A Season of Preparation

PAHP: Prepaid Ambulatory Health Plan for mental health services. SRS has contracted with Kansas Health Solutions (KHS), a CMHC-sponsored entity created to serve as the statewide managed care organization for mental health services.

Next steps for the PAHP work include:

• Obtaining CMS approval of the PAHP contract and related waiver changes. These items were submitted to CMS on March 1 ^st, with 45 days for the contract review and 90 days for the waiver review.
  
  
• Finalizing the PAHP’s per member per month (PMPM) rate – which will be based upon current utilization of mental health and behavioral management services – and finalizing the administrative cost plan, to be done in April.
  
  
• Finalizing the PAHP’s implementation plan, and monitoring it to completion, April through June. This includes preparation for activities such as utilization management including fraud and abuse, provider network training and management, and member services
  
  
• Comprehensive implementation readiness, including provider and staff training, member information, provider recruitment/credentialing, claims payment process development and testing, and access protocols. The PAHP has comprehensive implementation teams prepared and schedules developed; weekly implementation meetings are scheduled between SRS and the PAHP as well as the MMIS fiscal agent; and implementation plans are aligned to readiness in advance of the July 1^st implementation date.
  
  
• SRS staff have partnered with PAHP staff to hold numerous provider and stakeholder informational meetings, and have many more scheduled, in order to fully inform and help prepare all people involved in the public mental health treatment system for this transition.

Overall, in addition : SRS is preparing its own staff for readiness by training sessions (in person and web-based) for eligibility staff and program staff throughout the regions. Also, SRS has contracted with two consultants (one through a technical assistance arrangement with the National Association of State Mental Health Program Directors) to partner with SRS to conduct an EQRO-like readiness review both of SRS and of the PAHP, engaging providers, consumers and other stakeholders in the process. This is slated for late May and early June.

Collaboration with Kansas Health Policy Authority and the MMIS Fiscal Agent : Extensive work has been undertaken between SRS and KHPA/MMIS Fiscal Agent. Necessary system changes to conform to the state plan changes and 1915(b)/(c) waivers, for mental health, substance abuse, and PRTF services have been initiated and are well underway. In addition, representatives from the PAHP and PIHP have been designated to work with SRS and KHPA/Fiscal Agent staff to finalize the necessary system changes to support and smooth transition for all of these services effective with dates of service on July 1, 2007. The implementation timeline for these changes has been cooperatively developed between these organizations, being updated as the work phases arise and get completed for moving to the next stage. The most recently completed timeline for this focused work follows:

SRS staff continue to meet weekly (and sometimes several times per week) with KHPA and MMIS Fiscal Agent staff (most recently adding PAHP and PIHP staff into the discussions) to ensure that all implementation issues are identified, discussed, resolved and addressed timely.