Georgia MH Community Seeks Recovery Supports in Medicaid Redesign Efforts
Mental Health Weekly June 18, 2012
As Georgia health officials, like other struggling states around the country, embark on plans to redesign its Medicaid program with a goal to improve
health outcomes for beneficiaries, and rein in costs, the state’s mental health community say they want key efforts to focus on a recovery-oriented system of care for consumers with serious and persistent mental illnesses.
Officials at the Georgia Department of Community Health (DCH), which manages the state’s Medicaid program, on June 4 said they plan to announce the new delivery model for the Medicaid and CHIP (Children’s Health Insurance Program) redesign initiative this summer. They are also awaiting approval from the Centers for Medicare and Medicaid (CMS).
“The Medicaid program as it exists today is not financially sustainable,” Pamela A. Keene, spokesperson for the DCH, told MHW. “Georgia is seeking ways to also ease administrative burdens, improve quality of care and enhance social utilization.” Throughout the redesign process, DCH is continuing discussions with advocates, stakeholders, associations, physicians and other providers, said Keene.
The department has established stakeholder taskforces for the aged, blind and disabled; providers; and children and families, she said. The groups are comprised of hospitals, physicians, and other health care providers, advocates, caregivers, sister agencies and others. They also created an informal workgroup to focus on issues related to mental health and substance use disorders.
The implementation roll-out of the Medicaid redesign will commence during the first half of 2014, said DCH officials. The department also contracted with Navigant Consultants to assist with its research and redesign efforts. Following the release of Navigant’s report in January, the Georgia Association of Community Services Boards (GACSBs) commented and urged that Georgia’s Medicaid redesign cover all of the important components
of a recovery-focused behavioral health service delivery system, including peer support, supported employment, and supported living services.
Advocacy, provider input
Mental health advocates say they are particularly concerned about the loss of important social supports with a new Medicaid managed care program. “How will managed care companies handle housing, supported employment, and all those things necessary for someone to live in recovery,” said Ellen Yeager, director of public policy for Mental Health America (MHA) of Georgia, and a member of the aged, blind and disabled task force. “We’re all working on an RFP [Request for Proposal] and looking at what it needs,” Yeager told MHW. “I’d like to see the focus on consumers, and strong peer support from any managed care company that works with this population,” Yeager said.
The state’s mental health provider community say they are anxious to move away from a traditional Medicaid managed care model where the focus is on medically necessary services, i.e., authorization to see a physician and obtaining a prescription, said Tod Citron, director of the Cobb-Douglas Community Services Board and member of both the provider, and aged, blind and disabled task forces.
In a Medicaid redesign “world” the service delivery component is key, Citron, who also sits on the informal behavioral health group task force, told MHW. “We want a model comprised of services to help consumers with serious mental illnesses stay healthy, stable and move their lives forward,” he said. Medicaid mental health beneficiaries need a whole host of services, including housing and employment supports, and WRAP (Wellness Recovery Action Plan) services, said Citron, who represents GACSB in these stakeholder discussions. “Not having access to deep end services has been part of the conversation” in all of the groups, Citron said. “The real focus is a recovery-oriented system of care,” he said.
The state currently has contracts with three MCOs, he said. “We don’t know how many the state will contract with once the Medicaid redesign is completed,” Citron said. Regardless of how many, the administrative processes need to be simplified, he said. The various MCOs will no doubt include different sets of authorization processes, said Citron. “Why not have one set of established authorization processes, however many MCOs the state decides on?”
Administrative simplification re-mains a heavy theme throughout all of the task forces, said Citron. “Why not do away with precertification and preauthorization processes? Services at the front load entail quite a bit of administrative services and costs, he said. “If you need more authorization
for more intensive-level services that would be quite a different scenario,” said Citron.
Providers should partner with MCOs, added Citron. “It would be easy for MCOs to come directly to us larger vendors and capture a lot of that service delivery in their relationship with us,” he said. “We can partner on other arrangements besides a fee-for-service model,” he said. Other financial arrangements could include gain sharing, case rates, or sub-capitated arrangements, said Citron.
“This discussion is very different from five years ago when everyone signed contracts for a fee-for service model,” he said. “It doesn’t work well. It’s a ‘stringent’ model. Timely claims payments are at issue,” he said. MCOs get capitated arrangements with the state, he said. “Eighty percent must be service delivery and 20 percent of the dollars get absorbed into administrative functions of an MCO model,” he said.
A more effective model might be one where 5 percent goes toward administrative costs, he said. Other savings could be put toward reinvestments in service delivery, said Citron. Citron added, “MCOs absolutely need [the support of] community services boards and MCOs understand that. They want us to be positive, successful and viable.”
Sitting at the table
States are moving Medicaid into managed care all over the country, said Citron. “They’re confronted with escalating costs and they can’t contain those costs,” he said. Citron added, “It is critical that behavioral health professionals and community mental health center executives get themselves to the table. It’s so important that I speak on behalf of providers. My voice is heard among decision makers.”
The mental health community, including peers and consumers should talk to state health care officials, legislators and others in order to “end up with a good system versus something that crashes,” he said.
Georgia is a significant leader in peer supports, he said. Peers and certified peer specialists are fully a part of the redesigned Medicaid system, said Citron.
The task force will meet again in July, while the informal behavioral health group will meet more frequently, he said. “DCH is consistently seeking our feedback,” Citron said. “All of that is extremely positive.”