amerigroup tn partners in progress tnco conference october 28, 2015 1
TRANSCRIPT
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Amerigroup TNPartners in Progress
TNCO ConferenceOctober 28, 2015
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Agenda• Panel Introductions• Managed Care in TN• LTSS at Amerigroup• Employment & Community First (ECF)
CHOICES update• Amerigroup Provider Relations• ECF Preferred Providers• Crisis Prevention strategies
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Amerigroup Panelists
Dr. Jana Dreyzehner- BH Medical [email protected]
Kimberly Weakley- RVP Provider [email protected]
Rachel Turner- Director of Special Programs, [email protected]
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Managed Care in TN
• Key concepts for success in Managed Care• Transformation of Managed Care in TN• Expectations for Amerigroup:– Person-Centered– Quality Driven– Efficient– Effective
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Amerigroup LTSS
• Philosophy and approach to LTSS• Success in coordinating supports for
individuals in the CHOICES program• Integrated approach to providing LTSS• Profile of LTSS provider network
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Employment & Community First (ECF) CHOICES
Tennessee proposes to become the first state in the country to develop and implement an HCBS program that is specifically geared toward promoting and supporting integrated, competitive employment and independent living as the first and preferred option for all individuals with intellectual and developmental disabilities: Employment and Community First CHOICES
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Employment & Community First (ECF) CHOICES
• Amendment 27 to TN’s Managed Care waiver• Amendment 3- Amending Amerigroup’s
contract with the Bureau of TennCare to include ECF– Support Coordination– ECF Groups– Services• Employment
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ECF Staffing• Tina Brill- RVP LTSS• Rachel Turner- Director Special Programs, LTSS– Support Coordination– Employment Specialist– Housing Specialist– Provider Relations– Self Direction– Operations
• Consultants & Subject Matter Experts
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ECF Provider Network
• Network Development & Training• Network Adequacy• ECF Preferred Providers• Employment Focus
Amerigroup Provider Relations
Provider Relations Representatives• Recruitment• Credentialing & Contracting• Provider Orientation• Issue Resolution• Provider Satisfaction• CMS HCBS Setting Rules Compliance
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Provider WebsiteProviders can access the following services through providers.amerigroup.com: Provider newsletters Provider manuals Provider directory Panel listing Announcements Quick Reference Card Online forms Request precertification File claims Verify eligibility Website registration Join our network
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Your Reference Tools
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I/DD Crisis Stabilization and Prevention
Model of Support
Model of Support
A comprehensive, proactive, person-centered approach to the delivery of behavioral health crisis prevention and stabilization services -
for individuals with IDD who experience challenging behaviors that place themselves and others at risk of harm.
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Assessment/Planning/Prevention
• Person-centered assessment• Development of individualized Crisis Prevention and
Intervention Plan (WRAP-like concept)—ongoing process• MOS Champion (the individual’s “subject matter expert”)• MOS Team• MOS Liaison (MCO Expert)• MOS and individualized crisis prevention/stabilization training
with support from the Center for START Services
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MOS Team
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Person Supported
MOS Liaison Family
&FriendsSocial Clubs
Church
Service Providers
PsychotherapyBehavioral TherapySpeech & Language
Physical therapyOccupational therapy
MOS Champion
MedicalPrimary Care
PsychiatrySpecialist
CommunityEmployers
Law enforcementSchools
Crisis TeamPeer Support
Goals of the Model of Support
• Person will achieve a higher degree of stability and community tenure
• Support system will demonstrate effective and proactive management of the person’s daily living
• Person will benefit from improved quality of life• Utilization of law enforcement, ER and inpatient
hospitalization will decrease• Communities will gain increased experience and expertise
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