1	South Carolina Solutions – A Medical Homes Network Program
2	Overview Community Health Solutions, of America, LLC (CHS), is an administrative services organization headquartered in St. Petersburg, Florida with offices in Columbia, South Carolina and Louisville, Kentucky. CHS is a seasoned manager of government programs with experience in managing numerous state initiated health programs which have ranged from Healthy Kids Programs to Medicaid medical networks.
3	DHHS CONTRACT In April 2005, CHS was awarded a contract by DHHS to administer a Medical Homes Network Program (MHN) which was intended to introduce care and disease management services to areas within the State not being serviced by other health services organizations. CHS’s (MHN) South Carolina Solutions, has continually expanded its provider network and is now an approved MHN in all but a few of South Carolina’s counties.
4	South Carolina Solutions Model South Carolina Solutions’ Medical Home Network is provider orientated and emphasizes: The use of the Medical Home concept Focus on Disease Education, Care Coordination and Preventative Care Introduction of Quality Management oversight techniques Participation with Community-Based Support Groups
5	Contract Structure
6	Payment Structure
7	Shared Savings YES!!! There have been distributions!!!
8	Solutions’ Advantages Advantages to Providers: As a Solutions Advisory Board member, you can participate in the adoption of programs which meet the needs of the community You will benefit from the collaborative clinical strategies developed by CHS You will receive increased reimbursements $2.50 per enrollee per month FFS payments on all codes (RHC and FQHC still receive encounter rates) Cost Savings shared with Medical Home providers No financial risk to participating providers
9	Solutions’ Advantages No “Network” for specialty, outpatient or inpatient services No required calls to SC Solutions for authorization or notification Provider support through care management 24 Hour Nurse Line support Administrative support in the areas of enrollment, retention, “no shows” and reporting
10	Solutions’ Advantages Advantages to Enrollees: Establishing a Medical Home Enhanced outpatient services (adults) Preventative care Care coordination Disease management Quality improvement Integration with community-based organization Enrollees in nursing homes, receiving hospice care, or in a waiver program are not eligible for Solutions.
11	Solutions vs. Medicaid ID Cards: Remains the Same Billing/Payments: Remains the Same with Enhanced Reimbursement Benefits: Remains the Same Except for Enhanced Outpatient Services for Adults and other changes as determined by the Solutions Medical Home: Assignment of a Medical Home is required Referrals: Medical Home to establish a Referral Process – Members may be referred to from ANY Medicaid approved provider Eligibility: Remains the Same - checking online or via Medifax will give you information as to eligibility and enrollment Enrollment: Same as Medicaid. There is an enrollment form which needs to be completed and signed for enrollment into Solutions * Disenrollment: 90 Day Opt Out timeframe. Then assigned for next 9 months unless the Member has a qualifying event * Ceases when enrollment broker program goes into effect