1. Amerigroup TN Partners in Progress
TNCO Conference
October 28, 2015

2. Agenda Panel Introductions Managed Care in TN LTSS at Amerigroup
Employment & Community First (ECF) CHOICES update
Amerigroup Provider Relations
ECF Preferred Providers
Crisis Prevention strategies

3. Amerigroup Panelists
Dr. Jana Dreyzehner- BH Medical Director Kimberly Weakley- RVP Provider Solutions Rachel Turner- Director of Special Programs, LTSS

4. Managed Care in TN Transformation of Managed Care in TN
Key concepts for success in Managed Care
Transformation of Managed Care in TN
Expectations for Amerigroup:
Person-Centered
Quality Driven
Efficient
Effective

5. Amerigroup LTSS Philosophy and approach to LTSS
Success in coordinating supports for individuals in the CHOICES program
Integrated approach to providing LTSS
Profile of LTSS provider network

6. Employment & Community First (ECF) CHOICES
Tennessee proposes to become the first state in the country to develop and implement an HCBS program that is specifically geared toward promoting and supporting integrated, competitive employment and independent living as the first and preferred option for all individuals with intellectual and developmental disabilities: Employment and Community First CHOICES

7. Employment & Community First (ECF) CHOICES
Amendment 27 to TN’s Managed Care waiver
Amendment 3- Amending Amerigroup’s contract with the Bureau of TennCare to include ECF
Support Coordination
ECF Groups
Services
Employment

8. ECF Staffing Tina Brill- RVP LTSS
Rachel Turner- Director Special Programs, LTSS
Support Coordination
Employment Specialist
Housing Specialist
Provider Relations
Self Direction
Operations
Consultants & Subject Matter Experts

9. ECF Provider Network Network Development & Training Network Adequacy
ECF Preferred Providers
Employment Focus

10. Amerigroup Provider Relations
Provider Relations Representatives
Recruitment
Credentialing & Contracting
Provider Orientation
Issue Resolution
Provider Satisfaction
CMS HCBS Setting Rules Compliance

11. Provider Website
Providers can access the following services through providers.amerigroup.com:
Provider newsletters
Provider manuals
Provider directory
Panel listing
Announcements
Quick Reference Card
Online forms
Request precertification
File claims
Verify eligibility
Website registration
Join our network

12. Your Reference Tools 12

13. I/DD Crisis Stabilization and Prevention
Model of Support

14. Model of Support
A comprehensive, proactive, person-centered approach to the delivery of behavioral health crisis prevention and stabilization services - for individuals with IDD who experience challenging behaviors that place themselves and others at risk of harm.

15. Assessment/Planning/ Prevention
Person-centered assessment
Development of individualized Crisis Prevention and Intervention Plan (WRAP-like concept)—ongoing process
MOS Champion (the individual’s “subject matter expert”)
MOS Team
MOS Liaison (MCO Expert)
MOS and individualized crisis prevention/stabilization training with support from the Center for START Services

16. MOS Team MOS Champion MOS Liaison Family &Friends Medical
Person Supported
MOS Liaison
Family &Friends
Social Clubs
Church
Service Providers
Psychotherapy
Behavioral Therapy
Speech & Language
Physical therapy
Occupational therapy
MOS Champion
Medical
Primary Care
Psychiatry
Specialist
Community
Employers
Law enforcement
Schools
Crisis Team
Peer Support

17. Goals of the Model of Support
Person will achieve a higher degree of stability and community tenure
Support system will demonstrate effective and proactive management of the person’s daily living
Person will benefit from improved quality of life
Utilization of law enforcement, ER and inpatient hospitalization will decrease
Communities will gain increased experience and expertise