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Behavioral Health Integration: Non-Medicaid Aspects of RFP

Behavioral Health Integration: Non-Medicaid Aspects of RFP. Stakeholder Presentation September 30, 2013. Public Behavioral Health System.

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Behavioral Health Integration: Non-Medicaid Aspects of RFP

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  1. Behavioral Health Integration: Non-Medicaid Aspects of RFP Stakeholder Presentation September 30, 2013

  2. Public Behavioral Health System • The goal is to provide a seamless service delivery system that protects consumers and the public; and promotes timely access to services, care coordination, and wellness and recovery for all. • Funding sources should be invisible to participants and providers.

  3. Current Public Mental Health System Service Coverage • Participants access services that are covered under one or more funding mechanisms • Medicaid • Federally Funded Dually Eligible • State Funded Dually Eligible • Traumatic Brain Injury (TBI) • Division of Rehabilitation Services • Grant funds • Uninsured

  4. Current Public Mental Health Services • Outpatient Services include: • Individual and group counseling • Outpatient Mental Health Centers (OMHC) • Federally Qualified Health Centers (FQHC) • Psychiatric Rehabilitation Programs (PRP) • Mobile treatment • Supported Employment • Case management

  5. Current Public Mental Health Services • Inpatient Services include: • Hospitals and State-run facilities • Residential Rehabilitation Programs (RRP) • Respite care • Residential Crisis

  6. Substance Use Treatment Services

  7. Outpatient Treatment Services • Services - Assessment, Individual Counseling, Group Counseling, Opioid Maintenance Therapy, Intensive Outpatient • Current: MA patients are paid by MCO • Current: Uninsured are paid by grant funds • Current: Provider submits data in SMART • Current: authorizations by MCO • Current: Provider bills MCO (MA Patients) • Potential: Paid by ASO (MA and uninsured) • Potential: Provider will submit data to ASO • Potential: ASO authorizes services • Potential: Provider will bill ASO

  8. Residential Treatment Services • Services – Levels III.7 (medically monitored intensive), III.5 (clinically managed high intensity), III.3 (clinically managed medium intensity ),and III.1(halfway house - clinically managed low intensity) • Current: Paid by grant funds • Current: Jurisdiction authorizes service • Current: Provider submits data in SMART • Potential: Jurisdiction’s choice - Paid by grant funds OR by ASO • Potential: If jurisdiction chooses to have residential service paid by ASO, provider bills ASO • Potential: Provider will submit data to ASO and ASO will authorize service • Potential: jurisdiction submits data to ASO

  9. Recovery Services Services - Care Coordination, Continuing Care Recovery Checkups, Recovery Housing, Recovery Community Center Activities, Recovery Coaching • Current: Paid by grant funds • Current: Jurisdiction authorizes service • Current: Provider submits data in SMART • Potential: Paid by grant funds • Potential: Provider will submit all data to ASO • Potential: For Care Coordination, Continuing Care, and Recovery Coaching, ASO will authorize service

  10. Residential Services – Potential Choice • Jurisdiction can elect to have all, or any residential services paid by ASO • Jurisdiction will submit as data for services to ASO • If jurisdiction elects to have residential service managed by ASO, ASO will pay for service • ASO will authorize all services, regardless of who pays

  11. Data – Potential Change • Provider will submit all required data to ASO • Provider will submit data on all services to ASO, regardless of whether ASO pays for service • Data elements remain the same as those submitted through SMART • Department with input from jurisdictions and providers will develop standard reports

  12. Regulations Update • Move to accreditation requirement (date to be determined) • Provider Categories • Tier I: No behavioral health license needed – • Licensed or certified by applicable DHMH professional occupation board, provide services in accordance with requirements and scope of practice of Board regulations, maintain license or certification in good standing • Programs employing only licensed or certified staff meeting the above requirements do not need behavioral health license • Programs providing residential services must get license, even if they meet above requirements

  13. Regulations Update • Tier 2: Behavioral Health License Required • All programs providing treatment, rehabilitation, vocational services, counseling or education that do not meet requirements of Tier 1 • Must become accredited, if program falls within scope of coverage of approved accreditation organization. • Tier 3: DHMH License, Approval, or Certification Required • All programs providing treatment, rehabilitation, vocational services, counseling or education whose services are not covered by accreditation organization, and that are not licensed as in Tier 1 • Must meet requirements of DHMH regulations

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