Transcript NYS HCBS Waiver

NYS HCBS Waiver
Services
Process:
 NYS OMH solicited input from both
children’s mental health services providers
and families across NYS
 Sample of providers were asked to consult
with families and develop
recommendations for services
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Services
From this, six services were identified:
Respite, Skill Building, Family Support,
Intensive In Home, Crisis Response and
Individualized Care Coordination
 In addition, consumer service dollars (flex
dollars) were identified as needed to help
support on-going and emergency needs
when other resources were unavailable
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Services: Guiding Principles
Implementation of Child & Adolescent Service
System Principles (CASSP)
 Individualized, strength-based service plans
 Youth focused
 Family driven
 Community based
 Multi-system collaboration
 Culturally and linguistically competent workforce
 Least restrictive environment
Services
Services are designed to:
 Address age appropriate emotional and social
development and learning
 Provide enhanced engagement of families to
cultivate resiliency and promote parenting skills
for raising children with emotional health needs
 Assure availability of the right services at the
right time in the right amount in the right venue
Services
Ensure integrated and effective services
through one family/one plan
 Support therapeutic processes and
models and
 Provide continuity of care through the care
coordinator
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Development of Capacity
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1996 began with 125 slots in 5 boroughs of NYC and 6
counties
Gradual growth to current capacity of 1506 slots in 61
out of 62 counties
Ratios and rates were individualized per provider for
many years
2006 implemented standardized operational elements
such as:
6:1 enrollee to care coordinator ratio
5:1 care coordinator to supervisor
Standard upstate and downstate rates
Development of Capacity
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For determining slot allocation per county:
US General Population Statistics for
population of children shows population of
children aged 0 to 17 years by county; a %
estimate of children with SED is then
applied; slots are assigned per county
accordingly
Strategies for Provider and
Network Development
Establishing ICC agency:
 LGU announces availability of program and invites
interested agencies to submit criteria
 LGU reviews and makes recommendation to OMH
 OMH reviews for existing contracts with OMH and
related standing; consults with OMH Field Offices
regarding standing
 OMH approves and enters contractual agreement with
the new ICC agency authorizing billing of Medicaid for
approved number of slots; renewed annually
Strategies for Provider and
Network Development
Other than ICC, remaining 5 services may be
subcontracted out by ICC agency (required to
offer all 5 services)
To establish subcontractors:
 LGU issues Request for Services, reviews these
and submits recommendation to OMH Waiver
Coordinators
 OMH Waiver Coordinators check for other preexisting contracts and agency standing and
determine approval
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Structure for Provider Network
ICC agencies (the lead agencies) are considered
Organized Health Care Delivery Systems.
This enables them to:
 enter into contracts with the providers of the five
non- care coordination services
 bill Medicaid for six Waiver services
 monitor qualifications of subcontracted workers
as well as agency staff and
 complete Incident Reports.
Structure
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LGU can recommend that ICC agency provide
all 6 services as well as use sub-contractors
Providers can be private voluntary agencies or
for profit agencies
LGU can recommend to OMH that an agency be
discontinued as a service provider for cause and
can also recommend an addition of an ICC
agency (more than one are allowed per county)
Lessons Learned
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ICC should not be defined as primary clinician
Network cannot develop without a critical mass
(assurance needed that enough work will be
generated to make it fiscally viable)
Standardization of case load size and rates for
services is desirable
Need for accurate assessment tool (CANS)
integrated into service plan
Lessons Learned
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Standardize case record forms wherever
possible
Standardize required training curricula and be
attentive to evolution of training over time
Directly inform ICC agency fiscal officers as well
as program managers of billing rules and rates
Provide clear, distinct service definitions and
monitor the provider’s understanding of them
Greatest Successes
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Implementing individualized, strength based,
family driven model and influencing a cross
systems adaptation of this model
On-going effective engagement of children and
families throughout enrollment
Dis-enrollment from Waiver to less intensive
levels of care (75-79%)
Adoption of CANS and consequent integration
across OMH children’s programs
Most Problematic
Challenges to developing sufficient critical
mass in subcontractors
 Adapting to change on the provider level
 Implementation of standardization is an
on-going challenge
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