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“Show-Me” Implementation

“Show-Me” Implementation. The Current Status of Missouri’s Autism Law. DIFP Implementation. Autism Working Group Guidance to insurance industry Web resources Licensing update Regulatory update Further activities. Overview of Working Group. Cross section of stakeholders Open forum

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“Show-Me” Implementation

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  1. “Show-Me” Implementation The Current Status of Missouri’s Autism Law

  2. DIFP Implementation • Autism Working Group • Guidance to insurance industry • Web resources • Licensing update • Regulatory update • Further activities

  3. Overview of Working Group • Cross section of stakeholders • Open forum • Identified areas of clarification • Procedural (billing) codes • Provider and network credentialing • Identified needs • More consumer information and education • More provider information and education

  4. Regulatory Guidance • Claim coding • Acknowledge and encourage usage of HCPCS H0031, H0032, H2012 and H2019 • Publicize what codes if different • Improper claim denials • No administrative denials or coverage restrictions • Safe harbor for temporary modifications in guidelines to accommodate those already receiving treatment

  5. Autism Resource Webpage • Parent Resource Center • Provider Resource Center • FAQs • Link to the Autism law • Links to Department bulletins

  6. Parent Resource Center • Glossary of common health terminology (still under development) • Steps to ensuring insurance coverage for autism treatment • Links to complaint information • Links to other autism and health plan resources

  7. Provider Resource Center • Information on health ID cards • Links to provider complaint information • Links to carrier survey responses

  8. Licensing Update • 99 Behavior Analysts licensed • 21 Assistant Behavior Analysts licensed

  9. Regulatory Update • Consumer Activity since 1/1/2011 • 2 fully insured complaints • 10 self-funded complaints • 54 phone calls and inquiries • 120 product filings • Follow up to 20 others • Market Conduct monitoring

  10. What is next? • Report to Missouri General Assembly • Due February 2012 • Partial data call complete • Under evaluation • Provider survey • Status of service delivery systems • Status of licensed staff

  11. Outreach activities • Opportunities to highlight law • Ten public events throughout state • Provider summit under development • Discuss best practices • Identify areas of concern • Provide networking opportunity

  12. Questions? Angela Nelson, Director Division of Consumer Affairs Melissa Palmer, Legislative Liaison Missouri Department of Insurance www.insurance.mo.gov 800-726-7390

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