Behavioral health

As funds are determined to be available, Amerigroup Washington, Inc. will distribute behavioral health enhancement funding (BHEF) to all contracted certified behavioral health agencies (BHAs). Availability of funds is determined on a regional level; therefore, each BHA’s location(s) will receive their respective allocation of funds available per region. For CY2021, allocations are determined by the prior year (CY2020) run rate for each BHA location(s).

Amerigroup tracks revenue for the behavioral health portion of our premium to calculate our Behavioral Health Medical Loss Ratio for each region. During CY2020, Amerigroup created an encounter-based methodology to distribute these funds. To do so, we calculated the difference between the enhanced and nonenhanced member premium received by region. That difference was set aside as the available total for each region's BHEF, and then that total was calculated into a mental health enhanced premium and a substance use disorder (SUD) enhanced premium.

Utilizing each region's 2019 encountered services, we divided the total BHEF by total encounters for each region. For regions that went live in 2020, we applied encounters from 2019 regions that had a similar Amerigroup market share to create the enhanced premium. The specific distribution is outlined here:

• Encounters were tallied by a paid (accepted) claim in each quarter of 2020 with a date of service in 2020; enhanced funding per this methodology is only for services in CY2020, as CY2019 funds have been dispersed.

• Only Medicaid integrated managed care claims are tallied. (Foundational Community Supports/non-Medicaid encounters are excluded.)

• If valid claims are denied, they would be included in subsequent quarter payouts (when provider rebills or when we reprocess) as we pull the data by paid claim date and reconcile each quarter year-to-date.

• Mental health and SUD encounters are determined by the DX code submitted with the procedure code.

• Mental health encounters receive the mental health enhanced rate and SUD encounters receive the SUD enhanced rate, thus, following the Health Care Authority’s guidance to build these dollars into the rates.

Now that we have a year's worth of data for these payments, we plan to automate each BHA's behavioral health enhancement payment. We will take their total 2020 allocation and divide that by 12 equal payments, which will be dispersed monthly in CY2021 (for example, prior year run rate distribution). Amerigroup will reconcile each BHA location’s encounters twice annually to capture under- or overpayments of these funds based on received/accepted encounters in 2021.

If you have questions, please contact De’Shanel Childs at De’Shanel.Childs@anthem.com.

Behavioral Health Data Consolidation project

The Washington State health care purchasing mechanism, driven by state law and implemented under federal rules, required the integration of both mental health (MH) and substance use disorder (SUD, also known as chemical dependency) into a behavioral health care model. This behavioral health care model, known as Integrated Managed Care (IMC), became effective in all counties in Washington State on January 1, 2020.

The Behavioral Health Data Consolidation (BHDC) project developed and implemented a combined behavioral health care model, ultimately incorporating integrated behavioral health data collection, storage, and supporting reporting functions and substance abuse data collection into a database called the Behavioral Health Data System (BHDS).

Behavioral health supplemental data is a data set of about 100 data elements collected through 12 transactions from behavioral health providers and is a requirement by the Substance Abuse and Mental Health Services Administration (SAMHSA) as a part of the Block Grant funding the Health Care Authority (HCA) receives.

Effective January 1, 2020, managed care organizations (MCOs) and Behavioral Health Administrative Service Organizations (BH-ASOs) will serve as a bridge between providers and HCA by collecting the data from the providers via a standardized format and submitting the data to HCA via BHDS.

MCOs have selected Beacon Health Options* to develop the platform and standardized format for submitting these data transactions.

The design and implementation of this data collection platform is expected to:

• Create one uniform solution for behavioral health agencies to submit behavioral health supplemental data.

• Provide MCOs with a dedicated entity to manage, troubleshoot and report these data from their contracted networks.

Beacon Health Options will provide training and communication to the Amerigroup behavioral health network and further updates will be posted on this site. Additionally, the links to Beacon Health Option’s platform will also be provided here. Testing is to begin early summer 2020.

If you have questions, please contact De’Shanel Childs at De’Shanel.Childs@anthem.com.