October 22, 2018

Behavioral Health IMC Update (October)

Diane Halo, Project Manager for IMC

The Health Care Authority sent a letter to consumers at the end of September to advise them that as of January 1, 2019, Apple Health is shifting to whole-person care. This means care is coordinated so that people get the help they need, for physical and behavioral health (mental health and substance use disorder treatment).  The plans in this area are Molina, Community Health Plan of Washington, Coordinated Care, and Amerigroup.  The change will be automatic so that no one loses coverage. United Healthcare will no longer be available in this area.  Clients enrolled in United Healthcare will be switched to one of the four available plans and a notification will be sent out on November 20, 2018 informing members of this change. Members will have the option to change their plan to one in that is provided in our area.  If they don’t select a plan they will be automatically enrolled into a plan, which they can change at any time to one of the four plans available.  The next notification letter will be sent out late November/early December.

The Integrated Managed Care (IMC) Communications Workgroup met on October 9, 2018.  We finalized some documents for the providers to have in their offices to help with questions from the clients about the changes coming January 1, 2019.  These documents are available on our website to help providers with questions they may get from their clients.  Also, we discussed strategies for getting this information out to the community which may include radio, social media, and newspaper press releases. The next IMC Communications Workgroup will be November 13, 2018.

The Early Warning System (EWS) Workgroup met on October 9, 2018.  The purpose of the EWS is to address immediate issues that are arising from the transition to integrated managed care.  The EWS is both a data measurement and a regular communications process. At the October 9th meeting we discussed the indicators for the Greater Columbia Region when IMC is implemented.  Some of the Indicators include:  behavioral health claims status, top 5 reasons a BH claim or encounter is rejected and sent back to the provider, ED utilization, crisis hotline incoming calls, calls answered, and calls answered within 30 seconds, Designated Crisis Responder (DCR) response times, involuntary treatment act investigations, and more.  The next EWS Workgroup will be November 13, 2018.

The Provider Readiness Workgroup meeting on October 4th was cancelled because HCA had a Webinar about the SERI Guide on October 5th from 1-2:30 pm.   The next Provider Readiness Meeting will be October 18, 2018.  Amerigroup, Community Health Plan of Washington, Coordinated Care and Molina Healthcare are hosting a symposium for Behavioral Health Providers on October 22nd (Yakima), October 23rd (Tri-Cities) and October 24th (Walla Walla).  The purpose of the Symposium is to provide detailed instruction on the clinical and operational requirements and processes for providers in Greater Columbia in making the change to Integrated Managed Care, which has a go live date of January 1, 2019.  It is very important that the individuals that perform the operational and clinical work for your organization attend the symposium.