Transcript Slide 1

Putting It All Together:
Collaboration and Coordinated
Care
Workshop 11
Session Format
Jim Wotring, MSW: Director, National TA Center for Children’s Mental
Health, Georgetown University; Collaboration Opportunities under the
Affordable Care Act
Linda Sagor, MD, MPD: University of Massachusetts Memorial FaCES
(Foster Children Evaluation Services) Clinic
Bill Bouska, MPA: Oregon Health Authority, Children's Mental Health
System Manager
Discussion, Questions and Peer Sharing
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Collaboration Opportunities
Under The Affordable Care Act
Jim Wotring, MSW, Director
National Technical Assistance Center for Children’s
Mental Health,
Georgetown University
Affordable Care Act
General Provisions
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
General Provisions
Coverage of young adults to age
26 on their parents’ health
insurance plans – starting 2010
• The percentage of people ages 19-25 who
have any insurance coverage increased
from 64% to 73% as of June 2011.
• This translates into 2.5 million additional
young adults with coverage.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
General Provisions
State grants awarded to start Maternal, Infant,
and Early Childhood Home Visiting Programs for
vulnerable children.
$88 million in 2010 and $225 million in 2011 to
49 states, DC, and 5 U.S. territories.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
General Provisions
Opportunities:
• Add mental health screening, early identification, and
early intervention to home visiting programs.
• Add evidence-based interventions and referral pathways to
behavioral health services.
• List of grant awardees is found at:
http://www.hrsa.gov/about/news/2011tables/110922homev
isiting.html.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
General Provisions
New Medicaid Options for States
• Young adults previously in foster care will qualify
for Medicaid to age 25 beginning 2014. This will
immediately effect about 20,000 young adults.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
General Provisions
Opportunity and Collaboration
• Ensure that services offered for young adults
are appropriate to their behavioral health
needs and provided using a system of care
approach.
• Advocate with your state department of
mental health to modify its State Medicaid
Plan to change age and definitional criteria to
allow young adults to have access to both
child and adult State Plan services.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Insurance
Exchanges
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Insurance Exchanges
An Exchange is a single place where an array of
qualified health insurance plans are available for
purchase by individuals and businesses.
It is run by a governmental agency, state
government/non-profit partnership, or nonprofit
entity. Exchanges must be in place by Jan. 1, 2014.
Exchanges must include both plans offered to
individuals and a Small Business Health Options
Program (SHOP).
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Insurance Exchanges
Exchanges also will enroll individuals in CHIP, Medicaid,
and Basic Health Plans.
States can choose to establish an Exchange or default
operations to the federal government.
States have wide discretion in setting the standards,
requirements, and rates for plans offered in the Exchange and
for monitoring plans to ensure quality and hold down costs.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Insurance Exchanges
Exchange Health Plan Benefits Packages must offer
essential benefits, including rehabilitative and
habilitative services, and allows for additional
mental health and addiction services.
Exchanges will offer
plans with different
levels of benefits,
deductibles, and copays.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Insurance Exchanges
Opportunity and Collaboration
• HHS Secretary established “benchmark” standards
for health plans offered in Exchanges. 2011
• States can choose to establish an Exchange or
default operations to the federal government. 2013
• Approximately 25 million more Americans will
have coverage
• Exchanges will require new partnerships and
expanded network of providers
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid and CHIP
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid
Federal Medical Assistance Percentage
(FMAP) for new eligible populations
(incomes of 100% – 133% of poverty)
increases:
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•
•
•
•
2014,15, and 16
2017
2018
2019
2020 and beyond
100%
95%
94%
93%
90%
States can reduce their general fund costs
for serving newly eligible populations.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
CHIP
States must maintain current
eligibility levels for CHIP through
Sept. 2019.
States receive performance incentive
bonuses for increasing enrollment
and simplifying eligibility.
Beginning 2013, states will receive a
23% increase in the CHIP match rate
through 2019.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid and CHIP
Opportunity and Collaboration
• More parents will have coverage for behavioral
health services
• More providers will be needed, building capacity
• Significant amount of state general funds savings
could be realized that could be used to fund other
behavioral health services OR anything else
• States need to forge relationships with key
advocates/agencies with a strong plan to use
“savings”
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid 1915(i)
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid 1915(i)
State Plan Amendments
• As of February 2012, eight states
(Iowa, Nevada, Colorado, Washington,
Wisconsin, Idaho, Louisiana and
Oregon) have HHS-approved 1915(i)
options in place. A number of these
states have targeted expanded services
to people with serious mental illnesses.
• Many more are considering
implementing the option to serve
people with serious mental illnesses.
Bazelon Center for Mental Health Law, The Affordable Care Act at Year Two, March 2012. www.bazelon.org
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid 1915(i)
Started in 2010: Unique type of State plan benefit with
similarities to HCBS waivers
1915(i) State Plan Amendment (SPA): States can amend their
State Plans to offer HCBS as State Plan option benefits.
Breaks the “eligibility link” between HCBS and institutional level
of care currently required under a 1915(c) HCBS waiver.
Income eligibility is up to 150% of federal poverty level or 300%
of the maximum SSI payment.
Source: Kathy Poisal, Center for Medicare and Medicaid Services
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid 1915(i): Service Examples
Case
management
Adult Day
Health
Homemaker
Habilitation
Home
Health Aide
Respite Care
Psychosocial
Rehab
Personal
Care
Clinic
Services
Day treatment or
Partial
Hospitalization
States can also offer “Other” services
Source: Kathy Poisal, Center for Medicare and Medicaid Services
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid 1915(i): Eligibility
Determined by an individualized evaluation of need e.g.,
individuals with the same condition may differ in Activities
of Daily Living (ADL)
May be functional criteria such as ADLs or use scores from
the CAFAS or CANS to measure functioning.
May include State-defined risk factors
Needs-based criteria are not:
• descriptive characteristics of the person, or diagnosis
• population characteristics
• institutional levels of care
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid 1915(i): Population of
Focus Example
States can do one plan amendment with
several target populations:
• Child or young adult in need of supportive services for
activities of daily living (ADL) because he/she is not
functioning in home, school, or community and is at
eminent risk of removal from their home (risk factor).
Age can be specified e.g. 0-3.
• Adult in need of supportive services for (ADL) because
he/she is not functioning in the community and is at risk
of psychiatric hospitalization (risk factor).
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid 1915(i)
Opportunity and Collaboration
• States must provide services statewide, building
capacity with key partnerships
• States must serve all children who meet their
CMS approved 1915(i) population definition.
However, states may identify a very specific
population in order to limit their exposure.
• The 1915(i) SPA may be phased in over a fiveyear period, allowing states time for providers to
develop new, flexible, home and communitybased services.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid Sec. 2703
Health Homes
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Homes
Medicaid
Sec. 2703
Health
Homes
States can choose to enroll
Medicaid beneficiaries with
chronic conditions into
Health Homes through a
State Plan Option to
receive comprehensive,
system of care services.
As of February 2012, HHS
approved Medicaid state
plan amendments in three
states (Missouri, New York
and Rhode Island);
3 states (North Carolina,
Oregon and Washington)
are seeking approval; and
13 states have sought
planning funds from the
Centers for Medicare and
Medicaid Services (CMS).
Bazelon Center for Mental Health Law, The Affordable Care Act at Year Two, March 2012. www.bazelon.org
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Homes
January 1, 2011
• Health Homes can be
established in community
behavioral health or
developmental disability
organizations.
Funded by
increased FMAP
• 90% for certain services for two
years.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Homes
Must provide for an individual’s primary
care and disability-specific services needs in
one location, and provide care management
and coordination for all needed services.
States may experiment with innovative
payment methodologies, including case
rates, inclusive salaries, and other
mechanisms to save on costs of care.
Health Homes must serve all ages, though a
state can define specific enrollment criteria.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Homes
Waives comparability 1902(a)(10)(B) and statewideness
1902(a)(1)
Medicaid eligible individuals must have:
• two or more chronic conditions
• one condition and the risk of developing another
• or at least one serious and persistent mental health condition
The chronic conditions listed in statute include:
•
•
•
•
•
•
mental health condition
substance abuse disorder
asthma
diabetes
heart disease
being overweight (as evidenced by a BMI of > 25).
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Homes
Three distinct types of providers can provide
Health Home services: designated providers; a
team of health care professionals; and a health
team.
Providers of health home services are required
to report quality measures to the state as a
condition for receiving payment.
States are required to collect utilization,
expenditure, and quality data for a federal
interim survey and an independent evaluation.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Homes
Required
Health
Home
services
reimbursed
at 90%
federal
FMAP are:
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•
•
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Comprehensive Care Management;
Care coordination;
Health promotion;
Comprehensive transitional care
from inpatient to other settings;
• Individual and family support;
• Referral to community and social
support services; and
• Use of health information
technology, as feasible and
appropriate.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Homes
Opportunity and Collaboration
• Children and youth with serious
behavioral health problems and their
families will be able to receive integrated
care: both mind and body.
• Successful state systems of care and
wraparound processes can serve as
models for the design of Health Homes.
• Linkages and close partnerships to
primary care health providers will be
essential.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Citations and Resources
This presentation utilized the following organization web-sites:
• Government Health Care Website
www.HealthCare.Gov
• National Council for Community Behavioral Healthcare
www.TheNationalCouncil.org
• The Arc www.thearc.org
• The Kaiser Family Foundation
www.kff.org
• The Robert Wood Johnson Foundation/George Washington Univ
www.healthreformgps.org
• The Bazelon Center for Mental Health Law
www.bazelon.org
• The federal Centers for Medicare and Medicaid
www.cms.gov
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Jim Wotring
[email protected]
202-687-5052