National, State & Local Authorities

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.

California Department of Health Care Services – Indian Health Program

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.

Health Plan Monitoring and Enforcement – Service Access

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.

Illinois Division of Mental Health/Department of Human Services Fee for Service

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.

Illinois Division of Mental Health/Department of Human Services ASO Oversight

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.

Medicaid Rate Setting Analysis & Recommendations

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.

New Mexico State Collaborative for Behavioral Health Management MCO Oversight

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.

Louisiana Department of Health & Hospitals Fee for Service Rehab Conversion

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.

District of Columbia, Department of Mental Health

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.

Connecticut Department of Mental Health & Addiction Services

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.