HealthChoices Program Overview

Size: px
Start display at page:

Download "HealthChoices Program Overview"

Transcription

1 HealthChoices Program Overview Presented by: Kellie Wayda, MSW, LSW Director of Western Operations Office of Mental Health and Substance Abuse Services 7/20/2018 1

2 Agenda Managed Care Journey in PA HealthChoices Program: IN PARTICULAR BH-HC Questions 7/20/2018 2

3 Managed Care Journey Prior to managed care, Pennsylvania delivered health care serves to Medicaid beneficiaries using a fee-for-service (FFS) only model. Pennsylvania began testing managed care, on a voluntary basis in certain counties as early as Managed care was expanded over the years and the HealthChoices (HC) program was officially introduced in 1997: Initially offered on a voluntary basis to Medical Assistance (MA) eligible By 2013, HC was a statewide mandatory managed care program covering both PH and BH benefits for MA eligible. In 2015, Medicaid expansion increased number of eligible adults receiving services through the HC program. 7/20/2018 3

4 HealthChoices Program Overview In PA Behavioral Health Services are carved out from physical health Services Three primary goals: Improve access to health care services for MA recipients. Improve the quality of care available to MA recipients. Stabilize Pennsylvania's MA spending. HC is jointly funded by the federal and state government, but implemented and administered by the commonwealth s Department of Human Services (DHS). 7/20/2018 4

5 HC Program Overview BH-HC overview more specific Pennsylvania s Office of Mental Health and Substance Abuse Services (OMHSAS) has oversight of the BH-HC. As of January 2018, over 2.6 million people were enrolled in HC-BH. FY funding is projected to be $3.9 billion. 7/20/2018 5

6 HC Program State Plan Eligible Services Clozaril Support D&A Methadone Maintenance D&A Outpatient Inpatient Psychiatric Inpatient D&A MH Crisis Intervention MH Outpatient MH Partial Hospitalization Certified Peer Support Targeted Case Management (ICM, RC, Blended) Laboratory and Diagnostic Services Smoking Cessation Counseling Services ER evaluations for voluntary and involuntary commitments 7/20/2018 6

7 HC In Lieu of Services Non-hospital D&A Detox and Rehabilitation Certified Recovery Specialist Halfway House Psychiatric Rehabilitation Services Mobile Medication Licensed Psychologist, LSW, LPC Assertive Community Treatment Teams Other 7/20/2018 7

8 Behavioral Health Services All CHC participants will be covered by BH managed care through the existing behavioral health managed care organizations (BH-MCOs). This is a change for Aging Waiver participants and nursing facility residents. 7/20/2018 8

9 Behavioral Health Services NURSING FACILITIES To assure all individuals with mental illness who reside in, or apply for admission to, Medicaid-certified nursing facilities and are in need of the services provided by the facility receive services appropriate to their needs. Nursing Home Pre-Admission Screening and Resident Review Requirements related to mental health services: OMHSAS Bulletin Outlines requirements, processes, and responsibilities 7/20/2018 9

10 Behavioral Health Services SPECIALIZED SERVICES Mental health services beyond those that a nursing facility typically provides which is specified in an individualized plan of care that is developed and supervised by an interdisciplinary team. Services that are of a higher intensity and frequency than other mental health services which are provided by the nursing facility. Examples: partial hospitalization, psychiatric outpatient clinic, mental health crisis intervention, mobile mental health treatment, peer support services, mental health targeted case management 7/20/

11 HC Program Delivery HC PH and LTSS service/ benefits are managed by PH-MCOs and CHC DHS contracts directly with PH-MCOs and CHCs through competitive bid process. MA eligibles are: Offered a choice of PH-MCO and CHC. Offered a choice of Primary Care Physician (PCP). Eligible to receive covered services through the selected PH-MCO or CHC. 7/20/

12 HC Program Delivery BH-HC DELIVERY BH services/benefits are managed by counties or BH-MCOs: County is given the first opportunity to manage program directly (through a contract with the commonwealth) or subcontract with a BH-MCO. If county chooses not to participate or does not meet program standards, DHS will contract with BH-MCO through competitive bid process. 29 total BH contracts exist and 43 county or multicounty entities opted for the right of first opportunity. Only one BH-MCO in each county. 7/20/

13 HC Program Delivery Similar to PH-MCOs and CHCs, BH-MCOs establish provider networks. County (or BH-MCO) assume full risk for BH Services under managed care. MA eligibles are: Auto-enrolled in a BH-MCO based on county of residence. Offered a choice of BH providers within the BH-MCO. Eligible to receive covered services through assigned BH-MCO. 7/20/

14 HC Program Delivery Currently, there are five BH-MCOs that provide managed care to MA eligibles across the commonwealth. Community Behavioral Health Community Care Behavioral Health Magellan Behavioral Health PerformCare Beacon Health Options (formally Value Behavioral Heatlh) 7/20/

15 HC Program Delivery 7/20/

16 BH-HC Partnerships DHS County Behavioral Health/Human Services Primary contractor Alliance of Counties Behavioral Health MCOs Primary contractor Administrative services Subcontracted managed care partner 7/20/

17 Role of DHS and OMHSAS Monitor BH-MCO performance in meeting HealthChoices program standards and requirements: Monitoring team meetings Ongoing reporting requirements Quality management oversight Annual review process Further HealthChoices program development 7/20/

18 Role of County HealthChoices Visionary leadership to support the ongoing development of the local HealthChoices program. Integrated approach to meeting member needs. Ease of access to services Effective management of Medicaid and county funded services Joint service development to address gaps Furthering integrated care management Local oversight and management of the program. 7/20/

19 Role of BH-MCO Meet program standards and requirements. Perform delegated managed care functions. Be a responsive and accountable partner to counties. Bring state-of-the-art information technology used to further the aims of the program. Demonstrate fiscal accountability. Collaborate with human services, providers, and members. Cross-systems coordination. 7/20/

20 Role of BH-MCO Bring innovation, promote clinically competent, and recovery focused care Provide specialized care management for individuals with complex needs, including coordination of care with community-based services 7/20/

21 BH-MCO Critical Functions Member Education and Outreach Community Relations Customer Services Care Management Utilization Management Quality Management Outcomes Management Program Development Network Management Service Access Credentialing Contracting Training Claims Processing IT Finance 7/20/

22 Focus on Recovery Improving the Well-Being of the Individual and the Community Peer & Family Involvement Recovery Transformation Physical & Behavioral Health Integration Person with Lived Experience Focused Care Management Model Respecting Individual Differences Systems Integration (Children & Youth) 7/20/

OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN

OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN ISSUE DATE: EFFECTIVE DATE: NUMBER: September 22, 2009 October 1, 2009 OMHSAS-09-05 SUBJECT: Peer Support Services - Revised BY: Joan L. Erney,

More information

AD Ordering, Referring, and Prescribing Providers

AD Ordering, Referring, and Prescribing Providers Provider Notice To: From: All PerformCare Network Providers Scott Daubert, PhD, VP Operations Date: Revised December 1, 2017 (originally September 30, 2017) Subject: AD 17 104 Ordering, Referring, and

More information

Paula Stone Deputy Director, DMS, DHS

Paula Stone Deputy Director, DMS, DHS Paula Stone Deputy Director, DMS, DHS 1 Outpatient mental health services available to AR Medicaid beneficiaries include: Individual, family and group counseling services provided in an outpatient agency

More information

Treatment Planning. General Considerations

Treatment Planning. General Considerations Treatment Planning CBH Compliance has been tasked with ensuring that our providers adhere to documentation standards presented in state regulations, bulletins, CBH contractual documents, etc. Complying

More information

COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE ISSUE DAT E: DRAFT

COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE ISSUE DAT E: DRAFT MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE NUMBER: DRAFT ISSUE DAT E: DRAFT EFFECTIVE DATE: DRAFT SUBJECT: Behavioral Health Services:

More information

Mental Health Updates. Presented by EDS Provider Field Consultants

Mental Health Updates. Presented by EDS Provider Field Consultants Mental Health Updates Presented by EDS Provider Field Consultants October 2007 Agenda Session Objectives Outpatient Mental Health Medicaid Rehabilitation Option (MRO) Somatic Treatment Assertive Community

More information

UPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS

UPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS UPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS November 18, 2013 NYS OMH Behavioral Health Transition 2 Key MRT initiative to move fee-for-service populations and services into managed

More information

Maryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012

Maryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012 Maryland Medicaid Program Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance or MA. MA is a joint

More information

MassHealth Restructuring Overview

MassHealth Restructuring Overview 1 MassHealth Restructuring Overview State of the State, Assuring Access, Equity and Integrated Care Massachusetts League of Community Health Centers Marylou Sudders, Secretary Executive Office of Health

More information

COUNTY HUMAN SERVICES BLOCK GRANT REPORTING INSTRUCTIONS

COUNTY HUMAN SERVICES BLOCK GRANT REPORTING INSTRUCTIONS INSTRUCTIONS FOR THE ANNUAL INCOME AND EXPENDITURE REPORT Block Grant County with Joinder Arrangement FISCAL YEAR 2014-2015 COUNTY HUMAN SERVICES BLOCK GRANT REPORTING INSTRUCTIONS ISSUED BY: PENNSYLVANIA

More information

North Carolina s Transformation to Managed Care

North Carolina s Transformation to Managed Care North Carolina s Transformation to Managed Care Jay Ludlam, Assistant Secretary Department of Health and Human Services December 2017 My background Only 10+ years of experience in Medicaid Assistant Attorney

More information

Pennsylvania HealthChoices Behavioral Health Program

Pennsylvania HealthChoices Behavioral Health Program Pennsylvania HealthChoices Behavioral Health Program Early Warning Care Monitoring Program Lehigh/Capital Region First Quarter 2002 Report Commonwealth of Pennsylvania Department of Public Welfare Office

More information

Medicaid Transformation

Medicaid Transformation JOINT LEGISLATIVE COMMITTEE ON MEDICAID AND NC HEALTH CHOICE Medicaid Transformation Dr. Mandy Cohen, Dave Richard, Jay Ludlam Department of Health and Human Services Nov. 14, 2017 Recap: Where We Are

More information

COMMUNITY CARE 20TH ANNIVERSARY

COMMUNITY CARE 20TH ANNIVERSARY Community Care Conference: 20 years of HealthChoices, Recovery, and Innovation in Behavioral Health Services WEDNESDAY, OCTOBER 25, 2017 David L. Lawrence Convention Center 1000 Fort Duquesne Boulevard

More information

Partial Hospitalization. Shelly Rhodes, LPC

Partial Hospitalization. Shelly Rhodes, LPC Partial Hospitalization Shelly Rhodes, LPC Shelly.Rhodes@beaconhealthoptions.com Transition and Certification 2 Transition and Certification Current Rehabilitative Services for Persons with Mental Illness

More information

Arkansas Department of Human Services

Arkansas Department of Human Services Arkansas Department of Human Services Stakeholder Webinar May 31, 2018 Agenda OBH Certification Update Billing Update ConnectCare Services Transition Plan Tier 2 and Tier 3 New Services Q&A OBH CERTIFICATION

More information

Managed Long Term Services and Supports, an. Brian Stever, BSN RN Director of Health Informatics Presbyterian Senior Living April 28, 2016

Managed Long Term Services and Supports, an. Brian Stever, BSN RN Director of Health Informatics Presbyterian Senior Living April 28, 2016 Managed Long Term Services and Supports, an update Brian Stever, BSN RN Director of Health Informatics Presbyterian Senior Living April 28, 2016 Agenda What is Managed Long-Term Services and Support, MLTSS?

More information

Integrated Children s Services Initiative Frequently Asked Questions July 20, 2005

Integrated Children s Services Initiative Frequently Asked Questions July 20, 2005 Integrated Children s Services Initiative Frequently Asked Questions July 20, 2005 1. What is the rationale for this change? Last year the Department began the Integrated Children s Services Initiative

More information

Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012

Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012 Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012 Table of Contents CARE COORDINATION GENERAL REQUIREMENTS...4 RISK STRATIFICATION AND HEALTH ASSESSMENT PROCESS...6

More information

Acute Crisis Units. Shelly Rhodes, Provider Relations Manager

Acute Crisis Units. Shelly Rhodes, Provider Relations Manager Acute Crisis Units Shelly Rhodes, Provider Relations Manager Shelly.Rhodes@beaconhealthoptions.com Training Agenda Agenda: Transition and Certification Coverage of Services Service Code Definition Documentation

More information

Joining Passport Health Plan. Welcome IMPACT Plus Providers

Joining Passport Health Plan. Welcome IMPACT Plus Providers Joining Passport Health Plan Welcome IMPACT Plus Providers Agenda Passport Behavioral Health Services Overview Steps to Joining Passport Health Plan s Network Getting a Medicaid Number Enrolling in the

More information

Implementing Medicaid Behavioral Health Reform in New York

Implementing Medicaid Behavioral Health Reform in New York Redesign Medicaid in New York State Implementing Medicaid Behavioral Health Reform in New York Conference of Local Mental Hygiene Directors November 19, 2013 Agenda Goals Timeline BH Benefit Design Overview

More information

NAMI-NJ Conference December 6, Lynn A. Kovich Assistant Commissioner

NAMI-NJ Conference December 6, Lynn A. Kovich Assistant Commissioner NAMI-NJ Conference December 6, 2014 Lynn A. Kovich Assistant Commissioner Agenda Overview of Family Forums Division Changes Housing Overview New Initiatives Major Trends 2 Family Forums DMHAS, in conjunction

More information

Draft Children s Managed Care Transition MCO Requirements

Draft Children s Managed Care Transition MCO Requirements Draft Children s Managed Care Transition MCO Requirements OVERVIEW On February 1 st, New York State released for stakeholder feedback a draft version of the Medicaid Managed Care Organization (MCO) Children

More information

Commonwealth of Pennsylvania Department of Public Welfare Office of Mental Health and Substance Abuse Services

Commonwealth of Pennsylvania Department of Public Welfare Office of Mental Health and Substance Abuse Services Commonwealth of Pennsylvania Department of Public Welfare Office of Mental Health and Substance Abuse Services 2013 External Quality Review Report Community Behavioral HealthCare Network of Pennsylvania,

More information

2016 Quality Management Program Highlights. Spring 2017 Update

2016 Quality Management Program Highlights. Spring 2017 Update 2016 Quality Management Program Highlights Spring 2017 Update Table Of Contents Quality Management Program Overview.....3-4 Quality Committees.5 Data Monitoring and Enrollment Trends..6-7 QM/UM Plan Highlights....8

More information

Rehabilitation Research and Training Center on Aging with Developmental Disabilities Department of Disability and Human Development University of Illinois at Chicago http://www.rrtcadd.org/ By 2010 Managed

More information

Community Hospital Integration Projects Program (CHIPP) Guidelines

Community Hospital Integration Projects Program (CHIPP) Guidelines Community Hospital Integration Projects Program (CHIPP) Guidelines Office of Mental Health and Substance Abuse Services Department of Public Welfare Commonwealth of Pennsylvania Issued: July 2013 SECTION

More information

Transitioning to Community Services: HARPS, Health Homes and SPOA

Transitioning to Community Services: HARPS, Health Homes and SPOA Transitioning to Community Services: HARPS, Health Homes and SPOA P R E S E N T E R : G L E N N L I E B M A N, C EO Mental Health Association in New York State, Inc. Brief History of Health and Recovery

More information

Major Dimensions of Managed Behavioral Health Care Arrangements Level 3: MCO/BHO and Provider Contract

Major Dimensions of Managed Behavioral Health Care Arrangements Level 3: MCO/BHO and Provider Contract Introduction To understand how managed care operates in a state or locality it may be necessary to collect organizational, financial and clinical management information at multiple levels. For instance,

More information

MEDICAL ASSISTANCE BULLETIN

MEDICAL ASSISTANCE BULLETIN MEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE ISSUE DATE EFFECTIVE DATE NUMBER September 8, 1995 September 8, 1995 1153-95-01 SUBJECT Accessing Outpatient Wraparound

More information

Volume 26 No. 05 July Providers of Behavioral Health Services For Action Health Maintenance Organizations For Information Only

Volume 26 No. 05 July Providers of Behavioral Health Services For Action Health Maintenance Organizations For Information Only Newsletter Published by the N.J. Dept. of Human, Div. of Medical Assistance & Health & the Division of and Volume 26 No. 05 July 2016 TO: SUBJECT: Providers of Behavioral Health For Action Health Maintenance

More information

Implementing Medicaid Behavioral Health Reform in New York

Implementing Medicaid Behavioral Health Reform in New York Redesign Medicaid in New York State Implementing Medicaid Behavioral Health Reform in New York HIV Health and Human Services Planning Council of New York March 19, 2014 Agenda Goals Timeline BH Benefit

More information

FIDA. Care Management for ALL

FIDA. Care Management for ALL Care Management for ALL In 2011, Governor Andrew M. Cuomo established a Medicaid Redesign Team (MRT), which initiated significant reforms to the state s Medicaid program. This included a critical initiative

More information

Outpatient Behavioral Health Services (OBH)-General Information

Outpatient Behavioral Health Services (OBH)-General Information Outpatient Behavioral Health Services (OBH)-General Information 1 General Information Beneficiaries currently served by the RSPMI, LMHP, and SATS programs will begin transitioning to the Outpatient Behavioral

More information

BEHAVIORAL HEALTH REHABILITATION SERVICES

BEHAVIORAL HEALTH REHABILITATION SERVICES BEHAVIORAL HEALTH REHABILITATION SERVICES TODAY S AGENDA New Developments Update on PA of TSS Highlights of Draft Regulations CORRECTIVE ACTION WORKGROUP In response to: Ever Increasing Utilization Complaints

More information

Division of Mental Health, Developmental Disabilities & Substance Abuse Services NC Mental Health and Substance Use Service Array Survey

Division of Mental Health, Developmental Disabilities & Substance Abuse Services NC Mental Health and Substance Use Service Array Survey Table 1 Service Name Include any subcategories of service on a separate line In Table 2, please add service description and key terms Outpatient Treatment Behavioral Health Urgent Care (a type of outpatient)

More information

Overview of Medicaid. and the 1115 Medicaid Transformation Waiver. Opportunities for Supportive Housing Providers and Tenants August 2, 2016

Overview of Medicaid. and the 1115 Medicaid Transformation Waiver. Opportunities for Supportive Housing Providers and Tenants August 2, 2016 Overview of Medicaid and the 1115 Medicaid Transformation Waiver Opportunities for Supportive Housing Providers and Tenants August 2, 2016 Speaker Carol Wilkins, MPP Consultant carol.wilkins.ca@gmail.com

More information

The Money Follows the Person Demonstration in Massachusetts

The Money Follows the Person Demonstration in Massachusetts The Money Follows the Person Demonstration in Massachusetts Use of Concurrent 1915(b)(c) Waivers to Serve Elders and Adults with Disabilities Transitioning from Long-Stay Facilities HCBS Conference Arlington,

More information

Model of Care Heritage Provider Network & Arizona Priority Care Model of Care 2018

Model of Care Heritage Provider Network & Arizona Priority Care Model of Care 2018 Model of Care Model of Care 2018 Learning Objectives Program participants will be able to: List two differences between the Complex Care Management (CCM), and Special Needs Program (SNP) programs. Identify

More information

Requirements for Provider Type 21 Case Manager

Requirements for Provider Type 21 Case Manager Requirements for Provider Type 21 Case Manager Specialty Code 076 Peer Support Services 211 Medical Assistance Case Management for HIV&AIDS 212 Medical Assistance Case Management for Under 21 213 Early

More information

Children's System MCO Contracting Fair. November 6, 2017

Children's System MCO Contracting Fair. November 6, 2017 Children's System MCO Contracting Fair November 6, 2017 2 Guiding Principles Behind Children s Health and Behavioral Health MC Transition Key components of the managed care transition is to: Early identification

More information

Welcome and Introductions

Welcome and Introductions Integrating Care for Dual Eligible Beneficiaries National Conference of State Legislatures Fall Forum: Changing Roles of States in Long Term Services and Supports December 3, 2013 Sarah Barth, JD www.chcs.org

More information

Federal Legislation to Address the Opioid Crisis: Medicaid Provisions in the SUPPORT Act

Federal Legislation to Address the Opioid Crisis: Medicaid Provisions in the SUPPORT Act October 2018 Issue Brief Federal Legislation to Address the Opioid Crisis: Medicaid Provisions in the SUPPORT Act MaryBeth Musumeci and Jennifer Tolbert On October 3, 2018, the Senate overwhelmingly passed

More information

Access to Adult BH HCBS for Non-Health Home Enrollees: The State Designated Entity. February 22, 2018

Access to Adult BH HCBS for Non-Health Home Enrollees: The State Designated Entity. February 22, 2018 Access to Adult BH HCBS for Non-Health Home Enrollees: The State Designated Entity February 22, 2018 February 22, 2018 Agenda Overview of HARP and Adult BH HCBS What is a State Designated Entity? Becoming

More information

Improving Health Status through Behavioral Health Interventions

Improving Health Status through Behavioral Health Interventions Comorbidity in the Dual Eligible Population: Improving Health Status through Behavioral Health Interventions PREPARED FOR THE CALIFORNIA ASSOCIATION OF HEALTH PLANS 2013 SEMINAR SERIES JUNE 25, 2013 BEACON

More information

Medicaid Funded Services Plan

Medicaid Funded Services Plan Clinical Communication Bulletin 007 To: From: All Enrollees, Stakeholders, and Providers Cham Trowell, UM Director Date: May 10, 2016 Subject: Medicaid Funded Services Plan benefit changes, State Funded

More information

Medicaid Managed Care Readiness For Agency Staff --

Medicaid Managed Care Readiness For Agency Staff -- Medicaid Managed Care Readiness 101 -- For Agency Staff -- To Understand: Learning Objectives Basic principles of Managed Care as a payment vehicle for health care services The structure of the current

More information

TBH Medicaid Participating Provider ARQ Page 1

TBH Medicaid Participating Provider ARQ Page 1 TBH Medicaid Participating Provider ARQ Page 1 Room & Board Inpatient 90785 Interactive complexity code 90791 90792 90832 Room & Board Inpatient Psych Per Diem Psychiatric diagnostic evaluation Psychiatric

More information

Cardinal Innovations Healthcare 2017 Needs and Gaps Analysis

Cardinal Innovations Healthcare 2017 Needs and Gaps Analysis 2017 Community Mental Health, Substance Use and Developmental Disabilities Services Needs and Gaps Analysis for the Triad Region (Formerly known as CenterPoint Human Services) This study assesses the community

More information

From HARPs to DSRIP to VBP: What Do They Mean To You?

From HARPs to DSRIP to VBP: What Do They Mean To You? From HARPs to DSRIP to VBP: What Do They Mean To You? North Country NYAPRS 2016 Winter Forum Harvey Rosenthal Executive director 1 New York Association of Psychiatric Rehabilitation Services (NYAPRS) A

More information

Rehabilitative Behavioral Health Providers Frequently Asked Questions

Rehabilitative Behavioral Health Providers Frequently Asked Questions Rehabilitative Behavioral Health Providers Frequently Asked Questions Q. What has changed regarding rehabilitative behavioral health services? A. Effective July 1, 2016, South Carolina Department of Health

More information

Accomplishments and Challenges in Medicaid Mental Health Services

Accomplishments and Challenges in Medicaid Mental Health Services Accomplishments and Challenges in Medicaid Mental Health Services Innovation, Financing and Change June 5, 2008 Richard H. Dougherty, Ph.D. Accomplishments There has been significant reductions in state

More information

Medicaid Adult Mental Health (MH) Services

Medicaid Adult Mental Health (MH) Services Assessment/Intake Codes: 90791-90792 GT; DJ; TK +90875 (Interactive complexity add-on code) Medicaid Adult Mental Health (MH) Services 4 visits per year per consumer. 1 unit per episode Prior authorization

More information

CAPITAL AREA BEHAVIORAL HEALTH COLLABORATIVE, INC. CONTINUOUS QUALITY IMPROVEMENT PLAN 2013

CAPITAL AREA BEHAVIORAL HEALTH COLLABORATIVE, INC. CONTINUOUS QUALITY IMPROVEMENT PLAN 2013 CAPITAL AREA BEHAVIORAL HEALTH COLLABORATIVE, INC. CONTINUOUS QUALITY IMPROVEMENT PLAN 2013 Presented by: Scott W. Suhring Prepared by: Deborah S. Allen Contents INTRODUCTION... 3 CHILDREN/ADOLESCENT SERVICES...

More information

COMMONWEALTH COORDINATED CARE PLUS. A Managed Long Term Services and Supports Program

COMMONWEALTH COORDINATED CARE PLUS. A Managed Long Term Services and Supports Program COMMONWEALTH COORDINATED CARE PLUS A Managed Long Term Services and Supports Program Agenda Background and Key Facts Populations Services Regional Launch CCC Plus Enrollment 2 Overview of Commonwealth

More information

Beaver County Sequential Intercept Model and System of Care. Forensic Rights Conference December 1, 2011

Beaver County Sequential Intercept Model and System of Care. Forensic Rights Conference December 1, 2011 Beaver County Sequential Intercept Model and System of Care Forensic Rights Conference December 1, 2011 1 Agenda Overview of Beaver County Progression of Forensic / Behavioral Health Initiatives The Sequential

More information

WHAT ARE THE GOALS OF CHC?

WHAT ARE THE GOALS OF CHC? CHC Overview PHCA Conference September 27, 2017 Jennifer Burnett Deputy Secretary Kevin Hancock Chief of Staff Office of Long-Term Living Department of Human Services WHAT ARE THE GOALS OF CHC? 2 1 3 MANAGED

More information

OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN

OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN ISSUE DATE EFFECTIVE DATE: NUMBER: SUBJECT: Clarification of Policies Regarding the Authorization and Delivery of Behavioral Health Rehabilitation

More information

Behavioral Health Provider Training: Program Overview & Helpful Information

Behavioral Health Provider Training: Program Overview & Helpful Information Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused

More information

Family and Youth Peer Support September 19, 2011, 2:00 4:00 p.m., ET

Family and Youth Peer Support September 19, 2011, 2:00 4:00 p.m., ET Care Management Entity Quality Collaborative Technical Assistance Webinar Series Family and Youth Peer Support September 19, 2011, 2:00 4:00 p.m., ET For audio and to participate, dial: (866) 699-3239

More information

xwzelchzz April 20, 2009

xwzelchzz April 20, 2009 Z xwzelchzz April 20, 2009 Assertive Community Treatment and Community Treatment Teams in Pennsylvania Commonwealth of Pennsylvania Office of Mental Health and Substance Contents 1. Introduction...1 2.

More information

Behavioral Health and Service Integration Administration (BHSIA)

Behavioral Health and Service Integration Administration (BHSIA) Behavioral Health and Service Integration Administration (BHSIA) House Health Care and Wellness Committee Jane Beyer, Assistant Secretary Department of Social and Health Services January 13, 2015 1 BHSIA

More information

BEHAVIORAL HEALTH SERVICES PROVIDER MANUAL Chapter Two of the Medicaid Services Manual

BEHAVIORAL HEALTH SERVICES PROVIDER MANUAL Chapter Two of the Medicaid Services Manual BEHAVIORAL HEALTH SERVICES PROVIDER MANUAL Chapter Two of the Medicaid Services Manual Issued March 14, 2017 State of Louisiana Bureau of Health Services Financing SECTION: TABLE OF CONTENTS PAGE(S) 1

More information

Behavioral Health Providers: Frequently Asked Questions (FAQs)

Behavioral Health Providers: Frequently Asked Questions (FAQs) Behavioral Health Providers: Frequently Asked Questions (FAQs) Q. What has changed as far as behavioral health services? A1. Effective April 1, 2012, the professional and outpatient facility charges for

More information

Dallas County s Role in Behavioral Health and Supportive Services. Briefing to Dallas City Council Housing Committee

Dallas County s Role in Behavioral Health and Supportive Services. Briefing to Dallas City Council Housing Committee Dallas County s Role in Behavioral Health and Supportive Services Briefing to Dallas City Council Housing Committee 9 19 2016 Overview Dallas County Funding for Behavioral Health and Supportive Services

More information

Provider Handbook Supplement for HealthChoices Program Providers for Bucks, Cambria, Delaware, Lehigh, Montgomery and Northampton Counties

Provider Handbook Supplement for HealthChoices Program Providers for Bucks, Cambria, Delaware, Lehigh, Montgomery and Northampton Counties Magellan Behavioral Health of Pennsylvania, Inc.* Provider Handbook Supplement for HealthChoices Program Providers for Bucks, Cambria, Delaware, Lehigh, Montgomery and Northampton Counties * Magellan Healthcare,

More information

Alliance Behavioral Healthcare Level of Care Guidelines for State Funded Adult Mental Health and Substance Abuse Services

Alliance Behavioral Healthcare Level of Care Guidelines for State Funded Adult Mental Health and Substance Abuse Services Alliance Behavioral Healthcare of Care Guidelines for State Funded Adult Mental Health and Substance Abuse s Mental Health (Effective 10/1/2012) The levels of care criteria provide a framework for the

More information

Enhanced Mental Health Clinical Coverage Policy No: 8-A and Substance Abuse Services Amended Date: October 1, 2016.

Enhanced Mental Health Clinical Coverage Policy No: 8-A and Substance Abuse Services Amended Date: October 1, 2016. Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements... 1 2.1 Provisions... 1 2.1.1 General... 1 2.1.2 Specific... 2 2.2 Special

More information

Connecting person to person. Building healthier communities. Maximizing effective approaches to care. Partnering long-term with customers.

Connecting person to person. Building healthier communities. Maximizing effective approaches to care. Partnering long-term with customers. Connecting person to person. Building healthier communities. Maximizing effective approaches to care. Partnering long-term with customers. AmeriHealth Caritas Pennsylvania (PA) Community HealthChoices

More information

Quality Management Plan Fiscal Year

Quality Management Plan Fiscal Year Quality Management Plan Fiscal Year 2016-2017 Mental Health and Substance Abuse Division Contractor Services Section Quality Management and Compliance Unit Contents Introduction... 3 Purpose... 4 QM Committee...

More information

Maryland Medicaid s Partnership in Improving Behavioral Health Services. Susan Tucker Executive Director, Office of Health Services September 8, 2014

Maryland Medicaid s Partnership in Improving Behavioral Health Services. Susan Tucker Executive Director, Office of Health Services September 8, 2014 Maryland Medicaid s Partnership in Improving Behavioral Health Services Susan Tucker Executive Director, Office of Health Services September 8, 2014 Began in 1966 Maryland Medicaid By FY 14, we provided

More information

Peach State Health Plan Covered Services & Authorization Guidelines Programs for Behavioral Health

Peach State Health Plan Covered Services & Authorization Guidelines Programs for Behavioral Health Peach State Health Plan Covered s & Guidelines Programs for Health n-participating providers (those that are not contracted and credentialed with Peach State Health Plan) require prior authorization for

More information

Sunflower Health Plan

Sunflower Health Plan Key Components for Successful LTSS Integration: Case Studies of Ten Exemplar Programs Sunflower Health Plan Jennifer Windh September 2016 Long- term services and supports (LTSS) integration is the integration

More information

OMHSAS & MTFC. Accessing Medical Assistance Funding Presented by the OMHSAS Children s Bureau. Updated

OMHSAS & MTFC. Accessing Medical Assistance Funding Presented by the OMHSAS Children s Bureau. Updated OMHSAS & MTFC Accessing Medical Assistance Funding Presented by the OMHSAS Children s Bureau Updated 4-2-2010 OVERVIEW Who are we? The treatment components of MTFC are a Program Exception for MA purposes:

More information

MassHealth Accountable Care Update

MassHealth Accountable Care Update MassHealth Accountable Care Update Marylou Sudders Secretary Executive Office of Health & Human Services May 16, 2018 Partnering with CHCs: In it together! Community health centers have been providing

More information

Behavioral Health Provider Training: Program Overview & Helpful Information

Behavioral Health Provider Training: Program Overview & Helpful Information Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused

More information

IV. Clinical Policies and Procedures

IV. Clinical Policies and Procedures A. Introduction The role of ValueOptions NorthSTAR is to coordinate the delivery of clinical services. There are three parties to this care coordination process: the Enrollee, the Provider(s), and the

More information

Medicaid 101: The Basics for Homeless Advocates

Medicaid 101: The Basics for Homeless Advocates Medicaid 101: The Basics for Homeless Advocates July 29, 2014 The Source for Housing Solutions Peggy Bailey CSH Senior Policy Advisor Getting Started Things to Remember: Medicaid Agency 1. Medicaid is

More information

Cost Estimates of Individual Assessment Tools In Arkansas Medicaid Population

Cost Estimates of Individual Assessment Tools In Arkansas Medicaid Population Cost Estimates of Individual Assessment Tools In Arkansas Medicaid Population PREPARED BY: THE STEPHEN GROUP 814 Elm Street, Suite 309 Manchester, NH, 03102 Main: (603)419-9592 www.stephengroupinc.com

More information

Behavioral Health Services in Ohio Hospitals Ohio Hospital Association. Ohio Department of Medicaid January 23, 2018

Behavioral Health Services in Ohio Hospitals Ohio Hospital Association. Ohio Department of Medicaid January 23, 2018 Behavioral Health Services in Ohio Hospitals Ohio Hospital Association Ohio Department of Medicaid January 23, 2018 1 Outpatient Hospital Behavioral Health Services 2 OPHBH Services in Hospitals Outpatient

More information

MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN

MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE NUMBER: ISSUE DATE: EFFECTIVE DATE: SUBJECT: OMHSAS-03-04 BY: 12/19/03 Immediately Office

More information

Innovative Ways to Finance Mental Health Services in a Primary Care Setting

Innovative Ways to Finance Mental Health Services in a Primary Care Setting Innovative Ways to Finance Mental Health Services in a Primary Care Setting Prepared by: Kathleen Reynolds, MSW, ACSW Executive Director And Virginia Koster, MSW, ACSW Integrated Initiatives Coordinator

More information

DRUG MEDI-CAL ORGANIZED DELIVERY SYSTEM (DMC-ODS) PERFORMANCE METRICS. (version 6/23/17)

DRUG MEDI-CAL ORGANIZED DELIVERY SYSTEM (DMC-ODS) PERFORMANCE METRICS. (version 6/23/17) 1 Access Enrollment information to include the number of DMC-ODS beneficiaries served in the DMC-ODS program Clients Served: 1. Number of DMC-ODS beneficiaries served (admissions) by the DMC- ODS County

More information

Bulletin. DHS Provides Policy for Certified Community Behavioral Health Clinics TOPIC PURPOSE CONTACT SIGNED TERMINOLOGY NOTICE NUMBER DATE

Bulletin. DHS Provides Policy for Certified Community Behavioral Health Clinics TOPIC PURPOSE CONTACT SIGNED TERMINOLOGY NOTICE NUMBER DATE Bulletin NUMBER 17-51-01 DATE February 27, 2017 OF INTEREST TO County Directors Social Services Supervisors and Staff Case Managers and Care Coordinators Managed Care Organizations Mental Health Providers

More information

Recovery Homes: Recovery and Health Homes under Health Care Reform

Recovery Homes: Recovery and Health Homes under Health Care Reform Recovery Homes: Recovery and Health Homes under Health Care Reform 4/27/11 Richard H. Dougherty, Ph.D. DMA Health Strategies Challenges of health reform Increasing coverage Reducing costs of coverage Reducing

More information

Transforming Behavioral Health Care in Louisiana Magellan in Louisiana/ Dr. Craig Coenson/Year 1 Report to the Community

Transforming Behavioral Health Care in Louisiana Magellan in Louisiana/ Dr. Craig Coenson/Year 1 Report to the Community Transforming Behavioral Health Care in Louisiana Magellan in Louisiana/ Dr. Craig Coenson/Year 1 Report to the Community Today s Discussion Welcome and Introductions Year 1: A change for good Meeting our

More information

MEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE

MEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE MEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE SUBJECT BY NUMBER: ISSUE DATE: September 8, 1995 EFFECTIVE DATE: September 8, 1995 Mental Health Services Provided

More information

The Readmissions Quality Collaborative. Edith Kealey, MSW Kate M. Sherman, LCSW New York State Office of Mental Health, 2013

The Readmissions Quality Collaborative. Edith Kealey, MSW Kate M. Sherman, LCSW New York State Office of Mental Health, 2013 The Readmissions Quality Collaborative Edith Kealey, MSW Kate M. Sherman, LCSW New York State Office of Mental Health, 2013 Overview Background and Scope of the Problem The Readmissions Quality Collaborative

More information

Florida Medicaid. Behavioral Health Community Support and Rehabilitation Services Coverage Policy. Agency for Health Care Administration [Month YYYY]

Florida Medicaid. Behavioral Health Community Support and Rehabilitation Services Coverage Policy. Agency for Health Care Administration [Month YYYY] Florida Medicaid Behavioral Health Community Support and Rehabilitation Services Coverage Policy Agency for Health Care Administration [Month YYYY] Draft Rule Table of Contents 1.0 Introduction... 1 1.1

More information

Mental Health and Substance Abuse Services Bulletin COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE. Effective Date:

Mental Health and Substance Abuse Services Bulletin COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE. Effective Date: Mental Health and Substance Abuse Services Bulletin COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE Date of Issue: July 30, 1993 Effective Date: April 1, 1993 Number: OMH-93-09 Subject By Resource

More information

Introducing AmeriHealth Caritas Iowa

Introducing AmeriHealth Caritas Iowa Introducing AmeriHealth Caritas Iowa A presentation for Iowa providers. CPC; Q215 Iowa V1 Who We Are Who We Serve Agenda Our Mission AmeriHealth Caritas Iowa Why Partner With Us? Questions 2 2 Who We Are

More information

Behavioral Health Division JPS Health Network

Behavioral Health Division JPS Health Network Behavioral Health Division JPS Health Network Macro Trends 1 in 5 Adults in America experience a mental illness Diversion of Behavioral Health patients from jail Federal Prisons Mental Illness State Prison

More information

Adult BH HCBS Town Hall ROS Designated Providers. June 13, 2017

Adult BH HCBS Town Hall ROS Designated Providers. June 13, 2017 Adult BH HCBS Town Hall ROS Designated Providers June 13, 2017 June 28, 2017 2 Why Behavioral Health Transformation is Needed June 28, 2017 3 Why Behavioral Health Transformation is Needed In NYS, members

More information

Coverage of Behavioral Health Services for Children, Youth, and Young Adults with Significant Mental Health Conditions

Coverage of Behavioral Health Services for Children, Youth, and Young Adults with Significant Mental Health Conditions Coverage of Behavioral Health Services for Children, Youth, and Young Adults with Significant Mental Health Conditions Webinar Website: http://gucchdtacenter.georgetown.edu/resources/tawebinars.html Coverage

More information

ATTACHMENT II EXHIBIT II-C Effective Date: February 1, 2018 SERIOUS MENTAL ILLNESS SPECIALTY PLAN

ATTACHMENT II EXHIBIT II-C Effective Date: February 1, 2018 SERIOUS MENTAL ILLNESS SPECIALTY PLAN ATTACHMENT II EXHIBIT II-C Effective Date: February 1, 2018 SERIOUS MENTAL ILLNESS SPECIALTY PLAN The provisions in Attachment II and the MMA Exhibit apply to this Specialty Plan, unless otherwise specified

More information

State-Funded Enhanced Mental Health and Substance Abuse Services

State-Funded Enhanced Mental Health and Substance Abuse Services and and Contents 1.0 Description of the Service... 3 2.0 Individuals Eligible for State-Funded Services... 3 3.0 When State-Funded Services Are Covered... 3 3.1 General Criteria... 3 3.2 Specific Criteria...

More information

October 5 th & 6th, The Managed Care Technical Assistance Center of New York

October 5 th & 6th, The Managed Care Technical Assistance Center of New York October 5 th & 6th, 2015 The Managed Care Technical Assistance Center of New York What is MCTAC? MCTAC is a training, consultation, and educational resource center that offers resources to all mental health

More information

Navigating New York State s Transition to Managed Care

Navigating New York State s Transition to Managed Care Navigating New York State s Transition to Managed Care December 3, 2014 Mary McKernan McKay, Ph.D Andrew F. Cleek, Psy.D. Meaghan E. Baier, LMSW Agenda Introduction of the Managed Care Technical Assistance

More information

Leveraging Medicaid for Supported Employment: Options for States. Suzanne Fields, MSW, LICSW Technical Assistance Collaborative

Leveraging Medicaid for Supported Employment: Options for States. Suzanne Fields, MSW, LICSW Technical Assistance Collaborative Leveraging Medicaid for Supported Employment: Options for States Suzanne Fields, MSW, LICSW Technical Assistance Collaborative Supported Employment in Medicaid States have a variety of available mechanisms

More information