UPDATES FOR MEDICAID COVERED RESIDENTIAL TREATMENT SERVICES Ashley Harrell, LCSW Senior Program Advisor Developmental Disability and Behavioral Health Division, DMAS [email protected]
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UPDATES FOR MEDICAID COVEREDRESIDENTIAL TREATMENT SERVICES
Ashley Harrell, LCSWSenior Program Advisor
Developmental Disability and Behavioral Health Division, DMAS
Focus on Positive Outcomes for Children
Use models with evidence based treatment approaches, standardized medical necessity criteria, and specific program requirements.
Youth and family focused system that will match future Managed Care administration structures, oversight and contracting requirements.
Efficient service model that yields better outcomes to Medicaid enrollees using shorter lengths of stay and higher intensity services.
Care coordination before, during and after placements that helps to ensure effective programming and a successful return to the community and home settings.
Involvement of youth and families in all aspects of care to achieve long term outcomes.
Promote community engagement and tenure. Services are individualized, short term, and focused on comprehensive
discharge planning.
2
Goals for the Medicaid Residential Treatment Services Program
Unduplicated Members by Quarter by Service
136 138 136 131 118 113 9986
73
349 347320
286 285 294259 244 262
1104 10881062 1060 1046 1057
992
902873
0
200
400
600
800
1,000
1,200
2016 Q1 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2017 Q2 2017 Q3 2017 Q4 2018 Q1
RES A
TGH
PRTF
3
Current Medicaid Statistics for RTS
Data Source: VAD Auths Monthly Summary
Unduplicated Members by Month by Service
68 6765 64 63
63
67
7475
17
12 12 12 13 1313
14
14
1614
17
2119
17 16 17 17
0
10
20
30
40
50
60
70
80
EPSDTTGH
EPSDTPRTF
EPSDT1:1
4
Current Medicaid Statistics for EPSDT RTS
Data Source: VAD Auths Monthly Summary
Children's Residential Treatment Services
5
Where are Children Enrolled in Medicaid Placed in Virginia?
Data as of 4/2/2018: This map is updated by the 10th of each month.
EPSDT PRTF
14 Members
EPSDT TGH
76 Members
PRTF
710 Members
TGH
266 Members
Number of RTS Inquiries Submitted to Magellan of Virginia by Locality
6
Data as of 04/09/2018. This report is updated by the 10th of each month.
Number of RTS Inquiries Closed or Diverted
7
Data as of 04/09/2018. This report is updated by the 10th of each month.
Number of Assessments by IACCT
8
Data as of 04/09/2018. This report is updated by the 10th of each month.
Recommended Medicaid Covered Services
9
Data as of 04/09/2018. This report is updated by the 10th of each month.
Medicaid Covered Services Received within 30 Days After PRTF Discharge
12
Data as of 02/10/2018. This report is updated by the 10th of the month following end of quarter.“NO SERVICES” could indicate a member who is receiving services not requiring an authorization or being funded by another source (ex: MCO, CCC plus, or CSA).
Children’s Residential Treatment Services
Children’s Residential Treatment Services as defined by this program manual consist of two levels of care: Psychiatric Residential Treatment Facility (PRTF) services and Therapeutic Group Home (TGH) services.
As of May 1, 2018, DMAS and Magellan of Virginia no longer reimburse for Community-Based Residential Services for Children and Adolescents under 21 (Level A) group home services provided by a DSS licensed facility.
As of May 1, 2018, Two Levels of Care
All Behavioral Health Services are Covered by Managed Care
Plans
A fully integrated Physical and
Behavioral Health Continuum of Care
Magellan/DMAS Contractor will continue to
cover behavioral health treatment services for fee-
for-service members
Transforming the Delivery System of Medicaid Behavioral Health Services for Children Under 21
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Effective 1/1/18 for CCC Plus and Beginning 8/1/18 for Medallion 4.0
• Intensive In Home (IIH)
• Therapeutic Day Treatment (TDT)
• MH Case Management
• Family Support Partners
• EPSDT Behavioral Therapy
• Crisis Intervention
• Crisis Stabilization
Effective April 1, 2019 for both CCC Plus and Medallion 4.0
• Therapeutic Group Home
• Psychiatric Residential Treatment Services
• Treatment Foster Care Case Management
Transitioning to Managed Care
90 day Reassessment Requirement for Children placed prior to 7/1/17 eliminated (went in effect December 2017)
FAPT is automatically notified of a child going through the IACCT Process (January 2018).
Eliminate the IACCT Family Engagement Notification Form to Magellan (March 1, 2018).
Recommendation Meeting eliminated if all interested parties are in agreement with the treatment decision (March 26, 2018).
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Enhancing IACCT Process for the Transition
Transitioning to Managed Care
Adverse Childhood Experiences Screening (ACES) will be removed from IACCT process effective June 1, 2018. Residential Treatment Providers will be responsible for screening for trauma as part of treatment planning using the ACES or another trauma screening tool.
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Enhancing IACCT Process for the Transition
Transitioning to Managed Care
Continued promotion of community engagement and tenure, residential treatment needs to be individualized, short term, and focused on comprehensive discharge planning.
Reduce duplicative processes for children and families
Independent Certification Team to include licensed providers involved with child in the community
Streamline processes for psychosocial assessment, medical assessment
High touch care coordination by the managed care health plan to coordinate the member’s behavioral health and medical needs – full continuum of care.
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