Agenda - 5-2-16 Reg. Meeting - Laserfiche WebLink

Home Browse Search

Service Rate Increases Provide 034 Improved Access Increasing Throughout 2015, Sandhills Center increased reimbursement rates to providers for certain services to assist our network in offering high-quality services to people in the reimbursement communities we serve. Here are some details: rates ensures Evaluation and Management (E/M) Coding reimbursement rates increased those who are by 13 percent. These codes provide psychiatrists, non -psychiatric physicians, physician assistants and nurse practitioners the ability to effectively plan and served receive monitor integrated treatment around clinical history, examination and medical the highest decision-making. It allows people to receive individualized treatment based on their personal history and clinical care plan. It also gives providers an opportuni- quality of care. ty to be reimbursed for the care - both for the amount of time that is needed to counsel individuals, and to directly provide their care. This coordination of care is equally important as it supports the expectation that licensed clinicians and contracted providers work within an integrated physical and behavioral health framework that is accountable for achieving objectives and sustaining improvements in patients' outcomes. These outcomes include various quality indicators of behavioral and physical health. By increasing the E/M code rates, Sandhills Center is supporting licensed clinicians and providers in this integration of care work. We are continuing our commitment to ensuring those who are served receive the highest quality of care (that which is medically necessary) by contracted providers with the expertise to meet individu- als' clinical needs. The reimbursement rate to providers of community-based Intermediate Care Facilities (ICF) increased by five percent. These facilities provide a specialized residential option for care 24 hours a day, seven days a week. ICFs also provide treatment over an extended period of time for individuals with intellectual and developmental disabilities. This service offers the wrap-around support necessary for people to live in their communities, and promotes the attainment of the highest level of independent living while also offering assistance with physical and medical needs. ICF services are both comprehensive and individualized to effectively meet people's unique needs. Within 30 days of admission, each individual who receives ICF services must have an Individual Program Plan tailored to their specific situation. This must include opportunities for individual choice and self-management. The plan identifies goals for the individual to achieve, and describes individualized programs and supports to be used. Due to the intensity of services offered, ICF providers must meet and demonstrate a commitment to ongoing rigorous standards. These standards include participa- tion in the Certificate of Need process for the development or expansion of ICF services, licensure through the North Carolina Division of Health Service Regula- tion, network and utilization management requirements through the Local Management Entity/Managed Care Organizations (LME/MCOs), and regular monitoring by regulatory agencies.