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November 2011 October 20, 2011 Chris Spanos1. Health & Human Service Programs October 20, 2011 Chris Spanos2.

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Presentation on theme: "November 2011 October 20, 2011 Chris Spanos1. Health & Human Service Programs October 20, 2011 Chris Spanos2."— Presentation transcript:

1 November 2011 October 20, 2011 Chris Spanos1

2 Health & Human Service Programs October 20, 2011 Chris Spanos2

3  State moving to a managed care model for: ◦ Delivery of Medicaid Services ◦ Delivery of Comprehensive Services Act services October 20, 2011 Chris Spanos3

4 State Medicaid FundingLocal Responsibility  Behavioral Health Care  Local Social Services  Comprehensive Services Act (CSA)  Community Services Boards October 20, 2011 Chris Spanos4

5  Who will be affected: ◦ Individuals eligible to receive Medicaid services  Persons needing Behavioral Health care  Foster Care children and their families  Others covered by the CSA  What Local Agencies will be effected: ◦ Community Services Board Delivery of Services ◦ Local Social Services Delivery of Services ◦ Local Comprehensive Services Act (CSA) program October 20, 2011 Chris Spanos5

6 Local – State - Federal Funding Local - State – Federal Funding  Local Social Services Child Welfare Programs o Foster Care Program  CSA Program Foster Care Children Children with an IEP Children under Juvenile Justice court order October 20, 2011  Local Community Services Board (CSB) Services provided by the local Community Services Boards using Medicaid funding  Private Providers All fee-for-service providers, providing Behavioral Health Care Services, will go to rate setting Chris Spanos6

7 Virginia Medicaid Program October 20, 2011 Chris Spanos7

8  Use a “Risk Model” for the provision of publically funded behavioral health care funded by the Virginia Department of Medical Services (DMAS)  Currently Virginia Medicaid uses a fee-for- service model for Behavioral Health services out side of the Medicaid CO enrollees. October 20, 2011 Chris Spanos8

9  Behavioral Health Services ◦ Move from a fee-for-service model to a Care Coordination model Under a single Contractor ◦ Fee-For-Service enrollees will receive Behavioral Health Services under a Care Coordination Contractor  Beginning July 1, 2012,  Contractor: ASO (Administrative Services Only model)  Move to a Risk Model in third year October 20, 2011 Chris Spanos9

10  Medicaid/FAMIS/FAMIS Plus members who are in FFS (Fee-for-Service) receive and who receive traditional and non-traditional mental health and substance abuse treatment services from the FFS system will be the responsibility of the BHSA (Behavioral Health Services Administrator). DMAS will continue to be responsible for pharmacy services for these members. October 20, 2011 Chris Spanos10

11  Medicaid/FAMIS/FAMIS Plus member who are enrolled in a Managed Care Organization (MCO) will continue to receive traditional mental health services and pharmacy from the MCO. Non traditional mental health and substance abuse treatment services will be the responsibility of the BHSA. October 20, 2011 Chris Spanos11

12  Anticipated: ◦ Non Risk Administrative Services Only (ASO) Contact for two years ◦ Third Year move to a full risk model ◦ (explain risk model and what it means to local government) October 20, 2011 Chris Spanos12

13 Comprehensive Services Act October 20, 2011 Chris Spanos13

14  Medicaid Funding of CSA Services ◦ CSA Pool funded services by Medicaid  CSA is the only Medicaid for which Local Government pay a match on Medicaid services October 20, 2011 Chris Spanos14

15 Of a Care Coordination Model for Delivery of Behavioral Health Care Services October 20, 2011 Chris Spanos15

16 Local ProgramKey Dates  Medicaid ◦ Behavioral Health Care Coordination  Fee-for-Services is moved to Contractor managed program  November 2011 ◦ RFP Released  January 2012 ◦ Contractor Chosen  July 2012 ◦ Care Coordination model implemented through a Contractor October 20, 2011 Chris Spanos16

17 Local ProgramKey Dates  Comprehensive Services (CSA) ◦ Care Coordination Model  Local CSA services  December 2011 ◦ Government presents Executive Budget to the General Assembly  January to March 2012 ◦ General Assembly considers the Governor’s recommendation for a Care Coordination model  July 2012 ◦ implemented through a Contractor October 20, 2011 Chris Spanos17

18 Local Elected Officials October 20, 2011 Chris Spanos18

19  Who will pay for services if a judge orders a specific service or provider not covered/recognized by the care coordination provider?  Will all community-based services under CSA be covered under a care coordination contract, whether or not the children or families are Medicaid-eligible?  How does utilization review mesh with care coordination? Will there be more than one hoop to jump through? October 20, 2011 Chris Spanos19

20  What about crisis stabilization or emergency placements? Will a care coordinator have to approve services before they are rendered? What about weekends and holidays?  How will care coordination affect the FAPT process and workload?  How will disagreements between a local government and the care coordination provider be handled? October 20, 2011 Chris Spanos20

21  How will care coordination affect the workload and administrative burden on CSA coordination's?  Will this diminish the array of community-based services allowed for under CSA?  Will this affect early intervention/prevention (i.e., less intensive) services used to prevent higher end placements under CSA? October 20, 2011 Chris Spanos21

22  Will this affect local government’s funding of CSA?  Will this affect the sum-sufficiency of the program?  Who will pay for this contract? October 20, 2011 Chris Spanos22

23 Involved October 20, 2011 Chris Spanos23

24  Medicaid Enrollee Services ◦ VA Department of Medical Assistance Services ◦ VA Department of Social Services  Local Social Services Departments ◦ VA Department of Behavioral Health & Development Disabilities  Community Service Boards October 20, 2011 Chris Spanos24

25 Comprehensive Services Program ◦ Office of Comprehensive Services ◦ Supreme Court of Virginia  Executive Secretary ◦ VA Department of Social Services  State Department Central Office  Local Departments of Social Services ◦ VA Department of Education  Local School Divisions ◦ VA Department of Juvenile Justice  Court Services Units ◦ VA Department of Medical Assistance Services ◦ VA Department of Health October 20, 2011 Chris Spanos25

26 Comprehensive Services Act for At-Risk Families & Children October 20, 2011 Chris Spanos26

27 LocalityRegional  Governing Body ◦ Chief Administrator ◦ Fiscal Agent ◦ CPMT Chair/FAPT ◦ CSA Coordinator  Board/Dept of Social Services  Community Services Board ◦ single jurisdiction  Court Services Unit Dept of Juvenile Justice ◦ Single jurisdiction  School Division ◦ School Board ◦ School Superintendent  Community Services Board ◦ multi-jurisdictional  Court Service Unit Dept of Juvenile Justice  Dept of Health ◦ multi-jurisdictional  Board/Dept of Social Services ◦ multi-jurisdictional October 20, 2011 Chris Spanos27

28 Local Government County Representative on SEC Local Government Cities Representative on SEC ◦ Sherrin C. Alsop Member, King and Queen County Board of Supervisors 13325 Newtown Road Newtown, VA 23126 804 296-6804 salsop@kingandqueenco.net July 1, 2009 – June 30, 2012 salsop@kingandqueenco.net ◦ Joseph Paxton Rockingham County Administrator Rockingham County Administration Center 20 East Gay Street Harrisonburg, VA 22802 540 564-3011 jpaxton@rockinghamcountyva.gov July 1, 2009 – June 30, 2012 jpaxton@rockinghamcountyva.gov ◦ Mary Bunting City Manager City of Hampton 22 Lincoln Street 8th Floor, City Hall Hampton, VA 23669 757 727-6392 757 728-3037 – Fax mbunting@hampton.gov July 1, 2009 – June 30, 2012 mbunting@hampton.gov October 20, 2011 Chris Spanos28

29 VACOVML  Virginia Association of Counties ◦ B.R. "Beau" Blevins, III Government Relations Liaison (education, health and human services) 804-343-2503 bblevins@vaco.org  Virginia Municipal League ◦ Janet Areson, Janet Areson, ◦ Director of Policy Development 804-523-8522 jareson@vml.org October 20, 2011 Chris Spanos29

30 ◦ Chris Spanos Christopher J. Spanos Legislative & Pubic Affairs Counselor Virginia League of Social Services Executives ◦ Spanos Consulting Group LLC 707 Keats Road, Richmond, Virginia 23229 Telephone Direct Dial (804) 282-0278 E-mail ChrisSpanos@SpanosConsulting.com October 20, 2011 Chris Spanos30


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