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ValueOptions Provider Training:
Fully Integrated Duals Advantage
(FIDA) Program in NYS
2013
Objectives
2
Introduction to ValueOptions and FIDA Program
Overview of FIDA Program
• Provider Network
• Available Services
• Timeframes
Overview of ValueOptions
• Operational Areas
• Tools, Resources and Communications
How to Join FIDA Network
Questions and Answers
Introduction to ValueOptions
3
Founded in 1983
Largest independent behavioral health company
Serving over 32 million members
Contracts with 20 health plans
More than 50 Medicaid contracts in 14 states
Committed to principles of recovery and resiliency
Diverse client base
• Commercial Division
Employer Groups
Health Plans
• Federal Division
• Public Sector Division
ValueOptions National Presence
4
Regional support,
EAP staff and
corporate
support offices
Major service
centers
Public Program/
Medicaid
Membership
National
Innovation and
Technology
Center
AK
NM
MT
WY
CO UT
ID
AZ
NV
WA
CA
OR
TX
OK
KS
NE
SD
ND
IL
MS
AR
LA
MO
IA
MN WI
FL
KY
WV VA
NC
TN
SC
AL GA
RI
NJ
DE MD
ME
NY
PA
MI
VT NH
MA
CT
OH IN
HI
ValueOptions’ New York City Service Center
5
Located in its new offices at One Penn Plaza
Cares for 1.7 million Emblem members enrolled in
Commercial, Medicare, Medicaid benefit plans
Manages behavioral health benefits for VNS and Suffolk
county employees
Overview of Fully Integrated Duals
Advantage Program
6
Demonstration project
Federal-State partnership between the Centers for Medicare and
Medicaid Services (CMS) and the State of New York, Department
of Health (State/NYSDOH) designed to test new models of care for
individuals eligible for both Medicare and Medicaid (dual eligibles)
Program integrates and coordinates enrollee benefits and care
across the Medicare and Medicaid programs, enhancing the
availability of services that have historically been available on a
fee-for-service basis
Eligible Participants
7
Eligible Participants must be:
• Age 21 or older at the time of enrollment;
• Entitled to benefits under Medicare Part A and enrolled
under Medicare Parts B and D, and receiving full
Medicaid benefits; and
• Reside in a FIDA Demonstration County
Comprehensive Benefit Package
8
Capitated managed care program that provides
comprehensive array of Medicare, Medicaid, and
supplemental services – including:
All physical healthcare
All LTSS services currently available through Medicaid
Advantage Plus (MAP) program
Additional services currently only available through
HCBS Waivers
Additional supplemental services not currently
required in NYSDOH managed care plans
All behavioral healthcare
FIDA Coordination Model
9
Participant-Centered
Interdisciplinary Care Coordination Team, which
includes:
Participant,
Designee,
Primary Care Physician,
Behavioral Health Professional,
Care Coordinator, and
any other providers
• as chosen by Participant or
• as recommended by PCP or Care Coordinator and
agreed to by Participant
Beneficiary Protections
10
Independent Enrollment Broker
Independent Participant Ombudsman
Integrated Grievances and Appeals Processes
Choice of Plans
Choice of Providers
Maximum travel, distance, wait, and appointment times
Continuity of Care
Single Consolidated Statement of all Rights and
Responsibilities
No Costs
ValueOptions’ FIDA Provider Network Expansion
11
ValueOptions is expanding our provider network in:
• New York City (Bronx, Kings, New York, Queens and
Richmond)
• Long Island (Nassau and Suffolk)
• Westchester county region
Will include the full range of behavioral health services
currently covered under the Medicaid-fee-for-service
program
Available Services Under FIDA Program
12
FIDA Timeframes
13
Ongoing Network Readiness i.e. Contract with Providers
July 2014 Voluntary enrollment of Community Based Demonstration Dual Eligibles
October 2014 Passive enrollment of Community Based Demonstration Dual Eligibles
January 2015 Voluntary enrollment of Institution Based Demonstration Dual Eligibles
April 2015 Passive enrollment of Institution Based Demonstration Dual Eligibles
ValueOptions: Operational Areas
14
National Network Services:
• Provider Relations
• Provider Credentialing/Re-credentialing
• Contracting
Provider Relations
1
5
• Ensures members’ behavioral health care needs are met
through a geographically and clinically robust network
of providers
• Ensures maintenance of network composition by
engaging in assertive retention strategies
• Engages in timely and appropriate recruitment
• Engages in professional, consistent, and educative
communications with provider community and staff
Credentialing/Re-credentialing
1
6
• Completion of Credentialing Application required for network
participation
• Provider Re-credentialing (every 3 years)
Notified 4 months prior to due date (telephonic), 1 week
later (email/fax), 15 and 30 days prior to due date
Failure to respond to requests will result in disenrollment
from the network
Complete online, prepopulated re-credentialing
application
Attach updated license, certification and malpractice
information
Electronically sign the application (once signed, it is
automatically submitted)
Provider Contracting
1
7
ValueOptions Provider Agreements
Commercial and FIDA Contracting
Tools, Resources and Communications
1
8
• ValueOptions Website
• ProviderConnect®
• PaySpan Health®
• Training Opportunities
• Communication Channels
ValueOptions.com
1
9
ProviderConnectSM – Provider Online Services
2
0
PaySpan® Health
2
1
A tool enabling you to:
• Receive payments automatically
• Receive email notifications immediately upon payment
• View your remittance advice online
• Download an 835 file to use for auto-posting purposes
• Visit the PaySpan Health website at
www.payspanhealth.com
Training Opportunities
2
2
CEQuick
Training Webinars (New regulations, updates,
ProviderConnect, etc.)
Video Tutorial Library
Up to the Minute Communications
2
3
Provider PulseSM Messages
Fax and Email Communications
Provider Mailings
Constant Contact Alerts
Monthly Valued Provider eNewsletter
How to Join the FIDA Network
2
4
To initiate contract negotiations, providers need to:
• Fax a signed copy of the FIDA Letter of Intent and inventory of
services as soon as possible to ValueOptions Provider Relations
OR
• Scan the documents to email at
25
Questions?