Supportive Housing and the Division of Addiction Services

Report
NJPRA Annual Conference
11/22/13
Lynn A. Kovich
Assistant Commissioner
1
Agenda

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
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Update on the ASO/MBHO Process
Update on Rate Setting
Medicaid Expansion
Health Home/Learning Collaborative
Newly Awarded Contracts and
Current RFP’s
System Highlights
DMHAS Workplan
Recovery and Rebuilding Post Sandy
2
UPDATE ON THE
ASO/MBHO PROCESS
3
ASO/MBHO Process

DMHAS continues to work with NJ Medicaid on the behavioral health
components of the Medicaid Comprehensive Waiver.

New Jersey’s Waiver was approved by CMS on October 1, 2012.

The CMS approval letter and Special Terms and Conditions are posted
at: http://www.state.nj.us/humanservices/dmahs/home/waiver.html.

The DMHAS website provides updated information on the Waiver and
development of the MBHO at:
http://www.state.nj.us/humanservices/dmhs/home/mbho.html.

RFP to procure a vendor for the MBHO developed collaboratively by
DMHAS and DMAHS
◦ Review/finalize design elements by DMHAS/DMAHS executive staff and
interdivisional/interdepartmental partners
◦ Review/content from Department of Banking and Insurance (DOBI)
◦ Review/approval by DHS Central Office Procurement
◦ Review/approval by Office of Information Technology (OIT), Office of
Management and Budget (OMB), and the Office of the State Comptroller
(OSC)
◦ RFP transmitted to Department of Treasury, Division of Purchase and Property
(DPP)
◦ RFP published/posted by DPP
◦ Responsive bidder identified
4
Roles and Responsibilities in a
Managed Behavioral Healthcare
System
Eligibility
 Network Development and
Management
 Assessment and Referral
 Utilization Review
 Claims Administration
 Data Analytics
 Care Management
 Quality Management
 Financial Management

5
UPDATE ON RATE SETTING
6
Rate Setting

DMHAS has engaged Myers and Stauffer
(M&S), a national CPA firm, to conduct the
rate analyses for DMHAS services

Objectives:
◦ Develop a fee schedule that is reflective of the
costs incurred in providing the services, which will
be rolled out concurrent with ASO going live
◦ Encourage cost efficiencies through new
payment system
◦ Provide equity in rates or “like rates for like
services”
◦ Promote access to community alternatives to
institutional placement
◦ Maintain/increase access to services State-wide
7
Practice Groups

A series of meetings were held 12/9-12/12 that
included representatives from providers of mental
health and substance abuse services, DMHAS staff,
consumers and M&S
◦
◦
◦
◦
◦
◦
◦
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Outpatient
Partial Care
Residential
Supportive Housing
Methadone
Case Management
PACT
These meetings are a key opportunity for
stakeholders to provide very specific feedback to
both DMHAS and M&S on the costs required to
deliver services to clients.
8
Deliverables
Preliminary Rates
 Fiscal Analysis:

◦ Aggregate Fiscal Impact Program Wide
◦ Provider Level Fiscal Impacts
◦ Federal / State Fiscal Impacts

Final Rates:
◦ Ready, with any adjustments from stakeholder review,
hopefully by end of 1st quarter of CY14.
◦ They will not be effective until ASO goes live.
◦ They are for most services currently funded by DMHAS
◦ A subset of services will remain under contract
reimbursement
 Certain services where State needs to buy overall capacity,
as opposed to utilization, such as Emergency Services,
Intensive Family Support Services and PATH.
 Inpatient psychiatric services paid exclusively by Medicaid
are, for now, not part of this new rate-setting exercise.
9
MEDICAID EXPANSION
10
NJ FamilyCare Summary
Newly Eligible Populations
• Parents and Caretaker
Relatives
Increased Income Limits
• Single Adults and Childless
Couples
• 133% of the Federal
Poverty Level for most NJ
Residents ($25,975 for a
family of 3)
Federal Share of Benefits
Timetable
•
•
•
•
•
January 2014: 100%
January 2017: 95%
January 2018: 94%
January 2019: 93%
January 2020: 90%
• Increased Limits for
Children and Pregnant
Women
• Oct. 2013 – Applications
begin
• Jan. 2014 – New benefits
begin for an estimated
300,000 new Medicaid
beneficiaries
11
Overview
Before
After
NJ Family Care
• Families with income up to
133% of the federal poverty
level (FPL)
• Children in families with
incomes up to 350% FPL
• Pregnant Women up to
200% FPL
•
•
NJ Family Care
All Medicaid eligible
populations
Medicaid
Aged, Blind and Disabled
up to 100% FPL
Childless Adults up to 25%
FPL
12
NEW FAMILYCARE
IMPACT ON BEHAVIORAL
HEALTH CARE
13
Mental Health Parity and
Addictions Equity Act (MHPAEA)
in ACA
On October 3rd, 2008, the Paul Wellstone
and Pete Domenici Mental Health Parity and
Addiction Equity Act of 2008 was signed into
law. This Federal law requires group health
insurance plans (those with more than 50
insured employees) that offer coverage for
mental illness and substance use disorders to
provide those benefits in no more restrictive
way than all other medical and surgical
procedures covered by the plan.
 Within the ACA, States who are
implementing Medicaid Expansion need to
provide the 10 Essential Health Benefits
(EHBs) in the ABP that includes mental health
and substance abuse services

14
Benefit Plan

The Alternative Benefit Plan (ABP)
needs to meet MHPAEA
requirements

Plan D or General Assistance as
parents or childless adults will be
part of the ABP plan and receive a
richer benefit then they have
today.
15
10 Essential Health Benefits
Ambulatory Patient
Services
Rehabilitative &
Habilitative Services and
Devices
Emergency Services
Prescription Drugs
Hospitalization
Laboratory Services
Maternity and Newborn
Care
Preventive & Wellness
Services and Chronic
Disease Management
Mental Health and
Substance Abuse Disorder
Services
Pediatric Services
(inc. Oral & Vision Care)
16
BH Services in the ABP
BH services currently in the
State Medicaid Plan
• Targeted Case Management
(ICMS)
• Community Support Services
(1/14)
• Behavioral Health Home (1/14)
• MH Outpatient
• SUD Outpatient (limited)
• Adult Mental Health Rehabilitation
(group homes)
• Inpatient psychiatric services
• Opioid Treatment Services
• Psychiatrist, Psychologist or APN
• Partial Care/Hospitalization
• Medical Detox
• PACT
Additional BH services to
be covered in the ABP
*Non-medical detox
SUD partial care
SUD IOP
*SUD Halfway House
SUD Outpatient
*SUD short term
residential
• Psychiatric Emergency
Services/Affiliated
Emergency Services
•
•
•
•
•
•
*Subject to IMD exclusion
SUD - Substance Use Disorder
17
BEHAVIORAL HEALTH
HOMES AND LEARNING
COMMUNITY
18
Behavioral Health Home SPA

BHH SPA will include children/ adolescents/
youth
◦ DMAHS is working with DCF on the development
of the children’s program design
Targeted to individuals with Serious Mental
Illness who are at risk for high utilization of
services and children/adolescents/young
adults with Severe Emotional Disturbances
with a chronic medical condition
 Plan to roll out the service county by county

◦ Bergen and Mercer – calendar year 2014
◦ DMHAS and DMAHS will measure outcomes and
impact on costs
◦ Other counties to follow based on analysis of
initial homes and financial resources
19
Behavioral Health Home
Learning Community

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We have contracted with The National Council for
Behavioral Healthcare to develop and facilitate a
Behavioral Health Home Learning Community
An RLI for Bergen County providers to join the
Learning Community will be issued
Members of the Learning Community will develop
a Behavioral Health Home implementation plan
Upon approval of the plan by DMHAS they will
become certified Behavioral Health Homes and
eligible to provide the service to Medicaid
participants
Certified Behavioral Health Homes will have 2 years
to become accredited as a Behavioral Health
Home from a nationally recognized accrediting
body
20
Behavioral Health Home Services
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Comprehensive care management
Care coordination
Health promotion
Individual and family support services
(including authorized
representatives)
Comprehensive transitional care
(including community and systems
transitions)
Referral to community and social
support services
21
CURRENT RFP’S &
NEWLY AWARDED
CONTRACTS
22
Current RFP’s

Expansion of existing PACT and RIST programs in
Cumberland, Gloucester, Mercer, Middlesex,
Monmouth, Morris, Ocean, Salem and Union counties.
◦ Issued – 10/15/13
◦ Services will be targeted to facilitating the discharge of 70
persons on CEPP status at a state psychiatric hospital, for a
total of up to $2.45 million
◦ Due Date - 11/22/13 with a 1/3/14 notification date

Supportive housing in Burlington, Camden, Cumberland,
Gloucester, Hunterdon, Mercer, Morris, Passaic, Salem,
Somerset, Sussex, and Warren Counties
◦ Issued – 10/16/13
◦ Targeted to service 52 adults diagnosed with a serious and
persistent mental illness whose homelessness or risk of
homelessness places them at risk of psychiatric
hospitalization, for annualized funding of up to $1.3 million
◦ Due Date - 11/26/13 with a 1/13/14 notification date
23
Newly Awarded Contracts

On 6/17/13 DMHAS issued an RFP for the provision of
outpatient mental health care and integrated co-occurring
services to adult consumers age 21 and older presenting at
mental health ambulatory care centers.
◦ Awards went to Greater Trenton Community Mental Health Center
(Mercer), Trinitas Regional Medical Center (Union), Eva’s Village
(Passaic), CPC Behavioral Healthcare (Monmouth) and Inspira Health
Network (Gloucester, Cumberland, Salem and Camden).

On 8/20/13 DMHAS issued an RFP to support the creation of
long term residential, short term residential and halfway house
beds in response to Phase 2 Drug Court expansion.
◦ Awards went to Maryville, John Brooks Recovery Center, Straight &
Narrow, United Progress Inc., Real House, Integrity, Inc., Community
Recovery Services, RMS Housing Associates/Angel Hope House, CURA,
Inc., and Urban Renewal Corp.

On 9/10/13 DMHAS was awarded a Strategic Prevention
Framework - Partnerships for Success (SPF-PFS) cooperative
agreement from the Center for Substance Abuse Prevention
(CSAP). The agreement provides $2.2 million annually,
renewable for five years.
◦ The SPF-PFS is designed to address two of the nation's top substance
abuse prevention priorities: 1) underage drinking among persons aged
12 to 20; and 2) prescription drug misuse and abuse among persons
aged 12 to 25. The SPF-PFS is also intended to bring SAMHSA's Strategic
Prevention Framework (SPF) to a national scale.
24
SYSTEM HIGHLIGHTS
25
Admissions to NJ State Psychiatric Hospitals:
SFY 2006-2013
(Excluding Ann Klein Forensic Center)
3,500
3,000
2,938
2,811
2,763
2,500
2,247
2,223
2,070
2,000
2,064
1,891
1,500
1,000
SFY
2006
SFY
2007
SFY
2008
SFY
2009
SFY
2010
SFY
2011
SFY
2012
SFY
2013
NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems. November 2013.
26
Total Average Census at NJ State Psychiatric Hospitals
(excl. AKFC): SFY 2006 - 2013
2,200
2,122
2,116
2,000
1,951
1,806
1,800
1,671
1,600
1,591
1,534
1,450
1,400
1,200
1,000
SFY
2006
SFY
2007
SFY
2008
SFY
2009
SFY
2010
SFY
2011
SFY
2012
SFY
2013
NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems. November 2013.
27
Clients Served by the SMHA in Supportive Housing
(duplicated) SFY 2006 – SFY 2012
6,000
5,324
5,000
4,560
4,000
3,497
4,063
3,051
3,000
2,534
2,136
2,000
1,000
0
SFY 2006
SFY 2007
SFY 2008
SFY 2009
SFY 2010
SFY 2011
SFY 2012
NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems.
November 2013.
28
Clients Served by the SMHA in Supportive Housing (duplicated)
and in the Non Forensic State Hospitals SFY 2006 – SFY 2012
6,000
5,000
5,205
5,095
5,324
5,008
4,120
4,000
3,497
4,474
3,802
3,652
3,051
3,000
2,000
4,100
3,818
2,136
2,534
1,000
0
SFY 2006
SFY 2007
SFY 2008
# Served in Supportive Housing
SFY 2009
SFY 2010
SFY 2011
SFY 2012
# Served in Non Forensic State Hospitals
NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems. November 2013.
29
Total Adults Served by the SMHA in Community Services
(duplicated) SFY 2006 to SFY 2012
310,000
300,569
300,000
284,741
290,000
292,212
280,000
270,000
260,000
250,000
254,727
253,439
259,048
246,304
240,000
230,000
220,000
SFY 2006
SFY 2007
SFY 2008
SFY 2009
SFY 2010
SFY 2011
NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems.
November 2013
SFY 2012
30
DMHAS WORKPLAN
31
DMHAS 18-Month Workplan

Four strategic planning sessions held in Spring 2013 centered
around:
◦ workforce development
◦ community integration
◦ move to managed care
The feedback that was elicited is being used to generate tasks
within the 18 month workplan (January 2014-June 2015)
 The Parker Dennison workplan for the CSS was used as a
template, with additional interdependent priorities added to
create a division wide plan

◦ Division projects that are independent are not included on the
workplan, but will continue to develop during this timeframe, such as
suicide prevention, SBIRT, Sandy Initiative, etc.
DMHAS has identified team leads and workgroup members,
which have begun meeting this fall to discuss tasks and
timelines for the identified priority areas.
 The Communication Plan Workgroup, led by Susanne Mills, will
communicate, at least quarterly, with stakeholders to keep
them apprised of the status of the work being done on the
priorities. Communication may come via the website, email
announcements, meetings with providers, etc.

32
DMHAS Workplan Priorities

The workplan, which is in the process of being finalized,
consists of 11 priority areas that include:
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Community Support Services Implementation
Rates and Financial Terms/Financial Impact Analysis
Centralized Housing Authority
ASO Procurement
Community Integration
Workforce Development
Standard Level of Care Determination
Changes to DMHAS Functions
Consumer and Stakeholder Communication Plan
Olmstead Compliance
ASO Readiness and Implementation
Each of these priority areas are tied to at least one of
the three Strategic Planning Areas
There will be additional opportunities for stakeholder
involvement
33
RECOVERY AND
REBUILDING POST SANDY
34
Social Services Block Grant

This post Sandy recovery initiative includes the following services in the counties of Atlantic,
Bergen, Cape May, Cumberland, Essex, Hudson, Middlesex, Monmouth, Ocean and Union:
◦
MH and SA Outpatient ($5M)
◦
Early Intervention and Support Services ($4M)
◦
SA Detoxification & Short Term Residential ($7M)
◦
Supportive Housing & Career Services ($3.1M)
◦
Public Awareness Campaign ($2M)

Temporary staff have been hired, including Renee Burawski to manage the program

As of November 2013, UBHC is developing a panel of licensed clinicians to provide clinical
mental health and substance abuse outpatient counseling to individuals who resided in the
ten most impacted counties at the time of Sandy
◦

Individuals contacting the UBHC Access Center will be screened for services and provided
appointments with clinicians or referred to Detoxification and Short term Residential as
necessary
Substance abuse detoxification and short term residential were launched this month and are
accepting referrals
◦
As of 11/21 there have been 115 total authorizations in the Recovery and Rebuilding
Initiative including assessment (27), detoxification (47) and short term residential (41)
authorizations.

DMHAS will expand EISS in Monmouth and Ocean counties as of December 2013

Services will be available through September 2015

As this is special federal grant funding, it will also be considered payor of last resort
35
DMHAS Social Services Block Grant
Sandy Initiatives
October 2013 to September 30, 2015
Department of Human
Services
Division of Mental
Health
and Addiction
Services
Supportive Housing
400 beds total
Short Term Residential
and Detox
160 SUD and 240 SMI
and Co-Occurring
5 existing FFS providers,
6 locations
Additional services
include Supportive
Employment and
Education Services,
Housing Navigators
Additional services
include comprehensive
intake, family, individual
and group therapies,
medication monitoring,
case management
Outpatient
Counseling
UBHC/Rutgers
Network of Private
Practitioners
EISS expansion
(Monmouth and
Ocean)
Media Campaign
(MHANJ)
Additional services
include
psychiatric evaluation,
medication monitoring,
tele-behavioral health
support
36

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