NEW MEXICO’S INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE: TRANSFORMING THE SYSTEM

1. NEW MEXICO’S INTERAGENCY BEHAVIORAL HEALTH PURCHASING COLLABORATIVE: TRANSFORMING THE SYSTEM “Transforming Children’s Mental Health: States on the Cutting Edge” National Alliance for the Mentally Ill Austin, Texas June 20, 2005

2. BACKGROUND • September 2003-Governor Richardson announced the Behavioral Health Purchasing Collaborative • Better services • Better access • Better use of taxpayer dollars • HB 271–A bipartisan effort, effective May 19, 2004 • Goal is single behavioral health delivery system across multiple state agencies and multiple funding sources for all publicly funded populations

3. PROBLEMS TO BE SOLVED • Lack of common agreement about goals and outcomes • “Fragmentation” (per President’s New Freedom Commission Report), i.e., multiple approaches, plans, service definitions, billing processes, reporting requirements for similar or related services • Duplication of effort and infrastructures at state and local levels • Higher administrative costs for providers due to multiple state approaches and multiple contracting entities • Insufficient oversight of providers and services • Confusion for families and consumers • Insufficient services; inappropriate services • Not always maximizing resources across funding streams • Multiple disconnected advisory groups and processes working toward a different, sometimes disconnected goals

4. Children, Youth and Families Department Department of Health Human Services Department (Medicaid State Agency) Department of Corrections Aging and Long Term Services Department Public Education Department Department of Finance and Administration Department of Transportation Department of Labor Division of Vocational Rehabilitation Administrative Office of the Courts Mortgage Finance Authority Indian Affairs Department Health Policy Commission Developmental Disabilities Planning Council Governor’s Commission on Disability Governor’s Health Policy Coordinator Interagency Behavioral Health Purchasing Collaborative

5. STATUTORY PURPOSE • “To develop a statewide system of behavioral health care that promotes behavioral health and well-being of children, individuals and families; encourages a seamless system of care that is accessible and continuously available; and emphasizes prevention and early intervention, resiliency, recovery and rehabilitation”

6. STATUTORY DUTIES • Identify behavioral health needs statewide • Give special attention to regional differences, including cultural, rural, frontier, urban and border issues • Inventory all expenditures for mental health and substance abuse services • Plan, design and direct a statewide behavioral health system • Contract for operation of one or more behavioral health entities to ensure availability of services throughout the state • Develop a comprehensive statewide behavioral health plan • Seek and consider suggestions of Native Americans

7. VISION • A single behavioral health delivery system in New Mexico in which available funds are managed effectively and efficiently; the support of recovery and development of resiliency are expected; mental health is promoted; the adverse effects of substance abuse and mental illness are prevented or reduced; and behavioral health customers are assisted in participating fully in the life of their communities

8. PRINCIPLES AND VALUES • Commitment to recovery and resilience • Consumer/family directed • Result is quality of life • Commitment to high quality services with system performance and consumer/family outcomes • Commitment to diversity and cultural responsiveness • Commitment to integrated, community-based services, respecting community differences

9. DESIRED RESULTS • “Braided” flexible funding • Single billing process and consistent data collection and management • Common age-appropriate assessment process used in all service settings • Smooth transition from current systems to single system • Local Collaboratives are active participatory local voice; attention to rural and frontier areas • Attention to persons with unique service or access needs

10. DESIRED RESULTS • Uniform program standards, including common: • service definitions and requirements • utilization management requirements/criteria • system performance measures • consumer/family outcomes expectations • credentialing of providers • Sufficient number and distribution of providers • A comprehensive and coordinated benefit package, within available funding • Emphasis on evidence-based, best practices and practice based evidence

11. Players • Interagency Behavioral Health Purchasing Collaborative (Purchasing Collaborative) • Statewide Entity-ValueOptions • Local Collaboratives • Behavioral Health Planning Council (BHPC)

12. Interagency Behavioral Health Purchasing Collaborative • All involved state agencies operating as one, and retaining responsibility for agency specific funds, reporting, planning, etc. • Memorandum of Understanding signed by all state agencies to establish process for decision-making • First formal meeting held June 11, 2004 • BH Design Work Group (BHDWG) for day-to-day staff work • Cross Agency Coordinating Teams with specific tasks/responsibilities (e.g., Oversight Team, Local Collaboratives Team, Administrative Support Services Team, Policy and Planning Team and Workforce, Program Development and Research Team)

14. FUNCTIONS IN ADDITION TO STATUTORY DUTIES • “Keeper of the values and philosophy” • Collective oversight of statewide entity • Address system and individual problems that cannot be resolved at the local level • Assure consumer and family voice in governance, planning, implementation and evaluation

15. Statewide Entity Not just a vendor – a partner – to help the Purchasing Collaborative implement the law and achieve its purpose and vision

16. RESPONSIBILITIES • Contracting with and paying providers or provider groups • Helping to “braid” “blend” or “coordinate” multiple funding streams – increasing flexibility and maximizing resources • Credentialing and quality oversight of providers • Utilization review (UR) and management (UM) • Assuring care coordination • Assisting with development and nurturing of Local Collaboratives • Consumer/family/youth relations • Collecting, managing and reporting data

17. PROCUREMENT PROCESS • Single RFP to select the statewide entity • Open competitive procurement process pursuant to state procurement law • Draft RFP (Concept Paper) for stakeholder input • Consumer/family involvement in drafting of RFP and review of proposals • Joint selection and negotiation by Purchasing Collaborative agencies • Single contract with multiple agencies

18. LOCAL COLLABORATIVES • Local community groups developed in areas consistent with each of the State’s 13 judicial districts and grouped into 5 geographic regions and 1 non-geographic Native American Region for the 22 Tribes and Urban Indian populations • Based on Children’s Systems of Care Model and Principles, they consist of consumers, families, youth, providers, advocates, and other system representatives, such as courts, schools, churches, child welfare, juvenile/criminal justice, health improvement councils, tribes, vocational/ employment providers, housing authorities, area agencies on aging, local DWI councils, civic organizations, primary care providers, local government officials, and other interested individuals or groups

19. RESPONSIBILITIES • Identifying gaps and needs • Recommending service array • Capacity building and program development • Proposals to funding bodies • Evaluation of local providers and services • Agreeing on common protocols for referrals and follow-up of persons in need of multiple services

20. BEHAVIORAL HEALTH PLANNING COUNCIL • Single statewide behavioral health advisory group appointed by the Governor with 51% or more consumer/family/youth membership and having the following standing subcommittees: • Adults, Children/Adolescents, Substance Abuse (including DWI), Medicaid, Native Americans, Criminal/Juvenile Justice, Employment, Housing, Neurobehavioral issues • Replaced all previously existing behavioral health advisory councils and structures that were set up by statute or as part of grant requirements

21. STATUTORY DUTIES • Advocate for children, adolescents and adults with behavioral health needs • Report annually to the Governor and Legislature • Encourage development of a comprehensive, integrated, community-based behavioral health system • Advise the Collaborative agencies & statewide entity • Review and make recommendations for the comprehensive mental health plan, mental health and substance abuse block grant applications, Medicaid state plan, and all other by plans and applications

22. PROCESS • The Behavioral Health Planning Council and Local Collaboratives will be active partners with the Purchasing Collaborative and the statewide entity in evaluating services, monitoring trends and making recommendations for improvement • Contracts with the statewide entity and with providers will include performance and outcome requirements, with enforceable consequences for not meeting requirements and/or incentives for exceeding requirements

23. ROLES OF CONSUMERS, FAMILIES AND ADVOCATES • The Behavioral Health Planning Council which reports to the Collaborative and the Governor is the formal voice of consumers, families and advocates who make up a majority of the Council membership • Members in turn represent constituencies in their local communities • Consumers and families have had and will continue to have meaningful roles that will make a difference in governance, design, implementation and evaluation of services

24. TRIBAL ISSUES • Service dollars currently dedicated to tribal populations and communities will continue to be so dedicated • IHS and tribal providers will be considered essential providers with whom the statewide entity has to contract, if they meet criteria • Use of culturally appropriate and traditional healing services will be encouraged • On-going tribal input – as Advisors, on BH Planning Council, in tribal input meetings, during statewide planning process

25. CHILD SERVING SYSTEMS • Eight months prior to the formation of the Collaborative, the child serving systems were involved in planning a re-design of the children’s behavioral health system which transitioned into the Collaborative process • Children’s behavioral health, child welfare, juvenile justice (all within the Children, Youth and Families Department) and education have all been active contributors to the design and implementation of the new system through the Collaborative • Providers/advocates of children’s services have been actively involved in Local Collaborative development, work groups and public meetings

26. TRANSFORMATION PROCESS • Extremely inclusive process from the beginning through public involvement in work groups, local and regional stakeholder meetings and BHP Council meetings, that included consumers/ families/youth, advocates, providers, state agency staff, legislators and others • Double duty of State agency staff during past year • No new money or resources • Re-training/re-tooling of existing State agency staff to assume new roles and job duties

27. KEYS TO A CULTURAL TRANSFORMATION • Leadership • Political will • Inclusiveness • Stakeholder buy-in • A strong values base • Dedicated resources • Timing

28. CHALLENGES • Time • Anxiety/fear about change • Culture shift - letting go of turf, fear of: losing control over services/money/methods of accessing services or funds/livelihoods • Managing expectations-satisfying everyone all the time

29. ADDITIONAL INFORMATION

30. SERVICE DEFINITIONS • Exhaustive process of collapsing all pre-existing service definitions and codes from all State agencies into one definition and code for each service • Common HIPAA compliant definitions and service requirements for all services funded through or coordinated with the statewide entity using CPT and HCPCS Codes was a 3 year process that preceded the Collaborative but is ready for implementation July 1, 2005 • Will relieve significant burden from providers who have had to deal with multiple funding streams, management information systems and billing mechanisms in the past

31. Definition Billing code Target population Service exclusions Program requirements Staffing requirements Documentation requirements Admission requirements Continuing service criteria Discharge criteria Service authorization periods Service authorization units Benefit limits SERVICE REQUIREMENTS – for each covered service

32. TARGET DATES • September 2003 – March 2004 – Organizing, Planning and Concept Paper Development • Spring/Summer 2004 – Public Stakeholder Meetings (including tribal meetings) • July, 2004 – Draft Request for Proposals out for review and comment • November, 2004 – Request for Proposals Released • Spring 2005 – Vendor Selection • Spring 2005 – Transition and Contracting • July 1, 2005 – New System Begins Operating

33. PHASES • Pre-planning and transition: September 2003 – July 1, 2005 • Designing • Planning • Massive Public input • Federal approvals sought • Local Collaboratives criteria determined and development begun • Releasing RFP and selecting partner • Transition

34. PHASES • July 1, 2005 to June 30, 2006 • Services provided; providers paid • Transition continued • Expectations refined • Data systems refined • Identification of ways to maximize funding • Local Collaboratives developed further • Implement statewide behavioral health plan • Goals for Phase Two set

35. PHASES • July 1, 2006 to June 30, 2008 • more blending and flexibility of funding • additional funding streams added • Local Collaboratives refined • development of additional evidence-based, best and promising practices, practice based evidence • additional consumer/family operated services • performance expectations and consumer/family outcomes refined, measured and reported • additional resources sought (e.g., grants)