SPOKANE COUNTY COMMUNITY SERVICES, HOUSING, AND COMMUNITY DEVELOPMENT DEPARTMENT (CSHCD)

SPOKANE COUNTY COMMUNITY SERVICES, HOUSING, AND COMMUNITY DEVELOPMENT DEPARTMENT (CSHCD)

Spokane County Community Services, Housing, and Community Development Department

Spokane County Regional Behavioral Health Organization Who We Are and What We Do

What Happened to the Regional Support Networks (RSNs)? In 2014 the State Legislature passed Senate Bill 6312, directing DSHS to integrate funding and oversight for behavioral health (mental health and substance use) treatment services. The legislation changed how the state purchases mental health and substance use disorder (behavioral health) services beginning in 2016. It also legislated the integration of Medicaid behavioral health services with primary health services beginning in 2020.

Spokane County Regional Behavioral Health Organization (SCRBHO) In April, 2016 the state began purchasing behavioral health services through regionally operated Behavioral Health Organizations (BHO) through a managed-care structure There are eight BHOs across Washington State and two fully integrated regions- Southwest and North Central. Early Adopters have fully integrated services that include both behavioral health and physical health The other BHOs must have a plan to become fully integrated with physical health beginning in 2020.

WHAT REGION Does the SCRBHO Serve? Spokane County Regional Behavioral Health Organization (SCRBHO) began administering services April 1, 2016 with SCRBHO-contracted providers across 7 counties including: Services Include:

Current Siloed Medicaid Systems Mental Health Services & Chemical Dependency for people who meet Access to Care Standards DSHS administers benefits: County-based Behavioral Health Organization (BHO) contracts for Specialty mental health services and substance use disorder (SUD) State hospitals provide intensive psychiatric inpatient treatment Medical Services & Mental Health Services for people who do NOT meet ACS 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. Providers Providers Individual Client 4

New System: Whole-Person Care For Apple Health clients, physical health, mental health and substance use disorder services will be managed by one managed care plan that is responsible for keeping them well both mind and body. A single MCO will coordinate care for their clients, across the full continuum of physical and behavioral health services. Access to Care standards no longer apply; care is provided based on level of care guidelines and medical necessity. MCOs are held to HCA network adequacy standards and must have an adequate network including essential behavioral health provider types. Medical and behavioral health providers are working with the same payers (MCOs) and can move towards integrated clinical models that are supported by value-based and innovative payment methodologies. HCA s goal is to offer consumers a choice of at least 3 MCO s to enroll with. 9

Integrated Managed Care Regional service areas have the choice to adopt the new payment model before 2020, which is referred to as Mid-Adopter. Spokane County Community Services, Housing, and Community Development Department

Full Integration 3 Options Full Integration on January 2019 On Jan. 1, 2019 MCOs assume all risk and responsibility for Medicaid behavioral health services no delegation On Jan. 1, 2019 BH-ASO assumes responsibility for crisis system and other non- Medicaid functions Transition Year Beginning 2019 Full Integration by January 1, 2020 MCOs assume risk for Medicaid services, subcontract an agreed upon set of services and/or functions to the BHO for 1 year BHO maintains non-medicaid BH Contracts for 1 year can continue as BH-ASO in 2020 if desired Region must meet readiness review milestones during 2019 Full integration complete by January 1, 2020 No Transition Year Full Integration by January 1, 2020 On Jan 1, 2020 MCOs assume all risk and responsibility for Medicaid BH services no delegation On Jan 1, 2020 BH-ASO assumes responsibility for crisis system and other non-medicaid functions

This Region Selected: Full Integration on January 2019 On January 1, 2019, the MCOs assume all risk and responsibility for Medicaid behavioral health services no delegation On January 1, 2019, the BH-ASO assumes responsibility for crisis system and other non-medicaid functions

Update on Adoption Status 2018 2019 2019 w/ transition 2020 North Central Pierce North Sound Olympic (Salish) Spokane King Cascade Pacific (Thurston/ Mason) Okanogan (shifting regions) Greater Columbia Cascade Pacific (Great Rivers) Klickitat (shifting regions) 13

2017 Mid-Adopter Nov/Dec Develop key program design questions Initial program education Dec Jan 2018 Establish Obtain Leadership Team/ feedback on Advisory design and Committee procurement Finalize program design decisions Medicaid Integration Timeline HCA drafts MCO RFP Feb April Release RFP (approx. 60 days to respond) April MCO Responses Due Score RFP Proposals (30 days) May Announce Apparently Successful MCO Bidders ** MCO RFP Target Release Date Mid- February June Knowledge Transfer Begins Transition readiness between providers & MCOs Begins Aug HCA conducts Readiness Review Sep - Jan Signed Contracts 2019 Client Notifications Continuing provider readiness and knowledge transfer Client enrollment processes Jan 2019 Integrated coverage begins Key Acronyms RSA Regional Service Areas MCO Managed Care Organization BHO Behavioral Health Organization AH Apple Health (medical managed care) ACH Accountable Community of Health BH-ASO Behavioral Health Administrative Services Organization FIMC Fully-Integrated Managed Care HCA Health Care Authority NC North Central Mid-Adopter Regions: Regions pursuing fullyintegrated managed care before 2020 14

Services not included in MCO Contracts Crisis services for all members of the community Includes DMHPs State-funded services for Non-Medicaid beneficiaries County-funded services for Medicaid and Non-Medicaid Miscellaneous BH Ombudsman Committees formerly led by BHO WISe, CLIP, Behavioral Health Advisory Board, etc. 7

How will the crisis system be managed? HCA HCA Contract with BH- ASO Fully Integrated MCO Required sub-contract County or Procured Organization Required sub-contract Fully Integrated MCO Continuum of Integrated Clinical Services Individual Client 8

QUESTIONS

Overview Video: Integrated Managed Care https://www.youtube.com/watch?v=zwv1y X3czoU#action=share 18

THANK YOU Please reach out to us at Spokane County s Community Services, Housing, and Community Development Department, should you have any questions or concerns web tstern@spokanecounty.org www.spokanecounty.org/cshcd 509.477.4510 fax 509.477.6204 Spokane County Community Services, Housing, and Community Development Department 19