PIHP Questions From
"Partnering for Success"
Annual Meeting 4/12/07

These are questions from our “Partnering for Success” Annual Meeting 4/12/07.  We have all of your responses from the guided questions section of this meeting as well.  We are using those responses as we go forward with implementation and thank you for your input in this process.  It is clear from those responses that our system has great strength to build on! The questions below represent about three quarters of all of the questions we captured at this meeting.  We are in the process of researching the others and plan to post those on this site as soon as possible.  Once again, thank you for your valuable input in this process and we look forward to your continued questions through the question/answer section of this web site.

Q1.   In other States what are some of the prevention components or dollars with ValueOptions?

A.          ValueOptions administers Medicaid fund allocations for a number of accounts nationwide. Generally, ValueOptions collaborates with the applicable State agency to determine the appropriate Medicaid reimbursement. ValueOptions has a Prevention Education and Outreach function in almost all State programs; collaborate with local consumer, advocacy and community agencies as well as other Departments and physical health care MCO’s and providers to advocate for preventative health practices.

Q2.  Will ValueOptions be offering IT support for the KCPC Program?

A.  ValueOptions will not provide IT support for the KCPC Program. Providers are encouraged to continue using the existing resources available by and through the KCPC Program.

Q3. Are there dollars available to Dr’s offices serving pregnant women who are using substance abuse; to do screenings assessments and brief interventions in office to identify these women for other treatment options?  

A.     This is currently not a covered service however, will be considered for the future.

Q4. Will Claims be submitted through existing KCPC?

A. Claims for dates of service prior to July 1, 2007 should be submitted per the current procedures in Kansas.  For example, to the claim address on the member’s Kansas Medicaid ID card or through the KCPC billing system depending on funding source of services.  Any questions regarding claims for these dates of service should be directed to the Kansas Medicaid customer service number listed on the member’s ID card or to the State for KCPC billing questions per the current process.  All claims for eligible Medicaid enrollees for services covered under the SA-PIHP with dates of service of July 1, 2007 or after that have already been pre authorized by the current vendor will be honored and paid by ValueOptions.  Claims for eligible Medicaid enrollees for services covered under the SA-PIHP for services rendered by participating ValueOptions providers with dates of service of July 1, 2007 and after should be submitted to ValueOptions [Luton, Julie] via www.valueoptions.com <http://www.valueoptions.com/> .  ValueOptions accepts electronically submitted claims generated from ValueOptions’ EDI Claims Link for Windows® software or from your Practice Management System. 

ValueOptions also offers a HIPAA-compliant Single Claim Submission process where individual CMS-1500 claims may be submitted through the internet.

 Please contact the EDI Help Desk at 1-888-247-9311 for assistance with your EDI or Single Claim Submission claim submission questions.

Those providers that are not able to submit electronically should send their claims to ValueOptions at:

P. O. Box 12698
Norfolk, VA  23502
ATTN: KS Claims

Q5. Currently youth are eligible (financially) for AAPS-funded treatment if the family has an income of 200% or less of FPG. Will this be continued? 

A.     The current guidelines for adolescent treatment services will not change at this time.

Q6.   What population will be served by the Valueoptions funding?

A.           ValueOptions will manage the Medicaid and Block Grant funded population.  ValueOptions will not be managing the following funding sources: SB 67, SB 123, or TAF at this time.

Q7.   What components make up the partnership?

A.             Legally, the partnership for the SA-PIHP is between the Department of Social and Rehabilitation Services and ValueOptions of Kansas.  However, philosophically and operationally, to be effective, the partnership must encompass the entire substance abuse community in Kansas:  consumers and their families; advocacy and professional organizations; network providers; AAPS and all Kansans who are concerned about assuring the quality and availability of  publicly funded substance abuse services.  The program design—including elements such as regional quality management committees and regional representatives—was created to encourage participation in the operation and evaluation of the program by representatives of all stakeholder groups.

Q8.    Will there continue to be a cap?

A.      Yes there will continue to be a cap for AAPS funded services at this time.

Q9.    Will ValueOptions recruit new providers for the Medicaid or Block Grant Program?

A.      As a matter of priority, AAPS would like ValueOptions to enroll all currently AAPS-funded and Medicaid-approved providers into the ValueOptions provider network as soon as possible prior to the 7/1/07 go-live date for managed care of the substance abuse treatment system in KS.  In addition, AAPS is directing Value Options to work with other providers who may currently be providing Medicaid-funded substance abuse services to facilitate their enrollment into the provider network as soon as possible, hopefully prior to the 7/1/07 go-live date.  Some providers will need to take the steps necessary to become Medicaid-approved through AAPS as they work on the VO credentialing process.  Providers in that group should contact Debbie Stidham at dsxs@srs.ks.gov in order to facilitate the Medicaid-approved provider process.

Q10. I currently am participating in the ValueOptions Commercial/Non-HMO Network; will I have to negotiate a separate contract and reimbursement rate for services?

A.      If you currently participate in the ValueOptions Commercial/Non-HMO Network you will not have to negotiate a new agreement with ValueOptions. ValueOptions will send participating and Medicaid certified Kansas providers an amendment that will add the Medicaid and/or Block Grant membership to your existing agreement. The amendment will include a new reimbursement schedule that will be applicable to Medicaid members only. Your existing Commercial/Non-HMO reimbursement rates will remain the same.

Q11. As a Medicaid provider will I automatically participate in the  ValueOptions Commercial/Non-HMO Network?

A.      As a part of this recruitment effort, ValueOptions is seeking to include AAPS funded and Medicaid approved providers in the PIHP Network and Commercial/Non-HMO Networks, respectively.

Clinical, Authorization and Quality Services

 
Q12.  Who will actually be performing utilization review? 

 A.          Valueoptions Care management staff

 
 Q13.  Will Social Detox still be able to admit on demand regardless of client income or residency?

A.        Yes it will be an on demand service

Q14. Will Valueoptions cover medications such as Anabuse, Vivatrol etc? How about lab work?

A:      These are not covered at this time

Q15.  How will use of new medications available to assist with early abstinence be factored into the new plan?

A.      These services are not included in the Valueoptions contract.

Q16.  What plans do you have to coordinate efforts with the department of corrections?

A.              ValueOptions has already had initial meetings with the DOC and expect to work closely with them to develop and integrate service delivery to optimize opportunities under each funding stream. 

Q17. Will Valueoptions manage non-Medicaid clients?

A.      Yes, those who are eligible for SAPT-funded services

Q18.  How will Valueoptions manage court coerced unmotivated clients?

A.           ASAM provides excellent guidance on the role of engagement and the stages of change as a part of evaluating criteria for treatment and services.

Q19.  Other than the KCPC for initial authorization how will providers be authorized for further services on consumers? What type of documentation will be submitted to Valueoptions?

A.      CSR (continued Stay Review) in the KCPC

Q20. How is medical necessity defined especially for outpatient?

A.       ASAM criteria will be used for all levels of care, Medical Necessity decisions will be driven by the ASMA criteria in the KCPC.

Q21. Will Valueoptions be coordinating with Kansas Health Solutions (PAHP for mental health) in providing integrated dual diagnosis treatment to consumers with Medicaid?

A.       Valueoptions is currently meeting with the state to discuss enhancing co-occurring disorder strategies with the mental health partners

Q22. Will continuing care or after care be paid for as step-down level of care?

A.      Yes, when authorized

Q23. Can you estimate the amount of administrative time for UR per client?

A.      We do not Estimate any dramatic increase in UR time as a result of this change

Q24. We provide long term reintegration treatment for women and women with children. Will a 6 month treatment program or long term treatment be affected?

A.           Services are authorized based on medical necessity driven by the ASAM

Q25. What can Valueoptions of Kansas do for our agency? Where do we fit in this system (halfway house?)

A.      We would have to understand more about your specific program however if you are currently a provider in the network we do not perceive your service is changing.

Q26. How did the agency reduce its 5 week waiting list for inpatient services with patients?

A.       By following the level of care criteria provided in ASAM, you can gain a lot of guidance on establishing a person’s current motivation for treatment and their readiness for change. By using the level of care criteria we are sure that members are placed in the appropriate level of treatment needed for their presenting conditions. ASAM gives guidance for the need for continued stay in treatment.  By working with providers Valueoptions will use ASAM to improve the clinical appropriateness of care and hopefully reduce waiting lists.

Q27. Is Valueoptions going to understand and utilize NIDA principles when considering authorizations for treatment services?

A.      Yes in as much as the American society of addiction medicine has integrated those principles into the ASAM level of care criteria.

Q28. Is there risk of denial/refusal of services to court ordered or coercion because of consumers’ lack of or low motivation?

A.      Yes if the member does not meet the ASAM criteria for the requested level of treatment.

Q29. Is there risk of denial/refusal based on number of treatment episodes?

A.      Yes if the member does not meet the ASAM criteria for the requested level of treatment.

Q30. How will Valueoptions want us to handle the chronic recidivism client?

A.            Valueoptions Typically establishes programs for high utilizers in order to address their specific needs and establish the best possible opportunities for long-term recovery.

Q31.  How will we have to handle discharges?

A.            Valueoptions does not perceive this will be a change from the current system

Q32. How will Valueoptions reconcile early intervention services with ASAM criteria for medical necessity?

A.           Through protocols established with the state

Q33. How will you provide 24 hour crisis services for substance abuse clients?

A.            Valueoptions will maintain a 24 hour access line.

Q34. If substance abuse agency has licensed clinicians for co-occurring disorders do you have to refer to the MH clinics or can agency provide and get paid?

A.           Valueoptions is currently meeting with the state to discuss enhancing co-occurring disorder strategies with the mental health partners

Q35. What are the minimum provider credentials?

A.       ValueOptions has established a specialized Agency Credentialing application tailored for the State of Kansas Provider network. Provider requirement are outlined in the Agency credentialing application.

Q36.           Treating co-occurring disorders is encouraged. However, how will it be determined who will pay for the service?

A.            ValueOptions and the State are in Discussions