Technical Assistance and Training for Providers PM February 25, 2016 The Managed Care Technical Assistance Center of New York

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Leslie Horace Tyler
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1 Technical Assistance and Training for Providers 12 1 PM February 25, 2016 The Managed Care Technical Assistance Center of New York

February 23, 2016 Introduction & Housekeeping Children s System Training and Technical Assistance (MCTAC and CTAC) Housekeeping WebEx Chat Functionality for Q&A Slides are posted at MCTAC.

2 February 23, 2016 Introduction & Housekeeping Children s System Training and Technical Assistance (MCTAC and CTAC) Housekeeping WebEx Chat Functionality for Q&A Slides are posted at MCTAC.organd a recording will be available soon (usually less than one week) Questions not addressed today will be reviewed and incorporated into in- person events beginning in March Reminder: Information and timelines are current as of the date of the presentation

3 Agenda Brief MCTAC Overview Children s System Transformation Refresher & Review Specific areas providers will have to build knowledge/capacity around Lessons learned from adult system transition 2016 training & technical assistance for Children s Providers Tools & Resources

4 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.

5 MCTAC Partners

6 Refresher & Review from Parts 1 & 2 The Managed Care Technical Assistance Center of New York

7 Children s System Children s Health Homes, 1/1/2016 Statewide New State Plan Services, 1/1/2017 Statewide Transition to Managed Care, 1/1/2017 NYC/LI, 7/1/2017 Rest-of-State Children's HCBS, 1/1/2017 NYC/LI, 7/1/2017 Rest-of-State Rest-of-State Adult BH Managed Care Transition DSRIP OASAS Systems Transformation Adult HCBS Implementation Ongoing post-implementation for NYC and Rest of State adult system

8 Originally presented: February 11, 2016 Services for Medicaid Eligible Children Today Tomorrow Full Managed Care Implementation All Services in Medicaid Managed Care Current Behavioral Health State Plan Services Fee-for- Service Limited Array of HCBS Services (depending on Waiver program) available only to Waiver eligible Children through Fee-for- Service System Care Coordination Under 1915c Waivers and OMH TCM Program through Feefor-Service System Current Behavioral Health State Plan Services in Medicaid Managed Care Health Home Care Coordination available to significantly expanded population of children Foster Care Population transitions to Medicaid Managed Care Six New State Plan Services created and transition to Medicaid Managed Care Expanded array of HCBS Services based target and functional criteria transitions to Medicaid Managed Care

9 Originally presented: February 11, 2016 Children s Medicaid State Plan Amendment Six New Services: Crisis Intervention, Other Licensed Practitioner, Community Psychiatric Supports and Treatment (CPST), Psychosocial Rehabilitation, Family Peer Support Services and Youth Peer Support Services SPA Application - in final revision stage; projected to be submitted to CMS in April 2016 The State Proposed Budget Includes new investments of $7.5 million and $30 million in for the six new Medicaid State Plan services SPA Provider Manual in draft pending CMS approval of the children s SPA; draft projected to be released in February

10 Originally presented: February 11, 2016 Alignment of the five 1915(c) Children s HCBS Waiver under one array of HCBS benefits beginning in 2017 Habilitative Skill Building Caregiver/Family Supports and Services Prevocational Services Supported Employment Community Advocacy and Training Non-Medical Transportation Habilitation Respite (Crisis & Planned) Adaptive and Assistive Equipment Accessibility Modifications Palliative Care (includes Family Palliative Care Education, Bereavement, Massage and Expressive Therapy, and Pain and Symptom Management) Care Coordination (for children ineligible for or opting out of Health Home) ü Requires CMS Approval of 1115 Demonstration for Medicaid Managed Care ü 1915c Waiver Programs will be discontinued at the completion of the transition ü Expanded eligibility for HCBS will be phased in beginning in 2017 and eligibility include targeting and functional criteria ü HCBS will be paid in Medicaid Managed Care and Medicaid Feefor-Service system (for children in Medicaid and excluded from Managed Care)

11 Preliminary Steps and Readiness Domain Review The Managed Care Technical Assistance Center of New York

12 Beginning in September, 2014, MCTAC offered a tool targeting behavioral health providers to help them assess their own readiness for Managed Care and benchmark them with their fellow agencies around the state.

13 MCTAC Readiness Assessment Domains Domain Name Label in Graphs 1 Understanding MCO Priorities & Present Managed Care Involvement MCO Priorities 2 MCO Contracting Contracting 3 Communication /Reporting (Services authorization, etc.) Communication 4 IT System Requirements IT 5 Level of Care (LOC) Criteria / Utilization Management Practices Level of Care 6 Member Services/Grievance Procedures Member Services 7 8 Interface with Physical Health, Social Support and Health Homes Quality Management/Quality Studies/Incentive Opportunities Interface Quality 9 Finance and Billing Finance 10 Access Requirements Access Demonstrating Impact/Value (Data Management & Evaluation Capacity) Evaluation

14 14 Domain Average Score 7. Interface MCO Priorities Access Finance Contracting IT 3.17 TOTAL AVERAGE SCORE Level of Care Member Services Quality Communication Evaluation 2.63

16 The Managed Care Technical Assistance Center of New York

17 Exclusions and Transition Process for those carved-in Workflow Defining Roles and Responsibilities Communication Plan of Care Requirements Documentation/UM/Authorization Requirements Clear Designation Processes (HCBS, MCOs) Billing/Rate Information epaces/emedny

18 Calendar Outline, Tools & Resources The Managed Care Technical Assistance Center of New York

19 Webinar Series 3-part series presenting general information and outline of New York State s plan surrounding critical topics. In-Person System Transformation Update Events Offered statewide, 3-4 hour sessions including presentation by state agency children s leadership team and discussion. Target audience: executive leadership of child-serving agencies, MCO representatives, other stakeholders. Topics to include detailed information around: Programs, services, and members transitioning to managed care Provider protections HCBS State Plan Amendment Timelines for implementation Supports and technical assistance

20 Date Time Location & Address 3/21 1:00 PM 4:30 PM Long Island: Residence Inn Marriott 9 Gerhard Road Plainview, NY /22 9:00 AM 1:00 PM NYC: Kimmel Center, 60 Washington Square South Eisner and Lubin Auditorium, 4th floor New York, NY /31 1:00 PM 5:00 PM Hudson Valley: Poughkeepsie Grand Hotel 40 Civic Center Plaza Poughkeepsie, NY /1 9:00 AM 1:00 PM Albany: Radisson Hotel Albany 205 Wolf Rd. Albany, NY /12 9:00 AM 1:00 PM Buffalo: Adam's Mark Hotel & Event Center 120 Church St. Buffalo, NY /13 9:00 AM 1:00 PM Elmira: National Soaring Museum 51 Soaring Hill Drive Elmira, NY /14 9:00 AM 1:00 PM Syracuse: Sky Armory 351 South Clinton St. Syracuse, NY /19-4/20 TBD North Country (in conjunction with NCBHN)

21 SPA (1/1/17) June/July Designation process, billing, high-level serviceby-service overview (in-person and web-based). September In-person meetings on rates/billing codes, staffing requirements, caseloads, eligibility/medical necessity, deficit funding, EHR help October Webinars on referral process, documentation, continuing education, co-enrollment rules, exclusions, health home interaction, reporting requirements November/December Detailed overviews for each service (full-day statewide in person and web-based supplements)

22 Managed Care 1/1/17 NYC/LI, 7/1/17 ROS Contracting/Credentialing Statewide, both in-person and web-based and will include workshops and contracting fairs once plans have been identified. RCM, UM, and Outcomes Statewide, both in-person and web-based Implementation Series: Billing, UM guidelines, and credentialing after respective plan information has been released (3-4 months before transition date for NYC/LI & ROS respectively). Data and Outcomes Road Map - Offered yearlong & statewide covering Understanding Your Population, Key Performance Indicators, Costs and Revenue, Outcomes.

23 Providers will be required to complete the contracting and credentialing process to be considered an in-network provider New Contracts vs. Established Contracts Providers with existing Managed Care Contracts may only need to execute/sign contract amendment Providers without an existing contract with an MCO you will need to complete the full contracting and credentialing process State Protections Medicaid Rates for 2 Years from implementation date 5 or more Clients MMIS & NPI Technical Assistance Contracting Series outlines contracting basics, timelines, and process Contracting Fairs provides providers opportunity to meet with representatives from MCO plans

24 Provider credentialing is a systematic approach to the collection and verification of a provider's professional qualifications. The qualifications that are reviewed and verified include relevant training, licensure, certification, and registration to practice in a health care field. Based on current implementation timeline, providers should expect to begin contracting and credentialing processes in July in coordination with plans.

25 What is Utilization Management? The process by which an MCO decides whether specific health care services, or specific level of care, are appropriate for coverage under an enrollee s plan Primary purpose of the program is to ensure that services are medically necessary, appropriate, and cost-effective Maintain fidelity and integrity of service provisions while meeting UM standards and requirements

26 Claims Testing Providers and Managed Care Organizations are strongly encouraged to test claims Done with test claims and should go through a same process as live claim in test environment Providers should reach out to their EHR/Billing Vendors and when applicable Clearinghouses to make sure that their systems are set up correctly Billing Manual Billing Guidelines new vs existing clients Technical Assistance UM/Billing In-Person Presentations 26

27 Definition: All administrative and clinical functions that contribute to the capture, management, and collection of client service revenue. This describes the life cycle of a client account from creation to payment collection and resolution. The client account cycle is supported by a number of additional activities necessary to assure that all encounters are billable, meet regulatory requirements and revenue collection is maximized.

28 Contracting and Credentialing Claims Testing July 2016 August October 2016 September November December Billing January 2017 February March On-Going *Timeline relies on estimation of when information from state and designated MCOs is finalized and available.

29 HCBS (1/1/17) July - Service definitions, provider eligibility, application/designation process Sept - Plan of care and workflow development and implementation support Oct/Nov - Rates/billing codes, staffing requirements/ caseloads, eligibility medical necessity, deficit funding, start-up funds/ EHR help Nov - Utilization management, referral process, documentation, continuing education, co-enrollment rules, exclusions, health home interaction, reporting requirements, evaluation, outcomes Dec Detailed overviews for each service

30 Tools MCO Matrix: interactive online tool that provides critical information necessary for providers to successfully engage with the plans. Billing/Claims: tool that contains critical information for clean claim submission with field by field detail for the UB-04/837i form, plan by plan Glossary of Terms/Top Acronyms/Managed Care Language Guide Utilization Management: tool that provides guidance around prior authorization and concurrent review practices for each plan for state ambulatory services. Credentialing: An integrated tool that provides information on required credentialing processes & documentation Chargemaster: tool to assist providers in cross walking information from services provided to the necessary billing codes.

32 Children s Managed Care Design m s: NYSOMH Managed Care Mailbox: OMH-Managed-Care@omh.ny.gov NYSDOH Health Homes for Children: HHSC@health.ny.gov For questions & information related to Managed Care, SPA, and HCBS training and technical assistance: Mctac.info@nyu.edu

33 @CTACNY

4/7/2016. Provider Leadership Update. Reminder: Information and timelines are current as of the date of the presentation

4/7/2016. Provider Leadership Update. Reminder: Information and timelines are current as of the date of the presentation Provider Leadership Update The Managed Care Technical Assistance Center of New York Housekeeping: Slides are posted at MCTAC.org Questions not addressed today will be: reviewed and incorporated into future