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OBH Contractors Webinar

OBH Contractors Webinar. April 12, 2012. PRESENTERS Peter J. Calamari Ken Saucier Danita LeBlanc Dr. Rochelle Dunham Dr. Michael Gomila David McCants Randy Lemoine. Welcome & Introduction. Goal of Webinar. Goal of today’s Webinar is to:

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OBH Contractors Webinar

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  1. OBH Contractors Webinar April 12, 2012 PRESENTERS Peter J. Calamari Ken Saucier Danita LeBlanc Dr. Rochelle Dunham Dr. Michael Gomila David McCants Randy Lemoine

  2. Welcome & Introduction

  3. Goal of Webinar • Goal of today’s Webinar is to: • Introduce contractors to OBH’s Medicaid Enrollment Policy • Present Residential AD Options available in LBHP • Clarify Billing Process for current Fiscal Year – FY12 • Establish a Technical Assistance Process so that contractors can get ongoing assistance needed in implementing Clinical Advisor.

  4. Medicaid Application Policy

  5. Medicaid Application Policy • All individuals seeking OBH network services must complete the Medicaid application process if they are not a current recipient or have not been denied Medicaid in the last 12 months. • Providers are responsible for informing, encouraging, assisting clients with this process & maintaining required documentation of the application process

  6. Medicaid Application Policy (con.) • If individuals refuse to complete the Medicaid application, they will not be eligible to receive discounted Behavioral Health services from providers in the LA Behavioral Health Partnership. • If the individual is incapacitated and unable to complete the application, OBH will pay for services until the individual is able to complete the application. (see definitions)

  7. Medicaid Application Procedures

  8. Medicaid Application Procedures • Providers are to post signs in the facility informing individuals of the requirement to complete a Medicaid application. • Providers are to notify individuals of what information they will need to have with them to complete a Medicaid application

  9. Medicaid Application Submission

  10. Medicaid Application Submission • Online Medicaid application process – • https://bhsfweb.dhh.louisiana.gov/OnlineServices/ • confirmation number & date • Scan a paper application & email to celeste.gauthier@la.gov or jessica.brown3@la.gov • Keep copy of paper application & transmission documentation in the chart. • Fax a paper application to 318-253-4060. • Keep copy of paper application & transmission documentation in the chart

  11. Behavioral Health Residential Treatment Options

  12. Behavioral Health Residential Treatment Options - Grid

  13. Behavioral Health Residential Treatment Options – Grid (cont.)

  14. Behavioral Health Residential Treatment OptionsQuick Reference Grid See LBHP Service Manual and Codes for more detail http://new.dhh.louisiana.gov/index.cfm/page/538

  15. Behavioral Health Residential Treatment Options (cont.) • Psychiatric Residential Treatment Facility (PRTF) <21 • Therapeutic Group Homes (TGH) <21 • Addictive Disorders’ Residential Rehabilitation – Adolescents <21 • Addictive Disorders’ Residential Rehabilitation – Adults 21+

  16. Bed Limits

  17. Bed Limits • PRTF • Can be 17 or more beds • TGH • 8 beds or less • Residential Rehab-Adolescents • 16 beds or less • Residential Rehabilitation-Adults • No bed restriction b/c of ‘in lieu of’ service provision

  18. Accreditation

  19. Accreditation • Accreditation is required for all of the Behavioral Health Residential Treatment Options by CMS &/or the State: • Bodies: CARF, COA, JCO • PRTF – Accreditation is required before payment is received; CMS requirement • TGH- Allowed 18 months to achieve accreditation • Residential Rehabilitation- Adult & Adolescents: Allowed 12 months from 5/1/12 to achieve, with 3 months extension

  20. AD Residential Staffing

  21. AD Residential Staffing • AD Residential staffing rates for the various ASAM levels in the LBHP Service Manual are higher than previously required • OBH is currently reviewing the staffing requirements for the various ASAM levels

  22. Residential Per Diem

  23. Residential Per Diem • PRTF: • Per diem rate for Treatment & Room/Board paid by Medicaid • *Licensed & unlicensed staff covered in per diem • Physicians & pharmacists can bill separately–active treatment plan • TGH: • Per diem rate for Treatment by unlicensed staff paid by Medicaid. • Fee for service for Licensed staff can bill separately • Room/Board paid through State General Funds (SGF)

  24. Residential Per Diem (cont.) • Residential Rehabilitation-Adolescents & Adults • Per diem rate for treatment covers the services of both licensed & unlicensed staff. • Room and Board is paid through State General Funds • Rates vary based on ASAM levels

  25. FY12 Contracts Requiring LBHP Billing

  26. FY12 Contracts Requiring LBHP Billing • Assertive Community Treatment (ACT) • Substance Abuse Residential (All ASAM levels) • Substance Abuse Outpatient • Multi-systemic Therapy (MST)

  27. Contract Billing Procedures and Forms

  28. All Clients - Form

  29. Monthly Billing FormFee For Service

  30. OBH Invoice – Cost Reimbursement Form

  31. Clinical Advisor Technical Assistance

  32. Clinical Advisor (CA) Technical Assistance • Magellan Weekly CA Webinar • Priority Focus: CA access, configuration & billing • Critical Implementation Tasks & Timelines • Identify needs/issues for resolution • Tracking progress/ Update on corrections and enhancements • On-the-spot training by MGLN IT • Magellan Clinical Advisor Resources • www.magellanoflouisiana.com • Basic Training Guide • Billing Training Recorded Webinar • Computer-based Training (modules)

  33. Clinical Advisor (CA) Technical Assistance • Magellan Clinical Advisor Resources • Tim Hebert, MGLN-LA IT Director • TBhebert@magellanhealth.com • Joseph Chustz, MGLN-LA Sr. Program Analyst • JAchustz@magellanhealth.com • Paula Turner, MGLN-LA Claims Administrator • JPturner@magellanhealth.com • Magellan CA Helpdesk • Email: MEHelpDesk@Magellanhealth.com • Phone: 888-411-6343 • OBH CA support • Joseph Fontenot – joseph.fontenot@la.gov • Randall Lemoine - randall.lemoine@la.gov

  34. Presentation and Attachments Can Be Found at: http://new.dhh.louisiana.gov/index.cfm/faq/category/87

  35. Questions This Webinar will be available today for 30 minutes after the presentation for you to send questions. The answer to the questions will be posted on the OBH site by COB Tuesday, April 17, 2012 Other Contact Persons OBH Medicaid Policy Residential Options Billing Process Danita.Leblanc@la.gov Kenneth.Saucier@la.gov

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