Ohio Department of Mental Health Community Mental Health Prior Authorization Training

Ohio Department of Mental Health Community Mental Health Prior Authorization Training PowerPoint PPT Presentation


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Terry R. JonesOffice of Health Integration . Budget Overview and Office of Health Integration 2013 Work Plan. 2. The Mental Health Budget: . Emphasizes direct services to individuals with severe mental illnessContinues the efficient

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Ohio Department of Mental Health Community Mental Health Prior Authorization Training

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1. October- November 2011 Ohio Department of Mental Health Community Mental Health Prior Authorization Training 1

2. Terry R. Jones Office of Health Integration Budget Overview and Office of Health Integration 2013 Work Plan 2

3. The Mental Health Budget: Emphasizes direct services to individuals with severe mental illness Continues the efficient & effective operation of six regional psychiatric hospitals Protects community medication subsidy & continues to serve approximately 15,000 people Enables GRF non-Medicaid community subsidy to be used to address local priorities 3

4. Major Reforms Include: Medicaid responsibility is shifted to the State of Ohio (funding and management) Cost containment strategies for Medicaid based on data analysis Revisions to Medicaid community mental health benefit package in FY 13 in order to address gaps & better coordinate physical & behavioral health care 4

5. Medicaid Cost Containment – Short Term Based on data analysis in conjunction with providers, consumers & board representatives Analysis, approach and process was collaborative, but no consensus reached Data-informed policy decisions Preferable strategy compared to across the board cuts Experience of other states used as resource 5

6. Medicaid Cost Containment – Short Term Cost containment strategies for Medicaid based on data analysis: Service utilization limits Payment modifications Children entitled to all medically necessary services per Medicaid EPSDT requirements 6

7. Office of Health Integration State Fiscal Year 2013 Work Plan Focus staff & resources on integration of behavioral health & physical health care Coordination of policy, logistics and operations to support integration Medicaid Clinical Integration & Health Homes Oversight of SAMHSA Grant Pediatric Psychiatry Network 7

8. Office of Health Integration State Fiscal Year 2013 Work Plan Telemedicine Opportunities Block Grant Funds Health Information Technology Innovation in Integrated Care 8

9. Work Plan Overview Behavioral Health/Physical Health Integration Health Homes Benefit Administration Intensive Home Based Treatment Assertive Community Treatment Peer Support Partial Hospitalization Family Therapy 9

10. Behavioral Health/Physical Health Integration Health Homes for SPMI/SMI/SED Populations Development & implementation of health homes Service definitions, target populations, regions, practice site qualifications, payment methodologies, information system requirements, outcome measures Logistical Framework & Stakeholder Involvement Documentation, billing & other regulatory requirements 10

11. Behavioral Health/Physical Health Integration Reimbursement Treatment plan integration Health information technology Staffing arrangements & team composition Technical assistance & learning collaborative 11

12. Behavioral Health/Physical Health Integration Benefit Administration Merging the community mental health benefit with the mainstream Medicaid benefit administered by ODJFS Addressing reimbursement and service coding implications Transitioning claims processing from MACSIS to MITS 12

13. Behavioral Health/Physical Health Integration Transitioning claims payment to ODJFS Build on the work of the BH Coding Alignment Initiative To better align mental health service definitions and related coding requirements with national billing and EDI standards Eliminate administrative inefficiencies and IT customization 13

14. Intensive Home Based Treatment & Assertive Community Treatment Add to Medicaid State Plan Currently there is an ODMH rule/certification standard for each of these services Build on previous work to the extent possible 14

15. Peer Support Draft rules under development Collaboration with the Ohio Empowerment Coalition Training curriculum under development Alignment with CPST 15

16. Partial Hospitalization & Family Therapy Recommendation from the Behavioral Health Benefits committee to review and modify the partial hospitalization service standard to better align within the continuum of care Consider adding Family Therapy as an ODMH-certified service and include under the community mental health Medicaid benefit Family Therapy is currently reimbursed by ODJFS 16

17. Major Areas of Work State Plan Amendments ODJFS Rules ODMH Rules Interagency Agreement Amendments EPSDT Considerations 17

18. Major Areas of Work Data Analysis MACSIS Changes MITS Changes Training Consumer Notification 18

19. Next Steps General timeframe for completion within SFY ’13 Projects will be worked on concurrently Separate ad hoc groups will be formed to complete work Health Home Logistics Committees IHBT Committee ACT Committee Partial Hospitalization Committee Peer Support Committee Family Therapy Committee Feedback loop to all stakeholders 19

20. Contact Information Terry R. Jones Ohio Department of Mental Health Office of Health Integration Columbus, Ohio 43215 (614) 466-9982 20

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