Presented by Pat Winston and Shannon Landrum

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May 2008
Behavioral Health Provider Presentation
Presented by Pat Winston and Shannon
Landrum Bureau for Medical Services West Virginia
Department of Health and Human Resources
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Bureau for Medical Services Mission

• To maintain the Medicaid Program, while
  maintaining accountability for the use of
  resources, in a way that assures access to
  appropriate, medically necessary, and quality
  health services for all members provide these
  services in a user friendly manner to providers
  and members alike and focus on the future by
  providing preventive care programs.

3
West Virginia Medicaid Redesign
is Built Upon Health Improvement

• Provide members with the opportunity,
  responsibility and incentives to maintain and
  improve their health
• Coordinate care and
• Tailor benefits to population needs and

4
Flexibility through the Deficit Reduction Act

• Allows states to design benefit packages
  appropriate to specific populations.
• Only 40 of Medicaid members eligible to
  participate in Mountain Health Choices.
• Mountain Health Choices only available to AFDC
  related Medicaid clients children and healthy
  adults.

5
Process

• Mountain Health Choices
• Member Information Packet
• Mailed to all eligible members 60 days in advance
  of re-determination date
• 5 months total to choose between Basic and
  Enhanced
• Follow up postcard mailed on re-determination date

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(No Transcript)
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DEMOGRAPHICSWest Virginia Beneficiaries By
Expenditures
WEST VIRGINIA MEDICAID BENEFICIARIES AND
EXPENDITURES BY ENROLLMENT GROUP, SFY 2007
100
Elderly (31,144)
90
Blind Disabled (91,190)
80
Adults (60,233)
70
Children (191,316)
60
50
40
30
Note Beneficiaries are
20
enrollees who received
a Medicaid service.
10
Blind Disabled
0
includes adults,
children, and elderly
who qualify based on a
disability.
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DEMOGRAPHICS Population Forces Driving Changes

• 85 of Medicaid patients have or are at-risk for
  a chronic condition
• 70 prevalence rate of overweight or obese
• 70 are sedentary

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DEMOGRAPHICS Population Forces Driving Changes

• Located in rural, geographically and economically
  isolated areas
• Fatalistic approach to health status
• Do not access care unless sick

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Key Components of Redesign

• Prevention
• Personal Responsibility
• Care Management
• Establishment of a Medical Home

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Mountain Health Choices Benefit Plans

• Enhanced Plan offers services above and beyond
  traditional Medicaid, as well as potential
  rewards.
• Basic Plan offers a comprehensive set of
  benefits.

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West Virginia Mountain Health Choices

• Creates a partnership of Medicaid, its members
  and the provider
• Is patient-centered with pro-active personalized
  care

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Implementation

• Starting small to build on successes.
• Children and adults with children first target
  population.

14
West Virginia Mountain Health Choices

• Is not cost containment
• Does not cut services to low-income children
• Does not require providers to police patient
  behavior.
• Encourages healthy decision making.

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How can the Licensed Behavioral Health Centers
Assist?

• Examine Medicaid Card for the benefit package
• Assist through Coordination of Care/Targeted Case
  Management
• Advise the member of the importance of making
  their PCP aware of their behavioral health needs.

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Behavioral Health Providers

• Licensed Behavioral Health Centers
• Comprehensive Behavioral Health Centers
• Private Practitioners
• Psychiatrists
• Psychologists
• Psychiatric Nurse Practitioners

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Specialty Mental Health Services

• Psychiatrist
• Case Consultation 90887
• Medication Management EM codes and 90862
• Psychiatric Diagnostic Interview Evaluation 90801
• Assessment by a non-physician H0031 AJ
• Group Therapy 90853 AJ
• Family Therapy 90847 AJIndividual Therapy 90804
  AJ and 90806 AJ

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Specialty Mental Health Services

• Psychologist
• Psychiatric Diagnostic Interview Evaluation 90801
• Psychological Testing 96101, 96110, 96111, 96116,
  96118
• Individual Therapy 90804 and 90806
• Group Therapy 90853
• Family Therapy 90847

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Clinic Services

• Case Consultation 90887
• Medication Management 90862
• Psychological Testing 96101, 96110, 96111
• Mental Health Assessment by a non-physician H0031
• Screening by a Licensed Psychologist T1023 HE
• Mental Health Service Plan Development H0032
• Physician Coordinated Care Oversight Services
  Service Plan Development G9008

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Clinic Services continued

• Behavioral Health Counseling
• Professional, Individual H0004H0
• Professional, Group H0004H0HQSupportive,
  Individual H0004 Supportive, Group H0004 HQ

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Clinic Services continued

• Comprehensive Medication Services H2010
• Day Treatment H2012 Crisis Intervention H2011
  Community Psychiatric Supportive Treatment H0036
• Therapeutic Behavioral Services H2019H0 and
  H2019
• NEMT A0120HE and A0160HE

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Rehabilitation Services

• Mental Health Service Plan Development by
  Psychologist H0032 AH
• Skills Training and Development H2014 U4,
  H2014U1, H2014 HNU4, H2014HNU1
• Assertive Community Treatment H0040
• Comprehensive Community Support Services H2015
• Residential Childrens Services H0019U1, H0019U2,
  H0019U3
• Short-Term Residential for Children H0019U4

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Specialty Provider Enrollment

• Identify providers in your practice who can
  enroll to bill as a specialty provider.
• Obtain a Group Behavioral Health Specialty
  Provider Number
• Call Unisys provider enrollment at 1 888 483 0793
  for a packet.

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Assistance Available

• For questions regarding Mountain Health Choices
  in general, contact the Bureau for Medical
  Services at 558-1700
• For questions regarding training needs and your
  participation in the process, contact APS at 1
  800 378-0284
• For questions regarding payment or provider
  enrollment, contact Unisys at 1 888 483 0793

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Contact

• Shannon Landrum
• West Virginia
• Department of Health and Human Resources
• Bureau for Medical Services
• [phone]