Behavioral Health Integration_ Non-Medicaid Services

Behavioral Health Integration: Non-Medicaid Aspects of RFP
Stakeholder PresentationSeptember 30, 2013
Public Behavioral Health System
The goal is to provide a seamless service delivery system that protects consumers and the public; and promotes timely access to services, care coordination, and wellness and recovery for all.Funding sources should be invisible to participants and providers.
Current Public Mental Health System Service Coverage
Participants access services that are covered under one or more funding mechanismsMedicaidFederally Funded Dually EligibleState Funded Dually EligibleTraumatic Brain Injury (TBI)Division of Rehabilitation ServicesGrant fundsUninsured
Current Public Mental Health Services
Outpatient Services include:Individual and group counselingOutpatient Mental Health Centers (OMHC)Federally Qualified Health Centers (FQHC)Psychiatric Rehabilitation Programs (PRP)Mobile treatmentSupported EmploymentCase management
Current Public Mental Health Services
Inpatient Services include:Hospitals and State-run facilitiesResidential Rehabilitation Programs (RRP)Respite careResidential Crisis
Substance Use Treatment Services
Outpatient Treatment Services
Services - Assessment, Individual Counseling, Group Counseling, Opioid Maintenance Therapy, Intensive OutpatientCurrent: MA patients are paid by MCOCurrent: Uninsured are paid by grant fundsCurrent: Provider submits data in SMARTCurrent: authorizations by MCOCurrent: Provider bills MCO (MA Patients)Potential: PaidbyASO (MA and uninsured)Potential: Provider will submit data to ASOPotential: ASO authorizes servicesPotential: Provider will bill ASO
Residential Treatment Services
Services – Levels III.7 (medically monitored intensive), III.5 (clinically managed high intensity), III.3 (clinically managed medium intensity ),and III.1(halfway house - clinically managed low intensity)Current: Paid by grant fundsCurrent: Jurisdiction authorizes serviceCurrent: Provider submits data in SMARTPotential: Jurisdiction’schoice -Paidby grant funds OR by ASOPotential:Ifjurisdiction choosesto have residential servicepaid byASO, provider bills ASOPotential: Provider will submit data to ASO and ASO will authorize servicePotential: jurisdiction submits data to ASO
Recovery Services
Services - Care Coordination, Continuing Care Recovery Checkups, Recovery Housing, Recovery Community Center Activities,Recovery CoachingCurrent: Paid by grant fundsCurrent: Jurisdiction authorizes serviceCurrent: Provider submits data in SMARTPotential: Paidby grantfundsPotential: Provider will submit all data to ASOPotential: For Care Coordination, Continuing Care, and Recovery Coaching, ASOwill authorize service
Residential Services – Potential Choice
Jurisdiction can elect to have all, or any residential services paid by ASOJurisdiction will submit as data for services to ASOIf jurisdiction elects to have residential service managed by ASO, ASO will pay for serviceASO will authorize all services, regardless of who pays
Data – Potential Change
Provider will submit all required data to ASOProvider will submit data on all services to ASO, regardless of whether ASO pays for serviceData elements remain the same as those submitted through SMARTDepartment with input from jurisdictions and providers will develop standard reports
Regulations Update
Move to accreditation requirement (date to be determined)Provider CategoriesTier I:No behavioral health license needed–Licensed or certified by applicable DHMH professional occupation board, provide services in accordance with requirements and scope of practice of Board regulations, maintain license or certification in good standingPrograms employing only licensed or certified staff meeting the above requirements do not need behavioral health licensePrograms providing residential services must get license, even if they meet above requirements
Regulations Update
Tier 2:Behavioral Health LicenseRequiredAll programs providing treatment, rehabilitation, vocational services, counseling or education that do not meet requirements of Tier 1Must become accredited, if program falls within scope of coverage of approved accreditation organization.Tier 3:DHMH License, Approval, or Certification RequiredAll programs providing treatment, rehabilitation, vocational services, counseling or educationwhose services are not covered byaccreditationorganization, and that arenotlicensedas inTier1Must meet requirements of DHMH regulations