How Should My Agency Work with Medicaid?

Transcription

1 How Should My Agency Work with Medicaid? WEBINAR WILL BEGIN SHORTLY. *****YOU MUST DIAL-IN USING A TELEPHONE TO RECEIVE THE AUDIO PORTION OF THIS CALL**** US/CANADA DIAL-IN #: (800) PASSCODE:

2 Webinar Overview Panel Peggy Bailey, CSH Senior Policy Advisor Janette Kawachi, Ph.D., Program Director, Catholic Social Services of Washtenaw County Mark Shotwell, Program Director, Bonita House Inc.

3 Accessing Medicaid: What to Consider PEGGY BAILEY SENIOR POLICY ANALYST

4 Why Medicaid? Stable services funding source Covers both primary and behavioral health Strengthens partnership with health system (PSH residents need access to the mainstream system) Improved chronic disease management

5 Medicaid Limitations States restrict Medicaid billable providers General Reimbursement Can be slow May not support team oriented care Requires strong administrative infrastructure Does not cover all PSH services Experts estimate that Medicaid has ways to fund between 80 90% of services in PSH Things like housing search, move-in expenses, and related case management are not usually covered Gap between what Medicaid currently covers and it s full potential

6 Ways to Access Medicaid Bill Medicaid Directly mostly for health and behavioral health direct service providers Examples for supportive housing: Direct Access to Housing in San Francisco, Pathways to Housing, Baltimore Health Care for the Homeless, Colorado Coalition for the Homeless Partnership Service provider handles billing for a housing provider (models vary)

7 Partner, Partner, Partner Getting housing providers as Medicaid billable agencies is NOT usually the solution It s not just about Medicaid you have to access all insurance - Medicare and private Medicaid benefits need to align with PSH resident s needs Then housing providers can partner with Medicaid billing agencies (various options) Panel will explain how these partnerships can work

8 Avalon Housing, Inc Permanent Supportive Housing Catholic Social Services of Washtenaw County Housing Support Services

9 Basic Info Avalon owns and manages 282 units at 24 scattered sites throughout Ann Arbor, ranging from a duplex to a 48-unit complex. Supportive Housing Services Family and Community Services (126 family units) Housing Support Services (156 single adults units)

10 Housing Support Services Program of Catholic Social Services of Washtenaw County Partnership with Avalon since 2001 Staffing: 1 Program Director 6.5 FTE case managers 1 Med Coordinator On-site offices and home-based services Staffing from 8am 10pm with 24/7/365 crisis response services Services: Housing First, voluntary, ongoing, comprehensive, individualized

11 Profile of Single Adult Tenant Population (April, 2011) Total: 146 Single Adults Service Intensity: Very High Intensity (Daily): 25 (17%) High Intensity (Weekly): 33 (23%) Moderate (2x/month): 25 (17%) Low Intensity (1x/month): 34 (23%) Very Low Intensity (< 1x/month): 29 (20%) Needs: Chronic Health Issue: 45 (31%) Mental Illness: 101 (72%) Addiction Disorder: 45 (31%) Co-occurring (2+): 62 (42%)

12 Medicaid and Other Health Care Coverage in Supportive Housing Presenter: Mark Shotwell C.A.T.C. Bonita House Inc. Alameda County, California

13 Bonita House Inc. Located in Alameda County, California Social Rehabilitation Agency providing Integrated Dual Diagnosis Treatment services to adults with Co- Occurring Mental Health and Substance Use issues since Core services funding through Alameda County Behavioral Health Care Services and reimbursable through Medicaid. Housing funding through HUD (S+C, Section 202, Mckinney-Vento)

14 Homeless Outreach and Stabilization Team (HOST) HOST Assertive Community Treatment Team get Population: 90 Chronically Homeless Adults living with SPMI Housing First Model Field based Located in Alameda County, California--Urban area terdisciplinary Team of unlicensed Personal Service Coordinators, er staff, Psychiatric Nurse Practitioner, Social Worker, Physician s ssistant, Housing Manager, Employment Specialist, Financial and ministrative staff (16 Full-Time staff, 3 temporary contract admin. staff) Major funding through Medicaid, Mental Health Services Act (flexible funding), Shelter Plus Care

15 Two very different approaches to Medicaid and OHC billing Partnership with Lifelong Medical Care (Federally Qualified Health Care Center (FQHC) for 1 FTE Physician s Assistant. Lifelong handles all billing functions. Contract relationship with Alameda County Behavioral Health Care Services. Medicaid billing passes through County. HOST program essentially handles all billing functions.

16 Partnership with FQHC 1 FTE Physician s Assistant for medical care All PA services are billed through Lifelong FQHC 35% offset to PA salary for HOST through revenue All visits are home visits and reimburse at one rate Lifelong has long hx. of providing Medical and C.M. Services and case management services (grounded billing and productivity expectations) PA employee of FQHC=training and admin. support

17 Contract relationship with County Behavioral Health Care Services Total budget of HOST is $2.5 million per year Total annual revenue expectations through billing Medicaid is $585,000 (start-up time to meet this) All billing functions managed on-site by HOST Pass through with County for Medicaid billing Direct billing of Medicare and Other Health Care Coverage

18 Necessary resources for Contract relationship with County 30 hours per month minimum staff time for billing functions (data input, billing reconciliation, Error corr.) Utilization Review Function for quality of documentation 8 hours per week of UR coordinator time Daily quality review of documentation by supervisors within team meeting (all notes read every day) Mental Health Services Act funding also folded into HOST budget flexible funding for otherwise nonreimbursable services

19 Funding History Mid 90 s through Case Rate (State General Fund Dollars) 2008 switch to Fee-for-Service Medicaid dollars Other funding from local grants and HUD SHP ongoing

20 Medicaid Reimbursed Services Targeted Case Management (T1017 services) Assessment, IPOS development, referral/csm, follow-up/monitoring Variable rate established by local CMHSP Licensing requirements QMHP or supervision Community Living Supports (H2015 services) ADL assistance, medication management Fixed Rate ($15.00/hr) Crisis Intervention (H2011 services) Crisis Intervention Variable rate established by local CMHSP Licensing requirements QMHP or supervision

21 Medicaid Restrictions Medicaid billing criteria Medical Necessity Face-to-face interactions Must be documented and billed by encounter (15 min increments) Restricted Coverage: Must have Medicaid Open and active cases with CSTS Stringent eligibility criteria: SPMI Primary substance abuse not covered

22 Infrastructure and Administrative Requirements Agency Accreditation Staff provider qualifications, training and supervision Record keeping, billing and administrative requirements Fee for service claiming and budgeting Data collection and outcome reporting Increased risk and liability Relationship building

23 Catholic Social Services of Washtenaw County Program Director Janette Kawachi, Ph.D ext. 8

24 Medicaid and Other Health Care Coverage in Supportive Housing Presenter: Mark Shotwell C.A.T.C. Bonita House Inc. Alameda County, California

25 Bonita House Inc. Located in Alameda County, California Social Rehabilitation Agency providing Integrated Dual Diagnosis Treatment services to adults with Co- Occurring Mental Health and Substance Use issues since Core services funding through Alameda County Behavioral Health Care Services and reimbursable through Medicaid. Housing funding through HUD (S+C, Section 202, Mckinney-Vento)

26 Homeless Outreach and Stabilization Team (HOST) HOST Assertive Community Treatment Team get Population: 90 Chronically Homeless Adults living with SPMI Housing First Model Field based Located in Alameda County, California--Urban area terdisciplinary Team of unlicensed Personal Service Coordinators, er staff, Psychiatric Nurse Practitioner, Social Worker, Physician s ssistant, Housing Manager, Employment Specialist, Financial and ministrative staff (16 Full-Time staff, 3 temporary contract admin. staff) Major funding through Medicaid, Mental Health Services Act (flexible funding), Shelter Plus Care

27 Two very different approaches to Medicaid and OHC billing Partnership with Lifelong Medical Care (Federally Qualified Health Care Center (FQHC) for 1 FTE Physician s Assistant. Lifelong handles all billing functions. Contract relationship with Alameda County Behavioral Health Care Services. Medicaid billing passes through County. HOST program essentially handles all billing functions.

28 Partnership with FQHC 1 FTE Physician s Assistant for medical care All PA services are billed through Lifelong FQHC 35% offset to PA salary for HOST through revenue All visits are home visits and reimburse at one rate Lifelong has long hx. of providing Medical and C.M. Services and case management services (grounded billing and productivity expectations) PA employee of FQHC=training and admin. support

29 Contract relationship with County Behavioral Health Care Services Total budget of HOST is $2.5 million per year Total annual revenue expectations through billing Medicaid is $585,000 (start-up time to meet this) All billing functions managed on-site by HOST Pass through with County for Medicaid billing Direct billing of Medicare and Other Health Care Coverage

30 Necessary resources for Contract relationship with County 30 hours per month minimum staff time for billing functions (data input, billing reconciliation, Error corr.) Utilization Review Function for quality of documentation 8 hours per week of UR coordinator time Daily quality review of documentation by supervisors within team meeting (all notes read every day) Mental Health Services Act funding also folded into HOST budget flexible funding for otherwise nonreimbursable services