1. CC2.0 Behavioral Health 1115 Waiver Proposals August 6, 2018

2. Centennial Care 2.0 Waiver Behavioral Health Component
Focus on substance use disorders – the continuum of care
CMS Milestones
Access to critical levels of care for OUD and SUD
Use of Evidence-based, SUD patient placement criteria
Use of nationally recognized SUD specific program standards to set provider qualifications for residential treatment facilities
Implementation of comprehensive treatment and prevention strategies to address OUD
Improved care coordination & transitions between levels of care
08/06/18

3. American Society of Addiction Medicine (ASAM)
Use of Evidence Based SUD Patient Placement Criteria and Access to critical levels of care for OUD and SUD
Addressed in an Implementation Plan Showing existing services and Gaps in Service Offerings
American Society of Addiction Medicine (ASAM)
0.5 – Early intervention - Screening & Prevention
1.0 - Outpatient – Less than 9 hours services/week
2.1 – Intensive Outpatient – More than 9 hours/week
2.5 – Partial Hospitalization; Day Treatment
3.1 Clinically Managed Low-Intensity Residential
3.3 Clinically Managed Population Specific High Intensity Residential
3.5 Clinically Managed High Intensity Residential
3.7 Medically Monitored Intensive Residential
4.0 Medically Managed Intensive Inpatient
08/06/18

4. 0.5 – Early intervention Screening & Prevention
Screening, brief intervention & referral to treatment (SBIRT)
Pre and post tenancy support for housing
2 gaps addressed
08/06/18

5. SBIRT Screening, Brief Intervention, Referral to Treatment (SBIRT)
This initiative is a public health approach that serves individuals who are at risk of having or have a substance use disorder. New Mexico’s SBIRT serves individuals 18 years or older who are at risk for having or have a substance use disorder, as well as individuals who suffer from anxiety, depression, and trauma.
The current operational sites include:
First Nations Community Health Source (Zuni), Albuquerque
UNM Hospital/ Trauma Unit, Albuquerque
Santa Fe Indian Hospital that includes satellite site of Santa Clara Health Center, Santa Clara
White Sands Family Practice, Alamogordo
Sage Neuroscience, Albuquerque
Quick Care, Clovis
08/06/18

6. Why are we asking for SBIRT if we already have it?
Current program funded through a grant which ends in October
CC 2.0 Waiver Request and State Plan Amendment
Lowering age to 14 and above
Screening tools relevant to age
Expand into comprehensive types of medical settings
Expand throughout State
Trained practitioners as a requirement to participate
Expanding Cadre of Peer Support Workers to screen
Reimbursement through Medicaid – FFS & MCO
Maintaining screening for SUD, trauma, depression, anxiety
08/06/18

7. It’s the service to find it, and sustain it….
Housing for Individuals with Severe BH Conditions
The 2nd preventive measure
It’s the service to find it, and sustain it….
Pre-Tenancy support
Outreach
Housing search
Application assistance
Obtaining furnishings/household supplies
Move in assistance
Tenancy Sustaining Support
Property owner relationship management
Tenancy rights and responsibilities education
Eviction prevention
Subsidy program adherences
08/06/18

8. Use of nationally recognized SUD specific program standards to set provider qualifications for residential treatment facilities
Another Gap Addressed
3.1 Clinically Managed Low-Intensity Residential
3.3 Clinically Managed Population Specific High Intensity Residential
3.5 Clinically Managed High Intensity Residential
3.7 Medically Monitored Intensive Residential
08/06/18

9. Accredited Residential Treatment Centers
3.1 Clinically Managed Low-Intensity Residential
Step down longer term ARTC for adults recovery before transitioning to community – One reimbursement level
3.3 Clinically Managed Population Specific High Intensity Residential
Mid level ARTC stay with slower pace for cognitive difficulties or other impairments
3.5 Clinically Managed High Intensity Residential
Mid level ARTC with withdrawal management (3.2 WM)
3.7 Medically Monitored Intensive Residential
Short term M.D. & nursing care for withdrawal management
Third reimbursement level
3.3 Clinically Managed Population Specific High Intensity Residential
Mid level ARTC stay with slower pace for cognitive difficulties or other impairments
3.5 Clinically Managed High Intensity Residential
Mid level ARTC with withdrawal management
Second reimbursement level
08/06/18

10. Institute for Mental Illness - IMD
Institute for Mental Disease – IMD ( effective 1965)
What is in the law?
The IMD exclusion is found in section 1905(a)(B) of the Social Security Act, which prohibits “payments with respect to care or services for any individual who has not attained 65 years of age and who is a patient in an institution for mental diseases” except for “inpatient psychiatric hospital services for individuals under age 21.”
The law goes on to define “institutions for mental diseases” as any “hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.” The IMD exclusion was intended to ensure that states, rather than the federal government, would have principal responsibility for funding inpatient psychiatric services.
08/06/18

11. Another Gap Addressed ASAM 4
Another Gap Addressed ASAM 4.0 WM- Medically Managed Intensive Inpatient
Requested 30 days in an IMD, when there is a SUD diagnosis, from the federally-allowed “in lieu of service” of 15 days/month that MCOs are able to provide for adults 21 – 64
CMS: “States cannot allow for mental illness; only for SUD”
Wrote State Plan Amendment to allow for FFS as well as MCO
08/06/18

12. New Mexico’s Health Homes
CMS’ 5th Milestone: Improved Care Coordination and Transitions Between Levels of Care
New Mexico’s Health Homes
What is a Health Home?
08/06/18

13. CareLink NM Health Homes
Opportunity # Five Expand CLNM HHs & Add SUD
CareLink NM Health Homes
Opportunity # Five Expand CLNM HHs & Add SUD
Enhanced care coordination by BH agencies in the community
Current requirements: Chronic conditions only
Serious mental illness for adults
Severe emotional disturbance for children
All comorbidities are part of care
One of six activities: comprehensive transitional care
CC 2.0 Waiver:
Add substance use disorder to chronic conditions
Add children only and adult only as long as both in same county
Finish expansion throughout State in 2 more phases
08/06/18

14. CLNM Health Home Expansion Current Expansion (April – July 2018)
CLNM Provider
Current Members (7/01/18)
Projected Members 12/31/18
Guidance Center Lea County (Hobbs)
Children’s wrap-around
185 19
1,062 53
Hidalgo Medical Services (Lordsburg & Silver City) 57
471
Kewa Pueblo Health Corp (Santo Domingo Pueblo) 86
117
Mental Health Resources (Tucumcari, Fort Sumner, & Portales)
Children’s wrap around
218 9
1,190 68
New Mexico Solutions (Albuquerque)
162
486
Presbyterian Medical Services (Rio Rancho) 18
270
UNM Hospital Clinics (Albuquerque)
(live 7/01)
2,677
08/06/18

15. Five CC2.0 BH Waiver Requests and State Plan Amendment to add FFS
Screening, Brief Intervention, & referral to treatment
Supportive Housing: pre and post tenancy
Accredited Residential Treatment Centers
Waive IMD Exclusion for 15 day stay
Expand CLNM health homes & add SUD
Questions?
08/06/18