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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

Behavioral Health Partnership

Report to the Behavioral Health Oversight Council

October 12, 2005

implementation update
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
rates and fees
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
rates and fees4
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
rates and fees5
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
rates and fees6
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
rates and fees7
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.
rates and fees8
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.