Staggered Roll Out Plans of Care Moving to a Fee for Service 5-7-18 Sharon Weber
Staggered Roll Out To transition to a fee for service rather then a bundled rate the POC s will need to be discharged and re-entered This will be done in 4 stages Round 1: May 7 May 21, 2018 Plans of Care with a last covered day in May and June 2018 Round 2: May 22 June 5, 2018 Plans of Care with a last covered day in July 2018 Round 3: June 6 June 20, 2018 Plans of Care with a last covered day in August 2018 Round 4: June 20 June 30, 2018 POC s submitted outside the timeframes 2
Round 1 May 7 May 21, 2018 Last covered day in May, June 2018 Submit a new POC. Transaction type Update Corrected Reassessment Make no changes to the body of the Plan of Care and the Crisis Plan. Under Recommended Services, include each service that you currently have authorizations for in the system. For FCC, FSP, YSP, request number of units/month instead of days. Unit = 15 minutes For Respite and YFT, no change is required. Already billed in 15 minute units. Signature page, only the FCC s signature is required (this is an administrative change and not an actual reauthorization request). 3
Round 2 May 22 June 5, 2018 Last covered day in July 2018 Submit a new POC. Transaction type Update Corrected Reassessment Make no changes to the body of the Plan of Care and the Crisis Plan. Under Recommended Services, include each service that you currently have authorizations for in the system. For FCC, FSP, YSP, request number of units/month instead of days. Unit = 15 minutes For Respite and YFT, no change is required. Already billed in 15 minute units. Signature page, only the FCC s signature is required (this is an administrative change and not an actual reauthorization request). 4
Round 3 June 6 June 20, 2018 Last covered day in August 2018 Submit a new POC. Transaction type Update Corrected Reassessment Make no changes to the body of the Plan of Care and the Crisis Plan. Under Recommended Services, include each service that you currently have authorizations for in the system. For FCC, FSP, YSP, request number of units/month instead of days. Unit = 15 minutes For Respite and YFT, no change is required. Already billed in 15 minute units. Signature page: Guardian s signature and FCC s this is an administrative change and a reauthorization 5
Round 4, June 20 June 30, 2018 All POC s submitted outside the designated timeframes. All late submissions risk temporary non-auth status and will be processed last. Submit a new POC. Transaction type Update Corrected Reassessment Make no changes to the body of the Plan of Care and the Crisis Plan. Under Recommended Services, include each service that you currently have authorizations for in the system. For FCC, FSP, YSP, request number of units/month instead of days. Unit = 15 minutes For Respite and YFT, no change is required. Already billed in 15 minute units. Signature page: Guardian s signature and FCC s this is an administrative change and a reauthorization You may submit an Update Reassessment Plan of Care after July 1, 2018 to document any changes to objectives and strategies, as needed. 6
Coordination of Units per Month Providers will request units ( 15 minutes) and manage those units Unit requests for all roles will need to be specified in the Plan of Care. The units for each role are independent of the other roles Authorized units will be provided in a manner to support a family Refer to the Timelines and Requirements to see national standards of contact. We will look at the need of each family and youth. Both the State and Magellan recognize that we will have youth that need more and youth that need less. We will continue to have open dialogue regarding this. All needs must be clearly documented in Plans of Care. If more units are needed to serve a family within the specified time span, the POC update with the justification will be needed, Update Corrected Service Addition and must identify this need before the current units are expired 7
Service Additions If your Child and Family Team would like to request a new service before July 1, 2018, it will occur as a delayed process. Email WYClinical@magellanhealth.com a Choice of Provider form. Make sure the Choice of Provider form also indicates the start date of the new service. After July 1, 2018, the Clinical team will review all Choice of Provider forms The team will backdate the start date of new service authorizations to the date on the Choice of Provider form, as long as the Choice of Provider form was submitted on or before the start date of the new service. If the Choice of Provider form was submitted after the start date of the new service, the Clinical team will backdate the start date of the new service to the date the Choice of Provider form was submitted. 8
Case Reviews Clinical team will have limited availability for case review between May 1, 2018 and July 30, 2018. The primary focus of the Clinical team during this timeframe is to ensure all HFWA enrolled youth have Update Corrected Reassessment Plans of Care uploaded to MagellanProvider.com. If you have an urgent matter that requires immediate attention, please outreach Sharon Weber via text or email. Sharon will consult with the internal CME team to determine whether a case review will be scheduled, or if the matter will need to be discussed via email 9
Answers to Questions https://www.magellanofwyoming.com/providers/provider-communications/providerfaqs/ https://www.magellanofwyoming.com/providers/tools-training/hfwa-foundationstraining-opportunities/ https://www.magellanofwyoming.com/media/2533/hfwa-provider-requirements-andtimelines-8-10-v2docx.pdf 10
If you are watching this after the Learning Opportunity, please email Sharon your name and agency so you get credit for watching it! sweber@magellanhealth.com
Confidentiality statement for providers The information presented in this presentation is confidential and expected to be used solely in support of the delivery of services to Magellan members. By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc. *If the presentation includes legal information (e.g., an explanation of parity or HIPAA), add this: The information contained in this presentation is intended for educational purposes only and should not be considered legal advice. Recipients are encouraged to obtain legal guidance from their own legal advisors. 12