Transcript available here - NYS Council for Community Behavioral Healthcare

Redesign Medicaid in New York State
Implementing Medicaid Behavioral Health
Reform in New York
February 13th 2014
Agenda
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Project update/timeline
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Preliminary summary of RFI comment themes
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Questions
2
Project Update/timeline
Agenda
Comment Summary
RFI Comments
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RFI comments received from 48 entities: Plans, Providers,
Advocacy Groups, Local Governments, and other
Stakeholders
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All comments logged and sorted into categories

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Possible change to RFQ; No change; Update guidance documents
Common themes were identified across submissions
RFI Comments
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Some themes were universally supported across submitters
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Need coordination between PH and BH Providers;
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Clarification on Health Home and Plan roles;

Plans need to understand NY and local BH and non-Medicaid systems
of care
On some issues there was no consensus between responders
Common RFI Themes

Plan experience/ Staffing Flexibility
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Health Homes
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Integrating BH Services in Managed Care
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Information Technology Requirements
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Network Standards
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Utilization Management
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Performance Measurement
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Plan Reimbursement for Services
Plan Experience/ Staffing
Flexibility
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Focus on the experience of Plan BH staff
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Sharing of staff between Mainstream and HARP
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How much sharing is allowed?
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Ensure coordination of BH expertise between Mainstream and HARP
Staffing sufficiency
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How does the State evaluate adequate number of staff?
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Differentiate between smaller and larger Plan sizes by allowing
flexibility in staffing ratios based on need
Health Homes
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Clarification needed on
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Plan/Health Home role and functions regarding care plan development
and implementation
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Health Homes performance standards
Health Home capacity
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Care Management
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1915(i) Functional Assessments
Standardized Plan/ Health Home contracts?
Integrating BH Services

Common concerns:
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Availability of new 1915(i)-like services providers
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Capacity to perform 1915(i)-like functional assessments
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Pricing 1915(i)-like services
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Plan familiarity with NY service system including non-Medicaid
services
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Challenge of linking Plans to crisis and emergency response services
IT Requirements

Balancing need to exchange and integrate data (RHIOs) with
fiscal cost and existing technical capability
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Mixed recommendations on requirements to join RHIOs
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Availability of IT resources – essential for Providers to be
managed care IT ready
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Need for initial and ongoing Plan billing system
support/training
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Multiple requests for Plan web-based billing capacity
Network Services
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Plans and providers expressed general support for:
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Facilitating co-located Article 28 services/BH services
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Ensuring adequate and coordinated mobile crisis across Plans
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Mandating contracting for after hour and weekend services
General provider support and mixed Plan support on proposed
RFQ network standards
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Contracting with providers serving 5 or more members
Utilization Management
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Utilization Management Comments
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Plans reported on current process – need to adjust UM for1915(i)-like
services
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UM should reflect need for ongoing treatment and not just stabilization
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Need for the State to approve UM criteria and for Plans to inform
Providers and the public of these criteria
Performance Management
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Common concerns from both Plans and Providers
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Need to know what Performance Measures are

Don’t use measures for Pay for Performance in year 1- only establish
baseline data
Regulatory Flexibility
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Overall comments supportive of regulatory flexibility
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Recommendation to develop Regulatory Workgroup in first year
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Support for integrated licensing
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Few specific changes recommended
Plan Reimbursement for
Services
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Overall need to develop sound payment and rate structure on
both Plan and Provider level
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Plans and Providers supported:
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Innovative Plan/ Provider network partnerships – including subcontracting for Plan functions
BH specific Medical Loss Ratio
Next Steps
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State will conduct a survey to identify providers interested potential 1915i
providers
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State is developing guidance for 1915(i)-like services
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Meeting with MRT BH Workgroup on 2/26/14
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Revise RFQ based on feedback
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State will discuss relevant RFI issues with Plans and Health Home
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Post RFQ early March
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Preliminary Premium and Databook shortly after
Implement Start-Up Activities (with funding in 2014-15 Executive Budget)