changes to medicaid behavioral health programs …2014/06/08 · 2014 nami virginia state...
TRANSCRIPT
Karen E. Kimsey Deputy Director of Complex Care and Services Virginia Department of Medical Assistance Services 2014 NAMI Virginia State Convention June 8, 2014
www.dmas.virginia.gov 1
Department of Medical Assistance Services
Changes to Medicaid Behavioral
Health Programs and Services
Overview
Virginia Medicaid Behavioral Health Service Delivery Systems
Objectives of the Service Delivery Systems
DMAS Behavioral Health Covered Services
DMAS Behavioral Health Services Administrator (Magellan of Virginia)
DMAS Managed Care Behavioral Health Programs
DMAS Commonwealth Coordinated Care
On the Horizon
Virginia Medicaid Behavioral Health
Service Delivery Systems
DMAS
FFS/Magellan Traditional &
Non-traditional Services
Managed Care (Medallion II)
Traditional Services (7 Health Plans)
Commonwealth Coordinated Care
(April 2014)
Traditional & Non-traditional
Services (3 Health Plans)
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Improve timely access to quality behavioral health
services through qualified (credentialed) providers
(helping members in need get the right care at the right
time)
Improve health outcomes for members
Ensure efficient utilization of services
Develop quality and outcome measures
Promote member engagement.
Objectives of Virginia Medicaid
Behavioral Health Delivery Systems
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Behavioral Health Covered Services
Non-Traditional Services Intensive In-Home (IIH)
Therapeutic Day Treatment (TDT)
Mental Health Skill-Building
Psychosocial Rehabilitation
Crisis Intervention Services
Crisis Stabilization Services
Intensive Community Treatment
Mental Health and Substance Abuse
Targeted Case Management and Foster
Care Case Management
EPSDT Behavioral Therapy
Residential Treatment (Levels A, B, & C)
Substance Abuse Community Treatment
Traditional Services
Inpatient mental health services
Traditional outpatient mental health
and substance abuse treatment
services: Medication management, and
individual, family, and group
psychotherapy
Psychological/
neuropsychological testing
Pharmacy services
Temporary Detention Order (TDO)
Substance Abuse Treatment
Services (outpatient/opioid
medication treatment)
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Coverage for non-traditional services under the FAMIS MCO benefit plan is limited to: Mental Health Case
Management, IIH,TDT, and Mental Health and Substance Abuse Crisis Intervention services.
Improved Behavioral Health
Program Design
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DMAS Magellan
Fee For Service
Traditional & Non-traditional
services
Managed Care Non-traditional
services
DMAS has contracted with Magellan of Virginia as its
Behavioral Health Services Administrator (BHSA)
The contract and new program began in December 2013
The contract with Magellan fulfills the directive to improve
several program areas including:
The coordination of care for individuals receiving behavioral
health services with acute and primary services, and
The value of behavioral health services purchased by the
Commonwealth of Virginia
DMAS and Magellan of Virginia
Magellan Features
Customer Service (24/7 call center):
Member assistance: crisis calls, referral,
information, outreach and education;
Care Management services: care coordination,
interface with MCOs, appropriate care, timely
access; and
Quality Care Initiatives: psychotropic
medications, peer support program and
integrated care.
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How Do I Get Help through Magellan?
You can call Magellan toll-free (at no cost) any time.
Call 1-800-424-4046
If you are deaf or have trouble hearing, please call the
Magellan TDD line at1-800-424-4048. Or call the TTY
relay service at 711.
Magellan provides information in Spanish and other
languages if necessary. Translators are available as
needed.
Magellan staff provides personalized assistance to
callers to help you get the information you need.
Magellan’s member services staff will help you learn
about the services you may get and licensed clinicians
are also available to help determine your needs.
Other Resources and Getting Involved
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• The Magellan website is: www.MagellanofVirginia.com
• A special area “For Members” can help you find a provider, prepare for your appointments, and provides other information about getting care.
• The Member Handbook is posted on the website.
• Find information about the Magellan Governance Board
• Information to attend monthly stakeholder call with members
• Sign up for email updates
DMAS and Managed Care Organizations
DMAS Managed
Care
Traditional BH Services
Medical Services
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DMAS contracts with 7 health plans
called MCOs:
⁻ Anthem HealthKeepers
⁻ CoventryCares
⁻ InTotal Health
⁻ Kaiser Permanente
⁻ MajestaCare
⁻ Optima Family Care
⁻ Virginia Premier
Virginia’s MCOs manage behavioral
health services through an integrated
model that incorporates medical and
behavioral health care.
The focus of the MCOs’ model of care
is two-fold
1. For members to improve overall
health conditions
2. To create positive quality and
health outcomes
MCO Behavioral Health Programs
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All 7 MCOs have Behavioral Health programs
that provide:
• Medical, Behavioral, and Pharmacy (treats the
whole patient)
• 24/7 Nurse Access
• Toll free numbers
• Dedicated websites
• Care Management services including care
coordination and transportation.
Medallion II MCO Contacts
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MCO Member Services Phone # Website
Anthem HealthKeepers Plus 1-800-901-0020 www.anthem.com/vamedicaid
CoventryCares of Virginia 1-800-279-1878 www.CoventryCaresVA.com
InTotal Health 1-855-323-5588 www.intotalhealth.org
Kaiser Permanente 1-855-249-5025 www.kp.org/medicaid/va
MajestaCare 1-866-996-9140 www.MagestaCare.com
Optima Family Care 1-800-881-2166 www.optimahealth.com
Virginia Premier 1-800-828-7989 www.vapremier.com
Medallion II Managed Care HelpLine
Hours: Monday through Friday from 8:30 AM to 6:00 PM
Phone: 1-800-643-2273 (TDD: 1-800-817-6608)
Website: www.virginiamanagedcare.com
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• The CCC program is an integrated care initiative for
individuals who are currently served by both Medicare
and Medicaid & meet certain eligibility requirements.
• CCC began in April 2014 and operates under a 3 way
contract between CMS, DMAS, and the Medicare
Medicaid health plans (MMP).
• The CMS/DMAS contracted MMPs are:
Anthem HealthKeepers,
Humana
Virginia Premier
• All Individuals have a care coordinator that will coordinate
member care and services toward health goals.
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Commonwealth Coordinated Care
(April 2014)
Traditional BH Services
Non-Traditional BH Services
Medical Services
The CCC program operates under an integrated care
model that coordinates the delivery of primary, preventive,
behavioral, and long-term services
CCC Enrollment
Five Enrollment Regions
1.Central VA/Richmond
2.Tidewater
3.Northern Virginia
4.Roanoke area
5.Western/ Charlottesville area
Two Phases of Enrollment
• Voluntary Phase
– Eligible individuals elect to
proactively enroll in the program
• Passive (Automatic) Phase
– Eligible individuals are
automatically enrolled into the
CCC program through an
intelligent assignment algorithm
based upon previous health plan
enrollment, health plan network
that includes the current adult
day health provider or nursing
facility (if applicable)
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If an individual is unhappy with a chosen
health plan, he/she may, at any time, request
reassignment to another health plan or opt
out of the CCC program and return to
traditional Medicare and Medicaid (changes
will be made the first of the month)
CCC Implementation Phases
• Tidewater Area (Phase I)
– March 2014: Voluntary enrollment period announced
– April 1, 2014: Voluntary coverage started
– July 1, 2014: Automatic coverage begins for most beneficiaries (over 90%)
– August 1, 2014 Automatic enrollment begins for rest of Tidewater
• Central Virginia/Richmond Area (Phase I)
– March 2014: Voluntary enrollment period announced
– July 1, 2014: Automatic enrollment announced to beneficiaries
– September 1, 2014: Automatic coverage begins
• Northern VA, Roanoke, Charlottesville Areas (Phase II)
– June 1, 2014: Voluntary coverage begins
– August 2014: Automatic enrollment announced
– October 1, 2014: Automatic coverage begins
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Outreach for Members/Stakeholders
• Townhall Meetings
– 2 in each region
• May 29th –Charlottesville
• Stakeholder Presentations
– ARC of Virginia (June 2nd)
– Spotsylvania Hospital discharge planners (June 5th)
• Weekly Provider Calls ⁻ Nursing facilities- Mondays 2:30
⁻ Adult day health- Mondays 1:30
⁻ Personal care, service facilitators, home health- Mondays 2:00
⁻ Hospitals, Medical practices- Fridays 11:00
⁻ Behavioral health- Fridays 11:30
• Twice-Weekly Beneficiary Calls – Tuesdays and Fridays
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CCC Contacts
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MMP Phone # Website
Anthem HealthKeepers 1-855-817-5787
(TTY: 1-800-855-2880)
https://mss.anthem.com
Humana Gold Plus
Integrated
1-855-784-3602
(TTY: 711)
https://www.humana.com/
Virginia Premier Health Plan 1-855-338-6467
(TTY: 1-800-828-1120)
(TTD: 1-800-828-1140)
https://www.vapremier.com
/members/completecare/
Commonwealth Coordinated Care HelpLine
Hours: Monday through Friday from 8:30 AM to 6:00 PM
Phone: 1-855-889-5243 (TDD: 1-800-817-6608)
Website: http://www.virginiaccc.com/
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• More quality improvement projects focused on member
outreach and treatment outcomes.
• Continuing to seek member feedback and participation in
improving care delivery in Virginia.
• Magellan will be implementing a pilot project called the
Peer Bridger Program which is about peer support
services.
• Continued collaboration between Magellan and managed
care plans to promote a seamless continuum of care for
members served concurrently by or transitioning between
programs.
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