Creative Funding Approaches to Support Well

Report
Collaboration to Strengthen Management of Psychotropic
Medications for Children in Foster Care
Maximizing Opportunities to Increase Child and
Family Well Being
Through Innovative Funding Approaches
A Look at Massachusetts
Angelo McClain, Ph.D., LICSW
Commissioner, Massachusetts Department of Children and
Families
1
Children’s Behavioral Health
Initiative
• How it came about:
– Federal Medicaid program mandates Early Periodic Screening
Diagnosis and Treatment (EPSDT) for children under 21.
– Class action suit filed in Massachusetts in 2001, court found in
2006 that Massachusetts in violation of EPSDT provisions of the
Federal Medicaid Act
– Orders State to develop in-home services, including
comprehensive assessments, case management, behavior
supports, and mobile crisis services
• Who is Eligible:
– Children with SED, In addition to any other disabling condition,
such as autism spectrum disorders, developmental disability o
substance abuse
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2
Children’s Behavioral Health
Initiative Service Array
1. Intensive Care Coordination (ICC; Wraparound)
2. Family Support & Training (FS&T; Family
Partners)
3. In-Home Therapy (IHT)
4. In-Home Behavioral Services (IHBS)
5. Therapeutic Mentoring (TM)
6. Mobile Crisis Intervention (MCI)
7. Crisis Stabilization (CS) ( Approval denied by CMS)
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3
Children’s Behavioral Health Initiative
Systems Overview
HUB SERVICES
Intensive Care Coordination
(Wraparound)
Families
decide on
most appropriate
initial service
independently
or in consultation with
helping professions such as:
•primary care,
•mental health clinicians
• schools
•case workers
•community orgs
•faith leaders
•others
Emergency
Services
Mobile Crisis
Intervention
7/7/2015
•Clinical Assessment inc. CANS
•SED determination for eligibility
•Medical Necessity determination
•Care coordination
Additional
Services
(accessed
through
core clinical
services)
In-Home Therapy
•Clinical Assessment inc. CANS
•Medical necessity determination
•Care coordination available
•Behavior
Management
Therapy &
Monitoring
•Family Partners
Outpatient Therapy
•Clinical Assessment inc. CANS
•Medical necessity determination
•Care coordination available
•Therapeutic
Mentoring
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Crisis Stabilization
Leveraging Funding
• The Rosie D Judgment:
– Included language that required MassHealth to
pay for the new services, to the degree that
Federal approvals are obtained and Federal
Financial Participation is available
– MassHealth sought maximum clarity from CMS
by seeking to add the remedy services to its
Medicaid State Plan, through “State Plan
Amendments” (SPAs)
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5
Financing Through State Plan Amendment
Opportunities and Risks
Pros:
• Financial Partner to share cost…….not only
state contributions
• Provide clear authority, not dependent upon
periodic waiver renewals
Cons:
• Can be costly to implement
• Services must be available statewide
• Must meet medical necessity criteria
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6
Seeking Approval of SPAs…
…is an art and a science
• You need your Medicaid staff who regularly work with
CMS
• There are often policy and financial contexts, strategic
considerations, for every request and every decision, no
matter how minor
• Value of Subject Matter Experts (SMEs), e.g. a
consultant with recent experience working on CMS
submissions
• CMS staff in different regions can make different
decisions – stay connected to your networks
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Caring Together
Strengthening Children and Families Through Community-Connected Residential Treatment
• Joint partnership between the Massachusetts
Department of Mental Health & Department of Children
and Families
• A bold new approach to delivering residential services for
children and youth
– Integrated placement & community treatment
– Services “flex” to meet child’s changing needs
– Parent Partners
• IV – E Waiver
– Application Pending
– Use $$ currently reimbursing placement to purchase “Residential
Level of Service” in the community.
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TRADITIONAL SERVICE SYSTEM
CARING TOGETHER SERVICE SYSTEM
Child
Family
DMH Door
DCF Door
Multiple
doors
ONE DOOR
$$
$$
DMH Entrance
Requirements
JOINT ENTRANCE
REQUIREMENTS
DCF Entrance
Requirements
Joint System Management
DMH Area Offices (6)
Provider
B
Provider
C
Provider
D
Segregated Care = Multiple Clinical Teams
Same Clinical Team
Provider
A
DCF Area Offices (29)
Residential Level
of Service
Transition Services
Case Management
Behavioral Health
Improved access to seamless residential treatment9and
community based services for children and families
Benefits to Children and Families
• Integrates the way service are delivered to better
respond to families’ needs
• Maximizes flexibility of services and resources
• Shifts paradigm to recognize the importance of
delivering clinically intensive services primarily
within a child’s “home community”
• Keeps more families together; and reunites
others more quickly
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Paying for Performance
• Year 1 – Unbundled Payments
– Implement IV – E Waiver Program (pending approval)
– Gather Data While Providers Learn New Business
– Build Consensus on Performance Measures
• Year 2 – Establish Case Rate
– Blended Placement & Non-Placement
• Ex. 30 Placement; 20 Community = $240 / day
– Incentive to Increase Community Tenure
• Year 3 – Establish Well-Being Incentives
– Strengthening Families / Positive Youth Development
• Ex. Reduce Repeat Maltreatment; Educational / Vocational
Success; Reduce Reliance on Psychotropic Medication
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Multiple Payers – One Integrated Service
CHILD WELFARE
State Appropriation
(FFP Goes to General Fund)
$200M
MENTAL HEALTH
MEDICAID
State Appropriation
CBHI
$40M
CARING TOGETHER
Integrated Residential Treatment
For Children and Families
COMMUNITY SERVICES
FRC; Informal Supports
EDUCATION
Special Education Services
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Family Partner – Braiding the Funds to Change Payer, Not Partner
DMH $$$
Yes
Private Insurance
Want
DCF $$$
No
FP?
Family Partner
Eligible
STOP
Insurance
Status?
No
Masshealth
No
Have
Want
DMH $$$
FP?
FP?
No
DCF $$$
Yes
Yes
CBHI
ServicesC
ontinues
Yes
Masshealth $$$
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