1. P0382 (09/09) Behavioral Health Integration Overview EDS Annual Workshop Hoosier Healthwise October 22, 2009

2. 2 Network Development MDwise has selected Behavioral Health Management, Inc. (BHMI), an Indiana based provider organization to develop the MDwise Behavioral Health Provider Network.  Provider contracting  Provider credentialing Effective October 2, 2009 MDwise Behavioral Health Network is closed.

3. 3 MDwise Delivery Systems MDwise utilizes a delivery system of care. MDwise members choose or are assigned to a Primary Medical Provider (PMP) in one of the MDwise networks or Delivery Systems (see quick contact sheet). For Behavioral Health, the MDwise Delivery Systems are responsible for:  Claims payment  Prior authorization of services  Case Management

4. 4 How to check eligibility The most accurate way to confirm eligibility is to use one of the EDS systems (e.g. Web InterChange, Omni, AVR) Before providing services, it is necessary to confirm:  Is the member eligible for services today?  In what IHCP (Indiana Health Care Program) are they enrolled? (Hoosier Healthwise, Medicaid Select, Traditional Medicaid, HIP or Presumptive Eligibility)  If the member is in Hoosier Healthwise, what MCO are they assigned? (MDwise, Anthem, MHS)  If the member is enrolled in Hoosier Healthwise, what services are they eligible to receive? (Package A, B, C or P) *  If the member is with MDwise, what Delivery System are they assigned to?  Does the member have primary health insurance other than Medicaid (frequently seen with Package B moms)? * Note: Package P does not include behavioral health

5. 5 Outpatient Treatment Form (OTR) Prior Authorizations and Claims Once you have determined what program the member is in and what MDwise Delivery System, use the Quick Reference Sheet to find:  Phone number & Fax number for prior authorization  Claims address or EDI number  Phone number & Fax number for Pharmacy prior authorization (PerformRx) (See Quick Reference Sheet) * This information can be found on the MDwise Web site at www.MDwise.org

6. 6 Integration Let’s talk about integration.

7. 7 Let’s Talk Integration Roger Kathol speaks of this situation as “Headless Health” Head: BH/SUD System Body: PH System Residential Inpatient Inpatient Rehab Partial Nursing Homes IOP OP OP Home Care There is no or very little communication between the head and the body!

8. 8 MDwise Integration Grant Project  When somebody tells you nothing is impossible, ask him to dribble a football. ~Author Unknown  In cooperation with OMPP, MDwise has sponsored a grant project to support integrated care  Grant projects are innovative and put the “head” back on healthcare

9. 9 Example -Midtown CMHC Medical Home Model  Members with mental illness will receive medical care where their medical home is the mental health setting  A physician and RN will be onsite at Midtown to provide for the medical needs of our members  Outcomes to be measured: access, ER use, member satisfaction, monitoring of metabolic issues  Outcomes of medical home model will be compared to non-medical home model

10. 10 Example -Gallahue/Community Family Residency Program  Increase collaboration between family medicine and behavioral health  Behavioral health will be integrated into the family practice residency program of Community Hospital  Will implement a more systematic approach that will include routine mental health screenings for all new contacts, provide counseling within the primary care site if a brief therapy model is appropriate, more complex cases will be referred to Gallahue providers who will maintain regular communication with the medical provider

11. 11 Integrated Care Means:  Local management of behavioral health services  Improved coordination and collaboration between medical and behavioral health providers ( A work in progress)  Utilization management and case management services are integrated at the delivery system level; medical and behavioral health managers work together to manage members’ needs

12. 12 Integrated Care Means:  Building a “right sized” network of skilled providers, statewide  All providers work from the same contract and fee schedule  Delivery Systems assume risk for their members

13. 13 Challenges Ahead Taking down the silos that keep medical and behavioral health services apart  Location  Funding and payment systems  Information Technology  Old paradigms  Communication

14. 14 Provider Information Contracting Credentialing BHMI 8604 N.Allisonville Rd. Ste. 325 Indianapolis, IN 46250 317-237-5770 or 866-323-3464 www.InteCare.org Provider Questions & Inquiries MDwise Provider Relations317-630-2831 or 800-356-1204 PA Forms, PDL Provider Manual, Newsletters, information MDwise web site Hoosier Healthwise www.MDwise.org PA Phone & Fax Claims Inquiry Numbers MDwise Delivery System Information See Quick Contact Sheet

15. 15 Important Claims Information Note: Claims submission for Hoosier Healthwise Behavioral Health date of services 1/1/2009 should be submitted to MDwise Delivery System (see quick reference sheet) Healthy Indiana Plan (HIP) Claims should go to: MDwise (HIP) P.O Box 33049 Indianapolis, Indiana 46203 Payor ID: MDWIS

16. 16 Behavioral Health Questions??