Pays Medicaid for urgent care

Georgia Collaborative ASO

The Georgian Ministry of Behavioral Health and Developmental Disorders (DBHDD) has signed a contract with Beacon to provide administrative services in support of Georgia's publicly funded Behavioral Health and Mental and Developmental Disorders (IDD) system.

The insured population includes adults and children who are eligible for Medicaid for a fee and those who are not, as well as people with intellectual and developmental disabilities.

Services include:

  • Maintaining a 24-hour crisis and access line for behavioral health and mental and developmental disabilities services.
  • Use of the latest technologies to increase efficiency and improve the quality of care.
  • Providing focused usage management and review services for intensive services and an optimized process for less intensive services.
  • Monitoring and advising quality management for all providers of behavioral health and intellectual and developmental disabilities.

Beacon works as Georgia Collaborative ASO and works with long-time participants of the Georgia Health Care Behavioral Health Link (BHL) and Qlarant (formerly Delmarva Foundation):

  • BHL, a national network center for suicide prevention, has operated the Georgia Crisis & Access Line (GCAL) since 2006. GCAL is available to all Georgians around the clock.
  • Qlarant conducts person-centered reviews, quality improvement provider reviews, and other quality monitoring and reporting services relevant to the IDD quality management system.

PROGRAM FEATURES

The collaborative ensures access to high quality services and support services for the individuals covered by the following program components:

Georgia Crisis and Access Line

The GCAL operated by the BHL is a crisis response model for the mobile crisis and the coordination of services via an interactive system for emergency rooms, mobile crisis teams and crisis stabilization units.

GCAL employees offer crisis intervention by phone, mobile crisis dispatch services, urgent outpatient scheduling and referral tracking services for all government-funded crisis and inpatient beds.

Provider registration

The collaboration prospectively ensures that providers meet quality and compliance standards to provide community behavioral health services or mental and developmental disorder services. We also process vendor additions and changes in the network of approximately 675 IDD and behavioral health care providers. In 2018, we approved more than 1,000 provider requests and updates to ensure individuals have access to care and providers are paid.

Usage management

We ensure that individuals in need of behavioral health and mental and developmental disability services are given the right service at the right place at the right time, especially for higher levels of care, through prior approval and assessment. Beacon exceeded all initial and concurrent review thresholds with a 99% freshness metric for all care levels.

Nursing coordination

Our community-based care coordination program supports and serves individuals within behavioral health and the concurrent population with intellectual and developmental disabilities who have the most complex care needs and are in critical transition phases.

The program includes regionally based "recovery teams" made up of licensed Specialized Care Coordinators, Certified Peer Support Specialists (CPS) who may also be Certified Addiction Recovery Empowerment Specialists (CARES), and Community Transition Specialists (either CPS or CARES) .

Quality management

We conduct on-site quality audits of behavioral, mental and developmental health care providers to ensure they are continually improving quality in several state-determined dimensions of service delivery. As part of the on-site visits and afterwards, the providers receive training and technical support in order to improve identified problems in the provision of services.

In fiscal 18, we visited almost 200 behavioral medicine providers. Thanks to our training and technical support, we have helped improve assessment results in all four dimensions of the quality review tool.

Also in fiscal year 18, 162 IDD service providers received Quality Technical Assistance Consultations (QTAC). QTAC uses the results of quality checks to provide IDD providers with additional technical assistance to improve service delivery.

Pre-Screening and Resident Reviews (PASRR)

PASRR is a federally prescribed evaluation program to ensure that people are adequately accommodated in care facilities. Beacon completed more than 150 clinical
Monthly Level II evaluations to identify the need for placement in a qualified care facility and provide a range of service recommendations for providers in developing a personalized care plan for those with behavioral health needs.

FUTURE PROGRAM EXPANSIONS

Start of the IDD Case Management System:
Using technology to improve continuity of care

In fiscal year 19, ASO will introduce a new web-based case management system to facilitate the ingestion, assessment, monitoring and delivery of services for people with intellectual disabilities. The introduction of the system also includes several training events under the direction of the cooperation partner Qlarant.