Presentation Transcript

1. NJPRA Annual Conference11/22/13

   Lynn A. Kovich Assistant Commissioner
2. Agenda Update on the ASO/MBHO Process Update on Rate Setting Medicaid Expansion Health Home/Learning Collaborative Newly Awarded Contracts and Current RFP’s System Highlights DMHAS Workplan Recovery and Rebuilding Post Sandy
3. Update on the ASO/MBHO Process
4. ASO/MBHO Process DMHAS continues to work with NJ Medicaid on the behavioral health components of the Medicaid Comprehensive Waiver. New Jersey’s Waiver was approved by CMS on October 1, 2012. The CMS approval letter and Special Terms and Conditions are posted at: http://www.state.nj.us/humanservices/dmahs/home/waiver.html. The DMHAS website provides updated information on the Waiver and development of the MBHO at: http://www.state.nj.us/humanservices/dmhs/home/mbho.html. RFP to procure a vendor for the MBHO developed collaboratively by DMHAS and DMAHS Review/finalize design elements by DMHAS/DMAHS executive staff and interdivisional/interdepartmental partners Review/content from Department of Banking and Insurance (DOBI) Review/approval by DHS Central Office Procurement Review/approval by Office of Information Technology (OIT), Office of Management and Budget (OMB), and the Office of the State Comptroller (OSC) RFP transmitted to Department of Treasury, Division of Purchase and Property (DPP) RFP published/posted by DPP Responsive bidder identified
5. Roles and Responsibilities in a Managed Behavioral Healthcare System Eligibility Network Development and Management Assessment and Referral Utilization Review Claims Administration Data Analytics Care Management Quality Management Financial Management
6. Update on Rate Setting
7. Rate Setting DMHAS has engaged Myers and Stauffer (M&S), a national CPA firm, to conduct the rate analyses for DMHAS services Objectives: Develop a fee schedule that is reflective of the costs incurred in providing the services, which will be rolled out concurrent with ASO going live Encourage cost efficiencies through new payment system Provide equity in rates or “like rates for like services” Promote access to community alternatives to institutional placement Maintain/increase access to services State-wide
8. Practice Groups A series of meetings were held 12/9-12/12 that included representatives from providers of mental health and substance abuse services, DMHAS staff, consumers and M&S Outpatient Partial Care Residential Supportive Housing Methadone Case Management PACT These meetings are a key opportunity for stakeholders to provide very specific feedback to both DMHAS and M&S on the costs required to deliver services to clients.
9. Deliverables Preliminary Rates Fiscal Analysis: Aggregate Fiscal Impact Program Wide Provider Level Fiscal Impacts Federal / State Fiscal Impacts Final Rates: Ready, with any adjustments from stakeholder review, hopefully by end of 1st quarter of CY14. They will not be effective until ASO goes live. They are for most services currently funded by DMHAS A subset of services will remain under contract reimbursement Certain services where State needs to buy overall capacity, as opposed to utilization, such as Emergency Services, Intensive Family Support Services and PATH. Inpatient psychiatric services paid exclusively by Medicaid are, for now, not part of this new rate-setting exercise.
10. Medicaid Expansion
11. NJ FamilyCare Summary Increased Income Limits 133% of the Federal Poverty Level for most NJ Residents ($25,975 for a family of 3) Increased Limits for Children and Pregnant Women Newly Eligible Populations Parents and Caretaker Relatives Single Adults and Childless Couples Federal Share of Benefits January 2014: 100% January 2017: 95% January 2018: 94% January 2019: 93% January 2020: 90% Timetable Oct. 2013 – Applications begin Jan. 2014 – New benefits begin for an estimated 300,000 new Medicaid beneficiaries
12. Overview Before After NJ Family Care All Medicaid eligible populations NJ Family Care Families with income up to 133% of the federal poverty level (FPL) Children in families with incomes up to 350% FPL Pregnant Women up to 200% FPL Medicaid Aged, Blind and Disabled up to 100% FPL Childless Adults up to 25% FPL
13. New FamilyCare Impact on Behavioral Health Care
14. Mental Health Parity and Addictions Equity Act (MHPAEA) in ACA On October 3rd, 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was signed into law. This Federal law requires group health insurance plans (those with more than 50 insured employees) that offer coverage for mental illness and substance use disorders to provide those benefits in no more restrictive way than all other medical and surgical procedures covered by the plan. Within the ACA, States who are implementing Medicaid Expansion need to provide the 10 Essential Health Benefits (EHBs) in the ABP that includes mental health and substance abuse services
15. Benefit Plan The Alternative Benefit Plan (ABP) needs to meet MHPAEA requirements Plan D or General Assistance as parents or childless adults will be part of the ABP plan and receive a richer benefit then they have today.
16. 10 Essential Health Benefits Ambulatory Patient Services Rehabilitative & Habilitative Services and Devices Emergency Services Prescription Drugs Hospitalization Laboratory Services Maternity and Newborn Care Preventive & Wellness Services and Chronic Disease Management Mental Health and Substance Abuse Disorder Services Pediatric Services (inc. Oral & Vision Care)
17. BH Services in the ABP BH services currently in the State Medicaid Plan Additional BH services to be covered in the ABP Targeted Case Management (ICMS) Community Support Services (1/14) Behavioral Health Home (1/14) MH Outpatient SUD Outpatient (limited) Adult Mental Health Rehabilitation (group homes) Inpatient psychiatric services Opioid Treatment Services Psychiatrist, Psychologist or APN Partial Care/Hospitalization Medical Detox PACT *Non-medical detox SUD partial care SUD IOP *SUD Halfway House SUD Outpatient *SUD short term residential Psychiatric Emergency Services/Affiliated Emergency Services *Subject to IMD exclusion SUD - Substance Use Disorder
18. Behavioral Health Homes and Learning Community
19. Behavioral Health Home SPA BHH SPA will include children/ adolescents/ youth DMAHS is working with DCF on the development of the children’s program design Targeted to individuals with Serious Mental Illness who are at risk for high utilization of services and children/adolescents/young adults with Severe Emotional Disturbances with a chronic medical condition Plan to roll out the service county by county Bergen and Mercer – calendar year 2014 DMHAS and DMAHS will measure outcomes and impact on costs Other counties to follow based on analysis of initial homes and financial resources
20. Behavioral Health Home Learning Community We have contracted with The National Council for Behavioral Healthcare to develop and facilitate a Behavioral Health Home Learning Community An RLI for Bergen County providers to join the Learning Community will be issued Members of the Learning Community will develop a Behavioral Health Home implementation plan Upon approval of the plan by DMHAS they will become certified Behavioral Health Homes and eligible to provide the service to Medicaid participants Certified Behavioral Health Homes will have 2 years to become accredited as a Behavioral Health Home from a nationally recognized accrediting body
21. Behavioral Health Home Services Comprehensive care management Care coordination Health promotion Individual and family support services (including authorized representatives) Comprehensive transitional care (including community and systems transitions) Referral to community and social support services
22. Current RFP’s &Newly Awarded Contracts
23. Current RFP’s Expansion of existing PACT and RIST programs in Cumberland, Gloucester, Mercer, Middlesex, Monmouth, Morris, Ocean, Salem and Union counties. Issued – 10/15/13 Services will be targeted to facilitating the discharge of 70 persons on CEPP status at a state psychiatric hospital, for a total of up to $2.45 million Due Date - 11/22/13 with a 1/3/14 notification date Supportive housing in Burlington, Camden, Cumberland, Gloucester, Hunterdon, Mercer, Morris, Passaic, Salem, Somerset, Sussex, and Warren Counties Issued – 10/16/13 Targeted to service 52 adults diagnosed with a serious and persistent mental illness whose homelessness or risk of homelessness places them at risk of psychiatric hospitalization, for annualized funding of up to $1.3 million Due Date - 11/26/13 with a 1/13/14 notification date
24. Newly Awarded Contracts On 6/17/13 DMHAS issued an RFP for the provision of outpatient mental health care and integrated co-occurring services to adult consumers age 21 and older presenting at mental health ambulatory care centers. Awards went to Greater Trenton Community Mental Health Center (Mercer), Trinitas Regional Medical Center (Union), Eva’s Village (Passaic), CPC Behavioral Healthcare (Monmouth) and Inspira Health Network (Gloucester, Cumberland, Salem and Camden). On 8/20/13 DMHAS issued an RFP to support the creation of long term residential, short term residential and halfway house beds in response to Phase 2 Drug Court expansion. Awards went to Maryville, John Brooks Recovery Center, Straight & Narrow, United Progress Inc., Real House, Integrity, Inc., Community Recovery Services, RMS Housing Associates/Angel Hope House, CURA, Inc., and Urban Renewal Corp. On 9/10/13 DMHAS was awarded a Strategic Prevention Framework - Partnerships for Success (SPF-PFS) cooperative agreement from the Center for Substance Abuse Prevention (CSAP). The agreement provides $2.2 million annually, renewable for five years. The SPF-PFS is designed to address two of the nation's top substance abuse prevention priorities: 1) underage drinking among persons aged 12 to 20; and 2) prescription drug misuse and abuse among persons aged 12 to 25. The SPF-PFS is also intended to bring SAMHSA's Strategic Prevention Framework (SPF) to a national scale.
25. System Highlights
26. Admissions to NJ State Psychiatric Hospitals: SFY 2006-2013(Excluding Ann Klein Forensic Center) NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems. November 2013.
27. NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems. November 2013.
28. NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems. November 2013.
29. Clients Served by the SMHA in Supportive Housing (duplicated) and in the Non Forensic State Hospitals SFY 2006 – SFY 2012 NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems. November 2013.
30. NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems. November 2013
31. DMHAS Workplan
32. DMHAS 18-Month Workplan Four strategic planning sessions held in Spring 2013 centered around: workforce development community integration move to managed care The feedback that was elicited is being used to generate tasks within the 18 month workplan (January 2014-June 2015) The Parker Dennison workplan for the CSS was used as a template, with additional interdependent priorities added to create a division wide plan Division projects that are independent are not included on the workplan, but will continue to develop during this timeframe, such as suicide prevention, SBIRT, Sandy Initiative, etc. DMHAS has identified team leads and workgroup members, which have begun meeting this fall to discuss tasks and timelines for the identified priority areas.  The Communication Plan Workgroup, led by Susanne Mills, will communicate, at least quarterly, with stakeholders to keep them apprised of the status of the work being done on the priorities. Communication may come via the website, email announcements, meetings with providers, etc.
33. DMHAS Workplan Priorities The workplan, which is in the process of being finalized, consists of 11 priority areas that include:  Community Support Services Implementation Rates and Financial Terms/Financial Impact Analysis Centralized Housing Authority ASO Procurement Community Integration Workforce Development Standard Level of Care Determination Changes to DMHAS Functions Consumer and Stakeholder Communication Plan Olmstead Compliance ASO Readiness and Implementation Each of these priority areas are tied to at least one of the three Strategic Planning Areas There will be additional opportunities for stakeholder involvement
34. Recovery and Rebuilding Post Sandy
35. Social Services Block Grant This post Sandy recovery initiative includes the following services in the counties of Atlantic, Bergen, Cape May, Cumberland, Essex, Hudson, Middlesex, Monmouth, Ocean and Union: MH and SA Outpatient ($5M) Early Intervention and Support Services ($4M) SA Detoxification & Short Term Residential ($7M) Supportive Housing & Career Services ($3.1M) Public Awareness Campaign ($2M) Temporary staff have been hired, including Renee Burawski to manage the program As of November 2013, UBHC is developing a panel of licensed clinicians to provide clinical mental health and substance abuse outpatient counseling to individuals who resided in the ten most impacted counties at the time of Sandy Individuals contacting the UBHC Access Center will be screened for services and provided appointments with clinicians or referred to Detoxification and Short term Residential as necessary Substance abuse detoxification and short term residential were launched this month and are accepting referrals As of 11/21 there have been 115 total authorizations in the Recovery and Rebuilding Initiative including assessment (27), detoxification (47) and short term residential (41) authorizations. DMHAS will expand EISS in Monmouth and Ocean counties as of December 2013 Services will be available through September 2015 As this is special federal grant funding, it will also be considered payor of last resort
36. DMHAS Social Services Block Grant Sandy InitiativesOctober 2013 to September 30, 2015