ValueOptions Provider Training:

Fully Integrated Duals Advantage

(FIDA) Program in NYS

2013

Objectives

2

Introduction to ValueOptions and FIDA Program

Overview of FIDA Program

• Provider Network

• Available Services

• Timeframes

Overview of ValueOptions

• Operational Areas

• Tools, Resources and Communications

How to Join FIDA Network

Questions and Answers

Introduction to ValueOptions

3

Founded in 1983

Largest independent behavioral health company

Serving over 32 million members

Contracts with 20 health plans

More than 50 Medicaid contracts in 14 states

Committed to principles of recovery and resiliency

Diverse client base

• Commercial Division

Employer Groups

Health Plans

• Federal Division

• Public Sector Division

ValueOptions National Presence

4

Regional support,

EAP staff and

corporate

support offices

Major service

centers

Public Program/

Medicaid

Membership

National

Innovation and

Technology

Center

AK

NM

MT

WY

CO UT

ID

AZ

NV

WA

CA

OR

TX

OK

KS

NE

SD

ND

IL

MS

AR

LA

MO

IA

MN WI

FL

KY

WV VA

NC

TN

SC

AL GA

RI

NJ

DE MD

ME

NY

PA

MI

VT NH

MA

CT

OH IN

HI

ValueOptions’ New York City Service Center

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Located in its new offices at One Penn Plaza

Cares for 1.7 million Emblem members enrolled in

Commercial, Medicare, Medicaid benefit plans

Manages behavioral health benefits for VNS and Suffolk

county employees

Overview of Fully Integrated Duals

Advantage Program

6

Demonstration project

Federal-State partnership between the Centers for Medicare and

Medicaid Services (CMS) and the State of New York, Department

of Health (State/NYSDOH) designed to test new models of care for

individuals eligible for both Medicare and Medicaid (dual eligibles)

Program integrates and coordinates enrollee benefits and care

across the Medicare and Medicaid programs, enhancing the

availability of services that have historically been available on a

fee-for-service basis

Eligible Participants

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Eligible Participants must be:

• Age 21 or older at the time of enrollment;

• Entitled to benefits under Medicare Part A and enrolled

under Medicare Parts B and D, and receiving full

Medicaid benefits; and

• Reside in a FIDA Demonstration County

Comprehensive Benefit Package

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Capitated managed care program that provides

comprehensive array of Medicare, Medicaid, and

supplemental services – including:

All physical healthcare

All LTSS services currently available through Medicaid

Advantage Plus (MAP) program

Additional services currently only available through

HCBS Waivers

Additional supplemental services not currently

required in NYSDOH managed care plans

All behavioral healthcare

FIDA Coordination Model

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Participant-Centered

Interdisciplinary Care Coordination Team, which

includes:

Participant,

Designee,

Primary Care Physician,

Behavioral Health Professional,

Care Coordinator, and

any other providers

• as chosen by Participant or

• as recommended by PCP or Care Coordinator and

agreed to by Participant

Beneficiary Protections

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Independent Enrollment Broker

Independent Participant Ombudsman

Integrated Grievances and Appeals Processes

Choice of Plans

Choice of Providers

Maximum travel, distance, wait, and appointment times

Continuity of Care

Single Consolidated Statement of all Rights and

Responsibilities

No Costs

ValueOptions’ FIDA Provider Network Expansion

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ValueOptions is expanding our provider network in:

• New York City (Bronx, Kings, New York, Queens and

Richmond)

• Long Island (Nassau and Suffolk)

• Westchester county region

Will include the full range of behavioral health services

currently covered under the Medicaid-fee-for-service

program

Available Services Under FIDA Program

12

FIDA Timeframes

13

Ongoing Network Readiness i.e. Contract with Providers

July 2014 Voluntary enrollment of Community Based Demonstration Dual Eligibles

October 2014 Passive enrollment of Community Based Demonstration Dual Eligibles

January 2015 Voluntary enrollment of Institution Based Demonstration Dual Eligibles

April 2015 Passive enrollment of Institution Based Demonstration Dual Eligibles

ValueOptions: Operational Areas

14

National Network Services:

• Provider Relations

• Provider Credentialing/Re-credentialing

• Contracting

Provider Relations

1

5

• Ensures members’ behavioral health care needs are met

through a geographically and clinically robust network

of providers

• Ensures maintenance of network composition by

engaging in assertive retention strategies

• Engages in timely and appropriate recruitment

• Engages in professional, consistent, and educative

communications with provider community and staff

Credentialing/Re-credentialing

1

6

• Completion of Credentialing Application required for network

participation

• Provider Re-credentialing (every 3 years)

Notified 4 months prior to due date (telephonic), 1 week

later (email/fax), 15 and 30 days prior to due date

Failure to respond to requests will result in disenrollment

from the network

Complete online, prepopulated re-credentialing

application

Attach updated license, certification and malpractice

information

Electronically sign the application (once signed, it is

automatically submitted)

Provider Contracting

1

7

ValueOptions Provider Agreements

Commercial and FIDA Contracting

Tools, Resources and Communications

1

8

• ValueOptions Website

• ProviderConnect®

• PaySpan Health®

• Training Opportunities

• Communication Channels

ValueOptions.com

1

9

ProviderConnectSM – Provider Online Services

2

0

PaySpan® Health

2

1

A tool enabling you to:

• Receive payments automatically

• Receive email notifications immediately upon payment

• View your remittance advice online

• Download an 835 file to use for auto-posting purposes

• Visit the PaySpan Health website at

www.payspanhealth.com

Training Opportunities

2

2

CEQuick

Training Webinars (New regulations, updates,

ProviderConnect, etc.)

Video Tutorial Library

Up to the Minute Communications

2

3

Provider PulseSM Messages

Fax and Email Communications

Provider Mailings

Constant Contact Alerts

Monthly Valued Provider eNewsletter

How to Join the FIDA Network

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4

To initiate contract negotiations, providers need to:

• Fax a signed copy of the FIDA Letter of Intent and inventory of

services as soon as possible to ValueOptions Provider Relations

OR

• Scan the documents to email at

newyorkservicecenter@valueoptions.com.

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Questions?