Transcript Rehabilitation Services in a Health Home Environment

Douglas P. Ruderman, LCSW-R
Director, Bureau of Program
Coordination and Support
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Behavioral Health Organizations – Medicaid
Redesign Team
Health Homes - CMS Medicaid Option
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Improve healthcare delivery & integration of
care.
Improve outcomes for Medicaid beneficiaries.
Reduce or eliminate unnecessary state
expenditures.
Most importantly – Bring us closer to our
collective Mission - to facilitate real recovery
for those under our care and to improve the
capacity of communities to achieve these goals.
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The BHO is New York’s process for the
transition to a better managed behavioral
health system.
Bidders have been selected to negotiate
Regional BHO contracts.
In Phase 1 (Next 2 years) the BHO will monitor
inpatient activity for Medicaid fee-for-service
recipients only in Medicaid fee-for-service
behavioral health inpatient environments.
The BHO will also profile outpatient and HH
providers networks.
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It will be important for OMH licensed programs
and OMH funded community service programs
(e.g. housing) to work closely with inpatient units
and HH CM to make their programs easily and
quickly accessible.
Measures such as:
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time to first outpatient visit,
second outpatient visit,
first prescription fill,
These will be used to educate OMH and the BHO of
program efficacy & inform Phase 2 of the BHO/Medicaid
redesign process.
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The only HH service that Medicaid will reimburse
is care management.
HH care managers coordinate all services for the
Medicaid beneficiaries primarily within the
network of HH providers.
If a person you currently serve is assigned to a HH
he or she may continue to be served by your
program whether or not your program is part of
that HH network.
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The DOH received 165 letters of intent to submit
health home applications and it was decided to
phase in implementation
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Phase I - 13 counties:
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Phase II – 14 Counties:
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HH application due date for Phase I counties only is November 1, 2011.
Implementation is scheduled for January 1, 2012
HH application due date for Phase II counties only is February 1, 2012.
Implementation is tentatively scheduled for April 16, 2012.
Phase III – 35 Counties:
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HH application due date for Phase III counties only is April 21, 2012.
Implementation is tentatively scheduled for June 18, 2012.
http://www.health.ny.gov/health_care/medi
caid/program/medicaid_health_homes/
Health Home Information
Questions and Answers
High Cost Population Characteristics
Health Home Patient Flowchart
Interim Health Home Provider Qualifications
State Plan Amendment - Draft
TCM and Health Homes
Letters of Intent for Health Homes
NEW Managed Care and Health Homes
Rate Information
Rate Information
Rate Information Questions and Answers
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Care management services will be funded by
90% federal financial participation for 8
quarters
Adult TCM services have been identified to
transform into HH CM
HH CM will be reimbursed at its current TCM
rate for two years from November 1, 2011.
Year 1 will be through FFS from eMedNY.
Year 2 will be from the HH.
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Converted TCM program “slots” will become part of
a health home per approved HH application and
will be monitored via the SPOA process
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The LGU will manage movement into and out of
TCM via the SPOA process
 The HH will become a referral source to the SPOA for
HH recipients who require access to former TCM slots
 The HH will need to inform the SPOA if an individual
no longer requires a the support of a former TCM slot
 The SPOA will approve the movement out of and in to
the high touch slots in a HH
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OMH expects that the velocity of movement
into and out of high touch CM in HHs will be
swifter than what has been the history with
TCM
This expectation is based on the fact that the
HH will want to utilize (utilization
management) the high touch CM slots for those
most in need and will request to move those in
less need to other levels of HH CM
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SPOA will continue to manage the assignment of AOT
status individuals who are in need either CM or ACT
services
If the individual is a member of a HH network the
assignment will be made to a high touch slot in that HH
network
If the individual is not a member of a HH network the
assignment will continue via the current SPOA process
When the individual is no longer on AOT status the HH will
use its utilization management process to provide the
appropriate level of CM service
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State item ICMs are either:
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Working directly from OMH facilities
Working alongside community programs
These services will remain available to the
communities they currently serve either as HH
CM or as TCM
Access to these slots will remain with the
SPOA
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Health and behavioral health care linkages
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Social service needs
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There will be more flexibility to manage
contacts to the individual who most needs
them
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Many referrals will come from within HH
networks.
Services will continue to be reimbursed via
Medicaid Managed Care or Fee-For-Service
Medicaid.
The HH does NOT limit its enrollees freedom
of choice to access providers outside the
network. The Medicaid card will continue to
reimburse for all FFS services.
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OMH recommends that OMH funded and
licensed programs join HH networks who
serve recipients in your geographic service
area. Why?
HH have great potential to create a better
rehabilitation and recovery based system of
care through
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Coordination
Integration
Communication
Regulation
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Your program and the individual you serve
should have superior access to health care
programs and social services supports from all
other members of the HH network then you
probably have today.
The HH should be managing warm hand-offs
between inpatient and outpatient services.
Your program will better serve the client
through close HH CM collaboration.
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The plan of care will be coordinated by the HH
CM for the network.
A single plan of care - The individual served in
a HH will promote the integration your
program’s services with other services and
social supports.
In this way all services should provide the
individual with maximum support in
overcoming health and behavioral health
barriers that are preventing he or she from the
achievement of his or her goals.
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A HH network will eventually be linked via an
electronic medical record (EMR).
All participating rehabilitation programs will
be better informed through the HH Electronic
Medical Record (EMR) used by the network.
There may be assistance from the Regional
Health Information Organization (RHIO) if one
is active in your county.
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State plan programs will continue to operate
under the regulations that are applicable to
your program today.
TCM services transitioned to HH CM services
will no longer be part of the TCM SPA and will
not be regulated by the TCM regulations