Fayette County Behavioral Health Administration Advisory Board
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- Claud Payne
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1 Our Mission Fayette County Behavioral Health Administration enriches lives by providing access to and assuring choice among the best behavioral and developmental resources that promote recovery and resiliency.
2 Fayette County Behavioral Health Administration Advisory Board Fayette County HealthChoices Advisory Board Joint Informational Meeting August 14, 2012
3 Background Mental Health services in Fayette County are supported with two funding streams: County Base MH funds: services for those residents who have no way to pay; pays for necessary services not covered by Medicaid or other forms of insurance HealthChoices: PA managed behavioral health care program for the majority of residents who are Medicaideligible
4 Background County MH Funds County Base MH funds are allocated to local provider organizations through contracts that are approved by the County Commissioners. Services include outpatient MH, partial hospitalization, residential and housing services, and others County Base Reimbursement for inpatient services are authorized only after a Fayette County resident is admitted to a licensed inpatient unit and the patient is found to be ineligible for any other form of payment. No contract is issued (c ).
5 Background HealthChoices HEALTHCHOICES Pays for a wide variety of mental health and substance abuse services for HealthChoices (Medicaid) eligible residents, including some residents who have Medicaid as a back up to their Medicare coverage Beginning in 1999, PA Department of Public Welfare has contracted with Fayette County to manage the HealthChoices (Medicaid) funds used to pay for mental health and substance abuse services.
6 Background HealthChoices HealthChoices Fayette County contracts with Value Behavioral Health of PA for administrative services including contracting with providers and paying provider claims VBH-PA s provider network includes facilities and services throughout Western PA as well as services and facilities in other parts of PA and in neighboring states
7 Background Hospital Licensing License to operate a psychiatric inpatient unit within a general hospital is issued by the PA Department of Health (PA-DOH). PA-DOH issues only two kinds of psychiatric inpatient licenses child -- children under the age of 18, or adult years of age and older
8 Background - PROMISe Number (Provider number) PROMISe number allows practices, organizations and facilities to bill Medical Assistance for services the provider is licensed to provide. Application for PROMISe number is made directly to the PA Office of Medical Assistance. The application does not require support or endorsement from VBH-PA or Fayette County Behavioral Health Administration.
9 Background VBH-PA Contracting VBH-PA issues contracts for HealthChoices reimbursement for authorized psychiatric and substance abuse care delivered by hundreds of provider organizations and facilities in Pennsylvania and neighboring states Requirements include: a license to provide the service(s) in the State where the provider/facility is located a PA PROMISe number That the service is necessary to assure easy access and choice among service organizations and facilities as required by the PA- DPW contract for HealthChoices.
10 Psychiatric Inpatient Services Beginning in 1999, VBH-PA contracted for psychiatric inpatient care with: Highlands Hospital Brownsville General Hospital (now closed) Greene County Memorial Hospital (now SW Regional) Washington Hospital Mon Valley Hospital Braddock Hospital (now closed) West Virginia University Hospitals, and other licensed units in PA, Ohio, and West Virginia
11 Uniontown Hospital In 2010, Uniontown Hospital applied to PA-DOH for a license to provide adult psychiatric inpatient care. The hospital s stated intent was to replace the adult psychiatric beds lost to Fayette County residents when Brownsville Hospital closed A license to operate an adult inpatient psychiatric unit was issued by PA-DOH to Uniontown Hospital later that year. Throughout 2010 and 2011, Uniontown Hospital admitted patients with commercial insurance, those with Medicare and Medicare supplemental insurance plans, and adults who were admitted under Medicare but who also had HealthChoices (Medicaid) back-up - dual eligibles.
12 Fayette County Behavioral Health Administration s HealthChoices program, together with VBH-PA, is responsible for managing the MEDICAID reimbursable days of a dual eligible s stay, including: Assuring that the patient s continued stay is medically necessary so that public funds are not wasted on unnecessary care, and Assisting the patient in choosing among a number of non-hospital community-based providers who offer follow-up care.
13 Challenges Fayette County s HealthChoices contract with PA-DPW requires that the County HealthChoices program (through VBH-PA) pay for the Medicaid portion of a dual eligible's care even though VBH-PA did not have a contract with Uniontown Hospital. Out of-network (i.e., no-contract) reimbursement was not subject to negotiation
14 Other Challenges Patients were also being admitted to out-ofcounty hospitals, including Clarion Hospital, when Highlands was either full or, for other valid reasons, could not admit a Fayette County patient. Without a contract (in the case of Uniontown Hospital) or from a distance (in the case of Clarion Hospital), Fayette and VBH-PA care managers could not effectively assess the need for continued care; nor could they actively participate in arranging quality follow-up care in the community.
15 Addressing Challenges In 2012, FCBHA gave verbal approval to VBH-PA to execute a HealthChoices contract with Uniontown Hospital to: assure access to services that people were already choosing, re-establish the inpatient bed capacity that existed when Brownsville was open in order to minimize admissions to out-of-county facilities, and enable effective management of patient care and follow-up by holding Uniontown Hospital to the same standards that other contracted inpatient units, like Highlands, must comply
16 Of note. Fayette County Commissioners do not approve or review VBH-PA contracts for behavioral health services. Rate determination was part of the contract negotiations between VBH-PA and Uniontown Hospital. Once the contract was completed, FCBHA staff and the VBH-PA Medical Director immediately began working with hospital personnel to review care procedures and to educate nurses and social workers about available community resources. Uniontown Hospital is now held to the same admission and continued stay criteria that Highlands Hospital has complied with since 1999.
17 Of note Since the contract between Uniontown Hospital and VBH-PA was established on 3/20/12, reimbursement for care to HealthChoices patients has totaled thru 6/30/12: 102 Days Full Year in 2012 vs Uniontown Hospital: $ 31,050 $ 42,931 Highlands Hospital: $237,262 $ 958,910 Other Hospitals(13/36): $252,248 $1,365,238
18 Our Mission Fayette County Behavioral Health Administration enriches lives by providing access to and assuring choice among the best behavioral and developmental resources that promote recovery and resiliency.
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