7/3/12. Health Insurance 101 for Behavior Analysts AGENDA. June 19, California Association for Behavior Analysis (CALABA)

Transcription

1 Health Insurance 101 for Behavior Analysts June 19, 2012 CalABA Insurance Work Group Dr. David Adams, Psy-D, BCBA-D Sarah Trautman-Eslinger, M.A., BCBA AGENDA Introductions Overview of CALABA, Public Policy, and Insurance Work Group of Public Policy How to obtain a NPI How to complete the CAQH process Credentialing Federal Insurance Health Reform Overview of 2 types of Insurance Plans SB 946 and Regional Centers The Regulators of the Insurance Plans A brief but necessary disclaimer This presentation is strictly for informational purposes only. Members of the CalABA Board of Directors or members of the CalABA PPC have not entered into any formal relationship with the attendees. As in all professional matters and therapeutic issues, you are encouraged to consult professionals with respect to your individual agency and practice. Do not distribute or reproduce this material without permission CalABA. All rights reserved. California Association for Behavior Analysis (CALABA) The mission of CALABA is to promote the science and theory of behavior analysis through the support of research, education, and practice The Insurance Work Group is part of the Public Policy Committee of CALABA and has been developed to help provide training to behavior analysts with issues related to insurance. The 3 Step Process For practitioners provide and be eligible for reimbursement for ABA Tx through health insurance 1. Register NPI 2. Request CAQH number and complete CAQH file 3. Complete credentialing application for specific health insurance company The First Step Register for an NPI NPI stands for National Provider Identifier standard unique health identifier for health care providers, including BCBA and BCaBA adopted by Secretary of Health and Human Services (HHS) as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) 5-10 min. to complete You will usually receive your NPI number immediately following the online application 1

2 The First Step Register for an NPI Online Application: Welcome.do Phone Contact: Things you need: Basic Demographic Information Social security number and/or EIN (employee identification number) Taxonomy code 103K00000X = Behavior Analyst License number (if you have one) BCBA / BCaBA certificant number CAQH (Council for Affordable Quality Healthcare) Health plans, hospitals, and other managed care organizations across country use CAQH to collect data from licensed healthcare providers Reduces administrative burden of collecting provider data for credentialing and other business applications Contact insurance carrier (i.e. Cigna, Aetna, Magellan, etc.) to request CAQH number Several hours to complete application Information needed: References Previous employment (along with dates and addresses) Specific information about your facility/practice location Information about your graduate school, address, and graduation date Professional liability and coverage information Sections of interests in CAQH application Please contact CAQH for more information Additional documents needed to complete to application: CV/resume Proof of professional liability W-9 BCBA /BCaBA certificate Your licenses Attestation Signature Page Fax Cover Sheet Re-attest every 120 days Update when any documents update or renew BCBA /BCaBA Liability insurance save your work before leaving each section Review all sections for accuracy 2

3 Credentialing Process Review and complete credentialing application Malpractice insurance Required staff census information All requested documentation Prepare for site visit / review 90 to 180 days for the process follow up on status Credentialing Process Aetna join-aetna-network/join-provider-network.html UBH Cigna provider/customerservice/ individualpractitioners.jsp 31 States now have Autism Coverage Mandates Two Types of Health Insurance Plans Self-Insured State-Regulated Green States with Autism Insurance Reform Laws Red States with Reform in 2012 Yellow States Pursuing Autism Insurance Reform in 2012 Blue States NOT Currently Pursuing Autism Reform Source: Autism Votes, Self-Insured Plans Typically large companies (500+ employees) and government agencies Self-insured companies Pay employee benefits from own fund and assume all risk Essentially the company rents a Network from an insurance company Regulated by Department of Labor-ERISA Self-Insured Plans ERISA - The Employee Retirement Income Security Act Federal law sets minimum standards for self-insured plans to provide consumer protections (acts like a state DOI) ERISA preempts most state insurance regulation, including Autism mandates 3

4 Self-Insured Plans (not exhaustive) Many self-funded companies have elected to implement autism benefits: Arnold & Porter Law Firm Chapman Automotive Group Cisco City of Atlanta Deloitte DTE Energy Eli Lilly Fluer Google Greenville Hospital System Halliburton Home Depot IBM Imation Intel Lexington Medical Center Mayo Clinic Maxim Integrated Mercy Hospital (St. Louis) Michelin Microsoft Network Appliance, Inc Ohio State University Oracle Phoenix Fire Department PG&E Progressive Group Symantec TriQuint Semiconductor Time Warner University of Minnesota Wells Fargo Yahoo (California) State Regulated Department of Managed Health Care (DMHC) Regulates many of the HMO plans and Blue Cross and Blue Shield California Department of Insurance (DOI) Regulates many PPO s California Department of Insurance (CDI) health-issues/0025-autism/ -Information for consumers and practitioners Department of Managed Health Care (DMHC) br_autismtf.aspx Effective on July 1, 2012 Sunsets on July 1, 2014 SB 946 Scope of coverage Private health plans regulated by the state of California must provide behavioral health treatments, such as ABA and other evidence-based interventions, for individuals with a diagnosis of autism spectrum disorder or PDD-NOS. no age caps or dollar limits on ABA treatment ABA must be prescribed by an appropriate, licensed person before treatment can be approved. treatment plan must be developed and approved before ABA services can start. include measurable goals over a specific timeline developed and are supervised by qualified autism service provider. -Information on the Autism Advisory Task Force SB 946 and Regional Center Services Starting July 1 st eligible health plans will become the first payor for medically necessary ABA services for persons with ASD or PDD-NOS. The Regional Centers of California have always been the payor of last resort according to the Lanterman Act. Current clients whose ABA services are being paid for by their local Regional Center will need to obtain ABA services through their health insurance plan. This seems to include Healthy Families and CalPERS (as they appear to be covered under mental health parity AB 88). EXCLUDED PLANS are those plans that are self-funded and, therefore, federally regulated by ERISA as well as Medi-Cal. SB 946 and Regional Center Services cont d Many RCs developing different policies and procedures Regarding copay Timelines Transition procedures Best way to help clients transition is to be know the type of insurance plan each of your client s has. When in doubt, contact your local Regional Center and ask for clarification. 4

5 How is CalABA going to continue to support behavior analysts work with health insurance companies? More webinars that will sequentially help practitioners through the entire health insurance process from start to finish. CalAHIP! Special subscription service sponsored by CalABA that will provide comprehensive information and resources to practitioners working with health insurance companies. 5