Washington Coalition on Medicaid Outreach

Transcription

1 Washington Coalition on Medicaid Outreach Alison Robbins June 23, 2017

2 What is changing on July 1, 2017 in Medicaid behavioral health? In response to concerns expressed by the Washington State Tribes and Urban Indian Health Programs, the Centers for Medicare and Medicaid Services and the State agreed to give American Indians and Alaska Natives (AI/ANs) a choice in how their behavioral health care is covered under Medicaid: The Medicaid managed care program (through Behavioral Health Organizations or Managed Care Organizations), or The Medicaid Fee for Service (FFS) program. Behavioral health care means both: o Mental health services (which will become available through the Medicaid FFS program on July 1, 2017), and o Substance use disorder treatment services, which have remained available through the Medicaid FFS program since before April 1,

3 What is the difference between Medicaid Fee for Service and Medicaid Managed Care? 3

4 What Medicaid behavioral health coverage choices will American Indian/Alaska Native clients have? If the Medicaid client lives in a Fully Integrated Managed Care region, the client will be able to choose either: A Fully Integrated Managed Care plan, or The Fee for Service program. AI/AN clients will no longer have the option to choose Medicaid managed care for behavioral health only (the Behavioral Health Services Only benefit). 4

5 What Medicaid behavioral health coverage choices will American Indian/Alaska Native clients have? If the Medicaid client lives in a region with a Behavioral Health Organization, the client will be able to make two different choices: For behavioral health care coverage: The Behavioral Health Organization, or Medicaid Fee for Service. For physical health care coverage: An Apple Health Managed Care Plan, or Medicaid Fee for Service. AI/AN who live in an area served by a Primary Care Case Management Entity may also enroll in PCCM. 5

6 Can AI/AN individuals continue to access crisis services like they do now? For AI/AN Medicaid enrollees, their coverage will depend on whether they choose managed care or the Fee for Service program. For non-medicaid AI/AN individuals, they will continue to have the same access to behavioral health services as all other non-medicaid individuals through: Administrative Service Organizations in Medicaid Fully Integrated Managed Care regions, and Behavioral Health Organizations in the rest of the state. 6

7 How will a provider know what Medicaid coverage an AI/AN individual has? Providers need to check the ProviderOne Benefit Inquiry screen, which will show: The name of the Behavioral Health Organization (if the client has BHO coverage), or The name of the Fully Integrated Managed Care Plan (if the client has FIMC coverage). If the client has active Medicaid coverage but does not have BHO or FIMC coverage, that means that the client has Medicaid Fee For Service Coverage. Providers will not be able to see if a client is AI/AN. 7

8 What do AI/AN Medicaid enrollees need to do to make sure they can choose their behavioral health coverage? They need to self-identify as AI/AN with Medicaid. They can do this in one of the following ways: Call (Medical Assistance Customer Service) Websites When they apply, recertify, or submit a change in Washington Healthplanfinder, they can select Indian (American) in the drop down race selector. When they apply, recertify, or submit a change in Washington Connection, they can select American Indian/Alaska Native. They can always submit a request under Topic Other. Medicaid does not require tribal affiliation or proof of AI/AN status. 8

9 Integrated Managed Care 9

10 Moving to Integrated Managed Care 10

11 Poor Outcomes are the End Result Medicaid statewide measures for CY 2015*: SUD Treatment Penetration: 26.6% MH Treatment Penetration (broad definition): 42.9% Psychiatric Inpatient 30-day Readmission: 13.4% *Research and Data Analysis, Washington DSHS 11

12 Integrated MCO Contracts for Medicaid Beneficiaries Medicaid Covered Services (FIMC Contract) Medical Mental Health Substance Use Disorders Non-Medicaid Services for Medicaid Beneficiaries (Wrap-Around Contract) Behavioral Health services funded by State General Funds Two Types of Enrollment AH-FIMC: Enrollees with managed medical and behavioral health care BHSO: Enrollees with managed behavioral health services only 12

13 Services not included in MCO Contracts Crisis services for all members of the community Includes DMHPs County-funded services for Medicaid and Non-Medicaid Miscellaneous BH Ombudsman Committees formerly led by BHO WISe, CLIP, BH Advisory Board, FYSPRT, etc. Writing block grant project plans 13

14 Basics about Full Integration County Authority It is the decision of the county authority(s) in a Regional Service Area to move to an integrated model before In January 2020, the full State will transition per E2SSB In a multi-county region, all counties must agree. Consumer Choice Each region will have a minimum of 2 Managed Care Plans, which will be selected through a competitive procurement process. No region will have more than 5 plans. Collaboration No matter when a region goes forward, the implementation process will require a high degree of collaboration between providers, MCOs, county/bho staff, and the State. County/ BHO Role All regions will have the first right of refusal to keep their BHO in the role of BH-ASO, which is an entity that manages the crisis system regionally as well as certain non-medicaid funds. If desired, the county(s) can form a Interlocal Leadership Structure that that will lead the design & implementation from the local level. 14

15 Next Steps September 15, 2017: Binding Letters of Intent Due to be mid-adopter 1) January 2019 full integration, no transition 2) January 2019 MCOs assume risk, 1 year transition period Default: Full integration by January 2020 (no Demonstration incentives and no binding letter of intent due) 15

16 Request for Proposals Single Request for Proposals (RFP) for both 2019 and 2020: Release date early in 2018 for January 1, 2019 AND January 1, 2020 start dates; Contracts will be awarded for all Regional Service Areas (both those implementing in 2019 and those implementing in 2020); Network Adequacy submissions and Readiness Review for 2020 will take place in late

17 Managed Care: Questions? Accountable Communities of Health Practice Transformation Hub HCA Contacts Isabel Jones / Isabel.Jones@hca.wa.gov 17