The Authority

1. Using the Joint Planning Team (JPT) Mechanism to FinanceHigh Fidelity Wraparound (HFW)by Stan Mrozowski PhD, PA 06-16-11

2. The Authority • High Fidelity Wraparound (HFW) for children in the Commonwealth of Pennsylvania is being implemented using Joint Planning Teams (JPTs), which are administrative activities of the Behavioral Health– Managed Care Organizations (BH-MCOs). • The JPT coordinates development of a treatment plan for high-needs individuals in accordance with 42 CFR 438.208, which requires the identification, assessment and development of treatment plans for high-needs individuals.

3. Managed Care • For nearly 15 years Pennsylvania has managed the Medicaid behavioral health benefit through managed care; • There are 5 Behavioral Health Managed Care Organizations that cover different areas of the state; • The vast majority of children’s behavioral health services are financed through Medicaid, and are thus under managed care.

4. WHY Joint Planning Team [JPT]? This financing mechanism allows us to cover all of the costs of doing Wraparound at the highest fidelity: • Staff are able to do everything that is needed in the model (staff do not have to focus on “billable hours,” and are free to focus on the needs of the youth/family); • Coaching activities are covered; • Evaluation activities are covered.

5. Concept of JPT • The Behavioral Health Managed Care Organizations are contracting with various entities to carry out High Fidelity Wraparound. • These are BH-MCO administrative activities, and the entities are acting on behalf of the BH-MCO.

6. The Process • There are several steps to JPT financing.

7. Start-up is not included • Typically start-up has been through Health Choices Reinvestment (from the BH-MCOs profit). • State MH allocation funds to counties have been used. • Other funds such as Needs Based Plan, Integrated Children’s Service Plan grants, or Special Grants from the Office of Children, Youth, and Families can be used.

8. Quarterly Reports during Start-up • JPT quarterly report tracks all children enrolled in a HFW/JPT team. • The quarterly reports include information on: individuals enrolled in JPT, start and end dates for involvement in the team, number of hours of contact with JPT staff for each enrollee, and total expenditures for each staff level involved in JPT and the funding source (reinvestment, capitation or other). • The JPT quarterly report allows counties to report dollars for Coach, Supervisor and Evaluation costs.

9. After Start-up - Certification • In order to access funding through the administrative portion of a BH-MCO’s capitation rate, each JPT agency must be certified as a JPT provider by OMHSAS. • The Youth and Family Training Institute is responsible for providing training, coaching, and fidelity monitoring of High Fidelity Wraparound • YFTI also certifies the agencies.

10. The Funding Concept • Counties should realize cost savings due to the utilization of High Fidelity Wraparound; • Experience is showing reduced costs especially in such areas as Residential Treatment; • The savings in the Medical portion of the Health Choices rate is used as the basis for supporting the costs of High Fidelity Wraparound; • Medical savings is moved to a special category of the Administrative component of the capitation rate.

11. Ongoing… • This financing mechanism allows for the inclusion of HFW/JPT as an on-going part of the capitation rate in Managed Care. • This allows counties/BHMCOs to continue to work with high need youth and to continue to manage the costs.