Foundational Community Supports Teesha Kirschbaum, Health Care - PowerPoint PPT Presentation

Foundational Community Supports Teesha Kirschbaum, Health Care Authority Teesha.Kirschbaum@hca.wa.gov (360) 725-9997 November, 2019

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Wa Waiver Initiatives Initiative 1 Initiative 2 Initiative 3 Transformation through Accountable Enable Older Adults to Stay at Home; Delay Targeted Foundational Communities of Health or Avoid the Need for More Intensive Care Community Supports Delivery System Benefit: Medicaid Benefit: Supportive Transformation Alternative Care (MAC) Housing • Each region, through its • Community-based option for • Individualized, critical services and Accountable Community of Health, Medicaid clients and their families. supports that will assist Medicaid will be able to pursue projects that clients to obtain and maintain • Services to support unpaid family will transform the Medicaid caregivers. housing. The housing-related delivery system to serve the whole services do not include Medicaid person and use resources more payment for room and board. wisely. Benefit: Tailored Supports • Also known as Delivery System for Older Adults (TSOA) Benefit: Supportive Reform Incentive Payments (DSRIP). Employment • For individuals “at risk” of future • Services such as individualized Medicaid LTSS not currently job coaching and training, meeting Medicaid financial employer relations, and eligibility criteria. assistance with job placement. • Primarily services to support unpaid family caregivers. Pay for Performance Projects Medicaid Benefits/Services

How did we get here? FCS Launch MTP Application Eligible Medicaid TPA Contract clients can receive HCA submits an HCA awards supported application to CMS to Amerigroup employment and implement the 5-year contract to supportive Medicaid administer FCS housing benefits Transformation Project benefits 2015 2017 2018 MTP Approval FCS Protocol CMS establishes special CMS approves terms and conditions HCA’s protocol for (STCs) for how HCA FCS benefits, will implement, client eligibility evaluate and finance and provider MTP payment *CMS - Centers for Medicare & Medicaid Services, the federal agency that works in partnership with state governments to administer Medicaid

How is Foundational Community Supports structured? Medicaid Funds FCS benefits through Healthier • Funding WA Medicaid Transformation HCA 1 Receives funding from Medicaid • Holds contract with Amerigroup TPA • Program oversight DBHR 2 & ALTSA 3 Support network development and • provider engagement • Contracts with FCS providers Amerigroup • Manages client referrals and (TPA 4 ) Benefits authorizes FCS services administrator • Distributes provider payments • Tracks encounter data Community- Health care Community Long-term Tribal FCS based providers behavioral services & providers Data Providers organizations health supports (social services) agencies providers 1. Health Care Authority – Policy Division 2. Health Care Authority - Division of Behavioral Health & Recovery 3. Department of Social & Health Services - Aging and Long-term Support Administration 4. Third Party Administrator

What is Foundational Community Supports? It is… It isn’t… • Medicaid benefits for help • Subsidy for wages or finding housing and jobs : room & board • For all Medicaid-eligible • Supportive Housing to people find a home or stay in your home • Supported Employment to find the right job, right now

What benefits are available through Foundational Community Supports? Supportive housing helps you find a home or stay in your home ü Housing assessments and planning to find the home that’s right for you ü Outreach to landlords to identify available housing in your community ü Connection with community resources to get you all of the help you need, when you need it ü Assistance with housing applications so you are accepted the first time ü Education, training and coaching to resolve disputes, advocate for your needs and keep you in your home

What benefits are available through Foundational Community Supports? Supported employment helps you find the right work, right now ü Employment assessments and planning to find the right job for you, whenever you’re ready ü Outreach to employers to help build your network ü Connection with community resources to get you all of the help you need, when you need it ü Assistance with job applications so you can present your best self to employers ü Education, training and coaching to keep you in your job

Who is eligible to receive Foundational Community Supports benefits? FCS benefits are reserved for people with the greatest need. To qualify, you must: 1 Be enrolled in Medicaid Be at least 18 years old (Supportive Housing) or 16 years old 2 (Supported Employment) Meet the requirements for complex needs 3 • You have a medical necessity related to mental health, substance use disorder (SUD), activities of daily living, or complex physical health need(s) that prevents you from functioning successfully or living independently. • You meet specific risk factors that prevent you from finding or keeping a job or a safe home.

Who is eligible to receive Foundational Community Supports benefits? Supportive Housing risk factors Supported Employment risk One or more factors One or more ü Chronic homelessness ü Housing & Essential Needs (HEN) and Aged Blind or Disabled (ABD) enrollees ü Frequent or lengthy stays in an institutional ü Difficulty obtaining or maintaining setting (e.g. skilled nursing, inpatient hospital, psychiatric institution, prison or jail) employment due to age, physical or mental impairment, or traumatic brain injury ü Frequent stays in residential care settings ü SUD with a history of multiple treatments ü Frequent turnover of in-home caregivers ü Serious Mental Illness (SMI) or co-occurring ü Predictive Risk Intelligence System (PRISM) 1 mental and substance use disorders score of 1.5 or above 1. PRISM measures how much you use medical, social service, behavioral health and long-term care services.

Foundational Community Supports referral pathways Amerigroup Self referral: Contact Your provider Referral Amerigroup directly submits a referral form to Amerigroup Assignment Talk to your service provider Eligibility Determination No Your FCS provider Service Authorization Does this provider completes an already offer FCS assessment to Yes services through determine your Amerigroup? eligibility

Foundational Community Supports enrollment 5,759 FORECAST Original forecast estimate as of December 28, 2017 DSHS Research and Data Analysis Division 2,832 TOTAL ENROLLMENT ( as of February 27, 2019 ) TOTAL = 3,321 Supported Employment Only Clients 58% n = 1,937 Supportive Housing Only Clients 36% n =1,192 232 Both Supported Employment + Supportive Housing 6% n = 192 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 2018 2019 SOURCE: DSHS Research and Data Analysis Division, Integrated Databases DATE: March 2019

Amerigroup Washington Foundational Community Supports Third Party Administrator

Amerigroup as the FCS TPA We’re contract cted d with h the he HCA CA as the he Thi hird d Part rty Adm dmini nistrator r (TPA) of FCS CS and nd pr provi vide de adm dmini nistrative oversight of of: Ø Provider Network Ø Service Authorization Ø Claims payment and encounter tracking/reporting Ø Measuring outcomes and quality improvement Ø Sustainability Plan 17

Enrollee Count We curr currently ha have more tha han n 5,5 ,500 pe peopl ple enr nrolled d in n the he Founda undationa nal Co Communi unity Suppo upport rts (FCS CS) pr program 18

Provider Network A A FCS CS Provi vide der r Network rk continue nues to expa pand nd acr cross WA state. . We ha have 128 contract cted d pr provi vide ders. . 19

Referrals Anyone ne can n refer r a po potential enr nrollee to the he FCS CS pr program Ø Potential Enrollee Ø Family member Ø Provider Ø Aging and Long-term Support Administration (ALTSA) Ø Division of Behavioral Health & Recover (DBHR) Quick ck Reference ce Guide is a tool to quick ckly evaluate if a potential enrollee may be eligible for Supportive Housing and/or Supported Employment service ces. 20

FCS service reimbursement The here are onl nly thr hree HCP CPCS CS bi billing ng code des for r the he FCS CS pr program. . Ø Su Supported Employment Pre-employment services HCPCS code: H2023 Employment sustaining services HCPCS code: H2025 Ø Limit of 120 120 units (30 hours; 1 unit = 15 minutes) of service per 6 6 mon onth authorization period Ø Reimbursement rate of $25/ $25/unit of service Ø Su Supportive Housing Pre-housing and sustaining services: H0043 Ø Limit of 30 30 days of service per 6 6 mon onth authorization period Ø Reimbursement rate of $105/ $105/day Ø Services may be re reauthorized if a FCS enrollee continues to need services 21