Children's Health & Behavioral Health MRT Subcommittee

Quarterly Meeting

August 11, 2016

  • Presentation also available in Portable Document Format (PDF, 758KB)

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

  • Timeline Update
  • Children´s Services Update
    • State Plan Amendment
    • Children´s Home and Community Based Services
  • Plan Qualifications Process
  • Children´s Home and Community Based Services
  • HCBS Eligibility Criteria
  • Health Home Update
  • Readiness Resources
  • Other Project Updates

Children´s Transition Timeline

  • Children enroll in Health Homes - December 2016
  • Statewide - January 2017 - Implement New State Plan Services in FFS system
    • State is looking into a phase in strategy for the 6 SPA services.
    • A lot of complexity, with transitioning services currently in HCBS to SPA
    • Details and technical issues need to be worked out
    • More details anticipated to be provided at September MRT webinar
  • NYC/LI/Westchester - July 2017
    • SPA services (existing and new) to MMC
    • Children´s Home and Community Based Services to MMC
    • Children in the care of Voluntary Foster Care Agencies (VFCA) to MMC
    • Existing Children´s 1915(c) Care Coordination to Health Home
  • ROS - January 2018
    • Same transitions as above

The net cost of the design and impact on the Global Spending Cap is being analyzed.

Managed Care Readiness Funds

  • Updated recommendations are under review and the State will present feedback next month
  • Federal match strategy - under discussion
  • Priority areas for funding include SPA and HCBS Designated Provider Start-up Grants and Health Information Technology

Children´s Medicaid State Plan Amendment Progress Update

Children´s Medicaid State Plan Amendment

  • Revised DRAFT SPA Provider Manual will be released with Designation Application
  • Six New Services (require CMS approval):
    • Crisis Intervention
    • Other Licensed Practitioner
    • Community Psychiatric Supports and Treatment (CPST)
    • Psychosocial Rehabilitation (PSR)
    • Family Peer Support Services
    • Youth Peer Support and Training Services

Children´s Medicaid State Plan Amendment Key Concepts of SPA Services:

  • SPA services are available to children/youth under the age of 21 who are Medicaid eligible, that meet medical necessity
  • All SPA services can be delivered in the community where the child/youth lives, attends school, and/or engages in services.
  • SPA Designation/Application - in final review stage, stay tuned
  • Draft SPA rates and methodology will be made public via webinar

State Plan Amendment Services: Proposed New Services

Other Licensed Practitioner OLP

  • Reimbursement Authority
  • Delivery of services in the community
  • Services provided outside of the four walls of the agency

Psychosocial Rehabilitation Services PSR

  • Task-oriented services
  • Implementation of Treatment Plan
  • Restore the child´s role in the community

State Plan Amendment: Existing services moving into SPA

Existing OMH Serious Emotional Disturbance (SED) Waiver Services Existing OCFS Bridges to Health (B2H) Waiver Services New SPA Service
Crisis Response Services Immediate Crisis Response Services Crisis Intervention
Intensive In-Home Services Crisis Avoidance, Management & Training Intensive In-Home Services Community Psychiatric Supports & Treatment
Family Support Services   Family Peer Support Services
Youth Peer Advocate Services   Youth Peer Support and Training

SPA Provider Authority

  • Title 18 (Social Services Law) Authority to designate SPA providers
  • Joint Development of Children´s SPA regulations
  • Joint Standards of Care & Monitoring Tool (incorporated into SPA Provider Manual)
  • OMH will create new process for outpatient SPA services to authorize qualified providers and those currently without licensing categories (e.g. peer programs)
  • OASAS will make revisions to existing licensing categories for providers
  • OCFS and DOH are evaluating options that would enable VCFAs to meet the requirements for providing licensed medical services

Children´s Home and Community Based Services

Children´s Home and Community Based Services: Existing Services Moving into HCBS

Existing Services Care Coordination (for those ineligible for Health Home or opt out) Respite (Planned and Crisis) Habilitative Skill Building Prevocational Services Supported Employment Family and Caregiver Support Services Community Self-Advocacy Training and Support Habilitation Adaptive and Assistive Equipment Accessibility Modifications Palliative Care Customized Goods and Services
OMH SED Waiver Individualized Care Coordination Respite Skill Building Prevocational Services Supported Employment            
OCFS B2H Waiver Health Care Integration Crisis and Planned Respite Skill Building Prevocational Services Supported Employment Family and Caregiver Support Services Community Advocacy and Support Day Habilitation Adaptive and Assistive Equipment Accessibility Modifications    
CAH I/II Waiver Care Coordination Respite Care               Home and Vehicle Modifications Palliative Care  

HCBS Target Populations

  • Target populations and list potential populations under consideration

Level of Care

  • Serious Emotional Disturbance (SED)
  • Medical Fragility
  • Foster Care Developmental Disability

Level of Need

  • Serious Emotional Disturbance (SED) with or without co-occurring Substance-Related and Addictive Disorders
  • Children who Have Experienced Physical, Emotional, or Sexual Abuse, Neglect, or Maltreatment

Designation of SPA and HCBS Providers

  • Electronic Application
  • Must meet specific provider agency qualifications
  • Designation by joint State agency team
  • Assistance with provider Medicaid enrollment
  • Additional training specific to service delivery, billing and other implementation details to come

Transition of Children´s Benefits and Plan Qualification Process

Plan Qualification Expected Timeline

  • Release of Draft - 9/16/16
  • Release of Final Document - 10/14/16
  • Submissions by Plans - 12/14/16
  • State Review of Qualifications - 1/20/17

Plan Qualification Process

  • State will NOT issue a Request for Qualification (RFQ)
  • State WILL issue Plan Qualification Standards
  • Adult BH transition laid foundation for qualification
  • Highlight only areas that are unique to children´s transition
  • Stakeholder feedback, Desk Review and Readiness Review

Standards/Requirements: Areas in Progress

  • Provider Protections continue
  • Staffing & Additional Children´s Expertise
    • Demonstrated ability to work across child serving systems
  • Quality Strategy
  • Network Adequacy
    • Ensure robust OMH, OASAS, OCFS, DOH contracting
  • Clinical Expertise & UR
  • Staff Development
    • Child specific training for staff
  • Enhanced Stakeholder Engagement specifically NYS Education System
  • Health Home Interface
  • Claims Administration & Readiness
  • IT Infrastructure
    • Interface to OCFS Connections System

Health Home Serving Children (HHSC)

Health Home Serving Update Timeline

  • Health Homes Designated to Serve Children will begin to enroll children on December 2016
  • October 2016 enrollment date was recently changed to December 1, 2016 to align the effective date of changes in Health Home payment methodology that will address significant delays in the time it takes payments to flow from Plans, to Health Homes to care management agencies and to provide more time to complete readiness activities
  • The enrollment of Children in Early Intervention that may also be eligible for Health Home is scheduled to begin March 2017

Health Home Serving Children (HHSC) Update Timeline

  • On December 1, 2016 there will be access to MAPP HHTS Referral Portal to refer and enroll children
  • Health Home payments will begin for dates of service on and after December 1, 2016
  • To facilitate transition for OMH TCM Providers and providers that may be using a CANS tool that is IDENTICAL to the CANS-NY Health Home, beginning October 1, 2016:
    • OMH TCM providers will have access to UAS to begin pre-populating CANS-NY for their members
    • Certain VFCA in New York City that are required to have CANS that is identical to the CANS-NY for HH may begin to pre-populate CANS-NY for children that are eligible for Health Home
  • All other providers will have access to UAS on December 1, 2016
  • Key Readiness Activities that Remain Outstanding:
  • ASAs with HHSC and Managed Care Plans - January 2016 ASA or Customized
  • Access to HCS and UAS for Care Managers (HCS needed for UAS access for the CANS-NY)
  • Establishing/Documenting Network Provider Relationships - Department will release additional guidance this week
  • 100% Alignment with OMH TCM Providers, VFCA providers
  • 100% Alignment with Waiver Providers Identified in Contingency Letters
  • Health Home Start Up Funds for Health Homes Serving Children - those that have not received Health Home Development Funds and that have significantly expanded service area $7.2 million will be released soon
  • Information on MAPP Training and UAS released shortly

Other Project Updates

SPA Medical Necessity Criteria

  • Draft Medical Necessity Criteria was presented at the last MRT Subcommittee Quarterly In-Person meeting on June 2, 2016
  • Identical criteria was shared with the Managed Care Behavioral Health Medical Directors group
  • Both groups provided feedback which was considered by Interagency State Partners
  • This Draft is currently being considered by Interagency NYS Medical Directors for feedback before final revisions.

MCTAC SPA Webinar Series

  • Recently completed a 5 Part series on the upcoming SPA services.
  • 1,201 total attendees, representing 626 unique individuals, participated in the SPA service webinar series
  • FAQ document and other feedback is being collected and will be released soon
  • More information and access to recordings and powerpoints can be found at www.ctacny.org

MCTAC SPA Training Plan

  • June/July - High-level service-by-service walkthrough, designation process & billing rules overviews when available
  • September - Rates/billing codes, staffing requirements, caseloads, eligibility/medical necessity, deficit funding, EHR help (in-person)
  • October - Referral process, documentation, continuing education, co-enrollment rules, exclusions, health home interaction, reporting requirements (web-based)
  • November/December - Detailed training for each service (full-day statewide in-person and web-based supplements)
  • January 1, 2017 - SPA goes live! Ongoing support and training responsive to areas of provider need supporting implementation

Evidence Based Practice Survey

  • Projected Release end of August
  • To gather information from the provider community about current use of Evidence Based Practice (EBP) models, costs related to EBPs, and aspiration for future use of EBP models.
  • Survey Results will be sent to providers and stakeholders of all four State Agencies and MRT members
  • Survey will inform the prospective EBP addition to the SPA service CPST

CANS-NY Updates

  • CANS-NY Technical Assistance Institute RFP
    • Deadlines for the submission of proposals was June 17th, 2016
    • State hopes to announce a winning bid soon
    • More information on the CANS-NY Institute can be found here
  • CANS In-person Trainings
    • State-led training on the Child and Adolescent Needs and Strengths (CANS-NY):
    • Albany on June 22nd and 23rd
    • NYC on July 12th and 13th and again on August 29th and 30th
    • Rochester on August 18th and 19th

Children´s Transformation Website

  • A website has been created for New York State´s Children´s System Transformation. New information will be uploaded to this site as it becomes available.
  • Visit the Children´s Managed Care Website

RESOURCES TO STAY INFORMED:

OMH Managed Care Mail Log
OMH-Managed-Care@omh.ny.gov

Subscribe to children´s managed care listserv

Subscribe to DOH Health Home listserv

Health Home Bureau Mail Log (BML)

Children´s Managed Care Website