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Children’s Managed Care Design Update

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Presentation on theme: "Children’s Managed Care Design Update"— Presentation transcript:

1 Children’s Managed Care Design Update
Children’s MRT Behavioral Health Subcommittee March 24, 2014 10:00 – 11:00 AM

2 Call Agenda Welcome & Roll Call (Donna Bradbury)
Review of Proposed Model & Service/Acuity Tiers (Angela Keller) Goals of Transformation (Angela Keller) Other Design Activities (Linda Kelly) Proposed New State Plan Services (Steve Hanson) Proposed New 1915i-like Services (Mimi Weber) Request (Angela Keller)

3 Proposed 2016 Children’s Medicaid Managed Care Model
For all children 0-20 years old Service Provider Network Mainstream Medicaid Managed Care Organization: Benefit Package* All Health & Pharmacy Expanded Benefits Behavioral Health State Plan Services Potential Children’s 1915i – like Services Children’s 1915c HCBS Waivers (OMH and OCFS B2H) Required to contract Pediatric Specialty Health Care Providers Pediatric Health Care Providers Children’s Behavioral Health Providers Community Based Providers (e.g., family support/peer services) Required to have MOUs and/or working relationships Foster Care Providers School Districts, CSEs & EI Care Management for All Care Management will be provided by a range of models that are consistent with a child’s needs (e.g., Managed Care Plans, Patient Centered Medical Homes and Health Homes (HH). Health Homes will serve children with the highest level of need.) Local Government (LDSS, LGU, SPOA, Probation) (Angela) Community Services & Support s (non-Medicaid) Regional Planning Consortiums Juvenile Justice/ Criminal Justice System *MCOs may opt to contract with other entities (e.g., BHOs) to manage behavioral health benefits

4 (Angela)

5 Overarching Goals of Transformation
More children receive screening and services earlier (including prevention and mental health promotion) Provide a step down set of services for children discharged from Residential, Waiver or Inpatient Provide a richer array of services to prevent escalation into high level services Infusion of System of Care values into the design – family driven, strengths based, individualized and system focused Having better coordinated care, within and across systems. (Angela)

6 Other Design Activities
Review of EPSDT benefits & early behavioral health screening data in PCPs with DOH Continued exploration of overlay of High Fidelity Wraparound within managed care and health home designs for high need children with multi- system involvement Development of State credentialing process for evidence-based practices OASAS consideration of rehab option for youth SUD services The State workgroup will move on to eligibility criteria at the conclusion of benefit package development (Linda)

7 Proposed New State Plan Services
Mobile Crisis Intervention Community Psychiatric Supports & Treatment Other Licensed Practitioner (Steve)

8 Proposed New 1915i-Like Services
(Care Coordination) Skill Building Family and Caregiver Support Services Youth Support and Training Crisis and Planned Respite Prevocational Services Supported Employment Services (Education Support Services) Residential Supports Non-Medical Transportation (Mimi)

9 Feedback and Input to Proposed Benefit Package
Full proposed list and definitions to come out by and listserv today, along with a copy of these Power Point slides. Please return any written comments within two weeks (Monday, April 7) to Angela Keller at

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