available here - NYS Council for Community Behavioral Healthcare

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

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