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Collaboration to Strengthen Management of Psychotropic Medications for Children in Foster Care. Maximizing Opportunities to Increase Child and Family Well Being Through Innovative Funding Approaches. A Look at Massachusetts Angelo McClain, Ph.D., LICSW - PowerPoint PPT Presentation
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Maximizing Opportunities to Increase Child and Family Well Being
Through Innovative Funding Approaches
A Look at Massachusetts
Angelo McClain, Ph.D., LICSWCommissioner, Massachusetts Department of Children and
Families
Collaboration to Strengthen Management of Psychotropic Medications for Children in Foster Care
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Children’s Behavioral Health Initiative
• How it came about:– Federal Medicaid program mandates Early Periodic Screening
Diagnosis and Treatment (EPSDT) for children under 21. – Class action suit filed in Massachusetts in 2001, court found in
2006 that Massachusetts in violation of EPSDT provisions of the Federal Medicaid Act
– Orders State to develop in-home services, including comprehensive assessments, case management, behavior supports, and mobile crisis services
• Who is Eligible:– Children with SED, In addition to any other disabling condition,
such as autism spectrum disorders, developmental disability o substance abuse
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Children’s Behavioral Health Initiative Service Array
1. Intensive Care Coordination (ICC; Wraparound)
2. Family Support & Training (FS&T; Family Partners)
3. In-Home Therapy (IHT)
4. In-Home Behavioral Services (IHBS)
5. Therapeutic Mentoring (TM)
6. Mobile Crisis Intervention (MCI)
7. Crisis Stabilization (CS) ( Approval denied by CMS)
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404/22/23 4
Intensive Care Coordination(Wraparound)
•Clinical Assessment inc. CANS•SED determination for eligibility•Medical Necessity determination
•Care coordination
In-Home Therapy
•Clinical Assessment inc. CANS•Medical necessity determination
•Care coordination available
Outpatient Therapy
•Clinical Assessment inc. CANS•Medical necessity determination
•Care coordination available
Families decide on
most appropriateinitial serviceindependently
or in consultation with helping professions such as:
•primary care,•mental health clinicians
• schools•case workers
•community orgs•faith leaders
•others
EmergencyServices
Mobile Crisis Intervention
Crisis Stabilization
AdditionalServices
(accessedthrough
core clinicalservices)
•Behavior Management
Therapy & Monitoring
•Family Partners
•TherapeuticMentoring
Children’s Behavioral Health InitiativeSystems Overview
HUB SERVICES
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Leveraging Funding
• The Rosie D Judgment:– Included language that required MassHealth to
pay for the new services, to the degree that Federal approvals are obtained and Federal Financial Participation is available
– MassHealth sought maximum clarity from CMS by seeking to add the remedy services to its Medicaid State Plan, through “State Plan Amendments” (SPAs)
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Financing Through State Plan AmendmentOpportunities and Risks
Pros:• Financial Partner to share cost…….not only
state contributions• Provide clear authority, not dependent upon
periodic waiver renewalsCons:• Can be costly to implement• Services must be available statewide• Must meet medical necessity criteria
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Seeking Approval of SPAs……is an art and a science
• You need your Medicaid staff who regularly work with CMS
• There are often policy and financial contexts, strategic considerations, for every request and every decision, no matter how minor
• Value of Subject Matter Experts (SMEs), e.g. a consultant with recent experience working on CMS submissions
• CMS staff in different regions can make different decisions – stay connected to your networks
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Caring Together
Strengthening Children and Families Through Community-Connected Residential Treatment
• Joint partnership between the Massachusetts Department of Mental Health & Department of Children and Families
• A bold new approach to delivering residential services for children and youth– Integrated placement & community treatment– Services “flex” to meet child’s changing needs– Parent Partners
• IV – E Waiver– Application Pending– Use $$ currently reimbursing placement to purchase
“Residential Level of Service” in the community.
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DCF Area Offices (29)DMH Area Offices (6)
DMH Entrance Requirements
DMH Door DCF Door
DCF Entrance Requirements
Provider A
ONE DOOR
JOINT ENTRANCE REQUIREMENTS
Joint System Management
TRADITIONAL SERVICE SYSTEM
Residential Level of Service
Transition Services
Case Management
CARING TOGETHER SERVICE SYSTEM
Behavioral Health
Same C
linical Team
Provider B
Provider C
Provider D
Child
FamilyMultiple doors
$$ $$
Segregated Care = Multiple Clinical Teams Improved access to seamless residential treatment and community based services for children and families
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Benefits to Children and Families
• Integrates the way service are delivered to better respond to families’ needs
• Maximizes flexibility of services and resources• Shifts paradigm to recognize the importance of
delivering clinically intensive services primarily within a child’s “home community”
• Keeps more families together; and reunites others more quickly
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Paying for Performance• Year 1 – Unbundled Payments
– Implement IV – E Waiver Program (pending approval)– Gather Data While Providers Learn New Business– Build Consensus on Performance Measures
• Year 2 – Establish Case Rate– Blended Placement & Non-Placement
• Ex. 30 Placement; 20 Community = $240 / day– Incentive to Increase Community Tenure
• Year 3 – Establish Well-Being Incentives– Strengthening Families / Positive Youth Development
• Ex. Reduce Repeat Maltreatment; Educational / Vocational Success; Reduce Reliance on Psychotropic Medication
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Multiple Payers – One Integrated Service
CHILD WELFAREState Appropriation
(FFP Goes to General Fund)
MENTAL HEALTHState Appropriation
MEDICAIDCBHI
$200M $40M
EDUCATIONSpecial Education ServicesCOMMUNITY SERVICES
FRC; Informal Supports
CARING TOGETHERIntegrated Residential Treatment
For Children and Families
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Family Partner Eligible
Insurance Status?
Want FP?
Have FP?
DCF $$$
STOP
Want FP?
CBHI ServicesContinues
DCF $$$
Masshealth $$$
Masshealth
Private Insurance
No
Yes
No
Yes
Yes
Yes
No
No
DMH $$$
DMH $$$
Family Partner – Braiding the Funds to Change Payer, Not Partner