C21=\"NO\",C22=\"NO\"),\"NO GENERAL RISK FACTORS\",IF(COUNTIF(C19:C22,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING GENERAL RISK\"))))","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"}]
["Has member had preventable or unnecessary hospitalizations or ER visits over the last six months?  \n“Preventable” means they were directly attributable to their lack of adherence to or access to treatments, appointments, or understanding of their Chronic Diagnoses. \n“Unnecessary” means the health care need could or should have been met in an outpatient or urgent care setting instead. "]
["Is the member's current housing unsafe?"]
["Has the member reported any safety concerns in their environment or their community, have they been able to follow a Safety Plan over the last six months?"]
["Has member been a danger to themselves or others within the last six months?\nExamples: Suicidal or homicidal ideation or attempts, violence towards self or others, inclusive of self-harm or arson, subject of a temporary restraining order, etc.  "]
["Stability Risk Factors: \nAny \"Yes\" answer to the first question, or a \"No\" answer to the last four questions, skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result. \nIf there are no “Unclear” answers, and the tool did not skip to Member Engagement, proceed to Skills Based Risk Factors ",null,{"$f":"IF(AND(C24=\"\",C25=\"\",C26=\"\",C27=\"\",C28=\"\"),\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",IF(AND(C24=\"No\",C25=\"Yes\",C26=\"Yes\",C27=\"Yes\",C28=\"Yes\"),\"HEALTH AND SDOH CONDITIONS ARE STABLE\",IF(OR(C24=\"Yes\",C25=\"No\",C26=\"No\",C27=\"No\",C28=\"No\"),\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",IF(OR(C24=\"Unclear\",C25=\"Unclear\",C26=\"Unclear\",C27=\"Unclear\",C28=\"Unclear\"),\"UNCLEAR\",\"CONTINUE ASSESSING STABILITY\"))))","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"}]
["If the member has a mental health diagnosis, have they experienced an increase in symptoms, or the need for crisis management responses within the last six months? \nCrisis management could be provided through a formal crisis response team, or informally through their HHCM. "]
["If the member has a SUD diagnosis, has the member met and maintained their SUD goals over the last six months, such as Abstinence, Moderation, or Harm Reduction?\nSUD applies to legal and illegal drugs of abuse, alcohol, and/or tobacco if the member has identified a goal related to use of that substance."]
["Has the member had stable housing over the last six months?\n\"Stable\" means there have been no evictions, moves, or periods of homelessness."]
["If the member is in a relationship with chronic Intimate Partner Violence, have they been able to follow a Safety Plan over the last six months?"]
["If the member is involved in the Criminal Justice System, have they been following the requirements of their Parole/Probation over the last six months?"]
["SKILLS-BASED RISK FACTORS\nAny “No” answer skips straight to Member Engagement  \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nIf all answers are “Yes”, this ends the screening and generates a “Recommend Disenrollment” result.  \n\nThese questions should be answered as if the member did not have HHCM assistance. Some people may have assistance from someone else in their life such as family, home aides, or other types of case managers, which we are referring to collectively as “a caregiver”.  ",null,{"$f":"IF(AND(C30=\"\",C31=\"\",C32=\"\",C33=\"\",C34=\"\",C35=\"\"),\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\",IF(AND(C30=\"YES\",C31=\"YES\",C32=\"YES\",C33=\"YES\",C34=\"YES\",C35=\"YES\"),\"THEY HAVE THE SKILLS\",IF(COUNTIF(C30:C35,\"No\")>0,\"THEY DO NOT HAVE THE SKILLS YET\",IF(COUNTIF(C30:C35,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING SKILLS\"))))","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"}]
["Does the member or caregiver understand the frequency of outpatient follow up, schedule and keep their healthcare appointments, and have reliable transportation to get to their healthcare appointments without HHCM assistance? "]
["Does the member or caregiver understand who is on their Care Team and when/why/how to contact them without HHCM assistance? "]
["Does the member or caregiver maintain the member’s medication adherence without HHCM assistance? "]
["Is the member or caregiver aware of upcoming recertifications for benefits and can successfully recertify without HHCM assistance? \nThis could include Medicaid, SNAP, SSI, SSDI, Public Assistance, etc.  "]
["Does the member or caregiver manage the member’s day-to-day finances without HHCM assistance? \nThis could include paying rent, bills, budgeting, etc. "]
["Does the member or caregiver manage the member’s ADLs and IADLs without HHCM assistance? "]
["Member Engagement \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result. \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nA \"Yes\" answer for ALL THREE questions ends the screening and generates a “Recommend Continued Services” result. \n\nMembers with legal guardians may not be able to engage actively with the CM, and progress on HH POC goals may look different than for other members.  \nFor example:  A member with severe dementia may not be able to talk directly to the HHCM, and the HHCM's primary engagement may be with the member's son or daughter.  \nThe \"Member Engagement\" questions may be considered as \"Caregiver Engagement\" questions in these cases. ",null,{"$f":"IF(AND(C37=\"\",C38=\"\",C39=\"\"),\"IS MEMBER ENGAGED WITH HHCM SERVICES?\",IF(OR(C37=\"No\",C38=\"No\",C39=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C37=\"UNCLEAR\",C38=\"UNCLEAR\",C39=\"UNCLEAR\"),\"More Information Needed\",IF(AND(C37=\"Yes\",C38=\"Yes\",C39=\"Yes\"),\"Recommend Continued Services\",\"Continue Assessing Member Engagement\"))))","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"}]
["Does the member have non-maintenance goals left to accomplish on the POC?\n\nAn active (non-maintenance) goal is one that requires actions by the HHCM to elicit progress towards completion of the goal. The members' goal(s) would not be achieved without concrete interventions and support of the HHCM.\n\nMaintenance goals are goals that the member has met, and although ongoing, do not require any active assistance from the HHCM.  Example: “Member will continue to fill their medication monthly”."]
["Has the member been actively engaged and working with the CM on their HH POC Goals and Tasks in the last six months?\n\nA member is not actively engaged if they are only in touch with the HHCM to say they are busy, or will call them back, or if regularly, Core Services being provided are only being provided through the Care Team because the member is unavailable.  \n\nA member is not working with the HHCM on their HH POC Goals and Tasks if during their contacts they are solely updating the HHCM on their life or persistently addressing something not on the POC. "]
["Have the member and Care Manager been making progress on their HH POC Goals and Tasks in the last six months?\n\nA member and HHCM are not making progress on the HH POC Goals and Tasks if the same task is being attempted month after month and nothing changes or moves forward. "]
["COMMENTS                                                                                                                                                                                                                                                                                                                                       "]
[]
[]
[]
[]
[]
[]
["RESULTS OF CONTINUED ELIGIBILITY FOR SERVICES REVIEW"]
[{"$f":"IF(OR(C8=\"Recommend Disenrollment\",C17=\"Recommend Disenrollment\",C36=\"Recommend Disenrollment\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C8=\"More Information Needed\",C17=\"More Information Needed\",C36=\"More Information Needed\"),\"MORE INFORMATION NEEDED\",IF(C36=\"Recommend Continued Services\",\"RECOMMEND CONTINUED SERVICES\",IF(A7=\"Yes - DO NOT PROCEED WITH THE CES REVIEW\",\"CES REVIEW NOT REQUIRED- MEMBER IS HH+ ELIGIBLE\",\"CES REVIEW INCOMPLETE\"))))","v":"CES REVIEW INCOMPLETE"},null,null,null,{"$f":"A48","v":"CES REVIEW INCOMPLETE"}]
["DATE OF CES REVIEW","DATE NEXT CES REVIEW DUE","Supervisor Response to Recommendation (optional)"]
[null,{"$f":"IFERROR(_xlfn.IFS(A48=\"RECOMMEND CONTINUED SERVICES\", A50+180, A48=\"RECOMMEND DISENROLLMENT\", \"N/A\", A48=\"MORE INFORMATION NEEDED\", A50+60), \"\")","v":""}]
["REVIEWER NAME","TYPE OF STAFF COMPLETING THE TOOL"]
[]
["DOCUMENTS REVIEWED (optional)","DATE(S) OF THE DOCUMENTS (optional)"]
["PSYCKES:"]
["Care Plan:"]
["Comprehensive Assessment(s):"]
["Encounter Notes:"]
["Billing Support Questionnairres:"]

{"sheet":"CES Tool 8","index":9,"n_rows":58,"n_cols":5,"rows_kept":58,"cut":false,"hidden":true,"merged":[[13,0,13,1],[0,0,0,2],[9,0,9,1],[10,0,10,1],[7,0,7,1],[8,0,8,1],[11,0,11,2],[12,0,12,2],[25,0,25,1],[14,0,14,1],[15,0,15,1],[16,0,16,1],[17,0,17,1],[18,0,18,1],[19,0,19,1],[20,0,20,1],[21,0,21,1],[22,0,22,1],[23,0,23,1],[24,0,24,1],[38,0,38,1],[26,0,26,1],[27,0,27,1],[28,0,28,1],[29,0,29,1],[30,0,30,1],[31,0,31,1],[32,0,32,1],[33,0,33,1],[34,0,34,1],[35,0,35,1],[36,0,36,1],[37,0,37,1],[39,0,39,2],[40,0,45,2],[46,0,46,2],[47,0,47,2],[49,2,57,2]]}
["DOH CONTINUED ELIGIBILITY FOR SERVICES REVIEW TOOL \nUse with members enrolled for at least 1 year who are not pended, i.e. this should not be used on members who are Disengaged and in Diligent Search, or are Pended for any reason.                 \nDO NOT USE FOR ANY MEMBER THAT IS ELIGIBLE FOR HH+                                                                                                                                                                                                                               \n Look at CURRENT records.  That will generally mean documentation within the last 90 days, unless otherwise indicated. "]
["MEMBER NAME","MEMBER CIN","CARE MANAGER NAME"]
[]
["LAST IN PERSON CONTACT WITH MEMBER (DATE)","LAST CONTACT WITH AT LEAST ONE CARE TEAM MEMBER (DATE)","LAST COMPREHENSIVE REASSESSMENT (DATE)"]
[]
["ELIGIBLE FOR HH+ SMI OR HH+ HIV?","LENGTH OF STAY IN THEIR CURRENT HEALTH HOME PROGRAM (MONTHS) \n","TYPE OF REVIEW"]
[]
["BASIC ELIGIBILITY PRE-SCREEN  \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result.\nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.",null,{"$f":"IF(AND(C9=\"\",C11=\"\"),\"Is the Member Eligible for Health Home Services?\",IF(OR(C9=\"NO\",C11=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C9=\"UNCLEAR\",C11=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",IF(OR(C9=\"\",C11=\"\"),\"CONTINUE WITH THIS SECTION\",IF(AND(C9=\"Yes\",C11=\"Yes\"),\"PROCEED TO SIGNIFICANT RISK FACTORS\",\"Error\")))))","v":"Is the Member Eligible for Health Home Services?"}]
["Does the member still have qualifying diagnoses for Health Home?"]
["Which One(s)?"]
["Does the Member still have Active Medicaid, with no disqualifying R/E codes?\n\nRemember: Members can only be disenrolled due to inactive Medicaid if they are no longer eligible for Medicaid or if they have been refusing to take the necessary steps to fix the Medicaid case.  It is expected that HHCM’s will need to help members reactivate their Medicaid at times."]
[]
[]
["SIGNIFICANT RISK FACTORS \nSelection of at least one Concrete Example skips straight to Member Engagement \nSelection of “No Concrete Example of a Significant Risk Factor in record” skips straight to Additional Risk Factors. ",null,{"$f":"IF(C15=\"\",\"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?\",IF(C15=\"NONE OF THE ABOVE - PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO MEMBER ENGAGEMENT\"))","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"}]
["Select a Concrete Example of a Significant Risk Factor:"]
["Description/Specifics if indicated:"]
["Additional Risk Factors\nQuestions in this section DO NOT have to be answered in order.  As soon as the tool skips to another section or generates a result, stop answering further questions in this section. ",null,{"$f":"IF(AND(C18=\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",C23=\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",C29=\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\"),\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\",IF(OR(C18=\"MEMBER HAS GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",C29=\"THEY DO NOT HAVE THE SKILLS YET\"),\"SKIP TO MEMBER ENGAGEMENT\",IF(AND(C18=\"NO GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE STABLE\",C29=\"THEY HAVE THE SKILLS\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C18=\"UNCLEAR\",C23=\"UNCLEAR\",C29=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\"))))","v":"REVIEW GENERAL RISK, STABILITY, AND SKILLS"}]
["General Risk Factors: \nAny “Yes” answer skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result \nIf all answers are “No”, proceed to Stability Risk Factors ",null,{"$f":"IF(AND(C19=\"\",C20=\"\",C21=\"\",C22=\"\"),\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",IF(OR(C19=\"YES\",C20=\"YES\",C21=\"YES\",C22=\"YES\"),\"MEMBER HAS GENERAL RISK FACTORS\",IF(AND(C19=\"NO\",C20=\"NO\",C21=\"NO\",C22=\"NO\"),\"NO GENERAL RISK FACTORS\",IF(COUNTIF(C19:C22,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING GENERAL RISK\"))))","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"}]
["Has member had preventable or unnecessary hospitalizations or ER visits over the last six months?  \n“Preventable” means they were directly attributable to their lack of adherence to or access to treatments, appointments, or understanding of their Chronic Diagnoses. \n“Unnecessary” means the health care need could or should have been met in an outpatient or urgent care setting instead. "]
["Is the member's current housing unsafe?"]
["Has the member reported any safety concerns in their environment or their community, have they been able to follow a Safety Plan over the last six months?"]
["Has member been a danger to themselves or others within the last six months?\nExamples: Suicidal or homicidal ideation or attempts, violence towards self or others, inclusive of self-harm or arson, subject of a temporary restraining order, etc.  "]
["Stability Risk Factors: \nAny \"Yes\" answer to the first question, or a \"No\" answer to the last four questions, skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result. \nIf there are no “Unclear” answers, and the tool did not skip to Member Engagement, proceed to Skills Based Risk Factors ",null,{"$f":"IF(AND(C24=\"\",C25=\"\",C26=\"\",C27=\"\",C28=\"\"),\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",IF(AND(C24=\"No\",C25=\"Yes\",C26=\"Yes\",C27=\"Yes\",C28=\"Yes\"),\"HEALTH AND SDOH CONDITIONS ARE STABLE\",IF(OR(C24=\"Yes\",C25=\"No\",C26=\"No\",C27=\"No\",C28=\"No\"),\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",IF(OR(C24=\"Unclear\",C25=\"Unclear\",C26=\"Unclear\",C27=\"Unclear\",C28=\"Unclear\"),\"UNCLEAR\",\"CONTINUE ASSESSING STABILITY\"))))","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"}]
["If the member has a mental health diagnosis, have they experienced an increase in symptoms, or the need for crisis management responses within the last six months? \nCrisis management could be provided through a formal crisis response team, or informally through their HHCM. "]
["If the member has a SUD diagnosis, has the member met and maintained their SUD goals over the last six months, such as Abstinence, Moderation, or Harm Reduction?\nSUD applies to legal and illegal drugs of abuse, alcohol, and/or tobacco if the member has identified a goal related to use of that substance."]
["Has the member had stable housing over the last six months?\n\"Stable\" means there have been no evictions, moves, or periods of homelessness."]
["If the member is in a relationship with chronic Intimate Partner Violence, have they been able to follow a Safety Plan over the last six months?"]
["If the member is involved in the Criminal Justice System, have they been following the requirements of their Parole/Probation over the last six months?"]
["SKILLS-BASED RISK FACTORS\nAny “No” answer skips straight to Member Engagement  \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nIf all answers are “Yes”, this ends the screening and generates a “Recommend Disenrollment” result.  \n\nThese questions should be answered as if the member did not have HHCM assistance. Some people may have assistance from someone else in their life such as family, home aides, or other types of case managers, which we are referring to collectively as “a caregiver”.  ",null,{"$f":"IF(AND(C30=\"\",C31=\"\",C32=\"\",C33=\"\",C34=\"\",C35=\"\"),\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\",IF(AND(C30=\"YES\",C31=\"YES\",C32=\"YES\",C33=\"YES\",C34=\"YES\",C35=\"YES\"),\"THEY HAVE THE SKILLS\",IF(COUNTIF(C30:C35,\"No\")>0,\"THEY DO NOT HAVE THE SKILLS YET\",IF(COUNTIF(C30:C35,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING SKILLS\"))))","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"}]
["Does the member or caregiver understand the frequency of outpatient follow up, schedule and keep their healthcare appointments, and have reliable transportation to get to their healthcare appointments without HHCM assistance? "]
["Does the member or caregiver understand who is on their Care Team and when/why/how to contact them without HHCM assistance? "]
["Does the member or caregiver maintain the member’s medication adherence without HHCM assistance? "]
["Is the member or caregiver aware of upcoming recertifications for benefits and can successfully recertify without HHCM assistance? \nThis could include Medicaid, SNAP, SSI, SSDI, Public Assistance, etc.  "]
["Does the member or caregiver manage the member’s day-to-day finances without HHCM assistance? \nThis could include paying rent, bills, budgeting, etc. "]
["Does the member or caregiver manage the member’s ADLs and IADLs without HHCM assistance? "]
["Member Engagement \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result. \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nA \"Yes\" answer for ALL THREE questions ends the screening and generates a “Recommend Continued Services” result. \n\nMembers with legal guardians may not be able to engage actively with the CM, and progress on HH POC goals may look different than for other members.  \nFor example:  A member with severe dementia may not be able to talk directly to the HHCM, and the HHCM's primary engagement may be with the member's son or daughter.  \nThe \"Member Engagement\" questions may be considered as \"Caregiver Engagement\" questions in these cases. ",null,{"$f":"IF(AND(C37=\"\",C38=\"\",C39=\"\"),\"IS MEMBER ENGAGED WITH HHCM SERVICES?\",IF(OR(C37=\"No\",C38=\"No\",C39=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C37=\"UNCLEAR\",C38=\"UNCLEAR\",C39=\"UNCLEAR\"),\"More Information Needed\",IF(AND(C37=\"Yes\",C38=\"Yes\",C39=\"Yes\"),\"Recommend Continued Services\",\"Continue Assessing Member Engagement\"))))","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"}]
["Does the member have non-maintenance goals left to accomplish on the POC?\n\nAn active (non-maintenance) goal is one that requires actions by the HHCM to elicit progress towards completion of the goal. The members' goal(s) would not be achieved without concrete interventions and support of the HHCM.\n\nMaintenance goals are goals that the member has met, and although ongoing, do not require any active assistance from the HHCM.  Example: “Member will continue to fill their medication monthly”."]
["Has the member been actively engaged and working with the CM on their HH POC Goals and Tasks in the last six months?\n\nA member is not actively engaged if they are only in touch with the HHCM to say they are busy, or will call them back, or if regularly, Core Services being provided are only being provided through the Care Team because the member is unavailable.  \n\nA member is not working with the HHCM on their HH POC Goals and Tasks if during their contacts they are solely updating the HHCM on their life or persistently addressing something not on the POC. "]
["Have the member and Care Manager been making progress on their HH POC Goals and Tasks in the last six months?\n\nA member and HHCM are not making progress on the HH POC Goals and Tasks if the same task is being attempted month after month and nothing changes or moves forward. "]
["COMMENTS                                                                                                                                                                                                                                                                                                                                       "]
[]
[]
[]
[]
[]
[]
["RESULTS OF CONTINUED ELIGIBILITY FOR SERVICES REVIEW"]
[{"$f":"IF(OR(C8=\"Recommend Disenrollment\",C17=\"Recommend Disenrollment\",C36=\"Recommend Disenrollment\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C8=\"More Information Needed\",C17=\"More Information Needed\",C36=\"More Information Needed\"),\"MORE INFORMATION NEEDED\",IF(C36=\"Recommend Continued Services\",\"RECOMMEND CONTINUED SERVICES\",IF(A7=\"Yes - DO NOT PROCEED WITH THE CES REVIEW\",\"CES REVIEW NOT REQUIRED- MEMBER IS HH+ ELIGIBLE\",\"CES REVIEW INCOMPLETE\"))))","v":"CES REVIEW INCOMPLETE"},null,null,null,{"$f":"A48","v":"CES REVIEW INCOMPLETE"}]
["DATE OF CES REVIEW","DATE NEXT CES REVIEW DUE","Supervisor Response to Recommendation (optional)"]
[null,{"$f":"IFERROR(_xlfn.IFS(A48=\"RECOMMEND CONTINUED SERVICES\", A50+180, A48=\"RECOMMEND DISENROLLMENT\", \"N/A\", A48=\"MORE INFORMATION NEEDED\", A50+60), \"\")","v":""}]
["REVIEWER NAME","TYPE OF STAFF COMPLETING THE TOOL"]
[]
["DOCUMENTS REVIEWED (optional)","DATE(S) OF THE DOCUMENTS (optional)"]
["PSYCKES:"]
["Care Plan:"]
["Comprehensive Assessment(s):"]
["Encounter Notes:"]
["Billing Support Questionnairres:"]

{"sheet":"CES Tool 9","index":10,"n_rows":58,"n_cols":5,"rows_kept":58,"cut":false,"hidden":true,"merged":[[13,0,13,1],[0,0,0,2],[9,0,9,1],[10,0,10,1],[7,0,7,1],[8,0,8,1],[11,0,11,2],[12,0,12,2],[25,0,25,1],[14,0,14,1],[15,0,15,1],[16,0,16,1],[17,0,17,1],[18,0,18,1],[19,0,19,1],[20,0,20,1],[21,0,21,1],[22,0,22,1],[23,0,23,1],[24,0,24,1],[38,0,38,1],[26,0,26,1],[27,0,27,1],[28,0,28,1],[29,0,29,1],[30,0,30,1],[31,0,31,1],[32,0,32,1],[33,0,33,1],[34,0,34,1],[35,0,35,1],[36,0,36,1],[37,0,37,1],[39,0,39,2],[40,0,45,2],[46,0,46,2],[47,0,47,2],[49,2,57,2]]}
["DOH CONTINUED ELIGIBILITY FOR SERVICES REVIEW TOOL \nUse with members enrolled for at least 1 year who are not pended, i.e. this should not be used on members who are Disengaged and in Diligent Search, or are Pended for any reason.                 \nDO NOT USE FOR ANY MEMBER THAT IS ELIGIBLE FOR HH+                                                                                                                                                                                                                               \n Look at CURRENT records.  That will generally mean documentation within the last 90 days, unless otherwise indicated. "]
["MEMBER NAME","MEMBER CIN","CARE MANAGER NAME"]
[]
["LAST IN PERSON CONTACT WITH MEMBER (DATE)","LAST CONTACT WITH AT LEAST ONE CARE TEAM MEMBER (DATE)","LAST COMPREHENSIVE REASSESSMENT (DATE)"]
[]
["ELIGIBLE FOR HH+ SMI OR HH+ HIV?","LENGTH OF STAY IN THEIR CURRENT HEALTH HOME PROGRAM (MONTHS) \n","TYPE OF REVIEW"]
[]
["BASIC ELIGIBILITY PRE-SCREEN  \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result.\nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.",null,{"$f":"IF(AND(C9=\"\",C11=\"\"),\"Is the Member Eligible for Health Home Services?\",IF(OR(C9=\"NO\",C11=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C9=\"UNCLEAR\",C11=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",IF(OR(C9=\"\",C11=\"\"),\"CONTINUE WITH THIS SECTION\",IF(AND(C9=\"Yes\",C11=\"Yes\"),\"PROCEED TO SIGNIFICANT RISK FACTORS\",\"Error\")))))","v":"Is the Member Eligible for Health Home Services?"}]
["Does the member still have qualifying diagnoses for Health Home?"]
["Which One(s)?"]
["Does the Member still have Active Medicaid, with no disqualifying R/E codes?\n\nRemember: Members can only be disenrolled due to inactive Medicaid if they are no longer eligible for Medicaid or if they have been refusing to take the necessary steps to fix the Medicaid case.  It is expected that HHCM’s will need to help members reactivate their Medicaid at times."]
[]
[]
["SIGNIFICANT RISK FACTORS \nSelection of at least one Concrete Example skips straight to Member Engagement \nSelection of “No Concrete Example of a Significant Risk Factor in record” skips straight to Additional Risk Factors. ",null,{"$f":"IF(C15=\"\",\"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?\",IF(C15=\"NONE OF THE ABOVE - PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO MEMBER ENGAGEMENT\"))","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"}]
["Select a Concrete Example of a Significant Risk Factor:"]
["Description/Specifics if indicated:"]
["Additional Risk Factors\nQuestions in this section DO NOT have to be answered in order.  As soon as the tool skips to another section or generates a result, stop answering further questions in this section. ",null,{"$f":"IF(AND(C18=\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",C23=\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",C29=\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\"),\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\",IF(OR(C18=\"MEMBER HAS GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",C29=\"THEY DO NOT HAVE THE SKILLS YET\"),\"SKIP TO MEMBER ENGAGEMENT\",IF(AND(C18=\"NO GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE STABLE\",C29=\"THEY HAVE THE SKILLS\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C18=\"UNCLEAR\",C23=\"UNCLEAR\",C29=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\"))))","v":"REVIEW GENERAL RISK, STABILITY, AND SKILLS"}]
["General Risk Factors: \nAny “Yes” answer skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result \nIf all answers are “No”, proceed to Stability Risk Factors ",null,{"$f":"IF(AND(C19=\"\",C20=\"\",C21=\"\",C22=\"\"),\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",IF(OR(C19=\"YES\",C20=\"YES\",C21=\"YES\",C22=\"YES\"),\"MEMBER HAS GENERAL RISK FACTORS\",IF(AND(C19=\"NO\",C20=\"NO\",C21=\"NO\",C22=\"NO\"),\"NO GENERAL RISK FACTORS\",IF(COUNTIF(C19:C22,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING GENERAL RISK\"))))","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"}]
["Has member had preventable or unnecessary hospitalizations or ER visits over the last six months?  \n“Preventable” means they were directly attributable to their lack of adherence to or access to treatments, appointments, or understanding of their Chronic Diagnoses. \n“Unnecessary” means the health care need could or should have been met in an outpatient or urgent care setting instead. "]
["Is the member's current housing unsafe?"]
["Has the member reported any safety concerns in their environment or their community, have they been able to follow a Safety Plan over the last six months?"]
["Has member been a danger to themselves or others within the last six months?\nExamples: Suicidal or homicidal ideation or attempts, violence towards self or others, inclusive of self-harm or arson, subject of a temporary restraining order, etc.  "]
["Stability Risk Factors: \nAny \"Yes\" answer to the first question, or a \"No\" answer to the last four questions, skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result. \nIf there are no “Unclear” answers, and the tool did not skip to Member Engagement, proceed to Skills Based Risk Factors ",null,{"$f":"IF(AND(C24=\"\",C25=\"\",C26=\"\",C27=\"\",C28=\"\"),\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",IF(AND(C24=\"No\",C25=\"Yes\",C26=\"Yes\",C27=\"Yes\",C28=\"Yes\"),\"HEALTH AND SDOH CONDITIONS ARE STABLE\",IF(OR(C24=\"Yes\",C25=\"No\",C26=\"No\",C27=\"No\",C28=\"No\"),\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",IF(OR(C24=\"Unclear\",C25=\"Unclear\",C26=\"Unclear\",C27=\"Unclear\",C28=\"Unclear\"),\"UNCLEAR\",\"CONTINUE ASSESSING STABILITY\"))))","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"}]
["If the member has a mental health diagnosis, have they experienced an increase in symptoms, or the need for crisis management responses within the last six months? \nCrisis management could be provided through a formal crisis response team, or informally through their HHCM. "]
["If the member has a SUD diagnosis, has the member met and maintained their SUD goals over the last six months, such as Abstinence, Moderation, or Harm Reduction?\nSUD applies to legal and illegal drugs of abuse, alcohol, and/or tobacco if the member has identified a goal related to use of that substance."]
["Has the member had stable housing over the last six months?\n\"Stable\" means there have been no evictions, moves, or periods of homelessness."]
["If the member is in a relationship with chronic Intimate Partner Violence, have they been able to follow a Safety Plan over the last six months?"]
["If the member is involved in the Criminal Justice System, have they been following the requirements of their Parole/Probation over the last six months?"]
["SKILLS-BASED RISK FACTORS\nAny “No” answer skips straight to Member Engagement  \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nIf all answers are “Yes”, this ends the screening and generates a “Recommend Disenrollment” result.  \n\nThese questions should be answered as if the member did not have HHCM assistance. Some people may have assistance from someone else in their life such as family, home aides, or other types of case managers, which we are referring to collectively as “a caregiver”.  ",null,{"$f":"IF(AND(C30=\"\",C31=\"\",C32=\"\",C33=\"\",C34=\"\",C35=\"\"),\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\",IF(AND(C30=\"YES\",C31=\"YES\",C32=\"YES\",C33=\"YES\",C34=\"YES\",C35=\"YES\"),\"THEY HAVE THE SKILLS\",IF(COUNTIF(C30:C35,\"No\")>0,\"THEY DO NOT HAVE THE SKILLS YET\",IF(COUNTIF(C30:C35,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING SKILLS\"))))","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"}]
["Does the member or caregiver understand the frequency of outpatient follow up, schedule and keep their healthcare appointments, and have reliable transportation to get to their healthcare appointments without HHCM assistance? "]
["Does the member or caregiver understand who is on their Care Team and when/why/how to contact them without HHCM assistance? "]
["Does the member or caregiver maintain the member’s medication adherence without HHCM assistance? "]
["Is the member or caregiver aware of upcoming recertifications for benefits and can successfully recertify without HHCM assistance? \nThis could include Medicaid, SNAP, SSI, SSDI, Public Assistance, etc.  "]
["Does the member or caregiver manage the member’s day-to-day finances without HHCM assistance? \nThis could include paying rent, bills, budgeting, etc. "]
["Does the member or caregiver manage the member’s ADLs and IADLs without HHCM assistance? "]
["Member Engagement \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result. \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nA \"Yes\" answer for ALL THREE questions ends the screening and generates a “Recommend Continued Services” result. \n\nMembers with legal guardians may not be able to engage actively with the CM, and progress on HH POC goals may look different than for other members.  \nFor example:  A member with severe dementia may not be able to talk directly to the HHCM, and the HHCM's primary engagement may be with the member's son or daughter.  \nThe \"Member Engagement\" questions may be considered as \"Caregiver Engagement\" questions in these cases. ",null,{"$f":"IF(AND(C37=\"\",C38=\"\",C39=\"\"),\"IS MEMBER ENGAGED WITH HHCM SERVICES?\",IF(OR(C37=\"No\",C38=\"No\",C39=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C37=\"UNCLEAR\",C38=\"UNCLEAR\",C39=\"UNCLEAR\"),\"More Information Needed\",IF(AND(C37=\"Yes\",C38=\"Yes\",C39=\"Yes\"),\"Recommend Continued Services\",\"Continue Assessing Member Engagement\"))))","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"}]
["Does the member have non-maintenance goals left to accomplish on the POC?\n\nAn active (non-maintenance) goal is one that requires actions by the HHCM to elicit progress towards completion of the goal. The members' goal(s) would not be achieved without concrete interventions and support of the HHCM.\n\nMaintenance goals are goals that the member has met, and although ongoing, do not require any active assistance from the HHCM.  Example: “Member will continue to fill their medication monthly”."]
["Has the member been actively engaged and working with the CM on their HH POC Goals and Tasks in the last six months?\n\nA member is not actively engaged if they are only in touch with the HHCM to say they are busy, or will call them back, or if regularly, Core Services being provided are only being provided through the Care Team because the member is unavailable.  \n\nA member is not working with the HHCM on their HH POC Goals and Tasks if during their contacts they are solely updating the HHCM on their life or persistently addressing something not on the POC. "]
["Have the member and Care Manager been making progress on their HH POC Goals and Tasks in the last six months?\n\nA member and HHCM are not making progress on the HH POC Goals and Tasks if the same task is being attempted month after month and nothing changes or moves forward. "]
["COMMENTS                                                                                                                                                                                                                                                                                                                                       "]
[]
[]
[]
[]
[]
[]
["RESULTS OF CONTINUED ELIGIBILITY FOR SERVICES REVIEW"]
[{"$f":"IF(OR(C8=\"Recommend Disenrollment\",C17=\"Recommend Disenrollment\",C36=\"Recommend Disenrollment\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C8=\"More Information Needed\",C17=\"More Information Needed\",C36=\"More Information Needed\"),\"MORE INFORMATION NEEDED\",IF(C36=\"Recommend Continued Services\",\"RECOMMEND CONTINUED SERVICES\",IF(A7=\"Yes - DO NOT PROCEED WITH THE CES REVIEW\",\"CES REVIEW NOT REQUIRED- MEMBER IS HH+ ELIGIBLE\",\"CES REVIEW INCOMPLETE\"))))","v":"CES REVIEW INCOMPLETE"},null,null,null,{"$f":"A48","v":"CES REVIEW INCOMPLETE"}]
["DATE OF CES REVIEW","DATE NEXT CES REVIEW DUE","Supervisor Response to Recommendation (optional)"]
[null,{"$f":"IFERROR(_xlfn.IFS(A48=\"RECOMMEND CONTINUED SERVICES\", A50+180, A48=\"RECOMMEND DISENROLLMENT\", \"N/A\", A48=\"MORE INFORMATION NEEDED\", A50+60), \"\")","v":""}]
["REVIEWER NAME","TYPE OF STAFF COMPLETING THE TOOL"]
[]
["DOCUMENTS REVIEWED (optional)","DATE(S) OF THE DOCUMENTS (optional)"]
["PSYCKES:"]
["Care Plan:"]
["Comprehensive Assessment(s):"]
["Encounter Notes:"]
["Billing Support Questionnairres:"]

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["DOH CONTINUED ELIGIBILITY FOR SERVICES REVIEW TOOL \nUse with members enrolled for at least 1 year who are not pended, i.e. this should not be used on members who are Disengaged and in Diligent Search, or are Pended for any reason.                 \nDO NOT USE FOR ANY MEMBER THAT IS ELIGIBLE FOR HH+                                                                                                                                                                                                                               \n Look at CURRENT records.  That will generally mean documentation within the last 90 days, unless otherwise indicated. "]
["MEMBER NAME","MEMBER CIN","CARE MANAGER NAME"]
[]
["LAST IN PERSON CONTACT WITH MEMBER (DATE)","LAST CONTACT WITH AT LEAST ONE CARE TEAM MEMBER (DATE)","LAST COMPREHENSIVE REASSESSMENT (DATE)"]
[]
["ELIGIBLE FOR HH+ SMI OR HH+ HIV?","LENGTH OF STAY IN THEIR CURRENT HEALTH HOME PROGRAM (MONTHS) \n","TYPE OF REVIEW"]
[]
["BASIC ELIGIBILITY PRE-SCREEN  \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result.\nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.",null,{"$f":"IF(AND(C9=\"\",C11=\"\"),\"Is the Member Eligible for Health Home Services?\",IF(OR(C9=\"NO\",C11=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C9=\"UNCLEAR\",C11=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",IF(OR(C9=\"\",C11=\"\"),\"CONTINUE WITH THIS SECTION\",IF(AND(C9=\"Yes\",C11=\"Yes\"),\"PROCEED TO SIGNIFICANT RISK FACTORS\",\"Error\")))))","v":"Is the Member Eligible for Health Home Services?"}]
["Does the member still have qualifying diagnoses for Health Home?"]
["Which One(s)?"]
["Does the Member still have Active Medicaid, with no disqualifying R/E codes?\n\nRemember: Members can only be disenrolled due to inactive Medicaid if they are no longer eligible for Medicaid or if they have been refusing to take the necessary steps to fix the Medicaid case.  It is expected that HHCM’s will need to help members reactivate their Medicaid at times."]
[]
[]
["SIGNIFICANT RISK FACTORS \nSelection of at least one Concrete Example skips straight to Member Engagement \nSelection of “No Concrete Example of a Significant Risk Factor in record” skips straight to Additional Risk Factors. ",null,{"$f":"IF(C15=\"\",\"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?\",IF(C15=\"NONE OF THE ABOVE - PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO ADDITIONAL RISK FACTORS\",\"PROCEED TO MEMBER ENGAGEMENT\"))","v":"DOES MEMBER CURRENTLY HAVE A CONCRETE EXAMPLE OF A SIGNIFICANT RISK FACTOR?"}]
["Select a Concrete Example of a Significant Risk Factor:"]
["Description/Specifics if indicated:"]
["Additional Risk Factors\nQuestions in this section DO NOT have to be answered in order.  As soon as the tool skips to another section or generates a result, stop answering further questions in this section. ",null,{"$f":"IF(AND(C18=\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",C23=\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",C29=\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\"),\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\",IF(OR(C18=\"MEMBER HAS GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",C29=\"THEY DO NOT HAVE THE SKILLS YET\"),\"SKIP TO MEMBER ENGAGEMENT\",IF(AND(C18=\"NO GENERAL RISK FACTORS\",C23=\"HEALTH AND SDOH CONDITIONS ARE STABLE\",C29=\"THEY HAVE THE SKILLS\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C18=\"UNCLEAR\",C23=\"UNCLEAR\",C29=\"UNCLEAR\"),\"MORE INFORMATION NEEDED\",\"REVIEW GENERAL RISK, STABILITY, AND SKILLS\"))))","v":"REVIEW GENERAL RISK, STABILITY, AND SKILLS"}]
["General Risk Factors: \nAny “Yes” answer skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result \nIf all answers are “No”, proceed to Stability Risk Factors ",null,{"$f":"IF(AND(C19=\"\",C20=\"\",C21=\"\",C22=\"\"),\"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?\",IF(OR(C19=\"YES\",C20=\"YES\",C21=\"YES\",C22=\"YES\"),\"MEMBER HAS GENERAL RISK FACTORS\",IF(AND(C19=\"NO\",C20=\"NO\",C21=\"NO\",C22=\"NO\"),\"NO GENERAL RISK FACTORS\",IF(COUNTIF(C19:C22,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING GENERAL RISK\"))))","v":"DOES THE MEMBER HAVE ANY GENERAL RISK FACTORS?"}]
["Has member had preventable or unnecessary hospitalizations or ER visits over the last six months?  \n“Preventable” means they were directly attributable to their lack of adherence to or access to treatments, appointments, or understanding of their Chronic Diagnoses. \n“Unnecessary” means the health care need could or should have been met in an outpatient or urgent care setting instead. "]
["Is the member's current housing unsafe?"]
["Has the member reported any safety concerns in their environment or their community, have they been able to follow a Safety Plan over the last six months?"]
["Has member been a danger to themselves or others within the last six months?\nExamples: Suicidal or homicidal ideation or attempts, violence towards self or others, inclusive of self-harm or arson, subject of a temporary restraining order, etc.  "]
["Stability Risk Factors: \nAny \"Yes\" answer to the first question, or a \"No\" answer to the last four questions, skips straight to Member Engagement \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result. \nIf there are no “Unclear” answers, and the tool did not skip to Member Engagement, proceed to Skills Based Risk Factors ",null,{"$f":"IF(AND(C24=\"\",C25=\"\",C26=\"\",C27=\"\",C28=\"\"),\"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?\",IF(AND(C24=\"No\",C25=\"Yes\",C26=\"Yes\",C27=\"Yes\",C28=\"Yes\"),\"HEALTH AND SDOH CONDITIONS ARE STABLE\",IF(OR(C24=\"Yes\",C25=\"No\",C26=\"No\",C27=\"No\",C28=\"No\"),\"HEALTH AND SDOH CONDITIONS ARE NOT STABLE\",IF(OR(C24=\"Unclear\",C25=\"Unclear\",C26=\"Unclear\",C27=\"Unclear\",C28=\"Unclear\"),\"UNCLEAR\",\"CONTINUE ASSESSING STABILITY\"))))","v":"ARE MEMBER'S HEALTH AND SDOH CONDITIONS STABLE?"}]
["If the member has a mental health diagnosis, have they experienced an increase in symptoms, or the need for crisis management responses within the last six months? \nCrisis management could be provided through a formal crisis response team, or informally through their HHCM. "]
["If the member has a SUD diagnosis, has the member met and maintained their SUD goals over the last six months, such as Abstinence, Moderation, or Harm Reduction?\nSUD applies to legal and illegal drugs of abuse, alcohol, and/or tobacco if the member has identified a goal related to use of that substance."]
["Has the member had stable housing over the last six months?\n\"Stable\" means there have been no evictions, moves, or periods of homelessness."]
["If the member is in a relationship with chronic Intimate Partner Violence, have they been able to follow a Safety Plan over the last six months?"]
["If the member is involved in the Criminal Justice System, have they been following the requirements of their Parole/Probation over the last six months?"]
["SKILLS-BASED RISK FACTORS\nAny “No” answer skips straight to Member Engagement  \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nIf all answers are “Yes”, this ends the screening and generates a “Recommend Disenrollment” result.  \n\nThese questions should be answered as if the member did not have HHCM assistance. Some people may have assistance from someone else in their life such as family, home aides, or other types of case managers, which we are referring to collectively as “a caregiver”.  ",null,{"$f":"IF(AND(C30=\"\",C31=\"\",C32=\"\",C33=\"\",C34=\"\",C35=\"\"),\"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?\",IF(AND(C30=\"YES\",C31=\"YES\",C32=\"YES\",C33=\"YES\",C34=\"YES\",C35=\"YES\"),\"THEY HAVE THE SKILLS\",IF(COUNTIF(C30:C35,\"No\")>0,\"THEY DO NOT HAVE THE SKILLS YET\",IF(COUNTIF(C30:C35,\"Unclear\")>0,\"UNCLEAR\",\"CONTINUE ASSESSING SKILLS\"))))","v":"DOES MEMBER HAVE THE SKILLS TO MANAGE THEIR HEALTH AND SDOH NEEDS?"}]
["Does the member or caregiver understand the frequency of outpatient follow up, schedule and keep their healthcare appointments, and have reliable transportation to get to their healthcare appointments without HHCM assistance? "]
["Does the member or caregiver understand who is on their Care Team and when/why/how to contact them without HHCM assistance? "]
["Does the member or caregiver maintain the member’s medication adherence without HHCM assistance? "]
["Is the member or caregiver aware of upcoming recertifications for benefits and can successfully recertify without HHCM assistance? \nThis could include Medicaid, SNAP, SSI, SSDI, Public Assistance, etc.  "]
["Does the member or caregiver manage the member’s day-to-day finances without HHCM assistance? \nThis could include paying rent, bills, budgeting, etc. "]
["Does the member or caregiver manage the member’s ADLs and IADLs without HHCM assistance? "]
["Member Engagement \nAny “No” answer ends the screening and generates a “Recommend Disenrollment” result. \nAny “Unclear” answer ends the screening and generates a “More Information Needed” result.  \nA \"Yes\" answer for ALL THREE questions ends the screening and generates a “Recommend Continued Services” result. \n\nMembers with legal guardians may not be able to engage actively with the CM, and progress on HH POC goals may look different than for other members.  \nFor example:  A member with severe dementia may not be able to talk directly to the HHCM, and the HHCM's primary engagement may be with the member's son or daughter.  \nThe \"Member Engagement\" questions may be considered as \"Caregiver Engagement\" questions in these cases. ",null,{"$f":"IF(AND(C37=\"\",C38=\"\",C39=\"\"),\"IS MEMBER ENGAGED WITH HHCM SERVICES?\",IF(OR(C37=\"No\",C38=\"No\",C39=\"No\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C37=\"UNCLEAR\",C38=\"UNCLEAR\",C39=\"UNCLEAR\"),\"More Information Needed\",IF(AND(C37=\"Yes\",C38=\"Yes\",C39=\"Yes\"),\"Recommend Continued Services\",\"Continue Assessing Member Engagement\"))))","v":"IS MEMBER ENGAGED WITH HHCM SERVICES?"}]
["Does the member have non-maintenance goals left to accomplish on the POC?\n\nAn active (non-maintenance) goal is one that requires actions by the HHCM to elicit progress towards completion of the goal. The members' goal(s) would not be achieved without concrete interventions and support of the HHCM.\n\nMaintenance goals are goals that the member has met, and although ongoing, do not require any active assistance from the HHCM.  Example: “Member will continue to fill their medication monthly”."]
["Has the member been actively engaged and working with the CM on their HH POC Goals and Tasks in the last six months?\n\nA member is not actively engaged if they are only in touch with the HHCM to say they are busy, or will call them back, or if regularly, Core Services being provided are only being provided through the Care Team because the member is unavailable.  \n\nA member is not working with the HHCM on their HH POC Goals and Tasks if during their contacts they are solely updating the HHCM on their life or persistently addressing something not on the POC. "]
["Have the member and Care Manager been making progress on their HH POC Goals and Tasks in the last six months?\n\nA member and HHCM are not making progress on the HH POC Goals and Tasks if the same task is being attempted month after month and nothing changes or moves forward. "]
["COMMENTS                                                                                                                                                                                                                                                                                                                                       "]
[]
[]
[]
[]
[]
[]
["RESULTS OF CONTINUED ELIGIBILITY FOR SERVICES REVIEW"]
[{"$f":"IF(OR(C8=\"Recommend Disenrollment\",C17=\"Recommend Disenrollment\",C36=\"Recommend Disenrollment\"),\"RECOMMEND DISENROLLMENT\",IF(OR(C8=\"More Information Needed\",C17=\"More Information Needed\",C36=\"More Information Needed\"),\"MORE INFORMATION NEEDED\",IF(C36=\"Recommend Continued Services\",\"RECOMMEND CONTINUED SERVICES\",IF(A7=\"Yes - DO NOT PROCEED WITH THE CES REVIEW\",\"CES REVIEW NOT REQUIRED- MEMBER IS HH+ ELIGIBLE\",\"CES REVIEW INCOMPLETE\"))))","v":"CES REVIEW INCOMPLETE"},null,null,null,{"$f":"A48","v":"CES REVIEW INCOMPLETE"}]
["DATE OF CES REVIEW","DATE NEXT CES REVIEW DUE","Supervisor Response to Recommendation (optional)"]
[null,{"$f":"IFERROR(_xlfn.IFS(A48=\"RECOMMEND CONTINUED SERVICES\", A50+180, A48=\"RECOMMEND DISENROLLMENT\", \"N/A\", A48=\"MORE INFORMATION NEEDED\", A50+60), \"\")","v":""}]
["REVIEWER NAME","TYPE OF STAFF COMPLETING THE TOOL"]
[]
["DOCUMENTS REVIEWED (optional)","DATE(S) OF THE DOCUMENTS (optional)"]
["PSYCKES:"]
["Care Plan:"]
["Comprehensive Assessment(s):"]
["Encounter Notes:"]
["Billing Support Questionnairres:"]