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Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 1 Support for Friends and Family.

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Presentation on theme: "Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 1 Support for Friends and Family."— Presentation transcript:

1 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 1 Support for Friends and Family

2 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 2 Resources on Live and Work Well

3 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 3 Quick Links on Live and Work Well

4 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 4 Additional Quick Link Resources

5 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 5 Outcomes

6 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 6 The End Result Members who received Peer Coaching services:  Have a Significant Decrease in the number of behavioral health hospital admissions  Have a Significant Decrease in the number of behavioral health inpatient days  Have a Significant Increase in outpatient behavioral health visits  Have Significantly Decreased total behavioral health care costs

7 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 7 Evaluation of data The Recovery Community Services Program (RCSP) project funded through SAMHSA showed the following data from intake to six month follow up for recovery support services: 75% reported no substance use (increase of 19%) 96% reported no arrests at six month follow up 50% reported being employed (increase of 31%) 52% reported being housed (increase of 27%) Clients experiencing serious depression decreased 21% Clients experiencing serious anxiety decreased 21% Clients experiencing trouble understanding, concentrating or remembering decreased 26% Clients attempting suicide decreased 29%

8 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 8 Summary of Preliminary Utilization & Cost Findings 6 months pre-post, members who enroll in the program in New York and Wisconsin show: Significant Decreases in % who use inpatient services NY: 47.9% decrease (from 92.6% to 48.2%) WI: 38.6% decrease (from 71.5% to 43.9%) Significant Decreases in # of inpatient days NY: 62.5% decrease (from 11.2 days to 4.2) WI: 29.7% decrease (from 6.4 days to 4.5) Significant Increases in # of outpatient visits NY: 28.0% increase (from 8.5 visits to 11.8) WI: 22.9% increase (from 9.1 visits to 11.8) Significant Decreases in total BH costs NY: 47.1% decrease (from $9, to $5,291.59) WI: 24.3% decrease (from $7, to $5,716.31)

9 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 9 The Conclusion ► Peer support services are being recognized in a number of health and behavioral health environments. ► They are also implemented in criminal justice, adolescent services and HIV/AIDS. ► Prevention, intervention, treatment and recovery support services for substance use problems are highly effective and yield impressive savings to society. ► Outcomes for substance use treatment are as effective as outcomes for other chronic disease, i.e., hypertension, diabetes and asthma. (Briefing on Substance Use Treatment and Recovery in the U.S., Partners for Recovery)

10 Thank you.

11 Kelly Champ, Northeast Regional Vice President Optum Specialty Network Services January 30, 2015

12 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 12 The Chicken or The Egg  How do I get paid, or  How do I get in?  Who here is a Participating provider with Optum?  Who has Peer services they want to bring on board?  Who is looking to expand into Peer Services?

13 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 13 Reimbursement for Peer Support Services New York Historically, peer services were grant funded through NYS Peer services are now covered under the HARP benefit Home and Community Based Services waiver (formerly known as 1915i) Optum Effective 1/1/2015 peer services are a covered benefit for the New York Fully Integrated Dual Advantage Plans (FIDA) Optum is actively recruiting for peer support services through peer run entities and behavioral health provider groups that meet contracting and credentialing criteria

14 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 14 Submitting Claims for Peer Supports Similar to any other outpatient behavioral heath claim submission Coding to be used is: H0038 Self help/peer services Services are on a Per Unit basis, with a Unit being in 15 minute increments. Diagnosis code requirements: A valid behavioral health diagnosis must be included on the claim form (Source may vary based on Referral) Authorization by Optum Care Advocacy may be required

15 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 15 Submitting Claims for Peer Supports Providers may submit claims through: (Preferred) Clearinghouse –Provider can use vendor of choice –Optum Electronic Payor ID is CMS 1500 for paper claims –P.O. Box 30760,Salt Lake City, UT Claims must be submitted within 90 days of the date of service unless otherwise specified by contract Clean claims processed within contractual time guidelines/requirements

16 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 16 Peer Support Credentialing Process for Organizations: FYI Once potential organizations who employ Peer Support Specialists are identified, the Network Manager distributes the applicable application and supporting materials to the agency. The organization completes the application and supporting materials and submits them back to the Network Manager. Once the Network Manager receives the application and materials from the organization they submit a request to have a program audit conducted. All Peer Support organizations will need to pass a program audit prior to being credentialed. Once the audit of the organization has been completed, the Network Manager confirms the agency passed the audit and forwards the agency application and contract materials to the credentialing team for review and approval by the Credentialing Committee. The Credentialing Team Confirms all the Peer Support Specialists of the organization meet the certification, training, and credentialing criteria/requirements applicable to the state requirements, agency licensure type, accreditation, liability insurance, and is in good standing with applicable state and federal agencies Credentialing Committee for review and approval

17 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 17 Contracting and Credentialing for Peer Supports Training programs not on the approved list can be submitted for review but must be approved by Optum prior to credentialing or contracting the organization for peer support services If required by state regulation, peer support staff are supervised by an independently licensed mental health professional To provide peer support services, new providers must participate in a group contract; providers with existing contracts would require an addendum Rates for peer support services will be determined by the state and in accordance with your provider agreement

18 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 18 Contracting & Credentialing for Peer Supports State certification required, in states where it exists In states where certification is not required, the staff must have completed peer support training from an approved program and passed an exam The training program must be completed through any of the following approved programs which also must be approved by the applicable state office of mental/behavioral health –Appalachian Consulting –Depression and Bipolar Support Alliance –Recovery Innovations –Mental Health Association of Southeastern Pennsylvania –NAZCARE of Northern Arizona –The Connecticut Community for Addiction Recovery (CCAR) –Transformation Center –Mountain States

19 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 19 Peer Support Organization – Audit Process The Peer Support Program audit focuses on general agency policies, the specific supervision plan, hiring practices, and recordkeeping protocols (contact records) for peer support specialists The audit may be completed through a desktop review, or in the case of an unaccredited organization, may be completed on-site (audit team determines) The record keeping protocols include a review of: –Initial data gathering –Coordination of Care –Recovery Planning –Case Notes –Discharge Planning –General Record Development

20 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 20 Peer Support Organization - Audit Process Reviewing the Record Tool


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