1. 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 *

2. 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 *

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

4. *
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 *

5. 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 *

6. *
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 *

7. 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. *

8. *
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 *

9. 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 *

10. 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 *

11. *
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 *

12. *
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 *

13. *
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 *

14. 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 *

15. 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 *

16. 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 *

17. *
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 *

18. *
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 *

19. 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 *

20. *
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 *

21. *
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 *

22. More information