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G A CS B B O A R D R E T R E A T J E F F M I N O R R O B E R T D O R R M A Y 3 , 2 0 16
2 Georgia Department of Behavioral Health and Developmental Disabilities
J E F F M I N O R
Fee-for-Service Initiative G A CS B B O A R D R E T R E A T J E F - - PowerPoint PPT Presentation
Fee-for-Service Initiative G A CS B B O A R D R E T R E A T J E F - - PowerPoint PPT Presentation
Fee-for-Service Initiative G A CS B B O A R D R E T R E A T J E F F M I N O R R O B E R T D O R R M A Y 3 , 2 0 16 Background J E F F M I N O R Georgia Department of Behavioral Health and Developmental Disabilities 2 Background
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3 Georgia Department of Behavioral Health and Developmental Disabilities
Background
Accountability Provider Network Stability Ensuring Access to Services
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4 Georgia Department of Behavioral Health and Developmental Disabilities
Timeline
Core Provider Redesign (i.e. CCP) Administrative Services Organization (ASO) Provider Readiness
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5 Georgia Department of Behavioral Health and Developmental Disabilities
R O B E R T D O R R
Implementation
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6 Georgia Department of Behavioral Health and Developmental Disabilities
Provider Tiers
Tier One
Community Service Boards
Tier Two Plus
Medicaid/ State Contract
Tier Two
Medicaid Only
Tier Three
Specialty Services Only
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7 Georgia Department of Behavioral Health and Developmental Disabilities
Tier One Providers
Department leadership believes that Community
Service Boards are the backbone of the state’s public safety net and must ensure access to care for some of Georgia’s most-in-need.
This obligation to serve the uninsured and under-
insured makes CSBs unique, thus requiring a unique funding structure.
Funding Evolution should not destabilize the safety-
net.
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8 Georgia Department of Behavioral Health and Developmental Disabilities
July 1, 2017 Transition
Based upon current assessed risk:
Limited roll-out of Fee-For-Service effective July 1, 2016 Adult MH Core Benefit Package Adult AD Core Benefit Package Substance Abuse Intensive Outpatient Program Psychosocial Rehabilitation - Individual and Group Peer Support – Individual and Group and Whole Health and
Wellness
Phased transition of other Specialty Services beginning in
calendar year 2017
Phased transition of remaining GIA-based services to Fully
Costed Reimbursement contracts beginning in calendar year 2017
Implementation of approval-based Supplemental Support Funds
requests July 1, 2017
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9 Georgia Department of Behavioral Health and Developmental Disabilities
Adult BH Core Benefits Package
BH Assessment and Service Plan Development Psychological Testing Diagnostic Assessment Crisis Intervention Psychiatric Treatment (E&M) Nursing Services Medication Administration Psychosocial Rehabilitation - Individual Addictive Diseases Support Services Case Management Outpatient Services – Individual and Group Outpatient Services – Family Community Transition Planning Peer Support – Individual Peer Support – Whole Health and Wellness
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10 Georgia Department of Behavioral Health and Developmental Disabilities
Tier One Provider Funding
Maximum Reimbursement Limits
Maximum reimbursement limits are being assigned to
providers as a statewide budgetary control mechanism. This limit provides a reasonable assurance that the state allocation for community behavioral health services is not exceeded on an annual basis.
Initial limits for FY17 will be based upon FY16 contracted
values for the core benefit package and other selected services transitioning to FFS on July 1, 2016.
Maximum reimbursement limits will be reviewed for potential
adjustment to allow for possible redirects of funding at mid- year and year-end.
Reviews will be based upon actual utilization data collected.
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11 Georgia Department of Behavioral Health and Developmental Disabilities
Tier One Provider Funding
Minimum Reimbursement Limits
Tier One providers will be eligible for one year of transitional
revenue protection in the form of guaranteed minimum levels of reimbursement.
Minimum reimbursement limits for FY17 will be set based on 70% of
a provider’s FY16 funding levels for the core benefit package and
- ther services being transitioned to FFS on July 1, 2016. Actual
earned revenues will be reviewed and compared to initial Minimum Reimbursement Limits at mid-year and year-end.
Any shortfall between actual earned revenues and Minimum
Reimbursement Limits will be addressed through an increase in supplemental support funding at year-end or upon approved intermediate request by contractor.
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12 Georgia Department of Behavioral Health and Developmental Disabilities
Tier One Provider Funding
Supplemental Support Funding
Supplemental Support funding for FY17 contracts will carry
forward from FY16 contracts
Adjustments will be made based upon required additional
funding resulting from minimum reimbursement limits, if applicable
Future FFS Transitions
Remaining services not transitioning to FFS on July 1, 2016
will transition to FFS or to fully-costed reimbursement beginning in calendar year 2017
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13 Georgia Department of Behavioral Health and Developmental Disabilities
Funding Evolution Impact - Example 1
SFY 2016 SFY 2017 FFS SFY 2017 GIA or Allocation IMRL Reimbursement Adult MH 101 Adult Core 3,607,191.00 3,607,191.00 191 Supplemental Support Funds 782,842.00 782,842.00 103 Crisis Services 1,203,524.00 1,203,524.00 105 Peer Support 111,417.00 111,417.00 106 Employment Services 285,360.00 285,360.00 107 Residential 749,991.00 749,991.00 115 ADA Funded Services 109,171.00 109,171.00 117 Pharmacy 400,799.00 400,799.00 Adult AD 701 Adult Core 1,272,820.00 1,272,820.00 791 Supplemental Support Funds 285,666.00 285,666.00 703 Crisis Services 796,476.00 796,476.00 717 Pharmacy 141,424.00 141,424.00 602 HIV Intervention 56,617.00 56,617.00 625 RFW TANF Residential 528,000.00 528,000.00 State Adult BH Funding 10,331,298.00 4,991,428.00 5,339,870.00 Adult BH Funding Transitioned to FFS 4,991,428.00 Adult BH Funding Remaining GIA 5,339,870.00 At Risk after 70% Minimum Funding Limit for SFY 2017 1,497,428.40 % of Total BH Funding at Risk for FY 2017 14%
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14 Georgia Department of Behavioral Health and Developmental Disabilities
Funding Evolution Impact - Example 2
Funding Evolution Impact SFY 2016 SFY 2017 FFS SFY 2017 GIA or Allocation IMRL Reimbursement Adult MH 101 Adult Core 1,387,000.00 1,387,000.00 191 Supplemental Support Funds 558,181.00 558,181.00 103 Crisis Services
- 105 Peer Support
91,554.00 91,554.00 106 Employment Services 49,200.00 49,200.00 107 Residential 1,146,137.00 1,146,137.00 115 ADA Funded Services 134,806.00 134,806.00 117 Pharmacy 154,144.00 154,144.00 Adult AD 701 Adult Core 505,190.00 505,190.00 791 Supplemental Support Funds 128,110.00 128,110.00 703 Crisis Services
- 717 Pharmacy
56,132.00 56,132.00 602 HIV Intervention
- 625 RFW TANF Residential
- State Adult BH Funding
4,210,454.00 1,983,744.00 2,226,710.00 Adult BH Funding Transitioned to FFS 1,983,744.00 Adult BH Funding Remaining GIA 2,226,710.00 At Risk after 70% Minimum Funding Limit for SFY 2017 595,123.20 % of Total BH Funding at Risk for FY 2017 14%
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15 Georgia Department of Behavioral Health and Developmental Disabilities
Questions?
Please submit any remaining questions to Robyn Garrett-Gunnoe for consolidation and response by the Department.