Certified Community Behavioral Health Centers and New York State s Healthcare Reform: Considerations for Providers November 30, 2015 Joshua Rubin HealthManagement.com
Plan CCBHC basics NYS Health Reform How CCBHC fits Where the fit is less snug Where do you fit? Being a lead CCBHC agency Being a Designated Collaborating Organization The payoff for NYS
What is a CCBHC? A well-funded, coordinated, fully integrated comprehensive community-based provider of culturally and linguistically competent services that serves anyone, of any age, with a BH challenge while focusing on the needs of people with SED, SPMI and chronic SUD An always available single point of access and accountability for any member of the community who needs substance use or mental health treatment and support
Goals from the federal perspective To improve behavioral health by enhancing and expanding community-based mental health and substance use disorder treatment To improve integration with medical/surgical health care To expand the use of evidence-based practices To improve access to high quality care To expand and improve data collection Although required to serve everyone, they are targeted primarily at people with Serious Mental Illness (SMI), Serious Emotional Disturbance (SED), and chronic Substance Use Disorders (SUD)
Goals from the State perspective To improve behavioral health by enhancing and expanding community-based mental health and substance use disorder treatment To improve integration with medical/surgical health care To expand the use of evidence-based practices To improve access to high quality care To expand and improve data collection To improve the interface between the community BH system and the transforming healthcare system To increase federal financial participation in Medicaid funding for BH services
Goals from the provider perspective To improve behavioral health by enhancing and expanding community-based mental health and substance use disorder treatment To improve access to high quality care To expand and improve data collection To improve the interface between the community BH system and the transforming healthcare system To establish a consistent, reliable, robust funding stream that is consistent with the changes in healthcare in the United States Keep pace with inflation
Major NYS Health reform initiatives which CCBHC supports DSRIP HARP Health Homes HCBS SIM Prevention Agenda Potential state agency consolidation
CCBHCs and DSRIP Domain 2: System transformation Create integrated delivery system Implementation of care coordination and transitional care programs Connecting systems Domain 3: Clinical improvement At least one project must be BH 3.a.ii. BH community crisis stabilization
CCBHCs and DSRIP Domain 4: Population-wide strategy implementation Promote Mental Health and Prevent Substance Abuse; Prevent Chronic Disease; Prevent HIV/AIDS; and Promote Healthy Women, Infants and Children The 11 th Project Patient and Community Activation for Uninsured, Non- Utilizing and Low-Utilizing Populations Develop practices that promote activation and engagement Increase the volume of non-emergency (primary, behavioral and dental) care provided Form linkages between community-based primary and preventive services as well as other community-based health services to sustain and grow community and patient activation
CCBHCs and HARP Focus on specialized needs of people with SPMI and chronic SUD as a subset of the total population, not as separate from the total population Whole person care
CCBHCs and Health Homes CCBHC Care Coordination standards Partnerships or formal contracts with: FQHCs/rural health clinics, unless the CCBHC provides comprehensive healthcare services Inpatient psychiatry and detoxification Post-detoxification step-down services Residential programs Inpatient acute hospitals Department of Veterans Affairs facilities Other social services providers, including Schools Child welfare agencies Juvenile and criminal justice agencies and facilities Indian Health Service youth regional treatment centers Child placing agencies for therapeutic foster care service
CCBHCs and HCBS Many of the HCBS services are required services for CCBHCs HCBS Services Psychosocial Rehabilitation Community Psychiatric Support & Treatment (CPST) Employment Crisis Respite Habilitation/Residential Support Services Empowerment Services Peer Supports Education Support Services Family Support and Training Non-medical transportation
CCBHCs and SIM CCBHC APC Behavioral Health Risk/Complexity Low High Quadrant II BH Med Behavioral health clinician/case manager w/ responsibility for coordination w/ PCP PCP (with standard screening tools and guidelines) Outstationed medical nurse practitioner/physician at behavioral health site Specialty behavioral health Residential behavioral health Crisis/ED Behavioral health inpatient Other community supports Quadrant I BH Med Quadrant IV BH Med PCP (with standard screening tools and guidelines) Outstationed medical nurse practitioner/physician at behavioral health site Nurse care manager at behavioral health site Behavioral health clinician/case manager External care manager Specialty medical/surgical Specialty behavioral health Residential behavioral health Crisis/ ED Behavioral health and medical/surgical inpatient Other community supports Persons with serious mental illnesses could be served in all settings. Plan for and deliver services based upon the needs of the individual, personal choice and the specifics of the community and collaboration. PCP (with standard screening tools and behavioral health practice guidelines) PCP-based behavioral health consultant/care manager Psychiatric consultation Quadrant III BH Med PCP (with standard screening tools and behavioral health practice guidelines) PCP-based behavioral health consultant/care manager (or in specific specialties) Specialty medical/surgical Psychiatric consultation ED Medical/surgical inpatient Nursing home/home based care Other community supports Low Medical Risk/Complexity High
CCBHCs and the Prevention Agenda Emphasis on EBPs Priority areas Prevent chronic diseases Promote a healthy and safe environment Promote healthy women, infants and children Prevent HIV, sexually transmitted diseases, vaccinepreventable diseases and healthcare-associated infections Promote mental health and prevent substance abuse Promote Mental, Emotional and Behavioral Well- Being in Communities Prevent Substance Abuse and other Mental Emotional Behavioral Disorders Strengthen Infrastructure across Systems
CCBHCs and potential state agency consolidation Coordinated BH service system Not separate MH and SUD service systems Single license Integrated with a medical system that acknowledges and accounts for BH Serves the entire life cycle
Round holes State agencies aren t consolidated Licenses aren t consolidated CCBHCs are required to directly provide both services PPS is a cost-plus based construct that appears inconsistent with VBP Organizational authority standards envision agencies as CCBHCs, not agencies operating CCBHCs There is a loophole here
Where does your agency fit? There are big benefits to being a CCBHC There are also significant costs It s NOT a free lunch Designated Collaborating Organizations (DCOs) get some of the benefits, and some of the costs The real contest is us against them not us against ourselves
Minimum Standards by summer The Act establishes standards in six areas that an organization must meet to achieve CCBHC designation Staffing Accessibility Care coordination Service scope Quality/reporting Organizational authority
Staffing Standards Diverse backgrounds Psychiatrist Medical Director Psychiatric Nurse Credentialed Substance Abuse Counselor MH professional who can perform psychological testing Case management and family support staff Peer specialist/recovery coach Optional: LCSW, LMHC, Psychologist, LMFT, OT Licensed and accredited Culturally and linguistically competent and appropriate Including for Veterans and members of the Armed Services 19
Availability/Accessibility Standards Initial evaluation within one business day Comprehensive evaluation within 15 days Crisis management services available 24x7x365 Within three hours maximum Average response is within one hour Although regulated through state Medicaid systems, must serve everyone regardless of ability to pay, insurance status or state of residence Protocols in place for ED access 20
The CCBHC Palace Services for Armed Forces and Veterans 24x7 Crisis Services Screening, Assessment, Dx MH and SA Tx Patient-Centered Planning Psych Rehab Med. Screening and Monitoring Targeted Case Management Peer and Family Support
Uniform Reporting Standards Standardized data elements modeled on the FQHC Uniform Data System Encounter data Consumer demographics Staffing Service usage Service access Care coordination Clinical outcomes data Quality data, including performance incentive data Financial data 22
Organizational Authority Standards Nonprofit Local government behavioral health authority Indian Health Service, Indian tribe or Tribal organization Urban Indian organization Governing board (or advisory Board) members reasonably represent those served in terms of geographic areas, race, ethnicity, sex, gender identity, disability, age, and sexual orientation At least 51% consumer or family members 23
Lead CCBHC Agency Benefits PPS = Cost Plus payment Incentive for NYS to grow your program Prestige/reputation Experience with the program model of the future Preparation for VBP Attractive partner for PPSs Costs Data and reporting requirements Staffing requirements Administrative burden Upfront costs with an uncertain payoff Whether directly supplied by the CCBHC or by a DCO, the CCBHC is ultimately clinically responsible for all care provided
DCO Benefits PPS = Cost Plus payment Some small incentive for NYS to grow your program Some prestige Connection to a robust program model for your consumers Costs Some data and reporting requirements Upfront costs with an uncertain payoff
Return on investment The planning grant is a loss leader The payoff comes if, and only if, NYS makes it into the elite eight ROI comes from enhanced FMAP 65/35 is meaningfully better than 50/50 Would be a strong incentive for NYS to purchase services via CCBHCs The real competition begins now
In conclusion CCBHC represents a model the federal government supports. The next evolution of CMHCs CCBHC is an initiative that is being driven by the National Council because it is SO provider friendly There is a role in CCBHCs for LOTS of BH provider agencies, not just the big ones It s a marathon that begins with a sprint CCBHC is good for the people our organizations serve if NYS makes the cut
Behavioral Health Transition to Managed Care Update Certified Community Behavioral Health Clinics (CCBHC) Provider Application and Selection APRIL 2015
CCBHC Application 29
Application Timeline Action CCBHC Application to be Released Date 1 st Week of December 2015 All Questions on Application to be Submitted December 11, 2015 Tentative Release on Application Q&A December 18, 2015 CCBHC Application Due January 8, 2016 Tentative Selection of CCBHCs 1 st Week of February 2016 30
Application & Submission Requirements Applicants are required to complete and submit the following documentation for consideration: The NYS Application for Certified Community Behavioral Health Clinics (CCBHCs) The CCBHC Certification Criteria Readiness Tool (CCRT) The Application will be located on the NYS CCBHC Planning Grant Website Applications are to be submitted electronically by 5:00 PM on January 8, 2016 to: ccbhc@omh.ny.gov Subject: CCBHC Application Submission All questions may be submitted by 5:00 PM on December 11, 2015 to: ccbhc@omh.ny.gov 31
Selection Requirements 32
CCBHC Selection It is essential for New York to develop a strong proposal and have programs capable of meeting all requirements in order to move forward into the 2 year Program Demonstration Only 8 of the 24 States with a planning grant will be selected to participate MTM Services will help facilitate the selection process for the State New York plans on opening this initiative to all agencies who strongly demonstrate the ability to meet all certification requirements by August 2016 Federal requirement includes certification of at least 2 CCBHCs 33
Considerations for Selection- DRAFT Article 31 and 32 Licenses in Good Standing Capacity to Provide Core Services Across the Lifespan Participation in New York s Current Health Care Reform Initiatives Ability to Meet the CCBHC Criteria History of Providing an Array of Behavioral Health Services Geographic Diversity 34
Following CCBHC Selection Selection to participate in the CCBHC certification process does not guarantee that an agency will become certified as a CCBHC Agencies will be required to meet a set of predetermined, time-sensitive benchmarks pertaining to the criteria All participating agencies must meet all certification requirements by August 2016. 35
Questions? Thank you for participating! Please visit: http://www.omh.ny.gov/omhweb/bho/ccbhc.html for more information on New York s planning grant and http://www.samhsa.gov/section-223 for further tools and resources from SAMHSA 36