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Implementing Medicaid Behavioral Health Reform in New York February 13 th 2014 Redesign Medicaid in New York State.

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Presentation on theme: "Implementing Medicaid Behavioral Health Reform in New York February 13 th 2014 Redesign Medicaid in New York State."— Presentation transcript:

1 Implementing Medicaid Behavioral Health Reform in New York February 13 th 2014 Redesign Medicaid in New York State

2 Agenda  Project update/timeline  Preliminary summary of RFI comment themes  Questions 2

3 Project Update/timeline


5 Comment Summary Agenda

6 RFI Comments  RFI comments received from 48 entities: Plans, Providers, Advocacy Groups, Local Governments, and other Stakeholders  All comments logged and sorted into categories  Possible change to RFQ; No change; Update guidance documents  Common themes were identified across submissions

7 RFI Comments  Some themes were universally supported across submitters  Need coordination between PH and BH Providers;  Clarification on Health Home and Plan roles;  Plans need to understand NY and local BH and non-Medicaid systems of care  On some issues there was no consensus between responders

8 Common RFI Themes  Plan experience/ Staffing Flexibility  Health Homes  Integrating BH Services in Managed Care  Information Technology Requirements  Network Standards  Utilization Management  Performance Measurement  Plan Reimbursement for Services

9 Plan Experience/ Staffing Flexibility  Focus on the experience of Plan BH staff  Sharing of staff between Mainstream and HARP  How much sharing is allowed?  Ensure coordination of BH expertise between Mainstream and HARP  Staffing sufficiency  How does the State evaluate adequate number of staff?  Differentiate between smaller and larger Plan sizes by allowing flexibility in staffing ratios based on need

10 Health Homes  Clarification needed on  Plan/Health Home role and functions regarding care plan development and implementation  Health Homes performance standards  Health Home capacity  Care Management  1915(i) Functional Assessments  Standardized Plan/ Health Home contracts?

11 Integrating BH Services  Common concerns:  Availability of new 1915(i)-like services providers  Capacity to perform 1915(i)-like functional assessments  Pricing 1915(i)-like services  Plan familiarity with NY service system including non-Medicaid services  Challenge of linking Plans to crisis and emergency response services

12 IT Requirements  Balancing need to exchange and integrate data (RHIOs) with fiscal cost and existing technical capability  Mixed recommendations on requirements to join RHIOs  Availability of IT resources – essential for Providers to be managed care IT ready  Need for initial and ongoing Plan billing system support/training  Multiple requests for Plan web-based billing capacity

13 Network Services  Plans and providers expressed general support for:  Facilitating co-located Article 28 services/BH services  Ensuring adequate and coordinated mobile crisis across Plans  Mandating contracting for after hour and weekend services  General provider support and mixed Plan support on proposed RFQ network standards  Contracting with providers serving 5 or more members

14 Utilization Management  Utilization Management Comments  Plans reported on current process – need to adjust UM for1915(i)-like services  UM should reflect need for ongoing treatment and not just stabilization  Need for the State to approve UM criteria and for Plans to inform Providers and the public of these criteria

15 Performance Management  Common concerns from both Plans and Providers  Need to know what Performance Measures are  Don’t use measures for Pay for Performance in year 1- only establish baseline data

16 Regulatory Flexibility  Overall comments supportive of regulatory flexibility  Recommendation to develop Regulatory Workgroup in first year  Support for integrated licensing  Few specific changes recommended

17 Plan Reimbursement for Services  Overall need to develop sound payment and rate structure on both Plan and Provider level  Plans and Providers supported:  Innovative Plan/ Provider network partnerships – including sub- contracting for Plan functions  BH specific Medical Loss Ratio

18  State will conduct a survey to identify providers interested potential 1915i providers  State is developing guidance for 1915(i)-like services  Meeting with MRT BH Workgroup on 2/26/14  Revise RFQ based on feedback  State will discuss relevant RFI issues with Plans and Health Home  Post RFQ early March  Preliminary Premium and Databook shortly after  Implement Start-Up Activities (with funding in 2014-15 Executive Budget) Next Steps

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