g2 meeting

G2 MeetingOctober 3, 2013

Agenda

Managed Health Care for DFCS Children – Terri Branning

Outcome 8B – Counties Stock & Flow – Jim In County vs. Out of County Placements – Betsy

and Mable Outcome 2 – Carol Visitation and 8 in 8 - Counties

Managed Health Care for DFCS Children

Terri Branning

4

G2 PresentationOctober 3, 2013

Transition of Children in Foster Care, Receiving Adoption Assistance and Select Youth in Juvenile Justice to Medicaid Managed Care

5

Presenters

• Marcey Alter, Deputy Director, Division of Medicaid/Aging and Special Populations, Business Owner

• Terri Branning, Medicaid Business Analyst, DCH, Project Lead

• Earlie Rockette, Amerigroup, AVP Quality & Process Improvement, Project Lead

6

Purpose of Transition

• The transition of foster care, adoption assistance and juvenile justice members will create a new level of collaboration between DCH, DFCS, DJJ, DBHDD, DOE, DECAL and Amerigroup with a focus on:– Development of new relationships and processes to

facilitate the coordination of care for these members– Measureable improvement in physical and behavioral

health outcomes– Safety, permanence and well-being– Exchange of health information

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Multi-Agency Effort with Public Input

Member

DFCS

DJJ

DPH

DBHDD

DOE

Medicaid Division of

DCH

Stakeholders

DECAL

• An interagency task force of 7 child serving agencies was formed to address programmatic features, communication, health outcomes and education

• DCH also sought input from the Children and Families Task Force, as well as the Mental Health and Substance Use/Abuse Work Group

• Public Input• 2 public hearings• Online survey

8

Background

• DCH selected Amerigroup as the single statewide Care Management Organization (CMO) to serve eligible populations– The transition is effective 1/1/14

• Eligible Populations – approximately 27,000 members (approx. 8K members are in foster care)– Children, youth and young adults in foster care (new ACA rule up to 26

years)– Children and youth receiving adoption assistance– Children and youth enrolled in a home- and community-based waivers

(excluding the GAPP waiver) and in SSI– Youth in juvenile justice system placed in community residential care

9

Expenditures

• Foster Care and Adoption Assistance represent 1.4 % of Medicaid members and 2.1% of total Medicaid and CHIP expenditures

• High behavioral health (BH) needs for eligible populations• BH services represent 70% of total health care costs for members

in Foster Care and receiving Adoption Assistance• For members in community residential placement through the

juvenile justice system, BH services represent 87% of total costs

10

Not Business as Usual

• The new program will not be the same as current Amerigroup Georgia Families program

• New program will: – Provide additional care coordination and improved medical

oversight and health outcomes– Improve continuity of care when members transition into and out of

foster care– Improve access to necessary physical and behavioral health

services covered by the Medicaid program

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What’s Different?

• Care coordination team and health care plan for each member– Demonstration of individual health outcomes

• Virtual Health Record (VHR)• Dental Home• Monitoring & Oversight Committee and subcommittees• Value-based purchasing • NET change• Reporting

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What’s Different?

• Ombudsman staff – DCH will have 2 Ombudsman staff to advocate for foster

children and foster parents, plus members in adoption assistance and juvenile justice

– Amerigroup will have advocacy and ombudsman staff

– DCH and Amerigroup will continue to work with community advocates

13

What’s Different?

• Medication Management– Focus on psychotropic medications and ADD/ADHD

medications– Amerigroup will integrate management protocols with

DFCS/DJJ needs to ensure appropriate prescriptions, management and oversight• Emphasis on provider education

14

Agencies: What’s Different?

• Implementation in Year 1: – New processes, procedures and workflows between agencies– Interagency relationship: Enhanced collaboration and communication– Availability of health information through Virtual Health Record– Support for Kenny A. Consent Decree– Challenges:

• Changing culture at regional and county level• Critical for agencies:

– Consistency and standardization

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Current Priorities

Formed Interagency Workgroups with Amerigroup1. Communications, Education and Outreach2. Finance / Reimbursement / Accounting3. Information Technology / Health Information Technology4. Operations 5. Provider Network Development (includes recruitment and contracting)6. Transition of Care for members moving on 1/1/147. Use Cases

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Current PrioritiesFinal Workflows and Policies

– Develop and implement new workflows and policies across agencies

• Communication, Education and Outreach: – Agency staff– Providers (all types)– Members, foster parents, adoptive parents– Advocates and other stakeholders

17

Questions?

Outcome 8BCounties

Outcome Measure 8bChildren shall have had one of the following permanency outcomes within 12 months or less after entry: Reunification Permanent placement with relativesOr one of the following outcomes within 24 months: Adoption Permanent legal custody Guardianship

DeKalb P12 8B Cohort Children Who Entered Care During Period 12 and Who

Will Reach 24 Months in Care Between7/1/13 and 12/31/13

Newly Discharged 1Children Remaining Eligible 16•No/Unlikely 12•Yes 3•Possible 1

As of 10/1/13

Fulton P12 8B Cohort Children Who Entered Care During Period 12 and Who Will Reach 24

Months in Care Between

7/1/13 and 12/31/13

Fulton needs 2

additional 8b exits

by 12/31/13

10/3Newly Discharged

2 Pos.

Children Remaining

17

•No/Unlikely 13•Yes 2•Possible 2

Stock & FlowJim

What is “Stock and Flow?"

What is “Stock and Flow?"6-12 month “Tub”

13+ month “Tub”

Exits from Care

13+ month “Faucet Kids”

Exits from Care

Win Fabulous Prizes!!!

Children in Care 6-12 Months Dec 2012

Jan 2013

Feb 2013

Mar 2013

Apr 2013

May 2013

Jun 2013

Jul 2013

Aug 2013

Sep 2013

Number of Foster Care Cases open on the first day of the month 553 544 549 543 554 546 559 564 554 532 550

10 month average

Number of Children reaching 6 months total 19 18 24 27 24 19 11 29 15 27 213

10 month total

Number of Children reaching 13 months during the month 6 11 16 18 16 9 20 15 12 16 139

10 month total

Number of Children in care 6-12 Months exiting 3 4 5 6 1 10 2 4 16 6 57

10 month total

Number of Children in Care 6-12 Months on the last day of the month 133 131 135 141 147 146 137 143 128 128 137

10 month average

Discharge Reason Exits Exits Exits Exits Exits Exits Exits Exits Exits ExitsReunification 1 0 0 4 0 3 1 3 11 6Live with other relative 2 2 5 2 1 6 1 1 2 0Adoption finalized 0 0 0 0 0 1 0 0 0 0Guardianship 0 1 0 0 0 0 0 0 3 0

Positive Permanency Subtotal (a+b+c+d) 3 3 5 6 1 10 2 4 16 6 5610 month total

Emancipation 0 0 0 0 0 0 0 0 0 0Transfer to another agency 0 1 0 0 0 0 0 0 0 0Runaway 0 0 0 0 0 0 0 0 0 0Death of Child (May 2009 forward) 0 0 0 0 0 0 0 0 0 0Legal Status not mapped to AFCARS (May 2009 forward)0 0 0 0 0 0 0 0 0 0Total (a+b+c+d+e+f+g+h+i) 3 4 5 6 1 10 2 4 16 6

Positive Permanency Ratio:(a+b+c+d)/(D) 16% 17% 21% 22% 4% 53% 18% 14% 107% 22% 26%10 month average

Matriculation Ratio: (H)/(H+I) 67% 73% 76% 75% 94% 47% 91% 79% 43% 73% 71%10 month average

DeKalb

Children in Care 6-12 Months Dec 2012

Jan 2013

Feb 2013

Mar 2013

Apr 2013

May 2013

Jun 2013

Jul 2013

Aug 2013

Sep 2013


10 month average


10 month total

Number of Children reaching 13 months during the month 13 16 9 15 14 23 17 23 11 22 141

10 month total

Number of Children in care 6-12 Months exiting 6 4 8 10 3 6 9 4 6 9 56

10 month total

Number of Children in Care 6-12 Months on the last day of the month 153 153 157 158 158 151 134 113 123 105 144

10 month average




Positive Permanency Ratio:(a+b+c+d)/(D) 13% 20% 36% 32% 15% 22% 60% 33% 17% 69% 25%10 month average

Matriculation Ratio: (H)/(H+I) 68% 80% 53% 60% 82% 79% 65% 85% 65% 71% 72%10 month average

Fulton

All Children in Care 13+ MonthsDec 2012

Jan 2013

Feb 2013

Mar 2013

Apr 2013

May 2013

Jun 2013

Jul 2013

Aug 2013

Sep 2013


10 Month average


10 month total

Number of Children in care 13+ months exiting during the month 5 6 7 12 10 2 4 12 8 7 73

10 month total

Number of Children in Care 13+ Months on the last day of the month 256 256 253 253 262 260 275 275 262 263 262

10 Month average




Positive Permancy Ratio:(a+b+c+d)/D 67% 45% 38% 50% 44% 22% 20% 80% 42% 44% 44%10 Month average

DeKalb

All Children in Care 13+ MonthsDec 2012

Jan 2013

Feb 2013

Mar 2013

Apr 2013

May 2013

Jun 2013

Jul 2013

Aug 2013

Sep 2013


10 Month average


10 month total

Number of Children in care 13+ months exiting during the month 9 6 23 11 12 6 16 16 16 11 115

10 month total

Number of Children in Care 13+ Months on the last day of the month 395 402 378 378 386 399 389 388 365 370 387

10 Month average




Positive Permancy Ratio:(a+b+c+d)/D 54% 25% 211% 60% 79% 9% 88% 61% 127% 41% 67%10 Month average

Fulton

In County vs. Out of County Placements

Betsy and Mable

Outcome 2 UpdateKenny A. Consent Decree G2

Presented by: Carol Hall

Date: October 3, 2013

Georgia Department of Human Services

OUTCOME 2

Completion of CPS Investigations

Complete 95% of all CPS investigations of reported abuse or neglect within 30 Days of the report in accordance with …

Section 2106 of the Social Services Policy Manual

PAST PERFORMANCEAt least 95% of all investigations of reported abuse or neglect of foster children shall be completed within 30 days of receipt of the report

Reporting Periods

1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th

83% 78% 72% 72% 76% 84% 90% 66% 55% 77% 82% 81% 75% 73%

OUTCOME 2 IMPROVEMENT MEASURES

•November 2012 Formulated strategy for improvement

•February 2013 Initiated CAP

•April 2013 Identified members of work group

•May 2013 Held 1st work group meeting

•June Strengthened notification processDay 21: Send 2nd notice requiring update from case manager and supervisor; copy county & regional directorsDay 25: Send 3rd notice to regional & county directors requiring status

PERIOD 15 RESULTS

Goal 95%* Period 15 Performance 87%

Total 79Met 69Missed 10

* Not yet validated by AA’s

10 Misses Indicated by County

DeKalb (4)SSIU (2)Forsyth (1)Fulton (1)Taylor (1)Walton (1)

PERIOD 16 STATS-TO-DATE

Month to MonthMonth # of

Investigations Met Missed Counties

July 9 9 0 N/A

August 7 6 1 SSIU

September 15 15 0

October 9

July – December 2013

UPDATE

• Closed September with 15 cases

• Currently 9 open cases due to close in October • Currently at 97% for P16; Goal is 95%

• If (WHEN) all 9 cases close timely, we’ll end Oct @ 98%

OUTCOME 2 - Investigations Over 15 Days

Case Specific County County Director

Regional Director Due Date Investigating

County

Case Name: Dandora ColeCase/SHINES#: 17148497Child: Sincere Simon Gwinnett

D’Anna Liber(678) [email protected]

Lee Biggar(404) [email protected] 10/16/13 Open – 2 requests

Case Name: Gloria AsinorCase/SHINE#: 17150589Child: Brianna N. Sheffield Barrow

Holly Aguilar(770) [email protected]

Mary Havick(706) [email protected] 10/16/13 Open

Case Name: Ghislane LacroixCase/SHINES#: 17151473Child: Jasmine Williams Rockdale

Veronica Parrott

[email protected]

Randy Jenkins(404) [email protected] 10/16/13 Open

Case Name: Felisha PittsCase/SHINES#: 17151662Child: Ervin Harris SSIU

Carla Simms(404) [email protected]

Angela Coulon(404) [email protected] 10/18/13 Open

Case Name: Josef P. WinklerCase/SHINES#: 17151406Child: Nakayla Parks Fulton

Laurence Nelson(404) [email protected]

LaMarva Ivory(404) [email protected] 10/23/13 Open

mailto:[email protected]










OUTCOME 2 - Investigations Over 15 Days

Case Specific County County Director

Regional Director Due Date Investigating

County

Case Name: Wilhelmi RegisterCase/SHINES#: 17152720Child: Oasis & Leonidas Freeman DeKalb



Case Name: Christopher JacksonCase/SHINES#: 17152518Child: Marcus Phillips Fulton

Glenene Lanier(404) [email protected]


Case Name: Stephanie Miller-NdeneCase/SHINES: 17152909Child: Samuel Shareef DeKalb



Case Name: Patricia WallaceCase/SHINES: 17154302Child: Gerald Humbert DeKalb











County Visitation DataAugust 2013

8 in 8 VisitationCounties

QA Review of 8 in 8 : DeKalb Results for May 2013

20% review Initial Placements Planned Moves Disruptions Totals %

Number of children 11 5 4 20

Number of visits due 65 36 32 133

Number of visits made 48 24 29 101

Number of visits missed 17 12 3 32

Percent of visits made 74% 67% 91% 76%

All 8 in 8 requirements met 2 1 1 4 20%

All visits made but missed time or location requirement 1 NA 1 2 10%

At least one in-placement visit in the 1st wk 7 3 3 13 65%

At least one visit any location in the 1st wk 9 3 4 16 80%

Fulton 8 in 8 Sample Review = 20

May 2013 Initial Placements Planned Moves Disruptions Totals %

Number of children 10 5 5 20

Number of visits due 58 27 31 116

Number of visits made 37 21 18 76

Number of visits missed 21 6 13 40

Percent of visits made 64% 78% 58% 66%

All 8 in 8 requirements met 3 2 1 6 30%

All visits made but missed time or location requirement NA NA NA NA NA

At least one in-placement visit in the 1st wk 8 5 5 18 90 % =

At least one visit any location in the 1st wk 10 5 5 20 100%

DeKalb County

PlacementVisitation Data

FINAL

August 2013

DeKalb County

August2013

OM 20A

Child Visits

Administrator Supervisor

Required Made %

Lyles458/46398.92%

Cox 131 131 100%

Hill 122 118 96.72%

Njenga 134 133 99.25%

Scott 76 76 100%

Hicks Blake N/A N/A N/A

Johnson320/320100 %

Hall 74 74 100%

Jacob 100 100 100%

Pertiller 66 66 100%

Doe 80 80 100%

Rayne219/219

100%

Alston 107 107 100%

Garrett 112 112 100%

Summary 1002 997 99.50%Excellent 96.25% or greater

Good 92% - 96.24%

Needs Improvement <92%

Kenny A. Mandate 96.25%

DeKalb County

August2013

OM 20B

ChildPrivateVisits

Kenny A. Mandate96.25%

Excellent 96.25% or greater

Good 92% - 96.24%



Required Made %

Lyles238/238

100%

Cox 67 67 100%

Hill 63 63 100%

Njenga 69 69 100%

Scott 39 39 100%

HicksN/A Blake N/A N/A N/A

Johnson165/165

100%

Hall 40 40 100%

Jacob 52 52 100%


Doe 40 40 100%

Rayne112/112

100%

Alston 55 55 100%

Garrett 57 57 100%

Summary 515 515 100%

DeKalbCounty

August 2013

OM 21

Reunification

Visits

Excellent 85% or greater

Good 75% - 84.9%


Kenny A. Mandate 85%

Administrator

Supervisor

Required Made %

Lyles60/6198.4%

Cox 2 2 100%

Hill 29 29 100%

Njenga 30 29 96.7%

Scott 0 0 N/A


Johnson80/8198.8%

Hall 18 18 100%

Jacob 25 24 96.0%


Doe 18 18 100%

Rayne64/6598.5%

Alston 30 30 100%

Garrett 35 34 97.1%

Summary 207 204 98.6%

DeKalb County

August 2013

OM 22

CaretakerVisits



Good 87.5% - 94.9%

Needs Improvement <87.5


Required Made %

Lyles234/234

100%

Cox 66 66 100%

Hill 61 61 100%

Njenga 68 68 100%

Scott 39 39 100%


Johnson159/159

100%

Hall 34 34 100%

Jacob 52 52 100%


Doe 40 40 100%

Rayne109/11099.1%

Alston 54 54 100%

Garrett 56 55 98.2%

Summary 503 502 99.8%

DeKalbCounty

August 2013

OM 23

Sibling Visits


Good 80% - 89.9%



Administrator

Supervisor

Required Made %

Lyles25/2889.3%

Cox 8 8 100%

Hill 7 7 100%

Njenga 4 4 100%

Scott 9 6 66.7%

Hicksn/a Blake N/A N/A N/A

Johnson24/24100%

Hall 10 10 100%

Jacob 5 5 100%

Pertiller 3 3 100%

Doe 6 6 100%

Rayne6/6

100%

Alston 4 4 100%

Garrett 2 2 100%

Summary 58 55 94.8%

OM Goal Mar Apr May June JulyAugus

t

Child Visits20 A 96.25% 98.78% 98.13% 97.93% 97.96% 98.95% 99.50%

Child Private

20 B 96.25% 100% 99.62% 99.42% 99.43% 99.63% 100%

Reunification 21 85% 95.2% 92.3% 92.6% 91.7% 95.3% 98.6%

Caretaker 22 95% 98.8% 97.7% 97.5% 97.5% 98.5% 99.8%

Sibling 23 90% 97.0% 93.4% 95.1% 90.2% 89.2% 94.8%

DeKalb CountyVisitation Summary

March 2013 to August 2013

Fulton County

PlacementVisitation Data

FINAL

August 2013

Fulton County

August2013

OM 20A

Child Visits


Good 92% - 96.24%


Admin

Supervisor Required Made %

Russell

99.2%

Beasley 121 121 100%Greene 69 68 98.5%Hudson 105 105 100%Rudd 83 81 97.5%

Walker

100%

Haynes 105 105 100%Jemison-Gordon 93 93 100%

Trim 92 92 100%

Williams

98.0%

Booker 117 116 99.1%Carbins 117 114 97.4%Fulton 98 95 96.9%Scott-Morrow 77 76 98.7%

Summary 1077 1066 98.9%Kenny A. Mandate 96.25%

Fulton County

August2013

OM 20B

Child PrivateVisits


Good 92% - 96.24%


Admin


Russell

99.4%

Beasley 62 62 100%Greene 36 36 100%Hudson 55 55 100%Rudd 44 43 97.7%

Walker

100%

Haynes 57 57 100%Jemison-Gordon 48 48 100%

Trim 48 48 100%

Williams

99.0%

Booker 60 60 100%Carbins 59 59 100%Fulton 50 48 96.0%Scott-Morrow 42 42 100%Summary 561 558 99.4%Kenny A. Mandate

96.25%

Fulton County

August2013

OM 22

Caretaker

Visits


Good 87.5% - 94.9%

Needs Improvement <87.5


Admin


Russell

98.4%

Beasley 60 60 100%Greene 35 35 100%Hudson 53 53 100%Rudd 40 37 92.5%

Walker

97.4%

Haynes 57 53 93.0%Jemison-Gordon 47 47 100%Trim 47 47 100%

Williams

98.0%

Booker 59 58 98.3%Carbins 57 56 98.2%Fulton 50 49 98.0%Scott-Morrow 39 38 97.4%

Summary 544 533 98.0%

Fulton County

August2013

OM 21

Reunification

Visits


Good 75% - 84.9%



Admin


Russell

95.4%

Beasley 25 25 100%Greene 23 19 82.6%Hudson 26 26 100%Rudd 35 34 97.1%

Walker95.7%

Haynes 5 5 100%Jemison-Gordon 18 17 94.4%

Williams

92.9%

Booker 30 29 96.7%Carbins 42 39 92.9%Fulton 27 23 85.2%Scott-Morrow 13 13 100%

Summary 244 230 94.3%

Fulton County

August 2013

OM 23

Sibling Visits


Good 80% - 89.9%



Admin


Russell

93.6%

Beasley 13 10 76.9%Greene 10 10 100%Hudson 10 10 100%Rudd 14 14 100%

Walker

100%

Haynes 4 4 100%Jemison-Gordon 14 14 100%Trim 2 2 100%

Williams

100%

Booker 13 13 100%Carbins 14 14 100%Fulton 5 5 100%Scott-Morrow 8 8 100%Summary 107 104 97.2%

OM GoalMarc

h April May June July Aug

Child Visits20 A

96.25%

98.8%

96.8%

97.4%

98.9%

99.3%

98.9%

Child Private20 B

96.25% 100%

98.2%

98.5%

98.6%

99.8%

99.4%

Reunification 21 85%94.4

%90.5

%93.7

%95.8

%94.8

%94.3

%

Caretaker 22 95%98.2

%97.2

%96.5

%98.1

%99.1

%98.0

%

Sibling 23 90%97.8

%93.5

% 100%98.5

%98.4

%97.2

%

Fulton CountyVisitation Summary

March 2013 to August 2013

g2 meeting

Documents

coordination of care

agendamanaged health

expendituresfoster care

total health care costs

medicaid managed care

foster care new aca

community residential

additional care coordination