Thanks to Rebekah James for this report. She offers a good perspective with the following experience:
- Member of Medicaid Saves Lives
- Member of Therapy Workgroup
- Owner/Executive Director of Arkansas Therapy Outreach
- Practicing Speech-Language Pathologist
The BH-DD Provider-Led Coalition group is organized primarily of mental, behavioral and substance abuse treatment provider associations along with the Developmental Disabilities Provider Association (DDPA). The meeting was aimed at forming a committee and several subcommittees to focus the group’s work towards forming a provider-led managed care model by beginning work on the “BH-DD Provider-Owned Arkansas Shared-Savings Entity” (a PASSE). Colorado (Beacon) and Indiana (Anthem) are other states being reviewed for their implementation of a provider-led or hybrid managed care model. A traditional model is not preferred by any known providers, and this group is formed by those in support of the hybrid model.
At this time, tier 1 which is loosely termed to include most therapy services for those who do not meet the waiver (Tier 2) or institutional level of care (Tier 3) criteria are not grouped with the current provider-led managed care as discussed by DHS. With a reduced need to coordinate complex medical care, the Tier 1 population savings are intended to have been met in part through the therapy threshold and prior authorization system to provide the necessary level of therapy care while contributing to the requirement to balance an overall budget. The “soft therapy cap” as some refer to it is still planned to be implemented on July 1, 2017 assuming there are no issues with the RFP or contract to place the vendor for the prior authorization piece. Additionally, the Tier 1 behavioral health population is not expected to be included in the managed care model being discussed. DHS has proposed excluding tier one for both BH and DD populations and suggested their care would be managed by the Patient Centered Medical Homes. The group that met today is seeking more data from DHS to assist in developing a more accurate population criteria for Tiers 1, 2, and 3.
**This is my understanding from discussions, observations and notes provided during the meeting.