The RFP for MCOs to apply to become regional managed care administrators for the new and future Texas Star Kids program for Medicaid-eligible disabled children and adults with cystic fibrosis has closed and the contracts are to be rewarded in 2015 (at least well before 9/1/2015). Some traditional Medicaid eligibles will be moved into the new programs starting on 9/1/2015, with gradual conversion until 9/1/2016 and afterwards. The grace period for this client profile enrollment with a regional MCO will probably be the usual 90 days (after 9/1/2016).
Managed Medicaid organizations will then become a 100% administrator for Texas Medicaid by 9/1/2016. It is imperative that Medicaid therapy-based organizations (and all Texas Medicaid providers) scrutinize their respective managed Medicaid contracts for stipulations that are unfavorable, (i.e., decreased discount rates, more stringent authorization/claims requirements, provider network de-populating, etc). The risk factor with managed Medicaid should include the effective gross profit margins produced by those contracts for that Medicaid population clientele in your census. Refer to our conference talks on gross profit margin calculations for clientele profiles.
One of SynerImages’ mission as a healthcare business consultancy firm specializing in therapy-based organizations is to follow the life-cycle of an organization: from start-up, to compliance, to operational and financial efficiency. The managed Medicaid scenario that Texas therapists face in 2015 dictates that one must present a better product for the client (Medicaid eligibles and others) to these regional MCOs. That facet of therapy care is what will truly distinguish your therapy rehab from others, in addition to the capacity of local access to therapy care – in the minds of MCO provider network analysts.
SynerImages has a two-prong approach to this opportunity. First, we have formed an independent company, Therapy Collaborative Network (TCN), whose sole mission is to build a viable therapy-based provider network for Texas, for therapy organizations to obtain mutually fair and reasonable contracts with MCOs through therapist-capacity (coverage) and competence qualifications (higher standards of therapy quality assurance and utilization management) and the use of a legitimate, neutral, unobstructed, confidential, uninfluenced, unbiased, statistical, and independent individualized alternate messenger-model approach. One of these up-and-coming qualifications that MCOs will start to demand from therapy provider applicants is accreditation/certification status. NORFA was started to fill in this void in the industry. NORFA, as a certification company for therapy-based organizations (and currently in OPT “deeming status” application with CMS), has standards that supersede those of CMS’ requirements for OPTs. In this way, a NORFA certified therapy organization can present to the MCO, a standard of the highest quality in the industry.