ValueAdded

This is the 202nd issue of our VBH-PA information update. These updates will be

emailed to network providers monthly. Please feel free to share our newsletter

with others, and be sure your appropriate clinical and financial staffs receive

copies.

Inside this issue

Bed Availability Notification System for Non-Hospital D&A Residential Facilities ............... 2 Critical Incident Reporting Reminder ................................ 2 Provider Payment Suspensions Based on Credible Allegations of Fraud ....................................... 3

Value Recovery Coordination Program .................................. 4

Nurturing the Self ................... 5 Join Us! 2016 Mental Health Awareness Walk ...................... 5 Integration of BH and PH to Address Members’ Needs ...... 6 Check Internet Portal for Up-to-Date Information About PROMISe Enrollments ............. 6 2016 Winter WPIC Videoconference Series .......... 7

Vol. 18 Issue 4 April 2016

Notification of Change in Access

to Services

Providers must immediately notify Value Behavioral Health of PA, Inc. (VBH-PA)

by calling their Provider Field Coordinator or through notification in writing, or by

facsimile to 724-744-6363, to the attention of the Provider Relations Department,

upon the occurrence of any of the following:

1. Inability to provide emergent care within one hour, urgent care within 24

hours, or routine care within seven days.

2. Usage of alternative provider coverage in any situation when unable to treat

VBH-PA members in active treatment, e.g. vacation.

3. When reaching full (100%) capacity. Full capacity is considered the point at

which the provider is unable to meet the access standards noted above or is

unable to accept referrals for a particular level of care. Notices for full

(100%) capacity should contain the reason for reaching capacity, the effective

date, and the steps the provider will take to resume functioning at normal

capacity.

4. The inability to provide any portion of a prescribed service, e.g. BHRS.

Network providers must offer hours of operation that are no less than the hours of

operation offered to commercial members or comparable to Medicaid fee-for-

service if the provider serves only Medicaid members.

You may find this information in our online Provider Manual:

http://www.vbh-pa.com/provider/info/prvmanual/4_PartPrvResp/

notification_change_access_svcs.htm

2

ValueAdded—April 2016

Bed Availability Notification System for Non-Hospital

Drug and Alcohol Residential Facilities

The SW6 (Armstrong, Indiana, Butler, Lawrence, Washington and Westmoreland), NW3 (Mercer, Crawford and Venango), Greene and Beaver Counties’ SCAs, and Fayette County Behavioral Health Administration, in partnership with Value Behavioral Health of PA, are implementing a revised email Bed Availability Notification System. By utilizing this free, email-based bed availability notification system, each facility will be able to assist as many individuals as possible to achieve recovery as well as ensure maximum capacity and income to your agency. We are requesting that each non-hospital detox and/or rehab provider send email notifications of available beds to this new system. Upon receipt, the notifications will be automatically forwarded to all the SCA and MCO staff making non-hospital detox and rehab referrals. This includes all SW6, NW3, Greene and Beaver Counties’ SCA Assessment/Case Management Units and Fayette County Behavioral Health Administration. Once sent, no non-hospital providers will have access to the notifications, only MCO and designated SCA units. SCA Case Managers and MCO staff will be using these email notifications to speed the referral process. These email notifications can be sent at any time throughout the day or night, and the information on your facility’s bed availability and contact person will be immediately forwarded to the comprehensive distribution list of SCA Case Management Units and MCO staff. This email system is voluntary and has been established to streamline the referral process, as well as to ensure more immediate and appropriate linkages to residential placements for individuals in need of substance abuse treatment. If your agency would like to participate in this new, free Bed Availability Notification System, simply begin sending notifications to the following email address: nonhospba@swsix.com. To be forwarded, the subject line must contain the following text: “Non-Hospital Bed Available”. Please include the following information in the body of the email:

1. Name and address of the facility with the bed available. 2. The name, phone number and email address of the primary contact person at that facility. 3. The type of bed available (adult/adolescent, male/female, etc.). 4. The day this bed will be available.

If you have any questions on this new Bed Availability Notification System, please feel free to contact: Betsy Duncan, Southwest Behavioral Health Management, (724) 657-3470 ext. 37 or bduncan@swsix.com.

Critical Incident Reporting Reminder The VBH-PA Quality Management Department wants to remind providers of the continuing need to report all critical incidents to VBH-PA Risk Management. This is a requirement included in our contracts with all network providers. The Critical Incident reporting log and the Table of Incidents are available on the VBH-PA website http://www.vbh-pa.com/provider/prv_forms.htm. To report critical incidents, you may fax 855-287-8491 or call VBH-PA Risk Management and leave a confi-dential voicemail at:

Armstrong, Butler, Indiana, Lawrence, Washington, Westmoreland Counties:

Contact Corky Blackburn at (724) 744 6365

Beaver, Cambria, Crawford, Fayette, Greene, Mercer, Venango Counties: Contact Cindy Kemerer at (724) 744-6525

3 ValueAdded—April 2016

Effective immediately, the Value Behavioral Health of Pennsylvania (VBH-PA) Program

Integrity Department integrated a payment suspension process into the Fraud, Waste, and

Abuse policy to cooperate and coordinate with the Pennsylvania Department of Human

Services, Bureau of Program Integrity and Medicaid Fraud Control Section of the Attorney

General for any providers with credible allegations of fraud.

The implementation of the payment suspension process is based on the following:

42 CFR §455.23 requires that the State Medicaid agency must suspend all

Medicaid payment to a provider after the agency determines there is a

credible allegation of fraud for which an investigation is pending under

the Medicaid program against an individual or entity unless the agency has

good cause to not suspend payments or to suspend payments only in part.

Appendix F of the Behavioral Health MCO HealthChoices Programs

Standards and Requirements requires that the primary contractor or its

BH-MCO have a statement that allows for the suspension of payments at

the request of the department and Medicaid Fraud Control Section of the

Attorney General.

The VBH-PA payment suspension procedures are the following:

The VBH-PA Program Integrity Department will receive a request from

the Bureau of Program Integrity or the Medicaid Fraud Control Section

of the Attorney General to suspend payments for a provider suspected

of fraud. Conversely, the VBH-PA Program Integrity Department will

notify the Bureau of Program Integrity of providers that may meet the

credible allegation of fraud criteria; however, VBH-PA will not make

determinations of fraud without consultation from the primary

contractor, Bureau of Program Integrity, and/or the Medicaid Fraud

Control Section of the Attorney General.

The VBH-PA Program Integrity Department will implement the

payment suspension for provider. The provider’s claims will be

adjudicated; however, the payments for the claims will be held until the

payment suspension is lifted by the primary contractor, Bureau of

Program Integrity and/or the Medicaid Fraud Control Unit of the

Attorney General.

The VBH-PA Program Integrity Department will notify the provider of

the payment suspension; however, it may not be able to disclose all the

details from the payment suspension request.

Provider Payment Suspensions Based on

Credible Allegations of Fraud

Compliance Alert

4 ValueAdded—April 2016

Upcoming RTF Summits

Friday, April 29th

9:00 a.m.—11:00 a.m.

Friday, October 7th

9:00 a.m.—11:00 a.m.

Location:

Doubletree by Hilton

910 Sheraton Drive,

Mars, PA 16046

Upcoming BHRS Summits

(Your choice of two

locations per month.)

June 3—

Courtyard by Marriott

Greensburg, PA

June 10—

Hampton Inn & Suites

Mercer, PA

September 9—

Hampton Inn & Suites

Mercer, PA

September 16—

Courtyard by Marriott

Greensburg, PA

December 2—

Courtyard by Marriott

Greensburg, PA

December 9—

Hampton Inn & Suites

Mercer, PA

The Value Recovery Coordination (VRC) program at Value Behavioral Health of Pennsylvania

(VBH-PA) is designed to be a collaborative process that assesses, implements, coordinates,

monitors, and evaluates options and services to meet an individual’s health needs through

communication and available resources to promote quality, cost effective outcomes, and most

importantly, their successful tenure in the community. The Value Recovery Coordination program

began in 2014 and became fully implemented in 2015. The VRC program bases the intensity,

frequency and duration of member contact on their individual needs. VBH-PA moved towards

more intensive member contact (weekly, biweekly or monthly) and more intensive acuity

assessment of our members’ behavioral health needs as well as how medical concerns may be

impacting their behavioral health outlook.

Care Managers (CMs) track service utilization of high risk individuals in order to decrease their

utilization of higher levels of care (such as psychiatric inpatient care) and increase their utilization

of lower levels of care (such as outpatient services). The goal for these individuals is to ensure they

get the right level of care at the right time and in the right setting. The target population includes

adults (ages 18 and older) who have been identified as being in at least one of four high risk

populations with two or more inpatient hospitalization or residential facility stays within a six-

month period. The high risk populations include the following:

Seriously Mentally Ill

Co-Occurring Mental Health and Substance Use

Mental Health/Intellectual Disabilities

Mental Health/Complex Medical

Metrics have been identified to assess the program’s impact. These metrics include service

utilization by criteria category of individual high risk members using six-month pre- and post-

engagement in the VRC program. Outcomes that were measured included:

Inpatient hospitalization costs

Utilization of community based levels of care versus inpatient levels of care

Engagement with the VRC program and subsequent treatment is associated with reduced need for

inpatient hospitalizations and prolonged community tenure. The VRC program appears to be

associated with a significant change in service utilization patterns of members. Inpatient utilization

was decreased by 54% while outpatient services increased by 29%. Engagement in the VRC

program and subsequent treatment is associated with reduced need for inpatient psychiatric

hospitalizations and prolonged community tenure. Also notable were increases in Blended Case

Management (BCM), psychiatric rehabilitation, and peer support.

VBH-PA is very excited about the outcomes produced by the VRC program. This program

demonstrates that recovery is possible for our members and they can have increased community

tenure. We are enthusiastic about continuing to expand the VRC program so that we can reach

more of the members who may benefit from these collaborative efforts.

Value Recovery Coordination Program—

Where are We Now?

5

ValueAdded—April 2016

VBH-PA is pleased to announce the 2016 Mental Health Awareness Walk. On Tuesday, May

17, 2016, the Transition Age Advisory Group (“TAAG”) and the Family Advisory Committee

(“FAC”) will be hosting a walk around Twin Lakes Park in Westmoreland County to observe

Mental Health Awareness Month. Youth, young adults, families, and adults with behavioral

health challenges are resilient and need support from family, friends, and providers. Come and

show your support for our neighbors and friends! This one and a half mile walk will consist of

one lap around the lower lake. Please view the Save the Date flier for more information.

If you would like to exhibit at this year’s walk, please complete the exhibitor registration form.

Exhibit space is free, but limited, so please register early! Visit our homepage at www.vbh-

pa.com and click on the Mental Health Awareness Walk Exhibitor Registration form which

is listed under both the Provider and Member News and Events sections.

If you have any questions, please contact Karan Steele, Prevention, Education and Outreach

Coordinator, at (724) 744-6537 or karan.steele@beaconhealthoptions.com. We look forward to

seeing you on May 17th!

Join Us! 2016 Mental Health

Awareness Walk

Nurturing the Self

Incorporating nurture into our daily life helps us cope with the stress and uncertainties of the frail

human condition.

“Calm is all nature as a resting wheel.”

—William Wadsworth

How does one nurture one’s self, and why is it important? Since the 1970s more than a thousand self-help books have been

written on the subject, offering a wide range of diagnoses and remedies for what can be best described as the reality of the

human condition. In short, we are moving too fast and too furiously for our own good.

In his book Margin: Restoring Emotional, Physical, Financial and Time Reserves to Overloaded Lives, Dr. Richard Swenson described the

human condition and the problem facing most Americans succinctly. He writes: “Into my office on a regular basis comes a

steady parade of exhausted, hurting people. Most don’t realize that pain and the absence of margin (in their lives) are related.”

The “margin” he is describing is another way of saying we need to slow down and take better care of ourselves. Accordingly,

nurturing one’s self is the opposite of stressing oneself. Consider:

Stress is a sprint. Nurture is a nice long walk.

Stress is worry. Nurture is laughter.

Stress is tiring. Nurture is restful.

Stress is busy. Nurture is having some extra time.

Stress is obligation. Nurture is choice.

Stress is strain. Nurture is fun.

By Drew Edwards, EdD, MS

© 2004 Beacon Health Options

Source: Margin: Restoring Emotional, Physical, Financial and Time Reserves to Overloaded Lives by Richard A. Swenson.

Navpress, 1992; Waking the Dead by John Eldredge. Nelson Publishers, 2003.

6

ValueAdded—April 2016

Integration of Behavioral Health and Physical Health

to Address Members’ Needs Holistically

According to a National Association of State Mental Health Program Directors’ report, individuals who have been diagnosed

with serious mental illness die 25 years earlier than those without serious mental illness. The reasons for this are multi-

faceted. Some contributing factors include that individuals with serious persistent mental illness tend to have significant

physical health concerns such as diabetes and cardiovascular disease. Other contributing factors that were seen in a higher

proportion in those individuals included lower physical activity, higher rates of smoking, and side effects of psychotropic

medications which can contribute to health concerns. In addition, many individuals only access care at the primary physician

level although they may need more specialized treatment

VBH-PA is committed to making certain we are assisting our members in reaching their fullest potential. This means not

reviewing an individual’s needs in a silo at a discreet period of time, but instead looking at the whole person longitudinally.

In 2016, through state and local initiatives, increased emphasis is placed on the integration of behavioral health and physical

health care to make certain that the individual’s needs are being addressed through all of the systems involved.

If you as the provider would like to involve the physical health plans in your treatment, below are numbers to contact the

special needs units within each of the physical health plans. If a member would like to reach out to the special needs unit

within the physical health plan, please have them call the numbers below. In addition, VBH-PA is regularly involved with

the physical health plans for coordination of care. If there are any questions or concerns, please feel free to contact VBH-

PA.

PH-MCO

Member Contact

Phone Number

Provider Contact:

Contact Name

Provider Contact

Phone Number

Aetna 1-866-638-1232 Jeffrey Gonzalez 1-866-638-1232

AmeriHealth 1-888-991-7200 Dr. Michael Baer

Melissa Martin 1-800-521-6007

Gateway 1-800-642-3550 Will Wenger 1-800-642-3550

UnitedHealthcare 1-877-844-8844 Tami Barker 412-501-0872

UPMC for You 1-800-286-4242

Clinical Operations

Department. Ask for

Case Manager.

1-866-778-6073

Check the Internet Portal for Up-to-Date Information

About Your PROMISe Enrollments

Check the MA Enrolled Provider Portal Lookup Function at www.promise.dpw.state.pa.us. All

provider letters and portal login screens contain your next revalidation due date. Look for

changes on the provider portal for each 13-digit logon to check your service location.

7

ValueAdded—April 2016

Upcoming Trainings

View all of our

upcoming trainings on

the Provider Trainings

webpage: http://

www.vbh-pa.com/

provider/prv_trn.htm

Suggestions or ideas for

articles that you would

like to see published in

ValueAdded can be

faxed to Kim Tzoulis, Val-

ueAdded Editor, at (724)

744-6363 or emailed to

kimberly.tzoulis@

beaconhealthop-

tions.com

Articles of general im-

portance to the provid-

er network will be con-

sidered for publication.

Value Behavioral Health

of PA, Inc.

520 Pleasant Valley Rd

Trafford, PA 15085

Phone: (877) 615-8503

Fax: (724) 744-6363

www.vbh-pa.com

2016 WPIC Videoconferences Winter Series!

VBH-PA is pleased to announce that our Engagement Center will be a videoconferencing

site for the WPIC Office of Education and Regional Programming 2016 winter

videoconference series. These programs are free of charge and there are NO fees for

continuing education credits. The videoconferences are held from 1:00 p.m. to 3:00 p.m. in

the Walnut Room at VBH-PA’s Trafford Engagement Center. For CEU information,

registration information and complete descriptions of these trainings, please view the

“Upcoming Trainings” section on our Provider Training webpage.

Upcoming Videoconferences*

April 13—Mental Illness and Violence

April 27—Executive Function: A Neurodevelopmental Perspective

Registration:

To register for these trainings, please visit the ValueOptions® Provider Trainings Web page.

Select Pennsylvania from the state dropdown list (DO NOT change any of the other

fields) and then click on Select. Scroll down the screen and put a check mark in the box

next to the event(s) and then hit Register. Phone-in registrations will not be accepted.

*Please Note: These videoconferences are NOT webinars. You must be in attendance

at the Trafford Engagement Center to view these videoconferences. VBH-PA is one of

many sites offering this opportunity. Please click here to view all locations offering this

videoconference series. To register with another location, please contact the coordinator for

that site.