NYS Children's Standards Cover Letter
July 31, 2017
- Letter is also available in Portable Document Format (PDF)
Dear Managed Care Organization,
New York State´s vision for transitioning the Children´s Medicaid health and behavioral health services from a Fee-for-Service model to a managed care model is to improve clinical and recovery outcomes for children and youth with Behavioral Health and Home and Community Based Services (HCBS) needs (e.g., medically fragile children, those having BH needs, and children with developmental disabilities in Foster Care); reduce the growth in Medicaid costs through a reduction in unnecessary emergency and inpatient care; address needs early in childhood before they escalate and become more complex and costly in adulthood; integrate the delivery and care planning of behavioral health, health services, and community supports; and increase network capacity to deliver community-based recovery-oriented services and supports.
With these goals in mind, New York State is pleased to release the attached New York State Children´s Health and Behavioral Health Benefit Administration: Medicaid Managed Care Organization Children´s System Transformation Requirements and Standards. To ensure MCOs are equipped to meet the needs of the HCBS and BH population, MCOs will be reviewed and qualified against new health and BH specific administrative, performance and fiscal standards.
This is a statewide implementation for which MCOs will need to demonstrate that they have the experience, organizational capacity, and expertise to ensure the effective delivery of the expanded array of children´s health and behavioral health services.
MCOs are to complete Section 4 of this document and submit to Mercer Connect by 5:00 p.m. on October 31, 2017. NYS will offer a webinar on a date to be determined to discuss the qualification process and the Offsite Review Tool in greater detail.
This Children´s Standards package includes the following items:
- New York State Children´s Health and Behavioral Health Benefit Administration: Medicaid Managed Care Organization Children´s System Transformation Requirements and Standards.
- Section 4.0 Offsite Readiness Review Tool
Please be advised that some criteria described in this document are subject to change based on negotiations with the federal government. These items and notification of changes will be available on agency websites.
All questions must be submitted electronically to bho@omh.ny.gov by 5:00 p.m. September 1, 2017. Inquiries will not be answered on an individual basis. Responses will be posted in the form of FAQs on the Department of Health´s MRT Behavioral Health transition website, as well as the state agency websites.
Thank you for your efforts to assist NYS in transforming the Children´s Medicaid health and behavioral health services to a more effective managed care system.
Lana I. Earle, Deputy Director
Division of Program Development and Management
New York State Department of Health, Office of Health Insurance Programs
Jonathan Bick, Director
Division of Health Plan Contracting and Oversight
New York State Department of Health, Office of Health Insurance Programs
Donna M. Bradbury Associate Commissioner
New York State Office of Mental Health
Laura M. Velez Deputy Commissioner
Child Welfare & Community Services
New York State Office of Children & Family Services
Steve Hanson
Associate Commissioner
New York State Office of Alcoholism and Substance Abuse Services
JoAnn Lamphere Deputy Commissioner
New York State Office for People With Developmental Disabilities
Empire State Plaza, Corning Tower, Albany, NY 12237 health.ny.gov
