Managed Medi-Cal Behavioral Health Benefits. Alliance Board Meeting October 23, 2013
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1 Managed Medi-Cal Behavioral Health Benefits Alliance Board Meeting October 23, 2013
2 Purpose Discuss role of ACA in expanding benefits Review philosophy of integrated health care Review State policy process Discuss proposed benefits Next steps
3 Why now? Affordable Care Act Triple Aim» Cost, Quality, Outcomes Essential health benefits Parity» Same as Exchange plans» Based on Kaiser model» Medical and mental health benefits
4 What is integrated care? Simply put, it s a coordinated system that combines medical and behavioral health services to address the whole person, not just one aspect of his or her condition. Medical and mental health providers partner to coordinate the detection, treatment, and follow-up of both mental and physical conditions. Combining this care allows consumers to feel that, for almost any problem, they ve come to the right place. Dr. Alexander Blount Clinical Professor, Family Medicine and Psychiatry University of Massachusetts Medical School
5 What does that mean? Mental Health System Physical Health System
6 Why integrate care? Many behavioral and physical disorders are cooccurring People with serious mental health conditions die 25 years earlier Improving mental status and functioning positively impacts physical conditions There are better mental health outcomes when physical problems are managed
7 Why primary care and behavioral health? First line of intervention for many Avoid stigma surrounding mental health treatment Opportunity to intervene early and prevent more disabling disorders Psychosocial stress triggers physical illness and exacerbates existing chronic disease Results in lower overall health costs
8 Okay, I m sold, what s next? California DHCS: Define benefits still evolving Assign responsibility to MCP vs Counties still evolving» Mild/Moderate: MCP» Severe: County Amend contracts and issue rates after implementation? Alliance: Provider dialogue: capacity and ability Determine network Contracts, MOUs, Credentialing, Claims Identify processes
9 Wait, there s more Counties: Develop capacity for MHP and AOD Network development Contracts and MOU Identify processes
10 Medi-Cal MHSUD Delivery System Medi-Cal Managed Care Plans (MCP) County Mental Health Plan (MHP) County Alcohol and Other Drug Programs (AOD) Target Population: Children and adults in Managed Care Plans who meet medical necessity or EPSDT for Mental Health Services Target Population: Children and adults who meet medical necessity or EPSDT criteria for Medi-Cal Specialty Mental health Services Target Population: Children and adults who meet medical necessity or EPSDT criteria for Drug Medi-Cal Substance Use Disorder Services MCP services to be carved-in effective 1/1/14* Individual/group mental health evaluation and treatment (psychotherapy) Psychological testing when clinically indicated to evaluate a mental health condition Psychiatric consultation for medication management Outpatient laboratory, supplies and supplements Screening and Brief Intervention (SBI) (new service not currently offered) Drugs, excluding anti-psychotic drugs (which are covered by Medi-Cal FFS) Outpatient Services Mental Health Services (assessments plan development, therapy, rehabilitation and collateral) Medication Support Day Treatment Services and Day Rehabilitation Crises Intervention and Crises Stabilization Targeted Case Management Therapeutic Behavior Services Residential Services Adult Residential Treatment Services Crises Residential Treatment Services Inpatient Services Acute Psychiatric Inpatient Hospital Services Psychiatric Inpatient Hospital Professional Services Psychiatric Health Facility services Outpatient Services Outpatient Drug Free Intensive Outpatient (newly expanded to additional populations) Residential Services (newly expanded to additional populations) Narcotic Treatment Program Naltrexone New Services Voluntary Inpatient Detoxification Services (Administrative linkage to County AOD still being discussed) * MCP carve-in services, except for SBI, are currently offered through Medi-Cal FFS As of October 11, 2013
11 Developing a Network that Meets Beneficiary Needs Medi-Cal Managed Care Plans (MCP) County Mental Health Plan (MHP) County Alcohol and Other Drug Programs (AOD) MCP Behavior Health Providers MHP Behavior Health Providers AOD Behavior Health Providers Primary Care Physician Hospital Emergency and Acute Inpatient Services FQHCs Federally Qualified Health Clinics Behavior Health Providers May include: psychiatrists, psychologists, LCSW, marriage and family therapists, licensed professional/ clinical counselors, psychiatric nurses, Behavior Health Providers May include: psychiatrists, psychologists, LCSW, marriage and family therapists, licensed professional/ clinical counselors, psychiatric nurses, others including certified alcohol and drug counselors Outpatient Clinics (County owned and contracted) Psychiatric Inpatient Hospital Residential Treatment Facilities Outpatient Providers Narcotic Treatment Providers Residential Providers
12 Contracts and MOUs Contract County MHP Contract Enrollment Network/access standards Case Management and care coordination Payment/Financials Quality Oversight and Reporting Grievance and Appeals Medi-Cal MCP Contract MOU MOU Referral Criteria and Protocols Case management and Care Coordination PHI exchanges Dispute resolution Referral Criteria and Protocols, Patient Outcomes PHI exchanges County AOD Contract Patient Placement, Multi-disciplinary Tx Plans Beneficiary complaints, PHI exchanges
13 Next Steps for the Alliance Determine payment policy Medi-Cal rates ACA overlap? TBD Provider dialogue Ability Capacity MBHO relationship Claims and Credentialing Begin implementation
14 Questions?
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