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Amerigroup Washington

Amerigroup Washington offers Foundational Community Supports (FCS) targeted Medicaid benefits to help eligible clients with complex health needs maintain housing and employment stability. FCS provides supportive housing and supported employment services, connecting clients with resources, assistance, and coaching to find and keep a job or find and maintain a home.

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Amerigroup Washington

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  1. Amerigroup Washington Foundational Community Supports Third Party Administrator

  2. Foundational Community Supports (FCS) What it is • Targeted Medicaid benefits that help eligible clients with complex health needs obtain and maintain housing and employment stability. • Supportive Housing services • Supported Employment services What it isn’t • Ongoing payments for housing, rent, or room & board costs • Wages or wage enhancements for clients • Entitlement

  3. Who are the FCS partners? Funding Program oversight Benefits administrator FCS Providers Data Health Care Authority Division of Behavioral Health & Recovery Aging and Long-term Support Administration

  4. What benefits are available through FCS? Supported employment helps you find the right work, right now • Employment assessments and planning to find the right job for you, whenever you’re ready • Outreach to employers to help build your network • Connection with community resources to get you all of the help you need, when you need it • Assistance with job applications so you can present your best self to employers • Education, training and coach to keep you in your job

  5. What benefits are available through FCS? Supportive housing helps you find a home or stay in your home • Housing assessments and planning to find the home that’s right for you • Outreach to landlords to identify available housing in your community • Connection with community resources to get you all of the help you need, when you need it • Assistance with housing applications so you are accepted the first time • Education, training and coaching to resolve disputes, advocate for your needs and keep you in your home

  6. Who is eligible to receive FCS benefits? FCS benefits are reserved for people with the greatest need. To qualify, you must: 1 Qualify for Medicaid 2 Meet the requirements for complex needs • You have a medical necessityrelated to mental health, substance use disorder (SUD), activities of daily living, or complex physical health need(s) that prevents you from functioning successfully or living independently. • You meet specific risk factorsthat prevent you from finding or keeping a job or a safe home. Be at least 18 years old (Supportive Housing) or 16 years old (Supported Employment) 3

  7. Who is eligible to receive FCS benefits? 1. PRISM measures how much you use medical, social service, behavioral health and long-term care services.

  8. Amerigroup as the FCS TPA We’re contracted with the HCA as the Third Party Administrator (TPA) of FCS and provide administrative oversight of: • Provider Network • Service Authorization • Claims payment and encounter tracking/reporting • Measuring outcomes and quality improvement • Sustainability Plan Overview of FCS

  9. Enrollee Count We currently have 3,356 people enrolled in the FCS program * Data as of February 27, 2019

  10. Provider Network A FCS Provider Network has been built across Washington state * Data as of February 27, 2019

  11. Referrals Anyone can refer a potential enrollee to the FCS program • Potential Enrollee • Family member • Provider • Aging and Long-term Support Administration (ALTSA) • Division of Behavioral Health & Recover (DBHR) Quick Reference Guide is a tool to quickly evaluate if a potential enrollee may be eligible for Supportive Housing and/or Supported Employment services. The Quick Reference Guide can be downloaded at the FCS provider website. FCS Referral Form can be downloaded from the FCS provider website to refer a potential enrollee to the FCS program.

  12. Referrals Referral Amerigroup Your provider submits a referral form to Amerigroup Assignment Self referral: Contact Amerigroup directly Eligibility Determination Talk to your service provider Service Authorization N Your FCS provider completes an assessment to determine your eligibility Does this provider already offer FCS services through Amerigroup? Y

  13. FCS Service Reimbursement Supportive Housing Benefit • Per diem rate • Limit of 30 days of service per 6 monthauthorization period • Reimbursement rate of $105/day • Services may be reauthorizedif a participant continues to need services • “Exception to Rule” authorization process is available for additional service units within a 6 month period for participants who have exceptional service needs Supported Employment Benefit • 1 unit = 15 minutes of service • Limit of 120 units (30 hours) of service per 6 month authorization period • Reimbursement rate of$25/unitof service • Services may be reauthorized if a participant continues to need services • “Exception to Rule” authorization process is available for additional service units within a 6 month period for participants who have exceptional service needs

  14. Annual FCS Service Reimbursement Projection • Supportive housing servicesdelivered with a 1:20 caseload ratio*: (20FCS participants) x (2authorization periods) x (30 days of service) x ($105/day) = $126,000 • Supported employment services delivered with a 1:20 caseload ratio*: (20 FCS participants) x (2 authorization periods) x (120 service units) x ($25/unit) = $120,000 *The recommended FCS caseload is 15 – 20 participants per service provider; this is not a contractual requirement.

  15. Expanding Provider Network Providers interested in joining the provider network must have: • Tax ID • Medicaid ID • National Provider Identifier (NPI) To learn more about becoming a contracted FCS provider, contact us at FCSTPA@Amerigroup.com or 844-451-2828.

  16. Advisory Council An FCS Advisory Council has been established as a mechanism to incorporate client voice into services, processes, and outcomes • Enrollees • Providers • Stakeholders • Advocates across Washington Email FCSTPA@Amerigroup.com if you’re interested in joining the Advisory Council.

  17. Technical Assistance, Training + Support

  18. FCS Websites + Provider Manual FCS Resources available at your finger tips • Amerigroup FCS Provider Website: https://providers.amerigroup.com/pages/wa-foundational-community-supports.aspx • Provider Manual • Referral + Assessment Forms • Quick Reference Guide • FCS Provider Resource Guide: https://www.hca.wa.gov/assets/program/FCS-provider-resource-guide.pdf • Amerigroup FCS Client Website: https://www.myamerigroup.com/washington-fcs/home.html

  19. We’re here for you FCS Managers: Jacob Avery Jacob.Avery@amerigorup.com C: 206.718.5083 Joe Elder Joe.Elder@Amerigroup.com C: 206.247.9230 Leeza Lorence Leeza.Lorence@amerigroup.com C: 206.496.3517 Amerigroup Washington, Inc.Third Party Administrator FCSTPA@Amerigroup.com Phone: 844.451.2828 Fax: 844.470.8859

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