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Behavioral Health

Buckeye Partners with Community Mental Health Centers for Enhanced Care Management Program

Buckeye will soon launch a new program, BuckeyeSpectrum, designed to enhance treatment of Schizophrenia Spectrum Disorders for its members. BuckeyeSpectrum is a first of its kind, collaborative program with partnership between Buckeye and community mental health providers. Buckeye has partnered with community mental health centers that use current evidence-based best practices for the treatment of schizophrenia spectrum disorders. These treatment modalities include interventions designed for implementation with first episode psychosis and interventions designed for ongoing schizophrenia.

Combined therapies to target all areas affected by schizophrenia

In recent years, research has revealed effective methods for addressing all symptoms of schizophrenia spectrum disorders. First line treatment for schizophrenia has typically been administration of antipsychotic medications. While great strides have been made in the formulation of new medications to treat schizophrenia, these medications do little to address the negative symptoms (lack of motivation, lack of reported enjoyment of and quality of life, difficulty interacting socially) or cognitive dysfunction (difficulty with memory, executive function, attention) present in individuals with diagnoses of schizophrenia spectrum disorders. Research into and application of combined therapies to target all areas affected by schizophrenia has shown improved positive outcomes for individuals who live with schizophrenia.

Collaboration with community health centers

Buckeye has developed methods for working collaboratively with community mental health centers to enhance the therapeutic work that can be done with clients to improve their overall quality of and enjoyment of life. These community agencies are already utilizing the most recent evidence-based treatment methods in their work with individuals with diagnoses of schizophrenia.

BuckeyeSpectrum provides:

  • regular communication and collaboration with the clinical treatment team for clients affected by schizophrenia
  • the ability for clinicians at mental health centers to access consultation with entities such as Project ECHO without losing revenue from a client session or psychiatry appointment that would have taken place during the time of the consult.
  • the ability to contribute to work those clients are doing related to development of social skills and improved quality of life.
  • the ability for clients to have opportunities to participate in activities that allow them to practice social skills and allow them to experience an increased level of enjoyment in their day-to-day lives. The activities individuals with a diagnosis of schizophrenia can engage in as participants in BuckeyeSpectrum give them opportunities to employ the skills they are working on related to cognitive enhancement, memory and attention.
  • the program will allow individuals’ treatment teams to assist in meeting basic social determinants of health needs that might be present for those individuals. The reduction of stress presented by financial, social, education, health care, and neighborhood conditions will allow individuals to focus on improvement of cognitive, social and employment skills without the barriers of social determinants of health challenges.

BuckeyeSpectrum is designed to enhance the ability of our community partners and our members to experience the best quality care for schizophrenia spectrum disorders.  By enhancing collaboration with community mental health clinicians, we provide high quality, state of the art, fully inclusive care to individuals with diagnoses of schizophrenia spectrum disorders. 

Behavioral Health Readmission Policy

Effective November 18, 2021, the Managed Care Entity (MCE) members of the Ohio Association of Health Plans (OAHP) received approval from the Ohio Department of Medicaid, to implement a single MCE standard 30-Day Behavioral Health Readmission Policy and associated claims and clinical review programing.

Readmission Recoupment Policy (PDF)

Background

Effective November 18, 2021, the Managed Care Entity (MCE) members of the Ohio Association of Health Plans (OAHP) received approval from the Ohio Department of Medicaid, to implement a single MCE standard 30-Day Behavioral Health Readmission Policy and associated claims and clinical review programing.

Summary

The policy and the associated claims and clinical review program reviews all qualifying behavioral health readmissions occurring within 30 days to determine if the readmission was a preventable clinically related readmission. The policy articulates the quality and documentation expectations for the roles and responsibilities of various entities involved in the treatment and discharge planning of an individual with a behavioral health concern who requires hospitalization.

Please note the following highlights from policy revisions:

  • Reviews will be limited to readmissions to same facility as initial admission;
  • Pertinent and complete medical records for both admissions must be included with the claim submission to determine if the admission(s) is appropriate or is considered a preventable clinically related readmission;
  • Failure to provide complete medical records for a post-service clinical readmission review will result in an automatic administrative denial of the claim for the readmission
  • Prior Authorization processes and determinations are separate from any readmission review processes and determinations.

Impact

Payments for readmissions determined to be a preventable clinically related readmission will be adjusted to collapse the admissions into a single DRG payment.

Questions

To review the full policy, including policy effective date, for each MCE, and for any questions, please navigate to the appropriate MCE’s policy website and/or outreach to the MCE’s Provider Service’s Department.

Ohio Managed Care Plans

MCE

WEBSITE

PROVIDER SERVICES

Buckeye Community Health Plan

Buckeye Health Plan/providers

866-296-8731

CareSource

CareSource/providers/tools-resources/health partner policies

800-488-0134

Molina Healthcare of Ohio

Molina Healthcare/providers/OHl/Medicaid/home

855-322-4079

Paramount

Paramount Healthcare/services/providers/medical policies

800-891-2542

Aetna Better Health of Ohio

Aetna Better Health/ohio/providers/portal

 

1-855-364-0974 (TTY: 711)

Behavioral Health Resources