ALERT # 138 January 6, 2014 MBHP FISCAL YEAR 2014 PROVIDER RATE INCREASES AND INCENTIVES The following information should be noted immediately by your chief executive officer, chief medical officer, chief operating officer, program director, quality management director, compliance officer, billing director, and staff. The Massachusetts Behavioral Health Partnership (MBHP) is pleased to announce various provider reimbursement rate increases, effective January 1, 2014. In addition to outlining the details of these rate increases, this Alert provides updates regarding MBHP s provider rate incentive programs. With the implementation of these provider rate increases and incentives, MBHP continues its long-standing practice of using innovative payment strategies to ensure access to the highest quality of behavioral health services for MBHP Members, while seeking to provide fair and equitable reimbursement rates to its network providers. MBHP expects providers to utilize these funding enhancements to support investments in their programs aimed at improving access, quality of care including continuity of care and integration of physical and behavioral health care, and efficient utilization management. FY 2014 Rate Increase Overview MBHP will issue provider rate increases that will result in an expenditure of $5 million for the second half of FY 2014 (1/1/14-6/30/14). Of this amount, $1 million was appropriated by the legislature specifically for Inpatient Mental Health Services, and the remainder has been funded by MassHealth and ValueOptions /MBHP. Utilizing these funds, the following table summarizes the provider reimbursement rate increases that will be effective on January 1, 2014. MBHP Cumulative Rate Increases for Selected Behavioral Health Covered Services Covered Service % Increase Community-Based Acute Treatment (CBAT) and Intensive CBAT (ICBAT) 6.2% Enhanced Acute Treatment Services (E-ATS) - Adult 6.2% Enhanced Acute Treatment Services (E-ATS) - Adolescent 11.2% Inpatient Mental Health Services, Administratively Necessary Days, Boarding on a Pediatric Unit 4.7%* Level IV Acute Treatment Services (ATS) 4.7% Outpatient Medication Management 11.2% Outpatient Diagnostic Evaluation, Individual Treatment/Counseling, 3.1% Group Treatment/Counseling, Couples/Family Treatment/Counseling Other Services (See page 2 for inclusions and exclusions) 1.2% Average % Increase of Selected Covered Services 4.0% *Average increase across inpatient facility-specific rate increases 1
FY 2014 Rate Increase Specifications The following details the FY 2014 increases that MBHP is making to rates paid for selected covered services. Some covered services will not receive a rate increase. Most covered services will receive a base rate increase. A limited number of covered services will receive a base rate increase and an additional rate increase. Covered Services That Will Not Receive a Rate Increase The following covered services will not receive the base rate increase. Covered services that will not receive the base rate increase or any other rate increase Children s Behavioral Health Initiative (CBHI) services Acute Treatment Services (ATS) Clinical Stabilization Services (CSS) Methadone Dosing and Counseling Covered Services That Will Receive a Base Rate Increase Family Support & Training (FS&T) In-Home Behavioral Services (IHBS) In-Home Therapy (IHT) Intensive Care Coordination (ICC) Mobile Crisis Intervention (MCI) Therapeutic Mentoring (TM) Effective January 1, 2014, a base rate increase of 1.2% will be applied to most covered services. The following table lists the services that will receive a 1.2% base rate increase and no additional rate increases. Outpatient Services Covered services that will receive a 1.2% base rate increase Assessment for Safe and Appropriate Placement (ASAP) Bridge Visit Case Consultation Collateral Contact Dialectical Behavior Therapy (DBT) Family Consultation Acupuncture Community Crisis Stabilization (CCS) Community Support Program (CSP) inclusive of CSPECH Day Treatment Electroconvulsive Therapy (ECT) Emergency Services Program (ESP) - Adult ESP Crisis Planning outside an ESP Encounter Intensive Outpatient Program (IOP) Outpatient Detoxification Partial Hospitalization Program (PHP) Program of Assertive Community Treatment (PACT) Specialing Structured Outpatient Addictions Program (SOAP) Transitional Care Unit (TCU) 2
Covered Services That Will Receive a Base Rate Increase and Additional Rate Increases: Selected Outpatient and Diversionary Mental Health and Substance Use Disorder Services Effective January 1, 2014, providers of the following outpatient and diversionary mental health and substance use disorder services will receive increases listed in the following table. Rate increases are being applied to these selected service types in an effort to sustain specific services that are critical to supporting MBHP Members in the community, as well as to respond to the concerns expressed by providers about the viability of rates for these particular services. Selected Covered Service Rate Increase Base Rate Increase Additional Increase Cumulative Increase E-ATS - Adult 1.2% 5.0% 6.2% E-ATS - Adolescent 1.2% 10.0% 11.2% ICBAT and CBAT 1.2% 5.0% 6.2% Outpatient Medication Management, 1.2% 10.0% 11.2% including ESP Face-to-Face Psychiatry Outpatient Diagnostic Evaluation, Individual Treatment/Counseling, Group Treatment/Counseling, and Couples/Family Treatment/Counseling 1.2% 1.9% 3.1% Covered Services That Will Receive a Base Rate Increase and Additional Rate Increases: Inpatient Mental Health Services Effective January 1, 2014, inpatient mental health providers will receive an increase to each facility s individually set rate for Inpatient Mental Health Services. The rate increases will range from 3% to 5.9%. Factors that have been used in determining each hospital s specific rate increases include: a base rate increase funded by the legislature in the FY 2014 budget establishment of new floors for adult and child/adolescent rates pay-for-performance measures rate enhancement for Inpatient Mental Health Services for children (ages 0-7) MBHP Regional Directors will communicate specific rate increase amounts to inpatient providers soon after this Alert is disseminated. They will then schedule meetings with each inpatient provider as soon as possible to engage in a more detailed review of the rate methodology, the provider s performance on the pay-forperformance measures, and the provider s resulting individualized rate increase. Pay-for-Performance Measures The following measures comprise the pay-for-performance methodology used to determine this component of the FY 2014 rate increase for each inpatient provider. As in past years, MBHP is tying rate increases to provider compliance with certain measures of performance in the areas of access, quality and continuity of care, and utilization management. Points were awarded based on the provider s performance in each of the measures below. There were six measures used in the formula. The points accumulated for each applicable measure were totaled, earning the provider a hospitalspecific rate increase. Utilization Management: Length of Stay (LOS) o LOS Difference This indicator measures the difference between the facility s Risk Adjusted Mean Length of Stay (AdjMean) and its Actual Length of Stay (Actual) over a 12-month period. 3
Points were awarded based on the difference between the facility s AdjMean and Actual. The measurement period was a 12-month period run on October 6, 2013. o LOS Improvement This indicator measures the improvement in the facility s LOS Difference over the preceding year. The two compared measurement periods were 12-month periods run on October 6, 2013 and October 8, 2012. Access: Adjusted Mean o This indicator measures the case mix of each facility. Points were awarded based on the risk factors of the Members admitted to the facility during the measurement period. The measurement period was a 12-month period run on October 6, 2013. Continuity of Care: 7-Day Readmission Rate Difference o This indicator measures the difference between the facility s risk adjusted 7-day readmission rate and actual 7-day readmission rate over a 12-month period. Points were awarded based on the difference between the facility s actual and risk adjusted 7-day readmission rates. The measurement period was a 12-month period run on October 6, 2013. Access/Continuity of Care: State Agency-Involved Members o Inpatient child/adolescent and ICBAT facilities: Points were awarded based on the percentage of MBHP Members admitted to the facility during the measurement period who were state agencyinvolved (i.e., DCF, DYS, DDS and/or DMH) at the time of their admission. o Inpatient adult facilities: Points were awarded based on the percentage of MBHP Members admitted to the facility during the measurement period who were involved with DMH at the time of their admission. The measurement period was a 12-month period run on October 6, 2013. Access/Continuity of Care: Massachusetts Behavioral Health Access (MABHA) Reporting o Points were awarded based on the facility s performance in updating the bed availability website during the 12-month measurement period. Rate Enhancement for Inpatient Mental Health Services for Children (Ages 0-7) The funding that has been expended through the inpatient Rapid Admission Incentive (RAI) will be added to the amount available to inpatient mental health rate increases for inpatient mental health units serving children (ages 0-7). As further noted below, the RAI will be discontinued after December 31, 2013. Other Inpatient Services Administratively Necessary (AN) Days The following A code services shall be paid at each facility s individualized inpatient rate as of January 1, 2014: A1, A5, and A6. The following A code services shall be paid at the current standard rates for all inpatient providers plus a 4.7% rate increase: A2, A4, and AN. Level IV ATS This service will receive a rate increase of 4.7%. Provider Incentive Programs Since February 1, 2011, MBHP has offered several incentive payment programs to providers of various services. Please refer to Provider Alert #98 issued on February 10, 2011. The following incentive programs will continue to be available at this time: 4
SUMMARY OF PROVIDER RATE INCENTIVES Service Category Incentive/Nature of Increase Outpatient (mental health and substance use Incentive: Timely Outpatient Services Post-Discharge from disorder providers) Inpatient Mental Health (MH) and ICBAT Outpatient (CSPs operated by mental health Incentive: Community Support Program (CSP) visits at Inpatient and substance use disorder outpatient MH, ATS, E-ATS, and Level IV ATS providers prior to discharge providers) ATS, E-ATS, and Level IV ATS Incentive: ATS, E-ATS, and Level IV ATS provider arranges CSP visits at their program prior to discharge Please note that MBHP is considering modifications to the first incentive program above, the Timely Outpatient Services Post-Discharge from Inpatient MH and ICBAT, in order to better meet HEDIS measures related to follow-up after hospitalization as well as initiation and engagement in treatment for substance use disorders. Additionally, MBHP is discontinuing the Rapid Admission Incentive that has been available to Inpatient Mental Health, ICBAT, and Level IV ATS programs since 2011. The last date on which authorizations for the RAI will be issued will be December 31, 2013. As mentioned above, the funding that had been expended through this incentive will be added to the amount available to inpatient mental health rate increases for inpatient mental health units serving children (ages 0-7). Future Rate Increase Specifications MBHP anticipates that any potential provider rate adjustments for all levels of care will be contingent upon providers performance under various measures. One such measure that will likely apply to provider rate increases at multiple levels of care going forward is reporting their access and availability on the MABHA website. Inpatient Mental Health Services and ICBAT: Pay-for-Performance Indicators for Future Rate Increases MBHP anticipates that potential provider rate adjustments for inpatient and ICBAT levels of care in the future will be based upon a facility s performance on measures that will likely include but not be limited to: Utilization Management - Length of Stay Difference Utilization Management - Length of Stay Improvement Continuity of Care - Readmission Rate Difference Access/Continuity of Care - State Agency-Involved Members Access: MABHA Reporting - Providers will demonstrate compliance with reporting their daily bed availability, per existing MBHP policies and procedures. The current expectation for 24-hour levels of care is that providers will enter bed availability a minimum of three times per day (i.e., once per shift), seven days per week. Additionally, providers are encouraged to update the website whenever their bed availability changes due to an admission or discharge. Alternative Payment Methodologies (APM) In addition to continuing to pay attention to the fee-for-service rates we pay to network providers, MBHP is working on the development of APMs for behavioral health services and potentially models for integrated behavioral health and physical health care. Several network providers, representing a variety of levels of care and provider types, are engaged in a provider advisory group that will collaborate with us on this process. 5
Provider Action Required Contracting Beginning in January 2014, those providers who are contracted by MBHP for services that are subject to a rate increase will receive a revised Exhibit A (contract) Agreement. Providers will be required to sign and return the Exhibit A (contract) Agreement to MBHP. For contracted outpatient providers, an updated Outpatient Fee Schedule will also be sent. MBHP requests that providers waive MBHP s obligation to provide a 30-day notice in order to implement the rate increases effective January 1, 2014. Claims Providers should begin billing services at the new rates effective January 1, 2014. If your claim submission includes dates of service for December and January, please use a separate claim line for January dates of service. All claims submissions will continue to be subject to MBHP billing policies and procedures. Questions If you have questions regarding this Alert, please contact our Community Relations Department at 1-800-495-0086 (press 1 for the English menu, 2 for the Spanish menu, then 3 then 1 to skip prompts), Monday through Thursday, 8 a.m. to 5 p.m., and on Fridays from 9:30 a.m. to 5 p.m. You may also contact your MBHP Regional Director or Regional Network Manager with questions regarding the matters delineated in this Alert. Region Director Telephone Metro Boston Barbara Wilson (617) 350-1909 Northeast Donna Frates (978) 716-3370 Southeast Steve Etkind (508) 217-3233 Central Elizabeth O Brien (508) 890-6406 Western Linda Trott (413) 322-1802 6