Managed Care RFQ Package Released Today

The final Request for Qualifications regarding the inclusion of Behavioral Health Benefits into Managed Care has been sent to the Managed Care Plans.  They now have to respond to this so that they can become qualified.  They are mandated to provide the general behavioral package and have the choice to become a HARP. They can submit questions by April 30, 2014.  Responses will be posted in the form of FAQs on the Department of Health’s MRT Behavioral Health transition website, as well as the OMH and OASAS BHO websites.  A non-mandatory Applicant’s Conference for New York City applicants and other interested parties will be held towards the end of April. The State will notify all potential applicants of meeting details when scheduled.   This process for the rest of the state will generally lag by 6 months.

Definitions of 1915(i) – like services are in the document named 2014-3-21 Final RFQ  – these are the services that many of you will choose to provide…..including those of you who may want to become a Medicaid provider in the future.  It is worth taking a look.

There are six document links below:
2014-3-21 New York State Behavioral Health RFQ Coverletter
2014-3-21 Final RFQ
Chart of potential 2012 HARPS enrollees by Plan
NYS DATA BOOK FOR BEHAVIORAL HEALTH CARVE-IN AND HARPs
2015 HARP NYC CAPITATION RATE DEVELOPMENT
CY 2015 HARP NYC DRAFT RATE SHEET

The following message to the Plans was included.

March 21, 2014

Dear Managed Care Organization,

The New York State Department of Health (DOH) and the Offices of Mental Health (OMH) and Alcoholism and Substance Abuse Services (OASAS) are pleased to release the attached Request for Qualification regarding “Behavioral Health Benefit Administration: Managed Care Organizations and Health and Recovery Plans”.  The purpose of the RFQ is to qualify All Mainstream Plans in NYS to:

1.      Administer the full continuum of mental health and substance use disorder services for adults covered under the Medicaid State Plan; and, if interested, apply to
2.      Become Health and Recovery Plans (HARPs) and administer the full continuum of mental health, substance use disorder, and physical health services covered under the Medicaid State Plan as well as the enhanced Home and Community Based Services benefits (1915(i)) for adults with serious mental illness (SMI) and/or SUDs who meet eligibility requirements.

New York is committed to the careful and responsible transformation of the current Behavioral Health system to Medicaid managed care.  The design and development of the attached RFQ were guided by key principles adopted by the New York State Medicaid Redesign Team (MRT) including:

·        Person-Centered Care management
·        Integration of physical and behavioral health services
·        Recovery oriented services
·        Patient/Consumer Choice
·        Ensure adequate and comprehensive networks
·        Tie payment to outcomes
·        Track physical and behavioral health spending separately
·        Reinvest savings to improve services for BH populations
·        Address the unique needs of children, families & older adults

Through this RFQ, Plans will demonstrate that, directly or through partnership with a Behavioral Health Organization, they have the experience, organizational capacity, and staffing to ensure the effective delivery of behavioral health care for many of New York’s neediest citizens.

NYS will qualify mainstream MCOs and HARPs in 2 rounds based on geographic region and population characteristics. The first round will be in New York City (NYC).  The second round will be for the rest of the state.  The process for integrating children’s BH services into managed care will be specified by New York State at a later date.

RFQ applications for MCOs serving NYC are due by June 6, 2014. RFQ applications for Plans serving the rest of the state will be due approximately six months later with the exact date to be determined. Additionally the RFQ for the rest of the state may be modified based upon experience obtained during the NYC qualification process.

This RFQ package includes the following four items:

1. Behavioral Health Managed Care Request for Qualification Application
2. Data Book for Mainstream Managed Care Organizations and Health and Recovery Plans (HARPs) (updated from December 2013 distribution)
3. Preliminary premium for the NYC Health and Recovery Plan (HARP) benefit (see separate attachment from Mercer for explanation on rate development)
4. Chart showing the number of NYC and  NYS potential HARP enrollees by Plan

Please be advised that some criteria described in the RFQ are subject to change based on negotiations with the federal government.  These items and notification of changes will be available on the OMH, OASAS, and DOH websites.

All questions must be submitted electronically to bho@omh.ny.gov by April 30, 2014.  Inquiries will not be answered on an individual basis. Responses will be posted in the form of FAQs on the Department of Health’s MRT Behavioral Health transition website, as well as the OMH and OASAS BHO websites.

Plans may not initiate any communication with any other personnel of the State (DOH, OMH or OASAS) regarding the content of this RFQ or their submissions in response to this RFQ during the restricted time period.  Any information received as a result of such prohibited communications is not official and may not be relied upon. The initiation of such prohibited communications may result in the disqualification of the Applicant for designation.

A non-mandatory Applicant’s Conference for New York City applicants and other interested parties will be held towards the end of April.  The State will notify all potential applicants of meeting details when scheduled.
Thank you for your efforts to assist NYS in transforming the Medicaid behavioral health services to more effective managed care system.

Sincerely,
Jason Helgerson
New York State Medicaid Director, NYS Department of Health

Ann Sullivan, MD
Acting Commissioner, New York State Office of Mental Health

Arlene González Sánchez
Commissioner, New York State Office of Alcoholism and Substance Abuse Services

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