The New Face of Kentucky Medicaid FRYSC Conference

The New Face of Kentucky Medicaid FRYSC Conference July 14, 2015 Veronica Judy Cecil Chief of Staff Director, Division of Program Integrity Kentucky Department for Medicaid Services

Our Changing World A long-awaited day in Medicaid…. . • Center for Medicare and Medicaid Services (CMS) authorized a State Plan Amendment for Kentucky: – Expanding eligibility – Expanding mental health and substance use treatment services – Expanding provider network to include individual and group providers as well as licensed organizations beyond community mental health centers Kentucky Department for Medicaid Services 2

Medicaid Expansion Pregnant Women Elderly and Persons with Disabilities Children Parents *138% FPL = $15, 856 for an individual and $26, 951 for a family of three in 2013. Kentucky Department for Medicaid Services 3 Adults

Member Enrollment Mail in a paper application Find a kynector Visit a DCBS office Call 1 -855 -4 kynect Enroll online at kynect kyenroll. ky. gov There are several ways for individuals to enroll in Medicaid.

Mandatory Benefits/Services Cabinet for Health and Family Services 5

Benefit/Service Changes • Private Duty Nursing – Adds private duty nursing service as a new benefit, limited to 2000 hours per year. • Allergy Services – Clarifies benefit to include adults (children were already covered) • Prescription Drugs – Eliminates limit of 4 prescriptions per month • Eyeglasses – Eliminates annual dollar limit and sets a limit of one pair of eyeglasses per year, with an additional pair covered if first pair is lost or prescription changes. (Children only). • Physical, Occupational, Speech Therapy – Aligns the number of visits across eligibility groups to be 20 visits per year per therapy (combined for rehabilitative and habilitative). • Mental Health Services and Substance Use Services Kentucky Department for Medicaid Services 6

Medicaid Expansion Population More Screenings = Better Health • 17, 000 screened for colorectal cancer • 26, 000 received mammograms • 34, 000 screened for cervical cancer • 46, 000 screened for diabetes • 13, 000 received treatment for substance abuse • 80, 000 had preventive dental visits Kentucky Department for Medicaid Services 7

BEHAVIORAL HEALTH SERVICES Kentucky Department for Medicaid Services 8

Rehabilitation Services • • • • Screening Assessment Psychological Testing Crisis Intervention Mobile Crisis Residential Crisis Stabilization Day Treatment (Kids only) Peer Support Parent/Family Peer Support Intensive Outpatient Program Individual Outpatient Therapy Group Outpatient Therapy Family Outpatient Therapy • Collateral Outpatient Therapy (Kids only) • Partial Hospitalization • Service Planning (MH only) • Residential Services for Substance Use Disorders • Screening, Brief Intervention and Referral to Treatment (SU only) • Assertive Community Treatment (MH only) • Comprehensive Community Support Services (MH only) • Therapeutic Rehabilitation Program (MH only) Kentucky Department for Medicaid Services 9

Targeted Case Management • Children with Severe Emotional Disability (SED) and Adults with Severe Mental Illness (SMI) • Adolescents and Adults with Substance Use Disorders (SUD Moderate to Severe) • Adults and Children with Co-occurring Mental Health or Substance Use Disorders and Chronic or Complex Physical Health Issues (SMI, SED, or SUD and Physical Health conditions) Cabinet for Health and Family Services 10

NEW PROVIDER TYPES Kentucky Department for Medicaid Services 11

Provider Network Expansion Behavioral Health Services Prior to January 1, 2014 After January 1, 2014 CMHC Licensed Practitioner Licensed Organization Provider Group Community Mental Health Center (CMHC) Kentucky Department for Medicaid Services 12

Provider Network Expansion New individual and group provider types specific to Medicaid covered Behavioral Health Services include: * Previously limited to QMB Individual Provider Types • Licensed Clinical Social Worker (LCSW)* • Licensed Psychologist (LP)* • Licensed Professional Clinical Counselor (LPCC) • Licensed Marriage and Family Therapist (LMFT) • Licensed Psychological Practitioner (LPP) • Certified Psychologists with Autonomous Functioning • Licensed Professional Art Therapist • Licensed Behavior Analyst Group Provider Types • Behavioral Health Multi-Specialty Group (MSG) Kentucky Department for Medicaid Services 13

Provider Network Expansion Providers who can perform services under supervision of a Medicaid-enrolled licensed practitioner: • • • Licensed Professional Counselor Associate Marriage and Family Therapist Associate Certified Social Worker – Master’s Level Licensed Psychological Associate Licensed Professional Art Therapist Associate Licensed Assistant Behavioral Analyst Kentucky Department for Medicaid Services 14

Provider Network Expansion Non-licensed professionals, including: Ø Targeted Case Managers Ø Individual, provider group and licensed organization Ø Community Support Associates Ø Licensed organization Ø Peer Support Specialists Ø Provider group and licensed organization Ø Certified Alcohol and Drug Counselors** Ø Licensed organization Kentucky Department for Medicaid Services 15 ** House Bill 92

Provider Network Expansion Behavioral Health Services Organization (BHSO) • New licensure category developed by CHFS Office of Inspector General to provide clinical behavioral health services. • If a BHSO provides outpatient behavioral health services to treat individuals with substance use disorders or co-occurring disorders in which substance use disorder is the primary diagnosis, the BHSO will be required to be dually licensed as an AODE. • In addition to providing outpatient behavioral health services, BHSOs may provide residential services for substance use disorders, in which case the BHSO must also be dually licensed as an AODE. BHSO Webinar Link: http: //dbhdid. ky. gov/dbh/bhso. aspx Kentucky Department for Medicaid Services 16

Provider Network Expansion BHSOs will be licensed to provide one or more of the following behavioral health services as described in the Medicaid State Plan: • Screening • Assessment • Psychological testing • Crisis intervention • Mobile crisis • Day treatment • Peer support • Intensive outpatient services • Individual, group, family, or collateral outpatient therapy • Service planning for mental health disorders • Screening, brief intervention and referral to treatment for substance abuse • Assertive community treatment for mental health disorders • Targeted case management • Comprehensive community support services • Residential Substance Use (with AODE licensure) • Therapeutic rehabilitation for adults with a serious mental illness or children with severe emotional disabilities. Limited to Licensed Organizations Kentucky Department for Medicaid Services 17

Provider Network Expansion Residential Crisis Stabilization Units • New separate licensure category developed by CHFS Office of Inspector General for residential crisis stabilization units. • Because Community Mental Health Centers and Psychiatric Residential Treatment Facilities may provide crisis stabilization under their existing licenses, CMHCs and PRTFs will not be required to obtain separate licensure as a residential crisis stabilization unit to provide the service. Kentucky Department for Medicaid Services 18

Provider Network Expansion Non-Behavioral Health: ØSpeech Language Pathologist ØPhysical Therapist ØOccupational Therapist Cabinet for Health and Family Services 19

MEDICAID MANAGED CARE ORGANIZATIONS Kentucky Department for Medicaid Services 20

Managed Care Organizations (MCO) Ø Expanded in November 2011 Ø Except for Long Term Care and Waiver Services Ø Currently have 5 Managed Care Organizations Ø Anthem Ø Coventry. Cares (Aetna) Ø Humana Ø Passport Ø Wellcare Kentucky Department for Medicaid Services 21

KY Medicaid Population Total Current Medicaid Recipients 1, 319, 137 MCOs = 1, 198, 405 Fee-for-service = 117, 037 Kentucky Department for Medicaid Services Run Date 04/27/15 22

MCO OVERSIGHT ü Monthly Operational Meetings ü Reporting üMonthly üQuarterly üAnnual ü Actions Taken in 2013 and 2014 ü 2 Inquiry Letters ü 44 Letters of Concern ü 94 Corrective Action Plans (CAP) Kentucky Department for Medicaid Services 23

MCO OVERSIGHT ü Contract with Department of Insurance to investigate timely payment complaints ü Rector and Associates – Market Conduct Survey and Financial Review ü External Quality Review Organization (EQRO) üIsland Peer Review Organization (IPRO) ü Performance Improvement Plans (PIP) ü EQRO Studies ü Website for Program Quality and Outcomes http: //chfs. ky. gov/dms/pqomcoqbreports. htm Kentucky Department for Medicaid Services 24

NON-EMERGENCY MEDICAL TRANSPORTATION Kentucky Department for Medicaid Services 25

Non-Emergency Medical Transportation • Medicaid contracts with the Office of Transportation Delivery (OTD) in the Transportation Cabinet to administer the Non. Emergency Medical Transportation (NEMT) benefit • OTD contracts with brokers throughout the state a list of brokers can be found at this site: • http: //transportation. ky. gov/Transportation-Delivery/Pages/Human-Service. Transportation-Delivery-Brokers. aspx • Brokers contract with individual providers • Individuals can be transported to Medicaid covered services, including services outlined in their plan of care if they are in waiver • Individuals cannot be transported to the pharmacy Cabinet for Health and Family Services 26

Non-Emergency Medical Transportation In order to receive non-emergency transportation services an individual: • • Must be eligible on the date of service Cannot have a car registered in their name or in their household If the car is not in working order they can get a mechanic’s note If the car is used for work related purposes only, they need to get documentation to that effect – note of work hours • Must call at least 72 hours prior to their appointment unless emergency • Must go to the closest medical provider in their area unless the service is not available in that area, then they can be transported outside of their service are (service area designated by broker regions) Cabinet for Health and Family Services 27

Non-Emergency Medical Transportation • Individuals do not have to pay anything for the trip – not subject to copayment • Can have an escort if they need one – for example, if they are developmentally disabled and need someone to attend the appointment with them • Escorts/guardians do not have to pay for the service • Children under 14 must be accompanied by an adult • Any issues obtaining NEMT can be directed to OTD at (888) 941 -7433 or Medicaid at (800) 635 -2570 • Medicaid’s website: http: //chfs. ky. gov/dms/trans. htm Cabinet for Health and Family Services 28

QUESTIONS Veronica Cecil Veronica. Cecil@ky. gov Kentucky Department for Medicaid Services 29