1. ARMHS Restructuring ARMHS Advisory Workgroup November 1, 2013 Julie Pearson / Melinda Shamp DHS Adult Mental Health Division 1

2. Agenda Introductions Review 2013 Legislation Advisory Workgroup History & Recommendations Update on current work, timeline and data Next steps 2

3. 2013 Legislation “In addition to rate increases otherwise provided, the commissioner may restructure coverage policy and rates to improve access to adult rehabilitative mental health services and related mental health support services …” Laws of 2013, Chapter 108, Article 4, Sec. 28. 3

4. 2013 Legislation, Continued “… the projected state share of increased costs due to this paragraph is transferred from adult mental health grants …” Beginning with CY2015, $6 million per year state match will generate over $10 million per year in new federal funding. 4

5. 2013 Legislation, Continued “Payments made to managed care plans and county-based purchasing plans … shall reflect the rate changes described in this paragraph.” A combination of rate increases and changes in covered services is projected to result in a 30% increase in payment per ARMHS recipient 5

6. 2013 Legislation, Continued Is effective January 1, 2015 Will be in addition to another provision that increases MA rates for ARMHS and most other MA-covered mental health services by 5%, effective September 1, 2014. 6

7. ARMHS Advisory Workgroup DHS is reconvening and updating the workgroup that recommended the legislation Meetings planned for Nov 1 and Dec 6 Group includes a broad range of stakeholders Will build on Feb 2013 recommendations 7

8. ARMHS Workgroup - Feb 2013 Coverage for currently non-billable but required activities: Clinical direction and oversight, incl support for EBPs Functional assessments, incl LOCUS and interpretive summaries Treatment plan development Service coordination 8

9. ARMHS Workgroup - Feb 2013 Cost to cover currently non-billable but required activities: Initial time-study data indicates this may result in 20% average increase in reimbursement per recipient Need add’l time study data 9

10. ARMHS Workgroup - Feb 2013 Improved reimbursement for staff travel: Implications for services other than ARMHS CMS concerns Other ways to address no-shows 10

11. ARMHS Workgroup - Feb 2013 Telecommunications: ITV is already reimbursable for most MH services, including ARMHS Phone contacts are currently reimbursable only for ARMHS Community Intervention Propose to allow all (?) ARMHS services to be provided via phone, text, e-mail, or electronic messaging when clinically appropriate Coding / rates issue for text and e-mail 11

12. ARMHS Workgroup - Feb 2013 Client transportation: Transportation to MA-covered service is already reimbursable Transportation to non-MA covered services is a more difficult issue Olmstead decree Under discussion at DHS as a service that would not be conditional on receipt of any specific medical service 12

13. ARMHS Workgroup - Feb 2013 Integrated Model Competitive Employment: Must be done in partnership with Voc Rehab Improved reimbursement for clinical direction and service coordination will support IPS model Improved rates for all ARMHS services could support IPS model 1915(i) would allow broader coverage than rehab option, but still subject to CMS rules on supported employment and other constraints (see below) 13

14. ARMHS Workgroup - Feb 2013 Exploration of 1915(i) option: DHS checked with other states and expert consultants 1915(i) would allow broader range of services, but: Income eligibility would be limited to150% of FBG; Minnesota would have to exclude thousands who are on MA-EPD or spenddown Service planning would have to be moved from ARMHS providers to independent agencies State match would still be an issue 14

15. ARMHS Workgroup - Feb 2013 EBP – Family Support: Improved reimbursement for clinical direction and service coordination will help Improved rates for all ARMHS services could be structured to facilitate ARMHS engagement in Family Psycho-education and other EBPs such as IPS, IMR and IDDT 1915(i) would allow broader coverage than rehab option, but see negatives 15

16. ARMHS Workgroup - Feb 2013 Outreach / Wellness / Med Ed Expansion: Probably not MA-reimbursable in ARMHS Lower in Workgroup priorities, probably not affordable within the budgeted 30% increase May be covered through: Behavioral Health Homes Community Health Workers 16

17. ARMHS Workgroup - Feb 2013 Parenting / Family Services: Added as a no-cost ARMHS expansion in 2013 legislation An additional skill in the list of skill areas that can be included in ARMHS Currently billable as Basic Living and Social Skills DHS is considering options for provider training 17

18. ARMHS Advisory Workgroup How to encourage and facilitate ARMHS engagement in evidence-based practices, such as IPS, IMR, family psychoeducation? IDDT ? Certification process to qualify for tiered rates? How to define and assess fidelity to evidence- based practices, and how to attain fidelity? 18

19. Timeline Jan 2014: state plan amendments to CMS April 2014: prelim CMS agreement Summer – Fall 2014: Modify reimbursement systems, provider training and communication January 2015: full implementation 19

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21. Future Growth in ARMHS Recipients 11% growth due to expanded MA eligibility 5% in FY2016 and another 5% in FY2017 due to improved access resulting from rate and coverage changes 21

22. Add’l Questions and Comments: Melinda.M.Shamp@state.mn.us Julie.Pearson@state.mn.us 22