armhs restructuring armhs advisory workgroup december 6, 2013 julie pearson / melinda shamp dhs...
TRANSCRIPT
ARMHS Restructuring
ARMHS Advisory Workgroup
December 6, 2013
Julie Pearson / Melinda Shamp
DHS Adult Mental Health Division
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Agenda
Introductions Recap November 1st meeting Drafting State Plan Amendment (SPA)
• Service Definition Development
• Rate Methodology
• Time Study
AMHD Webpage Next steps
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Recap of November Meeting
2013 Legislation
“In addition to rate increases otherwise provided, the commissioner may restructure coverage policy and rates to improve access to adult rehabilitative mental health services and related mental health support services …”
Laws of 2013, Chapter 108, Article 4, Sec. 28. 3
Recap of Legislation, Continued
A combination of rate increases and changes in covered services is projected to result in a 30% increase in payment per ARMHS recipient
State funds $6 million + Fed match $10 million
= $16 million total increase (30%)
in covered services for ARMHS recipients4
Recap of Legislation, Continued
2013 LegislationEffective January 1, 2015
Rate increase will be in addition to the provision that increases MA rates 5% for ARMHS and most other MA-covered mental health services effective September 1, 2014.
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Recap Recommendations A Coverage for currently non-billable but
required activities:
• Clinical Direction and oversight, includes support for EBPs
• Functional assessments, includes LOCUS and interpretive summaries
• Individual Treatment Plan development
• Service coordination
Consider add’l time study data about Clinical Supervision role and responsibilities
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Recap – Recommendations B
Integrated Model Competitive Employment:• Must be done in partnership with Voc Rehab
• Improved reimbursement for clinical direction and service coordination will support IPS model
• Improved rates for all ARMHS services could support IPS model
• 1915(i) would allow broader coverage than rehab option, but still subject to CMS rules on supported employment and other constraints (see below)
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Recap – Recommendation B
EBP – Family Support:• Improved reimbursement for clinical direction
and service coordination will help
• Improved rates for all ARMHS services could be structured to facilitate ARMHS engagement in Family Psycho-education and other EBPs such as IPS, IMR and IDDT
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Recap – Recommendations B
Outreach / Wellness / Med Ed Expansion:• Probably not MA-reimbursable in ARMHS
• Lower in Workgroup priorities, probably not affordable within the budgeted 30% increase
• May be covered through:• Behavioral Health Homes
• Community Health Workers
***Put on Hold and see what happens with ACA and Behavioral Health Homes development
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Recap – Recommendations B
Parenting / Family Services:• Added as a no-cost ARMHS expansion in 2013
legislation
• An additional skill in the list of skill areas that can be included in ARMHS
• Currently billable as Basic Living and Social Skills
• DHS is considering options for provider training
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Recap Summary “What We Heard”
“Do Not Make This Harder Than What It Needs To Be”
First, Deal with Category A Improved rate coverage for Category A will influence what we can do about Service Expansion/ Category B“Phase in” Service Expansion/Category B
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Recap Summary What We Heard….
Reduction of AMHI grants to afford this expansion – essentially taking from one resource to expand another
CADI waiver concerns - moving to MN Choices. People potentially screened out of the waiver will use ARMHS.
Concerns about reduction in PCA services for persons with MI
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Service Definitions – SPA
Define the rate increase as justification for increase in quality of services, additional expectations, etc.
AND/OR Use of separate code for identified
services
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Service Definitions – SPAConsiderations: 2013 Children’s Legislation 256B.0943
• Mental health service plan development within CTSS
• Dev, review, and revise a child’s individual tx plan. Include client/client parent/caregivers, others to arrange tx and support activities of the plan.
• Administer standardized outcome measure, to evaluate effectiveness of services.
Input: Dr. Oni: “It is good that John K. was here today. In the early days of CTSS there was a lack of clinical supervision. Coverage for clinical supervision is vital to the quality of the services provided.”
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Service Plan Development
Considerations: H0032 Service Plan Development H0031 Mental Health assessment by
non-MD to bill for functional assessment
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Work Group Input
15 minute units is an admin burden Hiring more admin people than service
providers to keep up with billing, etc. Increase rates AND bill for the work that
is done Be paid for the work we do!
(John Everett and reiterated by others)
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Input, cont’d
Focus on expansion rather than the rate increase to preserve the additional services
Providers are doing the activities within Rec A– let’s get paid for it
Use a strategy to ensure CMS approval and keep in mind what they approve sets a precedent
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Rate Methodology
Usual and Customary Charges – FY 12 reimbursement is 76% of submitted charges aka
“usual & customary” service charges
• What’s included in these charges?
Comparable Services
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Time Study
Capture the time of the MH Professional conducting the functions of clinical supervision and guiding clinical direction• Let Melinda know if your agency is willing to
participate in time study in January
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Next Steps - Timeline
Dec 2013 - Jan 2014: Draft State Plan (SPA)
January 2014: Time Study
Jan 31st 2014: ARMHS Restructuring
Advisory Work Group - Final February 3, 2014: Submit draft SPA to CMS
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Next Steps - Timeline
April 2014: prelim CMS agreement
Summer – Fall 2014: Modify MMIS claims system, provider training and communication
January 2015: full implementation
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ARMHS Expansion Work Group posting location: Expansion Work Grouphttp://www.dhs.state.mn.us/dhs16_171741#P59_5196
[email protected]@state.mn.us
Add’l Questions and Comments