NEW MEXICO CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINICS Behavioral Health Collaborative July 14, 2016
CCBHCs: Not Just a Grant Actively identify community members with high cost, complex health needs Clinical redesign to address needs and improve health Data driven population health management Opportunity for system transformation More effective care at lower cost
Background Excellence in Mental Health Act $1.1 billion investment: The largest federal investment in community-based behavioral health in several generations Outlines criteria for CCBHCs that are based on best practices in behavioral health and currently existing Federally Qualified Health Center (FQHC) expectations Vision Improve overall health by bolstering communitybased mental health and addiction treatment Advance behavioral health care to the next stage of integration with physical health care
Background CCBHC Planning Grants: Partnership between SAMHSA and CMS 24 states selected for planning grants on October 19, 2015 8 states selected for 2-year demonstration project on December 31, 2016 Demonstration states will participate in national evaluation
NM CCBHC Implementation Team Teresa Gomez, CCBHC Project Director Karen Meador, Deputy Director, Behavioral Health Services Division, Human Services Department Sallyanne Wait, Behavioral Health Manager, Medical Assistance Division, Human Services Department Daphne Rood-Hopkins, Director, Children s Behavioral Health Division, Children, Youth, and Families Department Dr. Caroline Bonham, Department of Psychiatric and Behavioral Sciences, University of New Mexico Dr. Deborah Altschul, Department of Psychiatric and Behavioral Sciences, University of New Mexico Pamela Koster and Mindy Hale, Falling Colors Technology Dale Jarvis, CCBHC Fiscal Consultant Roxane Spruce Bly, CCBHC Medicaid Uptake Contractor Dr. Mary Ann Shaening, CCBHC CYFD Uptake Contractor
CCBHC Implementation Team Roles UNM Division of Community Behavioral Health completes needs and gaps analysis and develops enhanced data collection and reporting tools Falling Colors Technology enhances BHSDStar to meet data collection and reporting requirements Dale Jarvis provides technical assistance to develop Prospective Payment System
CCBHC Planning Objectives 1. Solicit meaningful stakeholder input 2. Comprehensive Needs Assessment & Gaps Analysis 3. Certify at least two Community Behavioral Health Clinics 4. Establish a Prospective Payment System (PPS) 5. Develop and submit a proposal for the 2-year demonstration program
CCBHC Opportunities Care coordination for individuals who have complex, costly health care needs Evidence-based practices ensure high quality services that improve outcomes Clinics are paid for the actual cost of providing care Long-term strategy to contain costs
Not a New Idea! CCBHCs build on the success of FQHCs Common set of quality measures Supported by Prospective Payment System (PPS) based on the real and anticipated cost of providing care Quantification of services, costs and outcomes Potential to transform the delivery of care
CCBHC Scope of Services Additional services are provided directly or through formal relationships with Designated Collaborating Organizations (DCOs) Outpatient Primary Care Screening & Monitoring Targeted Case Management Peer, Family Support & Counselor Services Crisis Services*** Individual Psychiatric Rehab Services Screening, Assessment, Diagnosis & Risk Assessment Treatment Planning Outpatient Mental Health & Substance Use Services CCBHCs must directly provide services in green Referrals to providers outside the CCBHC and DCOs Community-Based Mental Health Care for Veterans ***Unless there is an existing state- sanctioned, certified, or licensed system or network for the provision of crisis behavioral health services that dictates otherwise.
Care Coordination: The Linchpin of CCBHCs CCBHCs are an opportunity to improve the health of New Mexicans by: Providing community-based mental and substance use disorder services Integrating behavioral health with physical health care Utilizing evidence-based practices Increasing access to high quality care Care coordination is the linchpin holding these aspects of care together and ensures that CCBHC care improves outcomes while lowering costs
CCBHC Readiness Prospective clinics completed Readiness Assessment* Self-assessment gauged readiness and capacity for key requirements: Non-four walls system design Trauma informed care Prospective payment rate support Other feasibility and readiness considerations Service delivery and operational capacity *Available at https://sites.google.com/site/nmccbhcs/resources
CCBHC Certification
Six Program Requirements 1. Staffing 2. Availability and Accessibility of Services 3. Care Coordination 4. Scope of Services 5. Quality and other Reporting 6. Organizational Authority, Governance and Accreditation
CCBHC Criteria are Designed to Address: Wide variation across States in regulating behavioral health organizations and in the scope and scale of Medicaid plans Lack of a common data set for behavioral health organizations Improved community mental health center services with a particular focus on: Crisis response Care coordination with physical health Veteran s services Innovative programs that promote wellness and keep people out of hospitals, RTCs and ERs
Prospective NM CCBHCs: PMS Farmington & Rio Rancho Mental Health Resources La Clinica de Familia Hidalgo Medical Services Guidance Center of Lea County UNM - ABQ
Prospective NM CCBHCs Recruited prospective CCBHCs based on their existing capacity Identified a diverse group of sites, e.g. urban, rural, frontier, FQHC, and Tribal 638 Completed a Readiness Assessment with each prospective entity Sites reviewed findings from Readiness Assessments, clinical requirements, and decided whether or not to proceed with certification
Certification Process Application for Certification is required Application includes site-specific plan Plan addresses needs and gaps as identified in three sources: Readiness Assessment: Any item with a score of 1 or 2 needs to be addressed with a plan Current Standing on Certification & Licensing: any negative finding needs to be addressed with a plan Clinical Design Requirements: any requirements currently not in place (staffing, services, etc.) need to be addressed with a plan
CCBHC Certification Process Site submits Attestation of Intent to Pursue CCBHC Certification CCBHC Certification Team completes site visit to review gaps and needs from the above three sources; to assist in developing plans; and to find technical assistance for sites whenever possible. CCBHC Certification Plan/Application is reviewed by CCBHC Certification Team and the certification decision is made.
Prospective Payment System
Prospective Payment System A Prospective Payment System (PPS) is a payment methodology that is based on a pre-determined payment - regardless of the intensity of the actual service provided. Planning states are required to select one of two PPS options based on actual and anticipated costs: 1.PPS 1 Daily rate 2.PPS 2 Monthly rate that reimburses higher costs associated with providing all services necessary to meet the needs of special populations The NM CCBHC PPS1 payment will reflect all of the CCBHC services that are furnished to an individual in a single day Anticipated cost for care coordination is incorporated into the PPS rate, but cannot be billed separately as a demonstration service. PPS must take into account any CCBHC demonstration services that are already included in managed care capitation rates and strategies for avoiding duplication of payment.
Prospective Payment System New Mexico will establish a clinic-specific daily rate based on the total annual allowable costs divided by total annual visits (PPS1) Each CCBHC completes a Cost Report to establish the prospective payment States have the option to offer Quality Bonus Payments The CCBHC rate supersedes other rates, e.g. If a client receives a CCBHC service that is also a service reimbursed through the FQHC rate, the clinic will receive the CCBHC PPS rate
Prospective Payment Development Establish CCBHC encounters Translate CCBHC budget into Cost Report template Determine clinic-specific prospective payment Determine if NM will add Quality Bonus Payments Determine how PPS is incorporated into managed care capitation Design billing and data systems operationalize PPS Determine how prospective payments are adjusted from DY1 to DY2
Demonstration Program Proposal
Demonstration Program Proposal New Mexico will submit an application for the demonstration program by October 15, 2016 Final selection announced by December 31, 2016 Demonstration states have until June 30, 2017 to go live Demonstration states receive an enhanced federal match of 79.79%
Competitive Proposal Stakeholder outreach, engagement and input Comprehensive needs and gaps analysis CCBHC services align with the needs of the target population Clinical model that improves outcomes and reduces cost Cultural and linguistic competence Enhanced data collection and reporting
Ad Hoc Committee Role Provide input and guidance to develop the CCBHC demonstration proposal Meet each month through September 2016 Access the NM CCBHC Information Hub to stay informed and engaged about the CCBHC project Create Ad Hoc sub-committees or work groups as needed
CCBHC Project Update Ad Hoc Committee has met 4 times Analyzing Medicaid data pull to establish cost profiles for each CCBHC catchment area Convened work group to develop new clinical design Cost reporting technical assistance and support for each prospective CCBHC to complete preliminary cost reports Shared findings from Readiness Assessment and CCBHC clinical requirements with each prospective CCBHC
For More Information: NM CCBHC Project Site: https://sites.google.com/site/nmccbhcs/ Teresa Gomez NM CCBHC Project Director Teresa.gomez2@state.nm.us