1. The Future of Mental Health and Intellectual Disabilities Services

2. Welcome to a ride with more ups and downs than a rollercoaster.
--Ms. Frizzle

3. Customer Satisfaction
Triple Aim
Quality Outcomes
Customer Satisfaction
Reasonable Cost
Episode Storyline

4. Episode Location: Texas Medicaid

5. Managed Care is Texas Medicaid
82%
This is about financing and integration of healthcare services.

6. Where does the bar move next?
Stage 1
Statewide
STAR+PLUS
Acute Care Services for all Medicaid
Habilitation/
Attendant Care
MH Rehab/CM
September 2014
Stage 2
Texas Home Living Services
September 2017
Stage 3
HCS, ICF, CLASS, DBMD
Voluntary Program for persons currently enrolled
September 2020
STAR Kids

7. How do we design benefits to promote quality care at lower cost?

8. Attendant/Habilitation Services become part of the Medicaid State Plan
Assistance with activities of daily living provided to an individual because of a physical, cognitive or behavioral limitation related to disability or chronic health condition.
Habilitation
Assistance provided to an individual acquiring, retaining or improving:
skills related to activities of daily living; and
social and adaptive skills necessary to live and fully participate in the community.
Attendant/Habilitation Services become part of the
Medicaid State Plan
under the
Community First Choice option

9. 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

10. How do we know someone needs a covered benefit?

11. Comprehensive Assessment and Resource Allocation Tool
Evidence-based
Comprehensive Assessment and Resource Allocation Tool
Appropriate Tool for Authorization
Evidence Based
Nationally Recognized
Nationally Recognized
Comprehensive

12. Coordination of Care: What does the alphabet soup have in common?
ACO
PCMH
Health Home
HCIA
Patient Navigator
ISC
Customer
Local Provider

13. IDD system redesign includes the promotion of independent service coordination, ombudsman services and the prevention of inappropriate institutionalization.
DADS to contract with LIDDA for the independent service coordination function in the new program designed to provide basic attendant and habilitation services.
Service Coordination and Care Planning for Individuals with IDD
Assessment of need provided to MCO
Recommended plans of care provided to MCO and DADS
LIDDA-MCO written agreement on coordination of care
Annual report to MCO and DADS on outcomes based on an individual’s plan

14. New Requirement for STAR and STAR+PLUS
Requires 2 health home pilots in 2 service areas for people with Serious Mental Illness and at least one other chronic condition

15. Paying for
Value not
Volume

16. Performance and Quality Outcomes for Payment
SB 7
SB 58
1115 Transformation Waiver
DSHS Rider 78
HHSC MCO Contracts
Medicaid and Medicare Hospital Payment

17. Customer Satisfaction
Customer Engagement
Intellectual and Developmental Disability System Redesign Advisory Committee
STAR+PLUS Quality Council
STARKids Managed Care Advisory Committee
Behavioral Health Integration Advisory Committee

18. Are we all on the same bus?
Senate Bill 7
Senate Bill 58
SYSTEM DESIGN
Managed Care
BENEFIT DESIGN
Attendant/Habilitation
Rehabilitation/Case Management
ASSESSMENT
Comprehensive and Resource Allocation
Appropriate Authorization
PATIENT COORDINATION
Independent Service Coordination
Health Home
QUALITY OUTCOMES
Quality Based Payment;
Provider Performance
Performance and Quality Outcomes
CUSTOMER ENGAGEMENT
Advisory Committee

19. Step inside this wild ride.
--Ms. Frizzle

20. DISCUSSION

21. Melissa Rowan
Healthcare Policy Director
Texas Council of Community Centers
ext 109