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For downloading or printing: Technical Assistance Notes: Winter 2003 (PDF file - BIG: 1 MB) US Department of Health and Human Services Technical Assistance Notes - Winter 2003 Center for Health Services Financing and Managed Care (CHSFMC)
Mission Statement “Navigating the Managed Care and Financial System” In This Issue:
This issue features three programs:
This issue also highlights a variety of publications and other resources designed to assist HRSA grantees and other safety net providers negotiate the health care financing and managed care systems. Additional information can be obtained from CHSFMC's web: www.hrsa.gov/financeMC Technical Assistance Helps HRSA Grantees The HRSA Center for Health Services Financing and Managed Care (CHSFMC) offers a variety of programs and resources for HRSA grantees and other safety net providers. From strengthening their financial capability to enhancing cultural competencey, these services are designed to give grantees the tools, knowledge and skills needed to operate effectively in today's health care financing environment. Cultural Competence and Managed Care: A High Demand Technical Assistance Topic In recent months training and technical assistance in cultural and linguistic competence in managed care has been the most frequently requested service from HRSA's Health Services Financing and Managed Care Technical Assistance Center (MCTAC). Over the past year over 60 workshops have been provided on this topic to audiences such as local health departments, Area Health Education Centers, medical schools, HIV/AIDS providers, and community health centers. With the recognition that cultural competence was of growing importance to HRSA grantees and to State Medicaid agencies and health plans, MCTAC designed and made available a series of training sessions on the topic. These training opportunities were designed to assist health care professionals and managers develop the necessary skills and organizational capabilities to respond effectively to the needs of diverse patient populations within managed care settings. The MCTAC continues to offer these training resources and has arrangements with consultants who have extensive experience in working with health care organizations and health professionals to enhance their cultural and linguistic competency and who are also familiar with managed care arrangements and requirements. The consultant faculty works closely with the requesting organization to tailor the curriculum to the specific audience. Workshops cover the basics of cultural and linguistic services and emphasize successfull techniques that organizations can use to facilitate culturally and linguistically competent care. Sessions vary in length from half-day modules to a full day session. Individualized technical assistance is also available. Examples of topics covered in training sessions include:
Arrangements for training or technical assistance can be made through
the MCTAC: MCTAC Offers Technical Assistance on a Wide Variety of Topics A major vehicle for technical assistance is the HRSA Health Services Financing and Managed Care Technical Assistance Center, known as the MCTAC. The MCTAC offers comprehensive technical assistance and locally sponsored workshops on how to effectively seek third party reimbursement and successfully navigate the managed care system. A full range of services is available: workshops and training sessions; on-site, on-line and telephone technical assistance; technical publications and articles; and review of managed care contracts. The MCTAC is managed by the CHSFMC and operated under contract by John Snow, Inc. (JSI). Technical assistance is offered in the following areas:
The experts who conduct the training sessions and provide the technical assistance are senior executives from managed care organizations, health professions and the business world. They have extensive experience not only with managed care but also with programs serving Medicaid beneficiaries, medically underserved and special needs populations, and training health care professionals. Over the last year hundreds of HRSA grantees and safety net providers have received technical assistance from MCTAC. They represent the full breadth of HRSA programs. To access services and obtain further information on HRSA's MCTAC: Technical Assistance on Reimbursement for School Based Health Centers School based or school linked health centers (SBHCs) are now providing primary care services in approximately 1,300 sites across the country serving more than a million children. Yet, they face significant challenges: obtaining adequate financing for their services; receiving appropriate sources of third party revenue particularly through Medicaid and SCHIP; and building responsive billing and coding systems. To address these needs, the Health Services Financing and Managed Care Technical Assistance Center is offering SBHCs training and follow-up technical assistance in third party reimbursement, managed care contracting, and related practice management issues. This is a collaborative effort with the Bureau of Primary Health Care, the Maternal and Child Health Bureau, the Centers for Medicare and Medicaid Services, and the National Assembly of School Based Health Centers. A one-day training session for SBHCs and their sponsoring agency administrators has been presented in a number of States. It continues to be available in additional States. The session focuses on identifying the strategies and operational approaches required to assure adequate reimbursement from third party payers, as well as what SBHCs need to do to position themselves to successfully bill third party payers and participate in managed care networks. Training is conducted by experts in the field of organizational finance and managed care contracting who all have senior level experience in reimbursement arrangements and processes. Prior to the training sessions, the faculty discusses the needs and characteristics of the specific audience with the requesting party so that the material can be tailored appropriately for maximum benefit. The training and technical assistance focuses on helping SBHCs make the following improvements in financing and operations:
In recent months, sessions were held in California, Connecticut, Maryland, Michigan, Oregon, and Rhode Island. Facilitators presented a variety of topics that are relevant to the challenges and opportunities SBHCs face when working within a managed care environment. More sessions are in the planning stages. Hundreds of school based health center managers and finance personnel have attended these sessions. In addition follow-up technical assistance is available to SBHCs that attend the training. Arrangements for training and follow-up technical assistance can be
made through the MCTAC: Third Party Reimbursement Training and Technical Assistance Although most HRSA grantees are required to pursue third party reimbursement for eligible individuals and services, a recent study found that many grantees and subgrantees are not taking full advantage of opportunities to maximize their third party reimbursements. By increasing revenues from third party sources, HRSA funds can go further in assisting vulnerable populations not eligible for any form of health insurance. Increasing third party revenues helps ensure an organization's viability into the future and allows expansion of services consistent with its organizational mission. In response to the needs identified in the study, HRSA is offering training and technical assistance to grantees who are funded directly by HRSA and to subgrantees funded by States and localities that use HRSA grant funds along with their State and local monies. Training sessions cover the fundamentals of coding, billing and collections to improve revenues from sources such as Medicaid, State Children's Health Insurance Programs (SCHIP), Medicare, and private insurance. Each training session is a day and a half in length. Following the sessions, grantees are able to access individualized technical assistance services from a team of experts assembled by HRSA's contractor. Technical assistance includes written and on-line materials, telephone consultation and, when appropriate, on-site visits by the consultants. The curriculum includes the following topics:
This is a three-year initiative of HRSA. Its goal is to significantly improve the third party reimbursement effectiveness of HRSA grantees and subgrantees over that time frame. During 2002, the first year of the program, the training has been extensively piloted with the curriculum being continuously improved based on participant feedback. Sessions have been given in the following locations: Dallas TX, San Antonio TX, Lansing MI, Denver CO, Portland OR, Princeton NJ, Little Rock AR, and Dover DE. The rest of the states will be offered this training over the three-year period of the initiative. The following sites are scheduled for late 2002: Oklahoma City OK, Raleigh NC, Los Angeles CA, and Sacramento CA. For a full schedule of future training sessions, see: www.hrsa.gov/tpr The pilot sessions have been well received. For example, 130 individuals attended the session in Lansing, Michigan. They included senior management and a variety of financial operations staff. They came from a range of grantee types including MCH providers, health care for the homeless providers, community health centers, school based health centers, HIV/AIDS providers and rural programs. Several grantees had one-on-one technical assistance appointments with consultants at the conference site and are scheduled to receive further follow-up. Attendee satisfaction is high indicating the program is meeting their needs for third party reimbursement information. For more information, contact: Technical Assistance Resources Now Available CHSFMC has a growing number of useful publications and other resources available for HRSA grantees and other safety net providers. Publications: Residency Rotation Resource Guide on Managing Care Tufts Health Care Institute has developed a guide of curriculum materials for training in managed care settings --- the Curriculum Guide for Managing Care for Medical Residents. These materials were designed to support and facilitate the training of residents or medical students for practice in a managed care environment using a series of teaching sessions in community practices and at managed care organizations. The content development of the Guide was funded by HRSA’s Bureau of Health Professions and the CHSFMC. The Guide contains lesson plans, content summaries in slide format, case examples, practice scenarios, reference information, quizzes, and other instructional materials. The Guide has been divided into 12 easy-to-use sessions. For information about the Guide, go to: www.tmci.org Technical Assistance Costing Tool for HIV/AIDS Providers A Technical Assistance Costing Tool (TACT) has been developed to enable Ryan White Care Act grantees and other community-based providers of HIV/AIDS services to price their products and services for more effective managed care contracting or for improved reimbursement in a fee-for-service environment. The Center for Health Program Development and Management at the University of Maryland, Baltimore County is developing the computer-based tool with support from the CHSFMC. TACT uses utilization and cost data to determine the cost of care on both capitated and unit cost basis. The tool (software and documentation) and information about training should be available by Spring 2003. For more information about this valuable tool please contact Alexander Ross at 301-443-1550. Purchasing Specifications The Center for Health Services Research and Policy at the George Washington University (CHSRP) has developed a series of purchasing specifications for use by purchasers of managed care services. These specifications provide information and suggested language on key contracting issues for both Medicaid and other public and private sector purchasers as they prepare their purchasing agreements with managed care organizations. Development has been partially funded by CHSFMC. As of May 2002, a total of twenty purchasing specifications have been posted on the CHSRP website. An additional five are under development. The specifications fall into five broad groupings: (1) population-based; (2) service-related; (3) public health conditions; (4) specifications for operational issues; and (5) integrated specifications. They can be found at: www.gwhealthpolicy.org/managedcare_purchasingspecs.htm Purchasing Specifications Related to Pediatric Services: A User's Guide Many of the purchasing specifications developed by the Center for Health Services Research and Policy at the George Washington University relate directly or indirectly to the purchase of managed care services for children:
A User Guide has been developed to assist interested providers and
others in locating provisions in the twelve pediatric-related purchasing
specifications. By comparing different approaches to the same issue,
state officials, managed care organizations and behavioral health organizations,
providers, consumers, and other interested parties will gain a better
understanding of the policy options available to them. Interested purchasers,
in particular, will be able to draw from and, as appropriate, integrate
the different texts in order to develop language that precisely reflects
their own policy preferences. Best Practices in Cultural Competence from Award Winning HRSA Grantees Cultural Competence Works, a publication resulting from a national competition among HRSA grantees, describes a wide range of exemplary culturally competent methods and practices used by award winning organizations. This informative publication illustrates how these services add value to managed care arrangements, and enhances an organizations' ability to serve ethnically, linguistically and culturally diverse populations. Grantees included in the publication participated in a "Cultural Competence Works Competition" and were presented Awards for Excellence and Certificates of Recognition. Cultural Competence Works can be downloaded from the Center for Health Services Financing and Managed Care website at: www.hrsa.gov/financeMC It can also be ordered in hard copy from the HRSA Information Center at 1-888-ASK-HRSA or at: www.ask.hrsa.gov Other Resources: Brown Bag Managed Care Seminars for Federal Staff The Center for Health Services Financing and Managed Care continues to offer presentations on current managed care issues through "brown bag" lunchtime seminars available to all HRSA staff. It is available as well via Picture-Tel to Field Office staff, BPHC staff in East/West Towers, and CMS staff both in Baltimore and in Regional Offices. Recent topics have included: Applying Managed Care Principles to Vulnerable Populations; Relevance and Application of Guidelines in Managed Care For Children; and A Case Study on Risk Adjustment and Care of Populations with Special Needs. Information about future Brown Bag Seminars can be obtained by contacting the Center at 301-443-1550 or on CHSFMC's website: www.hrsa.gov/financeMC Technical Assistance Managed Care and Health Services Financing Technical Assistance Center
(MCTAC) Center for Health Service Financing & Managed Care (CHSFMC) Third Party Reimbursement Training & Technical Assistance Program
(TPR) Email Updates from CHSFMC Interested individuals can sign up for e-mail distribution of newly released studies and other managed care and financing information relevant to HRSA's grantees. Check the Center's website: www.hrsa.gov/financeMC HRSA Center for Health Services Financing and Managed Care Contact Information Address: Phone: (301) 443-1550 Staff: Rhoda Abrams, Director; Alexander Ross, Senior Health Policy Analyst; George Smith, Health Policy Analyst; Linda Welle, Health Policy Analyst; Lindsey Lonergan, Health Policy Analyst; Cindy Yen, Health Policy Analyst. Send questions or comments to: FinanceMC@hrsa.gov |
