PIHP Implementation Readiness
March through June, 2007

Go to Implementation Key Responsibilities
Go to Questions and Answers on PIHP
PIHP Questions From "Partnering for Success" Annual Meeting 4/12/07
Service Transition Plan for Existing Substance Abuse Clients
Invitation to June 14 Provider Forum

A Season of Preparation

PIHP: Prepaid Inpatient Health Plan for substance abuse services. SRS is contracting with Value Options (VO), one of the nation’s largest behavioral health care companies, serving over 24 million people across the country through publicly funded and commercial contracts with a wide variety of managed behavioral healthcare services. SRS will leverage the extensive experience of VO to successfully serve as the statewide managed care organization for both Medicaid and federal SAPT block grant-funded substance abuse services. Next steps for the PIHP work include:

• Submitting the final contract with Value Options of Kansas, together with the actuarial certification and SRS’s PIHP Quality Improvement Strategy to CMS for final review and approval. This will be done by the end of March, and CMS will have 45 days for the review process (they already approved the request for proposals as a model contract for PIHP services).
  
  
• Finalizing the PIHP’s implementation plan (by the end of March), 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 PIHP has comprehensive implementation teams prepared and schedules developed; weekly implementation meetings are scheduled between SRS and the PIHP 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 will partner with the PIHP to hold numerous provider and stakeholder informational meetings, including an all-day focused stakeholder conference, in order to fully inform and help prepare all people involved in the substance abuse treatment system.

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.

Value Options Implementation Plan : SRS is working closely with Value Options to finalize and implement their operational readiness plan as well. A copy of their current plan is likewise being posted to this site.

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: