Work Flow. The Managed Care Technical Assistance Center of New York

Transcription

1 Work Flow The Managed Care Technical Assistance Center of New York

2 The Managed Care Technical Assistance Center of New York

3 MCTAC is a training, consultation, and educational resource center that offers resources to all mental health and substance use disorder providers in New York State. MCTAC s Goal Provide training and intensive support on quality improvement strategies, including business, organizational and clinical practices to achieve the overall goal of preparing and assisting providers with the transition to Medicaid Managed Care.

4 Who is MCTAC?

5 MCTAC Partners

6

7 Step B B In collaboration with member, and in consultation with providers as necessary, HH Care Manager develops fully integrated Plan of Care (POC) that includes physical and behavioral health services, and recommended HCBS including the scope, duration, and frequency of HCBS; and Selected In-Network Providers 3 HH care manager consults with HCBS providers who recommend scope, duration, and frequency for HCBS. HH care manager completes POC. B.1. Health Home Care Manager refers member to Adult BH HCBS Provider for consultation B.2. Adult BH HCBS Provider conducts HCBS specific assessment and determines scope, duration and frequency B.3. Care Manager incorporates scope, duration and frequency in POC

8 Step C C HH Care Manager forwards fully integrated POC to MCO for approval of all physical health services, behavioral health services, and HCBS in the fully integrated Plan of Care (POC). MCO works collaboratively with HH care manager and member to finalize an approved Plan of Care The authorization and payment process are separate and apart from the POC process for the state plan services such as physical health services and behavioral health services.

9

10 Step B B The MCO also contracts with the HH or other state-designated entity to develop the BH HCBS Plan of Care (POC). In collaboration with member, care manager consults with HCBS providers who recommend scope, duration, and frequency for BH HCBS. Care manager completes POC. B.1. Health Home Care Manager refers member to Adult BH HCBS Provider B.2. Adult BH HCBS Provider conducts HCBS specific assessment and determines scope, duration and frequency B.3. Care Manager incorporates scope, duration and frequency in POC

11 Step C C Care Manager forwards HCBS POC to MCO. MCO is responsible for non-bh HCBS components of the fully integrated POC and for providing care coordination for the implementation of the individual s full POC, including BH HCBS The authorization and payment process are separate and apart from the POC process for the state plan services such as physical health services and behavioral health services.

12 Why would the Plan of Care be updated? Individual is reassessed (at least annually) with the NYS Community Mental Health Assessment. Or more frequently when warranted if there is a significant change in the member s medical and/or behavioral health condition or a significant change in their status such as hospitalization, loss of housing, or successfully completing a goal. Updating the Plan of Care Who can initiate the update to the Plan of Care?: Individuals receiving Adult BH HCBS Any provider delivering Adult BH HCBS Any service provider, including primary care, behavioral health, etc. Managed Care Organizations How is the Plan of Care Update initiated?: Communicate and inform Health Home Care Manager Care Manager will determine whether a new assessment is needed. Plan of care is updated accordingly.

13 Upcoming Plan of Care Webinar Dates Thursday, 11/12 10:00-11:00 MCTAC POC Training: Workflow 2:00-3:00 MCTAC POC Training: Plan of Care Wednesday, 11/18 2:00-3:00 MCTAC POC Training: Plan of Care Thursday, 11/19 10:00-11:00 MCTAC POC Training: Cross walk of services Friday, 11/20 2:00-3:00 MCTAC POC Training: Cross walk of services

14 @CTACNY