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ALL PROVIDER MEETING JUNE 15, 2016 1-3 PM

Join us for the Alliance Provider Meeting on June 15 to receive updates from various speakers and participate in breakout sessions on important topics related to our network development plan. Don't miss this opportunity to learn and connect with key stakeholders in the industry.

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ALL PROVIDER MEETING JUNE 15, 2016 1-3 PM

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  1. ALL PROVIDER MEETINGJUNE 15, 20161-3 PM

  2. AGENDAWelcome and Introductions  Alliance Provider Advisory Council (APAC) Updates (Mark Germann)MCO Leadership Updates (Michael Bollini)Provider Network Development Plan Update(Carlyle Johnson)New Service(s) Update(Kate Peterson)Provider Networks(Cathy Estes)Innovations Update(Jarret Stone) Breakout Sessions: TCL-Transitions to Community Living (Tinya Ramirez) room 104 An overview, how to access, how to best support an individual as they go thru the process. “Who we are, what we do, and how we would like to partner with you” NCTopps(Geyer Longenecker): room 105 How to submit NC-TOPPs interviews and use the NC-TOPPS reporting . system. The session also will review the use of data and reporting for quality improvement Next meeting: Wed. September 21, 2016

  3. Medicaid Reform/MergerUpdate

  4. Legislative Updates MCO’s are actively lobbying to have the General Assembly restore the $152 million cut that is planned for this coming Fiscal year (FY17). Joint Legislative Oversight Committee cut $112 this year, equates for Alliance $11 million this year and $17 millionBudget -The General Assembly is hard at work negotiating by July 1 a final budget amendment for the coming fiscal year. next year. At the GA there is some movement to lessen the overall reduction. $30 million to fund the governor’s Mental Health Task force initiatives, which would benefit our system Restoring $30 million of our single stream cut in FY16, and another $30 million fiscal year 17 so long as there is a Medicaid surplus and we are moving ahead with consolidation per the Secretary’s direction. Another 30 million If there is a certified surplus in the Medicaid budget lines exceeds expectations.

  5. Legislative Updates Senate Bill 734 which calls for a Statewide standing order that would allow anyone to walk into any pharmacy and be provided naloxone or Narcan.  Naloxone is an anti-overdose drug or Opioid Antagonist. S838, Medicaid Transformation Reporting - Talks about providing regular updates regarding the 1115 waiver – The 1115 was submitted to CMS on June 1st. The Waiver describes the provision of: 3 PHP on the physical health side (commercial managed care) to cover the entire state Up to 12 PLE’s to work within 6 regions MCO’s are to remain in our current form for up to 4 years after implementation (which equates to about 7 years)

  6. Proposed Regions

  7. MCO Consolidation Secretary has laid out to JLOC his direction to consolidate from 8 LME’s to 4. Alliance is partnered with Sandhills At this point there is no active consolidation plans. Partners/Smoky, Cardinal/CenterPoint, Trillium/Eastpointe

  8. Network Development PlanFY2015-16 Highlights

  9. Expand capacity for crisis, hospital diversion and respite services for all ages/disabilities Expand/enhance capacity of Facility Based Crisis Transitioned to new provider for Durham facility Working with identified vendor to develop second Wake Co. facility Cape Fear expanded crisis beds to 16 and added IVC capacity Advanced Practice Paramedic program Implemented in Durham and Wake counties

  10. Expand capacity for crisis, hospital diversion and respite services for all ages/disabilities Develop capacity for IDD Crisis Respite Working with provider to offer short-term (30-45 days) PRTF for children with autism; will be implemented FY17 Implement rapid response crisis diversion services for children and adolescents in Wake;. Creation of new in-lieu of service definition and expansion in all areas FY17 Implement CTI in Cumberland

  11. Increase capacity to serve dually diagnosed (IDD/MI) consumers Implemented Youth Villages Choices and Pinnacle Fostering Solutions models Implemented adolescent NC START program

  12. Identify high cost/high need populations and match with EBP Implemented treatment models for high needs youth Youth Villages Intercept model Kidspeace TFC Pinnacle Family Centered Treatment Implemented First Episode Psychosis Program Contract for EBP models for IIH Strengthening Families Eco-Systemic Family Therapy

  13. Alternative Service Definitions In Lieu Of OPT+ (submitted under review) Rapid Response (submitted under review) ACTT Step-Down (approved 7/1 implementation) CTI (submitted under review) Modified Definition CST+ (approved 7/1 implementation)

  14. Network Development PlanFY2016-17 Goals and Initiatives

  15. Expand capacity for crisis, hospital diversion and respite services for all ages/disabilities Assure availability of high quality, accessible, effective Mobile Crisis services in all counties Expand access to Behavioral Health Urgent Care Centers (Tier II Same Day Access) Expand capacity for facility based crisis services in Wake County Develop peer respite capacity Develop Facility Based Crisis capacity for children

  16. Increase breadth, access and quality of residential options Expand Enhanced Therapeutic Foster Care Implement Intensive Wrap-Around for children and transition age youth Support technology assisted homes

  17. Increase capacity to serve consumers with IDD or co-occurring IDD/MI Implement intensive autism treatment and assure service availability Implement IDD Crisis Respite facility

  18. Increase availability, tracking and oversight of specialty services and evidence-based practices Promote EBPs for PSR programs Implement EBP in Therapeutic Foster Care programs Implement Family Oriented EBPs within IIH Expand Trauma Informed Therapeutic Foster Care

  19. Develop and enhance the continuum of care for individuals with substance use disorders Define and create a service continuum Expand opioid treatment availability

  20. Questions?

  21. New Services Overview All Staff Meeting June 14, 2016

  22. For Adults ACT Step Down is an Alternative Service Definition that allows an ACT team to add staffing to work with folks as they titrate down the intensity of ACT.  ACT-Step Down allows for two visits vs. four but uses the same providers for continuity.​  All ACTT Providers Eligible Medicaid Only

  23. For Adults CST Plus allows for a more intensive CST service delivery for our higher needs consumers, who because of diagnoses do not qualify for ACTT.  There are three main differences:  More units available, require face to face therapy weekly, and allows providers to use internal clinical staff who are NOT team members to conduct the independent evaluation if more than six months of services is needed.  Eligibility: CST In-Network Providers serving 15 or more consumers currently. Medicaid Only

  24. For Adults and Youth Outpatient Plus is an approved Alternative Service Definition that allows for a therapist and QP team to provide a more intensive OPT and support/case coordination model.  There are one hour units and therapy must be delivered in the same frequency as the QP support and skill building.  This service is to fill the gap between OPT and intensive services such as IIHS and CST.  Eligibility: Phase One will be high volume Providers of CST, IIHS and Outpatient services combined. Medicaid Only***waiting for DMA fiscal approval

  25. For Co-Occurring MH/I/DD Youth Fostering Solutions is a TFC Model that is specific to the co-occuring I/DD and MH population of youth.  The model features small caseloads, bundled clinical support and individual skill building.  TFC families and staff are specifically trained to understand this population's needs.  The model also incorporates trauma informed training.  It is available in the Alliance catchment with immediate capacity.  Provider: Pinnacle Family Services chosen through RFP Medicaid Only

  26. For Co-Occurring MH/SU Youth This is state funded  pilot program using CASP funds allocated from the state.  The Provider specifically trains TFC homes for SU treatment and overlays the Seven Challenges EBP.  There is an LCAS doing OPT and Seven Challenges, and a small caseload per QP.  Provider selected through RFP: Easter Seals UCP Medicaid and IPRS

  27. Definitions in Process Rapid Response Critical Time Intervention We will be posting all new Alternative Service Definition and Scopes for Modifiers on our website, watch provider news.

  28. Provider Networks UpdateContracts Medicaid contracts are in the process of being sent out. If you do not receive your Medicaid contract by July 15, please contact contracts@alliancebhc.orgIf you receive your contract and have questions please contact your Provider Network Development Specialist.State contracts will be sent once Medicaid contracts are out. If you do not receive your State contract by July 31 please contact contracts@alliancebhc.org

  29. Reminder about ContractsIn accordance to the Provider Operations Manual, codes that have not been billed for at least 60 days prior to the contract process will not be renewed in your FY17 contract. This is for “stand alone codes”. For example, if you had CST in your contract and have not billed that code after January 1, 2016, it will not be included in your FY17 contract.

  30. Taxonomy InformationPlease ensure that you are putting the correct Taxonomy(s) on your claim submission.  Alliance anticipates turning on the taxonomy edit in the future and to reduce denials due to taxonomy issues you will want to ensure your claims are being submitted with the correct taxonomy.  If a MH/SA only Agency you will want to ensure that the taxonomy submitted on your claim is 251S00000X.  If you are an IDD or IDD/MH/SA Agency you will want to ensure 251S00000X and or  253Z00000X are included. LIP’s will want to utilize taxonomy’s specific to their licensure.

  31. NATIONAL ACCREDITATION LETTER REQUIREMENT FOR INNOVATIONS WAIVER PROVIDERSGuidance regarding the LME/MCO Communication Bulletin #J153 and the Joint Communication Bulletin #J153 National Accreditation (Update):Per Bulletin #J153 “The Division of Medical Assistance (DMA) believes the accreditation should include all of the modules that are the closest fit to what is being provided by the agency” and that “the provider should consult with the accrediting body on the modules and waiver definitions to determine what is needed.”Therefore, Alliance Behavioral Healthcare requests that you contact your individual accrediting bodies and obtain letters stating that modules you have been accredited to provide match the waiver service definitions. If you are not accredited in those areas then the update to Bulletin #J153 permits you “to obtain accreditation on additional models (modules) at their next review by the accrediting body.” Please include that date in your letter, if applicable.To be in compliance with the accreditation documentation required by Alliance and the State, please email accreditation letters as well as any questions to InnovationsWaiver@AllianceBHC.org  no later than July 1, 2016.

  32. END OF YEAR REMINDERSCut off Dates for Submitting Claims and Non-UCR Invoices7/20/16 – All FY16 non-UCR invoices and supporting documentation must be submitted to Accounts Payable8/29/16 – IPRS and County claims with dates of service 6/30/16 and prior must be submitted9/30/16 – Medicaid claims with dates of service 6/30/16 and prior must be submittedReminders6/21/16 – Last check run during FY16 for providers. This is in the check write schedule posted on our website.Additional details are posted in the Provider News

  33. Record Management and Document Manual UpdateA revised version of the  Records Management and Documentation Manual goes into effect July 1, 2016. Comments are being accepted until June 17th.  The links for the draft manual and comments can be found at the below links https://www.ncdhhs.gov/divisions/mhddsas/reports/records-management-and-documentation-manual-rmdm This is the mailbox to which all questions and feedback concerning the RM&DM should be sent for quality control: Feedback.RMDM3@dhhs.nc.gov

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