ARMHS Restructuring

1. ARMHS Restructuring ARMHS Advisory Workgroup December 6, 2013 Julie Pearson / Melinda Shamp DHS Adult Mental Health Division

2. Agenda • Introductions • Recap November 1st meeting • Drafting State Plan Amendment (SPA) • Service Definition Development • Rate Methodology • Time Study • AMHD Webpage • Next steps

3. Recap of November Meeting 2013 Legislation “In addition to rate increases otherwise provided, the commissioner may restructure coverage policy and rates to improve access to adult rehabilitative mental health services and related mental health support services …” Laws of 2013, Chapter 108, Article 4, Sec. 28.

4. Recap of Legislation, Continued • A combination of rate increases and changes in covered services is projected to result in a 30% increase in payment per ARMHS recipient State funds $6 million + Fed match $10 million = $16 million total increase (30%) in covered services for ARMHS recipients

5. Recap of Legislation, Continued 2013 Legislation • Effective January 1, 2015 • Rate increase will be in addition to the provision that increases MA rates 5% for ARMHS and most other MA-covered mental health services effective September 1, 2014.

6. Recap  Recommendations A • Coverage for currently non-billable but required activities: • Clinical Direction and oversight, includes support for EBPs • Functional assessments, includes LOCUS and interpretive summaries • Individual Treatment Plan development • Service coordination Consider add’l time study data about Clinical Supervision role and responsibilities

7. Recap – Recommendations B • Integrated Model Competitive Employment: • Must be done in partnership with Voc Rehab • Improved reimbursement for clinical direction and service coordination will support IPS model • Improved rates for all ARMHS services could support IPS model • 1915(i) would allow broader coverage than rehab option, but still subject to CMS rules on supported employment and other constraints (see below)

8. Recap – Recommendation B • EBP – Family Support: • Improved reimbursement for clinical direction and service coordination will help • Improved rates for all ARMHS services could be structured to facilitate ARMHS engagement in Family Psycho-education and other EBPs such as IPS, IMR and IDDT

9. Recap – Recommendations B • Outreach / Wellness / Med Ed Expansion: • Probably not MA-reimbursable in ARMHS • Lower in Workgroup priorities, probably not affordable within the budgeted 30% increase • May be covered through: • Behavioral Health Homes • Community Health Workers ***Put on Hold and see what happens with ACA and Behavioral Health Homes development

10. Recap – Recommendations B • Parenting / Family Services: • Added as a no-cost ARMHS expansion in 2013 legislation • An additional skill in the list of skill areas that can be included in ARMHS • Currently billable as Basic Living and Social Skills • DHS is considering options for provider training

11. Recap Summary “What We Heard” “Do Not Make This Harder Than What It Needs To Be” • First, Deal with Category A • Improved rate coverage for Category A will influence what we can do about Service Expansion/ Category B • “Phase in” Service Expansion/Category B

12. Recap Summary What We Heard…. • Reduction of AMHI grants to afford this expansion – essentially taking from one resource to expand another • CADI waiver concerns - moving to MN Choices. People potentially screened out of the waiver will use ARMHS. • Concerns about reduction in PCA services for persons with MI

13. Service Definitions – SPA • Define the rate increase as justification for increase in quality of services, additional expectations, etc. AND/OR • Use of separate code for identified services

14. Service Definitions – SPA Considerations: 2013 Children’s Legislation 256B.0943 • Mental health service plan development within CTSS • Dev, review, and revise a child’s individual tx plan. Include client/client parent/caregivers, others to arrange tx and support activities of the plan. • Administer standardized outcome measure, to evaluate effectiveness of services. Input: Dr. Oni: “It is good that John K. was here today. In the early days of CTSS there was a lack of clinical supervision. Coverage for clinical supervision is vital to the quality of the services provided.”

15. Service Plan Development • Considerations: • H0032 Service Plan Development • H0031 Mental Health assessment by non-MD to bill for functional assessment

16. Work Group Input • 15 minute units is an admin burden • Hiring more admin people than service providers to keep up with billing, etc. • Increase rates AND bill for the work that is done • Be paid for the work we do! (John Everett and reiterated by others)

17. Input, cont’d • Focus on expansion rather than the rate increase to preserve the additional services • Providers are doing the activities within Rec A– let’s get paid for it • Use a strategy to ensure CMS approval and keep in mind what they approve sets a precedent

18. Rate Methodology • Usual and Customary Charges – FY 12 reimbursement is 76% of submitted charges aka “usual & customary” service charges • What’s included in these charges? • Comparable Services

19. Time Study • Capture the time of the MH Professional conducting the functions of clinical supervision and guiding clinical direction • Let Melinda know if your agency is willing to participate in time study in January

20. Next Steps - Timeline • Dec 2013 - Jan 2014: Draft State Plan (SPA) • January 2014: Time Study • Jan 31st 2014: ARMHS Restructuring Advisory Work Group - Final • February 3, 2014: Submit draft SPA to CMS

21. Next Steps - Timeline • April 2014: prelim CMS agreement • Summer – Fall 2014: Modify MMIS claims system, provider training and communication • January 2015: full implementation

22. Add’l Questions and Comments ARMHS Expansion Work Group posting location: Expansion Work Group http://www.dhs.state.mn.us/dhs16_171741#P59_5196 Melinda.M.Shamp@state.mn.us Julie.Pearson@state.mn.us Dhs.Mhrehab-Adult@state.mn.us