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Behavioral Health Transition to Managed Care

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Managed Care Technical Assistance Center

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) have partnered with the Managed Care Technical Assistance Center (MCTAC) to provide technical assistance and training to behavioral health care providers Statewide to prepare for the transition of behavioral health services into Medicaid Managed Care.

For more information or to view upcoming and past events, please visit the MCTAC website.

Behavioral Health Transition Timeline

Adult Behavioral Health Managed Care Timeline

NYC Implementation

July 2015 - First Phase of HARP Enrollment Letters Distributed (see below for an explanation of initial enrollment process)

  • NY Medicaid Choice enrollment letters will be distributed in three phases:
    • Approximately 20,000 July/August distribution for October enrollment
    • Approximately 20,000 August/September distribution for November enrollment
    • Approximately 20,000 September/October distribution for December enrollment

October 1, 2015 - Mainstream Plans and HARPs implement non-HCBS behavioral health services for enrolled members

October 2015-January 2016 - HARP enrollment phases in

January 1, 2016 - HCBS begin for HARP population

Rest of State Implementation

June 30, 2015 - RFQ distributed (with expedited application for NYC designated Plans)

October 2015 - Conditional designation of Plans

October 2015-March 2016 - Plan Readiness Review Process

April 1, 2016 - First Phase of HARP Enrollment Letters Distributed

July 1, 2016 - Mainstream Plan Behavioral Health Management and Phased HARP Enrollment Begins

Explanation of Initial Enrollment Process

  1. Individuals initially identified by NYS as HARP eligible, who are already enrolled in an MCO with a HARP, will be passively enrolled in that Plan's HARP.
  2. Individuals identified for passive enrollment will be contacted by the NYS Enrollment Broker.
  3. They will be given 30 days to opt out or choose to enroll in another HARP.
  4. Once enrolled in a HARP, members will be given 90 days to choose another HARP or return to Mainstream before they are locked into the HARP for 9 additional months (after which they are free to change Plans at any time).
  5. Individuals initially identified as HARP eligible who are already enrolled in an MCO without a HARP will not be passively enrolled. They will be notified of their HARP eligibility and referred to the NYS Enrollment Broker to help them decide which Plan is right for them.
  6. HARP eligible individuals in an HIV SNP will be able to receive HCBS services through the HIV SNP. They will also be given the opportunity to enroll in another HARP. They will be notified of their HARP eligibility and referred to the NYS Enrollment Broker to help them decide which Plan is right for them.

Children´s Behavioral Health Managed Care Timeline

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

MRT Behavioral Health Subcommittee

For a list of members of the MRT Behavioral Health Subcommittee and information about past and upcoming meetings, please visit the MRT Behavioral Health Subcommittee Page https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health_reform.htm

Children´s Quarterly MRT Behavioral Health Subcommittee Meetings

Monday, April 27, 2015, 12:00-3:00pm

  • New York City - OASAS Field Office
    501 7th Avenue, Conference Room 8A
  • We apologize but we experienced technical difficulties with recording the Children´s MRT Health and Behavioral Health Subcommittee Meeting and can only make the written PowerPoint slides available.

Tuesday, February 3, 2015, 11:00am-2:00pm

  • Albany - OMH Office
    44 Holland Avenue, 8th Floor Conference Room
  • 2.5.15 Children´s Behavioral Health Workgroup Webcast Link:
  • Meeting Materials:

Monday, October 27, 2014, 12:00pm-3:00pm

  • New York City - OASAS Field Office
    501 7th Avenue, 8th Floor Conference Room
  • 10.27.14 Children´s Behavioral Health Workgroup Webcast Link:
  • Meeting Materials:

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

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

The New York State Office of Mental Health (OMH), Office for Alcoholism and Substance Abuse Services (OASAS), and Department of Health (DOH) announced the release of the Home and Community Based Services (HCBS) provider application for NYC behavioral health providers. This application allowed behavioral health providers in NYC to attest to provide new behavioral health HCBS, which will be available for eligible individuals in Health and Recovery Plans (HARPs) in NYC beginning in July 2015. These HCBS are recovery oriented and designed to assist individuals with significant behavioral health needs living in the community. This application and subsequent designation does not mandate providers to offer these services. The deadline for submitting the application form to the State was December 5, 2014.

The list of New York City (NYC) Agencies designated to provide Home and Community Based Services (HCBS) is now available. The linked spreadsheet contains the names of NYC providers designated to provide HCBS, along with which service(s) they have been designated to provide. Each provider listed has gone through the HCBS designation process established by New York State.

The HCBS provider manual, application and designation list can be accessed through the following link: http://omh.ny.gov/omhweb/guidance/hcbs/html/services-application/index.htm.

Any questions can be directed 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.

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.

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:

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.

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.

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.