Amerigroup TN Partners in Progress TNCO Conference October 28, 2015
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
Amerigroup Panelists Dr. Jana Dreyzehner- BH Medical Director Jana.Dreyzehner@amerigroup.com Kimberly Weakley- RVP Provider Solutions Kimberly.Weakley@amerigroup.com Rachel Turner- Director of Special Programs, LTSS Rachel.Turner@amerigroup.com
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
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
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
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
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
ECF Provider Network Network Development & Training Network Adequacy ECF Preferred Providers Employment Focus
Amerigroup Provider Relations Provider Relations Representatives Recruitment Credentialing & Contracting Provider Orientation Issue Resolution Provider Satisfaction CMS HCBS Setting Rules Compliance
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
Your Reference Tools 12
I/DD Crisis Stabilization and Prevention Model of Support
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.
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
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
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