How Should My Agency Work with Medicaid? WEBINAR WILL BEGIN SHORTLY…. *****YOU MUST DIAL-IN USING A TELEPHONE TO RECEIVE THE AUDIO PORTION OF THIS CALL**** US/CANADA DIAL-IN #: (800) 480-0235 PASSCODE: 665327

Webinar Overview

Panel • Peggy Bailey, CSH Senior Policy Advisor • Janette Kawachi, Ph.D., Program Director, Catholic Social Services of Washtenaw County • Mark Shotwell, Program Director, Bonita House Inc.

Accessing Medicaid: What to Consider

PEGGY BAILEY SENIOR POLICY ANALYST [email protected]

Why Medicaid? • Stable services funding source • Covers both primary and behavioral health • Strengthens partnership with health system (PSH residents need access to the mainstream system)

• Improved chronic disease management

Medicaid Limitations • States restrict Medicaid billable providers • General Reimbursement • Can be slow • May not support team oriented care

• Requires strong administrative infrastructure • Does not cover all PSH services • Experts estimate that Medicaid has ways to fund between 80 – 90% of services in PSH • Things like housing search, move-in expenses, and related case management are not usually covered • Gap between what Medicaid currently covers and it’s full potential

Ways to Access Medicaid • Bill Medicaid Directly – mostly for health and behavioral health direct service providers • Examples for supportive housing: Direct Access to Housing in San Francisco, Pathways to Housing, Baltimore Health Care for the Homeless, Colorado Coalition for the Homeless • Partnership – Service provider handles billing for a housing provider (models vary)

Partner, Partner, Partner • Getting housing providers as Medicaid billable agencies is NOT usually the solution • It’s not just about Medicaid…you have to access all insurance - Medicare and private • Medicaid benefits need to align with PSH resident’s needs • Then housing providers can partner with Medicaid billing agencies (various options) Panel will explain how these partnerships can work

Avalon Housing, Inc Permanent Supportive Housing

Catholic Social Services of Washtenaw County Housing Support Services

Basic Info Avalon owns and manages 282 units at 24 scattered sites throughout Ann Arbor, ranging from a duplex to a 48-unit complex.

Supportive Housing Services • Family and Community Services (126 family units) • Housing Support Services (156 single adults units)

Housing Support Services • Program of Catholic Social Services of Washtenaw County • Partnership with Avalon since 2001 • Staffing: • 1 Program Director • 6.5 FTE case managers • 1 Med Coordinator

• On-site offices and home-based services • Staffing from 8am – 10pm with 24/7/365 crisis response services

• Services: Housing First, voluntary, ongoing, comprehensive, individualized

Profile of Single Adult Tenant Population (April, 2011) • Total: 146 Single Adults • Service Intensity: • • • • •

Very High Intensity (Daily): High Intensity (Weekly): Moderate (2x/month): Low Intensity (1x/month): Very Low Intensity (< 1x/month):

25 33 25 34 29

(17%) (23%) (17%) (23%) (20%)

• Needs: • • • •

Chronic Health Issue: Mental Illness: Addiction Disorder: Co-occurring (2+):

45 101 45 62

(31%) (72%) (31%) (42%)

Medicaid and Other Health Care Coverage in Supportive Housing Presenter: Mark Shotwell C.A.T.C. Bonita House Inc. Alameda County, California

Bonita House Inc. • Located in Alameda County, California • Social Rehabilitation Agency providing Integrated Dual Diagnosis Treatment services to adults with CoOccurring Mental Health and Substance Use issues since 1971. • Core services funding through Alameda County Behavioral Health Care Services and reimbursable through Medicaid. • Housing funding through HUD (S+C, Section 202, Mckinney-Vento)

Homeless Outreach and Stabilization Team (HOST) HOST

• Assertive Community Treatment Team rget Population: 90 Chronically Homeless Adults living with SPMI • Housing First Model • Field based • Located in Alameda County, California--Urban area nterdisciplinary Team of unlicensed Personal Service Coordinators, eer staff, Psychiatric Nurse Practitioner, Social Worker, Physician’s Assistant, Housing Manager, Employment Specialist, Financial and dministrative staff (16 Full-Time staff, 3 temporary contract admin. staff) • Major funding through Medicaid, Mental Health Services Act (flexible funding), Shelter Plus Care

Two very different approaches to Medicaid and OHC billing • Partnership with Lifelong Medical Care (Federally Qualified Health Care Center (FQHC) for 1 FTE Physician’s Assistant. Lifelong handles all billing functions. • Contract relationship with Alameda County Behavioral Health Care Services. Medicaid billing passes through County. HOST program essentially handles all billing functions.

Partnership with FQHC 1 FTE Physician’s Assistant for medical care All PA services are billed through Lifelong FQHC 35% offset to PA salary for HOST through revenue All visits are home visits and reimburse at one rate Lifelong has long hx. of providing Medical and C.M. Services and case management services (grounded billing and productivity expectations) • PA employee of FQHC=training and admin. support • • • • •

Contract relationship with County Behavioral Health Care Services • Total budget of HOST is $2.5 million per year • Total annual revenue expectations through billing Medicaid is $585,000 (start-up time to meet this) • All billing functions managed on-site by HOST • Pass through with County for Medicaid billing • Direct billing of Medicare and Other Health Care Coverage

Necessary resources for Contract relationship with County • 30 hours per month minimum staff time for billing functions (data input, billing reconciliation, Error corr.) • Utilization Review Function for quality of documentation • 8 hours per week of UR coordinator time • Daily quality review of documentation by supervisors within team meeting (all notes read every day) • Mental Health Services Act funding also folded into HOST budget—flexible funding for otherwise nonreimbursable services

Funding History Mid 90’s through 2008 - Case Rate (State General Fund Dollars) 2008 switch to Fee-for-Service Medicaid dollars Other funding from local grants and HUD SHP ongoing

Medicaid Reimbursed Services • Targeted Case Management (T1017 services) • Assessment, IPOS development, referral/CSM, follow-up/monitoring • Variable rate established by local CMHSP • Licensing requirements – QMHP or supervision

• Community Living Supports (H2015 services) • ADL assistance, medication management • Fixed Rate ($15.00/hr)

• Crisis Intervention (H2011 services) • Crisis Intervention • Variable rate established by local CMHSP • Licensing requirements QMHP or supervision

Medicaid Restrictions • Medicaid billing criteria • Medical Necessity • Face-to-face interactions • Must be documented and billed by encounter (15 min increments)

• Restricted Coverage: • • • •

Must have Medicaid Open and active cases with CSTS Stringent eligibility criteria: SPMI Primary substance abuse not covered

Infrastructure and Administrative Requirements • Agency Accreditation • Staff provider qualifications, training and supervision • Record keeping, billing and administrative requirements • Fee for service claiming and budgeting • Data collection and outcome reporting • Increased risk and liability • Relationship building

Catholic Social Services of Washtenaw County Program Director Janette Kawachi, Ph.D. [email protected] 734-663-4219 ext. 8

Medicaid and Other Health Care Coverage in Supportive Housing Presenter: Mark Shotwell C.A.T.C. Bonita House Inc. Alameda County, California

Bonita House Inc. • Located in Alameda County, California • Social Rehabilitation Agency providing Integrated Dual Diagnosis Treatment services to adults with CoOccurring Mental Health and Substance Use issues since 1971. • Core services funding through Alameda County Behavioral Health Care Services and reimbursable through Medicaid. • Housing funding through HUD (S+C, Section 202, Mckinney-Vento)

Homeless Outreach and Stabilization Team (HOST) HOST

• Assertive Community Treatment Team rget Population: 90 Chronically Homeless Adults living with SPMI • Housing First Model • Field based • Located in Alameda County, California--Urban area nterdisciplinary Team of unlicensed Personal Service Coordinators, eer staff, Psychiatric Nurse Practitioner, Social Worker, Physician’s Assistant, Housing Manager, Employment Specialist, Financial and dministrative staff (16 Full-Time staff, 3 temporary contract admin. staff) • Major funding through Medicaid, Mental Health Services Act (flexible funding), Shelter Plus Care

Two very different approaches to Medicaid and OHC billing • Partnership with Lifelong Medical Care (Federally Qualified Health Care Center (FQHC) for 1 FTE Physician’s Assistant. Lifelong handles all billing functions. • Contract relationship with Alameda County Behavioral Health Care Services. Medicaid billing passes through County. HOST program essentially handles all billing functions.

Partnership with FQHC 1 FTE Physician’s Assistant for medical care All PA services are billed through Lifelong FQHC 35% offset to PA salary for HOST through revenue All visits are home visits and reimburse at one rate Lifelong has long hx. of providing Medical and C.M. Services and case management services (grounded billing and productivity expectations) • PA employee of FQHC=training and admin. support • • • • •

Contract relationship with County Behavioral Health Care Services • Total budget of HOST is $2.5 million per year • Total annual revenue expectations through billing Medicaid is $585,000 (start-up time to meet this) • All billing functions managed on-site by HOST • Pass through with County for Medicaid billing • Direct billing of Medicare and Other Health Care Coverage

Necessary resources for Contract relationship with County • 30 hours per month minimum staff time for billing functions (data input, billing reconciliation, Error corr.) • Utilization Review Function for quality of documentation • 8 hours per week of UR coordinator time • Daily quality review of documentation by supervisors within team meeting (all notes read every day) • Mental Health Services Act funding also folded into HOST budget—flexible funding for otherwise nonreimbursable services