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1 Welcome to the Webinar! We will begin the presentation shortly. Thank you for your patience. Attendees can access the presentation slides now at: A recording of the event will be made available on the same event page in the next few days.

2 Community Psychiatric Support and Treatment NEW YORK STATE PLAN AMENDMENT (SPA) SERVICE-BY-SERVICE OVERVIEW SERIES July 28, 2016

3 Presented by: Angela Keller, LMSW Director Tiffany Battles, LMSW Managed Care Planning Analyst Bureau of Children s Program Design, Policy & Planning Division of Managed Care NYS Office of Mental Health 3

4 Housekeeping & Logistics WebEx Chat Functionality for Q&A Slides are posted at MCTAC.org and a recording will be available soon (usually less than one week) Questions not addressed today will be reviewed and incorporated into future training and resources Reminder: Information and timelines are current as of the date of the presentation. Content presented is summary and discussion of the draft SPA manual currently available on-line. Please refer to the manual for further detail, definitions, references, and other useful information.

5 Goals for Today Review key information from SPA Manual Add context and clarity whenever possible Generate and answer questions Help inform service providers decision-making process about obtaining SPA designation The designation process will be finalized and announced soon. A presentation and opportunity for designation-specific questions will also be offered.

6 Agenda Children s System Transformation & SPA Refresher and Update CPST Walkthrough Upcoming training and available resources Q&A

7 Overview and Refresher of Children s State Plan Amendment (SPA)

8 What s Ahead for New York State s Children s System Children s Health Homes: Statewide 12/1/16 (NYSDOH Announcement made on July 19, 2016) New State Plan Services: Statewide 1/1/2017 Behavioral Health & SPA Services Transition to Managed Care (including children in the care of Voluntary Foster Care Agencies) NYC/LI/Westchester: 7/1/2017 and Rest-of-State: 1/1/2018 Children's Home and Community Based Services Transition to Managed Care NYC/LI/Westchester: 7/1/2017 and Rest-of-State: 1/1/2018

9 Children s Medicaid State Plan Amendment - Update Draft SPA Provider Manual was released on March 9, 2016 Six New Services (require CMS approval): Crisis Intervention Other Licensed Practitioner Community Psychiatric Supports and Treatment (CPST) Psychosocial Rehabilitation (PSR) Family Peer Support Services Youth Peer Support and Training Services SPA Designation/Application in final revision stage Draft SPA rates will be made public

10 State Plan Amendment Goals The main goals of the additional services in New York s State Medicaid Plan are to: Identify needs early on in a child s life; Maintain the child at home with support and services; Maintain the child in the community; Prevent the need for long-term and/or more expensive services; and Increase the delivery of services following trauma-informed care principles.

11 SPA Provider Manual Organization Definition of Service Components Allowable Service Modality Allowable Setting Admissions/Discharge Criteria (i.e., medical necessity) Limitations/Exclusions Agency/Supervisor/Practitioner Qualifications Training Requirements and Recommendations Recommended Staffing Ratio/Caseload Size Manual available at MCTAC.org under Resources

12 Key Points Proposed Medicaid State Plan Services will: Be available to all Medicaid eligible children under the age of 21 who meet medical necessity criteria (currently being refined). Be delivered in a culturally competent manner and be traumainformed. Allow interventions to be delivered in natural community-based settings where children and their families live and bolster lower intensity services to prevent the need for more restrictive settings and higher intensity services. Fall under the Early Periodic Screening, Diagnosis and Treatment benefits (known commonly as EPSDT).

13 Key Points (continued) The new benefits are stand alone services, not programs. Services provided to children and youth must include communication and coordination with the family, caregiver and/or legal guardian. Coordination with other child-serving systems should occur to achieve the treatment goals. When SPA services are launched, they will initially be billed under Medicaid fee-for-service until transitioned to Medicaid Managed Care. Once designated for SPA services, providers can begin the contracting process with Medicaid Managed Care Plans (starting January 2017). Further training on contracting is planned.

14 Medical Necessity Medical necessity includes any treatment that: Corrects or ameliorates conditions found through an EPSDT screening OR Addresses the prevention, diagnosis, and treatment of health impairments; the ability to achieve age-appropriate growth and development; and the ability to attain, maintain, or regain functional capacity. Each state plan service will have criteria for: admission continued stay discharge

15 Community Psychiatric Support & Treatment NEW YORK STATE PLAN AMENDMENT SERVICE-BY-SERVICE OVERVIEW SERIES July 28, 2016

16 Community Psychiatric Support & Treatment (CPST) Community-based rehabilitative services

17 Defining Family Family is a unit of people residing together, with significant attachment to the individual Includes both adults and children, with adults taking on parenthood/caregiving for the children, even if the individual is living outside of the home Family is broadly defined, and can include families created through: Birth Foster Care Adoption Self-created unit

18 Allowable modalities All interventions must be face-to-face Options: Individual Groups (should not exceed 6-8 members) Services may include collateral contacts

19 Settings and caseload size Settings: services can occur in a variety of settings including community locations where the child/youth lives, works, attends school, engages in services (e.g. provider office sites), and/or socializes. Caseload size: based on the needs of the child/youth and families with an emphasis on successful outcomes, individual satisfaction, and meeting the needs identified in the individual treatment plan.

20 Service Components Rehabilitative psychoeducation Strengths-based treatment planning Intensive interventions Rehabilitative supports Crisis avoidance Intermediate term crisis management

21 Rehabilitative Psychoeducation Helping the child and family (or other collateral supports) identify appropriate strategies or treatment options associated with: Child s behavioral health needs; Minimizing the impact of mental illness symptoms or emotional disturbances; Substance use or associated environmental stressors which interfere with the child s daily living, academic progress, resilience, relationships, and community integration Rehabilitative supports in the community Development of skills to meet the child s employment, housing, and education goals

22 Strengths-based treatment planning Facilitate participation in strengths-based planning for Medicaid services and treatments: Help child and family/caregiver, or other collateral supports identify strengths and needs, resources, and natural supports, within the context of the client s culture Develop goals and objectives to use person s strengths, resources, and natural supports to address functional deficits associated with their behavioral health disorder

23 Intensive interventions Help child develop skills to restore stability, support functional gains and adapt to community living through providing: Individual treatment and counseling and/or relationship based supportive counseling Solution focused interventions Harm Reduction Emotional, cognitive, and behavioral management Problem behavior analysis

24 Rehabilitative supports Provide rehabilitation and support to minimize the negative effects of behavioral health symptoms or emotional disturbances Includes improving life safety skills such as: Access to emergency services Basic safety practices and evacuation Physical and behavioral health care Knowing when to contact a physician Self-administration of medication for health conditions Understanding side effects of prescribed medications

25 Crisis avoidance Help child and family/caregiver to identify or respond to early warning signs of behavioral health crisis that would risk the child remaining in the community: Identification of potential psychiatric or personal crisis Practicing de-escalation skills Development of a crisis management plan Assessment of the step-by-step plan before a crisis occurs Strategies to take medication regularly Seeking other supports to restore stability and functioning

26 Intermediate Term Crisis Management Provide intermediate term crisis management to families following a crisis (beyond 72-hour period in which a crisis intervention team may have intervened under the new SPA) The purpose of this activity is to: Stabilize the child/youth in the home and natural environment Assist with goal setting to focus on the issues identified from mobile crisis intervention, emergency room crisis, and other referrals

27 Limitations/Exclusions A child with a single developmental disability diagnosis is ineligible to receive CPST Use of Evidence-Based Practices (EBP) require prior approval and fidelity reviews on an ongoing basis as determined necessary by New York State EBP Review Team. The Institute of Medicine (IOM) defines "evidence-based practice" as a combination of the following three factors: (1) best research evidence, (2) best clinical experience, and (3) consistent with patient values (IOM, 2001). Guidelines and instructions on how to become designated to deliver a specific EBP under CPST are forthcoming

28 Provider agency qualifications Any child serving agency or agency with children s behavioral health and health experience that is licensed, certified, approved or designated by DOH, OASAS, OCFS, or OMH to provide comparable and appropriate services Must comply with additional requirements including: Adhere to Medicaid requirements Ensure staff receive training on Mandated Reporting, Practitioners maintain licensure necessary to provide services Maintain needed insurance Follow safety precautions needed to protect child population Adhere to cultural competency guidelines Be knowledgeable about trauma-informed care

29 Staffing and service restrictions Qualification Minimum: Bachelor s degree + 2 years experience in children s mental health, addiction, foster care, child welfare or juvenile justice Minimum: Bachelor s degree + certification in an Evidenced Based Practice, and designated by the State Minimum: Master s degree in social work, psychology, or related human services plus one year of relevant experience OR who has been certified in an Evidenced Based Practice Limitations Cannot do: Intensive interventions, Crisis Avoidance, Intermediate term crisis management Cannot do: Intermediate term crisis management No restrictions - Practitioners with a master s degree may perform any of the activities under CPST without any exclusions This includes: Registered Professional Nurses with 1 yr behavioral health experience, Licensed occupational therapists, and Licensed Creative Arts Therapists to the extent they are operating

30 Supervision CPST providers must receive regularly scheduled supervision from someone who is a: Licensed clinical social worker (LCSW) Licensed mental health counselor (LMHC) Licensed creative arts therapist (LCAT) Licensed marriage and family therapist (LMFT) Licensed psychoanalyst Licensed psychologist Physician s assistant Psychiatrist Physician Registered Professional Nurse Nurse Practitioner Supervisors should have at least 2-3 years relevant work experience Supervision must include focus on trauma informed care and cultural needs of clients, and train staff on these issues

31 Children and Families Can Take the Lead Interventions and skill building identified by the CPST practitioner and family may be implemented by the child and family, with the assistance of a: Peer Psychosocial Rehabilitation practitioner CPST practitioner.

32 Admissions and continued stay The service is included in the child/youth s Care Plan Service is recommended by an LPHA. Require involvement of licensed practitioner to develop and achieve these outcomes. Frequency and intensity of service aligns with the unique needs of the child. This service is directed at developing specific skills and/or outcomes such as: Increase community participation Enhance personal relationships Establish healthy peer support networks Decrease use of alcohol/other drugs Increase independence Develop symptom management skills Avoid or effectively respond to triggers Increase/maintain personal selfsufficiency Develop coping strategies and effective functioning

33 Discharge criteria Child has successfully reached treatment plan goals Child/youth/family has been involved in the discharge process

34 Training requirements Required: Crisis management and avoidance planning Suicide prevention (e.g., SAFETALK) Individual, group, and family counseling Solution-focused interventions Emotional, cognitive, and behavior management techniques Evidence-based practice certification (as appropriate per State designation) Recommended Domestic violence Motivational interviewing Personal safety in the community

35 CPST Example Carlos, a 16 year old boy, and his family are experiencing difficulties due to his alcohol and drug use. His substance use is inhibiting his daily functioning, personal growth, and interpersonal relationships. Henry attends group sessions, led by a licensed practitioner, for teens who are using drugs and alcohol. The CPST provider visits the family at home to work on the identified goals within Carlos treatment plan and focuses on psycho education to inform him and his family about the negative effects of substance use and develop positive strategies to promote recovery. Carlos and his family have the goal of improving their relationship, identify the need for CPST once every two weeks to assess progress and make modifications when indicated.

36 CPST Example Ms. Diaz is a single parent to her 14-year-old daughter Nicole. Over the last year, Nicole has been experiencing increased levels of anxiety of depression contributing to truancy, failing grades, and strained family relationships. A qualified CPST provider has collaborated with the family to provide weekly treatment services in the home and school. The focus of these treatment services, as identified in the treatment plan include psychoeducation provided to Nicole and her family to assist them in understanding how her decreased functioning is related to her current mental health symptoms, effective treatments available to assist in minimizing the impact of these symptoms, individual psychotherapy to increase Nicole s ability to regulate her emotional states, and resource finding/mapping to help the family identify a network of resources and natural supports the family can utilize to stabilize Nicole in the home.

37 CPST Example Jerome, a 15-year-old male, is a child with a significant trauma history. While Jerome and his father, Mike, have been referred to outpatient in the past, this option has not really worked for the family. Mike has noticed that Jerome s behavior has taken a turn for the worse as he recently began using drugs and alcohol, which is having an impact on his daily functioning at home and school. A qualified CPST provider has collaborated with the family to provide treatment services in the community. Treatment services, as indicated on the treatment plan include, psychoeducation to inform Jerome and his family about the negative effects of substance use and develop positive strategies to promote recovery, trauma therapy to help Jerome address prior trauma and begin to heal, and assisting the family in identifying resources and natural supports in the community to prevent isolation, serve as a source of emotional support and aid the family in relapse prevention.

38 To be Finalized and Announced Provider designation criteria and process SPA service documentation requirements Utilization Management process CPST specific: Billing methodology and coding structure Language further defining medical necessity criteria Additional limitations Once finalized, these will be incorporated into the SPA Provider Manual and shared widely.

39 Training and Resources

40 SPA Training Series Schedule Thursday, 6/30 -- Other Licensed Practitioners Thursday, 7/7 -- Psychosocial Rehabilitation Services Thursday, 7/14-- Family Peer Support Services & Youth Peer Support and Training Thursday, 7/21 -- Community Psychiatric Supports and Treatment Thursday, 7/28 -- Crisis Intervention State-led training on the Child and Adolescent Needs and Strengths (CANS-NY): Albany on June 22 nd and 23 rd NYC on July 12 th and 13 th and again on August 29 th and 30 th Rochester on August 18 th and 19 th

41 SPA Training Plan June/July High-level service-by-service overview, designation process, billing rules when available September Rates/billing codes, staffing requirements, caseloads, eligibility/medical necessity, deficit funding, EHR help (in-person) October Referral process, documentation, continuing education, co-enrollment rules, exclusions, health home interaction, reporting requirements (web-based) November/December Detailed training for each service (full-day statewide in-person and web-based supplements) January 1, 2017 SPA services for children go live! Ongoing support and training responsive to areas of provider need supporting implementation

42 Resources and Information Please specify if kids system/managed care specific in subject line: NYS OMH Managed Care Mailbox OMH-Managed- NYSDOH Health Homes for Children: NYS OASAS Mailbox: NYS OCFS Mailbox: OCFS-Managed- Children s Managed Care Design: htm

43 Questions and Discussion Please send questions to: Logistical questions usually receive a response in 1 business day or less. Longer & more complicated questions can take longer. We appreciate your interest and patience! Visit to view past trainings, sign-up for updates and event announcements, and access resources

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