1. Medicaid Reimbursementfor tele-psychiatry Northern Human Services The NH experience

2. Program Overview • NHS: northern half of NH with 8% of the population • Multiple sites services to DD & Substance Abuse populations • No child psychiatry available within the region • HRSA grant to develop the technical capacity and clinical service and to ensure its sustainability • Gaining board of directors support • Required building the talent within IT department • Convincing clinical staff that it could work • Assuring financial staff that it would not inflate expenses

3. Process for engaging State partners • NH is a laboratory environment (geographic and population) • With the award notified potential partners and launched a “good will tour”. • Good Will Tour: to outline the process, discuss the value, offer to be a resource for other CMHC, ask for their help in achieving sustainability • Tour included: Bureau of Behavioral Health, Commissioner of the Department of Health & Human Services, UNH (Health Management and Policy Institute), Dartmouth Medical Center & the Department of Psychiatry, other NH CMHC who was attempting to initiate tele-health • Outlined a role for each of the potential players and key contact person • Provided brief updates as we progressed through the project. • Once the technical challenges were achieved and with a clinical partner, engaged in an intensive reimbursement planning effort with the Bureau of Behavioral Health (MH is carved out to BBH in NH) • BBH agreed to a pilot for one year

4. Successes & Challenges • BBH required to assure the new service codes would be budget neutral • High visibility. Tracking via a modifier code on the bill & satisfaction/outcomes. • No change was required to the “State Plan” (different delivery vehicle) • Other interested parties wanting to join the pilot. • Pressure to accelerate and expand (both internal & external) • BBH & Commissioner’s office outstanding partners as they view this as a portable model that will enhance services

5. Outcome of the partnership • We share the failures as well as the successes (commitment testimony) • Viewed as a partner to assist with other transformative issues. • Builds expectations that are not always achieved (electronic supervision) • Use of the technology grants permission to conduct other business (eligibility reviews etc.) • Establishes a platform for other innovation.

6. How do you maintain the relationship • We are the contracted entity for our region • Built in review of progress and problems re: the tele-health project with BBH • Semi-annual meeting with the Commissioner & BBH on the project

7. Lessons Learned • More extensive research on what is in place earlier. UNH was helpful in retrieving this information • Building in local grassroots support (other healthcare providers and legislators etc.) to get to the next level of other third party reimbursement • Let the staff become familiar with the equipment and the process (educate and control) • Engage billing and A/R staff early on

8. Resources & Tools • Build the case for the value added • Share the data/information (proposal and the process) • Face to face initial meetings • Support from the top (Board, Medical Director and CEO)

9. Current & Future • Bringing down the cost of transmission • Negotiating a longer term relationship with Dartmouth (provider) • Partnership with BBH, UNH to pursue legislation to require other third party reimbursement • Explore other clinical uses for the equipment (internal & external)