Accessibility, Utilization, and Availability of Services Section VI Fee-For-Service and Organizational Providers FY 17-18 Report prepared by: Cynthia Juarez, AAII
SECTION IV FEE-FOR-SERVICE PROVIDERS TABLE OF CONTENTS.... 1 LCSW In-County Fee-for-Service Providers.... 3 Psychiatrist In-County Fee-for-Service Providers..... 7 Organizational Providers...... 11
FEE-FOR-SERVICE PROVIDERS Licensed providers of specialty mental health services are a limited resource in Imperial County and Fee-For-Service providers collaborate with the MHP to ensure beneficiaries receive appropriate care. Fee-for-services providers enhance the provider network and offer treatment options to Imperial County Medi-Cal beneficiaries. Fee-For-Service providers consist of contract providers (in-county and out-of-county) and noncontract providers (in-county and out-of-county). The following report summarizes the contract and non-contract (in-county) fee-for-service providers and the contract (in-county and out-ofcounty) organizational providers. Contract Providers Contract providers enhance the provider network and offer additional treatment options to Imperial County Medi-Cal beneficiaries. Contracts are renewed every year and providers are held accountable to the same standards of access to care and services, timeliness, and quality as the MHP. In FY 16-17, the MHP contracted for services with three in-county providers, which included one Licensed Clinical Social Worker (LCSW) and two organizational providers. For beneficiaries to access the in-county contracted LCSW, the MHP will schedule the initial intake assessment with the provider and notify the beneficiary of the scheduled appointment. For beneficiaries to access an in-county contracted organizational provider, they may request an appointment directly from the provider or request a referral from the MHP. Beneficiaries receiving services from the MHP may also request to change provider, at which point the MHP will make a referral to the provider. If the MHP makes a referral to the provider s office, a notice is sent to the beneficiary with instructions to contact the provider and a notice is sent to the provider advising him/her that the beneficiary has been referred to his/her office. In FY 16-17, the MHP contracted for services with five out-of-county providers, which included one psychiatric inpatient facility and four organizational providers. Beneficiary access to services for each out-of-county provider is based upon the individual placement needs of each beneficiary. When a beneficiary receives services from one of the MHP s contracted providers, a Treatment Authorization Request (TAR) is elicited from the provider and reviewed by the Payment Authorization Unit (PAU). A notice is sent back to the providers with an approval, denial, or modification for treatment services. Non-Contract Providers In the event that specialty mental health services are needed and the MHP is unable to provide for said services, such as emergency services, the MHP accepts TARs from providers that do not have a contract with the MHP. In FY 16-17, the MHP utilized the services of one in-county non-contracted psychiatrist. There were 53 out-of-county providers available to provide services for Imperial County Medi- Cal beneficiaries. The disciplines for the out-of-county providers were: 52 psychiatrists and one Doctor of Osteopathic Medicine. PAU is responsible for reviewing and providing a response for each TAR submitted. Accessibility and Availability Report FY 16-17 1
Findings The data for the MHP s Fee-For-Service (FFS) providers has shown a significant increase in the number of beneficiaries and the number of services in spite of a decrease in the average number of services per beneficiary. The FFS psychiatrist exceeded the number of beneficiaries and the number of services for FY 16-17. In FY 16-17, the organizational providers started medication support services, which increased the number of beneficiaries served. The LCSW had a decrease in overall number of beneficiaries and services for FY 16-17. Overview of FFS Providers In FY 16-17, FFS providers served 13 beneficiaries, an increase from the number served the previous year. The number of beneficiaries is shown by discipline in Figure 6.1. Figure 6.1.: Total In-County FFS Beneficiaries by Provider Discipline FY 16-17 14 12 15 114 125 1 8 6 4 8 FFS LCSWs (contracted) FFS Psychiatrists (noncontracted) Organizational Providers 2 FY 15-16 FY 16-17 The total number of beneficiaries served by FFS providers in FY 16-17 reflects an increase of 8 beneficiaries (total 13) compared to the previous year when the total was 122 beneficiaries. This increase reflects a 7% change in the total beneficiaries served by FFS providers from the previous year. The decrease of 26 beneficiaries served by the LCSW reflects a 62% change from the previous year when the number was 42. The increase of 33 beneficiaries reflects a 41% change served by the FFS psychiatrist from 8 served the previous year. There was a significant increase in the number of beneficiaries served in FY 16-17. The Medi-Cal beneficiaries demographics are addressed by discipline. Calculations for anticipated numbers of beneficiaries and services for the FFS providers is based on the MHP s overall rate of change (6.1% in FY 16-17) due to the process of referral by which beneficiaries are directed to FFS providers. Accessibility and Availability Report FY 16-17 2
LCSW Fee-for-Service Provider In FY 16-17, the FFS LCSW provided an array of specialty mental health services to 16 beneficiaries, which is less than the 48 unduplicated Medi-Cal beneficiaries served the previous year. The distribution of this Medi-Cal population is shown by age, gender, ethnicity, and language in Figures 6.2 through 6.6, and Table 6.1, which illustrate the shifts in some categories from the previous year. Figure 6.2. LCSW Medi-Cal Beneficiary Age Distribution 12 1 8 6 4 2 11 9 8 6 3 1 8 6 5 5 4 4 4 3 2 2 2 1 1 1-5 6-11 12-17 18-2 21-24 25-34 35-44 45-54 55-64 FY 14-15 FY 15-16 FY 16-17 The largest age group served was the 6-11 group with 6 beneficiaries, or 38% of the population served. The 25-34 group was the second largest group in FY 16-17 with 4 beneficiaries, or 25% of the population served. The third largest age group was the 45-54 age group with 2 beneficiaries, or 13% of the population served. Figure 6.3. LCSW Medi-Cal Beneficiary Gender Distribution 3 22 2 16 2 1 11 7 9 FY 14-15 FY 15-16 FY 16-17 Male Female Other The largest gender group served by the LCSW in FY 16-17 was Female with 56% of the population. The male gender represents 44% of the population. Accessibility and Availability Report FY 16-17 3
Table 6.1. LCSW Medi-Cal Beneficiary Ethnic Distribution Period Black % Hispanic % White % Other % Total FY 16-17 % 12 75% 2 13% 2 12% 16 FY 15-16 1 2% 36 85.7% 5 12% % 42 FY 14-15 % 22 78.6% 6 21.4 % 28 The Hispanic group remained the largest ethnic group served by the LCSW in FY 16-17 with 12 beneficiaries, or 75% of the population served. Figure 6.4. Medi-Cal Beneficiary Language Distribution 4 3 32 2 1 18 1 1 13 FY 14-15 FY 15-16 FY 16-17 3 English Spanish Other English was the language reported by the largest number of beneficiaries receiving LCSW services with 13 beneficiaries, or 81% of the population served. Other or not language identified was indicated for 3 beneficiaries, which is a significant decrease compared to FY 15-16 when 32 beneficiaries spoke a language other than English or Spanish. No beneficiaries identified Spanish as their language during FY 15-16. Accessibility and Availability Report FY 16-17 4
Figure 6.5. Medi-Cal Ethnicity and Language Comparison 2 15 1 5 4 12 3 13 Ethnicity Language Hispanic Non Hispanic Spanish English Other A comparison of the language and ethnicity of beneficiaries indicates 75% are Hispanic with none having indicated Spanish as their spoken language. Beneficiaries representing all other ethnicities account for 25% of the Medi-Cal population with 81% of the population indicated English as their language. Other languages reported 19%. 2 Figure 6.6. City of Residence Medi-Cal Beneficiaries 16 11 12 1 3 7 7 7 7 1 FY 14-15 FY 15-16 FY 16-17 Brawley El Centro Imperial Other 9 4 2 The largest number of beneficiaries reported living in El Centro, with 9 beneficiaries or 56% of the population served by the LCSW in FY 16-17. The second largest group of beneficiaries reported living in Imperial, with 4 beneficiaries or 25% of the population served. FFS LCSW Service Utilization Medi-Cal Population FY 16-17 During FY 16-17, the LCSW provided mental health services to 14 beneficiaries and mental health services-therapy to 11 beneficiaries. This is a decrease when compared with the previous year when these services were provided to 4 beneficiaries and 33 beneficiaries respectively. The total number of services and average number per beneficiary are shown in Table 6.2. Accessibility and Availability Report FY 16-17 5
Table 6.2. Utilization by Number of Beneficiaries, Number of Services, and Average Number of Services FY 16-17 Number of Total Number Average Number Services Beneficiaries Of Services of Services Mental Health Services 14 26 1.9 Mental Health Services Therapy 11 29 2.6 Anticipated Utilization of Services FY 17-18 The anticipated number of beneficiaries and services are determined by applying the percentage of change in the Imperial County Medi-Cal population (6.1%) to the number of beneficiaries that used each category of service the previous year, then multiplying the number of anticipated beneficiaries by the average number of services for each category. The projected utilization of service for the 25 beneficiaries anticipated to seek services through FFS LCSWs in FY 17-18 is shown in Table 6.3. Table 6.3. Anticipated Utilization by Number of Beneficiaries, Services, and Average Number of Services FY 17-18 Number of Total Number Average Number Services Beneficiaries Of Services of Services Mental Health Services 15 28 1.9 Mental Health Services Therapy 12 31 2.6 Accessibility and Availability Report FY 16-17 6
Psychiatrist Fee-for-Service Providers In FY 16-17, one non-contracted in-county FFS Psychiatrist provided services to 113 beneficiaries, which is an increase of 33 beneficiaries compared to the 8 beneficiaries served in FY 15-16. This is a significant increase in the number of Medi-Cal beneficiaries receiving services from the FFS psychiatrist. The distribution of this Medi-Cal population is shown by age, gender, ethnicity, and language in Figures 6.7 through 6.11, and Table 6.4. Figure 6.7. FFS Psychiatrist Medi-Cal Beneficiary Age Distribution 35 3 25 2 15 1 5 19 15 12 11 11 6 5 4 4 6 6 4 5 4 3 4 4 1 31 25 22 19 9 6-11 12-17 18-2 21-24 25-34 35-44 45-54 55-64 FY 14-15 FY 15-16 FY 16-17 The largest age group in FY 16-17 was the 55-64 group 31 with beneficiaries, or 27% of the population served. The second largest group in FY 16-17 was the 45-54 group with 25 beneficiaries, or 22% of the population served. Other age group(s) with increased numbers were 35-44 group with 8 beneficiaries and 55-64 group with 9 beneficiaries. Figure 6.8. FFS Psychiatrist Medi-Cal Beneficiary Gender Distribution 7 6 5 4 3 2 1 65 48 43 21 37 16 FY 14-15 FY 15-16 FY 16-17 Male Female The female gender group was the largest gender group served by FFS Psychiatrists in FY 16-17 with 65 beneficiaries, or 58% of the population served. The male group accounted for 42% of the beneficiaries served by the in FY 16-17. Accessibility and Availability Report FY 16-17 7
Table 6.4. FFS Psychiatrist Medi-Cal Beneficiary Ethnic Distribution Period Black % Hispanic % White % Other % Total FY 16-17 7 6% 75 66% 18 16% 13 12% 113 FY 15-16 6 8% 37 46.3% 16 2% 2 25% 8 FY 14-15 5 13.5% 27 73% 5 13.5% % 37 The Hispanic group remained the largest ethnic group of beneficiaries in FY 16-17 with 75 beneficiaries, or 66% of the population served this is an increase of 38 beneficiaries served in this group when compared to FY 15-16. The second largest ethnic group of beneficiaries served was White, with 18 beneficiaries served. Figure 6.9. FFS Psychiatrist Medi-Cal Beneficiary Language Distribution 7 6 5 4 3 2 1 65 56 28 19 16 1 2 8 8 FY 14-15 FY 15-16 FY 16-17 English Spanish Other English remained the largest language group served by the FFS Psychiatrists with 65 beneficiaries, or 58% of the population served in FY 16-17. This is an increase from the previous year when 16 English speaking beneficiaries were served. Other or not language identified was the second largest language group with for 28 beneficiaries, or 25% of the population served. This is a decrease when compared to FY 15-16 when 56 beneficiaries were served. Spanish speaking beneficiaries reflected an increase of 12 beneficiaries from FY 15-16. Accessibility and Availability Report FY 16-17 8
Figure 6.1. Medi-Cal Ethnicity and Language Comparison 12 1 8 38 28 6 4 75 65 2 Ethnicity Language 2 Hispanic Non Hispanic Spanish English Other A comparison of the language and ethnicity of beneficiaries indicates 66% are Hispanic ethnicity, with 18% indicating Spanish as their spoken language. Beneficiaries representing all other ethnicities account for 34% of the Medi-Cal population and 58% of the population indicated English as their spoken language. Other languages reported 24%. The beneficiary city of residence shows only the major local cities reported by beneficiaries served by the FFS Psychiatrist, due to the small number of beneficiaries residing in other single cities and the large number of cities represented. Figure 6.11. FFS Psychiatrist City of Residence Medi-Cal Beneficiaries 5 4 3 32 3 41 41 2 1 12 8 14 16 15 5 4 FY 14-15 FY 15-16 FY 16-17 Brawley El Centro Imperial Other El Centro was indicated as bring the primary residence for the majority of beneficiaries, with 41 beneficiaries, or 36% of the population served, reported it as their city of residence in FY 16-17. The Other cities group was tied for the largest with 41 beneficiaries; the individual cities and number of beneficiaries are: Calexico 17; Winterhaven and Westmorland with 1 each; Heber 4; and Holtville 5; Niland 2 each; and non-identified 11. Accessibility and Availability Report FY 16-17 9
FFS Psychiatrist Service Utilization Medi-Cal Population FY 16-17 During FY 16-17, medication support services were provided to 96 beneficiaries for a total of 564 services. Mental health services were provided to 82 beneficiaries for a total of 176 services. This is an increase in both the number of beneficiaries served and the total number of services provided when compared to FY 15-16. The total number of services and average number per beneficiary are shown in Table 6.5. Table 6.5. Utilization by Number of Beneficiaries, Number of Services, and Average Number of Services FY 16-17 Number of Total Number Average Number Services Beneficiaries Of Services of Services Mental Health Services 82 176 2.1 Medication Support Services 96 564 5.9 Anticipated Utilization of Services FY 17-18 The anticipated number of beneficiaries and services are determined by applying the percentage of change in the Imperial County Medi-Cal population (6.1%) to the number of beneficiaries that used each category of service the previous year, then multiplying the number of anticipated beneficiaries by the average number of services for each category. The projected utilization of service for the 119 beneficiaries anticipated to seek services through FFS psychiatrists in FY 17-18 is shown on Table 6.6. Table 6.6. Anticipated Utilization by Number of Beneficiaries, Services, and Average Number of Services for FY 17-18 Number of Total Number Average Number Services Beneficiaries Of Services of Services Mental Health Services 87 187 2.1 Medication Support Services 12 598 5.9 Accessibility and Availability Report FY 16-17 1
Organizational Providers Contracted organizational providers served 125 Medi-Cal beneficiaries, which is an increase of 2 beneficiaries when compared to the 15 beneficiaries served in FY 15-16. The distribution of this Medi-Cal population is shown by age, gender, ethnicity, and language in Figures 6.12 through 6.16 and Table 6.7. Figure 6.12. Organizational Providers Medi-Cal Beneficiary Age Distribution 4 35 3 25 2 15 1 5 4 29 26 22 21 22 11 7 9 4 7 7 6 7 5 3 2 2-5 6-11 12-17 18-2 21-24 25-34 35-44 45-54 55-64 FY 15-16 FY 16-17 The largest age group in in FY 16-17 was the 6-11 group with 4 beneficiaries, or 32% of the population served in FY 15-16. The second largest group in FY 16-17 was the 12-17 group with 26 beneficiaries, or 21% of the population served. Figure 6.13. Organizational Providers Medi-Cal Beneficiary Gender Distribution 8 6 4 2 66 39 67 58 FY 15-16 FY 16-17 Male Female The female gender group was the largest gender group served by Organizational Providers in FY 16-17 with 67 beneficiaries, or 54% of the population served. The male group accounted for 46% of the beneficiaries served in FY 16-17. Accessibility and Availability Report FY 16-17 11
Table 6.7. Organizational Providers Medi-Cal Beneficiary Ethnic Distribution Period Black % Hispanic % White % Other % Total FY 16-17 4 3% 16 85% 9 7% 6 5% 125 FY 15-16 4 4% 8 76% 14 13% 7 6% 15 The Hispanic group remained the largest ethnic group of beneficiaries in FY 16-17 with 16 beneficiaries, or 85% of the population served.) The second largest ethnic group served was White with 9 beneficiaries, which reflects a decrease from FY 15-16. Figure 6.14. Organizational Providers Medi-Cal Beneficiary Language Distribution 9 8 7 6 5 4 3 2 1 79 79 28 14 18 12 FY 15-16 FY 16-17 English Spanish Other English remained the largest language group served by Organizational Providers with 79 beneficiaries, or 63% of the population served in FY 16-17. Spanish was the second largest language group that was identified with 28 beneficiaries, or 22% of the population served. Eighteen beneficiaries reported speaking a language other than English and Spanish in FY 16-17. Figure 6.15. Medi-Cal Ethnicity and Language Comparison 14 12 1 8 6 4 2 19 16 Ethnicity Language Hispanic Non Hispanic Spanish English Other 18 79 28 Accessibility and Availability Report FY 16-17 12
A comparison of the language and ethnicity of beneficiaries indicates 85% are Hispanic ethnicity, with 22% indicating Spanish as their spoken language. Beneficiaries representing all other ethnicities account for 15% of the Medi-Cal population and 78% of the population indicated English as their language. Languages other than Spanish and English are spoken by 24% of the population. The beneficiary city of residence shows only the major local cities reported by beneficiaries served by the Organizational Provider, due to the small number of beneficiaries residing in other cities and the large number of cities represented. The number of beneficiaries residing in the major local cities is represented in Figure 6.16. Figure 6.16 Organizational Provider City of Residence Medi-Cal Beneficiaries 8 7 6 5 4 3 2 1 23 11 51 69 23 1 16 FY 15-16 FY 16-17 Brawley El Centro Calexico Beaumont Other The majority of beneficiaries identified El Centro as their primary residence, with 69 beneficiaries or 55% of the population served. The second largest city of residence was Calexico with 23 beneficiaries, or 18% of the population served. Organizational Provider Service Utilization Medi-Cal Population FY 16-17 During FY 16-17, therapeutic behavioral services were provided to 48 beneficiaries, mental health services were provided to 73 beneficiaries, and therapy services were provided to 41 beneficiaries The total number of services and average number per beneficiary are shown in Table 6.8. Table 6.8. Utilization by Number of Beneficiaries, Number of Services, and Average Number of Services FY 16-17 Number of Total Number Average Number Services Beneficiaries Of Services of Services Medication Support Psychiatrist 4 32 8 Mental Health Services 73 51 6.9 Therapy Services 41 235 5.7 Therapeutic Behavioral Services 48 1,181 25 Accessibility and Availability Report FY 16-17 13
Anticipated Utilization of Services FY 17-18 The anticipated number of beneficiaries and services are determined by applying the percentage of change in the Imperial County Medi-Cal population (6.1%) to the number of beneficiaries that used each category of service the previous year, then multiplying the number of anticipated beneficiaries by the average number of services for each category. The projected utilization of service for the 133 beneficiaries anticipated to seek services through Organizational Providers in FY 17-18 is shown on Table 6.9. Table 6.9. Anticipated Utilization by Number of Beneficiaries, Services, and Average Number of Services for FY 17-18 Number of Total Number Average Number Services Beneficiaries Of Services of Services Medication Support Psychiatrist 4 34 8.5 Mental Health Services 77 532 6.9 Therapy Services 44 249 5.7 Therapeutic Behavioral Services 51 1253 24.6 Accessibility and Availability Report FY 16-17 14