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Suzanne Fields, Senior ConsultantThe Technical Assistance Collaborative
Webinar for Children and Family Futures December 12, 2011
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Webinar designed in response to survey responses and priorities
Structure of the 90 minute webinarPart 1: Affordable Care Act Timeline of ActivitiesAffordable Care Act‐ Timeline of ActivitiesDeep dive – 5 key activitiesTaking action
Part 2:Q & A Application of action steps
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Are you aware of your state’s timeline for key decisions and for implementation of key provisions of the Affordable Care Act (ACA)?
YesNoNot sure
2010
2011
26 provisions took effect March 23 ‐‐ ACA becomes lawApril 1, 2010 – States can cover more people on Medicaid without a waiverSept 23, 2010 – Allows young adults to stay on parent’s insurance until age 26. Also allows foster youth to remain eligible for Medicaid$15 billion in funding becomes available as part of the Prevention and Public Health Fund.
21 provisionsEstablishes the Center for Medicare and Medicaid Innovation to promote integrated care for dual eligiblesOct 1, 2011 Medicaid Community First Choice Option becomes available to help people who are disabled remain in the
2012
Oct 1, 2011 Medicaid Community First Choice Option becomes available to help people who are disabled remain in the community.Establishes health home provision for coordination of physical and behavioral health care for certain populations.Funding to support development of insurance exchangesMedical‐Loss Ratio for Insurers
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Essential Benefit package for Benchmark plans to be defined (moved from 2011 to Jan 2012).
Oct 2, 2013 additional funding for the Children’s Health Insurance Program authorizedData collection to reduce health disparities
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2013
2014
13 provisionsNew funding to cover certain preventative services under Medicaid becomes availableIncreases payments to primary care physicians under Medicaid to 100% of the Medicare rateOct 2, 2013 additional funding for the Children’s Health Insurance Program authorized
19 provisionsRequires states to cover people under 133% of FPL under the Medicaid programHealth insurance exchanges must be established by the statesMost people are required to have some type of health insurance coverageTax credits to help people purchase health insurance become availablePhysician payments tied to quality of care they provide
2015
2016
2018
1 provisionIncreased federal match for CHIP
1 provisionHealth care Choice Compacts
1 provisionTax on high cost insurance
Useful websites to track specifics:Kaiser: http://healthreform.kff.org/Timeline.aspx/NCSL: http://ncsl.org/US Government: http://www.healthcare.gov/HRSA: http://www.hrsa.gov/SAMHSA: http://wwwsamhsa gov/SAMHSA: http://www.samhsa.gov/CMS : http://www.cms.gov/National Council: http://www.thenationalcouncil.org/NCQA: http://www.ncqa.org/Coalition for Whole Health: http://www.lac.org/index.php/lac/national_healthcare_reform
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How closely have you followed the planning and implementation of the Affordable Care Act (ACA) in your state as it may affect your clients in need of treatment?
Very closelySomewhat closelyNot very closelyNot at all
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#1 What are systems doing in response to the ACA?
#2 What’s happening with primary care and behavioral health integration?
# 3 How do people know if they can be covered? How can people apply? # 3 How do people know if they can be covered? How can people apply?
#4 What are the benefits?
#5 How can I become a provider of services?
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State Medicaid AuthoritiesEnrollment expansionsHealth Insurance ExchangeManaged careNew models and servicesFinancial reformsQuality reformsData infrastructure
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SAMHSA Block Grants /State Mental Health Authorities & State Addictions Authorities
Child welfare
Physical Health Care
Commercial Insurers
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Costs, costs, costs…what?? And outcomes too?
Evolving Care http://www.milbank.org/reports/10430EvolvingCare/10430EvolvingCare.html
F d t li i l i t ti d lFour quadrant clinical integration modelhttp://www.integration.samhsa.gov/images/res/5.%20Four%20Quadrant%20Diagram.pdf
Health homes and other care management strategies
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Changing role of providers Is mental health ready? Is addictions ready?
Team approachesTeam approaches
Tele‐health
Home and community‐based approaches
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Eligibility does not equal enrollment
One common application process for publicly funded insurance: Medicaid & Exchange
Enrollment support
Presumptive eligibility
Redetermination time period
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Essential benefits ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices;laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
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IOM ReportNot to identify the benefits but the parameters to decide the benefits– specifics were not mentioned though some examples describedFramework: cost and benefit a typical small business plan rather than a comprehensive plan offered by larger employers
http://www.iom.edu/Reports/2011/Essential‐Health‐Benefits‐Balancing‐Coverage‐and‐Cost.aspx
Once released approx Jan 2012, then crosswalk to existing services
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State Medicaid plan and amendmentsState Medicaid provider manualsManaged care company provider manualsMember handbooksWebsites for Medicaid agency and State Mental Websites for Medicaid agency and State Mental Health and Substance Use authoritiesCalls/meetings with Medicaid or managed care staffTalking with established Medicaid providersInterviews with advocacy organizations (e.g. NAMI) or trade organizations
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• Become a Medicaid providerOption 1
• SubcontractOption 2
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• Merger Option 3
• Make ConnectionsOption 4
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Take an inventory of the services your organization offers and if your organization meets the provider qualifications For existing Medicaid services, READ service definitionsContact Medicaid and/or MCO Provider RelationsTalk with Trade Association, Other Medicaid Providers, Talk with Trade Association, Other Medicaid Providers, SMHA or SSALearn about the necessary provider infrastructureGather materials
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Get to know your “Single State Medicaid Agency” Maintain contact with your states SMHA & SSA Meet with your area FQHC’s, large primary care practices, other health institutions M i h M di id M d C O i iMeetwith Medicaid Managed Care OrganizationsLearn who are the Medicaid providers in your locality and develop relationships with these providers to help facilitate referrals for services
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LeadershipEligibilityProvider enrollment process and systemD li Delivery system◦ Traditional fee‐for‐service◦ Managed care◦ Long‐term care services
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Are you aware of any discussions in your state’s planning for ACA for any form of priority for parents and children in the child welfare system?
YesNoNot sure
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1. AccessMedicaid eligibility systems to determine eligibility of families
2. Identify the specialty services you need for children, youth, TAY, foster parents, parents and relative care givers. g
3. Advocate for Wraparound, In‐Home Services, Family Preservation, and individualized services to keep children at home.
4. Address the importance of trauma informed care for children and families/parents/caretakers .
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• Benefit design• Access / enrollment• Delivery system• Provider qualifications
Macro
• Provide services• Facilitate enrollmentMicro
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Learn about your state’s enrollment processEducate others about enrollment changesAdvocate for enrollment and outreach strategiesMonitor access issuesDedicate staff or other resources to facilitating enrollment in Medicaid Collaborate and coordinatewith associations, state or county MHA & SSA
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Become Medicaid and managed care “competent”Develop formal relationships with FQHCs and other Medicaid providers is criticalIdentify creative solutions to credentialing /licensing of SUD professionals pAdvocate for the inclusion of peer services and the need for enhanced training for all persons who work in MH & SUD services Learn about ACA workforce opportunities and new fundingDiversify funding streams
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Learn about the services covered in Medicaid and Medicaid Managed Care Advocate for states to amend their Medicaid program to include the health home option Ad t f ifi t f t l h lth d Advocate for specific types of mental health and substance use services Participate in public processes that will inform the design and development of the state’s Medicaid programBecome a resource to primary care
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Learn which providers are already billing insuranceLearn about managed care in your area, both commercial and public insurers◦ Who are the players? ◦ Who are the players? ◦ What are the credentialing requirements?◦ What services are covered?◦ Rates?◦ Other infrastructure requirements?
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Suzanne Fields, MSW, LICSWSenior [email protected]
Technical Assistance Collaborative 31 St. James Avenue, Suite 710, Boston, MA 02116www.tacinc.org
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