Critical Access Behavioral Health Agency (CABHA) UPDATE

Transcription

1 Critical Access Behaviral Health Agency (CABHA) UPDATE Jint Legislative Oversight Cmmittee n MH/DD/SAS April 14, 2010 Michael Watsn Assistant Secretary fr MH/DD/SAS Develpment Department f Health and Human Services 1

2 GOALS: CABHA IMPLEMENTATION T ensure that mental health and substance abuse services are delivered within a clinically sund prvider rganizatin with apprpriate medical versight. Mve the system ver time t a mre cmprehensive and cherent service delivery mdel Increase ecnmies f scale and efficiencies in the service system Increase cnsumer/family/stakehlder cnfidence in ur prvider netwrk 2

3 GOALS: CABHA IMPLEMENTATION CONT D Reduce clinical fragmentatin Reductin f Stand Alne service delivery Increase prvider 1 st Respnder capacity Embed case management in cmprehensive clinical prvider Insure that cnsumers have access t an array f apprpriate clinical services Increase accuntability within the MH/SA service system mnitr service and referral patterns Prvide a cmpetent clinical platfrm n which t implement best practice service mdels 3

4 Basic CABHA Service Requirements Services that must be delivered within the CABHA structure: Cmmunity Supprt Team (CST), Intensive In- Hme (IIH), Day Treatment (Effective July 1, 2010) NOTE: CMS Apprved CABHA as a Prvider Qualificatin fr the abve services New Services: Case Management/Peer Supprt Pending CMS Apprval 4

5 CABHA Certificatin Requirements Must prvide the cre services f: Cmprehensive Clinical Assessment Medicatin Management Outpatient Therapy Must deliver at least tw enhanced services In the same lcatin where it prvides the three cre services t create a cntinuum f care 5

6 CABHA Certificatin Requirements Cnt d Active Natinal Accreditatin f at least 3 years Medical Directr 100% FTE fr prviders serving mre than 750 cnsumers 60% billing 50% FTE fr prviders serving less than cnsumers 60% billing 8 hurs per week cnsumers n billing * Clinical Directr 100% FTE Quality Management/Staff Training Directr 100% FTE * Represents additinal effrt t scale Medical Directr requirements fr smaller prviders Implementatin Update #71 Nte: All prviders must prvide cre services regardless f their size/medical Directr requirements 6

7 CABHA Certificatin Overview Attestatin letter w/dcumentatin Desk reviews cnducted by DMH/DD/SAS DMA/DHSR Cllabratin Verificatin cnducted by LME Findings submitted t DMH/DD/SAS Interviews cnducted by DMH/DD/SAS Staff DMA Staff LME Staff 7

8 Desk Review Independent reviewers determine cmplete r incmplete If discrepancy between reviewers LME Team leader and/r designee will review and make determinatin In additin t the desk review DMH/DD/SAS cntacts the fllwing agencies t determine gd standing DMA DMH/DD/SAS Accuntability and Cnsumer Services DHSR 8

9 Verificatin Purpse Verifies the cmpnents f the Letter f Attestatin LME cnfirms evidence f a prvider s cmpliance with CABHA plicy prir t an interview being scheduled 9

10 Interview - Staffing CABHA Reginal Certificatin Team Must be peer t peer (age, disability, educatin) Tw staff frm DHHS One frm LME Systems Perfrmance Team One frm DMA At least ne f the abve will be licensed Tw staff frm LMEs within the regin At least ne must be licensed Medical Directr frm an LME in the regin 10

11 Interview LME Systems Perfrmance staff will serve as the team leader and be respnsible fr: Identify/ntify DMA and LME staff that will participate n the review cmmittee Crdinate interview Track activities related t interview Dcument results f interview Send prvider f decisin in writing 11

12 CABHA Attestatin Letters As f April 1, 2010, 550+ attestatin letters received Prviders submitting attestatin letters by April 1 will be cnsidered fr CABHA certificatin by July 1. Tracking system established fr attestatin letters 300 prviders have gne thrugh desk review prcess Prviders ntified f missing/deficient items May resubmit as ften as necessary t pass desk review 40 (13%) passed desk review and mved t gd standing review 7 cleared fr LME verificatin 12

13 Cmmn Reasns fr Nt Meeting Desk Review Criteria Prvider des nt prvide cre services Medicatin management, clinical assessment, utpatient therapy Prvider des nt have 3 year natinal accreditatin Prvider des nt have 2 enhanced services prviding a cntinuum Unable t verify credentials f licensed staff Nt in gd standing with DHHS Outstanding paybacks, unreslved Type A licensure vilatins, etc. 13

14 DHHS Requests t CMS CMS has already apprved CABHA requirements fr Intensive In-Hme, Day Treatment, and Cmmunity Supprt Team. Pending CMS request regarding CABHA and Case Management/Peer Supprt DHHS has requested CMS cnsider: Begin CABHA implementatin July 1, but allw 6 mnth transitin perid fr existing prviders, frm July 1 t December 31, 2010 Permit CABHA agencies t subcntract with ther prviders fr CABHA services N frmal respnse yet frm CMS 14

15 CABHA Mnitring Mnitring Gals Quality Services Implementatin f Best Practice Care Access Chice Referral t Apprpriate Services Primary Care Integratin Pst-Discharge Cntinuity f Care 1st Respnder Capacity 15

16 CABHA Mnitring Cnt d CABHA Mnitring Wrkgrup Cnsumers DHHS Staff LME Representatives Prviders Mnitring Wrk Plan Review CABHA Plicy & Prcedures Review Current Prvider Mnitring Effrts Develp Standardized CABHA Reprt Card 16

17 CABHA Mnitring Cnt d Mnitring Tls Paid Claims Data (e.g. referral patterns, service utilizatin) Cnsumer/Family Cmplaints Cnsumer Satisfactin Data NC Treatment Outcme and Prgram Perfrmance System (NC-TOPPS) data LME Prvider Risk Assessment & Mnitring Service Endrsement Results Review f High Cst/High Risk Cnsumers 1st Respnder Survey Data DMA Prgram Integrity Data Tracking f ED Use and Pst-Discharge Fllw Up 17

18 Questins? 18