NYS Posts Draft Plans to Implement Integrated Managed Medical/BH Care by 2014

NYAPRS Note: OMH and OASAS have posted new documents on their websites indicating current thinking about how to implement what’s often called Phase 2 fully integrated Medicaid managed mental health, addiction and medical services, currently scheduled to start in spring 2014.

The following is taken from the Power Point referenced below.

It reveals a plan to implement:

  • fully integrated special needs plans in New York City with special preference for mainstream health plans that already manage both medical and pharmacy benefits, as long as they can demonstrate full capacity to work with those with more serious behavioral health needs (could include partnerships with Behavioral Health Organizations or BHOs). For those who opt out of such a SNP, they’ll have the option to be served by a health plan in collaboration with a BHO.
  • Arrangements upstate are for mainstream health plans to join with state approved BHOs to deliver integrated medical and behavioral health services, unless those plans can demonstrate the ability to manage both medical and behavioral health benefits by themselves.

The draft time line for this transition is as follows:

  • Spring 2013           Finalize BHO/SNP program design
  • Summer 2013         Finalize BHO/SNP managed care contract requirements and financing and

Publish procurement documents for minimum 30 days

  • Fall/Winter 2013     Select SNPs/BHOs
  • Spring 2014           Fully operational

OMH, OASAS and the Health Department will be re-convening the Medicaid Redesign Team’s Behavioral Health Work Group in NYC in the coming days to provide input to these designs. NYAPRS is a member of this group and will keep you fully informed in the days to come.

For more details, we encourage you to attend next week’s NYAPRS conference to hear OMH Commissioner Hogan’s keynote remarks. You can register at http://www.nyaprs.org/conferences/annual-conference/index.cfm.

 

Power Point excerpts by NYAPRS

 

Fully Integrated Special Needs Plans (SNPs)

  • In New York City (“and other areas of the State where viable”), full benefit Special Needs Plans that integrate existing and currently carved out fee for service OMH and OASAS Medicaid services) will be “the preferred managed care vehicle” for members with “Significant” Behavioral Health Conditions
  • SNP eligibility criteria and specialized benefits will be developed by DOH, OASAS, OMH and NYC with stakeholder input.
  • SNPs will manage all behavioral health services for all their members.  Includes existing and specific carved out Behavioral Health services.
  • SNPs must have fully integrated care delivery and care management networks.
  • SNPs must be a licensed risk bearing entity in NYS.
  • A limited number of SNPs will be selected and preference will be given to mainstream plans (or freestanding SNPs) with robust specialty behavioral health expertise including active partnerships with Behavioral Health Organizations and Health Homes.
  • Existing plans that are designated as SNPs must demonstrate intent and ability to reach out to SNP eligible enrollees to enroll as many eligible enrollees as possible in SNPs.
  • Specialized enrollment strategies will be considered and employed to maximize the enrollment of the higher need eligible population into SNPs

 

Mainstream Plans/Behavioral Health Organizations

  • This may be the predominate model in most areas outside of NYC.
  • Mainstream plans will be responsible for all behavioral health services, both existing and currently ‘carved out’ fee for service OMH and OASAS services, for all their members.
  • Plans will be required to either contract with a state certified BHO or demonstrate capacity to meet carefully constructed State requirements for clinical management of behavioral health benefits.
  • Plan requirements will be jointly developed and monitored by OMH, OASAS and DOH with significant stakeholder input.
  • In communities with approved SNPs - this model will apply to the behavioral health population without “significant” behavioral health issues or those opting not to enroll in SNPs.
  • In communities without SNPs - this model will apply to all members.

 

Behavioral Health Benefit and Managed Care - Drafts

http://www.omh.ny.gov/omhweb/bho/index.html