HomeMy WebLinkAboutItem 06 Approval to Terminate the City’s Mental Health Services Contract with Heartspoken/Gilstrap Counseling, Inc., on March 1, 2019 ocoee
florida
AGENDA ITEM COVER SHEET
Meeting Date: 11/20/2018
Item # 6
Reviewed By:
Contact Name: Gene Williford, HR Director Department Director:
Contact Number: (407) 905-3154 City Manager: �A rii��
Subject: Termination of the City's Mental Health Services Contract with eartspoken/Gilstrap
Counseling, Inc. effective March 1, 2019.
Background Summary:
The City's Health insurance agent, The Crowne Group, is recommending the termination of the City's contract
with Heartspoken/Gilstrap Counseling, Inc. due to the implementation by Florida Blue of a capitation program
on Mental Health and Substance Abuse coverage on group health plans like the City's.
Issue:
Effective January 1, 2018 Florida Blue began charging a "capitated" per member/per month rate to manage
behavioral health services. Currently, the City contracts directly with Heartspoken/Gilstrap Counseling, Inc.
Recommendations
Terminate the City's contract with Heartspoken/Gilstrap Counseling, Inc. effective March 1, 2019.
Attachments:
Letter from The Crowne Group
Email from Florida Blue
Financial Impact:
The City will be required to pay $3.76 per member/per month for 2018 and $3.86 per member/per month for
2019. This will be required regardless of whether or not the City continues with Heartspoken/Gilstrap
Counseling, Inc. Termination of the contract with Heartspoken/Gilstrap Counseling, Inc. will result in financial
savings to the City of approximately $70,000 annually.
Type of Item: (please mark with an `x)
Public Hearing For Clerk's Dept Use:
Ordinance First Reading X Consent Agenda
Ordinance Second Reading Public Hearing
Resolution Regular Agenda
Commission Approval
Discussion&Direction
Original Document/Contract Attached for Execution by City Clerk
Original Document/Contract Held by Department for Execution
Reviewed by City Attorney N/A
Reviewed by Finance Dept. D•tiv __."—, N/A
The Crowne Group
October 3, 2018
Gene Williford
Human Resources/Risk Management Director
City of Ocoee
150 N Lakeshore Dr.
Ocoee,FL 34761
Re: Heartspoken/Gilstrap Counseling, Inc.
Mental Health Services Agreement
Dear Gene:
As you are aware, effective January 1, 2018, FL Blue implemented a capitation program
on Mental Health and Substance Abuse coverage offered on your group health plan.
They implemented the program on all ASO groups to reduce the rising cost of mental
health and substance abuse treatment. The program covers all members enrolled on your
group health plan and the capitation fee is billed monthly on a per member per month
basis.
That said it is Crowne's recommendation to discontinue the Mental Health Services
Agreement with Heartspoken/Gilstrap Counseling, Inc. effective January 1, 2019. If the
City proceeds with Crowne's recommendation, this should be communicated to all
members to avoid disruption for anyone currently receiving services from Heartspoken,
perhaps at open enrollment this year,
Since Heartspoken/Gilstrap is not a part of FL Blue's network, any member that
continues utilizing them after the contract is terminated will be considered out of network
and could be balance billed after the appropriate deductible and co-insurance is applied.
If there are any questions,members can contact FL Blue directly to be advised on how to
find a provider that is covered in the network.
Sincerely,
p •tL ���.�. �Q L 'Yt�V VLA
Roxane Herbstsommer
Account Management
2710 Rew Circle,Suite 200 Ocoee,FL 34761 (407)654-5414 p(407)654-9614 f
Bertling,Debbie
From: Williford,V.Gene
Sent: Thursday,December 07,2017 9:55 AM
To: Bertling,Debbie
Subject: Re:Florida Blue-Claims Invoice Capitation for BH/SA services
Thanks,
Sent from my iPhone
On Dec 7, 2017, at 7:14 AM, Bertling, Debbie<dbertling@ci.ocoee.fl.us>wrote:
Not sure if you got this email from Renee so I'm copying you on it.
From: Neal, Sharlene R [mailto:Sharlene.Neak bcbsfl.com]
Sent: Wednesday, December 06, 2017 6:39 PM
To: Bertling, Debbie
Cc: Roxane Herbstsommer (rherbstsommer@crowneinc.com); Eppl, George
Subject: Florida Blue-Claims Invoice Capitation for BH/SA services
Hi
Behavioral Health and Substance abuse has become a significant concern for employers. For example,
Opioids are now the leading cause of accidental death in the U.S., Opioid addiction declared a state of
emergency in Florida, broader substance abuse treatment coverage with little oversight can result in
significant fraudulent substance abuse treatment practices, the diagnosis of Autism Spectrum Disorder(ASD)
has more than doubled over the last two decades
New Directions Behavioral Health (NDBH) and Florida Blue partnered since 2011 to manage behavioral health
services and associated cost and quality. Effective 1/1/18 billing,ASO groups will be charged a capitated
(PMPM rate) amount for services on the claims invoice.
The risk arrangement with NDBH will work differently than some of our other capitation arrangements
- Provider claims will continue to be paid at a fee-for-service rate by Florida Blue to
minimize any disruption
Some services are not included in the PMPM rate. For these services, claims will be paid based on the FFS
allowance just as they have in the past. Examples include:
- Inpatient care for treatment of dementia
- Psychological testing performed by a medical provider
- Professional outpatient care for a mental health/substance
abuse diagnosis when performed by a primary care medical
provider
The new risk arrangement was developed with employer strategies in mind:
- Employers are looking for longer-term cost predictability that comes with a risk arrangement
- PMPM rate provides protection from unanticipated annual costs
- Risk arrangement is most appropriate to enable controls to hinder fraud, waste and abuse
Together, we are intensifying efforts to address the escalating issues impacting Behavioral Health in multiple
ways
1. Addressing the increase in fraudulent practices:
- Applying more scrutiny on providers being considered for contracting, expanding background
checks especially for residential treatment centers and sober home living
- Implementing new processes using data and analytics to identify fraudulent practices
1
• - More stringent reviews of medical records focused on delivery of and payment for appropriate
care which follow standards and protocols
2. Addressing cost and quality:
- Provider Rate Reduction Initiative
- Movement to a Risk Arrangement between NDBH & Florida Blue
In addition to the new financial arrangement, NDBH will be enhancing their utilization management approach
to drive higher quality and lower costs with a focus on medical necessity review for higher levels of care and
select outpatient procedures.
Please let us know if you have any questions or concerns
S. Renee Neal I Account Management Specialist
Office: 407-833-7709 I Fax: (407)804-4568 I Cell: (407)491-8871
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