LME/MCO Provider Steering Committee Update

LME/MCO Provider Steering Committee Update

September 14, 2015

LME/MCO Provider Steering Committee Update

LME/MCO Provider Steering Committee

The Steering Committee continues to monitor actions in the General Assembly, especially Medicaid Reform and the budget. Attorneys with the MCO’s are drafting a short agreement concerning reciprocity for monitoring between MCOs. The goal of the agreement is to eliminate the duplicity in monitoring providers that provide services to individuals in more than one MCO. Once the agreement is drafted it will be sent to the Attorney General’s office for approval.

The Steering Committee continues to meet monthly with representatives of DHHS. The meetings focus on how recommendations from the Steering Committee for streamlining the MH/DD/SA system can be implemented.

Other issues the Steering Committee continues to work on include:

  • State Budget
  • LME/MCO Credentialing and Re-Credentialing reciprocity
  • Routine monitoring reciprocity
  • PCG behavioral health pre/post enrollment on-site reviews
  • Back-up staffing
  • Single care agreements

Business Practices Subcommittee

Business Practices established a Care Coordination Task Force, comprised of MCOs and providers, which met for the first time at the end of August. The purpose of the meeting was twofold, first to educate members as to how they each handle care coordination and to look for opportunities for standardization. It was noted that the purpose of the task force is not to bring back targeted case management as it is not an allowable service under the current behavioral health waiver.

During the first meeting, members of the Task Force shared what is and is not working in care coordination. The group then developed a list of topics that should be discussed in more detail to see if there are opportunities for improvement and standardization.

The Business Practices Subcommittee is continuing its work on standardizing the enrollment data that should be required by all MCOs. The hope is that by having standardized date requirements it will allow for more consistency across the State.

Outcomes Subcommittee

The Outcomes Subcommittee is focusing on developing outcomes for Intensive In-home. Data is now being gathered on IIH from MCOs. The objective for the September meeting is to review the data and to begin developing parameters that MCOs can use to measure outcomes.

IT Subcommittee

ICD-10, which is scheduled to be implemented on October 1, 2015, is moving along on track. DMA is continuing to work to ensure the ICD 10 crosswalk is in line with DSM5.

The IT Subcommittee has established a task force to look at NPI numbers. The primary goal of the task force is to determine requirements for reporting needed by the State and MCO’s related to Site locations for service encounters of Medicaid and DMH services and to explore acceptable opportunities for providing Site Location information outside of 837 billing files if the 837 proves inadequate.