Amerigroup Washington Foundational Community Supports Third Party Administrator

Amerigroup Washington Foundational Community Supports Third Party Administrator

Foundational Community Supports (FCS) 2 What it isn’t • Targeted Medicaid benefits that help eligible clients with complex health needs obtain and maintain housing and employment stability. • Supportive Housing services • Supported Employment services • Ongoing payments for housing, rent, or room & board costs • Wages or wage enhancements for clients • Entitlement

Who are the FCS partners? Funding Program oversight Benefits administrator Medicaid • Funds FCS benefits through Healthier WA Medicaid Transformation HCA 1 • • Receives funding from Medicaid Holds contract with Amerigroup TPA DBHR 2 & ALTSA 3 • Support network development and provider engagement Amerigroup (TPA) • 1. 2. 3. • • • FCS Providers Provides administrative oversight of: Communitybased organizations (social services) Health Care Authority Division of Behavioral Health & Recovery Aging and Long-term Support Administration Health care providers • Provider network Service authorization Claims payment and encounter tracking/reporting Measuring outcomes and quality improvement Sustainability plan FCS Advisory Council Community behavioral health agencies Long-term services & supports providers Tribal providers Data

What benefits are available through FCS? Supported employment helps you find the right work, right now Ø Employment assessments and planning to find the right job for you, whenever you’re ready Ø Outreach to employers to help build your network Ø Connection with community resources to get you all of the help you need, when you need it Ø Assistance with job applications so you can present your best self to employers Ø Education, training and coach to keep you in your job 4

What benefits are available through FCS? Supportive housing helps you find a home or stay in your home Ø Housing assessments and planning to find the home that’s right for you Ø Outreach to landlords to identify available housing in your community Ø Connection with community resources to get you all of the help you need, when you need it Ø Assistance with housing applications so you are accepted the first time Ø Education, training and coaching to resolve disputes, advocate for your needs and keep you in your home 5

Who is eligible to receive FCS benefits? FCS benefits are reserved for people with the greatest need. To qualify, you must: 1 Qualify for Medicaid 2 Meet the requirements for complex needs • • 3 6 You have a medical necessity related to mental health, substance use disorder (SUD), activities of daily living, or complex physical health need(s) that prevents you from functioning successfully or living independently. You meet specific risk factors that prevent you from finding or keeping a job or a safe home. Be at least 18 years old (Supportive Housing) or 16 years old (Supported Employment)

Who is eligible to receive FCS benefits? Supportive Housing risk factors ✓Frequent or lengthy homelessness ✓Frequent or lengthy stays in an Supported Employment risk factors ✓Housing & Essential Needs (HEN) and Aged Blind or Disabled (ABD) enrollees institutional setting (e. g. skilled nursing, inpatient hospital, psychiatric institution, prison or jail) ✓Difficulty obtaining or maintaining settings ✓SUD with a history of multiple ✓Frequent stays in adult residential care employment due to age, physical or mental impairment, or traumatic brain injury ✓Frequent turnover of in-home caregivers treatments ✓Predictive Risk Intelligence System ✓Diagnosed mental health or SUD (PRISM)1 score of 1. 5 or above requiring continued treatment 1. PRISM measures how much you use medical, social service, behavioral health and long-term care services. 7

Amerigroup as the FCS TPA We’re contracted with the HCA as the Third Party Administrator (TPA) of FCS and provide administrative oversight of: Ø Provider Network Ø Service Authorization Overview of FCS Ø Claims payment and encounter tracking/reporting Ø Measuring outcomes and quality improvement Ø Sustainability Plan 8

Enrollee Count We currently have 3, 356 people enrolled in the FCS program * Data as of February 27, 2019 9

Provider Network A FCS Provider Network has been built across Washington state * Data as of February 27, 2019 10

Referrals Anyone can refer a potential enrollee to the FCS program Ø Ø Ø Potential Enrollee Family member Provider Aging and Long-term Support Administration (ALTSA) Division of Behavioral Health & Recover (DBHR) Quick Reference Guide is a tool to quickly evaluate if a potential enrollee may be eligible for Supportive Housing and/or Supported Employment services. The Quick Reference Guide can be downloaded at the FCS provider website. FCS Referral Form can be downloaded from the FCS provider website to refer a potential enrollee to the FCS program. 11

Referrals Amerigroup Self referral: Contact Amerigroup directly Your provider submits a referral form to Amerigroup Referral Assignment Talk to your service provider Eligibility Determination N Does this provider already offer FCS services through Amerigroup? Y Your FCS provider completes an assessment to determine your eligibility Service Authorization

FCS Service Reimbursement Supported Employment Benefit 13 Supportive Housing Benefit § 1 unit = 15 minutes of service § Per diem rate § Limit of 120 units (30 hours) of service per 6 month authorization period § Limit of 30 days of service per 6 month authorization period § Reimbursement rate of $25/unit of service § Reimbursement rate of $105/day § Services may be reauthorized if a participant continues to need services § “Exception to Rule” authorization process is available for additional service units within a 6 month period for participants who have exceptional service needs

Annual FCS Service Reimbursement Projection Ø Supportive housing services delivered with a 1: 20 caseload ratio*: (20 FCS participants) x (2 authorization periods) x (30 days of service) x ($105/day) = $126, 000 Ø Supported employment services delivered with a 1: 20 caseload ratio*: (20 FCS participants) x (2 authorization periods) x (120 service units) x ($25/unit) = $120, 000 *The recommended FCS caseload is 15 – 20 participants per service provider; this is not a contractual requirement. 14

Expanding Provider Network Providers interested in joining the provider network must have: Ø Tax ID Ø Medicaid ID Ø National Provider Identifier (NPI) To learn more about becoming a contracted FCS provider, contact us at FCSTPA@Amerigroup. com or 844 -451 -2828. 15

Advisory Council An FCS Advisory Council has been established as a mechanism to incorporate client voice into services, processes, and outcomes Ø Ø Enrollees Providers Stakeholders Advocates across Washington Email FCSTPA@Amerigroup. com if you’re interested in joining the Advisory Council. 16

Technical Assistance, Training + Support ALTSA DBHR State Supportive Housing Agency 17 Supported Employment Eastern WA: Amanda Polley 360 -522 -3547 Amanda. Polley@hca. wa. gov Eastern WA: Dawn Miller 360 -522 -3544 Dawn. Miller@hca. wa. gov Western WA: Kimberly Castle 360 -522 -6570 Kimberly. Castle@hca. wa. gov Western WA: Lisa Bennett-Perry 360 -725 -3257 lisa. bennett-perry@hca. wa. gov Region 1: Ian Harpole 509 -568 -3876 harpol@dshs. wa. gov Region 1: Jim Bischoff 509 -585 -8075 Bischj@dshs. wa. gov Region 2: Whitney Joy Howard 360 -791 - 2358 Howar. WJ@dshs. wa. gov Region 2: Krystal Baumann 360 -522 -2363 Smithka 1@dshs. wa. gov Region 3: John Kistner 360 -725 -3409 Kistn. J@dshs. wa. gov Region 3: Vicki Gilleg 360 -870 -4918 Gillev@dshs. wa. gov

FCS Websites + Provider Manual FCS Resources available at your finger tips Ø Amerigroup FCS Provider Website: https: //providers. amerigroup. com/pages/wafoundational-community-supports. aspx Ø Provider Manual Ø Referral + Assessment Forms Ø Quick Reference Guide Ø FCS Provider Resource Guide: https: //www. hca. wa. gov/assets/program/FCS-provider-resource-guide. pdf Ø Amerigroup FCS Client Website: https: //www. myamerigroup. com/washington-fcs/home. html 18

We’re here for you FCS Managers: Amerigroup Washington, Inc. Third Party Administrator FCSTPA@Amerigroup. com Phone: 844. 451. 2828 Fax: 844. 470. 8859 Jacob Avery Jacob. Avery@amerigorup. com C: 206. 718. 5083 Joe Elder Joe. Elder@Amerigroup. com C: 206. 247. 9230 Leeza Lorence Leeza. Lorence@amerigroup. com C: 206. 496. 3517