What are Some Takeaways from Ohio’s Behavioral Health Carve-In?
We are now well over a year from when Community Medicaid Behavioral Health services were carved into the Medicaid Managed Care Plans (MCPs). For many of our colleagues, MCP carve-in has been a struggle.
We are in new environment going from one major payer and one billing system (Medicaid/MITS), to working with five (5) separate and distinct MCPs, each requiring a little something different.
For their part, Ohio Department of Medicaid and the MCPs have been working hard to make sure our system is able to transition as smoothly as possible into this new world.
So what are some takeaways we can glean from this transition that should be helpful to our agencies in the future? Here are a couple of takeaways I wanted to provide as “food for thought”:
- Agencies must understand what product lines are included in their MCP Agreements and recognize that not all contracted product lines work/pay just like Medicaid!
- Agencies must have an effective Revenue Cycle Management (RCM) process in place in order to meet all of the MCP clinical and administrative contract provisions
- Agencies must develop a Clinical Compliance program to make sure all of the clinical services they are providing are medically necessary and clinically defensible when facing Managed Care scrutiny (clinical audits).
There are more takeaways, too numerous to mention in this newsletter. That is why I want to invite you to this year’s Ohio Council Annual Conference that will be held on Thursday October 17th and Friday October 18th at the Marriott Columbus University.
I am honored to participate on a panel at Thursday morning’s breakout session, entitled ORGANIZATIONAL COMPLIANCE – PRACTICAL TIPS, TRENDS, AND BEST PRACTICES.
I will be joined by colleagues Sonda Kunzi, Christine Smalley and Jennifer Riha, all of whom have been in the trenches, working with our Community Behavioral Health agencies on BH Redesign and MCP carve in from the very beginning.
It is my hope that this session will provide you the information you need to assist your organization in navigating through these unfamiliar “managed care waters”. I look forward to seeing you at the conference!
As always, please let us know how Pinnacle Partners can be of assistance to your organization!