Home and Community Based Services (HCBS) Presented by: Meredith L. Ray-LaBatt, MA, MSW Douglas P. Ruderman, LSCW-R

Home and Community Based Services (HCBS) Presented by: Meredith L. Ray-LaBatt, MA, MSW Douglas P. Ruderman, LSCW-R

2 Meredith Ray-LaBatt CHILDREN S HCBS SERVICES

Children s Transition Timelines 3 Children will begin to enroll in Health Homes Designated to Serve Children on January 1, 2016. OMH TCM providers and legacy clients will transition on January 1 st as well. The transition of care coordination services of the six 1915c children s Waivers (OMH SED, DOH CAH I/II, OCFS B2H) to Health Home will not occur until 2017. The newly proposed health and behavioral health Medicaid State Plan services will be implemented as soon as possible pending approval from CMS in early 2016. Managed Care Geographic Phase In January 1, 2017 NYC and Long Island Children's Transition to Managed Care July 1, 2017 Rest of State Children's Transition to Managed Care

Children's Transition Timelines In 2017, currently carved out Medicaid behavioral health services and children in foster care will be moved to Managed Care The existing Home and Community Based Services (HCBS) that are in the six 1915c children s Waivers (OMH SED, DOH CAH I/II, OCFS B2H) will be aligned to one array of HCBS benefits, pending CMS approval, and will be moved to Managed Care. As a result of this transition, the 1915c Waivers will be discontinued as separate programs once the transition is complete. Population Phase-In In 2017, children meeting Level of Care criteria will begin to receive HCBS benefits. In 2018, children meeting Level of Need criteria will begin to receive HCBS benefits (January for children with Medicaid; July for children who meet family of one Medicaid) 4

State Initiatives Timelines Month/Year Children s HCBS Waiver Health Homes Medicaid Managed Care September 2013 November 2014 March 2015 May 2015 June 2015 October 2015 December 2015 January 2016 July 2016 January 2017 OMH Waiver Application Submitted to CMS Temporary Extension expires 12/21/2015 Health Home Application Released Health Home Applications Due Approval of Health Homes services Children Designated Begin Phasing in Enrollment of Children in Health Homes Enrollment of Waiver youth into Health Homes Submit Draft SPA to CMS 5 Submit Children's 1115 Waiver to CMS Request to Implement New SPA Services* (*Pending CMS Approval) Begin Phase in of Behavioral Health Services to Medicaid Managed Care

6 Proposed Changes to the Current OMH Children s HCBS Wavier Expand the age of enrollment into Waiver from before 18 th birthday to before 21 st birthday Add three new services: Youth Peer Advocates, Pre- Vocational Services, and Supported Employment Status: Working with CMS to renew Wavier authority and comply with federal regulations and requirements implemented since last application

Proposed New Medicaid State Plan Services for Children Crisis Intervention* 7 Community Psychiatric Supports and Treatment (CPST)* Other Licensed Practitioner Psychosocial Rehabilitation Services* Family Peer Support Services* Youth Peer Advocacy and Training* *Current/Proposed New OMH HCBS Services

Proposed Children s HCBS Services The existing Home and Community Based Services (HCBS) that are in the six 1915c children s Waivers (OMH SED, DOH CAH I/II, OCFS B2H) will be aligned to one array of HCBS benefits, pending CMS approval, and will be moved to Managed Care. As a result of this transition, the 1915c Waivers will be discontinued as separate programs once the transition is complete. Care Coordination* Skill Building* Respite* Prevocational Services* Supported Employment Services* Non-Medical Transportation *Current/Proposed New OMH HCBS Services Habilitation Caregiver and Family Support Services (non-peer) Community Advocacy and Support Adaptive and Assistive Equipment Accessibility Modifications Palliative Care 8

9 Douglas Ruderman ADULT HCBS SERVICES

10 Adult HCBS Services Rehabilitation Psychosocial Rehabilitation Community Psychiatric Support and Treatment (CPST) Habilitation Crisis Intervention Short-Term Crisis Respite Intensive Crisis Intervention Educational Support Services Individual Employment Support Services Rehabilitation Prevocational Transitional Employment Support Intensive Employment Support On-going Supported Employment Empowerment Services Peer Supports Support Services Family Support and Training Non Medical Transportation Self Directed Services Pilot 10

Psychosocial Rehabilitation (PSR) Designed to assist the individual with compensating for or eliminating functional deficits and interpersonal and/or environmental barriers Activities included must be intended to achieve the identified goals or objectives as set forth in the individual s Recovery Plan. The intent is to restore the individual s functional level to the fullest possible 11 11

12 Community Psychiatric Support and Treatment (CPST) Time-limited goal-directed supports and solution-focused interventions The following activities are designed to help persons with serious mental illness to achieve stability and functional improvement in the following areas: Daily living Finances Housing Education Employment Personal recovery and/or resilience Family and interpersonal relationships and community integration. Designed to provide mobile treatment and rehabilitation services to individuals who have difficulty engaging in site- based programs 12

13 Habilitation Typically provided on a 1:1 basis and are designed to assist participants in acquiring, retaining and improving skills such as Communication and Socialization Self-help Domestic and Self-care Fine and gross motor skills Mobility Personal adjustment Relationship development Use of community resources and adaptive skills Assist participants with developing skills necessary for community living. Services include things such as: Instruction in accessing transportation Shopping and performing other necessary activities including Self-advocacy Locating housing Working with landlords and roommates and budgeting. Services are designed to enable the participant to integrate full into the community and endure recovery, health, welfare, safety and maximum independence of the participant. 13

14 Crisis Respite Important component of HCBS package Does not require New York State Community Health Assessment Does require individual to be enrolled in a HARP 14

Short Term Crisis Respite Short-term care and intervention strategy for individuals who are experiencing challenges in daily life that create risk for an escalation of symptoms that cannot be managed in the person s home and community environment Imminent risk for an escalation of symptoms and/or a loss of adult role functioning but who do not pose an imminent risk to the safety of themselves or others A challenging emotional crisis occurs which the individual is unable to manage without intensive assistance and support Referrals may come from Emergency room Community Self-referrals Treatment team Part of a step-down plan from an inpatient setting Crisis respite is provided in site-based residential settings. 15 15

16 Intensive Crisis Respite Short-term, residential care and clinical intervention strategy for individuals who are facing a behavioral health crisis, including Individuals who are suicidal Express homicidal ideation Experiencing acute escalation of mental health symptoms. Person must be able to agree on a suicide prevention plan. Individuals are at imminent risk for loss of functional abilities, and may raise safety concerns for themselves and others without this level of care. The immediate goal is to provide supports to help the individual stabilize and return to previous level of functioning or as a step-down from inpatient hospitalization. 16

Education Support 17 Assist individuals who want to start or return to school or formal training with a goal of achieving skills necessary to obtain employment and a specific career goal. Education Support Services are offered to the extent to which they are not available under a program funded by IDEA or available for funding by the NYS Adult Career & Continuing Education Services Office of Vocational Rehabilitation (ACCES-VR) (The Vocational Rehabilitation component (ACCES-VR) 17

Education Support (Cont.) 18 Support provided to participants who wish to complete formal education services such as: Community college, university or other college-level courses Formal classes, vocational/apprenticeship training, Test Assessing Secondary Completion (TASC) diploma prep classes, CASAC training Must relate to an employment goal documented in the service plan. Ongoing education support services is provided after a participant is successfully admitted to an educational program. Ongoing follow-along is support available for an unspecified period of time as needed by the participant in order to complete the educational program. 18

Pre-vocational 19 Time-limited services that prepare a participant for paid or unpaid employment with the ultimate goal of competitive employment Provides learning and work experiences in an integrated setting Occurs over a defined period of time and with specific person centered vocational goals Provide supports to individuals who will in the future need ongoing support to learn a new job and/or maintain a job in a competitive work environment or a self-employment arrangement The outcome of this pre-vocational activity is to gain the skills necessary to progress to obtaining and maintaining competitive 19

20 Transitional Employment Support Services Designed to strengthen the participant s work record and work skills toward the goal of achieving assisted or unassisted competitive employment at or above the minimum wage May only be provided by programs already providing this service such as Certified clubhouses, psychosocial clubs or substance use recovery centers Provides learning and work experiences where the individual can develop general, non-job-task-specific strengths and soft skills that contribute to employability such as punctuality and collaboration The outcome of this pre-vocational activity is to gain the skills necessary to progress to obtaining and maintaining competitive 20

Intensive Supported Employment 21 Assist individuals to obtain and keep competitive employment. Based on an evidence based practice of supported employment. Consists of intensive supports that enable individuals for whom competitive employment is unlikely, absent the provision of supports. Provides supports to participants who need to learn a new job and maintain a job in a competitive employment or self-employment arrangement. The outcome of this activity is documentation of the participant s stated career objective and a career plan used to guide individual employment support. 21

Ongoing Supported Employment 22 Provided after a participant successfully obtains and becomes oriented to competitive and integrated employment. Available for an indefinite period as needed by the participant to maintain their paid employment position. Supports participants who need ongoing support to learn a new job and maintain a job in a competitive employment or self-employment arrangement. Are compensated at or above the minimum wage and receive level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. The outcome of this activity is documentation of the participant s stated career objective and a career plan used to guide individual employment support. 22

Empowerment Services Peer Support Delivered by certified peer specialists Designed to promote skills for coping with and managing behavioral health symptoms Activities included must be intended to achieve the identified goals or objectives as set forth in the participants individualized recovery plan Emphasize the opportunity for peers to support each other in the restoration and expansion of the skills and strategies necessary to move forward in recovery 23 23

24 Family Support and Training Assist individuals who wish to have their family of choice educated and supported with respect to the individual s ongoing recovery Centered around and included in the individual s Plan of Care Distinct from free standing family support 24

HCBS Designated Non-Medical Transportation Providers 25 There is new guidance regarding the HCBS Non-Medical Transportation Service. To provide this service, you must be or become a Medicaid transportation vendor. If you are NOT a Medicaid transportation vendor, you will unable to provide Non-Medical Transportation as a Home and Community Based Service. In order to become certified by Medicaid, you must complete a New York State Medicaid Enrollment form at https://www.emedny.org/info/providerenrollment/transportation/index.aspx: After you have become a Medicaid Transportation provider, please inform the Office of Mental Health by e-mailing: omh.sm.co.hcbs- Application@omh.ny.gov 25

26 Self-Directed Services Pilot Plan is to add this service after conducting a pilot (2016/17) Pilot sites TBD 26

Links to OMH/OASAS Documents Manual, Billing Manual and Fee Schedule 27 HCBS Manual: https://www.omh.ny.gov/omhweb/news/2014/hcbs-manual.pdf HARP Billing Manual: https://www.omh.ny.gov/omhweb/bho/harp-mainstreambilling-manual.pdf Fee Schedule and Rate Codes: http://www.omh.ny.gov/omhweb/bho/phase2.html 27

Managed Care Technical Assistance Center (MCTAC) Overview What is MCTAC? MCTAC is a training, consultation, and educational resource center that offers resources to all mental health and substance use disorder providers in New York State. 28 MCTAC s Goal Provide training and intensive support on quality improvement strategies including business, organizational and clinical practices, to achieve the overall goal of preparing and assisting providers with the transition to Medicaid Managed Care.

Who is MCTAC? 29

MCTAC Partners 30

Visit www.mctac.org to view past trainings, sign-up for updates and event announcements, and access resources. 31 @@CTACNY mctac.info@nyu.edu