1. CFO Consortium Chief Financial Officers’ Consortium October 6, 2011

2. Readiness Guide
Managed Care
Early Childhood Intervention
1115 Waiver

3. Readiness Guide
Managed Care
Early Childhood Intervention
1115 Waiver

4. Healthcare Opportunities Workgroup
David Evans, Co-Chair
Susan Rushing, Co-Chair
Roddy Atkins
Carol Fontenot
Susan Garnett
Charlie Harris
Dr. Mark Janes
Veronica Sanchez
David Weden
Linda Werlein
Melissa Rowan
Established by the
Executive Directors’ Consortium

5. Guiding Principles for System Transformation
We serve a greater cause. Our primary responsibility is to ensure that specialized mental health/intellectual disability services and supports are available to those who need them. This is more important than any institution, tradition, or legacy role.
We welcome change. The changes underway provide an unprecedented opportunity to expand and improve care. We can play a key role in this transformation.
We build on success. If Community Centers are to be viable, we must deliver results within the resources available. We have a proven record of doing that in ways that meet local needs.
We enter a new arena. We must understand the larger healthcare environment and become valued partners within it.

6. Readiness Guide Core Areas
Learning Imperatives
Stakeholder Imperatives
Operational Imperatives
Financial Imperatives

7. What are the major changes impacting financial operations at Community Centers?

8. More Managed Care in 2011
HHSC
HMO
CENTER

9. Insurance Status in 2014

10. Even with strong economic growth,
the next Legislature will face significant budget challenges in 2013.

11. Financial Imperatives
Define True Costs of Services
Define Productivity
Define Required Reserves
Negotiate Reasonable Rates and Terms
Successfully Collect ALL Claims

12. Readiness Guide
Managed Care
Early Childhood Intervention
1115 Waiver

13. These things are happening
Program income will be from billing for services provided
State ECI office will give smaller grants
No reimbursement for uncollected billings
Services under managed care
Without proper management, these things could happen
Financial Deficits
Decreased staff and family satisfaction
Perception of lost culture or true lost culture

14. ECI: Children Enrolled in Managed Care
9/1/11
Therapists enroll independently as providers with TMHP.* MCO may require therapists to go through a credentialing process.
PT, OT, and ST evaluations are billed to MCO.
Nutrition, audiology and counseling services are billed to MCO.
TCM services are billed to TMHP.
SST services are reported in TKIDS and billed by DARS ECI.
Ongoing PT, OT and ST services are reported in TKIDS and billed by DARS ECI.
10/1/11
SST services are billed to THMP under same provider enrollment as ECI/TCM enrollment
Ongoing PT, OT and ST services are billed to THMP under same provider enrollment as ECI/TCM enrollment
3/1/12
March 1, 2012*NEW MCO areas and NEW MCOs
SST services are billed to THMP under same provider enrollment as ECI/TCM enrollment.
Ongoing PT, OT and ST services are billed to MCOs.
Source: DARS webinar, August 2011

15. Readiness Guide
Managed Care
Early Childhood Intervention
1115 Waiver

16. Medicaid 1115 Waiver Texas Healthcare Transformation and Quality Improvement Program
Statewide expansion of Medicaid managed care
Creation of Regional Healthcare Partnerships
Transition to quality-based payment systems for managed care and hospital
Pool to cover uncompensated care costs for hospitals and other providers

18. Resources HHSC Medicaid and CHIP Managed Care Services RFP
HHSC Managed Care Initiatives
HHSC Calendar of Client Education Sessions
Provider Training and Information
HHSC 1115 Waiver

19. Melissa Rowan
Healthcare Policy Director
Texas Council of Community Centers
ext 109
Texas Council Managed Care Webpage
For a user name and password contact:
Texas Council Healthcare Opportunities Workgroup Webpage