Access to Adult BH HCBS for Non-Health Home Enrollees: The State Designated Entity February 22, 2018
February 22, 2018 Agenda Overview of HARP and Adult BH HCBS What is a State Designated Entity? Becoming a contracted assessor agency for Adult BH HCBS The SDE and Access to Adult BH HCBS
The Health and Recovery Plan (HARP) New type of Medicaid Managed Care Plan for adults 21+ Designed for people with serious mental health conditions and substance use disorders Covers all benefits provided by Medicaid Managed Care Plans, including clinic, PROS, and ACT Also provides additional specialty services to help people live better, go to school, work and be part of the community
HARP Medicaid Managed Care and Adult BH HCBS Adult Behavioral Health Home and Community Based Services (BH HCBS) are specialty services offered only by HARPs. Most HARP enrollees will be eligible for BH HCBS (determined by an eligibility assessment). All HARP enrollees are eligible for Health Home Care Management (HHCM). HHCMs are given an increased monthly rate to provide enhanced care coordination to HARP enrollees, as needed to support their needs and access to HARP benefit package. MCOs, HHCMs, and providers will work together to assist HARP enrollees in accessing BH HCBS.
The MCO Role in Access to Adult BH HCBS MCOs are required to ensure each member receives an assessment to determine the member s need for BH HCBS, using the State-determined eligibility assessment. MCOs will also ensure that a person-centered plan of care meeting all federal requirements, is developed for each member. Currently, MCOs delegate the responsibility for assessment and person-centered care planning to contracted Health Homes. Initial assessment should occur within 30-90 days of enrollment in the HARP. Reassessment of BH HCBS and the plan of care must be completed at least annually or when warranted by changes in the member s needs.
1/25/2018 6 Requirement for Assessment and Care Plan for Adult BH HCBS Federal requirements for HCBS include an assessment of eligibility and development of a comprehensive person-centered plan of care. HARP members enrolled in Health Home (HH) receive the NYS Eligibility Assessment and care planning services through their HH Care Manager (CM). HARP members who are not enrolled in HH will have their NYS Eligibility Assessment and HCBS Plan of Care done by a State Designated Entity contracted with the MCO as an assessor agency for BH HCBS.
2/22/2018 7 Conflict-Free Care Management & SDE Federal rules for conflict-free care management require any HARP member being referred for HCBS to be offered a choice of service providers. MCO will review the POC to ensure choice of providers was given An employee who provides or supervises the NYS Eligibility Assessment and care planning services for an individual may not provide or supervise HCBS to that same individual Agencies who employ both Assessors for Adult BH HCBS and providers of Adult BH HCBS are required to have separate Supervisory structures and adequate firewalls in place to ensure for conflict-free care management.
1/25/2018 8 Individual Assessor Qualifications for Adult BH HCBS Assessors can be either: Employed as a Care Manager or Care Management Program Supervisor within the agency; or Employed, associated with, or contracted for work with another program within that agency (for example, a PROS practitioner, housing case manager, or outpatient clinician). Assessors must also meet the NYS Adult BH HCBS Assessor qualifications to perform NYS Eligibility Assessments, which include specific education, experience, supervision, and training requirements and are posted on the DOH website.
State Issued Changes to Improve Access Removal of the full Community Mental Health Assessment (CMHA) Abbreviated Assessor training for NYS Eligibility Assessment originally 12+ hours down to approx. 3! Resolved Issues with payment to CMA for NYS Eligibility Assessment: - Billing Roster eliminated (not effective) - Direct billing to emedny / edit resolved Revised Adult BH HCBS Workflow (October 2017) Adult BH HCBS Plan of Care template to be offered to MCOs, SDEs, and HHs to support more intuitive focus on integration and person-centered rehab goals.
HCBS Dashboard Data (01/24/18) HARP Enrolled 104,838 HH Enrolled 35,367 (34%) HCBS Assessed 14,998 HCBS Eligible 13,469 LOSD Requested 4,542 HCBS Authorized 1,862 HCBS Claimed 1,376
What is a State Designated Entity (SDE)? Currently, 66% of HARP enrollees are not enrolled in HH. MCOs will contract with eligible entities to provide assessment and care planning of BH HCBS for HARP enrollees not enrolled in a Health Home. Agencies that meet the following State-issued criteria are eligible to become a State Designated Entity (SDE) for Adult BH HCBS: Agencies or community-based organizations that are NYS-designated HHs, or affiliated with a HH, and who employ individuals meeting the NYS Assessor qualifications for Adult BH HCBS. An agency is considered affiliated with a HH when the agency has a contractual relationship with a NYS-designated HH for the provision of HH Care Management (HHCM) services. The State provided MCOs with a list of agencies meeting this criteria, to help MCOs begin contracting activities.
Becoming an Contracted Assessor Agency for Adult BH HCBS MCOs will reach out to agencies on the state-issued list who they would like to contract with as assessor agencies. MCOs must contract with a sufficient number of SDEs to meet the need in each county. Eligible agencies can amend existing contracts with MCOs to include SDE. The State will post and maintain an updated list of all contracted assessor agencies, by County, for public reference. NOTE: An SDE must have a contract as an assessor agency in place with an MCO before it can begin completing assessments and BH HCBS Plans of Care for individuals not enrolled in HH.
Connecting a HARP member to a Contracted Assessor Agency Start by contacting the member s MCO: The MCO will provide members and their providers with the names of contracted assessor agencies, and can advise on how to connect with contracted assessor agencies. The MCO will also have a list of SDEs they are contracted with to share with providers upon request. Before the Assessor begins any work with a HARP member, the Assessor must first contact the MCO to confirm the individual is not already being served by a Health Home or another assessor agency.
SDE Guidance Assessors can refer to Guidance for Improving Access to Adult Behavioral Health Home and Community Based Services (BH HCBS) for HARP and HARP-Eligible HIV Special Needs Plan Members Not Enrolled in Health Homes (released 1/24/18) for full workflow and requirements for linking HARP members to Adult BH HCBS. The guidance outlines the requirements and workflow for the assessor agency as well as the role of the MCO in oversight and monitoring.
Adult BH HCBS Stimulus BH HCBS Stimulus funds will be available through MCOs to increase BH HCBS. Providers may be given the opportunity to submit proposals to MCOs to receive stimulus funds. Vision: This stimulus is designed to provide financial supports to providers for innovation and rapid access of eligible HARP individuals to receive BH HCBS. Goals: Expand rehabilitation services for the HARP population Increase provision of HCBS Provide funds for innovative solutions to engagement, access, and utilization
BH HCBS Stimulus Funding Categories BH HCBS Access & Linkage Infrastructure: Workforce Development Outreach and Education BH HCBS Service Infrastructure: Capacity Building & Member Engagement Peer Support Development Crisis Respite Services Development Workforce Development
Resources & Guidance SDE Guidance: http://ctacny.org/sites/default/files/final%20sde%20 Guidance.pdf Adult BH HCBS Assessor Qualifications: https://www.health.ny.gov/health_care/medicaid/progr am/medicaid_health_homes/harp_bh/index.htm Questions? Please contact: omh.sm.co.hcbs-application@omh.ny.gov