New Mexico Behavioral Health Collaborative: Strengthening New Mexico s Behavioral Health Service Delivery System New Mexico s behavioral health service delivery system cannot sufficiently make necessary quality gains while continually being overstressed by the demands associated with complex regulations, inflexible financial incentives, and an inadequate workforce. Finance Regulations Workforce Goal: I. To increase the productivity, efficiency, and effectiveness of New Mexico s current behavioral health delivery system. II. III. To implement a value-based purchasing system that supports integrated care and reinforces better health outcomes. To identify, develop, and promote the implementation of effective strategies for state, counties, and municipalities to work together to fund the provision of better BH care, especially for high utilizers. Goal: I. To identify, align, and eliminate inconsistencies in BH statutes, regulations, data, and policies in order to allow for a more effective and efficient operation of the publicly funded service delivery system. II. Increase the adoption of personcentered interventions. Goal: I. Support the development of behavioral health practitioners. II. III. IV. Build a more multidisciplinary and competent BH workforce. Promote the future of excellence in the BH workforce and prepare for integrated care. Improve the public image of BH professions, raise awareness of its impact on the population, and promote the effectiveness of the service delivery system.
New Mexico Human Services Department Presentation to Behavioral Health Collaborative: Behavioral Health Collaborative Strategic Plan, SFY2015 - SFY2017 July 13, 2017
New Mexico s behavioral health service delivery system cannot sufficiently make necessary quality gains while continually being overstressed by the demands associated with complex regulations, inflexible financial incentives, and an inadequate workforce 2
Planning Session held July 30, 2015 Diverse group of stakeholders included: Senior managers from BH Collaborative agencies Two cabinet secretaries (Indian Affairs and Veteran Services) Three deputy secretaries (HSD, PED, CYFD) County Commissioners Behavioral Health Planning Council Local Collaboratives MCOs Behavioral Health Providers Association Other BH professional associations UNM partners Peers and family members Legislative Finance Committee Association of Counties 3
December 2015 draft report completed January 2016 final plan adopted by Behavioral Health Collaborative Work groups formed and goals identified in three areas: Finance Regulations Workforce Executive Team created with reps from BHSD, MAD and CYFD Met semi-monthly to monitor implementation 4
I. To increase the productivity, efficiency, and effectiveness of New Mexico s current behavioral health delivery system. II. To implement a value-based purchasing system that supports integrated care and reinforces better health outcomes. III. To identify, develop, and promote the implementation of effective strategies for state, counties, and municipalities to work together to fund the provision of better BH care, especially for high utilizers. 5
Strengthening Sustainability of Services: Medicaid Rule Change to be promulgated in Summer, 2017 to streamline service and staffing requirements CCSS will no longer require certification Recovery Services to be delivered for both individuals & groups ACT regulations modified to broaden staffing IOP certification process simplified Training & TA for peers in CCSS & supervision of CSWs Reimbursing Nursing-based services in BH settings 6
Implementing Evidence-Based Practices: PAX Good Behavioral Games Wraparound approach Infant Mental Health Multi-Systemic Therapy Cognitive Enhancement Therapy Dialectical Behavioral Therapy Assertive Community Treatment Implementing Innovations: CareLink-health homes Treat First model Integrated Quality Services Review (IQSR) Opioid State Targeted Response 7
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Pathways to Value-Based Purchasing CYFD Piloting VBP strategy for Wraparound in ABQ Patient Centered Medical Homes 250,000 Members $PMPM CareLink Health Homes SMI/SED Population $PMPM Centennial Care Delivery System Reforms ECHO-CARE Pilot 500 high-need/high cost members $PMPM Safety-Net Care Pool MCO Payment Reform Projects Hospital Quality Improvement Incentive Uncompensated Care Pool Bundled Payments for Episodes P4P Shared Risk Upside Risk Full Risk July 27, 2016 LFC HSD-BHSD 9
Supporting EMR Infrastructure Development: Emergency Department Information Exchange (EDIE) now implemented in 24 hospitals statewide and expanding Expanded CareLink advancing payment reform through capitated payments for 6 services in selected CMCH s & 2 FQHC s. Will be in 10 sites by January, 2018 Partnering with Counties & Municipalities to fund better provision of behavioral health services: The January 2017 New Mexico Association of Counties (NMAC) Conference showcased BH innovations in the counties of McKinley, Rio Arriba, Bernalillo, and Dona Ana. June conference: opioid crisis & increased access to Naloxone in detention centers; 2018: Crisis triage and EDIE 10
Developed and funded two Investment Zones; Rio Arriba County has implemented county-wide Pathways care coordination system; McKinley County has renovated the Gallup Detox center, converted old hospital into a SUD RTC. Bernalillo County approved 1/8 GRT ($16 million) to fund behavioral health services in Albuquerque & Bernalillo County. Four BHSD staff have received certificates of appreciation for participating in the 4 subcommittees. 11
I. To identify, align, and eliminate inconsistencies in BH statutes, regulations, data, and policies in order to allow for a more effective and efficient operation of the publicly funded service delivery system. II. Increase the adoption of person-centered interventions. 12
MMISR to be completed by 2018; progress on six-module RPF: 2 Proposals being submitted (Data system & Integration platform) 2 RFP s in review stage (Financial services & Quality assurance) 2 RFP s to be developed (Population Health Management & Unified Public Interface) Collaboration by DOH, CYFD, and BHSD on joint standards for Crisis Triage Centers. Treat First operating across 13 agencies in 18 local communities. In 15 months, 2,600 clients served. No Show rate is only 17.7% (compared to previous range of 20-45%) 13
New MAD rule to be promulgated by September 2017 which includes: Allows for individual and group recovery services Appropriately includes RNs in delivery of BH services. Eliminates requirement for certification of CCSS BHSD policy will reflect acceptance of adult RTC national accreditation Current challenges: Consolidating provider audit processes Medicaid parity review may impact strategies Contractual language on standard credentialing deferred for upcoming 1115 waiver application & procurement cycle 14
I. Support the development of behavioral health practitioners. II. Build a more multidisciplinary and competent BH workforce. III. Promote the future of excellence in the BH workforce and prepare for integrated care. IV. Improve the public image of BH professions, raise awareness of its impact of the population, and promote the effectiveness of the service delivery system. 15
Supporting BH Interns HED establishing a web-based clearinghouse for internship opportunities BH Workforce Subcommittee provided recommendations given to the NM Health Care Workforce Committee Reimbursement for BH interns under consideration. State collaborating with state Social Work departments at NMSU and UTEP to enhance curriculum on Clinical Reasoning and Care Formulation for Masters students. Building a more competent, multidisciplinary workforce Promoting cross-disciplinary supervision 16
A BH Clinical Practice Provider Guide has been developed and presentations will be given to senior classes at all major universities Have posted job opportunities on the NM Network of Care website Presented at workforce booths at the National Council on Behavioral Health, the National Association of Social Workers, NM Counseling Association Conference and the NASW-NM Conference Reciprocity Each of the professional boards is undertaking steps toward reciprocity through rule changes A NM Behavioral Health Workforce Development Summit is planned for Fall, 2017 bringing together disciplines in academia and BH & primary care practitioners. 17
Technology: A gap analysis conducted to determine EHR usage across BH providers. Sponsored an EHR Vendor event. Supervision: CBHTR developing tele-supervision statewide for Social Workers working towards independent licensure Pay It Forward campaign to identify certified practitioners willing to volunteer as Supervisors. Completed Clinical Supervision Certification. Expands ability to fund non-independently licensed therapists. CYFD and BHSD are jointly proposing certification of Peer Specialists and Family Support Specialists to the NM Credentialing Board. 18
CYFD Youth Support Services: Developing a Youth Support Services (YSS) Coach Training Curriculum, as well as training for community providers statewide (Opioid State Targeted Response grant). Developing workforce capabilities and expand substance abuse services (Adolescent Substance Use Reduction Effort Treatment Implementation). Adult and Peer: Expanding opportunities for certified BH workers through peer coaching CMS approved New Mexico s State Plan Amendment for the FQHC Community Based Psychiatric Residency Program in Dona Ana County involving Burrell College and La Clinica de Familia. 19
Detailed Strategic Plan Implementation document is now posted on the New Mexico Network of Care website. http://newmexico.networkofcare.org/mh/con tent.aspx?id=7568 20
New Mexico Behavioral Health Collaborative Strategic Plan Implementation Documents 1. Overview 2. Finance Workgroup a. b. Implementation 3. Regulations Workgroup a. b. Implementation 4. Workforce Workgroup a. b. Implementation January 1, 2016 June 30, 2017
June 27, 2017 Intended to be blank 2
June 27, 2017 New Mexico Behavioral Health Collaborative Strategic Plan Overview 3
June 27, 2017 Behavioral Health Collaborative Strategic Plan of Goals FINANCE GOAL 1: TO INCREASE THE PRODUCTIVITY, EFFICIENCY, AND EFFECTIVENESS OF NEW MEXICO S CURRENT BEHAVIORAL HEALTH DELIVERY SYSTEM G1, OBJECTIVE 1: Strengthen the sustainability of the BH Provider Network. G1, OBJECTIVE 2: Assure that the Business Model supports the Clinical Model. G1, OBJECTIVE 3: Further Strengthen Care Coordination within Centennial Care. GOAL 2: TO IMPLEMENT A VALUE BASED PURCHASING SYSTEM THAT SUPPORTS INTEGRATED CARE AND REINFORCE BETTER HEALTH OUTCOMES. G2, OBJECTIVE 1: Study the Managed Care Organizations (MCO) Pilot Payment Reform Projects and to determine the models with the greatest efficacy. G2, OBJECTIVE 2: Fund Infrastructure Development (data, referral, reporting capacity, IT technical support, and communication) to increase BH Electronic Medical Record (EMR) Adoption and Health Information Exchange (HIE) Participation. G2, OBJECTIVE 3: Develop and implement a phased service payment methodology that incentivizes the delivery of quality outcomes while improving population health. G2, OBJECTIVE 4: Identify payment strategies linked to quality and efficiency measures. GOAL 3: TO IDENTIFY, DEVELOP, AND PROMOTE THE IMPLEMENTATION OF EFFECTIVE STRATEGIES FOR STATE, COUNTIES, AND MUNICIAPLTIES TO WORK TOGETHER TO FIND THE PROVISION OF BETTER BH CARE, ESPECIALLY FOR HIGH UTILIZERS. G3, OBJECTIVE 1: Further heighten the awareness of the need for collaboration between state and local governments to better address BH issues. G3, OBJECTIVE 2: Pursue partnership opportunities between municipal/county governments and the state for BH system innovations. G3, OBJECTIVE 3: Capitalize on BH- related innovations within Bernalillo County to leverage meaningful BH service system effects in other counties. REGULATIONS GOAL 1: TO IDENTIFY, ALIGN, AND ELIMINATE INCONSITENCIES IN BH STATUTES, REGULATIONS, DATA, AND POLICIES IN ORDER TO ALLOW FOR A MORE EFECTIVE, EFFICIENT OPERATION OF THE PUBLICLY- FUNDED SERVICE DELIVERY SYSTEM G1, OBJECTIVE 1: To create an efficient and effective state system wide data information and management system. 1 G1, OBJECTIVE 2: Report on a consistent basis to BH stakeholders on the progress towards achieving needed regulatory changes that are being worked on by a variety of workgroups. 1 New objective inserted to reflect major related events 4
June 27, 2017 G1, OBJECTIVE 3: Consolidate provider audit processes across all public BH payors, to the maximum extent possible, and implement Deemed Status so that provider organizations with national BH accreditation can forgo duplicative certification/licensing processes. GOAL 2: INCREASE THE ADOPTION OF PERSON- CENTERED INTERVENTIONS. G2, OBJECTIVE 1: Develop and implement a Treat First practice model that addresses presenting problems first before initiating the assessment process thereby making service more accessible. G2, OBJECTIVE 2: Develop Adult Residential Treatment Center (RTC) standards to prepare for probable coverage under Medicaid and achievement of parity. WORKFORCE GOAL 1: SUPPORT THE DEVELOPMENT OF BEHAVIORAL HEALTH PRACTITIONERS. G1, OBJECTIVE 1: Expand the number of BH interns across BH disciplines. G1, OBJECTIVE 2: Develop and implement a methodology for orienting BH practitioners on how to gain entry into, and more effectively operate in, the NM publicly funded BH service delivery system. G1, OBJECTIVE 3: Incentivize the recruitment of out- of- state BH clinical talent. G1, OBJECTIVE 4: Encourage licensed and/or certified BH professionals who are not currently providing services in the public health system to provide these services. 2 G1, OBJECTIVE 5: Support BH professionals who are currently providing services in the public health system to continue providing these services. 3 GOAL 2: BUILD A MORE MULTIDISCIPLINARY AND COMPETENT BH WORKFORCE. G2, OBJECTIVE 1: Improve administrative efficiency in the provider network to support competent practice. G2 OBJECTIVE 2: To improve clinical practice through increased access to and financial support of appropriate clinical supervision. G2, OBJECTIVE 3: Develop and clarify reimbursement mechanisms for non- independently licensed counselors and social workers using clinical supervision oversight that contributes to progress towards independent licensure. G2, OBJECTIVE 4: Reimburse nursing- based services in BH setting. G2, OBJECTIVE 5: Integrate Certified Peer Support Workers (CPSWs) into new models of service delivery. G2, OBJECTIVE 6: Expand integrated care models by ensuring that there is comprehensive representation by relevant licensed BH professionals and certified paraprofessionals according to their scope of practice and full spectrum of skill- sets on all teams. G2, OBJECTIVE 7: Behavioral Health Services, CYFD, to assure that a trauma informed evidence- based and culturally competent array of services is available for children, youth, and families. 4 GOAL 3: PROMOTE THE FUTURE OF EXCELLENCE IN THE BH WORKFORCE AND PREPARE FOR INTEGRATED CARE. G3, OBJECTIVE 1: Expand statewide access to telehealth client care, as well as consultation, with BH clinicians. G3, OBJECTIVE 2: Support the development of community- based psychiatric residency programs in New Mexico. G3, OBJECTIVE 3: Increase access to resources across the health sector to enhance collaboration and cooperation among independent practitioners and providers. GOAL 4: IMPROVE THE PUBLIC IMAGE OF BH PROFESSIONS, RAISE AWARENESS OF ITS IMPACT ON THE POPULATION AND PROMOTE THE EFFECTIVENESS OF THE SERVICE DELIVERY SYSTEM. G4, OBJECTIVE 1: Develop a Social Marketing Campaign that aims to improve the image of the BH profession. 2 And/or certified is added text 3 New objective inserted to reflect major provider issue. 4 Removed original language, which directed the legislature: and added a departmental strategy. 5
June 27, 2017 New Mexico Behavioral Health Collaborative Strategic Plan Finance Workgroup Implementation Matrix
June 27, 2017 Behavioral Health Collaborative Strategic Plan: Finance Workgroup GOAL 1: TO INCREASE THE PRODUCTIVITY, EFFICIENCY, AND EFFECTIVENESS OF NEW MEXICO S CURRENT BEHAVIORAL HEALTH DELIVERY SYSTEM. G1, OBJECTIVE 1: Strengthen the sustainability of the BH Provider Network. Services: o CCSS services being modified to no longer require certification. o Recovery Services delivered for both individual and groups. o ACT regulations modified to broaden staffing. o IOP certification process simplified. Training and TA: o Developed for peers and delivery of CCSS and supervision of CSWs. Billing: o BHSD STAR system includes edits that increase clean claims and will reduce denials and improve timely payment. G1, OBJECTIVE 2: Assure that the Business Model supports the Clinical Model. Implementing the following evidence- based practices: o PAX Good Behavior Game, Wraparound, Infant Mental Health, Multi- Systemic Therapy, Dialectical Behavioral Therapy, and Assertive Community Treatment. Implementing the following promising practices: o Integrated Quality Services Review, CareLink, Treat First, and Opioid State Targeted Response. G1, OBJECTIVE 3: Further Strengthen Care Coordination within Centennial Care. Delegating Care Coordination though CareLink to expanded sites statewide. GOAL 2: TO IMPLEMENT A VALUE BASED PURCHASING SYSTEM THAT SUPPORTS INTEGRATED CARE AND REINFORCE BETTER HEALTH OUTCOMES. G2, OBJECTIVE 1: Study the Managed Care Organizations (MCO) Pilot Payment Reform Projects and to determine the models with the greatest efficacy. 2017 Centennial Care Contract includes expectations for MCOs to implement Value- Based Purchasing for 16% of provider payments. CYFD: piloting VBP strategy for high fidelity Wraparound through a capitated payment in order to reduce use of high- end care. G2, OBJECTIVE 2: Fund Infrastructure Development (data, referral, reporting capacity, IT technical support, and communication) to increase BH Electronic Medical Record (EMR) Adoption and Health Information Exchange (HIE) Participation. Emergency Department Information Exchange (EDIE) implemented in 24 hospitals statewide. Expanded CareLink initiative delegates Care Coordination. BHSD STAR has developed a data infrastructure to support care coordination functions. 2
June 27, 2017 G2, OBJECTIVE 3: Develop and implement a phased service payment methodology that incentivizes the delivery of quality outcomes while improving population health. Expansion of CareLink statewide, which includes a capitated payment methodology. The 1115 waiver concept paper (i.e. Centennial Care 2.0) includes payment reform opportunities using VBP methodologies and service opportunities (i.e. Wraparound and permanent supportive housing). G2, OBJECTIVE 4: Identify payment strategies linked to quality and efficiency measures. Reviewing CareLink Quality Measures for application in other targeted areas of need. GOAL 3: TO IDENTIFY, DEVELOP, AND PROMOTE THE IMPLEMENTATION OF EFFECTIVE STRATEGIES FOR STATE, COUNTIES, AND MUNICIAPLTIES TO WORK TOGETHER TO FIND THE PROVISION OF BETTER BH CARE, ESPECIALLY FOR HIGH UTILIZERS. G3, OBJECTIVE 1: Further heighten the awareness of the need for collaboration between state and local governments to better address BH issues. New Mexico Association of Counties (NMAC) is presenting targeted behavioral health issues at its annual and semi- annual meetings in 2017 and 2018, topics include: collaborative best practice approaches in NM counties, increased access to naloxone in detention centers, crisis triage, NM crisis line, and education about the Emergency Department Information Exchange (EDIE) system. G3, OBJECTIVE 2: Pursue partnership opportunities between municipal/county governments and the state for BH system innovations. Developed and funded two investment zones, Rio Arriba and McKinley counties. CYFD is using a braided funding method to place a health navigator from the UNM Health Sciences Center North Valley Family Medicine Clinic at the Bernalillo County Detention Center to link youth who are transitioning from detention to community based care. Overdose prevention initiatives between BHSD and Dona Ana, Bernalillo, Rio Arriba, and Santa Fe Counties to provide naloxone in county jails and probation and parole offices (Federal Grants: Prevent Prescription Drug/Opioid Overdose- Related Deaths and Opioid State Targeted Response). Santa Fe County is pursuing a local tax policy to support behavioral health services. Bernalillo County has passed a 1/8% gross receipts tax to support behavioral health services. G3, OBJECTIVE 3: Capitalize on BH- related innovations within Bernalillo County to leverage meaningful BH service system effects in other counties. Bernalillo County passed 1/8% GRT (16 million dollars) to be used for behavioral health services in Albuquerque and Bernalillo Counties. A collaboration of 22 city and 29 county partners worked together to establish priorities and funding. 3
June 27, 2017 Implementation Matrix Finance Workgroup GOAL 1: TO INCREASE THE PRODUCTIVITY, EFFICIENCY, AND EFFECTIVENESS OF NEW MEXICO S CURRENT BEHAVIORAL HEALTH DELIVERY SYSTEM. G1, OBJECTIVE 1: Strengthen the sustainability of the BH Provider Network. a. Identify unnecessary service definition requirements and regulatory barriers for all BH services, but in particular focus on Comprehensive Community Support Services (CCSS) and Recovery Services so that both services are more available and accessible. b. Review adequacy of peer delivered and recovery focused reimbursement rates, and allow for payment of individual services and in addition to group services. c. Develop and routinely distribute and make available (publicly posted) a performance dashboard related to timely claims payment rates, denial rates, and resolution timeline rates by payor; and identify practice and payor improvements to reduce denial rates. d. Provide guidance materials and technical assistance to help providers to correctly document and bill for publically funded behavioral health services. e. Develop and report publicly on all expenditures, by service and provider types for each payor, so that a comprehensive picture of what the BH service system is purchasing can be broadly understood. MAD has issued a supplement, which eliminates the requirement for certification of CCSS by July 1, 2017. Background checks will occur through CYFD until MCO contracts are amended. MAD will issue a supplement that allows for individual and group recovery services to be effective November 1, 2017. Assertive Community Treatment (ACT) regulations modified to broaden who can lead an ACT team, including: nurse practitioners, clinical nurse specialists, and prescribing psychologists. LOD and supplement sent to MCOs. IOP Certification process has been simplified and expedited. Training and technical assistance: o Developing component to use peers in the delivery of CCSS and supervision of CSWs. o CYFD developing response base vs. audit base assistance to programs. For example: infrastructure funded for Wraparound, infant mental health, and family support. HSD has established two positions to provide technical assistance for business and clinical issues. MAD will issue a supplement that allows for individual and group recovery services to be effective November 1, 2017. Non- Medicaid timely payment: o FY16 Invoice Based: invoices must be submitted within 30 days after end of month. Average time to payment is two weeks. o FY17 Claims: BHSD STAR system includes edits that increase clean claims and will reduce denials and improve timely payment. Medicaid timely payment: o All 4 MCOs met timeliness of payment standard: 90% clean claims payment within 30 days. Medicaid: o Both of the billing trainings were offered to Santa Fe providers on July 27 th (57 participants) and to Albuquerque providers on August 18 th (100 participants). Non- Medicaid: o BHSD STAR system includes edits that increase clean claims and will reduce denials and improve timely payment. A multi- year, all claims based funding sources, Directors Report will be completed by September 2017 trending funding patterns and population profiles. 4
June 27, 2017 G1, OBJECTIVE 2: Assure that the Business Model supports the Clinical Model. a. Provide funding for Clinical Supervision through incentives or Explore strategies by new VBP expectations in Medicaid. bonus payments that are potentially tied to quality indicators; The extension of clinical supervision certification to BHA 432 and invest in other areas worth leveraging, for a sounder return agencies enhances revenue possibilities, which could then be on investment, such as attaining quality standards, supporting redirected to support clinical supervision. multidisciplinary team consultation, implementing evidence- Molly Faulkner, UNM, is delivering group tele- supervision for based best practices and diverting BH utilization from MSWs statewide. emergency departments and detention centers. CYFD supports clinical supervision through required fidelity to Multi- Systemic Therapy (MST), Dialectical Behavioral Therapy (DBT), and Infant Mental Health (IMH), and Assertive Community Treatment (ACT). b. Identify ways to advance best practice models for clinical practice, such as, multidisciplinary teaming, Integrated Quality Service Reviews (IQSR), Wraparound, and Treat First. c. Determine and remediate what is prohibiting providers from being able to implement and make more available the services that reduce costs and improve quality outcomes. d. Develop new participation incentives for providers to implement integrated care. The following best practices are being promoted: 1.) Prospective payment models that reinforce multidisciplinary teaming. 2.) During the school year, 2016-2017, PAX Good Behavior Game is now in 242 classrooms and 37 schools. Training has already occurred, and agreements with districts are in place to add more than 300 additional classrooms and 3 additional school districts for the 2017-2018 academic year. 3.) Promoting integrated clinical practices through Integrated Quality Services Reviews (i.e., IQSR) 3 FQHC s in Southern New Mexico were trained in November 2016 and conducted reviews in winter. 4.) Supporting models for Wraparound, pilot in Albuquerque. CYFD establishing a Value- Based Purchasing approach to Wraparound, pilot in Albuquerque. Wraparound are included in the Medicaid waiver application. 5.) Expanded Infant Mental Health workforce from 10 to 56 clinicians statewide. 6.) Expanding the Treat First model. 7.) Expansion of CareLink model statewide. 8.) Expanded funding for the Opioid State Targeted Response (STR), which will increase training and TA for Medically Assisted Treatment. Promoting prospective payments through Value- Based Purchasing. Provider Association has submitted a list of service modifications needed to reduce cost and improve outcomes. The clinical policy group incorporated recommendations. They incorporated most recommendations into the new MAD Rule. New MAD rule developed and submitted for promulgation by August 2017. Expansion of CareLink from 2 to 10 Health Home sites by January 1, 2018. 5
June 27, 2017 G1, OBJECTIVE 3: Further Strengthen Care Coordination within Centennial Care. a. Review ongoing evaluation of Centennial Care s Care Delegating Care Coordination to local BH providers in CareLink; Coordination services to determine areas for improvement and expanding from 2 to 10 additional providers by January 1, implement corresponding performance improvement projects 2018. as appropriate. b. Develop and disseminate an evaluation report on Care Coordination, i.e., its cost effectiveness, efficiency, and outcomes. c. Examine the implementation of CareLink as an opportunity to learn lessons that may support shifting certain types of Care Coordination from the MCOs to the provider organizations at the community level. Dissemination of lessons learned are shared in CareLink Learning Community. Program evaluation will be shared in Fall 2017. GOAL 2: TO IMPLEMENT A VALUE BASED PURCHASING SYSTEM THAT SUPPORTS INTEGRATED CARE AND REINFORCE BETTER HEALTH OUTCOMES. G2, OBJECTIVE 1: Study the Managed Care Organizations (MCO) Pilot Payment Reform Projects and to determine the models with the greatest efficacy. a. Identify the pilot payment reform projects with the most significant results; and determine which of these are the best fit given NM s present service infrastructure and capacity. b. Identify payment reform initiatives that have been implemented in NM, and other states, that have the potential to improve quality and cost effectiveness of services in NM. c. Analyze the findings and present alternative payment recommendations to the Behavioral Health Collaborative. In principal, this objective is adopted, but the methodologies and specific activities needed to shift: 2017 Centennial Care contract includes specific expectations for MCO implementation of Value- Based Purchasing. 16% of provider payments must be in a three- tiered VBP arrangement. o Level 1: a minimum of 5% of all provider payments meet criteria: fee schedule based with bonus or incentives and/or withhold available when outcome/quality scores meet o o agreed- upon targets. Level 2: a minimum of 8% of all provider payments meet criteria: fee schedule based, upside- only shared savings available when outcome/quality scores meet agreed- upon targets (may include downside risk, and 2 or more bundled payments for episode of care. Level 3: a minimum of 3% of all provider payments meet criteria: fee schedule based or capitation with risk sharing (at least 5% for upside and downslide risk) and/or global or capitated payments with full risk. o Additional requirements: at least 3% of the overall 16% in VBP contracting must be with high volume hospitals and require readmission reduction targets of at least 5% of the hospitals baseline. Contractor must include payments to behavioral health community providers in calculating the percentage of overall spend in its VBP arrangements. Renewal of 1115 waiver submitted to CMS on April 1, 2017. o Centennial Care 2.0 concept paper will require VBP strategies. o RFP to be released September 2017. CYFD: piloting VBP strategy for high fidelity Wraparound through a capitated payment in order to reduce use of high- end care 6
June 27, 2017 G2, OBJECTIVE 2: Fund Infrastructure Development (data, referral, reporting capacity, IT technical support, and communication) to increase BH Electronic Medical Record (EMR) Adoption and Health Information Exchange (HIE) Participation. a. Create an incentive for BH EHR adoption one standard deviation beyond the current rate and increase BH participation in HIE by the same rate by July 2017. b. Develop and make available implementation guidance to assist providers with integrated EMR/HIE implementation. c. Ensure all efforts are aligned with and all resulting systems are certified for meaningful use. d. Incentivize the use of the HIE to facilitate Care Coordination across health and human service delivery systems in support of client health. Due to Medicaid deficit, unable to pursue the latest CMS incentives to include BH in the financing for HIE. However, Falling Colors Technology has conducted an EHR gap analysis and hosted an EHR vendor day. MCOs funded implementation of Emergency Department Information Exchange (EDIE) to enhance access to real time ER data into every hospital and medical center in the state. 24 hospitals are implementing currently, and all but two will be implementing by June. Vendors who have a certified EHR product will have already met meaningful use standards. Expansion of CareLink Initiative will delegate Care Coordination to 10 behavioral health agencies, which will increase the use of EHR and cross system information exchange. BHSD STAR has developed the data infrastructure to support Care Coordination function. G2, OBJECTIVE 3: Develop and implement a phased service payment methodology that incentivizes the delivery of quality outcomes while improving population health. a. Propose of a payment reform framework and its respective requirements. b. Develop and disseminate the methodology s logic model and other information necessary to create broad provider, payor, and other stakeholders understanding of the framework and why it would reinforce the further adoption of best practices. c. Support at least 50% of CMHCs adoption of payment reform methodologies within the 18 months of this plan. d. Evaluate the impact of adoption of payment reform methodologies in producing better quality outcomes and population health. e. Benchmark the effects of this payment methodology against the performance of other alternative payment methodologies. In principal, this objective is adopted, but the methodologies and specific activities needed to shift: Have utilized expansion of CareLink to advance payment reform through a capitated payment for 6 services with selected CMHCs and FQHCs. MCO evaluation by Fall 2017. CYFD is piloting VBP strategy for Wraparound in Albuquerque. The 1115 waiver concept paper (i.e. Centennial Care 2.0) includes payment reform opportunities using VBP methodologies and service opportunities (i.e. Wraparound and permanent supportive housing). Exploring innovations that have more flexible payment methods: o o Opioid State Targeted Response (STR) grant. Promoting Integration of Primary and Behavioral Health Care (PIP) grant. G2, OBJECTIVE 4: Identify payment strategies linked to quality and efficiency measures. a. Establish a single set of quality (and outcome) measures, to be Quality measures from CareLink are being reviewed for used during phases of payment reform, including useful application to other program areas. measures for client experience that address satisfaction, access, and quality, as well as functionality. b. Align quality measures, to the maximum extent possible, TBD across the various payors, regulatory authorities, and accrediting bodies. 7
June 27, 2017 c. Develop and implement provider incentives for participation in quality reporting. TBD GOAL 3: TO IDENTIFY, DEVELOP, AND PROMOTE THE IMPLEMENTATION OF EFFECTIVE STRATEGIES FOR STATE, COUNTIES, AND MUNICIAPLTIES TO WORK TOGETHER TO FIND THE PROVISION OF BETTER BH CARE, ESPECIALLY FOR HIGH UTILIZERS. G3, OBJECTIVE 1: Further heighten the awareness of the need for collaboration between state and local governments to better address BH issues. a. Provide a guide on nationally established inter- governmental and private sector models of collaboration to local NM governmental jurisdictions, with case illustrations, that have proven effectiveness in addressing social needs. b. Partner with local governments on developing information on the most efficacious collaborative approaches and identify partners that support an integrated, comprehensive response to the high utilizers of BH services build a bridge to reach better outcomes for high use clients. c. Incentivize participation by these identified partners in collaborative BH- related projects to better address the needs of high utilizers. d. Evaluate these collaborative projects and report on the results achieved in reducing utilization and improving outcomes. e. Use the collaborative model lessons learned into all relevant state level strategic planning processes. f. Support and incentivize collaboration among the various BH- related advisory and planning groups affiliated with local governments and communities including Health Councils, Local Collaboratives, and Prevention Coalitions in order to increase their effectiveness in addressing local BH issues. g. Showcase county and municipal behavioral health innovations, to include relevant websites, newsletters, and other forums such as those used by the Association of Counties and the Municipal League. In principal, this objective is adopted, but the methodologies and specific activities needed to shift: Association of Counties hosted a special pre- conference day, January 18 th, to explore collaborative best practice approaches on complex behavioral health systems especially focusing on high utilizer clients of local behavioral health services. Close to 100 members attended. At the semi- annual New Mexico Association of Counties (NMAC) meeting on June 23 rd, program has presented about on access to and distribution of naloxone in jails and detention centers, as well as increasing MAT capacity. January 2018 annual meeting topics: collaborative best practice approaches in NM counties, increased access to naloxone in detention, crisis triage, NM crisis line, and education about the Emergency Department Information Exchange (EDIE) system. Association of Counties posted county innovations on their website: http://www.nmcounties.org/resources/resources-forcounties/ G3, OBJECTIVE 2: Pursue partnership opportunities between municipal/county governments and the state for BH system innovations. a. Develop collaborative funding and program models between the state, local governments, and the private sector to support local BH systems, including: expansions of community- based supportive housing programs, jail diversion for individuals with BH conditions, and BH crisis response models. b. Construct a methodology whereby local financing from county or municipal sources could be utilized as a match for Medicaid. c. Delineate a pathway whereby local governments can use increased revenue resulting from matching Medicaid to expand the local continuum of care beyond what is included under the existing CC benefit plan. In principal, this objective is adopted, but the methodologies and specific activities needed to shift: Developed and funded two investment zones, Rio Arriba and McKinley counties. CYFD is using a braided funding method to place a health navigator from the UNM Health Sciences Center North Valley Family Medicine Clinic at the Bernalillo County Detention Center to link youth who are transitioning from detention to community based care. Substantial and ongoing efforts have been initiated that create partnerships between the state and local governments to 8
June 27, 2017 d. Reinvest cost savings resulting from effective BH programming into further strengthening community- based BH services, especially Wraparound prevention and wellness, and early intervention for children and adolescents. address critical behavioral health issues, especially preventing opioid overdose: overdose prevention initiatives between BHSD and Dona Ana, Bernalillo, Rio Arriba, and Santa Fe Counties to provide naloxone in county jails and probation and parole offices (Federal Grants: Prevent Prescription Drug/Opioid Overdose- Related Deaths and Opioid State Targeted Response). Santa Fe County is pursuing a local tax policy to support behavioral health services. Bernalillo County has passed a 1/8% gross receipts tax to support behavioral health services, primarily focusing on a crisis and response triage model. SFY16 all cost savings were eliminated due to state budget crisis. State intention to make investments was not able to happen. G3, OBJECTIVE 3: Capitalize on BH- related innovations within Bernalillo County to leverage meaningful BH service system effects in other counties. a. Collaborate with Bernalillo County to maximize revenue streams for the new BH service structure that will potentially lead to a reduction in costs and the achievement of better outcomes. b. Disseminate lessons learned from this collaboration to other communities across the state. c. Replicate and adapt this collaborative approach to meet the BH needs of other local or tribal governments who are receptive to partnering with the state. Bernalillo County passed 1/8% GRT (16 million dollars) to be used for behavioral health services in Albuquerque and Bernalillo Counties. A collaboration of 22 city and 29 county partners worked together to establish priorities and funding. In FY16 more than 27 million dollars was expended between the city and county. An example of innovative leveraging of resources: NM dispatchers utilize NMCAL services. CYFD collaborated with Bernalillo County to provide Mental Health First Aid training, in a train the trainer model, to First Responders (i.e. State Police, Albuquerque Police Department, Albuquerque Fire Department, and Metropolitan Detention Center.) Shifted their procurement process to a problem- based approach. TBD 9
June 27, 2017 New Mexico Behavioral Health Collaborative Strategic Plan Regulations Workgroup Implementation Matrix
Behavioral Health Collaborative Strategic Plan: Regulations Workgroup GOAL 1: TO IDENTIFY, ALIGN, AND ELIMINATE INCONSITENCIES IN BH STATUTES, REGULATIONS, DATA, AND POLICIES IN ORDER TO ALLOW FOR A MORE EFECTIVE, EFFICIENT OPERATION OF THE PUBLICLY- FUNDED SERVICE DELIVERY SYSTEM G1, OBJECTIVE 1: To create an efficient and effective state system wide data information and management system. 1 By 2018, MMISR Completed. on 6 module RFP: o 2 Proposals being submitted (data system & integration platform). o 2 RFP s in review stage (financial services & quality assurance). o 2 RFP s to be developed (population health management & unified public interface). Challenge: o Designing HHS 2020 Single, Multi- Agency Data System Customer Focused Enterprise. G1, OBJECTIVE 2: Report on a consistent basis to BH stakeholders on the progress towards achieving needed regulatory changes that are being worked on by a variety of workgroups. New MAD rule developed and submitted for promulgation by August 2017: o Allows for individual and group recovery services. o Appropriately includes RNs in delivery of BH services. o Eliminates requirement for certification of CCSS. CYFD LCA is updating its licensing regulations for Residential Treatment Facilities, Group Homes, and Day Treatment. 3 state departments (DOH, CYFD, BHSD) collaborated on joint standards for Crisis Triage Centers. G1, OBJECTIVE 3: Consolidate provider audit processes across all public BH payors, to the maximum extent possible, and implement Deemed Status so that provider organizations with national BH accreditation can forgo duplicative certification/licensing processes. Challenges: o Medicaid parity review may impact strategies. o NCQA requirements have proven to be a barrier to MCO centralized certification and consolidation of audits. o Given cost containment issues of Medicaid, the need to do a new procurement and the next 1115 waiver application, implementation of the following contractual language has been deferred to that procurement: Standards for Credentialing and Recredentialing, 4.8.14.1.3 use one standard credentialing form developed by the Provider Workgroup and collaborate with the other MCOs to develop other standard forms used for credentialing and recredentialing. GOAL 2: INCREASE THE ADOPTION OF PERSON- CENTERED INTERVENTIONS. G2, OBJECTIVE 1: Develop and implement a Treat First practice model that addresses presenting problems first before initiating the assessment process thereby making service more accessible. As of June 2017, Treat First is operating across 13 agencies in 18 local communities. No show rate: 17.7% and 2,600 clients served. G2, OBJECTIVE 2: Develop Adult Residential Treatment Center (RTC) standards to prepare for probable coverage under Medicaid and achievement of parity. BHSD policy and procedures will reflect: for any adult RTC national accreditation will be accepted by BHSD as evidence of accreditation. 1 New objective inserted to reflect major related events. 2
Implementation Matrix Regulations Workgroup GOAL 1: TO IDENTIFY, ALIGN, AND ELIMINATE INCONSISTENCIES IN BH STATUTES, REGULATIONS, DATA, AND POLICIES IN ORDER TO ALLOW FOR A MORE EFFECTIVE AND EFFICIENT OPERATION OF THE PUBLICLY- FUNDED SERVICE DELIVERY SYSTEM. G1, OBJECTIVE 1: To create an efficient and effective state system wide data information and management system. 1 a. Design a multi- module data information system. b. Design and implement an RFP for a module on enterprise data services. c. Design and implement a module on an integration platform. d. Design and implement a module on financial services. e. Design and implement a module on quality assurance. f. Design and implement a module on population health management. g. Design and implement a module on unified public interface. h. CYFD: Incorporating Adverse Childhood Experience (ACE) scores in assessment instruments. Data Services RFP, responses to vendor questions by June 2 nd. Systems Integration proposals are under review with oral presentations first week in June. Financial Service RFP work is in development. Quality Assurances RFP in review with CMS. Establishing baseline ACE scores as part of the Child and Adolescent Needs and Strengths assessment instrument. APEX is building a portal through which to gather the data. G1, OBJECTIVE 2: Report on a consistent basis to BH stakeholders on the progress towards achieving needed regulatory changes that are being worked on by a variety of workgroups. a. Identify the state agencies in the BHC that are undergoing regulatory changes that impact behavioral health. b. Conduct a gap analysis to determine if there are additional BH regulations that serve as barriers to effective and efficient BH service delivery that should be reviewed. c. Assure that each state agency in the BHC will engage in a Review Process that identifies regulations requiring revision, including any identified through the gap analysis. d. Issue a quarterly progress report on the proposed BH regulatory changes made by the respective state agencies and the timetable for administrative rule promulgation to include public comment periods. e. Establish a training/communication plan relative to the adoption of new or revised BH administrative rule adoption that includes provider, consumer, and other stakeholder input. In principal, this objective is adopted, but the methodologies and specific activities needed to shift: New MAD rule developed and submitted for promulgation by August 2017, which includes: o Allows for individual and group recovery services. o Appropriately includes RNs in delivery of BH services. o Eliminates requirement for certification of CCSS. CYFD LCA is updating its licensing regulations for Residential Treatment Facilities, Group Homes, and Day Treatment. 3 state departments (DOH, CYFD, BHSD) collaborated on joint standards for Crisis Triage Centers. Other examples of cross collaboration between MAD and BHSD to the MCOs include a list of 51 Letters of Direction. 1 New objective inserted to reflect major related events 3
G1, OBJECTIVE 3: Consolidate provider audit processes across all public BH payors, to the maximum extent possible, and implement Deemed Status so that provider organizations with national BH accreditation can forgo duplicative certification/licensing processes. a. NEW: Create a consolidated standards and audit process between CYFD, DOH, and HSD for crisis triage centers. b. Facilitate a task force comprised of representatives from public BH payors that is charged with consolidating provider audit processes to the maximum extent possible and upon completion propose a consolidation plan for review by the appropriate state authorities and to the BH stakeholder community. c. Upon review and approval, implement the consolidated BH provider audit process subsequent to the development and implementation of a communication plan for the publicly funded BH provider network. d. Implement deemed status in lieu of state certification/licensing surveys across CYFD, DOH, and HSD for community mental health centers. In principal, this objective is adopted, but the methodologies and specific activities needed to shift: Joint licensing standards across DOH, CYFD, and BHSD are being promulgated for Crisis Triage Centers. Following promulgation of Crisis Triage Center standards, national accreditation will be accepted as evidence of accreditation (i.e. deemed status) for community mental health centers and non- Medicaid adult RTC programs. GOAL 2: INCREASE THE ADOPTION OF PERSON- CENTERED INTERVENTIONS. G2, OBJECTIVE 1: Develop and implement a Treat First practice model that addresses presenting problems first before initiating the assessment process thereby making service more accessible. a. Finalize a Treat First protocol. A Steering Committee has guided the development of the protocol. Completed January 1, 2016. Feedback from providers and consumers has been positive. The current contract amendment for MCOs includes Treat First and includes a definition of Treat First. Will go into effect in April. b. Identify pilot provider sites to test the protocol. Six pilot sites were identified December 2015. c. Subsequent to beta testing, revise the protocol The protocol is being used during the trial period and will be revised at the as appropriate. end of the 6- month period. d. Develop and implement a provider- training Curriculum has been developed and implemented in pilot sites. curriculum. e. Establish a web- based data collection and Falling Colors Technology developed the web- based portal for data collection evaluation system. and evaluation. Sites collect data March September 2016 f. Gain the support of regulatory authorities and Accomplished payors to support the Treat First practice CYFD has been added to the workgroup. adoption. g. Launch trial practice period. Launched March 1, 2016 September 1, 2016 h. Produce report of pilot identifying lessons Monthly learning community meetings with the six sites will develop lessons learned and recommendations with the intent of and recommendations for implementation system- wide. building sustainability and implementing system- wide. 4
i. Finalize an expansion process. As of June 2017, Treat First is operating across 13 agencies in 18 local communities. G2, OBJECTIVE 2: Develop Adult Residential Treatment Center (RTC) standards to prepare for probable coverage under Medicaid and achievement of parity. a. Complete a NM environmental scan of Adult RTCs to determine service gaps. b. Promulgate standards for this service and adopt deemed status. c. These standards should be promulgated within the context of the Continuum of Care framework. Coop Consulting developed an inventory of all Adult RTC providers including: Where they are located, what their bed capacity is, occupancy rate, and waiting list. Policies and procedures will be developed to reflect the following: For any adult RTC national accreditation will be accepted by BHSD as evidence of accreditation. Lead: Juan Medina. 5