Community Medicaid Behavioral Health services have now been carved into the clients’ Medicaid Managed Care Plan (MCP) for well over a year.

As the system continues to move away from the the implementation phase of these Community Medicaid Redesign initiatives, behavioral health agencies must also continue to analyze these changes and its impact on their business models NOW.

Organizations must look at their last six to nine months of clinical activity under the new billing codes and requirements to make sure they have a firm handle on their agency’s current financial performance.

But as agencies evaluate this current financial impact, they must also look to new clinical opportunities that will benefit their clients and expand and/or enhance their missions.

Newer services such as TBS Group Service (Day Treatment) Per Diem (replaced the old Partial Hospitalization service), Intensive Home Based Treatment (IHBT) and Substance Use Disorder (SUD) Partial Hospitalization will provide agencies opportunities to identify those clinical needs and fill them.

With one of the State’s goals being to bend the cost curve, services that provide alternatives to expensive inpatient care will be welcomed.  New referral sources will open up for your organization based on these new services.  For example, a key clinical service missing from the Substance Use Disorder (SUD) continuum of care has been Partial Hospitalization (PHP).  Given our current opiate epidemic and the nature of this disease, this vital level of care is now reimbursable by Ohio Medicaid (and its contracted Medicaid MCPs).

Back in the day, most hospitals stabilizing patients on their inpatient detoxification units, could only refer back to into the Community SUD Agency network hoping the patient makes it to that appointment.  That client, in most cases, needed a higher level of care such SUD PHP.  Unfortunately, that level of care (and corresponding reimbursement) did not exist in the old Community Medicaid system.  Neither did SUD Residential Treatment.  But now, it does!
In fact, Ohio Medicaid has just increased reimbursement rates to several Community Medicaid services, including TBS Group Service (Day Treatment) Per Diem (another level of care developed during this BH Redesign initiative) as of August 1st!
Begin to have conversations with key referral sources to see what kind of clinical needs they have that your organization can fill.

For further information on the Ohio Medicaid’s Initiative website page for more on Behavioral Health Community Medicaid Redesign.  Here is the link to their website at Ohio Medicaid BH Redesign web page

At Pinnacle Partners, our mission is to assist Community Behavioral Health Agencies to not only survive but thrive in this new managed care environment.  Please let us know how we can be of assistance to your organization!