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Home My WebLink AboutDocumentation_Regular_Tab 06_05/09/2013 \ `'��! /�,�� 1► � � � �� /i v��/�� 1� �� .� � �( � /� ! �� '' ;�� ►� � �� 4-- - � ��1 � ,1 �� ► �-- �% i/�� - -- - -� � - - -- __ __ __ '�': _�, __ __ ��_,, Presentation For The Village of Tequesta HEALTH INSURANCE � � � � � M ay 9t", 2013 _ :x,� �� r x nr Objective: • Futures of Palm Beach ("Futures") wants to compete on an equal footing with other high-end drug and alcohol and eating disorder programs in the United States by accepting health insurance to help patients offset a portion of their patient services fee while continuing to comply with all aspects of Ordinance No. 1-11 as it stands today why• • High-end rehabilitation facilities, lil<e Futures, have adjusted their business models to accept third party insurance funds • Patients entering high-end rehabilitation facilities are more inclined in today's economic environment to use their health insurance to offset a portion of the cost of treatment • A significant number of potential patients have chosen competing rehabilitation facilities due to our inability to accept insurance • Futures needs to be able to accept third party health insurance in order to operate a robust business model and - to maintain a high-level program offering Actions Needed to Achieve Objective: • Worlc with the Village of Tequesta to amend the text of Ordinance No. 1-11 in the following manner: A) Amend language to allow Futures to accept third party billing for patient care with strict limitations B) Add language to allow Futures to provide outpatient services on a limited and qualified basis • Worl< with the Florida Department of Children and Families ("DCF") to obtain additional outpatient services ii�vnses to �r ��.�s�� c':�^ ��° �.:c;�;^g �,.::r �oses _ _ __ _-- � �� ;,�� rF' *. � � ,v�r YG � .. ` � : ., I I<ey Points: • A significant percentage of patients have the financial ability to pay the full patient services fee, but desire to offset a portion of this financial burden with their existing health insurance, similar to their current billing process with regular doctor visits, hospital stays and prescription drugs • The patient 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 will remain the responsibility of the patient • Cathy Claud, former Substance Abuse Service Coordinator for DCF of Southeastern Florida, has agreed to consult for Futures to assist in obtaining the required DCF licenses. She will assure the Village of Tequesta that the additional Outpatient Services licenses are needed strictly for billing purposes to health insurance providers for patients who have contracted for a minimum 30-day stay in Futures' residential treatment program ■ By continuing to require a minimum 30-day stay for all patients, Futures' proposal provides the Village of Tequesta with protection against creating a transient environment • Accepting third party insurance, as proposed by Futures, will not adversely affect the residents of the Village of ��sta ■ Utilization of health insurance does not reflect the character of a patient ■ Prohibiting Futures from accepting State or Federally funded insurance programs and Health Maintenance Organizations (HMO) will prevent lower cost insurance programs from participating _ __. _ _. _ _ _ _ _ _ .:.�c ,: �� • � � � � •�4 � !�'� � ,� � k .. .- � �� . _ �. �� ..,� � � �► � I � �"" :� � � _ - �' :� :�,� ; Proposed Solution: Amend Ordinance No. 1-11 in three areas of Section 78-4. Definitions Amendment #1: Add language in the Opening Paragraph of Section 78-4. Definitions to allow a rehabilitation facility to provide Outpatient Services Amendment #2: Amend language in Subparagraph 2 of Section 78-4. Definitions to allow a rehabilitation facility to accept third party billing for patient care and therefore accept third party health insurance. Add language to further qualify the types of third party health insurance that are not permitted for acceptance by a rehabilitation facility to include HMO insurance plans Amendment #3: Add a new Subparagraph 5 of Section 78-4. Definitions to further define Outpatient Services as added in Amendment #1. This amendment will define the three levels of Outpatient Services (outpatient, intensive outpatient, day/night treatment services or day/night with community housing treatment services), and significantly limit the number of patients residing outside of the rehabilitation facility that a rehabilitation facility can treat at any given time to: ■ A) Only patients who have completed a 30-day residential treatment program at the rehabilitation facility where Outpatient Services are rendered ■ B) Five percent (5%) of the rehabilitation facility's patient clientele for patients residing outside the rehabilitation facility Services Provided to Pateents Living Outside Futures Proposed Amendment Language = Three Patient Maximurr� Futures' Promise to the Village = No Patients .�� - �.� � � � � � � �� . 1� / i � � � � � �� :� s � � _ _ �� , �, � � � � . �=, � �, � Amendment #1 & Amendment #3 (Outpatient Services) Section 78-4. Definitions Rehabilitation facility means a private State of Florida licensed facility that provides rehabilitation care for patients who are eighteen years of age or older. The primary purpose of a rehabilitation facility is to provide treatment for drug and alcohol addiction and eating disorders; however, the rehabilitation facility must be a dual diagnostic facility staffed and equipped to provide treatment for co-occurring disorders. Rehabilitation facilities may also provide programs that promote health, wellness and overall lifestyle enhancements for their residents. Rehabilitation facilities must provide a structured residential living environment which includes the following features: 24-hour on-site security; 24-hour patient supervision by licensed nursing staff; and quality of life services such as swimming pools, garden areas, sport-courts, exterior patios or sitting areas, community living areas, meditation areas, fitness rooms, libraries, recreation rooms, televisions, on-site food preparation, and telephone and internet service. Rehabilitation facilities must provide short-term care treatment and extended care treatment, and may also provide Outpatient Services and follow-up treatment. Rehabilitation facilities shall not offer any services for individuals with a history of violent behavior or threats to the public health, safety and welfare or the health, safety and welfare of other patients. The following definitions apply to the definition of rehabilitation facility: Amendment #1: Insert language in the definition of rehabilitation facility to allow for such facility to provide Outpatient Services :� � � �� *� �!�e ViII�� .� �..� � z. Amendment #1 & Amendment #3 (Outpatient Services) NOTE: " Short-term'� is defined as a 3o-day minimum stay in Ordinance No. 1-11 Section 78-4. Definitions 5. �utpatient Services means a level of service, inc patient, intensive �utpatient and day/r�ig�t treatment services or day/night with community ho ' a ment services, provided to the rehabilitation facility's patients. Outpatient Services provid ients residing outside the rehabilitation facility shall be limited to patients who have completed the short-term program at the rehabilitation facility and shall not account for more than five percent (5%) of the rehabilitation facility's patient clientele. Amendment #3: Insert language as new Subparagraph 5 to further define Outpatient Services as added in Amendment #1. This amendment provides protection to the Village of Tequesta by addressing the concern of permitting a transient environment. Amendment #3 will drastically limit the number of patients residing outside the rehabilitation facility that a rehabilitation facility can treat at any given time by: A) Limiting the services for patients residing outside the rehabilitation facility to those who have completed a minimum 30-day residential treatment program at the rehabilitation facility where Outpatient Services are rendered B) Limiting the services to 5% of the rehabilitation facility's patient clientele for patients residing outside the rehabilitation facility (At maximum capacity, this would only be three Outpatient Service patients residing outside of the facility at any given time, and limited only to patients who have completed the 30-day program) Futures will not provide Outpatient Services to patients residing outside the rehabilitation facility. Futures requires the licenses for such Outpatient Services solely to ball health �nsurac�ce nroviders #or patients residing at the rehabilitation facility who are participating in the 30-day treatment plan >u,._ �._ . _ s±�:> �y. ;�� ..: > �� ;,� � � � "� � �� _ '�' _ � 1 ' � �� _ � * � � � �� r . � - �' � Amendment #2 Section 78-4. Definitions Private means privately owned and funded with no use of state or federal (including Medicare or Medicaid) funds for the operation of the facility, the treatment of patients, or research work that would require the acceptance and treatment of federally or state funded patients. Private also means that the rehabilitation facility may accept funds from third party insurance companies as an out-of-network provider; provided, however, the rehabilitation facility shall not accept health insurance funds provided by or arranged by a health maintenance organization. Amendment #2: Remove language from Subparagraph 2 to allow third party billing for patient care. Add language to allow for the acceptance of third party insurance and further qualify the types of third party health insurance which are not permitted for acceptance by a rehabilitation facility to include health maintenance organization insurance policies __ ., __ . —_ . _ ��►� �f � P�ti�nt's 3 �. -�� :, �' ��1�� -�,�� l� �'•�►�� . . � � � �� !ealth insurance providers reimburse patients after tal<ing into account their level of inedical needs based upon periodic �eviews conducted throughout their 30-day stay There are various levels of services that can be offered within this field: _ __- ....--- -- __- -- __-- .. - __ ___-- - -- � �'�, • Residen Su bstanc e Ab use Trea Services ( II & IV ! � __ _ _ -- -__ _ - - _ -- - _ _-- - • Residential Substance Abuse Treatment Services (Level I, ill & V) • PHP - Partial Hospitalization Program (Day/Night Treatment Services or Day/Night with Community Housing: Clinical Services) • IOP - Intensive Outpatient • OP - Outpatient Services • Intervention • Prevention • Aftercare Services • Methadone Outpatient Treatment Services ' �;; NOTE: Futures is currently licensed for the services outlined in blue. Futures needs to obtain the licenses outlined in red in order to bill the patient's health insurance providers. Those licenses not outlined are of no significance to the operations of Futures nor to the health insurance initiative �� f a Patient's 3�- �� -�� .� . �. Futures Daily Rate Schedule 30-Day Rates Residential Substance Abuse Treatment Services $2,150/day 30-day residential treatment program (Includes 30-day treatment in a 2 bedroom unit) Outpatient Substance Abuse Treatment Services Day/night treatment services or day/night with community housing treatment services $1,450/day Intensive outpatient $995/day Outpatient $350/day *Note: Futures requires a minimum 30-day stay for all patients. The rates are quoted as daily rates strictly for insurance reimbursement purposes *Note: The patient services agreement will be based on the 30-day residential treatment program rate of $2,150/day. The patient 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 patient's health insurance provider depending on the utilization review of the patient by the insurance provider throughout the 30-day stay �� f a Patient's 3�� t� � � � �� -�� ±��''.��'�� - �� . Example: Patient Service Fee Agreement $2,150 / Day Residential Treatment (2 Bedroom) Patient is responsible for all costs not covered by insurance Scenario: A patient is admitted and through the third party insurance company's review they are approved for 7 days of residential treatment, 10 days of PHP, 5 days of IOP and 5 days of OP. Futures can only bill the insurance company according to those codes and must be licensed to do so Insurance companies dictate and approve the level of treatment type a rehabilitation facility can provide to a patient for reimbursement purposes. The insurance company may approve three days of residential treatment for one patient and 10 days of residential treatment for another patient. Futures can only bill for the level of treatment dictated by the insurance company, and Futures must be licensed to provide such levels of care. Futures is currently not licensed for lower levels of Outpatient Service, therefore, cannot bill for such services ,' ; �� : � � , r> �_ ,� r�� m� .;� � � � • •- • Futures mission is to provide Cost of Residential $64,500 $64,500 the highest level of treatment Treatment 30-Day available to the greatest Ins�urance Support for Days number of patients, reducing 1— 7 RTC $� $11,092 relapses and improving lives. Conveying our mission does Insurance Support for Days not always eliminate the 8-17 PHP $� $12,458 economic impact of treatment on the patient's Insurance Support for Days $� $4,975 18 — 22 IOP decision as highlighted here Insurance Support for Days 23 — 27 OP $0 $1,750 Total Support from Insurance $� $30,275 B�lance Due from Patient $64,500 $34,225 ��, ;�� ; �:��. ��:��- - ,, . .- . Cost of Residential Futures has identified the Tre�itment 30-Day $64,500 $64,500 $64,500 need to include insurance support into our business Insurance Support for �2 model without disrupting our Days 1-7 RTC $o $11 ,om erd ,�.�er� $11 ,o9z model for clinical treatment �° �.2 or service standards Insurance Support for $0 $12,458 ,�er'� #1 & $12,458 Days 8 17 PHP �� Insurance Support for #'L �' Days 18 — 22 IOP $0 $4 �e $4,975 �' #2 InsuranceSupportfor �5$�1� Days 23 — 27 OP $� $1 m $1,750 P Tot�l Support from Insurance $� $30,275 $30,275 Balance Due from $64,500 $34,225 $34,225 Patient �� f � Patient's 3�� .,. . � ��.�-��,�� -��: , .. �.. � � Important point to note: Futures will always _ ____ -- � _ _ �__ --__-_---_ rovide the hi hest level of residential --- .__ .___ p g v --------.___ Residential Treatment substance abuse treatment services to our � Da � � �---------- Y/NightTreatment �� -`-" patients throughout their 30-day stay. We will V- ---�— --- .___"_� t �- � Intensive Out � �� not reduce our level of service regardless of the .---__._�_ • ------._.._______� p _________pat�ent Treatment level of insurance reimbursement. Futures — Out ' `�`-��------ wishes to obtain the outpatient licenses (PHP, > �``"` �r�atrnent � .________�__--�._.__ IOP and OP) for insurance billing purposes only. J _,__� ----- _______ -----_._____ Futures will NOT market and will NOT treat i 2 � -- - ; � � � r _,___. -._..._ . . . ---_..�. __._._ ,._-.,.� 345 67 8 ` �,_� � ---� g 101112 r--� 20 � .___ ,, , atients residin outside of the rehabilitation 131415 r-"' - p g 16i�1s - r -,_._ �---,--, � - facility. Cathy Claud, our consultant, is willing � LevelofCare Provided Z2 Z3 24 25 26 27 Zg �g 3D to speal< with a representative from the Village Level ofCare Bllled for Insurance of Tequesta to explain this is a customary Length of Stay practice in dealing with health insurance �roviders � � 1 ;;� � � � �- ; -. �. . . . . Allow Insurance Help Success of Quality of Patients • Futures Policies & Procedures Business • Risk Management Plan • 24 Hour Care Common Industry • 32 facility security cameras/24 Hour Surveillance Practice • Maintain "high level pricing • Prohibit Federal/State/HMO/In-Network Allow Outpatient Solely to Accept Transient • MOST IMPORTANT: Futures will not market and Services Insurance Enviranment will not treat patients residing outside of the rehabilitation facility • Maximum exposure of three patients not living at facility; all of which must have completed a minimum 30-day stay • All patients continually drug-tested throughout treatment �+,.� -s.:^`+» t _ :.a. ��.}. �w��x �; , -� � . , � .. � , . � . . <;�.;a; ar". �:: . . . . . . . . k i Futures will NOT market and Limiting Restrictions: � will NOT treat patients - 5% of Total Patients (Maximum residing outside of the '� V�� of 3 Patients) rehabilitation facility `:�,, - Patients must have completed a ,. = • " �It'1'llt �UtpatlEllt minimum 30-day Stay Exposure �' �� Insurance DCF Requires Requires Licensing for Outpatient for Billing licensing � i �� • � O � � � � � �