Greetings Medicaid Providers,
The Division of Behavioral Health (DBH) has been working hard the last two months since announcing two large efforts of moving the Behavioral Health Medicaid claims to the MMIS as well as developing our Request for Proposal (RFP) for a Behavioral Health Organization. We want to provide an update on the current status of these initiatives.
Behavioral Health Medicaid Claims Transition
DBH has been working to transition the Medicaid claims processing duties back to Health Care Services’ (HCS) claims processor/fiscal agent and align all Medicaid claims back under one platform (MMIS). Extensive scoping and alignment have taken place between both agencies to ensure a successful transition.
The project vision goals are as follows:
- Reduce administrative burden for provider and DBH staff
- Improve claim processing and user support
- Reduce claim processing delays
- Improve provider performance
- Leverage existing State processes and vendors
Activities and Milestones:
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Discovery and Lessons Learned Sessions: Conducted multiple meetings internally and with our technical assistance vendor to identify the key goals and objectives, scoped transition duties, developed projected timeline and key milestones, and discussed lessons learned from prior transition activities.
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Key Vendor Activities: Multiple meetings have occurred with the MMIS vendor, fiscal agent and Optum. Meetings will continue to occur to identify dependencies, timelines and transition duties.
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Considerations: Identified and scoped critical conversion components and considerations. Examples include (but are not limited to):
- Claims clean up and runout activities
- Service Authorization conversion and continuation
- Third Party Liability
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Policy and Procedures: Both DBH and HCS have begun gathering policies and procedures for review, editing, and merging for streamlining between agencies.
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Phased approach: To reduce risk and minimize large scale issues, claims will be transitioned to the MMIS in phases based on provider types, specialties, and date of service. The phased approach is as follows:
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October 1, 2024: Independent Psychologists
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November 1, 2024: Independent Licensed Independent Clinical Social Workers (LCSW) & Independent Licensed Professional Counselors (LPC)
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December 1, 2024: Independent Licensed Marriage and Family Therapists (LMFT) & Autism providers
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January 1, 2025: Mental Health Clinics, 1115 Providers and State Plan Services (Community Behavioral Health Services)
Please note these milestones and activities are not all inclusive and are subject to change. Claims transitions are incredibly difficult and require many moving pieces to fall into place at the same time. We are on target to transition all providers to the MMIS by January 1, 2025. Further communication will be provided as we get closer to transition activities.
Behavioral Health Organization
DBH will be soliciting proposals for a behavioral health organization (BHO) with demonstrated specialized expertise in the behavioral health Medicaid system to partner in fully implementing and realizing the services available under the 1115 Alaska Substance Use Disorder and Behavioral Health Program (1115) waiver demonstration. The BHO will be instrumental in connecting resources available to the provider community and addressing gaps in care through data driven strategies.
Ongoing Tasks:
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Finalize Draft RFP: Once all internal feedback has been received, DBH will publish a draft of the RFP to release for public comment.
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Public Comment Intake: Publish Draft RFP to collect and review feedback from public comment period. During this phase potential offerors and Alaska Medicaid stakeholders are invited to provide feedback on the RFP, particularly the Scope of Work, and Deliverables in Section 3 of the RFP. After review, DOH will then transition the RFP into a FINAL phase, notwithstanding any subsequent amendments to the RFP.
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Publish Final Draft: Release Final draft of RFP for solicitation of vendors capable of fulfilling the scope of work identified, estimated to be released at the end of May 2024.
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Procurement Evaluation Committee (PEC): The PEC will consist of DBH subject matter experts as well as up to three (3) external stakeholders. If you are interested in participating as a PEC member, please provide your interest and contact information through the public comment process. Please keep in mind that being a PEC member can require up to six (6) months of participation throughout the process.
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Award Contract: Upon selection of a successful vendor, a notice of intent to award will be issued. Go-live for the BHO contract is anticipated to be January 1, 2025.
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Implementation Activities: Upon award, DBH will work immediately with the vendor to prepare for the full implementation. Providers can expect orientation sessions after go-live to introduce the BHO, provide information on what they will be prepared to support as well as additional communications on activities the BHO will conduct throughout the life of the contract.
DBH and HCS are committed to working together with our technical support vendor to achieve the best possible outcome for our provider community. There will still be bumps along the way, but we are excited for the direction we are headed. There is no required provider action at this time, but if you have any questions, please email mpassunit@alaska.gov.
Thank you,
Andrea Mueca
Deputy Director
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