2. APSE June 22, 2017
Agenda:
Why States should implement Supported Employment – Joe Marrone
WA DBHR’s history and focus on Employment – Melodie Pazolt
1115 Medicaid Transformation Demonstration Overview
King County’s history and focus on employment – Lisa Floyd
WA DBHR’s current efforts to implement Supported Employment using grant funds and pilot projects – Lisa Bennett-Perry

3. Social determinants of health are the economic and social conditions that affect health outcomes and are the underlying, contributing factors of health inequities. Examples include housing, educational attainment, employment and the environment.

4. Higher rates of unemployment cause more illness and premature death.
is bad for your health:
Higher rates of unemployment cause more illness and premature death.
As job insecurity continues, it acts as a chronic stressor whose effects grow with the length of exposure; it increases sickness absence and health service use.

5. Washington State Department of Social & Health Services
Employment Rate through UI data for adults in outpatient mental health services WA State
Individuals
2013:Q1
2013:Q2
2013:Q3
2013:Q4
2014:Q1
Total with SSNs
50,387
50,834
48,812
47,962
51,165
Employed Clients
4,514
5,183
5,184
4,960
5,142
% Emp 9%
10%
11%
WAGES
Monthly Wages
$754
$764
$766
$782
$788
Wage Rate
$12.10
$11.97
$11.80
$12.15
$11.99
HOURS
Weekly Hours 14 15
Washington State Department of Social & Health Services

6. Building on Opportunities – Housing & Employment:
Legislative direction to improve client outcomes (Employment and Housing) and use Evidence-based, Research-based, and Promising Practices – SB5732-HB1519 (2013)
Nationally Recognized Policy Academies (Housing 3000: Chronic Homeless Policy Academy & Olmstead Policy Academy)
Supportive Housing and Supported Employment services authorized in SB 6312 (2014)
Healthier Washington SIM Grant - CMMI

7. Centers for Medicaid & Medicare Services (CMS)
Policy Bulletins
Housing-Related Activities and Services (2015)
Technical Guide regarding employment and employment related services (2011)
First Episode Psychosis – Supported Employment Services for young adults (2015)

8. 1115 Medicaid Transformation Demonstration
Fidelity to Evidence-based practices
Medicaid Requirements
1115 Medicaid Transformation Demonstration
Outcomes & Sustainability

9. Housing and Employment For Better Health: An Update on the Medicaid Transformation Demonstration
On behalf of the HCA and DSHS, thanks for letting us be here with you today to talk about the demonstration.

10. Medicaid Transformation demonstration

11. Medicaid transformation goals
Over the five-year demonstration, Washington will:
Integrate physical and behavioral health purchasing and service delivery
Convert 90% of Medicaid provider payments to reward outcomes
Support provider capacity to adopt new payment and care models
Implement population health strategies that improve health equity
Provide targeted services that address the needs of our aging populations and address the key determinants of health
Goals over the next five years all focus on moving from a volume-based health system to a value-based health system. This includes addressing social determinants of health, incentivizing providers to deliver quality over quantity, and rewarding better health outcomes.

12. Medicaid Transformation Demonstration
Five-year demonstration of innovative strategies to improve health outcomes and use resources wisely
Authorizes up to $1.5 billion in federal investments
Three initiatives:
Transformation through Accountable Communities of Health
Up to $1.1B
Long-term Services and Supports
$175M
Foundational Community Support Services
$200M
Within the five-year Medicaid transformation demonstration, there are three initiatives: Long-term services & supports, Transformation through ACHs, and Foundational Community Support Services. The role of participating providers (clinical & social) is centered around the initiative of Transformation through ACHs. This presentation will focus on how ACHs work with their community partners to plan for and distribute funds for population health improvement projects under the demonstration.
Incentive Payments
Services
Services

13. Foundational Community Supports (FCS)
The WHY – We know that for our beneficiaries with the most complex needs, the best route to health isn’t just through a Doctor’s office, nor can stability be maintained solely with a prescription pad. We must also address the foundational needs that prevent our most vulnerable individuals from maintaining healthy lives. We cannot expect someone to manage their chronic health condition if they are first worried about where they are going to sleep tonight, and we cannot expect someone to get off the path of long-term dependence on health and social services, without the supports necessary for them to reenter and remain in the workforce.
The Foundational Community Supports program, under Initiative 3 of the demonstration, seeks to address these needs through targeted Medicaid benefits for Supportive Housing and Supported Employment services in order to help individuals stabilize their basic needs so they can better address their health conditions. We believe this will improve health outcomes and reduce dependence on more intensive service settings, creating a strong business case for sustainability after the demonstration.

14. Foundational Community Supports
What it is
Targeted Medicaid benefits that help eligible clients with complex health needs obtain and maintain housing and employment stability.
Supportive Housing services
Supported Employment services
What it isn’t
Ongoing payments for housing, rent, or room & board costs
Wages or wage enhancements for clients
Entitlement
Foundational Community Supports are not an entitlement; rather, support is targeted to those with the greatest and most immediate needs

15. Supportive housing
Community Transition Services (NEW to FCS)
One-time supports for individuals transitioning out of institutions or at imminent risk of becoming institutionalized
Includes rental deposit, move-in costs, household furnishings and other necessary supports
Community Support Services
Housing assessment and development of a plan to address barriers
Assistance with applications, community resources, and outreach to landlords
Education, training, coaching, resolving disputes, and advocacy
Supportive housing services do not include funds for room and board or the development of housing.

16. Community transition services
One-time expenses
NOT room & board
WA: COPES Waiver, DD Community Transition Services
Provided today under 1915c waivers
Eligibility limited to a subset within the target populations who meet an institutional level of care
“Institution” will be defined in protocol
Institutional level of care
Specific waiver is COPES, we’re doing it, other states are doing it.

17. Supportive housing target population
Chronically homeless (HUD definition)
Frequent/lengthy institutional contact
Frequent/lengthy adult residential care stays
Frequent turnover of in-home caregivers
PRISM Score 1.5+
(Predictive Risk Intelligence SysteM)

18. Supported employment Individual Placement and Support (IPS) model
Principles of supported employment
Open to anyone who wants to work
Focus on competitive employment
Systematic job development
Prioritize rapid job search
Client preferences guide decisions
Individualized long-term supports
Integrated with treatment
Benefits counseling included
Services may include
Employment assessment and development of a plan to address barriers
Assistance with applications, community resources and outreach to employers
Education, training, coaching to maintain employment
More detailed service descriptions will be included in the WAC and protocol.

19. Supported employment target population
Aged, Blind, Disabled (ABD)/Housing and Essential Needs (HEN)
Individuals with severe and persistent mental illness, individuals with multiple episodes of inpatient substance use treatment and/or co- occurring
Working age youth with behavioral health conditions
Individuals receiving long-term services and supports

20. Medicaid HCA – DBHR – ALTSA TPA Medicaid funds flow Current Model
SH/SE - CBOs
SH/SE – Health care providers
SH/SE – Comm. BH Agencies
SH/SE – LTSS Providers
SH/SE – Tribal Providers
Program oversight
Benefits administrator
This funds flow model represents the current approach. It remains a joint effort across HCA, DBHR and ALTSA, with a single TPA administering the benefits. HCA will hold the contract with the TPA, while DBHR and ALTSA will lead network development and provider support.
Data
Provider 20

21. Provider reimbursements
Rates TBD
FCS Cost Model per user, per month:
Supportive Housing: $575*
Supported Employment: $550*
Encounter units
Supportive Housing: Monthly
Supported Employment: ¼ Hour
*Cost model does not represent actual rates for services

22. Foundational Community Supports Next steps
Protocol must be approved before services can be provided
Foundational Community Supports protocol
Procurement released March 24th
Third party administrator
HCA: Program authorization
DBHR: Certification WAC
WAC
Benefits will be provided statewide
Initial provision of services to begin July 2017
In some regions, where there might not be this capacity, it may take time to develop out further – but “you’re not going to miss the train.”

23. Learn more at www.hca.wa.gov/hw
Features:
Demonstration videos
Fact sheets
Timeline
How to prepare: Engage, Inform, Communicate
We recognize that you have questions and you have your own stakeholders to communicate with. To meet this need, we have prepared a Communications Library. You can access the library right now by visiting our website hca.wa.gov/hw
From our website you can download our video, fact sheets, the timeline and more. This is designed to be your direct line to resources to help you with engagement.

24. Send questions to: medicaidtransformation @hca.wa.gov
Join the Healthier Washington Feedback Network. Sign up at: hca.wa.gov/hw
Send questions to:
Thank you for participating today. Please join our feedback network to stay in-the-know about Healthier Washington. 24

25. Thank You! Melodie Pazolt Recovery Support Services Supervisor DBHR
Department of Social and Health Services
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