NYAPRS Executive Seminar Pathways to Medicaid for HCBS Services Andrew Cleek, PsyD John Lee
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1 NYAPRS Executive Seminar Pathways to Medicaid for HCBS Services Andrew Cleek, PsyD John Lee
2 Managed Care TAC (MCTAC) Overview What is MCTAC? MCTAC is a training, consultation, and educational resource center that offers resources to all mental health and substance use disorder providers in New York State. MCTAC s Goal Provide training and intensive support on quality improvement strategies including business, organizational and clinical practices, to achieve the overall goal of preparing and assisting providers with the transition to Medicaid Managed Care. 2
3 Participation Rate Unique agency participation in MCTAC activities as of 3/1/15: 537 unique agencies 195 (46%) of OASAS 342 (62%) OMH Agencies 3
4 Preliminary Analysis Overview 313 MCTAC Readiness Assessments were included in analysis OMH, OASAS and OMH/OASAS were represented (~30% each) 162 (52%) agencies did not score in the Top 25% in any Factor There are no statistically significant differences by Region There are statistically significant differences by Reimbursement There are statistically significant differences by Agency Type 4
5 MMC Readiness Assessment This MMC Readiness Tool is designed to provide organizations with 11 categories of processes, practices and change management activities needed to effectively prepare for and function during the early stages of a business relationship with a Managed Care organization. When completed, the self-assessment tool offers a snapshot of the organization s current level of readiness as well as an assessment of the need for technical assistance. This tool may be helpful as a planning resource to guide organizations in their preparation and decision making activities. 5
6 Managed Care Experience ~50% have little to no experience in billing managed care ~50% have a decent amount of experience in billing managed care companies 6
7 MCTAC Readiness Assessment - Domains Domain Name Label in Graphs 1 Understanding MCO Priorities & Present Managed Care Involvement MCO Priorities 2 MCO Contracting Contracting 3 Communication /Reporting (Services authorization, etc.) Communication 4 IT System Requirements IT 5 Level of Care (LOC) Criteria / Utilization Management Practices Level of Care 6 Member Services/Grievance Procedures Member Services 7 Interface with Physical Health, Social Support and Health Homes 8 Quality Management/Quality Studies/Incentive Opportunities Quality 9 Finance and Billing Finance 10 Access Requirements Access 11 Demonstrating Impact/Value (Data Management & Evaluation Capacity) Interface Evaluation Aggregate Total Score Total Score 7
8 Average Score by Domain Domain Average Score 1. MCO Priorities Contracting Communication IT Level of Care Member Services Interface Quality Finance Access Evaluation 2.43 Total Score
9 There were differences in Domains by Reimbursement Level Domain Scores by Agency's Managed Care Reimbursement 3.00** ** 1.86** ** 1. MCO Priorities 2. Contracting 3. Communication 4. IT Less than 10% More than 10% 3.66 * p<0.05; ** p<.001 9
10 Domain Scores by Agency's Managed Care Reimbursement ** 2.43** ** Level of Care 6. Member Services 7. Interface 8. Quality Less than 10% More than 10% * p<0.05; ** p<
11 Domain Scores by Agency's Managed Care Reimbursement ** 2.87** * ** Finance 10. Access 11. Evaluation Total Score Less than 10% More than 10% * p<0.05; ** p<
12 Sample Agency Readiness Benchmark Report 12
13 TOOLS 13
14 14
15
16 HCBS TA Plan Foundations Training: Morning: Foundations in Essential Business and Operations Practices Needed to Work Effectively with MCOs Afternoon: Exploring Options for Deploying the Practices Essential to the Work with MCOs Target Population: HCBS-only providers and other selected small providers 16
17 Pre-Day One Training Title Training Content Audience Type of Training HCBS Services Foundations Training Will provide foundational knowledge of each HCBS service Clear distinctions between MH v SUD Explore how HCBS services match with other state services, what they are, what they do, how they fit into a consumer s plan of care HCBS Providers Health Home Staff Web Based & In Person HCBS Service Process Step by step process by which a consumer accesses HCBS services: Including assessment, care planning, referral, authorization for services HCBS Providers Health Home Staff In Person & Web Based (To be followed by Learning Communities as needed) HCBS Provider Readiness Training Contracting (completed) How to become Medicaid provider (if needed) Billing and coding Record keeping clinical and administrative record keeping Staffing OMIG requirements, HIPAA training HCBS Providers In Person & Web Based (To be followed by Learning Communities as needed) Health Homes Trainings All training in Foundation and Service Categories Education on workflow for a health home care manager Provide MC 101 training for Health Home staff Care Planning Health Home Staff In Person & Web Based 17
18 Health Home Care Management Training Type of Training Timeline MCO 101, HCBS Foundations training: for Health Home senior staff and Health Home Care Managers Training InterRAI Training: for all health home care management staff and NOT DELIVERED BY MCTAC Work flow, step by step process for assessment: What workflow looks like both generally and specifically for HH care managers. May 2015 May/June 2015 May/June
19 HCBS Agency Training Type of Training Timeline HCBS foundational training: provide foundational knowledge of each HCBS service May 2015 HCBS Administrative training April/May/June 2015 HCBS Work Flow training: What workflow looks like both generally and specifically for HH Administrators. May/June 2015 HCBS Operational Training May/June
20 Questions and Discussion Visit to view past trainings, sign-up for upcoming events, and access 20
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