From: To: Subject: Date: Norman Chris P Scott Chad D; WILCOX Richard A RE: KEPRO representation Friday, December 22, 2017 4:33:12 PM Hi Chad, I think the group that Rick is heading up will be looking at solutions like this, but I am concerned that we do it in a way that’s sustainable. I look forward to more discussion about how we can make this happen. ________________________________________________________________ Chris Norman, MBA Director – Integrated Health Programs OREGON HEALTH AUTHORITY Health Systems Division Email: Chris.P.Norman@state.or.us Desk: 503.945.7818 Mobile: 503.884.5643 www.oregon.gov/OHA Assistant: Paige.K.Hook@state.or.us desk: 503.793.2533 From: Scott Chad D Sent: Friday, December 22, 2017 4:04 PM To: WILCOX Richard A Cc: Norman Chris P Subject: RE: KEPRO representation It seems like OHA is trying to respond to Kepro’s outcomes, those outcomes being, OHA is forced to authorize Medicaid payment for services that have been determined as not medically necessary due to limited access or options for housing or services and supports outside of a licensed or institutional setting. There are improvements in the ways Kepro does their work, but the scope of work and the contract are basic, CMS gives OHA criteria and OHA ensures that criteria is met in order to receive 60% reimbursement of Medicaid expenditures. The Kepro contract is funded 75% by CMS and has been approved by CMS, so I’m confused why this seems like a workgroup about the Kepro contract versus answering the question, Why can’t Medicaid members in Oregon with a behavioral health condition simply receive needed services and supports in a setting they choose or the most integrated community setting possible for their level of recovery? Did you see my email yesterday? There are literally dozens of funded and staffed projects within OHA that are intended to and could resolve our current dilemma but are simply not being done or 2018-0867 016 12/19/2018 are performed and managed so poorly that they either don’t exist or exist as a useless resource for providers and members. Kepro can listen to, respond, adjust and fix any issues with their process or staff, but without a new majority focus on the absolute failings of other units and projects that have not only contributed to this issue but have caused it, we will simply be refining the piece of work that is illuminating the failures or others. The best starting point really is to develop a simple inventory of current projects that are or could be a resource for Medicaid members determined able to live outside of a licensed setting. A good example is the UCC MAX charge I put together this morning. With a simple action, OHA can invest $300,000 a year in an HCBS procedure code that will result in 100 additional people having access to home based habilitation and the opportunity to receive the same services and supports in their own home they receive in a licensed setting. If you do the math, that’s a pretty good investment. $300,000 a year versus (residential PMPM as of 11/21 is $4207 = (4207x12)100 = $5,642,400.00). That’s a $5.3 million dollar return on investment for just adjusting 1 HCBS code/rate for 1 provider = not to mention the reduced risk to OHA to not have to fund $5.3 million dollars in non-medically appropriate services. Why isn’t OHA doing things like this every day all day? I’ve invited you to a meeting with Homewatch to hear their ideas about how to improve the transition and authorization process for members leaving licensed care and transitioning into their services. Take note of this tone in the email. It’s a good example of the type of delivery system we could have in place of the current system we do. These providers want people in the community, how can we get more of that? If we have that, Kepro doing good work wouldn’t be such a crisis for OHA. From: WILCOX Richard A Sent: Friday, December 22, 2017 3:05 PM To: Scott Chad D Cc: Norman Chris P Subject: Re: KEPRO representation Hi I think we’re just going with that as an interim name. I am drafting a charter, but if you take a look at the draft work plan I sent out the other day, it should give you a decent idea of what I can see as the scope.I’d appreciate any feedback you might have. Thanks and happy holidays. 2018-0867 017 12/19/2018 Sent from my iPhone On Dec 22, 2017, at 2:38 PM, Scott Chad D wrote: This group is titled “inpatient challenges” and that seems inaccurate. What would you say is the purpose and intent of this workgroup? From: Debra Brooks [mailto:dbrooks@kepro.com] Sent: Friday, December 22, 2017 1:58 PM To: Scott Chad D ; WILCOX Richard A Cc: Norman Chris P ; Maggie Klein ; Jared Nyagol Subject: RE: KEPRO representation Thanks for the invite, Rick. I would be happy to attend. As a matter of fact, it’s already on my calendar. It was great to see you, yesterday at the Exec. Plus one meeting. Have a great holiday. Debra Debra Brooks, LCSW Manager, Behavioral Health KEPRO 1750 Blankenship Rd. Suite #425 West Linn, Or 97068 844-658-1729 x4696 503-404-4092 x4696 844-673-8034(f) dbrooks@kepro.com Connect with KEPRO: LinkedIn www.KEPRO.com This transmission is intended only for the use of the addressee and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you are not the intended recipient, or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you received this e-mail communication in error, please immediately notify the sender by replying to the communication. Thank you 2018-0867 018 12/19/2018 From: Scott Chad D [mailto:CHAD.D.SCOTT@dhsoha.state.or.us] Sent: Friday, December 22, 2017 12:55 PM To: WILCOX Richard A Cc: Norman Chris P ; Maggie Klein ; Debra Brooks Subject: RE: KEPRO representation You can reach out. I would suggest Maggie and Debra, both included on this email. Thanks From: WILCOX Richard A Sent: Friday, December 22, 2017 12:38 PM To: Scott Chad D Cc: Norman Chris P Subject: KEPRO representation Hi Chad, We have another “Inpatient Challenges” meeting on January 10 from 3-3:45. We’d like to get someone from KEPRO to attend. Who would you suggest? Debra Brooks? Whoever it is, would you prefer to reach out to them, or would you like me to do it? Thanks Rick Wilcox Olmstead Policy Coordinator OREGON HEALTH AUTHORITY Health Policy and Analytics Behavioral Health Policy Unit Richard.a.wilcox@dhsoha.state.or.us Desk: (503) 945-5955 Mobile: (503) 884-8764 http://www.oregon.gov/OHA Confidentiality Notice: This e-mail and any attached files are confidential. Be advised that any unauthorized use of this e-mail and attachments is prohibited. If you have received this e-mail in error, immediately notify the sender by e-mail or telephone, and destroy this message and all attachments. 2018-0867 019 12/19/2018