Florida’s Child Welfare Prepaid Mental Health Plan

1. Florida’s Child Welfare Prepaid Mental Health Plan

2. Historical Context - Florida Statute 409.912.8 • FCC Behavioral Health Network Board was formed. Began work on a response to the Florida Agency for Health Care Administration RFP 0603 for a Child Welfare Prepaid Mental Health Plan (CWPMHP). • Through an ITN process, FCCBHN selected Magellan Behavioral Health of Florida, Inc. and a Memorandum of Agreement was set forth to establish roles and responsibilities within the partnership.

3. Historical Context • Partnership between CBC Lead Agencies and Magellan was formed • August 2006 the Florida AHCA announced its award of the CWPMHP to The Community Based Care Partnership, LTD • February 2007 the Child Welfare Prepaid Mental Health Plan will be implemented

4. The CBC Partnership LTD

5. Legal Structure

6. CBC Partnership • General Partners • CBC of Seminole is the general partner in the CBC Partnership and is the primary liaison/contract manager with AHCA and other CBCs • Magellan of Floridais the general partnerwho provides the financial resources to meet the capitalization requirements of AHCA, underwrites the financial risk and manages the day-to-day administrative services the program. • Limited Partners. • Multiple CBCs throughout Florida have entered into a contract with the CBC of Seminole County to carry out the operational requirements of the ACHA contract at the local level

7. Shared Governance • Operating Committee with 50% participation by CBCs and Magellan • Approve provider network, rates, & methodology • Approve clinical policy including medical necessity criteria and work flows • Receive and utilize QI and community stakeholder input in program re-design

8. PartnershipStaff • Employed by the Florida Coalition for Children • Project Director • Specialized Therapeutic Foster Care Coordinator • Therapeutic Group Care Coordinator

9. Magellan Behavioral Health Services of Florida, Inc. • Magellan Behavioral Health of Florida, Inc. (Magellan) was established in 2004 as a Florida corporation dedicated to providing managed behavioral health services to Florida’s Medicaid eligible populations. • Magellan Staff • Sr. Account Executive • Customer Service Associates • Care Managers • QI Staf

10. Features of the Program • Covers Medicaid eligible children enrolled in HomeSafeNet throughout Florida (excludes Areas 1 & 6) • Does NOT cover parents • Does NOT cover Medically Needy (“spend-down”) population • There is NO retroactive eligibility for this program

11. Features of the Program • Covers allowable Medicaid services as described in the AHCA Handbook with the addition of new services as included in the Proposal to AHCA • Does NOT cover services prior to enrollment in HomeSafeNet • Recipients may access any provider in the contracted network (No wrong door)

12. Magellan’s Role • Assuring Medically Necessary Services are delivered • Definition of Medical Necessity (AHCA) • Community Behavioral Health Services Coverage and Limitations Handbook • Medical Necessity Criteria by Level of Care • Authorizations and Concurrent Review

13. Care Management - Authorizations • No prior authorizations for traditional outpatient services • Initial authorizations for other services completed by Magellan through consultation with CBC “Point of Contact” • Concurrent review by Magellan in consultation with the CBC and the providers

14. CBC ROLE • Provide first line of review for eligibility criteria to avoid delays in authorizations • Serve as link between provider and Magellan to ensure Child Welfare children receive appropriate and necessary services • Continue to provide Single Point of Access (SPOA) functions for Comprehensive Behavioral Assessments, and packet preparation for STFC, TGC and SIPP • Partnership and Magellan can provide enhanced provider accountability, supported by clear communication regarding practiceexpectations and performance feedback, leads to continuous improvement in the processes and outcomes of care delivery.

15. CBC ROLE (Continued) • Serve as link with SAMH office for prioritizing admissions to STGC and SIPP • Communicate with providers and assist with training of provider staff • Review provider trends in service delivery for quality improvement and service management

16. “Point of Contact” Role • Single Point of contact with Magellan for STFC & STGC & other services Requiring Authorization • Lead MDT/Review process within the CBC • SPOA for referrals and review of CBHA • Lead renewal and discharge planning processes for STFC and STGC

17. Family Support Services of North Florida’s Point of Contact • Laura M. Beyrle, BA • Family Support Services of North Florida • 4057 Carmichael Avenue • 3000 Building, Ste. 101 • Jacksonville, FL 32207 • Ph: (904) 421-5820 Fax: (904) 421-5801 • Email: laura.beyrle@fssnf.org • *Currently hiring UM Manager who will serve as backup contact person

18. Family Support Services of North FloridaAuthorization Process • STFC and STGC • Family Support Services (FSS) will hold MDT staffings for each child requesting initial and reauthorization for services • FSS will schedule MDT staffings on Friday’s at 9:00 am. The location of these meetings will vary • The MDT staffing schedule will be forwarded in advance to all parties (Providers, TCM, Foster Parents, etc) • FSS will contact Magellan directly for authorization of services based on the treatment team discussion at the child’s MDT Staffing

19. Family Support Services of North FloridaReferral Process • CBHA • FSS will complete CBHA Referral Form for children requiring out-of-home care and placed in shelter status • FSS will ensure Medicaid is active and forward referral form to CBHA provider agencies on a rotating basis • CBHA provider agencies will return quality reviewed CBHA’s to FSS no later than 24 calendar days from referral date • Magellan is responsible for CBHA provider certification and reimbursement

20. Transition Plan

21. Transition Timeline

22. Q & A