Editor’s Note: On December 7, Manatt Health and the Anthem Public Policy Institute co-hosted a new webinar examining the growing role of Medicaid managed care in addressing the social and economic challenges affecting health outcomes for patients with a mental health and/or substance use disorder (MH/SUD) diagnosis. We had so many excellent questions during the program that there wasn’t time to address them all. Below are a few that were asked by multiple participants along with the responses from our presenters.
If you or anyone on your team couldn’t participate in the session—or want to view it again—click here to access it free on demand. If you would like to download a free copy of the presentation for your continued reference, click here. ____________________________________
Question 1: How does payment work for social support connections?
Answer 1: In the past, TennCare had a mental health case management benefit which was focused on linkage to other services. This was a reimbursable service. However, there were no outcomes measures. TennCare has just implemented a Serious Mental Illness (SMI) model, focusing on care coordination, with quality metrics. The quality metrics will be reported and measured against standards. Health Home providers are paid on a case rate when a Health Home activity is rendered.
Question 2: Who pays for room and board services?
Answer 2: Room and board are usually covered by the member’s Social Security Income (SSI) check.
Question 3: How many dedicated case managers do the Managed Care Organizations (MCOs) have for social support connecting?
Answer 3: TennCare does not prescribe a set number of staff for MCO case managers, but they must have staffing to fulfill the population health requirements for outreach and care coordination at the MCO level.
Question 4: What tools are used to assess social needs? Are the tools the same for children and adults?
Answer 4: The Bureau of TennCare does not prescribe a tool and there isn't a statewide tool that is adopted by all providers. Some agencies use the Daily Living Activities (DLA-20) Functional Assessment, Child and Adolescent Needs and Strengths (CANS), Adult Needs and Strengths Assessment (ANSA) or home-grown tools. All of our providers use some type of tool.
Question 5: Is 42 CFR Part 2 (Patient Record Confidentiality Regulations) a barrier to sharing information between providers and MCOs in the TennCare program?
Answer 5: No, it is not a barrier. Our MCOs have individual professional contracts with behavioral health providers. All information is transmitted securely.
New White Paper Available
The webinar was based on a new white paper from the Anthem Public Policy Institute that explores the importance of Medicaid managed care in providing social supports to MH/SUD patients. The white paper is part of an Anthem Public Policy Institute series that looks at the approaches to and benefits of integrating physical health, mental health and substance use disorder benefits, as well as related areas of managed care innovation. To access the full white paper series, click here.