December 3, 2013 Report on Meeting with Medicaid Managed Behavioral Health Care Leadership

On November 15, 2014 Richard Brown and Celeste Putnam met with Medicaid managed behavioral health care staff regarding several issues associated with implementation of the Managed Medical Assistance program (MMA). Below is a brief summary of the discussion:  Tentative agreement that Addiction Receiving Facilities should be treated as Crisis Stabilization Units as alternative services and will consider residential detoxification as an alternative to inpatient detoxification.  Clarified that residential treatment is a covered service under the MMA program.  Stated that the American Society of Addiction Medicine guidelines were referenced in the Invitation to Negotiate and should be reflected in the contracts.  Agreed to work with FADAA on the use of screening processes for substance use disorders in primary care and obstetrics and gynecological medical practices.  Acknowledged that Club House will be included in the contract requirements for the MMAs.  Clarified that the requirements for site location codes and new Medicaid provider applications for work in additional Regions are fee-for-service requirements and will not be required by health plans.  Also clarified that providers that are not enrolled in Medicaid can be a provider for a health plan if a health plan registers with them with Medicaid. Medicaid provider enrollment is not necessary. Also, only one registration is required.

Medicaid Statewide Managed Care Program

Between September 23rd when AHCA made their initial announcements, and November 5th, AHCA posted several different awards. The chart below shows all the awards noticed as of December 3, 2013. The original awards are shown by X, the intent to protest by P, subsequent settlements (later awards) by an S and awards for the Long Term Care Program by LTC. To date, the AHCA website does not include a posting of the phase in schedule for the Managed Medical Assistance plans.

Region 1 2 3 4 5 6 7 8 9 10 11 Total by Health Plan Original Selection

Standard Health Plans

Allowable 2 2 3-5 3-5 2-4 4-7 3-6 2-4 2-4 2-4 5-10

1 number of Health Plans Amerigroup X X S P P P S 4 BHO- none LTC LTC

Better Health X X X 3 PSN BHO- Psychcare Care Access PSN P 0 Coventry Health P P P P P P P P P P S 1 Care of Florida LTC LTC LTC First Coast P X 1 Advantage-PSN BHO- Value Options Humana X X X X X 5 BHO-Psychcare LTC LTC LTC Integral P X X 2 BHO-Psychcare Molina P P P P S S P S 3 LTC LTC Prestige X X X X X P X X 7 BHO-Psychcare Preferred X 1 Medical Plan BHO- Psychcare Salubris P 0 Simply Health P S 1 Care Plan South Florida S 1 Community Care Network Sunshine State X X X X X X X X X 9 Health Plan LTC LTC LTC LTC LTC LTC LTC LTC LTC LTC BHO-Cenpatico United Health P P S X P P S P X 4 BHO-United LTC LTC LTC LTC LTC LTC LTC LTC LTC Behavioral Health Wellcare X X S X X X X P P X 8 BHO-none Total –Region 2 2 4 4 4 7 6 3 3 3 10 Original MMA Additional LTC LTC LTC LTC LTC LTC LTC LTC LTC LTC LTC LTC American Elder Care

Specialty Plans

Florida MHS, X X X X X X X X 8 Inc. (Magellan Complete Care Serious Mental Illness) Freedom Health- X X X X X X X X 8 Cardiovascular Freedom Health- X X X X X X X X 8 Chronic Obstructive Pulmonary 8

Freedom Health- X X X X X X X X

2 Congestive Heart Failure Freedom Health X X X X X X X X 8 –Diabetes Specialty Plan Simply X X X X X X X X X X 10 Healthcare Plans –HIV/AIDS AHF MCO of X X 2 Florida- HIV/AIDS Sunshine State X X X X X X X X X X X 11 Health Plan – Child Welfare Florida Medicaid Implementation of International Classification of Diseases (ICD-10) Medicaid has posted information on their website that provides the following information. Currently, health care entities are required by federal regulations to use a standard code set to indicate diagnoses and procedures on transactions. For diagnoses, the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code set is used. For inpatient hospital procedures, the ICD-9 procedure code set (PCS) is used. Effective October 1, 2014, the standard code set that is required for diagnosis codes is changing to the ICD-10-CM and the standard code set that is required for inpatient hospital procedures is changing to the ICD-10- PCS. The effective date of the ICD-10 conversion is not likely to be delayed. Other procedure code sets known as Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) used in other claims transactions are not changing. These codes are used in almost every clinical and administrative process and system, which will necessitate changes and adjustments in many areas of health care payment and reporting. Reasons for making these code set changes are irrefutable. The practice of medicine has changed dramatically in the last several decades. Many new conditions have been discovered, many new treatments developed, and many new types of medical devices have been made available to patients. The ICD-9 code set is not capable of being enhanced to add codes or to capture new and emerging health concerns. The ICD-10 code set will enable a much better description of the current practice of medicine and has the flexibility to adapt as medicine changes. The Agency for Health Care Administration is beginning the activities needed to prepare Florida Medicaid for the changes in the diagnosis code set. The ICD-10 Transition Project contains five distinct areas of activities and tasks: 1. Impact Analysis: Conduct an ICD-10 Impact Analysis. 2. Medicaid Policy Changes: Develop changes in Medicaid policy that govern the use of diagnosis and inpatient hospital procedure codes. 3. Medicaid Reimbursement Rates: Develop the most appropriate reimbursement rates for the new diagnosis/procedure code system in a budget neutral manner. 4. Outreach and Training: Conduct provider training for the Medicaid changes needed for the ICD-10 transition. This training will not be “code set training,” but rather an opportunity to explain the impact of changes in Medicaid policies and reimbursement rates required because of the change in the code set. 5. Update the Florida Medicaid Management Information System (FMMIS) to reflect the new policy and reimbursement rates.

3 The plans that are being made now will follow the timeline below. CSG Government Solutions has been chosen to assist the Agency in completing the tasks and activities required for a successful transition.

Status Update on the Department of Children and Families 65E-14 Rule Promulgation S On November 27th the Department of Children and Families sent out an advisory stating that the Joint Administrative Procedures Committee (JAPC) has tolled (interrupted) the rulemaking process for revisions to Chapter 65E-14, F.A.C., pending the Department's response to the Committee's review. Notice to this affect is available on the JAPC website at http://www.japc.state.fl.us/ (Use the "Rule Search" feature on the left-hand toolbar by typing in 65E-14. The letter is posted there.)

According to a conversation with Jimmers Micallef from the Department, the Rule Making Committee sent the Department a letter dated October 3, 2014 raising several issues about the rule. The issues were primarily technical in nature (see exceptions below). The Department has requested that the rule promulgation process be put on hold until JAPC's issues are addressed.

FADAA sent extensive comments to the Department on the proposed rule. As a result of related discussions at the November FADAA Board Meeting, Mark Fontaine met with the Department to further discuss the importance of the FADAA feedback provided to the Department. Subsequently, the Department is addressing many of the issues raised by FADAA and others. The Department must also make changes to the proposed rule in response to the Committee’s issues. When the response is finished it will go through the review process at the Department. It then goes to the Governor's office for final review and then to JAPC.

Once approved by JAPC, the Department will then be given the authority to go ahead with the Notice of Rule Change which will reflect changes made in response to the comments they received and JAPC's issues. According to Mr. Micallef, the Department does not intend to have another hearing.

As stated above, the majority of the comments from the Joint Administrative Procedures Committee were technical, however there were some issues raised that may be of interest. These are as follows:

65E-14.016(2) The subsection gives the Department the unbridled discretion to determine whether a “related party involvement has caused an increase in cost.” A rule that “is vague, fails to establish adequate standards for agency decisions, or vests unbridled discretion in the agency” is an invalid exercise of delegated legislative authority. See §120.52(8)(d), Fla. Stat. (2013

4 65E-14.016(3) Here, the rule list transactions “which may be questioned by the Department.” However, no criteria are set forth to apprise the reader of the circumstances governing when the Department will or will not take such action. A rule that “is vague, fails to establish adequate standards for agency decisions, or vests unbridled discretion in the agency” is an invalid exercise of delegated legislative authority. See §120.52(8)(d), Fla. Stat. (2013).

65E-14.021(2) Please explain how the Department determines whether it is necessary to establish additional SAMH Cost Centers for statewide use.

65E-14.021(6)(c) The rule states that “revenue shall be allocated to Cost Centers pursuant to a written methodology.” Please explain where this “written methodology” is located. In the absence of a reference to an established methodology, this requirement is vague.

65E-14.021(9) (b) 2.c. The rule should outline the criteria that the Director of the Substance Abuse and Mental Health Program Office will use in determining whether to exclude a specific cost center from the requirements of the rule.

65E-14.021(10)(j) CF-MH 1049: Please see the comments for rule 64E-14.021(10)(i). The form provided to the Committee has the wrong rule number. The form states: “This document contains confidential information that shall be secured from unauthorized access in accordance with ss. 394.455(3), 394.4615, [and] 397.501(7), F.S.” This sentence must be revised because section 394.455(3), F.S., does not contain any provisions regarding the confidentiality of information.

The form requires an entity to provide a client’s social security number. Section 119.071(5)(a)2.a., F.S., prohibits an agency from collecting social security numbers unless it has stated in writing the purpose for collection and it is “[s]pecifically authorized by law to do so … or [i]mperative for the performance of that agency's duties and responsibilities as prescribed by law.” The statute also requires an agency to identify the specific federal or state law Mr. Jimmers Micallef October 3, 2013 Page 11 governing the collection, use or release of social security numbers. See §119.071(5)(a)2.b., Fla. Stat. (2013). Please review the aforementioned statutes and revise the forms as necessary. (Note: This comment is applicable to all the forms contained in the pamphlet which solicit social security numbers.) Number of Uninsured Children in Florida Has Declined

A new report recently released shows the number of uninsured children in Florida has declined by 14 percent between 2010 and 2012. The report, released by the Georgetown University Center for Children and Families, attributes the positive shift to the success of Medicaid and the Children’s Health Insurance Program (known as KidCare in Florida).

Statewide Inpatient Psychiatric Program

On November 27, 2013 Medicaid announced that the 1915(b)(4) Statewide Inpatient Psychiatric Program (SIPP) waiver expires on 12/31/2013. Beginning 1/1/2014, any willing and eligible provider may apply to Medicaid to become a provider of SIPP services. These providers must meet licensing requirements and a pre- certification on-site review. Services will continue to be reimbursed on a fee-for-service basis until the Managed Medical Assistance program is implemented. Medicare Same Day Billing Guidelines

SAMHSA recently announced that The Centers for Medicare and Medicaid Services (CMS) released

5 new guidance on same day billing in Medicare. The guidance strengthens support for integrated primary and behavioral healthcare integration because Medicare Part B pays for reasonable and necessary integrated health care services when they are furnished on the same day, to the same patient, by the same professional or a different professional. The guidelines specifically name mental health care services which include services for persons with substance use disorders. The Guidance is available at: Same Day Billing for Mental Health Services and Primary Care Services. Additional information on financing for integration of services is available at the Center for Integrated Health Solutions website, http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/Same-Day-Billing-Text-Only-Fact-Sheet-ICN908978.pdf

SAMHSA’s Update on Making Integrated Care Work

In their most recent newsletter the Center for Integrated Health Solutions published a brief article by David Lloyd on Person-Centered Care. The article stresses the importance of customer satisfaction and person centered care in the evolving health care system. According to the article the following factors are essential to program management:  High quality of services  Convenience  A satisfactory experience  Accessibility  Friendly care

To ensure that the organization is prepared to address these necessary components, the author states that the following capabilities are necessary:  Data collection and analysis  Same day access  A customer satisfaction feedback system

This article and other related information is available at: http://www.integration.samhsa.gov/about-us/esolutions-newsletter/esolutions-november-2013

New Training Program for Community Behavioral Health Organizations The National Council for Behavioral Health has created a new opportunity for your organization to prepare for working in the new healthcare marketplaces: the Mastering Back Office Management Learning Community. The training will address the following topics:  Credentialing staff on provider panels  Internal referrals to appropriately credentialed staff  Obtaining pre-certifications, authorizations, and re-authorizations, as needed prior to service continuation  Support enrollment needs of clients  Clinical focus to meet the managed care best practices (e.g., mental illness-focused brief therapy “treat to target” models, shift in paying for volume to paying for value/quality/outcomes)  Collection of co-pays

6  Timely and accurate claims submission This National Council learning community, conducted in partnership with MTM Services, provides nine months of customized training and technical assistance that includes a readiness assessment, online conference, webinars, web-based consulting, resource website, toolkit, and rapid change plan development consulting. The Mastering Back Office Management Learning Community will begin in January 2014 and is open to National Council members. Cost of participation is $7,500. Non-members are encouraged to join, but must become a member prior to the learning community’s onset. Learn more and apply by Dec. 11 to join this unique learning opportunity. Questions? Email Mohini Venkatesh at [email protected].

Training Offered by Center for Medicare and Medicaid Services

"CMS Telemedicine Credentialing & Privileging Rule: Keys to Compliance" Tuesday, January 7th, 2014 1:00-2:30 p.m. ET http://www.healthcaretraininggroup.net/35P/0/2/pD72QPc/p9DRSJD7i/p0e/

This informational, 90-minute webinar will provide you with key strategies necessary to reduce risk, avoid legal liability and comply with the CMS telemedicine credentialing & privileging rules.

CMS improvements in patient-service delivery systems have transformed the patient/doctor relationship, paving the way for advances in telemedicine healthcare. What can your healthcare organization do to comply with all CMS telemedicine credentialing and privileging rules, minimize legal liability risk and effective strategies to help implement a telemedicine program? Please join us for this informative, 90-minute webinar where you will discover:  How the CMS rule changed telemedicine credentialing & privileging  Key provisions for compliant & protective telemedicine agreements  How the recent HIPPA changes impact CMS telemedicine rules  Critical legal issues telemedicine practitioners face daily  Strategies to avoid risk when implementing the CMS Telemedicine rule Presenter: Sue Dill Calloway, R.N., M.S.N, J.D. is a nurse attorney and medical-legal consultant. She has done many educational programs for nurses, physicians, and other health care providers.

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