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Behavioral Health Partnership

Behavioral Health Partnership. Report to the Behavioral Health Oversight Council October 12, 2005. Implementation Update. Go-live: January 1, 2006 Waiver amendment – submitted, awaiting CMS questions MCO notification to independent practitioners DCF/DSS/MMIS/VO systems programming

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Behavioral Health Partnership

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  1. Behavioral Health Partnership Report to the Behavioral Health Oversight Council October 12, 2005

  2. Implementation Update • Go-live: January 1, 2006 • Waiver amendment – submitted, awaiting CMS questions • MCO notification to independent practitioners • DCF/DSS/MMIS/VO systems programming • Provider orientation/member orientation

  3. Rates and Fees • General • Medicaid rate/fee setting continues • By statute, intensive service rates will be based on rates in effect on 7/1/05 • Provider request for MCO contracts/rates/fees suspended due to non-disclosure terms • Pursuing rate/fee information directly from MCOs

  4. Rates and Fees • Independent practitioners • MMIS structure requires that non-MD BHP practitioners pay at a percentage of BHP psychiatrists • Departments proposes amending fee schedules to pay APRN, PHD and LMLC at a percentage of MD • This would result in fee increases for the majority of APRN/PHD/LMLC fees

  5. Rates and Fees • Home-based Services (MST, MDFT, FFT, other) • Will remain FFS for HUSKY A/B, current grants will remain • Uniform procedure specific weighted average based on MCO rates and weighted by enrollment • If significant winners/losers, will address either through provider specific rates or grant adjustments

  6. Rates and Fees • Intensive, In-Home, Child and Adolescent Psychiatric Services (IICAPS) • Converts to fee-for service for Husky A and B and DCF clients for dates of service after 12/31/05 • Providers will continue to receive full grant funding for quarter ending 3/31/06 • Some slots in each IICAPS team will remain grant funded • DCF/DSS will analyze fee-for-service utilization and consider adjustment of rates and grants in October 2006

  7. Rates and Fees • IICAPS Rate Setting Methodology • Compiled cost and revenue information from the six providers that responded to the DCF IICAPS survey. • Developed weighted average costs for an IICAPS team for salary and other expenses. Expenses were weighted by program capacity. • Increased clinician and medical director/psychiatrist line items due to concerns about clinician recruitment/retention and grant funding limitations restricting psychiatric services.

  8. Rates and Fees • IICAPS Rate Setting Methodology • Estimated IICAPS team utilization by assuming that on average the members of the IICAPS team have eight clients, incur 5.5 billable hours per week and operate at 90% capacity. • Calculated a cost per session by dividing recommended costs by estimated utilization. • Determine grant impact.

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