OM: NY Begins Readiness Reviews for Upstate HARPs

New York Begins Readiness Reviews For Integrated Medicaid Medical/Behavioral Managed Care Plans Outside New York City

Open Minds News Report |March 13, 2016

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During March 2016, the New York State Office of Mental Health (OMH) is starting on-site readiness reviews for Medicaid managed care organizations (MCOs) that will provide integrated medical and specialty behavioral health services to Medicaid beneficiaries living outside the New York City (NYC) area. The state is in the process of ending its Medicaid behavioral health carve out for specialty services. The integrated plans went live in New York City in January 2016. The MCOs are slated to begin providing services outside the NYC area on July 1, 2016.

As part of the move to integrate behavioral health, all Medicaid mainstream managed care plans (MMC) in the state have had to demonstrate capacity to provide behavioral health services, either on their own, or by partnering with a behavioral health organization (BHO). The MMC plans could also apply to establish specialized Health and Recovery Plans(HARP) for their members with serious mental illness (SMI) or addiction disorder. For the plans serving the rest of the state, the OMH accepted applications through September 18, 2015, from designated MCOs serving New York City.

According to a recent notice issued by Health Management Associates (HMA), the plan designations were announced in New York City in the fall of 2015. The current announcement addresses plans that do not operate in the city, as well as plans that had been approved in the city that are seeking approval to operate in non-NYC counties.

New York Medicaid MCO Preliminary Plan Designations

Region

Plan Name

Designation Status

BHO

NYC and Upstate

Affinity Health Plan Inc

Conditional HARP

Beacon Health Options

NYC and Upstate

Empire Blue Cross Blue Shield HealthPlus (Formerly Amerigroup)

HARP

None

NYC and Upstate

Health Insurance Plan of Greater New York (Emblem)

HARP

Beacon

NYC and Upstate

HealthFirst PHSP Inc

HARP

None

NYC and Upstate

NYS Catholic Health Plan Inc (Fidelis)

HARP

None

NYC and Upstate

United Healthcare Of NY Inc.

HARP

Optum

NYC and Upstate

WellCare of New York

Mainstream

None

NYC Only

AmidaCare Inc

HIV-SNP

Beacon

NYC Only

MetroPlus

HIV-SNP and HARP

Beacon

NYC Only

VNS Choice Select Health SNP

HIV-SNP

Beacon

Upstate Only

Capital District Physicians Health Plan

Conditional HARP

None

Upstate Only

Crystal Run

Conditional Mainstream

Beacon

Upstate Only

Excellus

Conditional HARP

Centene

Upstate Only

HealthNow

Conditional Mainstream

Health Integrated

Upstate Only

Independent Health Association

Conditional HARP

Beacon

Upstate Only

MVP

Conditional HARP

Beacon

Upstate Only

TotalCare (A Today’s Option)

Conditional HARP

Beacon

Upstate Only

YourCare (Fomerly Univera)

Conditional HARP

Beacon

Mainstream MCOs are New York’s name for health plans that provide services to individuals not requiring long-term services and supports. Currently, Medicaid MCOs do not provide specialty behavioral health services; but the state is working to transition behavioral health services to the MCOs. In order to continue providing Medicaid services, mainstream MCOs were required to prove that they are able to provide all behavioral health services to adults.

HARPs are a Medicaid Special Needs Plan (SNP) operated by New York’s Medicaid MCOs. The HARPs have a specialized staff with behavioral health expertise, and the plan provides all covered services available through Medicaid managed care, in addition to an enhanced benefit package that includes BH HCBS for eligible enrollees. HARP eligibility criteria has been determined by the state. HARP eligibles cannot be dual enrolled (receiving both Medicare and Medicaid) or participating in a program with the Office for People With Development Disabilities (OPWDD).

HARPS in New York City began implementing BH HCBS on January 1, 2016, three months after the mainstream Medicaid managed care organizations (MCOs) began covering non-HCBS behavioral health services. In the rest of the state outside New York City, the mainstream Medicaid managed care plans will begin non-HCBS behavioral health services on July 1, 2016. The delay to launch the BH HCBS for the HARP population is intended follow the New York City roll-out and maintain a three month window between the two types of plans.

The plans for each region can be viewed online athttp://matrix.mctac.org/(accessed March 9, 2016).

OPEN MINDSlast reported on this topic in “New York Medicaid Delays Statewide Launch Of Behavioral Health Home & Community Based Services For HARP Population,” which published on January 24, 2016. The article is available athttps://www.openminds.com/market-intelligence/news/719000.htm/.

For more information, contact: Benjamin Rosen, Director, Public Information, New York State Office of Mental Health, 44 Holland Avenue, Albany, New York 12229; 518-474-6540; Fax: 518-473-3456; Email;Benjamin.rosen@omh.ny.gov; Website:https://www.omh.ny.gov/omhweb/bho/managed-care-timeline.html.

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