Presentation on theme: "Douglas P. Ruderman, LCSW-R Director, Bureau of Program Coordination and Support."— Presentation transcript:
Douglas P. Ruderman, LCSW-R Director, Bureau of Program Coordination and Support
Behavioral Health Organizations – Medicaid Redesign Team Health Homes - CMS Medicaid Option
Improve healthcare delivery & integration of care. Improve outcomes for Medicaid beneficiaries. Reduce or eliminate unnecessary state expenditures. Most importantly – Bring us closer to our collective Mission - to facilitate real recovery for those under our care and to improve the capacity of communities to achieve these goals.
The BHO is New York’s process for the transition to a better managed behavioral health system. Bidders have been selected to negotiate Regional BHO contracts. In Phase 1 (Next 2 years) the BHO will monitor inpatient activity for Medicaid fee-for-service recipients only in Medicaid fee-for-service behavioral health inpatient environments. The BHO will also profile outpatient and HH providers networks.
It will be important for OMH licensed programs and OMH funded community service programs (e.g. housing) to work closely with inpatient units and HH CM to make their programs easily and quickly accessible. Measures such as: time to first outpatient visit, second outpatient visit, first prescription fill, These will be used to educate OMH and the BHO of program efficacy & inform Phase 2 of the BHO/Medicaid redesign process.
The only HH service that Medicaid will reimburse is care management. HH care managers coordinate all services for the Medicaid beneficiaries primarily within the network of HH providers. If a person you currently serve is assigned to a HH he or she may continue to be served by your program whether or not your program is part of that HH network. 6
The DOH received 165 letters of intent to submit health home applications and it was decided to phase in implementation Phase I - 13 counties: HH application due date for Phase I counties only is November 1, Implementation is scheduled for January 1, 2012 Phase II – 14 Counties: HH application due date for Phase II counties only is February 1, Implementation is tentatively scheduled for April 16, Phase III – 35 Counties: HH application due date for Phase III counties only is April 21, Implementation is tentatively scheduled for June 18, 2012.
Health Home Information Questions and Answers High Cost Population Characteristics Health Home Patient Flowchart Interim Health Home Provider Qualifications State Plan Amendment - Draft TCM and Health Homes Letters of Intent for Health Homes NEW Managed Care and Health Homes Rate Information Rate Information Questions and Answers caid/program/medicaid_health_homes/
Care management services will be funded by 90% federal financial participation for 8 quarters Adult TCM services have been identified to transform into HH CM HH CM will be reimbursed at its current TCM rate for two years from November 1, Year 1 will be through FFS from eMedNY. Year 2 will be from the HH. 9
Converted TCM program “slots” will become part of a health home per approved HH application and will be monitored via the SPOA process The LGU will manage movement into and out of TCM via the SPOA process The HH will become a referral source to the SPOA for HH recipients who require access to former TCM slots The HH will need to inform the SPOA if an individual no longer requires a the support of a former TCM slot The SPOA will approve the movement out of and in to the high touch slots in a HH 10
OMH expects that the velocity of movement into and out of high touch CM in HHs will be swifter than what has been the history with TCM This expectation is based on the fact that the HH will want to utilize (utilization management) the high touch CM slots for those most in need and will request to move those in less need to other levels of HH CM 11
SPOA will continue to manage the assignment of AOT status individuals who are in need either CM or ACT services If the individual is a member of a HH network the assignment will be made to a high touch slot in that HH network If the individual is not a member of a HH network the assignment will continue via the current SPOA process When the individual is no longer on AOT status the HH will use its utilization management process to provide the appropriate level of CM service 12
State item ICMs are either: Working directly from OMH facilities Working alongside community programs These services will remain available to the communities they currently serve either as HH CM or as TCM Access to these slots will remain with the SPOA 13
Health and behavioral health care linkages Social service needs There will be more flexibility to manage contacts to the individual who most needs them 14
Many referrals will come from within HH networks. Services will continue to be reimbursed via Medicaid Managed Care or Fee-For-Service Medicaid. The HH does NOT limit its enrollees freedom of choice to access providers outside the network. The Medicaid card will continue to reimburse for all FFS services. 15
OMH recommends that OMH funded and licensed programs join HH networks who serve recipients in your geographic service area. Why? HH have great potential to create a better rehabilitation and recovery based system of care through Coordination Integration Communication Regulation
Your program and the individual you serve should have superior access to health care programs and social services supports from all other members of the HH network then you probably have today. The HH should be managing warm hand-offs between inpatient and outpatient services. Your program will better serve the client through close HH CM collaboration.
The plan of care will be coordinated by the HH CM for the network. A single plan of care - The individual served in a HH will promote the integration your program’s services with other services and social supports. In this way all services should provide the individual with maximum support in overcoming health and behavioral health barriers that are preventing he or she from the achievement of his or her goals.
A HH network will eventually be linked via an electronic medical record (EMR). All participating rehabilitation programs will be better informed through the HH Electronic Medical Record (EMR) used by the network. There may be assistance from the Regional Health Information Organization (RHIO) if one is active in your county.
State plan programs will continue to operate under the regulations that are applicable to your program today. TCM services transitioned to HH CM services will no longer be part of the TCM SPA and will not be regulated by the TCM regulations