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Home My WebLink AboutHandouts_Workshop_AOM _03/04/2013_Futures � � � / � � � � - � • � - � - � 3 . , � - � , ` ( `��_�� /�� _��\/� - ��1�� i ,�11>;- ��fr�� FU U RES _ � ; --- �i�� - - - .a t'ERSC)NAUZED TREATtitENT FC�R EATING DISC)RDEf2S &ADDICTIC�NS ' � � � � G � � � ! �� c� �v , Y� �, � { _ �:�, �� ,,.y .� � = � � � t�t 1 �(��?R7� ��"�4.. . �� - � ��Y � �t 1 - *k .1� TU ��. ' 1 . � 7:: �,:;;r Z'°",.�.�"n��. i .�.z � ,.?b , r�1 ` � -� . . - - Summa � • Futures of Palm Beach ("Futures") wishes to adapt to the changing landscape of high-end drug and alcohol and eating disorder programs in the United States by allowing partial payment of our client services fee through health insurance. • The goal of the initiative is to provide clients with the ability to offset a portion of their : cash burden by utilizing health insurance. �• A significant percentage of clients have the financial ability to pay the full client ''� services fee in cash, but desire to offset a portion of this cash burden with their �� existing health insurance, similar to what they currently do with regular doctor visits, ' hospital stays and prescription drugs. • The client services fee will remain at a level that classifies Futures as a high-end program and facility. The balance of the fee that is NOT covered by health insurance remains the responsibility of the client. • In order to capitalize on the third party insurance initiative, Futures needs to obtain additional licenses STRICTLY for billing purposes. ,;. __ • Cathy Claud, former Substance Abuse Service Coordinator for DCF of Southeastern --' "`� � .-�� -°- Florida, has agreed to consult for Futures to obtain the required licenses. She can - �,�, �s ,?•; .�= assure the Village of Tequesta that the additional licenses are needed STRICTLY for ,.,., =_ _ . ` , �. - E� l�1 U 1=. �- the billing of health insurance providers for clients who have contracted for a minimum "`°'" 30-day stay in Futures' residential treatment program. �`�� i � �� 2 - r c •e_s i '"��"�)�' 04",r°� �c�d —"s�.. Addressin the Client Fee g • Futures' client services fees have steadily increased from October 1, 2012 (Grand Opening) to today . We believe the current rates are tracking similar to those of the other high-end facilities throughout the country. • A patient who wishes to use their health insurance to offset a portion of the client services fee will provide their health insurance details to Futures, which will verify that client's coverage amounts. The client will be responsible for any difference between the client services fee and the insurance reimbursement amount, which will be documented in a Client Services Financial Agreement. • Example: Client Services Fee: $64,500 Health Insurance Reimbursement: $35,000 Client Responsibility: $29,500 • Futures will NOT accept any state or federal funds (including Medicare and Medicaid), - and will be very selective in which insurance coverages are accepted to ensure certainty of reimbursement and acceptable levels of reimbursement. - • The client services fee will remain the responsibility of the client in accordance with �' ��,� � - the Client Services Financial Agreement, leaving the client with a significant cash �.`i; `'''� =� `�=- burden due and payable even after utilizing their health insurance. If the cash burden ,'� __ � , � , y - """'' ' - is not significant, then the client has a"Cadillac" policy with exceptional coverage that f�lJ UELES _ signifies a qualified client. 3 . .,�p _ • ��, s� a, � .� .± r VI "' �" y f;: � .: �.,�; ,. - ii , i Understandin Health Insurance ; g NOTE: • Health insurance providers, within the behavioral health field, reimburse clients after taking into account their level of inedical needs based upon periodic reviews Futures is currently licensed for the conducted throughout their 30-day stay. services outlined in , but is NOT permitted to conduct emergency or medical detoxification services per • There are various levels of services that can be offered within this field: the Zoning Ordinance. Therefore, - Detoxification (Futures cannot perform emergency or medical detoxification services) � Futures only conducts low-level — - detoxification services for clients in need of a"dry-out". Futures needs - Intensive Inpatient Services to obtain the licenses outlined in � in order to take advantage of the !- Residential Substance Abuse Treatment Services (Levels I-IV) health insurance initiative, - --- reasoning explained on the - Residential Substance Abuse Treatment Services (Level V) following slide. Those licenses not outlined are of no significance to the operations of Futures nor to the - Outpatient Substance Abuse Treatment Services (All Outpatient Services below are separate health insurance initiative. licenses. - � I • PHP — Partial Hospitalization Program (Day/Night Treatment Services or Day/Night with Community Housing: � � Clinical Services) � I i ; • IOP — Intensive Outpatient • OP — Outpatient Services . . , - • Intervention ;�y �'!�%�' , ��';�_ • Prevention — ��.".` � � � . — f��.� L� � 1'. � ' • Aftercare Services ,;� � z�"'� ;�, � a � .�� . � � i :.. - Methadone Outpatient Treatment Services 4 Understanding Health Insurance • When a patient is approved by their health insurance provider for treatment, the health - insurance provider will be in frequent contact with the nursing and clinical staff at Futures reviewing the client's medical needs for certain levels of treatment. As mentioned on the previous page, Futures is already ficensed for two of the highest levels of care, and therefore can currently bill health insurance providers for these levels of care (Futures is NOT currently doing this). The issue is that the level of care �' ' that can be billed at any point in time is determined by the health insurance provider ; based on discussions with Futures' staff. If at any point in time during the clienYs 30- day stay the health insurance provider only permits Futures to bill for PHP, IOP, or , OP, Futures is unable to bill because we are NOT currently licensed by DCF for these ', levels of service. The next slide is an example of what a client's reimbursement may ' look like during a 30-day stay. • Important point to note: Futures will always provide Residential Substance Abuse Treatment Services for our clients. We will NOT provide lower levels of services - commensurate with the levels of services dictated by the health insurers for billing purposes. Futures wishes to obtain the outpatient licenses (PHP, IOP and OP) for insurance billing purposes ONLY. Futures will NOT market and will NOT treat clients on any outpatient basis. Cathy Claud, our consultant, is more than willing to speak - with a representative from the Village of Tequesta to explain that this is a customary practice in the behavioral health field in dealing with health insurance providers. In � _° k summary, Futures will provide clients with the highest level of care throughout their �� .r,_�, �� 30-day stay regardless of the reimbursement allowed by the client's health insurance =ti;;"'� '' �';"�_ provider. � -,,,��' � ' ,., � f�l_1 U Rl� � � 5 � ;.:. � - - 1 " " ' f . '_ � Exam le of a Client Usin Health p g Insurance Futures Daily Rate Schedule 30-Day Rates Detoxification Services $2,500/ day � Residential Substance Abuse Treatment Services: 30-Day Residential Treatment Program $2,150/ day � (Includes 30-day treatment in a two bedroom unit) ; Studio Upgrade (Cash Only) $200/ day � One -bedroom Upgrade (Cash Only) $300/ day :� i Outpatient Substance Abuse Treatment Services '� PHP $1,450/ day 10 P $995 / day '` OP $350/ day • Futures requires a minimum 30-day stay for all clients. The rates are quoted as daily rates strictly for insurance reimbursement purposes. • Futures cannot perform emergency or medical detoxification services, and only perForms low-level detoxification services for clients in need of a"dry-out". _, - • The Client Services Financial Agreement will be based on the 30-Day Residential - ,,�,,�: Treatment Program rate of $2,150 / day. Client is responsible for $64,500 for the 30- :?:;;%=_ =� ,;�;=;:_ day stay. The daily rates in this schedule are the rates that will be billed to the client's � ��` "� '� - heath insurance provider. F�.�-v (� U lJ IZ f:� ,A _ 6 _ rn � - _>�;:, ' Exam le of a Client Usin Health p g Insurance Client Service Fee Agreement $2,150/ day Residential Treatment (Two bedroom) *Client is responsible for all costs that are NOT covered by insurance Scenario: A client is admitted and, based upon the health insurance company's review, they are approved for 3 days of detox, 7 days of residential treatment, 10 days of PHP, 5 days of IOP, �_ ; and 5 days of OP. Futures can only bill according to those codes and must be licensed to do ; so. Client's policy provides for a$2,000 deductible, 85%/15% up to a client maximum out-of- pocket of $6,000, 100% thereafter. $ 2,000 Patient Deductible Insurance Company Pay 85% $ 6,000 Patient Out of Pocket Max Client Pay 15% Futures TreatmentTvae Daily Rate Treatment Davs Total Billed Client Portion Carrier Portion DETOX $ 2,500 3 $ 7,500 $ 2,825 $ 4,675 „, RTC $ 2,150 7 $ 15,050 $ 2,257 $ 12,793 PHP $ 1,450 10 $ 14,500 $ 918 $ 13,582 IOP $ 995 5 $ 4,975 $ - $ 4,975 OP $ 350 5 $ 1,750 $ - $ 1,750 30 $ 43,775 $ 6,000 $ 37,775 - :- ,J.�=�: �L�I �.`��r''= _ , � �=- - ��"� �� - E�11 URt:� -- -- - � . _. _ .. _ . ..._ .._ ,.. -� - Exam le of a Client Usin Health p g Insurance CI i ent Servi ces Fi na nci a l Agreement $ 64,500 Amount Covered by Health Insurance $ 37,775 Balance Duefrom Client $ 26,725 ::� '• In this example, the client selected a two bedroom unit and committed to a 30-day ; stay at Futures. The Client Services Financial Agreement states that the client is responsible for any portion of the $64,500 for the 30-day stay not covered by their health insurance provider. If the client had selected a studio or a one-bedroom unit, they would have been responsible for an additional $200 or $300 per night in cash. �- - .., .s,; �; ��_ _.. ,.ti � _ . , �_ � �'""' � ' ' - f�11 UR(�.� � . � �,,,� 8 - Next Steps • Futures needs to obtain the three Outpatient licenses and the Intensive Inpatient license in order to receive reimbursements from health insurance providers. • In order to obtain these licenses, Futures requires Zoning Verification from the Village of Tequesta confirming that the services indicated can be provided at the location in accordance with the municipality's zoning codes, which Futures feels is not prohibited per Ordinance No. 1-11. • We, therefore, respectfully request the Village of Tequesta Zoning Office to execute the attached Substance Abuse and Mental Health Program Office Zoning Verification for Substance Abuse License form by Monday, March 4, 2013. • We are prepared to submit our application to DCF on Wednesday, March 6, 2013, and the only remaining deliverable to complete the application is the Zoning Verification Form. • Time is of the essence because Futures has a pipeline of potential clients who would like to utilize their health insurance, and we receive additional inquiries daily from people who desire the same. Everyday we wait, we lose potential clients and in turn revenue. .__. _,, �ti'�� ' ys,�� i'-' �� _ �'v�� .� - � f�11 URLS - � ___ �� - 9 . �,':"-»"S- ..1;t"� F.,,=._. � a> �"-:Fr'., .,..... �::.. � Thank You - Futures of Palm Beach .�:�� _._� :. :_ �_ ___ ,. , _. � _ �.ti ;�' �1� ` 1y �'�_ - ��'.•ir � �•� - � f� U l.) f�t l�. � _. - i��: - �n �