Mental Health Targeted Case Management Managed Care Programs: Case Management, Care Coordination, and Care Management In Managed Care July 23, 2009 Videoconference Richard Seurer, DHS-Adult Mental Health Division What is MH-TCM the basics Services that will assist the individuals with serious mental illness/emotional disturbance in gaining access to needed medical, social, educational, and other services What is MH-TCM the basics Minnesota Statutes Adult mental health case management services (Minnesota Statute, section 245.462) means activities that are coordinated with the community support services program and are designed to help adults with serious and persistent mental illness in gaining access to needed medical, social, educational, vocational, and other necessary services as they relate to the client's mental health needs. 1
What is MH-TCM the basics Assisting individuals in gaining access to needed services and resources not just medical, mental health, social services but all needed services/resources. Examples: financial benefits, health coverage, child care, housing, education, vocational training, social resources, transportation resources. What is MH-TCM the basics Case management services include: developing a functional assessment, an individual community support plan, referring and assisting the person to obtain needed mental health and other services, ensuring coordination of services, and monitoring the delivery of services What is MH-TCM the basics Federal definition of targeted case management Case management services (mental health targeted case management for people experiencing emotional disturbances and serious mental illness is one type of targeted case management) mean services that will assist the individuals eligible under the State plan in gaining access to needed medical, social, educational, and other services and to include the following components: 2
What is MH-TCM the basics and to include the following components: Assessment Development of a specific care plan Referral and related activities to obtain needed services Monitoring and follow-up activities The four federal components are the same as those required by Minnesota Statute. What is MH-TCM the basics Model often referred to as a broker model mental health case manager does not provide clinical or rehabilitation services (at least in terms of what DHS is paying for) What is MH-TCM the basics MH-TCM case manager is an advocate, a resource expert, educator, assessor, planner, emotional supporter, linker, referrer, quality monitor 3
What is MH-TCM the basics Reimbursement is for the provision of a qualifying core service component Who Receives MH-TCM Feds permits states to define targeted populations most states define populations of people with developmental disabilities, and/or mental illness Adult with Serious and Persistent Mental Illness Child with Severe Emotional Disturbance Minnesota Statute, section 245.462, subdivision 20 (definitions) Who Receives MH-TCM In calendar year 2008: 21,568 adults received at least one reimbursed unit of mental health case management services; 9,426 children Adults: 2.5% American Indian, 2.7% Asian, 10.5% Black, 81.8% White, 2.2% Hispanic Children: 5.5% American Indian,.9% Asian, 11.8% Black, 72.8% White, 5.7% Hispanic 4
Who Receives MH-TCM New as of January 1, 2009, eligible recipients of MinnesotaCare and GAMC Comprehensive mental health benefit set in all Minnesota Health Care Programs 2007 Governor s Mental Health Initiative have phased in ACT, IRTS, Crisis Response Services, ARMHS, Rule 5, and now MH-TCM Who Provides MH-TCM Counties county-provided about 80 providers (See handout thanks to Deb Wesley) Private providers county-contracted about 55 providers Tribal authorities tribal-provided White Earth, Fond du Lac Private providers tribal-contracted Managed Care Organizations MCO-provided none currently Private and county providers MCO-contracted many contracts being finalized now - (updated information in about a month) How is MH-TCM Reimbursed Case management is reimbursed based on a monthly rate (encounter rate for tribal provider or QFHC) if at least one of the four qualifying service component (see above) is provided during the month. Phone option for some fee-for-services adult MH-TCM for low intensity services 5
How is MH-TCM Reimbursed County-provided monthly rates are determined by an annual time study county costs, cm activities, caseload size (recommended up to 30-1 - adult monthly rates range from $207 to $772/month - child monthly rates range from $367 to $2089/month (caseload size recommended up to 15-1) How is MH-TCM Reimbursed Tribal authority-provided receive an encounter rate for face-to-face contact federally determined rate about $260 per contact County-contracted (private providers) receive a monthly rate negotiated by host county and approved by DHS How is MH-TCM Reimbursed Effective July 1, 2009, managed care organizations are paid a capitation to manage and pay for MH-TCM for eligible enrollees MCO is paid by DHS a monthly capitation per all enrollees not per recipient of MH-TCM monthly capitation varies specific to subgroup that individual fits into examples: pregnant women - $.60 per month (low) to $11+ per month (high). 6
How is MH-TCM Reimbursed No MCOs provide MH-TCM with their own staff MCOs negotiate a monthly rate with county and private providers On MCO implementing a three tier monthly rate low, intermediate, complex level of services determined by cm-contact and related activities provided to the individual How is MH-TCM Reimbursed Total reimbursement: SFY08 $46 million plus county local funds ($40 paid by MMIS, $6 in state grants, and county local dollars) MH-TCM is in benefit set of Minnesota Health Care Programs as of January 1, 2009 New Federal TCM Rule as of July 1, 2009 7
Effective July 1, 2009, MH-TCM services are added to the health benefits set available to eligible enrollees of prepaid MHCP (including PMAP, prepaid GAMC, MinnesotaCare, MSHO, SNBC and MDHO). For enrollees, MCOs will be responsible for both determining eligibility for MH-TCM, and for providing the service, either directly or through contracted providers. Most mental health consumers currently receiving MH-TCM are not be impacted by this change and will continue to receive their case management services from their current providers (counties and county-contracted providers) under a fee-for-service model. DHS data indicates that approximately 17% of adults and 26% of child receiving MH-TCM are receiving the rest of their health care through prepaid plans and will be affected by this change. (about 4500 individuals) Impacted enrollees received a letter informing them of change of MCO role, and MCO contact phone. Counties and current MH-TCM providers were asked to assist impacted enrollees to understand this change; and smooth transition MH- TCM services to new provider if needed. 8
Statewide videoconferences occurred in March and June to inform and engage providers and counties in this transition. Provider e-mail contact list was developed, and communications have been occurring monthly. Disability Linkage Line is also resource for phone information support for impacted enrollees. CMHS has been working with policy and operations advisory groups for 18+ months in planning this transition. 9
All MCOs agreed to authorize at least up to 3 months of continued MH-TCM services (July, August, September) by current provider to allow sufficient time for transition and/or completion of contracting. At this time, participating MCOs have contracted/are finalizing contracting with counties and many existing MH-TCM providers to provide MH-TCM to MCO eligible enrollees. All private providers receiving at least same monthly rate (per statute, providers required). Handful of counties are not interested in contracting with MCO. Not all private providers being offered contracts. Some private providers not interested in contracting with MCO. 10
One expected outcome of the MCO contracts is that physical and mental health services will be more integrated. Managed care has demonstrated increased access to health care and better preventative care. (see handout with MCOs implementation/contact information) MH-TCM case managers will be asked to be more active in screening/assessing physical health care needs of their clients, help clients access basic physical health care services, monitor client s recommended treatment, screen clients lifestyle activities and plan for wellness, coordinate/integrate in new ways/levels with primary care providers. 11
New Federal TCM rule Previous federal administration concerned with cost growth and audit concerns Deficit Reduction Act Proposed new interim final rule of TCM Congress put on moratorium because of stakeholder concerns Public input New administration has issued new rule effective July 1, 2009 New Federal TCM rule Definition of TCM (mental health) is not significantly changed Many proposed changes/limits in interim rule have been rescinded DHS is continuing to analyze the rule; and will have communication with CMS regional office for clarifications More information to follow Questions? Thank You MH-TCM DHS contacts Adult - Richard.Seurer@state.mn.us Child - Brownell.Mack@state.mn.us 12