FRYSC Conference July 14, 2015 The New Face of Kentucky Medicaid Veronica Judy Cecil Chief of Staff...

FRYSC ConferenceJuly 14, 2015

The New Face of Kentucky Medicaid

Veronica Judy CecilChief of Staff

Director, Division of Program IntegrityKentucky Department for Medicaid Services

Our Changing World

• Center for Medicare and Medicaid Services (CMS) authorized a State Plan Amendment for Kentucky:

– Expanding eligibility

– Expanding mental health and substance use treatment services

– Expanding provider network to include individual and group providers as well as licensed organizations beyond community mental health centers

A long-awaited day in Medicaid…..

Kentucky Department for Medicaid Services2

Medicaid Expansion

Kentucky Department for Medicaid Services

Elderly and Persons with Disabilities

Children

*138% FPL = $15,856 for an individual and $26,951 for a family of three in 2013.

Parents Adults

Pregnant Women

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There are several ways for individuals to enroll in Medicaid.

Member Enrollment

Mail in a paper application

Call 1-855-4kynectVisit a DCBS office

Find a kynector

Enroll online at kynectkyenroll.ky.gov

Mandatory Benefits/Services

Cabinet for Health and Family Services 5

Benefit/Service Changes

Kentucky Department for Medicaid Services 6

• Private Duty Nursing – Adds private duty nursing service as a new benefit, limited to 2000 hours per year.

• Allergy Services – Clarifies benefit to include adults (children were already covered)

• Prescription Drugs – Eliminates limit of 4 prescriptions per month

• Eyeglasses – Eliminates annual dollar limit and sets a limit of one pair of eyeglasses per year, with an additional pair covered if first pair is lost or prescription changes. (Children only).

• Physical, Occupational, Speech Therapy – Aligns the number of visits across eligibility groups to be 20 visits per year per therapy (combined for rehabilitative and habilitative).

• Mental Health Services and Substance Use Services

More Screenings = Better Health•17,000 screened for colorectal cancer•26,000 received mammograms•34,000 screened for cervical cancer•46,000 screened for diabetes•13,000 received treatment for substance abuse•80,000 had preventive dental visits


Medicaid Expansion Population

BEHAVIORAL HEALTH SERVICES


Rehabilitation Services• Screening • Assessment• Psychological Testing • Crisis Intervention• Mobile Crisis• Residential Crisis Stabilization• Day Treatment (Kids only)• Peer Support• Parent/Family Peer Support• Intensive Outpatient Program• Individual Outpatient Therapy • Group Outpatient Therapy• Family Outpatient Therapy

• Collateral Outpatient Therapy (Kids only)

• Partial Hospitalization• Service Planning (MH only)• Residential Services for

Substance Use Disorders • Screening, Brief Intervention

and Referral to Treatment (SU only)

• Assertive Community Treatment (MH only)

• Comprehensive Community Support Services (MH only)

• Therapeutic Rehabilitation Program (MH only)


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Targeted Case Management

• Children with Severe Emotional Disability (SED) and Adults with Severe Mental Illness (SMI)

• Adolescents and Adults with Substance Use Disorders

(SUD Moderate to Severe)

• Adults and Children with Co-occurring Mental Health or Substance Use Disorders and Chronic or Complex Physical Health Issues (SMI, SED, or SUD and Physical Health conditions)

Cabinet for Health and Family Services10

NEW PROVIDER TYPES


Provider Network Expansion

Prior to January 1, 2014 After January 1, 2014


Behavioral Health Services

Community Mental Health

Center (CMHC)

CMHCLicensed

Practitioner

Licensed Organization

Provider Group

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New individual and group provider types specific to Medicaid covered Behavioral Health Services include:

Individual Provider Types• Licensed Clinical Social Worker (LCSW)*• Licensed Psychologist (LP)*• Licensed Professional Clinical Counselor (LPCC)• Licensed Marriage and Family Therapist (LMFT)• Licensed Psychological Practitioner (LPP)

• Certified Psychologists with Autonomous Functioning• Licensed Professional Art Therapist • Licensed Behavior Analyst

Group Provider Types• Behavioral Health Multi-Specialty Group (MSG)


* Previously limited to QMB


Providers who can perform services under supervision of a Medicaid-enrolled licensed practitioner:

• Licensed Professional Counselor Associate• Marriage and Family Therapist Associate• Certified Social Worker – Master’s Level• Licensed Psychological Associate• Licensed Professional Art Therapist Associate • Licensed Assistant Behavioral Analyst



Non-licensed professionals, including:

Targeted Case Managers Individual, provider group and licensed organization

Community Support AssociatesLicensed organization

Peer Support SpecialistsProvider group and licensed organization

Certified Alcohol and Drug Counselors**Licensed organization


** House Bill 92


Behavioral Health Services Organization (BHSO)

• New licensure category developed by CHFS Office of Inspector General to provide clinical behavioral health services.

• If a BHSO provides outpatient behavioral health services to treat individuals with substance use disorders or co-occurring disorders in which substance use disorder is the primary diagnosis, the BHSO will be required to be dually licensed as an AODE.

• In addition to providing outpatient behavioral health services, BHSOs may provide residential services for substance use disorders, in which case the BHSO must also be dually licensed as an AODE.

BHSO Webinar Link:

http://dbhdid.ky.gov/dbh/bhso.aspxKentucky Department for Medicaid Services

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Provider Network ExpansionBHSOs will be licensed to provide one or more of the following behavioral health services as described in the Medicaid State Plan:

• Screening• Assessment• Psychological testing• Crisis intervention• Mobile crisis• Day treatment• Peer support• Intensive outpatient services• Individual, group, family, or collateral outpatient therapy• Service planning for mental health disorders• Screening, brief intervention and referral to treatment for substance abuse• Assertive community treatment for mental health disorders• Targeted case management• Comprehensive community support services• Residential Substance Use (with AODE licensure)• Therapeutic rehabilitation for adults with a serious mental illness or children with

severe emotional disabilities.


Limited toLicensed

Organizations

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Residential Crisis Stabilization Units• New separate licensure category developed by CHFS

Office of Inspector General for residential crisis stabilization units.

• Because Community Mental Health Centers and Psychiatric Residential Treatment Facilities may provide crisis stabilization under their existing licenses, CMHCs and PRTFs will not be required to obtain separate licensure as a residential crisis stabilization unit to provide the service.



Non-Behavioral Health:Speech Language Pathologist

Physical Therapist

Occupational Therapist


MEDICAID MANAGED CARE ORGANIZATIONS



Managed Care Organizations (MCO)

Expanded in November 2011 Except for Long Term Care and Waiver

Services

Currently have 5 Managed Care Organizations Anthem CoventryCares (Aetna) Humana Passport Wellcare


KY Medicaid Population

Total Current Medicaid RecipientsTotal Current Medicaid Recipients

1,319,1371,319,137MCOs = 1,198,405MCOs = 1,198,405

Fee-for-service = 117,037Fee-for-service = 117,037

Run Date 04/27/15

MCO OVERSIGHT

Monthly Operational MeetingsReporting

Monthly QuarterlyAnnual

Actions Taken in 2013 and 20142 Inquiry Letters44 Letters of Concern94 Corrective Action Plans (CAP)


MCO OVERSIGHT

Contract with Department of Insurance to investigate timely payment complaints

Rector and Associates – Market Conduct Survey and Financial Review

External Quality Review Organization (EQRO)Island Peer Review Organization (IPRO)

Performance Improvement Plans (PIP)EQRO StudiesWebsite for Program Quality and Outcomes http://chfs.ky.gov/dms/pqomcoqbreports.htm


NON-EMERGENCYMEDICAL

TRANSPORTATION



Non-Emergency Medical Transportation• Medicaid contracts with the Office of Transportation Delivery

(OTD) in the Transportation Cabinet to administer the Non-Emergency Medical Transportation (NEMT) benefit

• OTD contracts with brokers throughout the state a list of brokers can be found at this site:

• http://transportation.ky.gov/Transportation-Delivery/Pages/Human-Service-Transportation-Delivery-Brokers.aspx

• Brokers contract with individual providers • Individuals can be transported to Medicaid covered services,

including services outlined in their plan of care if they are in waiver

• Individuals cannot be transported to the pharmacy


In order to receive non-emergency transportation services an individual:

•Must be eligible on the date of service

•Cannot have a car registered in their name or in their household

•If the car is not in working order they can get a mechanic’s note

•If the car is used for work related purposes only, they need to get documentation to that effect – note of work hours

•Must call at least 72 hours prior to their appointment unless emergency

•Must go to the closest medical provider in their area unless the service is not available in that area, then they can be transported outside of their service are (service area designated by broker regions)

Non-Emergency Medical Transportation


• Individuals do not have to pay anything for the trip – not subject to copayment

• Can have an escort if they need one – for example, if they are developmentally disabled and need someone to attend the appointment with them

• Escorts/guardians do not have to pay for the service• Children under 14 must be accompanied by an adult • Any issues obtaining NEMT can be directed to OTD

at (888) 941-7433 or Medicaid at (800) 635-2570

Non-Emergency Medical Transportation

• Medicaid’s website: http://chfs.ky.gov/dms/trans.htm

QUESTIONS

Veronica Cecil

[email protected]


FRYSC Conference July 14, 2015 The New Face of Kentucky Medicaid Veronica Judy Cecil Chief of Staff...

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