P0382 (09/09)

Behavioral Health Integration Overview EDS Annual Workshop

Behavioral Health Integration Overview EDS Annual Workshop

Hoosier HealthwiseOctober 22, 2009

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Network Development

MDwise has selected Behavioral Health Management, Inc. (BHMI), an Indiana based provider organization to develop the MDwise Behavioral Health Provider Network. Provider contracting Provider credentialing

Effective October 2, 2009 MDwise Behavioral Health Network is closed.

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MDwise Delivery Systems

MDwise utilizes a delivery system of care. MDwise members choose or are assigned to a Primary Medical Provider (PMP) in one of the MDwise networks or Delivery Systems (see quick contact sheet). For Behavioral Health, the MDwise Delivery Systems are responsible for: Claims payment Prior authorization of services Case Management

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How to check eligibility

The most accurate way to confirm eligibility is to use one of the EDS systems (e.g. Web InterChange, Omni, AVR)Before providing services, it is necessary to confirm:

Is the member eligible for services today? In what IHCP (Indiana Health Care Program) are they enrolled?

(Hoosier Healthwise, Medicaid Select, Traditional Medicaid, HIP or Presumptive Eligibility)

If the member is in Hoosier Healthwise, what MCO are they assigned? (MDwise, Anthem, MHS)

If the member is enrolled in Hoosier Healthwise, what services are they eligible to receive? (Package A, B, C or P)*

If the member is with MDwise, what Delivery System are they assigned to?

Does the member have primary health insurance other than Medicaid (frequently seen with Package B moms)?

* Note: Package P does not include behavioral health

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Outpatient Treatment Form (OTR) Prior Authorizations and Claims

Once you have determined what program the member is in and what MDwise Delivery System, use the Quick Reference Sheet to find:

Phone number & Fax number for prior authorization

Claims address or EDI number Phone number & Fax number for Pharmacy

prior authorization (PerformRx)(See Quick Reference Sheet)

* This information can be found on the MDwise Web site at www.MDwise.org

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Integration

Let’s talk about integration.

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Let’s Talk Integration

Roger Kathol speaks of this situation as “Headless Health” Head: BH/SUD System Body: PH System Residential Inpatient Inpatient Rehab Partial Nursing

Homes IOP OP OP Home Care

There is no or very little communication between the head and the body!

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MDwise Integration Grant Project

When somebody tells you nothing is impossible, ask him to dribble a football.  ~Author Unknown

In cooperation with OMPP, MDwise has sponsored a grant project to support integrated careGrant projects are innovative and put the “head” back on healthcare

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Example -Midtown CMHC

Medical Home Model Members with mental illness will receive

medical care where their medical home is the mental health setting

A physician and RN will be onsite at Midtown to provide for the medical needs of our members

Outcomes to be measured: access, ER use, member satisfaction, monitoring of metabolic issues

Outcomes of medical home model will be compared to non-medical home model

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Example -Gallahue/Community Family Residency Program

Increase collaboration between family medicine and behavioral health

Behavioral health will be integrated into the family practice residency program of Community Hospital

Will implement a more systematic approach that will include routine mental health screenings for all new contacts, provide counseling within the primary care site if a brief therapy model is appropriate, more complex cases will be referred to Gallahue providers who will maintain regular communication with the medical provider

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Integrated Care Means:

Local management of behavioral health services

Improved coordination and collaboration between medical and behavioral health providers ( A work in progress)

Utilization management and case management services are integrated at the delivery system level; medical and behavioral health managers work together to manage members’ needs

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Integrated Care Means:

Building a “right sized” network of skilled providers, statewide

All providers work from the same contract and fee schedule

Delivery Systems assume risk for their members

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Challenges Ahead

Taking down the silos that keep medical and behavioral health services apart Location Funding and payment systems Information Technology Old paradigms Communication

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Provider Information

ContractingCredentialing

BHMI8604 N.Allisonville Rd.Ste. 325Indianapolis, IN 46250

317-237-5770 or 866-323-3464

www.InteCare.org

Provider Questions & Inquiries

MDwise Provider Relations

317-630-2831 or800-356-1204

PA Forms, PDLProvider Manual, Newsletters, information

MDwise web siteHoosier Healthwise

www.MDwise.org

PA Phone & FaxClaims Inquiry Numbers

MDwise Delivery System Information

See Quick Contact Sheet

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Important Claims Information

Note:Claims submission for Hoosier Healthwise Behavioral Health date of services 1/1/2009 should be submitted to MDwise Delivery System (see quick reference sheet)

Healthy Indiana Plan (HIP) Claims should go to: MDwise (HIP) P.O Box 33049 Indianapolis, Indiana 46203 Payor ID: MDWIS

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Behavioral Health

Questions??