Medicaid Reimbursement for telepsychiatry

1
Medicaid Reimbursementfor tele-psychiatry

• Northern Human Services
• The NH experience

2
Program Overview

• NHS northern half of NH with 8 of the
  population
• Multiple sites services to DD Substance Abuse
  populations
• No child psychiatry available within the region
• HRSA grant to develop the technical capacity and
  clinical service and to ensure its sustainability
• Gaining board of directors support
• Required building the talent within IT department
• Convincing clinical staff that it could work
• Assuring financial staff that it would not
  inflate expenses

3
Process for engaging State partners

• NH is a laboratory environment (geographic and
  population)
• With the award notified potential partners and
  launched a good will tour.
• Good Will Tour to outline the process, discuss
  the value, offer to be a resource for other CMHC,
  ask for their help in achieving sustainability
• Tour included Bureau of Behavioral Health,
  Commissioner of the Department of Health Human
  Services, UNH (Health Management and Policy
  Institute), Dartmouth Medical Center the
  Department of Psychiatry, other NH CMHC who was
  attempting to initiate tele-health
• Outlined a role for each of the potential players
  and key contact person
• Provided brief updates as we progressed through
  the project.
• Once the technical challenges were achieved and
  with a clinical partner, engaged in an intensive
  reimbursement planning effort with the Bureau of
  Behavioral Health (MH is carved out to BBH in NH)
• BBH agreed to a pilot for one year

4
Successes Challenges

• BBH required to assure the new service codes
  would be budget neutral
• High visibility. Tracking via a modifier code on
  the bill satisfaction/outcomes.
• No change was required to the State Plan
  (different delivery vehicle)
• Other interested parties wanting to join the
  pilot.
• Pressure to accelerate and expand (both internal
  external)
• BBH Commissioners office outstanding partners
  as they view this as a portable model that will
  enhance services

5
Outcome of the partnership

• We share the failures as well as the successes
  (commitment testimony)
• Viewed as a partner to assist with other
  transformative issues.
• Builds expectations that are not always achieved
  (electronic supervision)
• Use of the technology grants permission to
  conduct other business (eligibility reviews etc.)
• Establishes a platform for other innovation.

6
How do you maintain the relationship

• We are the contracted entity for our region
• Built in review of progress and problems re the
  tele-health project with BBH
• Semi-annual meeting with the Commissioner BBH
  on the project

7
Lessons Learned

• More extensive research on what is in place
  earlier. UNH was helpful in retrieving this
  information
• Building in local grassroots support (other
  healthcare providers and legislators etc.) to get
  to the next level of other third party
  reimbursement
• Let the staff become familiar with the equipment
  and the process (educate and control)
• Engage billing and A/R staff early on

8
Resources Tools

• Build the case for the value added
• Share the data/information (proposal and the
  process)
• Face to face initial meetings
• Support from the top (Board, Medical Director and
  CEO)

9
Current Future

• Bringing down the cost of transmission
• Negotiating a longer term relationship with
  Dartmouth (provider)
• Partnership with BBH, UNH to pursue legislation
  to require other third party reimbursement
• Explore other clinical uses for the equipment
  (internal external)