OM: NYS Moving FFS Behavioral Health to Integrated Managed Care in 2014

New York Medicaid Moving All Fee-For-Service Behavioral Health To Integrated Managed Care In 2014; RFPs Expected Late Summer 2013
Open Minds  June 10, 2013
 

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New York Medicaid is moving all fee-for-service behavioral health services via specialized integrated managed care plans in 2014; a request for qualifications from interested plans is expected by late summer 2013. Preliminary details were released on May 1, 2013 at the New York Medicaid Redesign Team, Behavioral Health Work Group meeting. The state announced that it is in the process of finalizing the program design; two types of plans with specialized behavioral health features are anticipated. Both will provide integrated physical and behavioral health services for adults and children with serious mental illness (SMI) or addiction disorders. The plans will provide all Medicaid state plan services for physical health, behavioral health, pharmacy, long-term care, and Health Homes.

 

Currently almost all Medicaid beneficiaries are enrolled in managed care plans for physical health; these plans are at-risk for some behavioral health services. The behavioral health services covered by the plan depend on the beneficiaries' Medicaid eligibility category. Benefits for beneficiaries eligible through Temporary Aid to Needy Families (TANF) are different than the benefits for beneficiaries who qualify for Supplemental Security Income (SSI) payments due to a disability. Currently services not covered by the Medicaid managed care plan are provided through unmanaged fee-for-service. The New York Medicaid Redesign, which launched in 2010, sought to move all Medicaid services into managed care.

 

As the first phase of New York’s Medicaid Redesign, in 2011, the state selected five regional managed behavioral organizations (BHOs) to monitor inpatient behavioral health services for Medicaid-enrolled individuals whose inpatient behavioral health services are not covered by a Medicaid managed care plan and who also are not enrolled in Medicare. The Phase One BHOs launched in 2012; during this phase the BHOs interact with provider organizations to review treatment and discharge aftercare plans for Medicaid fee-for service admissions to inpatient mental health, detoxification, and substance use rehabilitation units.

 

Phase Two moves all fee-for-service behavioral health services to managed care through two models: Health and Recovery Plans (HARP) and other specialized integrated behavioral health physical health plans (referred to as non-HARP entities). The HARPs will enroll a subset of individuals with high use of intensive services. HARPs will provide all Medicaid state plan services for physical health, behavioral health, pharmacy, long-term care, and Health Homes; HARPs will also manage new 1115 Medicaid waiver benefits for Home- and Community-Based 1915(i) waiver-like services that are not currently offered in the state Medicaid plan. Enrollment in both the HARPs and non-HARPs will launch in April 2014 in New York City.

 

The state is in the process of finalizing the program design and anticipates posting a request for qualifications (RFQ) for HARP and non-HARPs by late summer 2013 for plans to serve adults in New York City. The RFQ review will determine whether a plan can qualify alone or in partnership with a BHO or if it must partner with a qualified BHO. Plans applying to develop HARPs must also be qualified via the RFQ. The plans would be selected by winter 2013, and become fully operational by spring 2014. A RFQ for the rest of the state would be released during the winter of 2014; these plans would be fully operational by fall 2014.

 

The Phase Two plans were outlined in a May 1, 2013 presentation at the New York Medicaid Redesign Team Meeting Of The Behavioral Health Subcommittee “Managed Care And Behavioral Health.” In Phase Two, behavioral health will be managed by HARPs or by non-HARP mainstream managed care plans that meet the standards for managing behavioral health benefits or that partner with BHOs to meet the standards.

 

Initially, the HARP and non-HARP entities will enroll non-dual eligible beneficiaries. Individuals with developmental disabilities who are eligible for managed care services through the state Office of Persons With Developmental Disabilities are excluded from HARP enrollment. The inclusion criteria are based on diagnosis and service utilization. Both the HARPs and non-HARPs must use individual plans of care and provide person-centered care coordination that accounts for both in-plan benefits and non-plan services, such as housing or assisted outpatient treatment.

 

The state is developing enhanced performance standards for the non-HARP behavioral health managed care plans and HARPs; the measures under development address access to behavioral health services, post-inpatient or emergency department discharge follow-up, service engagement, medication management, or improved physical health.

 

A link to the full text of “New York Medicaid Redesign Team Meeting Of The Behavioral Health Subcommittee: Managed Care And Behavioral Health” may be found in The OPEN MINDS Circle Library atwww.openminds.com/library/050113nymedicaidbhoharpstatus.htm

A link to the full text of “New York Medicaid Redesign Team Meeting Of The Behavioral Health Subcommittee: Presentation: HARP and Non-HARP Medicaid Data” may be found in The OPEN MINDS Circle Library atwww.openminds.com/library/050113nyharpnonharpdiff.htm

OPEN MINDS also reported on this topic in “New York Medicaid Unveils Plans for Fully Capitated Managed Care Behavioral Health System by April 2013.” The article is available at www.openminds.com/market-intelligence/premium/omol/2012/013012mhcd8.htm

For more information, contact: Bill Schwarz, Director, Public Affairs Group, New York State Department of Health, Corning Tower, Empire State Plaza, Albany, New York 12237; 518-474-7354; Website:www.health.ny.gov

New York Medicaid Moving All Fee-For-Service Behavioral Health To Integrated Managed Care In 2014; RFPs Expected Late Summer 2013. (2013, June 10). OPEN MINDS Weekly News Wire.

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