Transcript Behavioral Health Health Choices Update

Behavioral Health Services for Recovery & Independence
OMHSAS Advisory Committee
January 4, 2007
General Updates
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Personnel Updates/ DPW
Joint Office DPW/Education
Anticipated Retirements
Legislative Changes
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State
Federal
Setting the Agenda for the next 4 years
Governor’s Inauguration : January 16
Governor’s Budget Address: February 6
7/7/2015
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Washington Report
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SAMSHA ; Terry Cline, Oklahoma
Medicaid Rehab Option
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Regulations expected to be issued in the first quarter of the
year
Issues include:
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Time limits on rehab option
New requirements for documentation
Bundling vs reimbursement for episode of care
Impact on mental health services
Targeted Case Management (TCM)
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7/7/2015
Publication as “Interim Final Rule” limits duration of the
comment period and likelihood of modifications
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Washington Update ( continued)
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Audits/ Medicaid Integrity Program
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7/7/2015
CMS and OIG stepping up audits on Medicaid mental
health services
Resurgence of behavioral health audits
CMS using plan amendments submissions to change
rehab documentation
OIG annual work plan ( on line) : focus on adult and child
rehabilitation services
New resources and mandate for compliance and fraud and
abuse
All providers who receive more than $5M must have
compliance program in place 1/1/07
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Washington Update ( cont.)
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Medicare
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7/7/2015
Part D: Open Enrollment- Nov 15- Dec 31
Low Income Subsidy ( LIS) available to individuals
who are dual eligible ( 9 million out of 23)
CMS has informed those who lost dual eligible
status but are still LIS eligible
Notification given to those who must change plans
PA: PACE/Medicare Part D enrollment
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Meeting Our Objectives:
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Service Area Planning: Community Support Planning continuing; Spring
Meetings
State Plan Amendments: Formal Submission to CMS; 90 days to respond
Transformation Activity: Regional provider meetings with PCPA; Message
of Recovery; 2 agencies highlighted who have transformed; CST inventory
and distribution
Housing Update: Statewide meetings held with County MH/MR programs ;
LHOT reps; targeted TA with HC counties
BH Taskforce Report Issued for Comment: Comments Received; DPW
reviewing
MH/JJ Systems Reform; Comprehensive Planning Agenda; Individual Case
Intervention; Systems/Service Development
Education/BH Systems Initiative; Secretary/Secretary bi-weekly meetings;
Intend to issue bulletins regarding partial hospitalization programs/education
Integrated Treatment ( D&A/MH)- Clinical Standards Draft Issued to
Committee
Aging Case Review Follow-up/Expansion;
Medicare/Medicaid Data Review
7/7/2015
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HealthChoices Update
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CMS approved waiver for the HC BH Expansion
Implementation began on January 1, 2007
County Human Services Staff including MH/MR /
SCA’s will co-monitor state contract
Meeting in State College today
Linda Zelch: Project Manager (412-565-5226)
Joanie Morgan ( Central Area Field Manager)
OMHSAS operations contact: ( 717-214-9076)
CCBHO number: (1- 866-878-6046)
7/7/2015
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HealthChoices Update
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HC County Option: 15 counties
Technical and Cost Proposals finalized
Recommendations made to the Secretary of
Welfare to support all of the proposals
Final Rates have been issued
Readiness Review : spring, 2007
Implementation will begin on July 1, 2007
7/7/2015
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HEALTHCHOICES ZONES
Erie
Warren
Bradford Susquehanna
Crawford
Wayne
Wyoming
Forest
Cameron
Elk
Sullivan
Lackawanna
Venango
Lycoming
Pike
Mercer
Luzerne
Clinton
Clarion
Jefferson
Columbia
Monroe
Montour
Clearfield
Lawrence
Union
Centre
Carbon
Butler
Northumberland
Armstrong
Snyder
Northampton
Beaver
Indiana
Mifflin
Schuylkill
Lehigh
Cambria
Juniata
Allegheny
Blair Huntingdon
Berks
Perry Dauphin
Lebanon
Westmoreland
Bucks
Montgomery
Washington
Cumberland
Greene
7/7/2015
Fayette
McKean
Potter
Tioga
SomersetBedford
Franklin
Fulton
Adams
York
Lancaster
Philadelphia
Chester
Delaware
SOUTHEAST
Implemented Feb.
1997
SOUTHWEST
Implemented Jan. 1999
LEHIGH/CAPITAL
Implemented Oct. 2001
NORTHEAST
BH Implementation
July 1, 2006
NORTH/CENTRAL
STATE OPTION
BH Implementation
January 1, 2007
NORTH CENTRAL
COUNTY OPTION
BH Implementation
July 1, 2007
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HealthChoices Overview
County
Oversight
Lackawanna, Susquehanna
Luzerne, Wyoming
NBHCC- County Operated 501C3
MCO/ASO
Community Care Behavioral Health
Organization (Community Care)
Comments
ASO contract with
Community Care County
retains Full Risk
January 1, 2007
23 County Contract
DPW, Office of Mental Health & Substance Abuse
& County Human Services
Community Care Behavioral Health
Organization (CCBHO)
Full Risk Sub-Contract
July 1, 2007
HealthAssurance/
Community Behavioral Care Network of Pa
Blair
Bedford /Somerset
Franklin/Fulton
Lycoming/Clinton
Carbon/Monroe/Pike
Mercer/Venango/Clarion
Erie County
Cambria County
7/7/2015
Blair County and CABHC
Bedford /Somerset County
Franklin/Fulton County
Lycoming/Clinton County
Full risk Sub-Contract
HealthAssurance/
Community Behavioral Care Network of
HealthAssurance/
Community Behavioral Care Network of
HealthAssurance/
Community Behavioral Care Network of
Carbon /Monroe/Pike County
Community Care Behavioral Health
Organization (CCBHO)
Mercer/Venango/Clarion Counties
Value Behavioral Health of PA
Erie County
Value Behavioral Health of PA
Cambria County
Value Behavioral Health of PA
Full Risk Sub-Contract
Full Risk Sub-Contract;
Full Risk Sub-Contract;
Full Risk Sub-Contract
Full Risk Sub-Contract
Full Risk Sub-Contract Full
Risk Sub-Contract
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HealthChoices Overview
7/7/2015
County
Oversight
MCO/ASO
Comments
Lackawanna, Susquenaanna
Bucks Co. Behavioral H
Full Risk Sub-Contract
Chester
Montgomery
Delaware
Chester Office of Behavioral Health
Montgomery Office of Behavioral Health
DelCare
Magellan, Inc. of PA
Community Care Behavioral Health
Organization (CCBHO)
Magellan, Inc. of PA
Magellan, Inc of PA
Philadelphia
City of Philadelphia
Allegheny
Allegheny County HealthChoices, Inc
(ACHI)
Community Care Behavioral Health
Organization (CCBHO)
Full Risk Sub-Contract
Beaver
Beaver County
ASO w Value Behavioral
Health of PA
ASO contract with VBH of PA;
County retains Full Risk
Fayette
Fayette- Allegheny County HealthChoices, Inc
(ACHI)
ASO w Value Behavioral
Health of PA
ASO contract with VBH of PA;
County retains Full Risk
Full Risk Sub-Contract
Full Risk Sub-Contract
Full risk Sub-Contract
County Operated 501C-3 Behavioral
Health Organization; County retains
Community Behavioral Health (CBH)
Full Risk
Greene
Southwest 6:
Westmoreland
Washington, Indiana,
Armstrong; Butler,
Lawrence Counties
OMHSAS
Value Behavioral Health of PA
(VBH of PA)
Full Risk Contract
SouthWest Behavioral Management, Inc. Each
County also has limited oversight
responsibilities
Value Behavioral Health of PA
(VBH of PA)
Full Risk Sub-Contract;
Berks
Berks County
York/Adams
Lehigh
Northampton
Capital 5: Dauphin,
Cumberland, Perry,
Lancaster, Lebanon
York/Adams County
Lehigh County
Northampton County
Community Care Behavioral Health
Organization (CCBHO)
Community Care Behavioral Health
Organization (CCBHO)
Magellan Inc. of PA
Magellan Inc. of PA
Full Risk Sub-Contract
Full Risk Sub-Contract;
Full Risk Sub-Contract;
Capital Area Behavioral Health Collaborative
HealthAssurance/ Community
Behavioral Care Network of Pa
Full Risk Sub-Contract
Full risk Sub-Contract
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Emerging Trends
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Community of Practice
 Consensus on what works; Regulatory and Contract Reform
( FY 08/09)
 Consumer and Family Driven
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7/7/2015
Evidence Based Practices
Promising Practices
Culturally Relevant Practices
Emerging Technology
An Array of Options
Centers of Excellence
Commitment to fidelity, evaluation, outcomes, and performance
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Quality Management Strategy: Raising the
Bar to Excellence
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OMHSAS Retreat: Charlie Curie/ Co-Chairs/ Executive Staff/
QI and Division Chiefs
Ten Domains identified by SAMSHA for mental health
/substance abuse
Review of Domains;
1) SA- Not using substances : MH- Alleviation of Symptoms
2) Employment/Educational Pursuit
3) Housing
4) Connectedness
5) Lack of involvement with Criminal Justice
6) Access to Services
7) Engaged in Treatment/ Recovery Plan
8) Consumer Satisfaction
9) Cost Effectiveness
10) Use of Evidence Base Practices
Our Work 07/08 and beyond…..
7/7/2015
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Transition from the past to the future.
Drawing by Brenda Wagner
“There are two ways to look at your life. One is as though nothing is a miracle; the other is as
though everything is.” – Albert Einstein