Alliance Behavioral Healthcare. August 27, 2013

Transcription

1 Committee name: Alliance Behavioral Healthcare Alliance Provider Advisory Council (APAC) August 27, 2013 APAC Alliance Provider Advisory Council Meeting date: August 27, 2013 Report submitted Co-Chair: Carlyle Johnson, Ph.D. Date: ; Co-chair: Mark Germann Date: by and Approved: Terri Rose Betsey Torsell Tim Brooks (Durham) Lauren Durant (Durham) Mark Germann (Wake) Adrienne Monroe Alicia Camacho Patricia Little (Johnston) Wendy Wenzel (Wake) Michael Boles (Wake) (Durham) Members Jesse Brayboy Steve Strickland Trish Hussey (Durham) Bobby Jo Hopf (Wake) David Ingram (Wake) (Johnston) Steven King Tara Woodard Peter Baker (Durham) Sara Leonard (Wake) Laurie Stickney (Wake) (Johnston) Carlyle Johnson, Tasha Griffin, Bobbie Jo Hopf, Mark Germann, Patricia Little, Tim Brooks, Steve Strickland, Wendy Wenzel, Laurie Members Present: Stickney, David Ingram, Alicia Camacho, Lauren Durant, Terri Rose BY PHONE: Adrienne Monroe, Jesse Brayboy, Steve King, Peter Baker, Trish Hussey Vince Wagner, Alison Reiber, Beth Melcher, Rob Robinson, Tracy Hayes, Lena Klumper, Sean Schreiber, Cathy Estes, Kelly Goodfellow Guest(s): BY PHONE: Janis Nutt, Lori Caviness Scribe: Nikkia Frazier Welcome and Introductions Introductions were made around the table, including those joining by telephone. There are several members of the Alliance Senior Management Team and other Alliance staff members present. The group was informed that the senior management staff at Alliance is holding this meeting on their calendar and will be joining the meeting as needed. Review of July meeting minutes. Minutes approved as written. Announcements: 1 Alliance Provider Advisory Council minutes August 27, 2013

2 Distribution of Final Operational Agreement for this committee The final document was submitted by Mark Germann and Tim Brooks. This document will be distributed to Alliance Senior Management electronically for review. There may be some additional tasks asked of this committee as well. Alliance Updates Provider Selection and Retention (Tracy) Selection criteria In accordance with federal law and our contract with the State, Alliance is required to develop operational procedures. Although the document has already been submitted to URAC and is signed by the Area Director, Alliance does not consider the document final and is interested in having the feedback of this committee. All MCO s now have the ability now to choose the providers with whom they would like to contract. The goals of these procedures are to (1) ensure that we have the highest quality providers that we can (2) ensure that we are meeting the accessibility requirements with sufficient providers (3) promote efficiency and (4) to ensure the viability of the Alliance Provider Network. The Alliance Provider Network is currently closed; this applies to current providers that want to add an additional site and/or service. This does not apply to linking licensed individual practitioners to provider agencies. As we identify a service need we will open the network for that specific need. We have an RFI/RFP procedure to help streamline this process. We also can post a specific request on the website. Alliance endeavors to be transparent about what our needs are. Retention criteria This procedure is not yet final, but Senior Management wants to give this committee a preliminary list of the factors that will be considered when it s time for a contract renewal. Those factors include the availability of funds, compliance with the Alliance contract, compliance with our policies and procedures, medical necessity, evidence based and best practices, meeting the Access and Information Center standards, no reject policy, full cooperation with program integrity activities, consumer satisfaction surveys, etc. Conversely, criteria that would lead us not to renew are if a provider is not in compliance, has not billed in previous 60 days prior to contract review, not in good standing with other MCO s, the IRS, Department of Labor, DMA and/or DMH. Additionally, if we have issued 3 or more Plans of Correction for the same or substantially similar findings, failing to payback any overpayments, consistent volume of claim denials, quality of care concerns or 2 Alliance Provider Advisory Council minutes August 27, 2013

3 grievances that have not be satisfactorily resolved, the contract may not be renewed. Finally, if we have identified excess capacity for the services then we would issue an RFP/RFI (e.g. if we have 40 providers of a particular service, but only need 25). The accepted providers would get contracts; the remaining providers would have their contracts ended. Feedback regarding these procedures should be sent to the APAC co-chairs in the next 30 days. Carlyle will send the document out electronically to the group. Provider Operations manual (Tracy) The manual will be posted on the Alliance website soon. The biggest change to the manual pertains to URAC s very specific requirements concerning conflict resolution with a provider. Whenever Alliance takes action against a provider, the provider can request a review by a 3 person panel; the panel would include a provider peer. If the ruling of the panel is not satisfactory to the provider, there is an opportunity for an appeal with a new panel. Alliance is requesting the help of this committee to identify a pool of potential provider peers. This committee is also asked to provide feedback on this manual within the next 30 days. Please send your questions and/or comments to Carlyle prior to the next meeting so the issues can be discussed at next month s meeting. This committee will meet again on 9/24/13. Network Development Plan (Beth) This plan outlines the ways that Alliance would work to fill the gap when a network deficit is identified. There are 3 service development areas: 1. Specific Service Requests - Feedback from Access, Care Coordination and other daily operations of Alliance. From that feedback we would pull available data from claims, UM, QM, Compliance and any other relevant departments and present it to the Provider Network Management Committee for evaluation. The PNMC has just identified a need for prescribers. Details will be posted soon. Alliance will be also developing an RFP around Supported Employment soon. 2. Local Business Plan Initiatives another opportunity to open up the network. LBP templates will guide this process. (Will be discussed next). 3. Promote Evidence Based and Best Practices - this process will identify service areas that are overpopulated. Alliance is working to identify what the best practices are for enhanced services and develop an RFI/RFP around those best practices. Areas being considered currently are IIH, CST and SAIOP. We are starting to evaluate the criteria that make a good IIH, CST or SAIOP program. We are very early in this process; want this process to be open. The RFI/RFP will be posted to the website. Will Alliance look first to existing providers or will you open up the network to everyone? 3 Alliance Provider Advisory Council minutes August 27, 2013

4 Depends on the service. Alliance will first try to look to our Provider Network whenever possible. What is the best way to find out what the current service needs are? They will be on the website. Other ways that providers can be selected? Payer source can dictate (e.g. if Wake County has allocated dollars for a certain provider), if there is an emergency need to serve a consumer/s, provider assignment (e.g. MCT is assigned to DCA) Provider Profile Alliance has completed a provider profile of our whole network by county. This document will be ready for distribution when this committee meets next month (9/24/13). This will give a good sense of what the network currently looks like. Network development practices should be based on the needs of our consumers and Alliance will work to validate that it s a true need for our network. Alliance will likely be reducing the number of contracts in order to right size the provider network. What is your (APAC) reaction to this? Was this expected? A surprise? What if you have more qualified providers than you need? How will Alliance decide who to contract with? We are currently doing geo-mapping to evaluate saturation. There is not a national norm we are first trying to focus on quality/best practice/fiscal viability/meeting expectations providers. We think through that process there will be some natural attrition. APAC Suggestion: Less check boxes and more qualitative looks at how services are being provided. Really look at the infrastructure. Provider interviews and/or shadowing may be a consideration. Rob informed the group that Alliance would really like the support and backing of this committee throughout this process. Alliance Local Business Plan (Lena) Carlyle will send the power point and the draft of the local business plan to this committee electronically. The plan is a DHHS requirement and must include short and long term measurable goals. The State has given us a template to use. Alliance intends for this to be a living document rather than a static one; we will amend as necessary over the 3 year time period. The plan requires approval from the county commissioners of the Alliance catchment area. Lena requests feedback within the next 2 weeks so the document can be moved forward and submitted on time. The Alliance LBP has 5 State Initiatives and 3 Local Initiatives. Lena reviewed the issues, reasons for action and measurable goals for each state and local initiative. (Document: LBP Presentation to APAC ) 4 Alliance Provider Advisory Council minutes August 27, 2013

5 5 State Initiatives: Transition to Community Living ACTT/Supported Employment Crisis Service Enhancement Closer to Home (PRTF) IDD Waitlist Local Initiatives PROACT Open Access Diversion/Jail Initiatives Perception of Care surveys The Quality Management department is in the process of analyzing the data. Aggregate data will be put on the website when available. QM staff will provide an update on current Quality Improvement Projects at next month s meeting (9/24/13). Re-Credentialing (Cathy) Within accreditation guidelines, we are required to do initial and a minimum of every 3 years to do re-credentialing for Agencies, hospitals, LP, LIPs, Groups, CABHAs, we are hitting close to 3000 re-credentialing processes that we have to do. We are starting in September, next month, because it s timely. We will send out info on what we are requiring. Very similar to initial credentialing. PSV for owners, directors, managing employees. Will be providing definitions also. Cathy hopes to do some every quarter. Alliance will be staggering the process to get it done in the 3 year requirements. 3 years from the time the providers were credentialed, not the go live date. Initial was more about check boxes, re-credentialing also takes into account similar points from the retention policy. This information was not available for the initial credentialing. PNCC-also need providers to be a part of the credentialing committee. Please contact Cathy if interested, meets once a week. Disaster Preparedness (Carlyle) This will also be discussed at the next All Provider Meeting (9/18/13). First concern is does each provider have a plan for maintaining operations. We also need a plan for providing behavioral health services in times of disaster/inclement weather. 5 Alliance Provider Advisory Council minutes August 27, 2013

6 Update on IMT Site Visit IMT review of Alliance will occur the day after the All Provider Meeting (9/19/13). Reviewer will come in to meet with staff throughout the day. If any members from this committee are available, Alliance is also requesting provider representation. We have to make sure we are compliant with the Medicaid waiver. Agenda for Alliance quarterly All Provider Meeting The next APM is 9/18. We will cover the same topics that were covered in this meeting, including updates from the local PACs, record retention and Project Lazarus. Alliance requests the feedback of this committee on the selection of agenda topics. We want to cover topics that are important to providers; topics that are better communicated in person. Alliance is trying to pull together an IDD breakout meeting before the APM. Follow-up Items: Next Steps: APAC input for Provider Network Collaboration Project Alliance is striving to familiarize ourselves with our network providers and find effective ways of communicating with the pool. We want to make sure that we are using the APAC committees and subcommittees for feedback and subsequently closing the loop. So far most feedback from providers has been centered making the Alliance website more informative. In terms of the design and information, what would this committee like to see on the Alliance webpage? What features would be helpful to you as a provider? What is working well? What is not working? Responses: Searches by provider, keyword, funding source, language and service Geo-mapping, a link to area map; bus routes A who to contact if section A listing of departmental responsibilities Can providers have access to a list of staff and phone numbers and/or addresses? 6 Alliance Provider Advisory Council minutes August 27, 2013

7 If there are generic departmental addresses (i.e. the QM Help and Provider Network s), providers need to know what questions they can get answered from that address. Is there a way to remove unused links/unnecessary information? Reference materials, QM information (e.g. what constitutes a good plan) Written FAQs Some way to identify/highlight new information/features that have been added to the website Updates from local provider advisory councils Cumberland Reminder - Cumberland provider meeting is the 1 st Monday of the month. Durham: Johnston - well attended. Used as a networking meeting. Occurs the 2 nd Wednesday of every month at 2:30. There was an I/DD specific meeting held in Johnston recently. Wake - CPAC meeting. There were some complaints about the amount of time that authorizations are taking; a request was made to speed up approvals for enhanced services. Also complaints regarding the timeliness and responsiveness of call center staff. The next meeting will be September 24, 2013 (the fourth Tuesday of every month). 7 Alliance Provider Advisory Council minutes August 27, 2013