Focus Areas
National, State & Local Authorities
Parker Dennison core staff have provided consultation services to more than 30 authorities (national/state/regional/local jurisdictions) and eight national public sector managed care entities. Services have focused nearly exclusively on system transformation issues and have included readiness reviews for operational areas, technical training on key tasks (utilization management, crisis, central access, prior authorization, claims, service definitions, needs assessment, network development and management), and operational supports during start up.
States in which Parker Dennison has provided services to local, regional, or state jurisdictions or public sector managed care entities include: Ohio, Virginia, Missouri, Iowa, Hawaii, Nebraska, Colorado, Arizona, Alaska, California, Massachusetts, Maryland, North Carolina, South Carolina, Texas, Tennessee, Illinois, New Mexico, Washington, District of Columbia, Oregon, Wyoming, Montana, Kansas, Georgia, and Florida.
Providing technical assistance (TA) to the Department of Health Care Services (DHCS) and tribal
communities in California to support effective implementation of the Indian Health Program Organized Delivery System (IHP-ODS). This contract is part of a larger strategy and portfolio of investments designed to support the five-phase implementation of the Drug Medi-Cal Organized Delivery System Waiver (DMC-ODS) in California. The IHP-ODS is the last phase of the DMC-ODS implementation, perhaps the most complex, and potentially one of the most impactful for the community served. IHPODS poses unique challenges because tribal health programs have not been part of Drug Medi-Cal and tribes largely operate independently. There is no unifying financial or administrative structure for tribal health programs in California. A significant part of the IHP-ODS is scoping, identifying, and creating an administrative entity that can play a managed care function for tribal health programs. Parker Dennison will scope the technical capacities and parameters for the administrative entity in partnership with the Department of Health Care Services and with the Centers for Medicaid and Medicare on key policy implementation issues, and support engagement of tribal partners throughout the process.
Assisted a state with the investigation of a health plan’s possible violations of provider network access regulations for mental health services. The project included review of the state’s survey results, analysis of the health plan quality improvement actions, and development of remediation strategies to improve enrollees’ access to services. Parker Dennison consultants served as behavioral health managed care experts for attorneys in the state enforcement division during the investigation and negotiations with the health plan.
Multi-year contract to assist with conversion from a primarily grant based system of reimbursement to fee for service, enhancing quality, and facilitation of Medicaid waiver development to support resolution of Olmstead related class action suits. Task areas have included providing pilot test evaluation, and facilitation of stakeholder groups including oversight, services, and finance work groups; developing, administering, and analyzing results from provider fee for service readiness assessment process; conducting readiness review of state authority structures to administer fee for service including reviewing information systems, claims, authorizations, recovery focus, conversion structures, and available resources. Parker Dennison has also assisted with development of two Medicaid state plan amendments and associated rules to enhance recovery/resiliency focus and fee for service compatibility. In addition we have provided consultation regarding rate setting, financial impacts on providers, and related fiscal issues.
Assisted the state in the needs identification leading to the decision to procure an administrative services organization (ASO) and assisted in drafting the request for proposal. Managed and assisted in the drafting of the RFP and selection criteria. Assisted in the contract drafting and negotiation between the state and the selected vendor and provided implementation guidance and oversight. Parker Dennison continues to be involved with ongoing oversight of the ASO including evaluation of performance in key functional areas.
Developed Medicaid rate analysis methodology that includes detailed analysis of service definitions and requirements, CMS region comparison, adjustments for cost of living, and expected productivity/staff costs. Developed models for capacity maintenance and fee-for-service interface for services that cannot be maintained exclusively on fee-for-service rates (e.g., crisis services, residential). Assisted with rate setting in Connecticut, Hawaii, Louisiana, North Carolina, New Mexico, and Alabama.
Assisted the Collaborative with conducting the implementation readiness review of the selected Single Entity (MCO). Assistance included feedback on the design of the overall readiness review process, and targeted assessment of provider and care management/authorization issues most likely to impact consumer care and provider stability during the initial phases of implementation. The readiness assessment included a review of documents, as well as onsite observation, interaction and evaluation of key operating processes.
Provided assistance in the conversion from case rate reimbursement to fee-for-service methodology. Included drafting of new Medicaid state plan service definitions, development of new eligibility determination process/protocol, prior authorization impact, new assessment and service planning, development of rate methodologies and proposed rates, training for authority and providers on new processes. Utilized a cooperative work group approach to development including facilitating authority/provider product development work groups.
Provided consultation to the District of Columbia Department of Mental Health regarding the implementation of the Medicaid Rehabilitation Option and concurrent conversion to fee-for-service reimbursement. Technical assistance included focus on the development of a DMH Provider Relations function including the development of job descriptions for manager and staff, facilitation of retreat to set provider relations goals, training of provider relations staff, and initial monitoring and feedback on staff performance. Developed provider ‘operations manual’ which delineates best practices for provider serving youth in a fee-for-service environment which serves as the tool used by Provider Relations to orient and train new or distressed contracted providers.
Assisted in converting mental health group homes from state grant funding to fee for service under the Medicaid Rehabilitation Option. The consulting team assisted DMHAS staff with revising the service definitions and evaluating state infrastructure needs at both DMHAS and the Medicaid agency for supporting the implementation. A summary report outlined priorities for ongoing training as well as for more intensive technical assistance. Ongoing local assistance was delivered through DMHAS Regional Staff, who had been coached and trained as part of the preparation process. The consulting team assisted DMHAS staff with identifying ongoing performance indicators for the network, as well as strategies for evaluating changes in client outcomes as a result of the conversion. The consulting team also worked closely with Medicaid in developing written materials to assist providers in meeting the documentation requirements for prior and continuing authorization for service. While the project has resulted in an increase in FFP for Connecticut, the more impressive outcome is the increased satisfaction of clients with the services they are receiving in group homes, and the perceived improvement in service quality by providers, consumers, and DMHAS staff.
Providers
Parker Dennison has a rich history of extensive work with community based behavioral health providers and hospitals having provided training and technical assistance to over 400 providers in more than 40 states since 1989. As long time senior consultants affiliated with the National Council for Community Behavioral Healthcare (The National Council), a nonprofit trade association representing more than 900 providers in 46 states, Parker Dennison has consulted and been featured trainers to virtually all of their member states.
Consulting focus has been nearly exclusively on operational responses to changing funding environments and methodologies, with an emphasis on honoring and preserving the non-profit and community-based values. Authors of more than 20 monographs or manuals on provider technical operations issues, Parker Dennison has frequently been called upon by state authorities to assist providers with turn around, transition, or financial crisis issues.
Developed comprehensive merger work plan for non-profit behavioral health providers, including pre-merger evaluation and negotiation, comprehensive due diligence, and integration phases. Provided facilitation, expert consultation, mediation, and solution-focused issue resolution between merger candidates. Provided technical support and expertise for operational integration activities including in clinical, financial, and MIS/decision support.
Developed comprehensive behavioral health managed care readiness assessment tool, planning process, and training/technical assistance approach. Assessed over 200 public sector behavioral health providers and authorities including in clinical, billing, utilization management, data, finances, quality, compliance, and related functions. Developed training manuals for core operational requirements in key areas such as utilization management, access, and documentation. Conducted assessments in 24 states.
Prepare various financial models for authorities and providers including break-even analysis, rate/cost impacts, productivity, and utilization projections. Based on the modeling, provide detailed recommendations for operational modifications including specific cost restructuring, productivity enhancements, and service/case mix. Financial modeling has been provided to both provider and authority clients.
Provided consultation regarding operational best practices for successful implementation of the Medicaid Rehabilitation Option and concurrent fee-for-service conversion. Technical assistance included readiness review and development of work plans with focus on the clinical model, authorization process, billing and costs, utilization management, documentation, intake/triage, and related data and tracking analysis and methodologies. Services were provided to 90% of contracted provider network.
Provided consultation to the District of Columbia Department of Mental Health and its providers regarding the implementation of the Medicaid Rehabilitation Option and concurrent conversion to fee-far-service reimbursement. Technical assistance included focus on provider readiness and development for successful operations, authorization process, utilization management, documentation, intake/triage, billing/claims process flow, and staff development activities. Included consultation to both non-profit community providers, as well as a large ($50 million annual budget) District-operated public provider. Services were provided to 100% of the provider network.
Provided assistance in the conversion from case rate reimbursement to fee-for-service methodology. Included developing provider readiness tool, conversion financial impact analysis and tools, training to providers on various topics including fee-for-service operational best practices, new service definitions, new clinical programming, documentation, and compliance. Provided services to 90% of the provider network.
At the request of the Secretary, Parker Dennison team members assisted at-risk providers in southeastern New Mexico with assessments of current operational practices and recommended actions to improve positioning and performance in an environment that includes increasing proportions of fee-for-service reimbursement. Consultants tailored national best practices for fee-for-service performance for providers with the unique challenges of delivering services in rural and frontier areas in New Mexico, and developed provider work plans inclusive of specific activities, performance targets and time lines. Involved reviews of five agencies with a planned expansion to the remainder of the contracted network.
Managed Care & Health Plans
Since 1989, Parker Dennison has worked with public and private sector managed care entities ranging from the very largest, national firms to non-profit regional and local managed care entities. Always operational in focus, our work has included assisting with bids including assessing provider network needs, care management strategy development, provider training needs and actual proposal management and drafting.
Parker Dennison consultants have been key team leads for nearly a dozen public sector mental health, substance abuse, and child welfare managed care implementations including in Iowa, Massachusetts, Arizona, Texas, Maryland, Wisconsin, Kansas, Tennessee, and Colorado. We have also assisted health plans with developing or enhancing internal behavioral health capabilities in preparation for fully integrated models under Medicaid waivers and healthcare reform.
Assisted the largest Medicaid health plan in the state in all phases of implementing an 1115 managed care waiver that includes behavioral health, physical health, long term care services and supports, consolidation of twelve legacy waivers, and Medicaid expansion benefits. The scope of work included assessment of operational capacity buy or build decisions, all phases of procurement and contracting with a behavioral health administrative services organization, strategy and proposal development, and implementation assistance.
Reviewed one of the top 25 provider-sponsored non-profit Medicaid managed care health plans in the nation for readiness to integrate behavioral health benefits into their book of business. The health plan was a consortium including a university physicians group, two non-profit hospitals, and an FQHC. Parker Dennison conducted a high-level review of the plan’s strengths and development needs in order to manage behavioral health benefits, helped design and adapt their case management, utilization management, provider relations, and member services models, and drafted a proposal to one of their key state clients demonstrating their enhanced capabilities to manage the full spectrum of benefits.
Assessed health plan operational systems to determine readiness to manage behavioral health in competitive environments. Evaluated buy/build decisions to enhance behavioral health management competencies, recommended development plans for improvement, and assisted with implementation. When ‘buy’ decisions were preferred, assisted with all phases of behavioral health organization RFP/RFI development, proposal evaluation, contract negotiation, and implementation.
Assisted national managed care organization, ValueOptions, with the implementation of a statewide mental health carve-out in Massachusetts. Funding was primarily Medicaid, with a small portion of non-Medicaid state funding. Project activities included: provider network development, contracting and credentialing; plan for network gap analysis; interface with representatives from state agencies (Medicaid and Department of Mental Health); provider orientation and training; provider manual development; and recruitment and training of permanent staff.
Assisted national managed care organization, Magellan, with the implementation of two statewide carve-outs in Iowa. One project was for Medicaid mental health funding for all levels of care and the second was for substance abuse services, inclusive of Medicaid and non-Medicaid funding and the corresponding two state agencies. Activities on both projects included: provider network development and contracting; interface with state agency representatives; financial modeling for proposed non-Medicaid funding allocations for providers; and provider training.
Participated in two types of projects for Regional Behavioral Health Authorities (RBHAs) in Arizona. RBHAs are responsible for a single system of care for behavioral health services in a region of the state, and for a wide range of funding and populations, including Medicaid and non-Medicaid for all ages, child welfare behavioral health, housing, vocational, federal block grant and county dollars. The first project was to assist national managed care organization, Value Options, with development of the winning proposal and implementation of a regional managed care carve-out inclusive of all behavioral health funding for Maricopa County, Arizona, which includes the Phoenix metropolitan area, as well as surrounding rural areas. Activities included implementation assistance in the areas of: provider network development, network management, contracting, and credentialing; provider training and manual development; claims and information systems; network needs assessment, coordination and distribution of housing and substance abuse funding; and interface with state agency representatives. The second project was to assist an incumbent RBHA, Northern Arizona Regional Behavioral Health Authority (NARBHA) in Flagstaff, with a successful proposal to continue its contract with the state during required re-procurement. NARBHA is responsible for approximately the northern half of the state, which is largely comprised of extremely rural and geographically isolated areas.
Assisted a partnership of a national managed care organization, Value Options, and a local provider with implementing a project in Kansas designed to privatize foster care functions and apply managed care technologies to the services and funding.
Rate Modeling & Financial Analysis
Parker Dennison has extensive experience with development of rate models for Medicaid and state-funded community behavioral health services, including actual and estimated cost-based rates and use of a market basket of rates from other states with adjustments to account for geographic and cost differences. Activities have included guidance for stakeholder processes for input on rate methodologies and assumptions, validation of proposed rates using provider cost data and impact analyses to project the estimated costs for revised rate models.
We have experience with adapting rate models to the unique needs of crisis services or other core services in geographically isolated areas, and developing models to test the validity of provider requests for rate increases under appropriate staffing, productivity and administrative cost levels.
Assistance with the development of rates for an expansion of Medicaid rehabilitation services, including fiscal impact analysis and CMS approval of proposed methodology and rates. The project included validation of the rates based on provider cost and performance data at the time of implementation of the state plan amendment and five years later to determine if rates created barriers to access. Parker Dennison also developed a rate model for state-funded residential services and a corresponding impact analysis on system costs for conversion of residential grants to per diem rates.
Developed rates for Medicaid rehabilitation services based on a market basket of rates for similar services from other states. The rates were then adjusted to estimated Louisiana costs based on an index that accounted for differences including cost of behavioral health personnel, median income and cost of living in other states compared to Louisiana.
Developed rates for an amendment to the Medicaid state plan based on a market basket of rates from other states, and New Mexico’s current rates for similar services across multiple state departments. Parker Dennison also assisted with presenting the rates and underlying methodology to CMS as a part of the SPA approval.
Developed a methodology for a multi-year project to review rates for encounters submitted to support risk-based contract payments. The analysis included provider costs, staffing, and productivity data to assess whether rate adjustments were appropriate. A separate tool was developed to assist providers with projecting encounter value with variable population mixes, staffing models and service utilization.
ADA/OLMSTEAD/IMD
Parker Dennison is a national behavioral healthcare consulting firm, offering the combined talents of clinical, operational, and financial professionals since 1989. Our consultants have specific experience with modeling and operational supports for preparation for or response to ADA/Olmstead litigation for behavioral health and developmental disabilities populations.
In coordination with the Court Expert, assessed readiness of key state systems to implement a significant provision of a settlement agreement focused on the separation of housing and services funding and operations. The engagement included detailed operational analysis, facilitation of public stakeholder comment, and the development of a granular operational work plan to guide the state in its development. The project was funded by the Department of Health and Human Services (HHS)/ Substance Abuse and Mental Health Services Administration (SAMHSA).
As a part of litigation between the state’s legal action center and the Department of Public Welfare, Parker Dennison developed extensive financial models analyzing the net costs or savings associated with transitioning persons with developmental disabilities from state-operated centers to community settings. The project included extensive review of materials, preparation of five scenarios including the transition time and costs for placing individuals, and multiple variables, such as closing a portion of the centers and varying levels of individual medical needs. A written summary report was prepared for submission to the court and the project included a deposition related to the financial models
In preparation for negotiations between the Commonwealth and the U.S. Department of Justice, Parker Dennison prepared financial models analyzing the savings associated with placing persons with intellectual or developmental disabilities from state-operated training centers into HCBS waiver slots in the community. The project included working with a team of attorneys and investigators to develop appropriate assumptions for the financial modeling. The modeling included closure of four centers, the federal and state costs associated with serving persons in the community, and the number of HCBS slots that could be purchased with the net savings from closures.
As a part of a long-term contract with the state, Parker Dennison has assisted in the conversion of community services from a grant basis to fee-for-service, developing and implementing a Medicaid state plan amendment and corresponding state administrative rule change, rate setting for all new services, and analyses of residential service costs and clinical profiles. Consultants have also provided extensive assistance to the state with implementing an ADA/Olmstead consent decree (Williams’s v Quinn) to transition persons from nursing facilities deemed to be IMDs to community living arrangements. Specific activities included preparing an HCBS waiver with the associated services, provider network and cost neutrality modeling components, as well as developing the clinical assumptions, operational requirements and financial modeling associated with implementing the consent decree.