GA Families 360 Informational Session
March 27, 2014
David Bolt, Director of Training
Deborah Moore, Provider Relations Representative - SW Territory
Power Point Presentation delivered – not yet authorized to release a copy of the presentation.
Benefits will stay the same.
Adoptive Assistance members can opt out first 90 days. After 90 days can change every 12 months during enrollment period. Adoption Assistance intake to opt out of program - call
1.855.661.2021
Coming soon - CBT Provider Training on Web
Amerigroup does not determine placements.
Amerigroup is serving total of 26,494
Foster Care – 11,048
Adoption Assistance – 15,265
DJJ – 181
The following items are staying the same:
Medical Decision
Placements
Safety Issues
Medications
Transportation
Service Choices
The following are different:
Enhances interagency collaboration
Dental and medical home
Timelines
Intake Line 24/7 (similar to call center)
Care Coordination Team
Psychotropic Medication Oversight
Ombudsmen staff (AGP and DCH)
System of Care
Trauma Informed and Systems of Care training for providers
The intake line is for members, not providers – this is not a crisis line.
Affirmed the 90 day open authorization transition period. 90 day period participating and nonparticipating providers can see 360 clients; no auth is required through June 3. On June 4, will transition to participating providers. If non-participating has been delivering services, will direct to in-network provider. After 90 days it will be business as usual with required authorizations.
Requirements can be checked online and a list of services definitions are posted on www.amerigroup.com
- click on providers – select state – select feature on left side.
Psychotropic Medication Management
Members with more than one psychotropic medication will have their meds reviewed by 360
Medical Director of pharmacy review team. Goal: Assess efficacy of medication that youth are on related to the diagnosis. Assess efficacy other treatment options.

This is not an authorization or approval process for anything currently in place. After a medication is prescribed, they will look at medical diagnosis and review multiple medications.
Information will be communicated with the prescriber.
Intake Unit
Similar to call center. 24/7
Goal: respond to member, family can care giver inquiry, request for information, help with maneuvering the health care system.
Access by members or legal guardian
Not a crisis line.
Online Assistance
Includes all basic functions (changing PCP, locating a dentist, etc.)
Research available PCP, PCDs,
Access to information by DJJ, Adoption Assistance manager, or DFCS case manager
Care Management Information
Regional team based on:
County of custody - DFCS
County of placement – DJJ
Community Training and Outreach department
Training Informed Care System of Care
Foster Parent Association
Low Impact Child Removal
Training will be various formats as needed and available.
Specialty training:
Calm Parenting Technique
Lower Impact removal of children for law enforcement
TF-CBT
Trauma Screening and Assessments in Court Decisions
Value Added Benefits:
Boys and Girls Club membership (does not include summer camp)
Girl Scout membership
Weight Watchers
Flu shots
Annual parenting magazine subscription
24 hour nurse helpline
Free Power Zone Program for those eligible
Free over the counter medications
Entertainment discounts
Being health Brings Rewards
Covered Diabetic Supplies
Healthy Living Programs
Easy Website Access
Overview of Network Development Team
Contracting
Operations
Provider Relations
Network Development
Open Network to all Amerigroup providers

Expanding Network
Enhance Collaboration
Ongoing Education Sessions and orientation
Contracting and credentialing process
Contract – Existing providers will not need to amend contracts.
DCH development report (every 2 weeks)
Net Steps
Go-live
Contact Information
Gf360@amergiroup.com
for general questions
Ga360trng@amerigrorup.com
for training requests
Questions:
Will document requirement be different for 360?
No
In the MICP, individual counseling requires psychological evaluation before treatment.
What is 360 requirement? Will follow same practice standards as CMO members
After June 3, providers will need to request authorization, if required – Recommend putting in requests mid-May.
DME – will clinical guidelines change under 360? No
Will there be changes for MH after 90 day? Check CPT codes to see if authorization is required. 4/11/2014 Rule in effect for pre-authorization for in-home services. Purportedly, this also applies to in-home intake. In effect after 90 days. After 90 days, if seeing a member they will try to redirect to participating provider.
Provider Service Unit - call 800.454.3730 for claims issues. If no response after 48 hours email gf360@amerigrioup.com
If no response after 72 hours contact Provider Service Managers:
Central, SW and SE – Rosalyn.mobley@amerigroup.com
BH rep – latisa.kidd@amerigroup.com
Atlanta, N or E – cheryle.martman@amerigroup.com
BH rep - Dorothy.averitt@amerigroup.com
Amerigroup Ombudsmen:
Tonya Chambers-Ashburn, Ombudsman Program Manager
Chastity Harvey (northern region)
Ronald Dunham ( southern region)
What do we do about patients coming into foster care who still have WellCare in the portal?
All foster care members, adoption assistance members, as well as those in DJJ were transferred effective 3/3/2014. All foster care has been transferred over. If adoption assistance, it could show straight Medicaid, it should not show WellCare.
You indicated that as long as provider is an Amerigroup provider they can bill for services even if not PCP. They are turning away our clients.

Contact Provider Relations Representative to assist. Different providers have received education/materials. Sometimes there is turnover; not all staff are informed. Amerigroup might need to reach out to some providers. Reach out to DFCS case manager, if foster child, or reach out to Ombudsman. Amerigroup is having to reeducate some providers and provide assurances that will be paid.
Can we expect referrals from DFCS case managers?
It will just be insurance; might be combination of DFCS case management or Amerigroup care coordination. Amerigroup will not be sending referrals – will come from standard channels.
Difference is it will be Amerigroup network.
Will PIN be provided?
Will not disclose the PIN – HIPAA verify for security to protect members.
For existing providers can our information be sent to case workers for referral purposes?
DFCS, DJJ, internal care coordination staff?
Are OTRs to continue as normal?
Will follow up. Understanding is to continue as normal.
If DFCS is not identifying PCP, is Amerigroup identifying? Foster children are being assigned with one that is not in their area.
Identify based on:
child’s records
claims data - last doctor shown seen
geography
PCPs can be changed as frequently as needed.
For existing providers, can Amerigroup provide DFCS or DJJ information for referral purposes?
Providers are already on list of network of providers. Amerigroup does not classify - do not send select list of providers
Is there a way Amerigroup can ask who foster parent is?
DFCS is legal guardian and has ability to make PCP changes - change has to be initiated by
DFCS. There is an E-form for DFCS case worker to fill out. If information is identified in the form,
Amerigroup will have information listed. Care managers are going through case loads reaching out to legal guardians first, before reaching out to fosters.
Is primary dentist required as a PCP?
Yes, every child will have PCP and PCD.
Additional items:
Informative website:
Medical necessity criteria, CPT codes, etc.
FAQs about PRTF, crisis stabilization units, etc.
Provider manual for medical and dental
Contact information
How to bill claims on quick reference cards
Additional question posed about PRTF referral process. Are CORE providers only type who can refer?

No – referred to From FAQ.
Will there be a liaison?
Ameirgroup is restricted to initially working with the DFCS case manager. Will open to working with different providers. David Bolt will take question back to see if there is a method.
Presumptive eligibility for foster care – should be very little lag time. David.bolt@amerigroup.com
A case often does not progress
Educating DFCS. Perhaps CPS worker filled out form, but next unit has not sent in form with updated information.
Out of network providers refusing to see clients.
(CCI, CPA, foster kids)
Reach out to DFCS case worker and escalate through DFCS to Ursula Davis and/or Ombudsman staff.