Community Mental Health Assessment Requirements Letter

InterRAI Community Mental Health Assessments and April 23, 2015

April 15, 2015

Dear Health Home:

As you know, Medicaid–funded behavioral health services for many Medicaid beneficiaries will be moving into managed care. The transition of the benefits to managed care will in begin New York City. This transition to managed care is designed to create a system that provides New Yorkers with fully integrated behavioral and physical health services offered within a comprehensive, accessible and recovery oriented system.

This memo is intended to provide information and the necessary steps that Health Homes will need to take to be operationally ready for the key role they will play in the implementation of behavioral health managed care in the conducting of functional assessments (the Uniform Assessment – Community Mental Health (UA–CMH) Pilot), the delivery of care management, and the preparation of person–centered care plans. To support the Behavioral Health Implementation in New York City, we will conduct a one–hour webinar on Thursday, April 23. The webinar will begin at 9:00 am. The purpose of this webinar is to provide an overview of the organizational readiness steps that must be completed by Managed Care Organizations, Health Homes, and Health Home Care Management Agencies in preparation of the July 1, 2015 implementation.

There will two types of managed care plans available to individuals:

Qualified Mainstream MCOs: For all adults served in mainstream MCOs throughout the State, the qualified MCO will integrate all Medicaid State Plan covered services for mental illness, substance use disorders (SUDs), and physical health (PH) conditions and some additional behavioral health services available in Managed Care only. Premiums for mainstream Plans will be adjusted to reflect the additional BH benefits of mainstream enrollees.

Health and Recovery Plans (HARPs): HARPs are a distinctly qualified, specialized and integrated managed care product for adults meeting the serious mental illness (SMI) and SUD targeting criteria and risk factors. They will facilitate the integration of physical health, mental health, and substance use services for individuals requiring specialized expertise, tools, and protocols which are not consistently found within most medical plans.

Within the HARPs, access to an enhanced benefit package will be offered in addition to all Medicaid behavioral health and physical health benefits. The enhanced benefit package of

Home and Community Services (HCBS) is designed to assist enrollees in their recovery and continued tenure in the community. Federal requirements indicate that eligibility to HCBS must be based on an assessment of functional needs. All HARP members will need to receive an annual assessment to determine HCBS eligibility.

It is anticipated that all individuals enrolled in a HARP will receive Care Management from a Health Home or other State–designated organizations that have been identified by the HARP to provide care management. Additionally, the entity providing the care management services, will also conduct functional assessment to determine eligibility for HCBS services and to assist in developing required plans of care for members receiving HCBS services. Entities providing care management will need to be able to access the assessment tools and required training using the Health Commerce System (HCS).

1. Required Access to Health Commerce System

Care Managers will use the Uniform Assessment – Community Mental Health (UA–CMH) Pilot to access the two tools. Staff will use the UAS–NY Training Environment to access course and reference materials. Both web–based application are accessed through the Health Commerce System, a secure, web portal managed and maintained by the New York State Department of Health. Health Homes and Care Management agencies already have appropriate access to the HCS and will have access to both applications. Agencies that do not have access to the HCS, will need to work with the Department to facilitate access to the HCS.

Each individual in your organization who will access the HCBS eligibility assessment tool and the Community Mental Health assessment must have their own individual HCS user account. Staff who do not have their own account must work with the HCS Coordinator from their respective organization. Each organization has at least one HCS Coordinator.

The UA–CMH Pilot application defines what information may be read or edited, and what functions may be performed. All individuals who will access the HCBS eligibility assessment tool and the Community Mental Health assessment must be assigned a UA–CMH role by your organization´s HCS Coordinator. You will work with your HCS Coordinator and determine the appropriate roles to be assigned. Your HCS Coordinator will perform the task of assigning the roles in the HCS to your staff´s HCS accounts.

2. Assessment Tools

As a part of the requirements of enrollment in a HARP, all individuals will require assessment for HCBS eligibility using a tool derived from the interRAI Community Mental Health assessment designed for New York. To ensure that eligible HARP members gain access to HCBS and that those services are guided by an appropriate, person–centered plan of care the HCBS eligibility assessment tool will be conducted to determine if HARP enrollees are eligible for HCBS services and the full Community Mental Health assessment, which is a required, validated instrument, will assist in the development of a strengths–based, person–centered care plan.

3. Required Training

Prior to being able to access the assessment tools, Health Home Care Managers must complete the "Understanding the Community Mental Health Assessment" course. This online, web–based course is comprised of a number of modules and will take approximately twelve hours to complete. We strongly encourage learners to complete this course over several weeks rather than in one or two sessions. Additional ongoing training will be made available to Health Home Care Managers in the form of webinars, face–to face training, and learning communities. The "Understanding the Community Mental Health Assessment" course will be available beginning on May 15, 2015. The course will be available in the UAS–NY Training Environment, which is accessed through the Health Commerce System (HCS). All organizations should develop a plan to have all Care Managers who will be working with HARP enrollees trained on this tool and granted access to HCS, and every effort should be made to have Health Home Care Managers who are currently serving HARP eligible individuals to complete the training as soon as possible.

4. Implementation Plan

The statewide implementation of the UA–CMH Pilot application will be implemented in phases.

Phase 1 is focused on the implementation of the UA–CMH Pilot application in the five boroughs of New York City. HARPS and Health Home Programs, along with their respective Health Home Care Management Agencies, are required to begin training on May 15, 2015. Information on the implementation phases for the rest of state and the migration of the UA–CMH Pilot application to the Uniform Assessment System for New York (UAS–NY) will be provided at a later date.

Please submit any questions regarding the Behavioral Health Implementation to the Health Home email web form under the subject "Behavioral Health Implementation".