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Terry R. JonesOffice of Health Integration . Budget Overview and Office of Health Integration 2013 Work Plan. 2. The Mental Health Budget: . Emphasizes direct services to individuals with severe mental illnessContinues the efficient
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1. October- November 2011 Ohio Department of Mental Health Community Mental Health Prior Authorization Training 1
2. Terry R. Jones
Office of Health Integration Budget Overview and Office of Health Integration 2013 Work Plan 2
3. The Mental Health Budget: Emphasizes direct services to individuals with severe mental illness
Continues the efficient & effective operation of six regional psychiatric hospitals
Protects community medication subsidy & continues to serve approximately 15,000 people
Enables GRF non-Medicaid community subsidy to be used to address local priorities 3
4. Major Reforms Include: Medicaid responsibility is shifted to the State of Ohio (funding and management)
Cost containment strategies for Medicaid based on data analysis
Revisions to Medicaid community mental health benefit package in FY 13 in order to address gaps & better coordinate physical & behavioral health care 4
5. Medicaid Cost Containment Short Term Based on data analysis in conjunction with providers, consumers & board representatives
Analysis, approach and process was collaborative, but no consensus reached
Data-informed policy decisions
Preferable strategy compared to across the board cuts
Experience of other states used as resource 5
6. Medicaid Cost Containment Short Term Cost containment strategies for Medicaid based on data analysis:
Service utilization limits
Payment modifications
Children entitled to all medically necessary services per Medicaid EPSDT requirements 6
7. Office of Health IntegrationState Fiscal Year 2013 Work Plan Focus staff & resources on integration of behavioral health & physical health care
Coordination of policy, logistics and operations to support integration
Medicaid
Clinical Integration & Health Homes
Oversight of SAMHSA Grant
Pediatric Psychiatry Network
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8. Office of Health IntegrationState Fiscal Year 2013 Work Plan Telemedicine Opportunities
Block Grant Funds
Health Information Technology
Innovation in Integrated Care
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9. Work Plan Overview Behavioral Health/Physical Health Integration
Health Homes
Benefit Administration
Intensive Home Based Treatment
Assertive Community Treatment
Peer Support
Partial Hospitalization
Family Therapy
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10. Behavioral Health/Physical Health Integration Health Homes for SPMI/SMI/SED Populations
Development & implementation of health homes
Service definitions, target populations, regions, practice site qualifications, payment methodologies, information system requirements, outcome measures
Logistical Framework & Stakeholder Involvement
Documentation, billing & other regulatory requirements
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11. Behavioral Health/Physical Health Integration Reimbursement
Treatment plan integration
Health information technology
Staffing arrangements & team composition
Technical assistance & learning collaborative
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12. Behavioral Health/Physical Health Integration Benefit Administration
Merging the community mental health benefit with the mainstream Medicaid benefit administered by ODJFS
Addressing reimbursement and service coding implications
Transitioning claims processing from MACSIS to MITS
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13. Behavioral Health/Physical Health Integration Transitioning claims payment to ODJFS
Build on the work of the BH Coding Alignment Initiative
To better align mental health service definitions and related coding requirements with national billing and EDI standards
Eliminate administrative inefficiencies and IT customization
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14. Intensive Home Based Treatment & Assertive Community Treatment Add to Medicaid State Plan
Currently there is an ODMH rule/certification standard for each of these services
Build on previous work to the extent possible
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15. Peer Support Draft rules under development
Collaboration with the Ohio Empowerment Coalition
Training curriculum under development
Alignment with CPST
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16. Partial Hospitalization & Family Therapy Recommendation from the Behavioral Health Benefits committee to review and modify the partial hospitalization service standard to better align within the continuum of care
Consider adding Family Therapy as an ODMH-certified service and include under the community mental health Medicaid benefit
Family Therapy is currently reimbursed by ODJFS
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17. Major Areas of Work State Plan Amendments
ODJFS Rules
ODMH Rules
Interagency Agreement Amendments
EPSDT Considerations
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18. Major Areas of Work Data Analysis
MACSIS Changes
MITS Changes
Training
Consumer Notification
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19. Next Steps General timeframe for completion within SFY 13
Projects will be worked on concurrently
Separate ad hoc groups will be formed to complete work
Health Home Logistics Committees
IHBT Committee
ACT Committee
Partial Hospitalization Committee
Peer Support Committee
Family Therapy Committee
Feedback loop to all stakeholders
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20. Contact Information Terry R. Jones
Ohio Department of Mental Health
Office of Health Integration
Columbus, Ohio 43215
(614) 466-9982
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