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Parallel Paths to Purchasing Transformation 2020: Fully Integrated Managed Care System Transition Period 2014 Legislative Action: SSB 6312 By January 1, 2020, the community behavioral health program must be fully integrated in a managed care health system that provides medical care, mental health and substance use disorder services for Medicaid clients Apple Health Managed Care Plans Behavioral Health Organizations 2016 RSAs Integrated Purchasing in Early Adopter RSAs, with shared savings incentives 3
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Mental Health Services for people who meet Access to Care Standards (ACS) Medical Services & Mental Health Services for people who do NOT meet ACS Chemical Dependency Services DSHS administers benefits: County-based Regional Support Network (RSN) contracts for mental health services State hospitals provide intensive psychiatric inpatient treatment HCA administers medical benefits (including prescription drug coverage) and mental health benefits for Medicaid enrollees who do not meet ACS Contracts with Healthy Options plans for medical and non-acs mental health managed care services Direct contracts with providers for fee-for-service (FFS) enrollees HCA administers dental benefits via direct contracts with providers. DSHS administers chemical dependency benefits: Contracts with counties and tribes for outpatient services, including opiate substitution treatment Direct contracts with residential treatment agencies for residential services Providers Providers Providers Individual Client 5
For Apple Health clients, physical health, mental health and substance use disorder services will be managed by one managed care organization instead of three systems. Access to Care standards no longer apply; care is provided based on level of care guidelines and medical necessity. Fully Integrated Managed Care contracts require coordination with county-managed programs, criminal justice, long-term supports and services, tribal entities, etc. via an Allied System Coordination Plan. 6
Early Adopter Region: Systems integrated to better coordinate services for clients Healthcare Authority (HCA) Early Adopter agreement Counties Collaboration Medicaid Health Plan Regional network of essential behavioral health services Physical Health, Mental Health and Chemical Dependency Providers Accountable Communities of Health e.g., Business/Employment Community/Faith-Based Organizations Consumers Criminal Justice Education Health Care Providers Housing Jails Local Governments Long-Term Supports & Services Managed Care Organizations Philanthropic Organizations Public Health Transportation Tribes Etc Individual Client 7
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GROUP MEDICAL SERVICES MH AND SUD SERVICES Clients enrolled in apple health-managed care plans today Clients who are not enrolled in Apple Health managed care today (e.g. on Medicare, Native American/American Indian people) Through FIMC managed care plans Through fee-for-service coverage (and additional coverage) Through FIMC managed care plans Through FIMC managed care plans under Behavioral Health Services Only (BHSO), set up for ensuring those enrolled in Medicaid can continue to access services Non-Medicaid No change Through Behavioral Health Administrative Services Organization 9
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HCA HCA Contract with BH-ASO Fully Integrated MCO Required sub-contract BH-ASO Required sub-contract Fully Integrated MCO Continuum of Integrated Clinical Services Individual Client 12
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December 2015: Signed Contracts with Apparently Successful Bidder MCOs January-February 2016: Readiness Review & Client Mailings, Community Events March 2016: Client notice of enrollment in managed care plan; updated client handbook; insurance card April 1, 2016: Coverage effective 16
Federal Notice: The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. 17