Behavioral Health Transition to Managed Care
Upcoming Behavioral Health Medicaid Managed Care Kick-Off Forums
The New York State Office of Mental Health (OMH), Office of and Alcoholism and Substance Abuse Services (OASAS), Department of Health (DOH), and the New York City Department of Health and Mental Hygiene (NYC DOHMH) are pleased to announce a series of Behavioral Health Medicaid Managed Care Kick-Off Forums.
The behavioral health Medicaid managed care transition will facilitate a fully integrated behavioral health and physical health service system. This will include the development of specialized Health and Recovery Plans (HARPs) for individuals with significant behavioral health needs. For adults 21 and older, this change will go into effect April 2015 in New York City (NYC) and October 2015 in the rest of New York State (NYS). The transformation for children’s services will begin January 2016.
To assist behavioral health providers, New York State has contracted for a Managed Care Technical Assistance Center (MCTAC). MCTAC will be led by NYU’s McSilver Institute in partnership with the National Center on Addiction and Substance Abuse (CASA) at Columbia University. MCTAC will provide tools and trainings that will assist providers in improving business and clinical practices, as they transition to Medicaid managed care.
Behavioral health providers are invited to send administrative, fiscal, and clinical senior executive leadership representatives to attend one of the Kick-Off Forums to learn more about the upcoming changes in Medicaid managed care. Specifically, these forums will provide:
- An overview of behavioral health Medicaid managed care changes in NYS;
- An introduction to the Medicaid Managed Care Technical Assistance Center;
- A discussion of critical factors for managed care readiness; and
- Information on available resources and upcoming trainings.
Additionally, the forums will provide time for networking with managed care plans (as plan availability permits).
Behavioral Health Transition Timeline
Jason Helgerson, NYS Medicaid Director, has announced a change in the implementation date for the transition of behavioral health services into Medicaid Managed Care to April 1, 2015 for adults in NYC, and October 1, 2015 for adults in the rest of NYS. The Department of Health, OMH, and OASAS have revised the timeline to reflect this change and will be posting an updated timeline shortly. Please visit the link below to view the letter from Jason Helgerson to the MRT Behavioral Health Work Group announcing the implementation date change.
- Implementation Date Change (PDF, 163KB)
Children's Quarterly MRT Behavioral Health Subcommittee Meeting
Monday, April 28, 2014, 12:00pm-3:00pm
- New York City-OMH Field Office
330 Fifth Avenue, Conference Room A
- 4.28.14 Children's Behavioral health Workgroup Webcast Link:
Monday, July 28, 2014, 12:00pm-3:00pm
- New York City-OMH Field Office
330 Fifth Avenue, Conference Room A
- 7.28.14 Children's Behavioral Health Workgroup Webcast Link:
- Meeting Materials:
Behavioral Health Draft Rate Ranges for the Rest of State (ROS) HARP Population
On May 23, 2014 NYS released draft rate ranges for the Rest of State HARP population. These ranges were developed for a full year contract period (7/1/2015 – 6/30/2016), though the contract period would likely only be from 7/1/2015 – 3/31/2016.
Home and Community Based Services (HCBS) Provider Manual
New York State is pleased to release the initial version of the Home and Community Based Services (HCBS) Manual that will be used as a basis to begin the HCBS designation process for HCBS providers in NYC as part of the transition of behavioral health services into Medicaid Managed Care. The Office of Mental Health (OMH), Office of Alcoholism and Substance Abuse (OASAS) and the Department of Health (DOH) are open to stakeholder input on the established service standards as the 1115 waiver amendment is being negotiated with the Centers for Medicaid and Medicare Services (CMS). This manual is subject to change based upon the final terms and conditions approved by CMS. All comments should be submitted electronically by December 5, 2014 to BHO@omh.ny.gov.
Behavioral Health RFQ Applicant's Conference for New York City Applicants
On May 2, 2014 Managed Care applicants and other interested parties participated in a Applicant's Conference where the State responded to questions on the RFQ "for Behavioral Health Benefit Administration: Managed Care Organizations and Health and Recovery Plans." The following materials were presented to attendees.
- Behavioral Health Managed Care Applicant's Conference Power Point (PDF, 741KB)
- Behavioral Health RFQ Questions (PDF, 391KB)
Written responses to inquiries not addressed at the RFQ Applicant's Conference are posted below. New York State is formulating responses to additional questions and will post the answers as soon as possible.
- Behavioral Health Frequently Asked Questions (PDF, 501KB)
NYS Request for Qualification Package
NYS released the Request for Qualification regarding "Behavioral Health Administration: Managed Care Organizations and Health and Recovery Plans". Applications for Managed Care Organizations serving New York City are due by June 6, 2014. RFQ applications for Managed Care Organizations serving the rest of the state will be due approximately six months later.
This RFQ package includes the following four items that accompany the RFQ cover letter:
- New York State Behavioral Health Managed Care RFQ Cover Letter (PDF, 159KB)
- Behavioral Health Managed Care Request for Qualification Application (PDF, 783KB)
- Data Book for Mainstream Managed Care Organizations and Health and Recovery Plans (HARPs) (updated from December 2013 distribution)(PDF, 573KB)
- Preliminary premium for the NYC Health and Recovery Plan (HARP) benefit (PDF, 10KB)
- 2015 HARP NYC Capitation Rate Development (PDF)
- Chart showing the number of NYC and NYS potential HARP enrollees by Plan (PDF)
NYS has modified templates for Medicaid Managed Care Plan financial and enrollment projections. Instructions and templates can be found below. These documents were amended on 5/22/14.
- Instructions for financial projections (PDF, 23KB)
- Financial projections template (Schedules B & H are HARP only) (XLS, 284KB)
Behavioral Health Transition RFI/RFQ Webinar
A webinar was held by the NYS Department of Health (DOH), Office of Mental Health (OMH), and Office of Alcoholism and Substance Abuse Services (OASAS): "RFI/RFQ for Managed Care Behavioral Health Services and HARP".
This presentation focused on the newly released Request for Information/ DRAFT Request for Qualification (RFI/RFQ) to NYS Medicaid Managed Care Plans. Plans will be submitting applications to New York State demonstrating that they have the organizational capacity to ensure the delivery of quality behavioral health care, managed by Health Plans, Health Plans in partnership with Behavioral Health Organizations, and/or Health and Recovery Plans (HARPs) These applications will be reviewed against new behavioral health specific administrative, clinical, program, and fiscal standards. The RFI is designed to solicit input concerning New York's draft proposal to manage behavioral health services.
The webinar took place on Tuesday, December 17, 2013 at 1:00 PM. Below you will find the slides presented in the webinar.
- MRT Webinar on Behavioral Health Managed Care (PDF, 334KB)
Behavioral Health 1115 Waiver Amendment
The three documents below were sent to the federal Centers for Medicare and Medicaid Services (CMS) on December 30, 2013. The cover letter to CMS describes how the Behavioral Health 1115 Waiver Amendment allows NYS to provide behavioral health services to individuals with significant mental health and substance use disorder treatment needs under our Partnership Plan.
The 34 page BH waiver amendment describes how NYS will manage the formerly carved out State Plan BH services under Medicaid Mainstream Managed Care Plans and Behavioral Health Organizations and/or through new managed care lines of business called Health And Recovery Plans (HARPs). Attachment C in the waiver amendment describes new 1915i home and community based services that will be managed by the HARPs. The third document is in question and answer format, and is in response to preliminary questions from CMS.
- Cover letter to CMS (PDF, 76KB)
- NYS Partnership Plan Behavioral Health Amendment (PDF, 449KB)
- Response to CMS Preliminary Questions on Behavioral Health 1115 Amendment (PDF, 803KB)