Children's MRT Health and Behavioral Health Subcommittee

Quarterly Meeting
Albany, New York

  • Presentation is also available in Portable Document Format (PDF, 327KB)

July 27, 2015

Children´s Leadership Team

  • Donna Bradbury, Associate Commissioner, Division Of Integrated Community Services For Children & Families, NYSOMH
  • Lana I. Earle, Deputy Director, Division of Program Development and Management, Office of Health Insurance Programs, NYS DOH
  • Steve Hanson, Associate Commissioner, Treatment Services, NYS OASAS
  • Laura Velez, Deputy Commissioner, Child Welfare & Community Services, NYS OCFS

Agenda

  • Children´s Timeline Review
  • State Agency Updates
  • Children´s Readiness Resources Discussion
  • Health Home Serving Children Update
  • State Plan Amendment (SPA) New Children´s Behavioral Health Services Update
  • Provider Designation Process
  • Upcoming MRT Meetings

Children´s Timeline Review

Children´s Transition Timelines

  • Children will begin to enroll in Health Homes Designated to Serve Children on January 1, 2016.
    • OMH TCM providers and legacy clients will transition on January 1st as well.
    • The transition of care coordination services of the six 1915c children´s Waivers (OMH SED, DOH CAH I/II, OCFS B2H) to Health Home will not occur until 2017.
  • The newly proposed health and behavioral health Medicaid State Plan services will be implemented as soon as possible pending approval from CMS in early 2016.

Geographic Phase In

  • January 1, 2017 - NYC and Long Island Children´s Transition to Managed Care
  • July 1, 2017 - Rest of State Children´s Transition to Managed Care
  • In 2017, currently carved out Medicaid behavioral health services and children in foster care will be moved to Managed Care
  • The existing Home and Community Based Services (HCBS) that are in the six 1915c children´s Waivers (OMH SED, DOH CAH I/II, OCFS B2H) will be aligned to one array of HCBS benefits, pending CMS approval, and will be moved to Managed Care. As a result of this transition, the 1915c Waivers will be discontinued as separate programs once the transition is complete.

Population Phase-In

  • In 2017, children meeting Level of Care criteria will begin to receive HCBS benefits.
  • In 2018, children meeting Level of Need criteria will begin to receive HCBS benefits (January for children with Medicaid; July for children who meet "family of one" Medicaid)

Agency Updates

Foster Care System (OCFS) Update

  • Health Home training for Foster Care agencies that will be Health Home care managers:
    • Series of Webinars underway: 2 completed, more forthcoming
    • Face-to-Face training on Roles and Responsibilities being scheduled
    • NYS to offer training to LDSS
  • Foster care/Managed Care Readiness funds:
    • Draft allocation amounts announced
    • Final allocation and contracting process pending OSC approval
  • Foundations in Managed Care Sessions for Voluntary Foster Care Agencies:
    • Sessions scheduled for July 24, 28 and 30
  • On-going Data Analysis: Empire Health and Chapin Hall to inform MCO PMPM and Residual Per Diem development
  • Residual Per Diem: Meeting with Mercer to explore models in other states
  • Exploring Small Clinic Licensure

OASAS Update

  • LOCADTR 3.0 Adolescent Module
  • Adolescent Residential Redesign
  • Recovery Support Services
    • Clubhouse
    • Family Peer Support
    • Youth Peer Support

OMH Update

  • Day treatment program development
  • RTF program development

Team Update

  • NYU, Wagner School Special Convening (July 15): Health Reform Efforts - Family & Child Development Services
    • Outcomes: to engage in discussion regarding an offer of assistance with children´s design
  • Managed Care Academy, TA Network, University of Maryland, Baltimore (July 21-22)
    • Outcomes: continued technical assistance available on specific topics of the children´s design

Children´s Readiness Resources Discussion

Health Homes Serving Children Update

Designation Process Health Homes Serving Children

  • April 29, 2015 Webinar - Health Home Design Updates (rates, referral process)
    http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/hhsc_webinars.htm
  • June 15th - Health Home Designations Announced
    http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/health_homes_and_children.htm
    • 16 Health Homes Contingently Designated to Serve Children
      • 12 adult Health Home expanding to serve children, 4 new children´s Health Homes
    • All 16 accepted designations, have agreed to address contingencies (e.g., network expansion, including existing care managers TCM, Waiver, foster care agencies, clarification on approach to tailor services or governance structure, certify ability to pay downstream care managers)
    • Contingency responses due back to State Team on August 17
    • Every county has at least two designated Children´s Health Homes
    • June 24th Webinar Held to Review Next Steps with Designated Health Homes (Finalizing network partner lists, responding to contingencies, Data Exchange Agreements, Business Associate Agreements)

Timeline for Enrollment:
Considerations for Assessing and Mitigating Readiness Risk

  • Upon completing the Application Review and Designation Process, and at the request of stakeholders (e.g., new and existing Health Homes designated to serve children, care management agencies and voluntary foster care agencies making readiness decisions), the State assessed the overall "readiness risk" associated with implementing all key components of the Health Home Design for Children and moved the begin enrollment date from October 1, 2015 to January 1, 2016
  • Readiness Risk Factors Evaluated:
    • Programming, training, testing and launching MAPP modifications for children scheduled for October 1, 2015, including implementing:
      • Children´s referral and assignment portal process
      • CANS-NY (as modified) assessment tool in MAPP
      • The ability to integrate CANS-NY, Health Home algorithms and Health Home rates in MAPP
    • Testing of and potential modifications to the CANS-NY assessment tool and Health Home algorithms
    • Time for Designated Health Homes to meet contingencies and complete other administrative/readiness activities
    • Time for new care management agencies with expertise in serving children with complex needs to forge relationships with new and existing Health Homes
    • Time for Health Homes, Care Management Agencies and Plans to complete and participate in key trainings - MAPP, CANS-NY
    • Timing of CMS approval of State Plan Amendments
    • As part of the readiness risk assessment, the State also considered the effort and investments (such as budgetary, staffing and other readiness activities) that Health Homes and care management agencies will begin to make as well as the loss of a small amount of Health Home Development Funds (approximately $60,000 per designated Children´s Health Home)
      • Existing Health Homes designated to serve children will be directed to use part of HHDFs for expansion efforts

Updated Schedule for Enrolling Children In Health Homes

Updated Schedule of Activities for Expanding Health Homes to Better Serve Children Due Date
Draft Health Home Application to Serve Children Released June 30, 2014 ‐ Completed
Due Date to Submit Comments on Draft Health Home Application to Serve Children July 30, 2014 ‐ Completed
Due Date to Submit Letter of Interest July 30, 2014 ‐ Completed
Final Health Home Application to Serve Children Released November 3, 2014 ‐ Completed
Due Date to Submit Health Home Application to Serve Children March 2, 2015 – Completed
Review and Approval of Health Home Applications to Serve Children by the State March 2, 2015 to June 15, 2015 ‐ Completed
HH and Network Partner Readiness Activities June 15, 2015 to December 31, 2015
State Webinars, Training and Other Readiness Activities Through December 31, 2015
Begin Phasing in the Enrollment of Children in Health Homes January 1, 2016
Children´s Behavioral Health Services and other Children´s Populations Transition to Managed Care January 2017 (NYC/LI) July 2017 (ROS)

CANS-NY Testing and Health Home Per Member Per Month Rates

  • CANS-NY Testing Complete - data in process of being analyzed, assignments based on draft algorithms for High/Medium/Low being examined, comments and suggestions received from Medically Fragile Children and other agency testers
  • Assessment and/or Algorithms will be adjusted and retested

CANS-NY Training

Other Trainings

NYS Process for Conflict Free Health Home

All children who are Medicaid eligible will be offered choice of:

  • Plan Enrollment and Plan Selection
  • Health Home Enrollment

With respect to conflict-free care management requirements for Health Homes:

  • To promote and ensure integrated care for the best interest of the client, it is possible that an individual may receive care management and direct care services from the same entity, however, in these instances the care management and direct service components will be under different administrative/supervisory structures of the entity.
  • There will be utilization management and quality oversight by the Managed Care Plans for Medicaid services.
  • There are appeal, grievance, fair hearing, and beneficiary complaint processes in place for both Managed Care and Health Home services.

Clarification on Conflict of Interest Requirements for OMH SED Waiver, for October 2015 implementation

Next Steps - Health Homes Serving Children

  • Review of Contingency Response Letters submitted by Health Homes Designated to Serve Children
  • Approach to prioritize enrollment of Children (TCM, highest needs)
  • Additional Standards for children
  • Additional trainings to be scheduled
    • Webinar for Care at Home I/II Providers (TBD, Sometime in August)
    • Follow Up Session for OMH TCM Providers (August 24)
    • Systems training for Health Homes (Education, Juvenile Justice, Foster Care/Child Welfare)

State Plan Amendment (SPA) for Children´s Health Home

  • SPA to amend Health Home State Plan
    • Discussions with CMS ongoing - last discussion July 14
  • SPA to amend Early Intervention State Plan
    • Discussion with Early Intervention and Health Home CMS Teams being scheduled to discuss State approach (i.e., Health Home care manager assume the role of ongoing service coordinator for children eligible for Health Home and Early Intervention)
    • Not likely this SPA will be finalized by January 1, 2016

State Plan Amendment New Children´s Medicaid Behavioral Health Services - Update

State Plan Amendment (SPA) for New Children´s Medicaid Behavioral Health Services - Process Update

  • Calls with CMS on draft Amendment
    • June 17: overview and introduction
    • July 16: CMS provided technical assistance
    • Next Steps: revision of draft & CMS comment
    • Formal Submission planned for 9/30/15

SPA for New Children´s Medicaid Behavioral Health State Plan Services: Collaboration with Adult Team - Crisis Intervention

  • Adult: October 1 implementation through Managed Care Mainstream Plan
  • 2016 Children´s implementation through Medicaid State Plan amendment
  • 3-5 year vision on Statewide model for adults and children

SPA for New Children´s Medicaid Behavioral Health State Plan Services - Provider Manual Development

  • Will be shared by mid-August for feedback
  • Guidance for both Plans and Providers
  • Supports SPA negotiations with CMS this Fall

Provider Designation Processes

SPA for New Children´s Medicaid Behavioral Health State Plan Services: Discussion on Appendix D - Provider Competencies in Evidence Based Practice (EBP) Designation (sent prior to meeting)

  • Is the process clear as outlined?
  • What edits or revisions are suggested?
  • Questions?

Children´s HCBS Provider Designation

  • Grandfathering of current children´s 1915c HCBS providers
  • Expansion of designation for current children´s HCBS providers
  • Application for newly designated children´s HCBS providers

Children´s HCBS Designation Process - Existing HCBS Waiver Providers

  • Pre-populated application for existing children´s HCBS providers to
    1. confirm grandfathered service designation and/or
    2. request expanded designation for new services
  • Applications reviewed for completeness
  • 1915c State staff review application of existing children´s HCBS providers

Children´s HCBS Designation Process - New HCBS Providers

  • HCBS Designation application for new providers
  • Applications reviewed for completeness
  • State team divided across HCBS services by content expertise
  • Teams review applications of new providers

Upcoming Meetings

Monthly Children´s MRT Subcommittee Calls

  • August 24 - (tentative) review proposed network adequacy standards and provider mapping
  • September 29 - (tentative) HCBS Enrollment process
  • October 26 Quarterly In-Person Meeting (New York City) - Reviewing projections for LON/LOC populations
  • November 4 - (tentative) Review of 1115 Application
  • December 21 - (tentative) Expectations for Plans to manage children´s benefits

Questions?

Angela Keller, LMSW
Director, Bureau of Children´s Program Design, Policy & Planning
Division of Managed Care
NYS Office of Mental Health
Angela.Keller@omh.ny.gov