Behavioral Health Transition to Managed Care Update The Current State of Behavioral Health Opportunities for Integration and Certified Community Behavioral Health Clinics (CCBHC) APRIL 2015
The Current State 2
THE NEW ENEMY!!!! Credit: NYSP Crime Laboratory 3
INVEST The increase in opioid prescriptions from 1999 to 2015 could account for about 20 percent of the observed decline in men s labor force participation (LFP) during that same period. Alan B. Krueger, Princeton University
Expanding our Services = Peer Engagement 20 Locations = Family Support Navigators 11 Locations = Youth Clubhouses 13 Locations = Recovery Community Centers 16 Locations = Regional Addiction Resource Centers 10 Locations = Rapid Capital Expansion Bed Awards 5 Locations, 96 Beds = Rapid Capital Expansion OTP Awards 4 Locations, 600 Slots = New OTP 11 Locations, 2,500+ Slots = Expanded OTP Capacity 3 Locations, 900+ Slot Increase = Opioid STR Grant Focus County 16 Counties
ENGAGE THE 9 1 of 10
CO-OCCURRING SUD & MENTAL HEALTH SUD ONLY CO-OCCURING 46% 54% 10
OPPORTUNITIES 11
Integrated Outpatient Services IOS DSRIP 3ai Model 2 ENGAGE THE 9 Programmatic Issues Payment Issues
September 2017 Medicaid Update Article Integrated Services: Guidance for Licensed/Certified Facilities, including Billing under FFS and Medicaid Managed Care https://www.health.ny.gov/health_care/medicaid/progra m/update/2017/sep17_mu.pdf. E THE 9
ENGAGE THE 9 Regulatory Modernization Workgroup (RMI) The Limited Integrated License (LIL) Single License Article 99
CCBHCs 15
May 2015 Background Congress passed legislation establishing the CCBHC demo program The Legislation required SAMSHA to: Establish CCBHC certification criteria Provide guidance on CCBHC Prospective Payment System (PPS) Administer 1 year planning grants for States to develop a CCBHC demo proposal Competitively select 8 States to participate in the CCBHC demonstration Report findings and recommendations to Congress on CCBHC OMH, OASAS, and DOH worked collaboratively in preparing the planning grant 16
May 2015 Timeline Action NYS submits CCBHC Planning Grant Application SAMHSA awards 23 states planning grants Date July 2015 October 2015 New York submits proposal for the 2 year Demonstration Program October 2016 8 States (including NY) are selected to participate in the 2 year Demonstration December 2016 Program NYS Demonstration Program begins July 1, 2017 NYS Demonstration Program ends June 30, 2019 Final Report to Congress on CCBHC demonstration program December 2021 17
Support for CCBHC Implementation in NYS Key community providers, advocates, and stakeholders are strongly urging NYS to participate The CCBHC provides an opportunity to work collaboratively with community stakeholders to improve access and the quality of the behavioral health care system CCBHCs are an innovative way to strengthen the behavioral health safety net in a redesigned system of care The opportunity for NYS to shape program design through participation in the demo will not likely exist again
Planning Grant States awarded the 1 year planning grant are charged with: Collaborating with key stakeholders to develop the CCBHC proposal Certifying at least 2 clinics as a CCBHC based on the SAMHSA criteria Providing technical assistance to the certified clinics in order to enhance the clinic s ability to meet certification standards Developing a PPS Methodology Proposal for 2 year Service Demonstration
May 2015 What is a Certified Community Behavioral Health Clinic (CCBHC)? A CCBHC provides comprehensive community behavioral health services A CCBHC is designed to: Improve access to quality care 9 Core Services with requirements for coordination agreements with health and social service providers Reduce ER and hospitalizations Foster diverse health system partnerships CCBHC services in NY are carved out of Medicaid Managed Care 20
May 2015 CCBHC Scope of Services Under the established criteria, the following 9 services must be provided by a CCBHC or partnering agency: Must be provided directly by the CCBHC Crisis mental health services (24-hour mobile crisis teams, emergency crisis intervention services, crisis stabilization) 3 hour community response Outpatient mental health and substance use services Screening, assessment, and diagnosis Patient-centered treatment planning that includes risk assessment and crisis planning May be provided by CCBHC or Designated Collaborating Organization Physical Health screening and health risk monitoring Care management Psychiatric rehabilitation services Peer support and family supports Community-based mental health care for veterans and members of the armed forces 21
May 2015 Designated Collaborating Organizations (DCO) CCBHCs may contract with DCOs to fully furnish services that are not required to be directly provided by the CCBHC All DCOs must be appropriately licensed or certified to perform activities and procedures detailed within the approved scope of services Opportunity for providers who are unable to meet the certification criteria to participate in this initiative 22
Who do CCBHCs Serve? Provides services across the lifespan Adults with serious mental illness Children with serious emotional disturbance Individuals with long-term chronic addiction Others with mild or moderate mental illness and substance use disorders Underserved individuals and families Low income individuals and families Those who are insured, uninsured or on Medicaid Those with complex health profiles Members of our armed services and veterans and their families
May 2015 CCBHC Certification Criteria The certification criteria is extensive and includes the following categories: Staffing Availability and Accessibility of Services Care Coordination Scope of Services Quality and Other Reporting Organizational Authority and Governance 24
CCBHC Providers in New York State Central Region Syracuse Behavioral Health Citizen Advocate Hudson River Bikur Cholim Long Island Central Nassau Guidance and Counseling Services NYC New Horizon Counseling Center PROMESA VIP Samaritan Daytop Village Services for the Underserved Western Strong Memorial Hospital Spectrum Lakeshore Behavioral Health/BestSelf Behavioral Health, Inc Mid-Erie Mental Health Services /Endeavor Health Services
CCBHC and Current NYS Health Reform Initiatives CCBHC is intended to support ongoing healthcare reform initiatives such as: Managed Care Health Homes Balancing Incentive Programs Home and Community Based Services Delivery System Reform Incentive Payment (DSRIP) Program Value-Based Payments
CCBHC and Value-Based Payments The core components of CCBHC align well with NYS s goals for Value-Based Payment (VBP) CCBHC Design CCBHCs are expected to provide a comprehensive quality care and develop comprehensive provider networks, promoting value over volume and system collaboration Quality Bonus Payments (QBP) QBP incentivizes efforts to continuously improve quality of care and reduce avoidable hospital use by rewarding providers for meeting service-based goals
May 2015 Certification Criteria-Comprehensive Networks CCBHC fosters diverse health system partnerships to help coordinated care and access a full spectrum of treatment. Partnerships include: FQHCs Inpatient psychiatric facilities Substance use detoxification Residential programs Inpatient acute care hospitals and outpatient clinics Department of Veterans Affairs medical centers and clinics Other community Supports, and providers Examples include: schools, child welfare agencies, criminal justice agencies, etc. 28
CCBHC/FQHC Care Coordination Agreements
May 2015 PPS Methodology Development New York developed a Prospective Payment System (PPS) for Medicaid reimbursement for CCBHC services CCBHCs have a daily PPS rate that is specific to each program Average is $268 per day The PPS is threshold visit that is paid on a FFS basis CCBHC services and payments are carved out of Medicaid Managed care 30
FQHC Standards imbedded in PPS Development PPS rate is a daily threshold amount PPS is based on the average cost of all allowed services provided by all allowable providers PPS supports comprehensive CCBHC services PPS rates are determined separately for each individual CCBHC States using Medicaid managed care organizations (MCOs) must make up the difference between what the MCO pays and the PPS rate.
May 2015 Data Reporting and Collection New York will be participating in a National evaluation led by the U.S. Department of Health and Human Services To meet this requirement, the State and selected CCBHCs must work to: Develop or enhance data collection and reporting capacity to meet PPS and quality measurement provisions Design or modify data collection systems for program implementation 32
May 2015 Questions? 33