Children's Health and Behavioral Redesign Updates - June 22, 2017

Childrens Health and Behavioral Health Redesign Updates June 22, 2017

2 June 22, 2017 Agenda Children's 1115 Waiver Submission and Modifications Transitioning 1915(c) Waiver to 1115 MRT Waiver Operationalizing 1115 Waiver Upcoming Training Schedule Draft Medicaid MCO Children s System Transition Requirements and Standards: Stakeholder Feedback SPA/HCBS Provider Designation Update of State Agency Regulations Children's Health Home

3 June 22, 2017 Children s 1115 MRT Waiver Submitted to CMS on May 9, 2017

4 June 22, 2017 Modifications Reflected in 1115 MRT Submission 1) Waiver will be implemented Statewide 2) Avoids bifurcating the transition of Care at Home/medically fragile children to Managed Care by including OPWDD CAH waiver (along with DOH CAH waiver) in the Children s 1115 MRT Waiver 3) RRSYs will remain carved out of Managed Care and will transition at a later date In addition and as discussed, the effective date for 6 New Children s SPA Services (Crisis Intervention, CPST, Family and Peer Supports, PSR, Other Licensed Practitioners) will be aligned with the date benefits will transition to managed care

5 June 22, 2017 Children s 1115 Waiver Submitted to CMS on May 9, 2017 Schedule of Key Implementation Dates New York State Proposed 1115 Waiver Amendment (Effective Date of Waiver Amendment January 1, 2018) Effective Date Children s 1115 Waiver Six 1915(c) Children s Waivers (OMH HCBS Waiver, Bridges to Health (DD, MFC, SED), DOH Care at Home I/II and OPWDD Care at Home) authority transitions to 1115 waiver authority 1/1/18 Preparatory activities for aligned service delivery and transition of care coordination for children/families from 1915(c) Children s Waivers to Health Home (OMH HCBS Waiver, Bridges to Health (DD, MFC, SED), DOH Care at Home I/II and OPWDD Care at Home) 1/1/18 to 7/1/18 7/1/18 to 12/31/18 Complete alignment of Children s HCBS 1915(c) under 1115 (Level of Care Population) Children s Behavioral Health Benefits Transition to Managed Care and Exemption from Enrollment in Managed Care will be Removed for Children in the Six 1915(c) Waivers Foster Care Population to Managed Care Expansion of Children s HCBS for Community Eligible and Family of One Level of Need Population 7/1/18 1/1/19 1/1/19

6 June 22, 2017 Transitioning 1915(c) Waiver to 1115 MRT Waiver Objective is to ensure the transition of children and families to the 1115 is smooth, well informed and there is no disruption in services State partners are preparing a draft Transition Plan for review and comment by stakeholders and CMS Major features of the Transition Plan to include: A set period of 1/1/18 to 7/1/18 to prepare for Health Home enrollment Service continuity of care provisions Assurance of provider reimbursement throughout transition The Transition Plan will be finalized well in advance of 1/1/18 Target Date August 2017 Detailed guidance will be provided including: Assistance for providers and children and families with readiness activities, including written materials, webinars, and in person meetings to help communicate and educate families about the Transition Plan and be responsive to their questions and concerns

7 June 22, 2017 Transitioning 1915(c) Waiver to 1115 MRT Waiver The Transition Plan provides a road map for all activities under the Children s system transformation, including: The timing and process for transitioning from 1915(c) care management to Health Home care management The timing and process for transitioning from 1915(c) HCBS to the fully aligned 1115 HCBS Clearly defined billing rules and procedures during and after the Transition Period More formal communication and education activities will begin in September 2017 when the Transition Plan is finalized It is anticipated first transition activities for children/families will be scheduled to begin in March/April 2018

8 June 22, 2017 Operationalizing 1115 Waiver In addition to transitioning currently enrolled 1915(c) children to the 1115 waiver the State Partners will be working to develop detailed procedures and guidance to operationalize 1115 waiver, including: Use of Independent Entity to determine HCBS eligibility for family of one and members not currently enrolled in Medicaid Developmental Disability (DD) eligibility will remain a function of OPWDD Training on new services and aligned HCBS services Procedures for accessing SPA and HCBS services for children and families, providers, Health Homes, care management agencies, and plans Training for Health Homes, and care management agencies using CANS-NY and applied algorithm for HCBS eligibly, approval of HCBS services by plans and plans of care SPA and HCBS rates will be finalized (also subject to CMS approvals)

9 June 22, 2017 Transitioning 1915(c) Waiver to 1115 MRT Waiver

10 June 22, 2017 Upcoming Provider Training Topics Managed Care Contracting Revenue Cycle Management Utilization Management Rules Managed Care Billing and Rates SPA/HCBS In-depth Service Specific Implementation Support HCBS Workflow Family Centered Training Interaction Between Health Homes, MCOs, Providers, And Families Detailed scheduled will be made and will be advertised via list serves and MCTAC as soon as possible

11 June 22, 2017 Draft Medicaid MCO Children s System Transition Requirements and Standards: Stakeholder Feedback Comments were due on April 5, 2017 State received comments from 20 entities: Plans, Providers, Advocacy Groups, Local Governments, and other Stakeholders Common themes were identified across submissions July 2017: Anticipated release date of Final Children s Requirements and Standards MCOs will have 90 days to submit responses Qualification process will be statewide

12 June 22, 2017 Stakeholder Feedback Takeaways Main Theme: Clarifying that transition is broader than behavioral health managed care (inclusive of OPWDD, Foster Care and Medically Fragile populations) Personnel: Ensuring there are experienced and qualified staff to meet the needs of the children s population while also allowing for staffing flexibility BH Medical/Clinical Directors MCO Foster Care Liaison MCO Medically Fragile Liaison Network and Contracting: Establishing comprehensive networks prior to transition Utilization Management: Sharing medical necessity and prior authorization rules to MCOs and providers Billing: Understanding the Managed Care payment structure

13 June 22, 2017 Stakeholder Feedback: Next Steps Standards will be revised, including reflecting the inclusion of the OPWDD CAH in the 1115 Waiver, and final Standards will be released in late July MCOs will have 90 days to submit responses Qualification process will be statewide State is working on an Children s Design Implementation Guidance similar to the Implementation Guidance document developed for the Adult BH transition The State is continuing to work on amendments to the Medicaid Managed Care Model Contract Implement start-up activities Readiness trainings for MCO and providers is being developed Additional information will be sent out through the children s managed care listserv To subscribe visit: http://www.omh.ny.gov/omhweb/childservice/

14 June 22, 2017 Update of State Agency Regulations DOH Title 18 provides authority for interagency designation of SPA providers for the 6 added services for children/ youth under age 21; crisis intervention, other licensed practitioner, community psychiatric support and treatment, psychosocial rehabilitation, family peer support services and youth peer support services The State cannot designate providers in advance of approval of DOH Title 18, OMH regulations and OASAS regulations to implement State Plan services All regulations are making their way through internal and formal review process anticipated date of approval October 2017

June 22, 2017 15 OASAS Regulations Will be presented to the Behavioral Health Advisory Council on July 12, 2017 Providers receive an OASAS Operating Certificate for the 6 new SPA services for those who apply to treat youth with a Substance Use Disorder OASAS Certification Process Attestation Process for those providers who are currently certified by OASAS and/or licensed by OMH Other providers will apply through an OASAS Certification Application Once a Provider is has been Designated they will receive an OASAS application OASAS Certification Certification for those who are currently certified by OASAS and/or licensed by OMH will occur at the same time as SPA designation Providers requiring a full application will be reviewed and certification issued within 90- 120 days after OASAS receives a completed application. Please note a completed application can be submitted prior to SPA designation

June 22, 2017 16 OMH Regulations Will be presented to the Behavioral Health Services Advisory Council on July 12, 2017 Creating regulatory pathways to authorize new six State Plan services Analyzing MH Law to discern which services require licensure Developing a mechanism to facilitate agency licensure/ authorization of new services beginning with Provider Designation Application Working to develop required regulations and move them towards promulgation

17 June 22, 2017 Designation of Children s SPA and HCBS Providers Application was revised to include additional questions and has been in production as of 6/14/17 The Designation Application re-release will be forthcoming and is available online: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/ children/provider_design.htm For applications that were submitted prior to the 6/14/17 modification date, an e-mail will be sent by NYS requesting additional information from provider agencies that have previously submitted applications New York State (NYS) will be prioritizing current system providers under the auspices of the five State agencies in the initial review period for designation

18 June 22, 2017 Designation of Children s SPA and HCBS Providers Applications will be accepted on ongoing basis For initial start up providers should submit Application asap but no later than July 31, 2017 Formal designations for current system providers will likely occur in October anticipated date regulations will be approved An outline of assessment criteria which State Partners will be utilizing in reviewing applications SPA/HCBS designation will be available online: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/provide r_design.htm Providers are encouraged to reference these guides when completing their application.

Childrens Health Home Updates

June 22, 2017 20 Monthly Outreach and Enrollment Trends as of May 2017 As of May 2017 1st Quarter February 2nd Quarter April December January March May Outreach 3,718 4,187 4,585 3,595 3,494 3,068 Enrollment 2,779 4,412 6,039 7,658 8,218 9,631 Outreach: Child/legal representative working with a care manager, consent to enroll has not been signed Enrollment: Consent has been signed, child is enrolled

June 22, 2017 Monthly Health Home Outreach Trends as of May 2017 * Note: Enrollment & Outreach data is reported as a point-in-time reference as of May 31, 2017 21 HH NAME As of May 2017 ADIRONDACK HEALTH INSTITUTE INC CATHOLIC CHARITIES MH CHHUNY LLC CHILDREN'S HEALTH HOME OF WNY CNYHHN INC COMMUNITY CARE MANAGEMENT PART COORDINATED BEHAVIORAL CARE IN GREATER ROCHESTER HLTH HOME NE HUDSON RIVER HEALTHCARE INC INSTITUTE FOR FAMILY HLTH MONTEFIORE MEDICAL CENTER MOUNT SINAI HLTH HM SER CHILDR NIAGARA FALLS MEM MED CTR ST MARYS HEALTHCARE THE COLLABORATIVE FOR CHILDREN Totals HHSC Outreach 1/2017 30 114 862 0 22 32 387 19 116 5 18 0 115 12 2,455 4,187 4/2017 5/2017 12/2016 2/2017 3/2017 21 146 859 60 87 36 242 23 107 58 25 61 111 25 7 587 40 125 1,030 28 168 1,057 25 131 1,002 0 27 16 34 478 20 148 13 10 46 26 34 345 25 93 25 28 28 25 57 39 45 324 24 92 59 32 54 121 29 44 329 15 90 136 15 0 7 144 31 6 7 4 8 6 1,225 3,068 2,293 3,718 2,600 4,585 1,659 3,595 1,483 3,494 Note: Northwell is continuing its readiness activities to become designated to serve children

June 22, 2017 22 Monthly Health Home Enrollment Trends as of May 2017 *Please Note: Enrollment & Outreach data is reported as a point-in-time reference as of May 31, 2017 HH NAME May 2017 ADIRONDACK HEALTH INSTITUTE INC CATHOLIC CHARITIES MH CHHUNY LLC CHILDREN'S HEALTH HOME OF WNY CNYHHN INC COMMUNITY CARE MANAGEMENT PART COORDINATED BEHAVIORAL CARE IN GREATER ROCHESTER HLTH HOME NE HUDSON RIVER HEALTHCARE INC INSTITUTE FOR FAMILY HLTH MONTEFIORE MEDICAL CENTER MOUNT SINAI HLTH HM SER CHILDR NIAGARA FALLS MEM MED CTR ST MARYS HEALTHCARE THE COLLABORATIVE FOR CHILDREN Totals HHSC Enrollment 2/2017 166 221 1,589 0 55 96 658 27 324 4 64 0 86 87 1,035 4,412 5/2017 12/2016 1/2017 3/2017 4/2017 139 158 934 188 266 216 310 231 320 255 344 2,130 2,629 182 2,778 283 3,126 349 0 83 59 102 835 33 343 54 75 501 23 217 67 110 61 113 80 126 1,055 1,119 1,339 40 382 19 91 65 145 97 43 392 21 93 89 156 101 42 509 14 117 125 158 107 3 9 23 0 61 71 520 79 39 128 96 1,649 6,039 2,250 7,658 2,418 8,218 2,940 9,631 2,779

June 22, 2017 23 Enrollment in Children s Health Home by Age As of June 20, 2017 Age Group Under 3 3 to 5 6 to 10 11 to 17 18 to 21 Grand Total Enrollment Outreach Total 210 843 542 752 2267 6,452 10,251 1,417 21,139 1,424 3,176 4,747 1,573 11,462 3,276 5,504 1,023 10,856 Data by age only, may include persons 21 years and younger being served within an adult HH also Data on slide will not match previous slides due to the data being pulled at different times

June 22, 2017 24 Transition of OMH TCM to Health Homes It has been and continues to be the State s intent to rate reconcile OMH TCM providers to ensure cash flow stability For a two year period, OMH TCM rates will be reconciled quarterly (Note reconciliation process does not apply to OMH State Operated TCM providers) Under the initial schedule, with full conversion anticipated by the end of January 2017 by all providers, reconciliation was to begin after all OMH TCM had stopped billing OMH TCM rate- this approach was designed to ensure maintenance of cash flow and avoid double billing In practice not all OMH TCM providers completed the transition process by end of January extensions granted thru March, many completed the conversion well beyond March, many different approaches to transitional billing rules and ending billing of TCM DOH will be taking into account experience with OMH TCM conversion as it provides guidance to waiver providers that will convert to Health Home, including periodic webinars to trouble shoot and address questions

June 22, 2017 25 TCM Providers Rate Reconciliation The differences in timing and approaches to conversion across TCM providers impacts timing and information required to perform reconciliation Webinar held on May 19, 2017 to discuss process including the need for providers to attest to the date they stopped billing legacy rates attestations were due May 24, 2017 DOH is working on the initial reconciliation for the OMH TCM providers that converted to HHSC as of December 2016, and is focusing and prioritizing providers experiencing cash flow difficulties The initial reconciliation will be for the December 2016 to March 2017 period and quarterly thereafter A subsequent reconciliation will be calculated for providers that converted to HHSC after December 2016 DOH will be reaching out to providers that had a date and/or MMIS Provider Id in the attestation that is not consistent with OMH TCM claims OMH providers encouraged to contact DOH directly with issues or concerns Important NOTE: Reconciliation calculations will be determined through data entered in the MAPP Health Home Tracking System all data must be update for reconciliation to be accurate

June 22, 2017 26 Status of Readiness Activities for Enrolling EI and Health Home Eligible Children in Health Home The Department of Health, Health Home Serving Children and the Bureau of Early Intervention have been working with Health Homes, Early Intervention providers and other stakeholders to ensure processes and systems are in place for enrolling eligible EI children in Health Homes Initial begin date to enroll EI children March 2017 at that time EI stakeholders requested more time to complete readiness activities, Health Homes were still building adequate networks/ entering into Business Associate Agreements, and cross training activities in Health Home systems and program requirements and EI systems and program requirements incomplete Begin enrollment date moved to September 2017 Letters of Interest to provide EI were due April 28, 2017 A few providers have indicated they are ready now In response, DOH provided opportunity for providers who submitted Letters of Interest to provide EI to demonstrate to DOH and lead HH, through an attestation process, they are ready to serve EI children

June 22, 2017 27 Health Home and DOH EI Approved Providers The NYS DOH Health Home program and the Bureau of Early Intervention is pleased to announce the following agencies have been approved for early enrollment of Early Intervention children within the Health Home program and the lead Health Home(s) they will be working with. Approved Provider: In the Approved Health Home network of: Blythedale Children's Hospital BAHN Health Home Erie County ARC Heritage Centers NYSARC OHK Healthy Kids Health Home Liberty Resources LLC CCF Health Home People, Inc. OHK Healthy Kids Health Home St Mary's Hospital for Children/EI - Extraordinary Pediatrics CCF; CCMP; HRHCare; Mt Sinai; Northwell All other providers interested in providing Health Home Care Management services to Early Intervention children who meet the eligibility and appropriateness for Health Home and Early Intervention On-going Service Coordination will be reviewed for their readiness and cross-trained staff for an implementation date of September 2017.

RESOURCES TO STAY INFORMED: OMH Managed Care Mail Log OMH-Managed-Care@omh.ny.gov Children s Designation Mail Log OMH-Childrens-Designation@omh.ny.gov Subscribe to children s managed care listserv http://www.omh.ny.gov/omhweb/childservice/ Subscribe to DOH Health Home listserv http://www.health.ny.gov/health_care/medicaid/program/medicaid _health_homes/listserv.htm Health Home Bureau Mail Log (BML) https://apps.health.ny.gov/pubdoh/health_care/medicaid/program /medicaid_health_homes/emailHealthHome.action