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Hardy Presents Update on Critical OMAP Activities
August 19, 2004

Mr. Jim Hardy, currently serving as the project manager for Fee-For-Service Operations and Policy in the Office of Medical Assistance (OMAP) met this week with the PCPA Executive Committee. Mr. Hardy provided updates on several OMAP related projects. The updates included:

1. Access Plus. Mr. Hardy provided an extensive overview of OMAP’s efforts to "manage care" in the current fee-for-service (FFS) areas. With the delay in expansion of the HealthChoices program, OMAP plans to expand the use of the Primary Care Case Management (PCCM) model into all FFS areas. The goals of this plan include improving quality and access in management of care to FFS eligibles and containing cost growth. While the Access Plus program will exclude behavioral health services, PCPA providers in non-HealthChoices locations should be aware of the changes in physical health care coverage for Medical Assistance (MA) enrollees. The Access Plus program will reach over 240,000 enrollees in 42 counties. The Access Plus program will be administered by a single statewide vendor, with a Request for Proposals scheduled for release this week. The initial contract will be for a 28 month period, effectively delaying any HealthChoices expansion (physical health only) for that period. Utilizing enhanced primary care case management and incorporating various disease management components Mr. Hardy emphatically stated that vendors must implement a plan to deal with consumers with behavioral health comorbidity. A presentation on Access Plus is available.

2. Medicare Drug Program. Mr. Hardy also addressed the pending problems to be faced by "dual-eligibles" when the new Medicare Drug Prescription program is fully implemented. OMAP is very concerned about the impact on many consumers, including behavioral health consumers. In spite of regulations over 1000 pages in length, Mr. Hardy indicated there are many unanswered questions that will impact pharmacy services.

3. OMHSAS/OMAP. Mr. Hardy indicated that discussions continue between the Office of Mental Health and Substance Abuse Services (OMHSAS) and OMAP around the most effective ways to set policy and manage the behavioral health component of the MA program. In a prior meeting with the PCPA Executive Committee, OMHSAS Deputy Secretary Joan Erney indicated such plans were being considered whereby OMHSAS would assume the policy and budget management for MA funds.

4. In a brief discussion around Residential Treatment Facility (RTF) rate setting, Mr. Hardy indicated a willingness to work with PCPA to resolve issues. Connell O’Brien, PCPA Policy Specialist will be developing a list of problems in this area.

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