CC2.0 Behavioral Health 1115 Waiver Proposals August 6, 2018

1. CC2.0 Behavioral Health 1115 Waiver Proposals August 6, 2018

2. Centennial Care 2.0 WaiverBehavioral Health Component Focus on substance use disorders – the continuum of care CMS Milestones • Access to critical levels of care for OUD and SUD • Use of Evidence-based, SUD patient placement criteria • Use of nationally recognized SUD specific program standards to set provider qualifications for residential treatment facilities • Implementation of comprehensive treatment and prevention strategies to address OUD • Improved care coordination & transitions between levels of care

3. Addressed in an Implementation Plan Showing existing services and Gaps in Service Offerings • Use of Evidence Based SUD Patient Placement Criteriaand Access to critical levels of care for OUD and SUD American Society of Addiction Medicine (ASAM) 0.5 – Early intervention - Screening & Prevention 1.0 - Outpatient – Less than 9 hours services/week 2.1 – Intensive Outpatient – More than 9 hours/week 2.5 – Partial Hospitalization; Day Treatment 3.1 Clinically Managed Low-Intensity Residential 3.3 Clinically Managed Population Specific High Intensity Residential 3.5 Clinically Managed High Intensity Residential 3.7 Medically Monitored Intensive Residential 4.0 Medically Managed Intensive Inpatient

4. 0.5 – Early intervention Screening & Prevention • Screening, brief intervention & referral to treatment (SBIRT) • Pre and post tenancy support for housing 2 gaps addressed

5. SBIRT • Screening, Brief Intervention, Referral to Treatment (SBIRT) • This initiative is a public health approach that serves individuals who are at risk of having or have a substance use disorder. New Mexico’s SBIRT serves individuals 18 years or older who are at risk for having or have a substance use disorder, as well as individuals who suffer from anxiety, depression, and trauma. • The current operational sites include: • First Nations Community Health Source (Zuni), Albuquerque • UNM Hospital/ Trauma Unit, Albuquerque • Santa Fe Indian Hospital that includes satellite site of Santa Clara Health Center, Santa Clara • White Sands Family Practice, Alamogordo • Sage Neuroscience, Albuquerque • Quick Care, Clovis

6. Why are we asking for SBIRTif we already have it? Current program funded through a grant which ends in October

7. Housing for Individuals with Severe BH Conditions The 2nd preventive measure It’s the service to find it, and sustain it…. • Pre-Tenancy support • Outreach • Housing search • Application assistance • Obtaining furnishings/household supplies • Move in assistance • Tenancy Sustaining Support • Property owner relationship management • Tenancy rights and responsibilities education • Eviction prevention • Subsidy program adherences

8. Use of nationally recognized SUD specific program standards to set provider qualifications for residential treatment facilities Another Gap Addressed • 3.1 Clinically Managed Low-Intensity Residential • 3.3 Clinically Managed Population Specific High Intensity Residential • 3.5 Clinically Managed High Intensity Residential • 3.7 Medically Monitored Intensive Residential

9. AccreditedResidential Treatment Centers 3.1 Clinically Managed Low-Intensity Residential • Step down longer term ARTC for adults recovery before transitioning to community – One reimbursement level 3.3 Clinically Managed Population Specific High Intensity Residential • Mid level ARTC stay with slower pace for cognitive difficulties or other impairments 3.5 Clinically Managed High Intensity Residential • Mid level ARTC with withdrawal management (3.2 WM) 3.7 Medically Monitored Intensive Residential • Short term M.D. & nursing care for withdrawal management Third reimbursement level • 3.3 Clinically Managed Population Specific High Intensity Residential • Mid level ARTC stay with slower pace for cognitive difficulties or other impairments • 3.5 Clinically Managed High Intensity Residential • Mid level ARTC with withdrawal management • Second reimbursement level

10. Institute for Mental Illness - IMD Institute for Mental Disease – IMD ( effective 1965) What is in the law? The IMD exclusion is found in section 1905(a)(B) of the Social Security Act, which prohibits “payments with respect to care or services for any individual who has not attained 65 years of age and who is a patient in an institution for mental diseases” except for “inpatient psychiatric hospital services for individuals under age 21.” The law goes on to define “institutions for mental diseases” as any “hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.” The IMD exclusion was intended to ensure that states, rather than the federal government, would have principal responsibility for funding inpatient psychiatric services.

11. Another Gap AddressedASAM 4.0 WM- Medically Managed Intensive Inpatient • Requested 30 days in an IMD, when there is a SUD diagnosis, from the federally-allowed “in lieu of service” of 15 days/month that MCOs are able to provide for adults 21 – 64 • CMS: “States cannot allow for mental illness; only for SUD” • Wrote State Plan Amendment to allow for FFS as well as MCO

12. CMS’ 5th Milestone:Improved Care Coordination and Transitions Between Levels of Care New Mexico’s Health Homes What is a Health Home?

13. Opportunity # FiveExpand CLNM HHs & Add SUD CareLink NM Health Homes Opportunity # FiveExpand CLNM HHs & Add SUD • Enhanced care coordination by BH agencies in the community • Current requirements: Chronic conditions only • Serious mental illness for adults • Severe emotional disturbance for children • All comorbidities are part of care • One of six activities: comprehensive transitional care • CC 2.0 Waiver: • Add substance use disorder to chronic conditions • Add children only and adult only as long as both in same county • Finish expansion throughout State in 2 more phases

14. CLNM Health Home ExpansionCurrent Expansion (April – July 2018)

15. Five CC2.0 BH Waiver Requestsand State Plan Amendment to add FFS • Screening, Brief Intervention, & referral to treatment • Supportive Housing: pre and post tenancy • Accredited Residential Treatment Centers • Waive IMD Exclusion for 15 day stay • Expand CLNM health homes & add SUD Questions?