Coordination with MCOs A Regional Model * 07/16/96 Coordination with MCOs A Regional Model Panel Discussion with Members of the Houston-Galveston Area Regional CFC Focus Group *

Welcome and Introduction * 07/16/96 Welcome and Introduction Partners in the Houston-Galveston Area Regional CFC Focus Group: Gulf Coast Center, The Harris Center, Texana Center, Tri-County Behavioral Healthcare, Amerigroup, Molina, Superior & United Health Care Introduce Panel Members Session Purpose: To demonstrate how the Regional Focus Group developed Coordination with partnering MCOs Sheri *

Overview Implementation Structure Successes Challenges Model Summary * 07/16/96 Overview Implementation Structure Successes Challenges Model Summary Sheri *

* 07/16/96 Implementation Texana Center reached out to LIDDAs and MCO representatives in February 2015 Prepare for CFC Implementation Identify the players and roles Develop a common understanding of the information coming from the state Coordinate for the development of consistent practices within the region Sheri *

Structure Location: The Harris Center, central to the region * 07/16/96 Structure Location: The Harris Center, central to the region Frequency: Monthly, second Tuesday, 10-12 Participants: Authority Directors, CFC Managers, CFC Service Coordinators, MCO Directors, MCO LTC Supervisors, RN Case managers Sheri *

* 07/16/96 Successes CFC Implementation Process “Working the List” (March – June 2015) Exchanged information about the number of people on the list, number of people with DIDs, capacity of the Centers to address the list Identified contacts at LIDDA and MCO to address locating individuals, managing FTP site LIDDA Representatives: Kenyonika, Leigh *

Successes Collaborated for Regional CFC Training (June 2015) * 07/16/96 Successes Collaborated for Regional CFC Training (June 2015) Assessment Process Individual’s volunteered for onsite assessment MCO Representatives provided expert advice on how to ask questions, how to score responses, and common assessment situations Maribel, Caren Z. *

* 07/16/96 Successes Facilitated Access to Network of Providers with IDD expertise Provider Meetings following CFC meeting every other month Meet and greet for MCO representatives and Providers Panel of MCO representatives to explain contracting process Kenyonika, Caren, Michelle *

Successes Developed Forms and Processes necessary to CFC Operations * 07/16/96 Successes Developed Forms and Processes necessary to CFC Operations Notification of LIDDA Reassignment and LIDDA Actions (July 2015) – no issues LIDDA Contact Information Coversheet (September 2015) – model for DADS Contact Information Sheet and CFC Packet Checklist (December 2015) Maribel, Danny *

Successes Opportunity for LIDDAs to better understand the MCO world. * 07/16/96 Successes Opportunity for LIDDAs to better understand the MCO world. Opportunity for MCOs to better understand the LIDDA world. Learned internal processes Examples Caren, Michelle, Maribel, Danny *

* 07/16/96 Successes Identified CFC implementation issues and resolved through Focus Group discussions: Delayed MCO processes Timelines Lack of feedback or direction Lack of process consistencies Michelle, Maribel, Danny *

* 07/16/96 Successes Develop better understanding of the roles of the MCOs and LIDDAs. MCO Authorization LIDDA On-going Service Coordination Role of MCO & LIDDA in PDP process Outcomes Monitoring Progress Michelle, Caren, Danny, Maribel, Kenyonika *

* 07/16/96 Successes Continued effort to develop consistent CFC procedures for LIDDAs and MCOs (February 2016) Suspension of services to individuals due to loss of Medicaid eligibility Revisions to CFC Assessment (H6516) Withdrawal from CFC services Transition of service coordination from MCO to LIDDA Michelle, Maribel, Kenyonika, Danny *

Challenges Processes that require direction from state * 07/16/96 Challenges Processes that require direction from state Exchanging information – use of Form 2067 vs. use of spreadsheet in FTP site Provider choice Family refusal to agree to authorized amount Demographic changes Service Utilization Change in health status Caren, Leigh *

Challenges Processes that require direction from state * 07/16/96 Challenges Processes that require direction from state Communication with families Suspension/termination due to non-compliance Implementation plans Clarification of roles – who to contact for what Michelle, Maribel, Danny, Kenyonika *

Challenges Developing processes that will Increase enrollment numbers * 07/16/96 Challenges Developing processes that will Increase enrollment numbers Decrease time required for enrollment process Facilitate communication between LIDDA and MCO regarding active services Ensure timely renewal and updated ID/RCs Michelle, Caren, Maribel, Danny, Kenyonika *

* 07/16/96 Model Interest by state organizations for a similar regional model to be implemented in other areas of the state Suggestions for Implementation Lessons Learned Sheri *

* 07/16/96 Model Interest by state organizations for a similar regional model to be implemented in other areas of the state Senate Bill 7 IDD System Redesign - Subcommittee for Managed Care Texas Council and IDD Leadership HHSC and DADS Address Network Adequacy Sheri *

Model Suggestions for Implementation. * 07/16/96 Model Suggestions for Implementation. Designate responsible entities – Contact List, Agenda, Minutes, Liaison to Texas Council Erin Lawler, HHSC and DADS Set meeting date, time & location Meet monthly until membership agrees to alternate schedule Set Agenda: challenges/opportunities, procedures, action items Sheri *

* 07/16/96 Model Lessons Learned. Do have members with a working knowledge of the CFC processes Do respectfully bring issues to the table Do focus on work: make assignments, take action Do share experiences Do maintain confidentiality Caren, Michelle, Leigh *

* 07/16/96 Summary The Houston – Galveston Area Regional CFC Focus Group has been helpful to both LIDDAs and MCOs Future role for Regional Focus Groups Information and training to CFC providers Increasing the number of individuals receiving CFC services Questions Sheri, Leigh, Caren, Michelle *

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