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Ohio County Behavioral Health Boards Regional Meeting Fall 2018 OhioMedicaid
Ohio County Behavioral Health Boards Regional Meeting
Fall 2018
OhioMedicaid
Agenda
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• Expansion
• Work Requirement and Community Engagement Waiver
• BH Redesign
• Ongoing Monitoring
• Technical Assistance
• Background Checks, Tiering, and Certificate of Qualification for Employment
• BHCC – Plan for 2019
• Questions & Answers
Work Requirement & Community Engagement Waiver
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Expansion
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2018 Group VIII AssessmentThe Ohio Medicaid 2018 Group VIII Assessment is a follow-up report to continue to evaluate the impact of the 2014 Group VIII expansion.
RESEARCH TEAM
ABOUTIn 2015, the Ohio General Assembly required ODM to provide a report evaluating the impact of Ohio’s 2014 Medicaid expansion. ODM delivered the first report in 2016.
Expansion Assessment Overview
5,867 individuals participated in the telephone survey and 25 focus groups were conducted.
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Key Findings: Medicaid working to improve lives
Average number of individuals enrolled in SFY 2018, down from 721,000 in SFY 2017.
692,0001,180,940*
individuals accessed health care as a result
of Ohio Medicaid expansion.
89%of participants in
2016 had no health insurance at the
time of enrollment.*Includes coverage for more than 630,000 individuals to date with
behavioral health needs who previously relied on county-funded
services or went untreated.
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Expansion
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In general, Medicaid expansion has been beneficial to Ohio Group VIII enrollees by*:
1) facilitating continued employment, new employment, and job-seeking;
2) increasing primary care and reducing emergency department use;
3) lessening medical debt and financial hardship;
4) improving mental health;
5) assisting in addressing unhealthy behaviors such as tobacco use; and
6) enabling enrollees to act as caregivers for family members.
Compared to the 2016 Group VIII Assessment, a higher percentage of all Group VIII enrollees are now employed, access primary care providers, use emergency department services less, report better mental health, and are optimistic about their individual functioning.
*2018 Ohio Medicaid Group VIII Assessment, Executive Summary:A Follow-Up to the 2016 Ohio Medicaid Group VIII AssessmentAugust 2018
Behavioral HealthRedesign
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Behavioral Health Redesign Strategic Plan
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1. Elevation (2012) – shift Medicaid match to the state to ensure more consistent provision of treatment services statewide, supported by Departments of Medicaid and Mental Health and Addiction Services
2. Expansion (2014) – extended Medicaid coverage to more than 630,000 very low-income Ohioans with behavioral health needs who previously relied on county-funded services or went untreated
3. Modernization (January 1, 2018) – expand Medicaid services for individuals with the most intense need and update Medicaid billing codes for behavioral health providers to align with national standards
4. Integration (July 1, 2018) – coordinate physical and behavioral health care services within Medicaid managed care to support recovery for individuals with a substance use disorder or mental illness
Why Medicaid Managed Care?
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Improved health outcomes by paying for quality: ability to incentivize/penalize performance for member outcomes and experience Access to care: federally-mandated provider network requirements and monitoring across all provider types Value-based reimbursement: allows for a system to reward plans and providers based on performance and the quality of services provided Care Management: allows for person-centered care integration based on the needs of the whole personLong-term sustainability: better able to predict budget due to full-risk managed care contracts
Individuals Receiving Behavioral Health Services
of the total Medicaid population have been diagnosed with and treated for a behavioral health condition
26%
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Ongoing Monitoring
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Working Together Post-Managed Care Implementation: Integration Task Force
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• Convenes weekly (bi-weekly effective Oct.) to discuss post-implementation progress
• Includes provider and advocacy groups, MCPs, as well as ODM, OhioMHAS, and JMOC
• Addresses ongoing discussion items• Typical agenda includes:
» Configuration updates » Practitioner enrollment updates» MCP report-out» Glide path report updates» Contingency plan updates» MCP rapid response team report-out
State Monitoring
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• State continually monitors the MCPs for program compliance with BH Redesign and Managed Care Integration, including (but not limited to) review of:
» continuity of care for consumers, » access to and utilization of services, » number of participating providers, and » accurate, prompt provider payment
• State continues to report latest updates to JMOC» Latest JMOC presentation, held on September 20th:
http://www.jmoc.state.oh.us/assets/meetings/JMOCSept2018Final.pdf
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Top Reasons for Claim Denials Across MCPs
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• Missing primary insurance information • Invalid/missing modifier (service code modifier or degree level
modifier)• Invalid diagnosis code for the service • Procedure inappropriate for provider specialty (billing SUD
services under MH NPI, practitioner credentials need updated, or billing lab codes without a contract)
• Member not enrolled with plan or no longer Medicaid eligible • Invalid/missing NDC# • Invalid/missing information from ordering physician
Technical Assistance
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MCP Technical Assistance
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• Providers are encouraged to reach out directly to the MCPs with any questions or issues.
» MCPs are amenable to providing 1:1 technical assistance.• MCPs have established rapid response teams to resolve inquiries within a
timely fashion.• MCPs are holding webinars to update providers on latest information.• A Provider Complaint Form is available at
providercomplaints.ohiomh.com. Providers are encouraged to work directly with the MCP before submitting a complaint to ODM.
Medicaid Managed Care Plan Resource Guide (updated on a regular basis)Plans have developed a comprehensive resource guide identifying individuals who will serve as points of contact for provider inquiries regarding MCP operations, billing, prior authorization, and pharmacy: http://bh.medicaid.ohio.gov/Provider/Medicaid-Managed-Care-Plans.
MCP Technical Assistance Contacts
State Technical AssistanceOhio Medicaid Provider Hotline: 1-800-686-1516
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Aetna:Provider Assistance Resources:
Rapid Response Team: [email protected] Authorization Questions: 1-855-364-0974, option 2, then 424/7 Notification Fax: 1-855-734-9393Provider Services: 1-855-364-0974, option 2, then 5Escalation/Other Questions: Afet Kilinc, 959-299-7278, 614-254-3229, [email protected]
Buckeye:Provider Assistance Resources:
Rapid Response Team: [email protected] Relations: 1-866-246-4356, ext 2429124/7 Prior Authorization Line: 1-800-224-199124/7 OH Notification Fax: 1-866-535-6974Escalation/Other Questions: Laura Paynter, (866)246-4356, ext. 24446, [email protected]
CareSource:Provider Assistance Resources:
Rapid Response Team: 1-800-488-013424/7 Notification Fax: 1-937-487-166424/7 Notification Email: [email protected]/Other Questions: Terry Jones, 614-225-4613,[email protected]
Molina:Provider Assistance Resources:
Rapid Response Team: [email protected] Services/Prior Authorization Questions: 1-855-322-407924/7 Notification Fax: 1-866-449-6843Care Management Referrals: [email protected]/Other Questions: Emily Higgins, (614)212-6298, [email protected]
Paramount:Provider Assistance Resources:
Rapid Response Team: 1-419-887-2564Rapid Response Email: [email protected] 24/7 Notification Fax: 1-844-282-4901Provider Relations Email: [email protected] Health Fax: 1-567-661-0841Escalation/Other Questions: Linda Nordahl, 419-887-2279, [email protected]
United:Provider Assistance Resources:
Rapid Response Team: [email protected]/7 Phone Line: 1-800-600-900724/7 Provider Prior Authorization Request: 1-866-261-769224/7 Online Prior Authorization Request via Provider Portal: www.providerexpress.com and www.UnitedHealthcareOnline.comEscalation/Other Questions: Tracey Izzard-Everett, (614)410-7592, [email protected]
Extended Repayment Option: MCP 54.6% Advanced Payment Agreements
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• To be considered, providers must submit an application of intent. Requirements for participation will include:
o Billing the MCPso Verifying all staff have enrolled with ODM and affiliated with the agencyo Contracting and credentialing completed or in process
• Providers will work with plans to negotiate a repayment schedule that is unique to the specific situation
o Recoupment will not be done through first dollar reimbursemento Percentage of expected revenue received to date will be consideredo ODM is supportive of plans delaying recoupment past Nov. 2018 and extending the
recoupment schedule beyond Jul. 2019 • ODM will act as a third party if needed in plan-provider negotiations• Providers will sign an addendum to their original agreements outlining the new terms*• A technical assistance component will be implemented
*Applicable to MCP 54.6% agreements only. Does not apply to CareSource and Molina enhanced agreements.
http://bh.medicaid.ohio.gov/Provider/Medicaid-Managed-Care-Plans
ODM Resources: • Medicaid Consumer hotline: 1-800-324-8680
• Beneficiary Ombudsman: Sherri Warner (Phone: 614-752-4599; Email: [email protected])
OhioMHAS Resources:• Client Rights and Advocacy Resources (http://mha.ohio.gov/Default.aspx?tabid=270)
Local Resources:• National Alliance on Mental Illness helpline: 1-800-686-2646
• Ohio Association of County Behavioral Health Authorities, Board Directory (http://www.oacbha.org/mappage.php)
MCP Resources:• Medicaid Consumer hotline: 1-800-324-8680
• See consumer’s Medicaid card
The resources below can help individuals in accessing current or new services:
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Available Consumer Resources
Background Checks, Tiering, and Certificate of
Qualification for Employment
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Background Checks, Tiering, CQEs*
• Emergency rule was put in place, effective July 1, 2018. The revised permanent version of the rule became effective October 28, 2018:
• Revised changes to rule:» Providers will be able to enroll as long as they’ve demonstrated they’ve applied for a
certificate of qualification for employment (CQE). » Providers will be allowed to continue to provide services as long as their CQE is not
denied, while those who are pending would be allowed to continue until October 1, 2019, when ODM will submit the rule to JCARR again.
• ODM will continue to work with stakeholders on any additional considerations to the revised rule, including review of some of the disqualifying offenses, and which types of offenses should fall under which tiers.
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*Background checks, tiering, and CQE requirements apply to all Medicaid provider types, and are not specific to just BH providers
Certificate of Qualification for Employment (CQE)
• The CQE process allows people with a previous felony or misdemeanor conviction to apply to a local common pleas court (usually where they live) for the CQE.
• If a CQE is issued, the CQE provides the person relief from a “civil impact” or “collateral sanction.”
• The CQE process is managed by the Ohio Department of Rehabilitation & Correction (ODRC).
» ODRC CQE website: http://drc.ohio.gov/cqe. Includes a list of approved CQEs.
• Fully electronic application:https://www.drccqe.com/Login2.aspx?APPTHEME=OHCQE
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Behavioral Health CareCoordination (BHCC)
Plan for 2019
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Context: Accountability for care coordination
Medicaid Managed Care Plan
Comprehensive Primary Care
(CPC)
Qualified Behavioral Health
Entity• Mutual Accountability• Alignment on care plan, patient
relationship, transitions of care, etc.• Common identification of needs and
assignment of care coordination
• Require health plans to delegate components of care coordination to qualified behavioral health entities (“Model 2” design)
• Care management identification strategy for high risk population
• Require health plans to financially reward practices that keep people well and hold down total cost of care, including behavioral health
• Care coordination defaults to primary care unless otherwise assigned by the plan
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BHCC – Plan for 2019
• The Behavioral Health Care Coordination program is being implemented July 1, 2019.
• Work is ongoing with the State, the managed care plans, providers, and associations to:
» finalize details on reporting, » move the program forward, and » ensure the providers and managed care plans are ready to implement
come July 1st.
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SUD Treatment under BH Redesign & 1115 Waiver
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Opportunities to Review and Comment on 1115 Waiver• The draft SUD 1115 waiver application has been posted for a public
comment at this address:https://medicaid.ohio.gov/RESOURCES/Public-Notices/Substance-Use-Disorder-Treatment-Waiver-ProposalComments can be submitted until 11.25.2018
• ODM held two public meetings to discuss the 1115 Waiver: November 15, 2:00 pm; ODM Office, 50 W. Town St, Columbus OHNovember 20, 1:00 pm; Paramount office, 1901 Wood Circle, Maumee OH
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1115 SUD Waiver Goals
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» Increase access to SUD treatment with emphasis on:
» Medication Assisted Treatment
» Residential SUD treatment
» Implement consistent SUD residential treatment according to clinical treatment guidelines set by the American Society on Addiction Medicine (ASAM)
» Develop performance and outcome measures for successful SUD treatment
**Please visit : http://bh.medicaid.ohio.gov/training for ASAM and other training resources**
Waiver Timeline
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August-September 2018• Gather data and conduct
background meetings to ensure past efforts are documented in waiver
• Draft waiver
October 2018• Conduct stakeholder
meeting• Finalize waiver for
posting for public comment
• Post waiver for 30-day public comment
November 2018• Finalize Waiver and
implementation plan• Submit Waiver and
Implementation Plan by Nov. 30th
December 2018• Finalize waiver with
CMS
August 2018 September 2018 October 2018 November 2018 December 2018 Spring 2019
Spring 2019• Receive approval from CMS• Submit HIT Plan to CMS
April 1• Submit SUD Monitoring
Plan to CMS with performance measure baselines May 1
• Submit Evaluation Design to CMS July 1
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