Virginia Association of Community-Based Providers - Medicaid Behavioral Health Service Redesign 2024

VIRGINIA ASSOCIATION OF COMMUNITY-BASED PROVIDERS PROVIDER PERSPECTIVE: PROVIDER PERSPECTIVE: Medicaid Community Medicaid Community- -Based Behavioral Health Service Redesign Health Service Redesign August 20, 2024 Based Behavioral Mindy Carlin, Executive Director

An association of private-sectororganizations that provide community-based behavioral health and substance use disorder and ABA services funded by Medicaid to Virginia s most vulnerable populations, founded in 2013. Who is the VACBP Amonglargest associationsrepresenting the interests of private-sector behavioral health providers In Virginia, with more than 70 agencies with 5,500 employees that have more than 260 facilities across the Commonwealth. 2

Who is the VACBP Members range from providers with fewer than 10 employees to more than 500, from agencies with one location to more than 30, serving the behavioral health needs of individuals in all regions of the Commonwealth. Served 38,500 individuals in 2023, including more than 27,000 Medicaid members. 3

2020-2024 Advocated in support of redesign of services to enable a more comprehensive, seamless, person-centered, evidence-based, trauma-informed continuum of services. May 13, 2024 Virginia General Assembly passed biennial budget; Governor signed budget. May 20, 2024 VACBP launches member provider survey to gather input. June 2024 August 2024 VACBP member provider workgroups further evaluating survey results and developing service-specific recommendations. September 2024 October 2024 VACBP to share recommendations with DMAS, DBHDS, policy leaders and others, as appropriate. VACBP A proactive approach to engaging in legacy service redesign 4

VACBP member survey focus Concerns and opportunities related to redesign of legacy services Gaps in the current continuum of services What s working and should be retained re: each existing legacy service What improvements are recommended in redesign of each service Thoughts on how evidence-based and trauma-informed principles can be integrated into the redesigned services Specific recommendations related to each redesigned services, including service design, eligibility requirements, medical necessity criteria, unit/rate structure, workforce components, possible tiers within each service Workforce needs and considerations associated with the redesign 5

RESULTS: Concerns about redesign Negative impact on service accessibility for consumers Uncertainty re: what s coming Adequate time to prepare for the changes Rates will cover the additional costs associated with the redesigned service how can this be done in a revenue neutral way Additional training/requirements/costs associated with evidence-based practices Upfront costs/training for providers to transition to the redesigned services Credentialing/licensing for new services Negative impacts on workforce Challenges with transition to redesigned services with the Medicaid MCOs 6

RESULTS: Gaps in current continuum Lack of early intervention, prevention and recovery services Ability to provide independent living/skills-focused service (like MHSS) for those who have not been hospitalized or are on medication for SMI Barriers today to accessing support from a psychiatrist/medication Focus should be on preventing hospitalization Step-down service from MHSS and outpatient services School-based services that are aligned with current structure of education system Solutions to address social determinants of health Ongoing case management support Longer term supports that recognize the chronic nature of SMI 7

Potential to improve access to services Enable more flexibility in delivering services to be more person-centered and better address needs Address gaps in the current service continuum Opportunity for tiered services Options for early intervention, prevention and recovery services Options for longer term, less intensive maintenance services that recognize the ongoing and chronic nature of mental illness Improved patient outcomes with integration of evidence-based services Realign/better align MCO requirements with the regulations/DMAS Chance to allow private-sector providers to deliver and bill for the Targeted Case Management service RESULTS: Excitement around redesign 8

VACBP provider workgroups Goal is to gather provider input and consensus on the redesign/ replacement of each of the identified legacy services Service definitions Eligibility requirements Medical necessity criteria Unit/rate structure Workforce considerations Possible tiers within each service Other recommendations Service-specific workgroups Independent Living/Skills-focused Service(s) (Mental Health Skills Building/MHSS) Case Management Intensive In-Home-like Service(s) School-Based Service(s) Assessments 9

Considerations for policymakers Encourage state agencies involved in the process to be transparent and inclusive in the redesign of services. Be open to learning about provider feedback, proposals, questions and concerns. Learn more about evidence-based practices and how integrating them into the redesigned services may impact the cost to deliver services. Identify mechanisms and methods to weigh investments in community-based services against reduced costs associated with hospitalizations, inpatient and residential services to help to measure the impact. 10

Considerations for policymakers Evaluate the impact social determinants of health have on behavioral health and how to address some of those issues (i.e., housing and food security). Support a no wrong door approach in the design and delivery of services for Virginia s most vulnerable residents. Consider potential challenges in implementing the redesign of services in a revenue neutral manner and how to address those challenges. Share interests, questions or concerns policymakers would like factored into the process. Stay informed as the process proceeds. 11

THANK YOU! Mindy Carlin mindy.carlin@accesspointpa.com 571-242-2684 (cell)