We Serve A Greater Cause Discussion of the Future Service Delivery Design for Behavioral Health Services Executive Directors’ Consortium November 2012

Healthcare Opportunities Workgroup July 2012 Meeting David Evans, Co-Chair Susan Rushing, Co-Chair Roddy Atkins Carol Fontenot Susan Garnett Charlie Harris Dr. Mark Janes Veronica Sanchez David Weden Linda Werlein Mark Carmona Melissa Rowan Terry Crocker Beth Lawson Jenny Goode Kristi Daughtery Libby Moore Established by the Executive Directors’ Consortium

What are the major environmental considerations for future service delivery design?

1915B Selective Contracting Waiver

Statewide Medicaid Managed Care HHSC HMO CENTER

CURRENT COVERED SERVICES STAR and STAR+PLUS Psychiatric Services Licensed Professional Counseling Inpatient Psychiatric Care (state/private hospital; children and adults) ECI Services Outpatient Substance Use Disorder Treatment including assessment, detoxification services, counseling treatment and medication assisted therapy Residential Substance Use Disorder Treatment services including detoxification, substance use disorder treatment including room and board

Texas Healthcare Transformation and Quality Improvement Program Quality-Based Payment Reform for Hospitals Texas Healthcare Transformation and Quality Improvement Program 1115 Waiver

Medicaid Expansion is a State Decision Coverage for all individuals below $15,400 a year (138%) of the Federal Poverty Level. Over 1.3 million adults in Texas in 2014. Medicaid benefits cover a full range of medical needs but access to providers will be an issue. Benchmark package can differ from current Medicaid benefits. State GR Cost $92 M in FY 2014 and $1.3 B thru FY 2017 Federal Funding $2.4 B in FY 2014 and $24 B through FY 2017

PCG Phase 2 Options Rider 71 Study Service Delivery System Governance and Oversight Funding and Finance Expand the standalone BHO service model (NorthSTAR) to select areas of the state or statewide Develop a public reporting process on performance of LMHAs and contracted DSHS substance abuse providers Leverage the 1115 with proper oversight Expand the use of STAR and STAR+PLUS to manage behavioral health care Develop consistent rules for supervision of advance practice registered nurses Increase funding to targeted services Expand the use of the YES waiver Develop a 1915(i) for wraparound services Investigate a pilot for a specialty health plan Reinstate Graduate Medical Education Privatize state hospitals and leverage local inpatient resources PCG Phase 2 Options Rider 71 Study

What are the options for future service delivery design?

(Integrated Managed Care Financing) Full Carve-In (Integrated Managed Care Financing) Medicaid HMO Traditional Carve-Out (Segregated Managed Care Financing) Medicaid HMO BHO STAR & STAR PLUS (Modified Carve-In) (Integrated Financing w/Specialty MH Services) Medicaid HMO (Including Standard BH) Specialty MH (Target Population)

What does the HOW recommend for consideration for the future service delivery design?

Access to care when services are needed Choice in health plans and providers Integration of care at the plan and provider level Local control over important community decisions Funding and management through the 1115 T

Recommendations 1. Carve-in Medicaid covered behavioral health services into STAR and STAR+PLUS Ensure protection of vital Medicaid services for people with SMI through a designated benefit package and capitation rate Require plans to support and fund designated health homes for people with SMI Require a network of certified comprehensive MH providers 2. Retain local control over important community decisions through LMHAs 3. Strengthen community behavioral health services through the 1115 Transformation Waiver

Carve-in Medicaid covered MH into STAR and STAR+PLUS Psychiatric Services Licensed Professional Counseling Inpatient Psychiatric Care (state/private hospital; children and adults) ECI Services Outpatient Substance Use Disorder Treatment including assessment, detoxification services, counseling treatment and medication assisted therapy Residential Substance Use Disorder Treatment services including detoxification, substance use disorder treatment including room and board Mental Health Rehabilitation Services, including Targeted Case Management

New Requirements for STAR and STAR+PLUS Ensure protection of vital Medicaid services for people with SMI through a designated benefit package and capitation rate Require STAR and STAR+PLUS plans to support and fund designated health homes for people with SMI

Carve-in Medicaid covered MH into STAR and STAR+PLUS New Designations Comprehensive Service Providers Certified by DSHS Able to provide the full array of services in the TRR service package Designated Health Homes Holistic approach to delivering care Primary or Specialty care practice Designated responsibilities

over Important Community Decisions Local planning Managing and providing services for people who are medically indigent Securing local funds Managing crisis response Linkage and provision of supportive housing Interfacing with criminal justice Facilitating benefit eligibility Assisting with access to covered services Coordinating essential services across systems Educating the public Disaster response Retain Local Control over Important Community Decisions through LMHAs

Regional Healthcare Partnership Local Government Entity Able to Transfer (IGT) Funds to draw down Federal Match Serves as a Performing Provider and receives Direct Payment from HHSC for UCC and DSRIP Statewide Coverage Strengthen community behavioral health services through the 1115 Transformation Waiver Regional Healthcare Partnership

Available Funds: Community Centers Community Centers were allocated 10% of available DSRIP funds in Pass 1, which can be claimed if the Center has available IGT. Demonstration Year Total DSRIP Funding (IGT + Federal Match) Community Center DY 1 (modified formula) $500 million $ 40 million DY 2 $2.30 billion $230 million DY 3 $2.66 billion $266 million DY 4 $2.85 billion $285 million DY 5 $3.10 billion $310 million Total, DSRIP all funds $11.41 billion $1.1 billion There may be additional funds available to Community Centers in Pass 2 but it is too early to know.

Access to care when services are needed Choice in health plans and providers Integration of care at the plan and provider level Local control over important community decisions Funding and management through the 1115 T

Discussion