Referral Management Follow-up Conference Call 3-1-17

Purpose of Meeting:

Re-visit the new Referral Management process for Home and Community Treatment (HCT) and RCS 28Home and Community which began on February 1, 2017

Facilitators: Paul Maheux, Office of Child and Family Services; Keara Dupont Anctil, Kepro

Provider Comments:

  • When agency notified Kepro of capacity to pick up several members in Kennebec County, they were told that there were only 2 cases in Kennebec County with only 1 available for the agency to pick up. The rest are indicated as having a family choice provider.
  • Agency is experiencing the same issue trying to pick up members in certain areas but there are either no families or those on the list have indicated a family choice with another agency.

Discussion:

  • There are times when there may not be many children available in a particular town, and there also may be greater competition in certain areas with multiple providers.
  • It would be very helpful if agencies would report all towns they can serve as opposed to whole counties. Sometimes Kepro has made a match based on county report, but then agency has indicated not being able to serve the town in that county.

Questions and Responses:

  • Can there be two referral management lists, one that indicates general availability and one that indicates those that have indicated a family choice for provider?
  • No. The change was made to have only one list. However, ongoing discussion is occurring regarding identifying those clients that have specified a family choice provider.
  • Can the referral management list be sent to providers more frequently?
  • Several providersindicated that once per week would be helpful as they plan for staffing and to consider serving in high-needs areas.
  • One provider indicated that this may actually not be helpful since the agency can’t actually get the referral information.
  • OCFS will work with Kepro regarding providing the general referral management list more frequently than once/month as was originally planned.
  • When the new Referral Management list goes out to providers, will it show who is truly generally available?
  • Not at this time. Only those members who have reached the top of the referral management list in their location and have indicated a family choice provider get removed from the list as the referral gets handed off to the family choice provider to manage.
  • Can the list indicate by an asterisk if a member has an indication of a family choice provider?
  • Will take this into consideration.
  • When will the next referral management list be going out to providers?
  • The date has not been determined yet, but should be soon.

Clarification about family choice process:

  • Even whena family choice provider is indicated, member still must wait their turn based on when the referral was made
  • If a family choice is not indicated, Kepro will generally match the member with an agency with reported capacity within a day or so.
  • HCT seems to have many family choice providers indicated

Questions and Responses:

  • Has the Department thought about not having family choice provider since eligibility for services is based on Medical necessity?
  • While OCFS has had many discussions about family choice, the MaineCare rule is very clear. If they wish, families may choose their preferred provider.
  • Provider:Some familiesprefer to have all of their services “under one roof”
  • Families have many reasons for family choice

Questions from TCM agencies and Responses:

  • Provider reports that they experience a “bottle neck” in referrals. Could this be occurring due to Kepro not being able to reach parent?
  • If next family on list has preferred provider, an agency reporting capacity would be matched immediately with the next available member on the list. If all clients on the list in that area have a preferred provider thenthe families are contacted to ask if they want to wait or move forward with a provider with capacity. This could take some time but is necessary to respect client choice.
  • A member is moved to their preferred provider if the family cannot be reached after onecall and no response by noon the following day.
  • Can Kepro:
  • Contact TCM if unable to reach family?
  • Contact TCM when there is a match?
  • Work with TCMs to facilitate contact with families?
  • Contact TCM sooner than thirdattempt to contact family to call TCM into action to facilitate contact with families?
  • Several TCM agencies indicated that families are much more likely to answer a call from the TCM than Kepro.
  • Discussion:
  • Notifications of when a match is made comein through TCM download.
  • When a match is made, notification goes to the receiving agency and the referent.
  • Members that have indicated a preferred provider are not moved to an agency’s referral management list until they have reached the top of the list for their area. Even if no family choice provider has been indicated, members are still assigned based on their referral date and town.
  • If a family wishes to return to the general RM list after being on a preferred provider list for a while, can they go back on the general list?
  • Yes, and they will return to the list on their new date of return and not their original referral date. This is because they were offered a provider for service, but refused and chose to move to their Preferred Provider.

OCFS Questions for Providers

  • Do TCMs explain the RM process to families?
  • Yes. Having those conversations.
  • Have you found anything good or better about the new process?
  • Notifications helpful. Brandy at Kepro very helpful.
  • Flawless process to get referral information for top child with preferred provider indication.
  • Additional information in downloads has been very helpful.

Other:

OCFS is also considering the request by providers to take into account daytime vs evening hour’s availability.

Next meeting:
Beginning of April 2017