Fee-for-Service Initiative G A CS B B O A R D R E T R E A T J E F - PowerPoint PPT Presentation

Fee-for-Service Initiative G A CS B B O A R D R E T R E A T J E F F M I N O R R O B E R T D O R R M A Y 3 , 2 0 16

Background J E F F M I N O R Georgia Department of Behavioral Health and Developmental Disabilities 2

Background  Accountability  Provider Network Stability  Ensuring Access to Services Georgia Department of Behavioral Health and Developmental Disabilities 3

Timeline  Core Provider Redesign (i.e. CCP)  Administrative Services Organization (ASO)  Provider Readiness Georgia Department of Behavioral Health and Developmental Disabilities 4

Implementation R O B E R T D O R R Georgia Department of Behavioral Health and Developmental Disabilities 5

Provider Tiers  Tier One  Community Service Boards  Tier Two Plus  Medicaid/ State Contract  Tier Two  Medicaid Only  Tier Three  Specialty Services Only Georgia Department of Behavioral Health and Developmental Disabilities 6

Tier One Providers  Department leadership believes that Community Service Boards are the backbone of the state’s public safety net and must ensure access to care for some of Georgia’s most-in-need.  This obligation to serve the uninsured and under- insured makes CSBs unique, thus requiring a unique funding structure.  Funding Evolution should not destabilize the safety- net. Georgia Department of Behavioral Health and Developmental Disabilities 7

July 1, 2017 Transition Based upon current assessed risk:  Limited roll-out of Fee-For-Service effective July 1, 2016  Adult MH Core Benefit Package  Adult AD Core Benefit Package  Substance Abuse Intensive Outpatient Program  Psychosocial Rehabilitation - Individual and Group  Peer Support – Individual and Group and Whole Health and Wellness  Phased transition of other Specialty Services beginning in calendar year 2017  Phased transition of remaining GIA-based services to Fully Costed Reimbursement contracts beginning in calendar year 2017  Implementation of approval-based Supplemental Support Funds requests July 1, 2017 Georgia Department of Behavioral Health and Developmental Disabilities 8

Adult BH Core Benefits Package BH Assessment and Service Plan Development Psychological Testing Diagnostic Assessment Crisis Intervention Psychiatric Treatment (E&M) Nursing Services Medication Administration Psychosocial Rehabilitation - Individual Addictive Diseases Support Services Case Management Outpatient Services – Individual and Group Outpatient Services – Family Community Transition Planning Peer Support – Individual Peer Support – Whole Health and Wellness Georgia Department of Behavioral Health and Developmental Disabilities 9

Tier One Provider Funding  Maximum Reimbursement Limits  Maximum reimbursement limits are being assigned to providers as a statewide budgetary control mechanism. This limit provides a reasonable assurance that the state allocation for community behavioral health services is not exceeded on an annual basis.  Initial limits for FY17 will be based upon FY16 contracted values for the core benefit package and other selected services transitioning to FFS on July 1, 2016.  Maximum reimbursement limits will be reviewed for potential adjustment to allow for possible redirects of funding at mid- year and year-end.  Reviews will be based upon actual utilization data collected. Georgia Department of Behavioral Health and Developmental Disabilities 10

Tier One Provider Funding  Minimum Reimbursement Limits  Tier One providers will be eligible for one year of transitional revenue protection in the form of guaranteed minimum levels of reimbursement.  Minimum reimbursement limits for FY17 will be set based on 70% of a provider’s FY16 funding levels for the core benefit package and other services being transitioned to FFS on July 1, 2016. Actual earned revenues will be reviewed and compared to initial Minimum Reimbursement Limits at mid-year and year-end.  Any shortfall between actual earned revenues and Minimum Reimbursement Limits will be addressed through an increase in supplemental support funding at year-end or upon approved intermediate request by contractor. Georgia Department of Behavioral Health and Developmental Disabilities 11

Tier One Provider Funding  Supplemental Support Funding  Supplemental Support funding for FY17 contracts will carry forward from FY16 contracts  Adjustments will be made based upon required additional funding resulting from minimum reimbursement limits, if applicable  Future FFS Transitions  Remaining services not transitioning to FFS on July 1, 2016 will transition to FFS or to fully-costed reimbursement beginning in calendar year 2017 Georgia Department of Behavioral Health and Developmental Disabilities 12

Funding Evolution Impact - Example 1 SFY 2016 SFY 2017 FFS SFY 2017 GIA or Allocation IMRL Reimbursement Adult MH 101 Adult Core 3,607,191.00 3,607,191.00 191 Supplemental Support Funds 782,842.00 782,842.00 103 Crisis Services 1,203,524.00 1,203,524.00 105 Peer Support 111,417.00 111,417.00 106 Employment Services 285,360.00 285,360.00 107 Residential 749,991.00 749,991.00 115 ADA Funded Services 109,171.00 109,171.00 117 Pharmacy 400,799.00 400,799.00 Adult AD 701 Adult Core 1,272,820.00 1,272,820.00 791 Supplemental Support Funds 285,666.00 285,666.00 703 Crisis Services 796,476.00 796,476.00 717 Pharmacy 141,424.00 141,424.00 602 HIV Intervention 56,617.00 56,617.00 625 RFW TANF Residential 528,000.00 528,000.00 State Adult BH Funding 10,331,298.00 4,991,428.00 5,339,870.00 Adult BH Funding Transitioned to FFS 4,991,428.00 Adult BH Funding Remaining GIA 5,339,870.00 At Risk after 70% Minimum Funding Limit for SFY 2017 1,497,428.40 % of Total BH Funding at Risk for FY 2017 14% Georgia Department of Behavioral Health and Developmental Disabilities 13

Funding Evolution Impact - Example 2 Funding Evolution Impact SFY 2016 SFY 2017 FFS SFY 2017 GIA or Allocation IMRL Reimbursement Adult MH 101 Adult Core 1,387,000.00 1,387,000.00 191 Supplemental Support Funds 558,181.00 558,181.00 103 Crisis Services - - 105 Peer Support 91,554.00 91,554.00 106 Employment Services 49,200.00 49,200.00 107 Residential 1,146,137.00 1,146,137.00 115 ADA Funded Services 134,806.00 134,806.00 117 Pharmacy 154,144.00 154,144.00 Adult AD 701 Adult Core 505,190.00 505,190.00 791 Supplemental Support Funds 128,110.00 128,110.00 703 Crisis Services - 717 Pharmacy 56,132.00 56,132.00 602 HIV Intervention - 625 RFW TANF Residential - State Adult BH Funding 4,210,454.00 1,983,744.00 2,226,710.00 Adult BH Funding Transitioned to FFS 1,983,744.00 Adult BH Funding Remaining GIA 2,226,710.00 At Risk after 70% Minimum Funding Limit for SFY 2017 595,123.20 % of Total BH Funding at Risk for FY 2017 14% Georgia Department of Behavioral Health and Developmental Disabilities 14

Questions? Please submit any remaining questions to Robyn Garrett-Gunnoe for consolidation and response by the Department. Georgia Department of Behavioral Health and Developmental Disabilities 15