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Welcome! Today’s Webinar will begin shortly…
Keep in mind: • Everyone is currently muted. • Use the chat box to submit questions or comments to the
presenters. Choose send to “All Panelists” in the dropdown. • If you are having technical issues, send a message via chat to
the “Host” or email [email protected]. • See www.ctacny.com for the webinar recording.
Embracing Change Together: Partnering for Successful Child and
Family Outcomes Angela Keller, LMSW
Director, Bureau of Children’s Program Design, Policy & Planning Division of Managed Care
NYS Office of Mental Health
Andrew Cleek, PhD Lydia Franco, LMSW
Community Technical Assistance Center
Overview
• The Children’s Plan – Key Points – Cross system efforts
• Revised Timeline • Proposed Services • The Children’s Summit
– Purpose – Registration Details
• Questions
Poll Question • Is this your first introduction to the children’s
managed care transition? A. Yes, I have not been able to listen to many
previous webinars on this topic. B. I have heard it a few times but it has been a
while. C. I have listened often to the webinars on this
topic. D. I am very familiar - I could present on this topic!
Children’s State Leadership Team • Donna Bradbury, Associate Commissioner,
Division Of Integrated Community Services For Children & Families, NYSOMH
• Lana I. Earle, Deputy Director, Division of Program Development and Management, Office of Health Insurance Programs, NYS DOH
• Steve Hanson, Associate Commissioner, NYS OASAS
• Laura Velez, Deputy Commissioner, Child Welfare & Community Services, NYS OCFS
The Children’s Plan – Key Points
• Expand services available to all children with needs and challenges
• Expand the number of children that can obtain Medicaid services
• Offer all children Medicaid services within a Managed Care delivery system
• Integrate service delivery within the Health Homes to Serve Children model
The GOAL is to… Get children back on their developmental trajectory:
– Identify needs early – Maintain the child at home with support and services – Infuse a trauma informed approach in service delivery – Maintain the child in the community (least restrictive) – Prevent longer term need for higher end services
Focus on
recovery and building
resilience!
The Aim of Redesign: Improve Quality
• Early identification and intervention • Accountability for outcomes and quality
services • Integrated approaches to planning and service
provision • Increasing intervention access by enhancing
service array and continuum of care • All children - regardless of system of payer -
have equal access to needed services
Design Target Populations
• Children and youth younger than 21 • Children with Serious Emotional Disturbance
(SED) • Children in Foster Care who have SED, are
Developmentally Disabled, Medically Fragile, or have experienced trauma
• Children who require significant medical or technological health supports
• Youth with Substance Use Disorders
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Children and their families receive the right services, at the right time, in the right amount.
Revised Children’s Timelines Health Homes Designated to Serve Children – enrollment begins October 1, 2015
– OMH TCM providers and legacy clients will transition on October 1st as well.
The proposed Medicaid State Plan services will be implemented as soon as possible, pending approval from CMS, and available on a fee-for-service basis initially. Managed Care - Geographic Phase-In Timeline • January 1, 2017 – NYC and Long Island Children's Transition to Managed
Care • July 1, 2017 – Rest of State Children's Transition to Managed Care Population Phase In for LOC/LON
Revised Children’s Timeline (continued)
• The transition of care coordination services of the six 1915c children’s Waivers (OMH SED, DOH CAH I/II, OCFS B2H) to Health Home Serving Children will occur in 2017.
• In 2017, currently carved out Medicaid behavioral health services and children in foster care will be moved to Managed Care.
• The existing Home and Community Based Services (HCBS) that are in the six 1915c children’s Waivers (OMH SED, DOH CAH I/II, OCFS B2H) will be aligned to one array of HCBS benefits, pending CMS approval, and will be moved to Managed Care.
• The 1915c Waivers will be discontinued as separate programs once the transition is complete.
Proposed New Medicaid State Plan Services
• Crisis Intervention • Community Psychiatric Supports and Treatment
(CPST) • Other Licensed Practitioner • Psychosocial Rehabilitation Services • Family Peer Support Services • Youth Peer Advocacy and Training
Home and Community Based Services (HCBS) Benefits
• Care Coordination (only for those ineligible for, or opt out of, Health Home)
• Skill Building • Family/Caregiver
Support Services • Crisis & Planned
Respite • Prevocational Services • Supported Employment
Services
• Community Advocacy and Support
• Non-Medical Transportation
• Day Habilitation • Adaptive and Assistive
Equipment • Accessibility
Modifications • Palliative Care
Risk/Non-Risk Model
• Existing carved-out State Medicaid services – in Plan capitation and at risk in 2017
• New HCBS benefits - outside Plan capitation rate and non-risk for two years, with government mandated rates in 2017
• New State Plan Medicaid services - in Plan capitation rate and at risk, reflecting costs and utilization as soon as possible pending CMS approval
New Approach to Eligibility for Children’s HCBS Benefits
• Level of Care – criteria met and determined by assessment that would indicate a child is eligible for or at risk of medical institutional placement in licensed by NYS OMH, Intermediate Care Facility for the Mentally Retarded (ICF/MR), or skill nursing facility/Hospital. Existing criteria for the six current children’s 1915c Waivers.
• Level of Need – criteria met and determined by assessment that would indicate a child has needs that cannot be met only by non-medical institutional State Plan Services, but who does not qualify for Level of Care.
Children without Medicaid • Individuals with third party health insurance and dual coverage
(Medicaid/Medicare) – excluded from managed care in NYS • Children’s design includes proposal to evaluate LON/LOC
eligibility to establish disability and need for HCBS benefits, then follow with determination of Medicaid eligibility without regard to parental income
• Once eligible for Medicaid through LON/LOC eligibility and Medicaid budget methodology, the door is opened to access all Medicaid services for which the child is eligible (e.g., health home, State Plan services, HCBS)
• HCBS benefits will be available in Medicaid Managed Care and in separate, equal system in fee-for-service Medicaid for these “family of one” children who cannot enroll in a Plan
CANS (Child and Adolescent Needs and Strengths Assessment)
• John Lyons, PhD, author (www.praedfoundation.org) of the CANS
• A multi-purpose tool to support decision making, including level of care and service planning, to facilitate quality improvement initiatives, and to allow for the monitoring of outcomes of services.
• Developed from a communication perspective so as to facilitate the linkage between the assessment process and the design of individualized service plans including the application of evidence-based practices.
CANS-NY Uses Used in New York for 20 years, predominantly with OMH programs and, more recently, the OCFS Bridges to Health Waiver Future Uses: • Determine acuity for Health Home (HH) care management
and rate assignment (October 2015)
• Provide information that may help determine if children meet the HH eligibility functional criteria for Serious Emotional Disturbance (SED) and Trauma (October 2015)
• Determine need for Home Community Based Services within Managed Care (2017), including use of a yet to be developed Brief CANS Screen
Health Homes to Serve Children
• Health Home model is important in the intersection with the managed care transition
• Many children eligible for Medicaid State Plan and HCBS benefits will be eligible for Health Home
• Health Home Care Managers will coordinate ALL services a child and family needs to access to reach their goals, through development and monitoring of service plan
The Children’s Services Summit
Summit Objectives
• Participants will have the opportunity to learn about: – The children’s system redesign, innovative
practices, and the hope for improved behavioral outcomes for youth and families;
– Partnering with various sectors to provide quality services for successful outcomes;
– Organizational competencies and strategies necessary to succeed in the new managed care system;
– Available technical assistance opportunities to support you in this transition
Why should we attend? • Keynote Susan Dreyfus, President and CEO of the Alliance for Strong
Families and Communities, will kick off the event with an inspiring discussion about system transformation, its complexities, and how organizations can plan for successful futures.
• Hear national leaders of child-serving organizations present transformational models aimed at adapting to an environment that demands greater accountability, increased efficiency in delivering services, and reduced variations in care.
• Workshops will be offered specifically geared towards: – aligning child and family needs with new service delivery models – gaining knowledge in successful integration of health and behavioral health
systems – data driven clinical decision-making – fiscal strategies for long term sustainability
• Learn about upcoming technical assistance opportunities
Summit Agenda 8:30 – 9:00 am Registration / Coffee and Continental Breakfast 9:00 – 10:30am Opening Remarks and Introduction Keynote: Susan Dreyfus, President & CEO, Alliance for Strong Families & Communities 10:30 – 12:00pm Case Study Presentations 12:00 – 1:00pm Lunch 1:00 – 2:00pm Panel Discussion: “Disruptive Forces Leading to Opportunities in NY State” 2:15 – 3:15pm Workshop Series 1 3:30 – 4:30pm Workshops Series 2 4:40 – 5:00 pm Closing Remarks: Upcoming Technical Assistance Opportunities
Who should participate?
• All child-serving agencies licensed, certified or funded by the Office of Mental Health, Office of Children and Family Services, Department of Health, and Office of Alcoholism and Substance Abuse Services are invited to attend.
• We ask provider agency leaders to identify a Change Management Team to join the summit that includes an Executive Leader (CEO/COO), a fiscal representative (CFO), a Program Manager/ Director, an Evaluation/ Quality Assurance representative, Family Support Leader, or Youth Advocate.
• Limited to 4 representatives from each provider agency
How to participate in the Summit? Choose one date…
Monday, June 29th, 2015
NYU Kimmel Center 60 Washington Sq. South
New York City, NY 10010
OR
Tuesday, June 30th, 2015 Hilton Albany
40 Lodge Street Albany, NY 12207
How to participate in the Summit? Register…
1. As a provider agency, complete Parts I and II of the Managed Care Readiness Assessment Tool and the Children’s Addendum found here: http://mctac.org/page/provider-readiness
2. Upon completion of the tool, you will be sent a link to register for the summit.
3. Provider agency change management teams will register together. Please determine who will participate prior to submitting.
4. Provider agencies that have already completed the tool and addendum should have already received a link to register.
Registration for Non-Providers
• Non-provider groups, such as: – Local Government Officials – State agency staff – Children’s Advocacy and Membership Associations
• Received an email with a direct link to register.
Space is limited! Waiting list will be used if necessary.
The Managed Care Readiness Assessment Tool
A Readiness Assessment Tool
• Helps to assess managed care readiness – Same as what was distributed under MCTAC
• Addendum specific to assessing child-serving service delivery models
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Managed Care Readiness Assessment Tool – Part I
Content Areas
• Understanding MCO Priorities
• MCO Contracting
• Communication /Reporting
• IT System Requirements
• Credentialing Process
• Level of Care (LOC) Criteria / Utilization Management Practices
• Member Services/Grievance Procedures
• Medical Management
• Quality Management/Quality Studies/Incentive Opportunities
• Finance and Billing
• Access Requirements
• Demonstrating Impact/Value (Data Management & Evaluation Capacity)
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Readiness Tool: Addendum, Part II
• Addendum for Child-Serving Organizations: – Early Identification and Screening – Treatment Models and Evidence-Based Practices – Outcome Measures and Tracking – Agency Assessment of Service Array – Trauma Informed Care Principles
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How to complete the tool:
1. Download a hard copy of the tool (Parts I and II) 2. Meet with the key members of your
leadership/executive management team and fill out a hard copy of the assessment together.
3. Once fully completed, enter responses through our online survey tool.
4. Each agency will receive an individualized report of their responses.
Access here: http://mctac.org/page/provider-readiness
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Guidance on Completing the Readiness Tool and Addendum:
Webinar: May 20, 2015
1:30-2:30pm
See emails for registration link
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We are a resource for you! www.ctacny.com
www.mctac.org
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CTAC Technical Assistance Efforts
• Comprehensive Children’s Technical Assistance – Expansion to all of children’s programs – Training, consultation, and educational resources – Series of offerings on business practices, managed
care readiness, best practices, and workforce development for all sectors from residential programs through to peer support programs
– Stay tuned for announcements!
Questions
Resources MRT Website https://www.health.ny.gov/health_care/medicaid/redesign/
DOH Health Homes Website https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/
Children’s Resources and Medicaid Managed Care Listserv http://www.omh.ny.gov/omhweb/childservice/
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