Implementing Medicaid Behavioral Health Reform in New York January 8, 2015 Redesign Medicaid in New York State Managed Care Policy and Planning Meeting.

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Presentation transcript:

Implementing Medicaid Behavioral Health Reform in New York January 8, 2015 Redesign Medicaid in New York State Managed Care Policy and Planning Meeting

Agenda  NYC Timeline Update  Mobile Crisis Services Update  Billing Manual Update  Readiness Review Desk Audit Update and Next Steps  Medicaid Managed Care Payment Obligations for BH Services  Rest of State RFQ timeframe 2

NYC Timeline Update  Proposed implementation timeframe  January 9, 2015 – Readiness review information request distributed  March, Anticipated CMS approval  April 1, Begin passive enrollment  July 1, Plans begin managing BH benefit

Mobile Crisis Services  State seeking authority to move Mobile Crisis Services into the Mainstream Benefit Package  Pros for this change:  All members will have access to Mobile Crisis Services which was previously only available to HARP members  Creates needed community crisis capacity  Reduces unnecessary inpatient admissions  Next Steps  1115 Waiver will be amended to reflect this change 3

Billing Manual Update  Released billing manual to Plans for feedback on 12/17  State is currently processing comments  Updated version to be released to Plans and Providers (and billing vendors)

Readiness Review Desk Audit Update and Next Steps  Information Request to be distributed to Plans on 1/9  Provides overview of Readiness Review process  Identifies critical factors that must be in place for Plans by “Go-Live”  Lays out examples of and schedule for documents to be submitted  Webinar scheduled for week of 1/12/15 for detailed walkthrough of :  Desk audit tool identifying key requirements to be approved for implementation  Deliverable submission process  Readiness review timeline  Plans to submit requested documents by 2/17/15 4

Medicaid Managed Care Payment Obligations for BH Services  BH Government Rates Currently Apply to:  Mainstream Plans-Article 31 Mental Health Clinics  Post Carve-in of BH Services and Operation of HARPs  All BH ambulatory services (MH and SUD) are covered by government rates in mainstream and HARPs  Excludes Rehabilitation Services for Residents of Community Residences  Includes Extended Observation Beds (EOB) in Comprehensive Psych Emergency Program (CPEPs)  FIDA Plans  “For Covered Items and Services that are part of the traditional Medicaid benefit package, the FIDA Plan shall pay any OMH or OASAS licensed or certified Provider of Behavioral Health Services at least the applicable Medicaid Fee for Service rate for a period of not more than two (2) years from the date that at least one Health and Recovery Plan (HARP) shall have been approved in the FIDA Plan’s Service Area ( ).” 7

Rest of State (ROS) RFQ Tentative Timeframe  Early 2015  NYS distributes ROS RFQ to Plans  Spring 2015  Plans submit RFQ to State  State reviews RFQ submissions  Summer 2015  Plan Conditional Designation Awarded 8