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Important Announcements for Tufts Public Health Plan Providers - May 2017

Thursday, May 11, 2017   (0 Comments)
Posted by: Shelly Schweizer
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Important Announcements for  
Tufts Public Health Plan Providers - May 2017

Jennifer Warkentin, Ph.D., Director of Professional Affairs for MPA

MPA holds regular meetings with health plans to advocate for positive changes, voice members' concerns, educate the insurers about research and innovative evidence-based assessments, treatments, and standards of care, and learn about initiatives and issues the health plans are working on. We also work to ensure compliance with state and federal laws and regulations, particularly around parity. Following is a summary of new information we have gathered and responses to recent provider concerns:
  • Relative value of care. Tufts Public Plan continues to reimburse the same amount for 90837 as it does for 90834. MPA views this as a barrier to members accessing the most effective and evidence-based treatments, such as exposure therapy. We will continue to advocate for a change to that policy.

  • Description of psychologists on their website. The Tufts Public Plan website lists psychologists only by their degree (Ph.D., Psy.D., Ed.D.), without the descriptor "psychologist" which we believe is confusing for their members. We've asked them to add our title to the listings, and they report they're working on it but don't know when the change will be implemented.

  • Case consultation codes. As a reminder to providers, Tufts Public Plan covers 4 units per day of 90882 (case consultation), with no pre-authorization required. The requirements for use and documentation of that code would be the same as those outlined in our Beacon memo.

  • Complex cases and intensive case management. Providers who are treating someone with complex diagnoses or serious mental illness can refer their patients to also receive intensive case management services. This is part of the management department, and can be reached via the provider relations department.

  • Continuity of care. Tufts Public Plan's policy is to allow 4 sessions to ease transition in cases where there is an active treatment relationship. Additional sessions require the medical director's approval. They do not cover services when current members want to return to a previous provider who is not on Tufts Public Plan's panel. We will continue to advocate for members to have the option to continue with their existing provider, and we are also supporting a legislative bill that would require health plans to provide that option.

  • Specialization lists. Tufts Public Plan requests that providers check off only areas that they actively specialize in on the specialization list on the website. Providers don't need to indicate all the diagnoses they might be willing to treat, depending on the case, and the specialization list doesn't limit them to only those diagnoses.
We will continue to meet with Tufts Public Plan quarterly to raise your concerns and assist in improving all psychological services for Tufts Public Plan patients.

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