September 2021 Provider News - Special Edition (BH Providers)

Date: 09/23/21

In This Issue

HCA Fee Schedule - CCW Methodology: 2% BH Fee Schedule Update

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HCA Fee Schedule

2% Behavioral Health Rate Managed Care Increase

The 2021-2023 operating budget included a 2% increase for all services paid through the behavioral health portion of the Managed Care capitation rates (as referenced services defined in the State’s Medicaid State Plan and the managed care contracts). The rate increase is retroactively effective back to April 1, 2021.

This communication is intended to provide some additional context on the rate increase and alert Coordinated Care providers on what they can expect and when. The process may take some time, depending on a variety of factors, including the type of contract, provider type and system changes necessary to effectuate this change, both retrospectively and prospectively. We recognize these funds are critical, especially now during this workforce crisis so we are providing assurances that we will make all efforts to expedite payments beginning in October. There will be some differences in how other MCOs pass these funds on to you.

Retrospective Payments (April 1^st to September 30^th 2021)

Paid claims from Q1 2021 will be used as the baseline to determine the average quarterly payment rate to providers. The paid claims from Q1 will include 5 months of runout (at least). The claims will include all BH services including PACT, WISe, Crisis, and BH Enhancement funds. This will include both IMC and IFC lines of business. The baseline excludes low level BH provided by non BHAs (this is covered under the PH benefit), and out of state providers.
The average quarterly payment rate will be multiplied by 2%. Quarterly payments will be made for Q2 2021 and Q3 2021.
Coordinated Care will follow the definition Milliman provides for determining the BH expenses that fall under the BH benefit (vs. the PH benefit).
Manual payments will be generated and providers will receive money through an EFT exchange or by paper check. Claims will not be reprocessed.
Coordinated Care is waiting on the final specifications and rate certification in order to calculate the final amount due to each provider and which providers are due to receive the 2% increase. Once Coordinated Care receives the final specs and the financial reconciliation funds from the HCA through Q2, the payment process will begin.
Coordinated Care will generate Letters of Agreement (LOA) with the settlement amount for each provider. The LOAs can be generated electronically and sent via email. Providers will be required to electronically sign and return the LOA in order to receive payment.
This same process will occur again once Coordinated Care receives funds through Q3.

Prospective Payments (Timeframe: October 1^st 2021 and moving forward)

Coordinated Care will re-contract with BH providers in its network to increase rates on a go-forward basis. The new contracted rates will amount to a 2% increase to providers vs. what was paid in Q1 2021. Depending on the contract structure, the 2% increase may be applied to the base capitation amount, the % of premium, the invoiced amount, or the base fee schedule.
We anticipate new contracts for providers on some sort of capitation payment will be quicker to implement due to the nature of these contracts. Those providers paid on a fee schedule will likely take longer to complete. This could take several months for many providers.
For those that extend beyond 10/1, providers will be made whole with a retrospective payment process similar to that outlined above.

Note that there are additional Medicaid fee schedule increases launching on 10/1/21 for designated primary care and pediatric critical care services. These increases will be loaded in our clearinghouse on or around October 1^st (as soon as we receive the new fee schedules from the HCA) and systems will be configured to pay the updated amounts.

If you have questions, please reach out to Kate Mundell (Mary.Mundell@coordinatedcarehealth.com) and Jess Molberg (Jessica.L.Molberg@coordinatedcarehealth.com).