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OBH Contractors Webinar. April 12, 2012. PRESENTERS Peter J. Calamari Ken Saucier Danita LeBlanc Dr. Rochelle Dunham Dr. Michael Gomila David McCants Randy Lemoine. Welcome & Introduction. Goal of Webinar. Goal of today’s Webinar is to:

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OBH Contractors Webinar

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Obh contractors webinar

OBH Contractors Webinar

April 12, 2012

PRESENTERS

Peter J. Calamari

Ken Saucier

Danita LeBlanc

Dr. Rochelle Dunham

Dr. Michael Gomila

David McCants

Randy Lemoine


Welcome introduction

Welcome & Introduction


Goal of webinar

Goal of Webinar

  • Goal of today’s Webinar is to:

    • Introduce contractors to OBH’s Medicaid Enrollment Policy

    • Present Residential AD Options available in LBHP

    • Clarify Billing Process for current Fiscal Year – FY12

    • Establish a Technical Assistance Process so that contractors can get ongoing assistance needed in implementing Clinical Advisor.


Medicaid application policy

Medicaid Application Policy


Medicaid application policy1

Medicaid Application Policy

  • All individuals seeking OBH network services must complete the Medicaid application process if they are not a current recipient or have not been denied Medicaid in the last 12 months.

  • Providers are responsible for informing, encouraging, assisting clients with this process & maintaining required documentation of the application process


Medicaid application policy con

Medicaid Application Policy (con.)

  • If individuals refuse to complete the Medicaid application, they will not be eligible to receive discounted Behavioral Health services from providers in the LA Behavioral Health Partnership.

  • If the individual is incapacitated and unable to complete the application, OBH will pay for services until the individual is able to complete the application. (see definitions)


Medicaid application procedures

Medicaid Application Procedures


Medicaid application procedures1

Medicaid Application Procedures

  • Providers are to post signs in the facility informing individuals of the requirement to complete a Medicaid application.

  • Providers are to notify individuals of what information they will need to have with them to complete a Medicaid application


Medicaid application submission

Medicaid Application Submission


Medicaid application submission1

Medicaid Application Submission

  • Online Medicaid application process –

    • https://bhsfweb.dhh.louisiana.gov/OnlineServices/

    • confirmation number & date

  • Scan a paper application & email to [email protected] or [email protected]

    • Keep copy of paper application & transmission documentation in the chart.

  • Fax a paper application to 318-253-4060.

    • Keep copy of paper application & transmission documentation in the chart


Behavioral health residential treatment options

Behavioral Health Residential Treatment Options


Behavioral health residential treatment options grid

Behavioral Health Residential Treatment Options - Grid


Behavioral health residential treatment options grid cont

Behavioral Health Residential Treatment Options – Grid (cont.)


Behavioral health residential treatment options quick reference grid

Behavioral Health Residential Treatment OptionsQuick Reference Grid

See LBHP Service Manual and Codes for more detail

http://new.dhh.louisiana.gov/index.cfm/page/538


Behavioral health residential treatment options cont

Behavioral Health Residential Treatment Options (cont.)

  • Psychiatric Residential Treatment Facility (PRTF) <21

  • Therapeutic Group Homes (TGH) <21

  • Addictive Disorders’ Residential Rehabilitation – Adolescents <21

  • Addictive Disorders’ Residential Rehabilitation – Adults 21+


Bed limits

Bed Limits


Bed limits1

Bed Limits

  • PRTF

    • Can be 17 or more beds

  • TGH

    • 8 beds or less

  • Residential Rehab-Adolescents

    • 16 beds or less

  • Residential Rehabilitation-Adults

    • No bed restriction b/c of ‘in lieu of’ service provision


Accreditation

Accreditation


Accreditation1

Accreditation

  • Accreditation is required for all of the Behavioral Health Residential Treatment Options by CMS &/or the State:

    • Bodies: CARF, COA, JCO

  • PRTF – Accreditation is required before payment is received; CMS requirement

  • TGH- Allowed 18 months to achieve accreditation

  • Residential Rehabilitation- Adult & Adolescents: Allowed 12 months from 5/1/12 to achieve, with 3 months extension


Ad residential staffing

AD Residential Staffing


Ad residential staffing1

AD Residential Staffing

  • AD Residential staffing rates for the various ASAM levels in the LBHP Service Manual are higher than previously required

  • OBH is currently reviewing the staffing requirements for the various ASAM levels


Residential per diem

Residential Per Diem


Residential per diem1

Residential Per Diem

  • PRTF:

    • Per diem rate for Treatment & Room/Board paid by Medicaid

    • *Licensed & unlicensed staff covered in per diem

    • Physicians & pharmacists can bill separately–active treatment plan

  • TGH:

    • Per diem rate for Treatment by unlicensed staff paid by Medicaid.

    • Fee for service for Licensed staff can bill separately

    • Room/Board paid through State General Funds (SGF)


Residential per diem cont

Residential Per Diem (cont.)

  • Residential Rehabilitation-Adolescents & Adults

    • Per diem rate for treatment covers the services of both licensed & unlicensed staff.

    • Room and Board is paid through State General Funds

    • Rates vary based on ASAM levels


Fy12 contracts requiring lbhp billing

FY12 Contracts Requiring LBHP Billing


Fy12 contracts requiring lbhp billing1

FY12 Contracts Requiring LBHP Billing

  • Assertive Community Treatment (ACT)

  • Substance Abuse Residential (All ASAM levels)

  • Substance Abuse Outpatient

  • Multi-systemic Therapy (MST)


Contract billing procedures and forms

Contract Billing Procedures and Forms


All clients form

All Clients - Form


Monthly billing form fee for service

Monthly Billing FormFee For Service


Obh invoice cost reimbursement form

OBH Invoice – Cost Reimbursement Form


Clinical advisor technical assistance

Clinical Advisor Technical Assistance


Clinical advisor ca technical assistance

Clinical Advisor (CA) Technical Assistance

  • Magellan Weekly CA Webinar

    • Priority Focus: CA access, configuration & billing

    • Critical Implementation Tasks & Timelines

    • Identify needs/issues for resolution

    • Tracking progress/ Update on corrections and enhancements

    • On-the-spot training by MGLN IT

  • Magellan Clinical Advisor Resources

    • www.magellanoflouisiana.com

      • Basic Training Guide

      • Billing Training Recorded Webinar

      • Computer-based Training (modules)


Clinical advisor ca technical assistance1

Clinical Advisor (CA) Technical Assistance

  • Magellan Clinical Advisor Resources

    • Tim Hebert, MGLN-LA IT Director

      • [email protected]

    • Joseph Chustz, MGLN-LA Sr. Program Analyst

      • [email protected]

    • Paula Turner, MGLN-LA Claims Administrator

      • [email protected]

  • Magellan CA Helpdesk

    • Email: [email protected]

    • Phone: 888-411-6343

  • OBH CA support

    • Joseph Fontenot – [email protected]

    • Randall Lemoine - [email protected]


Presentation and attachments can be found at

Presentation and Attachments Can Be Found at:

http://new.dhh.louisiana.gov/index.cfm/faq/category/87


Questions

Questions

This Webinar will be available today for 30 minutes after the presentation for you to send questions. The answer to the questions will be posted on the OBH site by COB Tuesday, April 17, 2012

Other Contact Persons

OBH Medicaid Policy

Residential Options

Billing Process

[email protected]

[email protected]


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