Coverage of Behavioral Health Services for Children, Youth, and Young Adults with Significant Mental Health Conditions
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1 Coverage of Behavioral Health Services for Children, Youth, and Young Adults with Significant Mental Health Conditions Webinar Website:
2 Coverage of Behavioral Health Services for Children, Youth, and Young Adults with Significant Mental Health Conditions Sherry Peters, M.S.W. Director, PRTF Waiver Initiative Georgetown University s National Technical Assistance Center for Children s Mental Health Gary Blau, Ph.D. Chief, Child, Adolescent and Family Branch Substance Abuse and Mental Health Services Administration (SAMHSA) Jean Close, M.A. Technical Director, Disabled and Elderly Health Programs Group Centers for Medicare and Medicaid Services (CMS) Jennifer Grant Mississippi Division of Medicaid, Bureau of Mental Health Programs Laura Taffs, L.C.P.C. and Jane Bernard Montana Children s Mental Health Bureau Frances Purdy, M.Ed., J.D. The National Federation of Families for Children s Mental Health
3 8 Joint CMCS and SAMHSA Informational Bulletin Purpose is to assist states to design a benefit that will meet the needs of children, youth, and young adults with significant mental health conditions Policy-Guidance/Downloads/CIB pdf
4 9 Components of Informational Bulletin Background Benefit Design Medicaid Authorities and Demonstrations Quality Measures
5 10 Background for Development of Informational Bulletin Substance Abuse and Mental Health Services Administration s (SAMHSA) Children s Mental Health Initiative (CMHI) Centers for Medicare and Medicaid (CMS) Psychiatric Residential Treatment Facility (PRTF)Waiver Demonstration Program
6 11 Benefit Design Intensive Care Coordination: Wraparound Approach Parent and Youth Support Services Intensive In- Home Services Respite Mobile Crisis Response and Stabilization Flex Funds Trauma Informed Systems and Evidence-Based Treatments Addressing Trauma
7 13 CMS: Partnering with States to Achieve a High Performing Medicaid Program Moving from a safety net program To a full partner in the health care system Ensuring better care, better health, lower costs
8 Promoting Better Care Almost eight percent of youth in the Medicaid/CHIP program had a major depressive disorder in This number is significantly higher for youth in child welfare (18.1 percent). American Indian/Alaska Native youth have almost three times the rate of suicide than the general population. The rate of current illicit drug use among all youth (Medicaid and non-medicaid) aged 12 to 17 is 10.1 percent. Children exposed to trauma, exhibit symptoms consistent with individuals diagnosed with post-traumatic stress disorder and other mental health conditions.
9 Better Health: EPSDT Early and Periodic Screening, Diagnostic and Treatment Services Provides: Preventive and comprehensive health services for Medicaid eligible individuals under age 21 States must provide medically necessary treatment whether or not such services are covered under a State s Medicaid plan.
10 16 Services Section 1905(a) of the Act specifies: Medical assistance means payment of part or all of the cost of the following care and services Mandatory Services Inpatient/outpatient hospital care Physicians services Nurse midwife services Pediatric & family nurse practitioner services Federally qualified health center/rural health clinic Lab and x-ray Prenatal care Family planning Skilled nursing facilty, age 21+ Home health care EPSDT Medical and surgical dental services Vaccines for children Tobacco cessation, pregnant women
11 17 Optional Services Licensed practitioners Private duty nursing Nurse practitioner Clinic Dental Physical; occupational; speech, hearing, language therapies Prescribed drugs Prosthetic devices, dentures, eyeglasses Diagnostic, screening, preventive Rehabilitative Case management Respiratory care Inpatient hospital services to individuals age 65+ in an Institution for Mental Diseases (IMD) Nursing facility services, under age 21 ICF/IDD Inpatient psychiatric, under age 21 Hospice care Personal care Transportation, emergency and critical access hospitals Optometric End-stage renal Preventive
12 18 Medicaid Authorities and Demonstration Programs 1915(a) Authority 1915 (c) Authority 1915(b) Authority 1115 Authorities 1915(i) State Plan Amendment Section 2703 Health Homes Money Follows the Person Rebalancing Demonstration (MFP) Balancing Incentive Program
13 19 Programs Waiving Certain Medicaid Statutory Provisions: Waivers 1915(a): Waives compliance with the freedom of choice for individuals who elect to obtain services from a certain organization 1915(b): Waives compliance with the freedom of choice and statewideness requirements 1915(c): Allows State Medicaid programs to offer special services to beneficiaries at risk of institutionalization in a NF or ICF/IDD 1115 Demonstrations: enables States to demonstrate different approaches to promoting the objectives of the Medicaid program through waivers of certain 1902 provisions
14 20 Health Home Services Health home services include: Comprehensive care management; Care coordination and health promotion; Comprehensive transitional care from inpatient to other settings; Individual and family support; Referral to community and social support services; Use of health information technology, as feasible and appropriate.
15 (i) State Plan Home & Community- Based Services Section 1915(i) established by the Deficit Reduction Act [DRA] of 2005 and amended through the Affordable Care Act of 2010 State option to amend the state plan to offer HCBS as a state plan benefit with similarities to HCBS waivers Individuals do not have to meet institutional Level of Care [LOC] Services may include respite care, case management, personal care, behavioral interventions, skills training, supported employment, mentoring, parent and youth support partners.
16 22 Quality Reporting CHIPRA HITECH Affordable Care Act
17 Better Health: Lower Costs The Children s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) and the Affordable Care Act promoted new Clinical quality reporting programs adding to existing Medicare quality reporting programs Measure sets that may be used by state Medicaid programs and private plans. Core measure sets which include measures related to hospital readmission rates for children and youth with mental health and substance use conditions.
18 24 Benefit Design in Mississippi s PRTF Waiver Demonstration: MYPAC Case Management Wraparound Services Respite Flex Funds
19 25 Benefit Design in Montana s PRTF Waiver Demonstration 1. Caregiver Peer-To-Peer Support (Peer Specialist) 2. Consultative Clinical and Therapeutic Services 3. Customized Goods and Services 4. Education and Support Services 5. Family Support Specialist 6. In-Home Therapy 7. Non-Medical Transportation 8. Respite Care 9. Wraparound Facilitation
20 26 Medicaid Authorities used in Mississippi 1915(a) Authority 1915 (c) Authority Money Follows the Person Rebalancing Demonstration (MFP) Balancing Incentive Program
21 27 Medicaid Authorities Used in Montana 1915(c) HCBS Bridge Waiver (for those youth who were on the PRTF Demonstration Waiver on 9/30/12) 1915(i) HCBS State Plan Amendment, effective 1/1/13 Money Follows the Person (Operational Protocol not officially approved by CMS)
22 28 Montana s Explanation (next slide) There was concern that youth at lower levels of care were going to be served by the 1915(i) HCBS SPA. The needs-based eligibility criteria appears to be targeting youth who were either in a PRTF or acute hospital (behavior health), or at risk of PRTF placement, and receiving 3 or more outpatient services. Indeed the youth currently enrolled in the 1915(i) are not the lower levels of care youth.
23 29 Group Homes PRTF / Hospitals Montana i-home Home Support Services Outpatient Services This pyramid represents Medicaid reimbursed services for youth with Serious Emotional Disturbance with the top tier being the most intense level of care. The second level includes therapeutic group homes or Montana i-home. I- home is for a small percentage of Medicaid eligible youth who have needs for services in the home and community setting. The next level, Home Support Services, is a program of services delivered in the home and community where youth have needs for services but not as intensively as Montana i- home. However, some youth may receive Montana i-home services and Home Support Services. The bottom level is outpatient services where youth are able to be served in outpatient settings, including schools.
24 30 Sustainability in Mississippi Intensive Outpatient Psychiatric Wraparound Facilitation Community Support Services
25 31 Sustainability in Montana 1915(c) Bridge Waiver (youth who were enrolled in the PRTF Demonstration Waiver on 9/30/12) 1915(i) HCBS SPA effective 1/1/13; needsbased eligibility criteria less stringent that PRTF LOC Train/implement CANS (build a database) EBP training Contracted for high fidelity wraparound facilitation training (facilitators and coaches)
26 32 Montana - continued Contracted for Peer-to-Peer training (peers and coaches) Contracted with an entity skilled in rate setting methodology for some of the services included in the 1915(i) and the Bridge Waiver Wellness Recovery Action Planning through the Copeland Center train the trainer 100% federal funding for personnel dedicated to the Bridge Waiver and the 1915(i) HCBS SPA
27 33 Importance of Informational Bulletin For Youth and Young Adults For Family Advocacy Efforts For State Medicaid Agencies For State and Local Mental Health and Substance Abuse Agencies For Providers
28 34 Certified Parent Support Provider The only national standard in parent-to-parent or caregiver support requires Personal experience parenting a child who experiences emotional, developmental, behavioral, substance use, or mental health challenges 88 contact hours of training (8 in each domain) 1, 000 supervised hours of parent support experience (paid or unpaid) Disclosure of past/current legal involvement Adherence to the Code of Ethics Passage of national exam Payment of fees Re-certification in 2 years
29 35 Contact Information Sherry Peters, Gary Blau, Jean Close, Jennifer Grant, Laura Taffs, Jane Bernard, Frances Purdy,
30 IMPORTANT LINKS Evaluation Form: Webinar Website: Data Matters:
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