OMH Managed Care Updates – May 2016

Managed Care Updates – May 2016

As the Behavioral Health Managed Care Implementation moves forward, OMH continues to assess the readiness of Managed Care Organizations (MCO) to manage the behavioral health population outside of New York City beginning July 1, 2016. We are also continuing to monitor the ongoing implementation of the behavioral health carve-in in New York City, and transferring lessons learned over to the Rest-of-State readiness process.

Please find below important information for providers regarding BH Managed Care:

HCBS Provider Survey Results

The HCBS Status Survey delivered to designated providers in New York City has concluded. We would like to thank all of the providers who responded to the survey with their current status. Of the providers surveyed, 82 have not yet responded. OMH will be contacting those providers shortly to obtain their HCBS status to ensure proper designation. The results of the survey will be posted to the OMH website.

DSRIP/PPS Update from the NYAPRS Executive Seminar

The New York Association of Psychiatric Rehabilitation Services, Inc. (NYAPRS) held their 2016 Executive Seminar Beyond Survival to Success on April 21st and 22nd. At the seminar, the DOH Office of Health Insurance Programs presented “When You’ve Seen One PPS / DSRIP…”, which provided updates to the Delivery System Reform Incentive Payment Program, and Performing Provider Systems (PPS). The PPS portion of the presentation delivered valuable insight into the integration of care. A slideshow for the presentation can be found here:

http://www.nyaprs.org/conferences/executive-seminars/executive-seminar-2016/documents/OneDSRIP_000.pdf

Provider Guidance

Claims Testing:

Based on the lessons learned during the NYC implementation, it is critical that providers prepare to test claims submissions with health plans. A number of behavioral health providers did not test their systems and ran into significant challenges submitting claims to MCOs. As of April 15th, 2016, MCOs are allowing providers to test their claims submission processes. Providers need to proactively reach out to their contracted MCOs to begin conversations around steps for testing. If for any reason you are unable to reach the MCO for technical assistance with your claims submission process, please document your concern in the attached OMH Managed Care Question Form.

Guidance on Erroneous FFS Claims:

OMH and OASAS are developing a strategy for the recoupment and repayment of behavioral health claims that were erroneously billed as fee for service during the initial phase of the New York City BH Managed Care implementation (between October 1, 2015- January 21, 2016). Guidance delivered to both providers and MCOs will be forthcoming.

Contracting with Managed Care Plans

NYS has built in protections to ensure that individuals continue to receive the care that they need after July 1, 2016 implementation. MCOs are required to contract with all behavioral health providers that are licensed and certified by OMH and OASAS who currently serve 5 or more of the MCOs members. MCOs must also develop an adequate network of behavioral health agencies based on NYS required minimum network standards. Information for providers about contracting with Medicaid Managed Care can be found here:

http://www.health.ny.gov/health_care/managed_care/providers/#model_contracts

Managed Care Technical Assistance Center (MCTAC) has also developed tools and training outlining strategies designed to assist providers with the contracting and credentialing process which can be found here:

http://mctac.org/page/get-the-right-tools/#goto_CONT

Training/Technical Assistance

Coordinated Care Services, Inc. (CCSI) Webinar – What is the NYS value based payment roadmap, and why do I need to know about it?

CCSI’s Center for Collaboration in Community Health is hosting a webinar series developed to share insight about approaches for succeeding in the new Medicaid Managed Care service delivery system. The May 25th webinar provides an overview of how the NYS healthcare system plans to shift from a fee-for-service model to a value based payment model. Covered items include the timeline for rollout, the levels for payment and what those levels reflect, and where attention should be focused. Providers can register for the webinar at here.

MCTAC

Led by NYU’s McSilver Institute for Poverty Policy and Research, in partnership with the National Center on Addiction and Substance Abuse (CASA) at Columbia and a group of leading academic and service-delivery organizations, the Managed Care Technical Assistance Center (MCTAC) offers a variety of tools to assist behavioral health providers with New York’s changing managed care environment. Through MCTAC, providers have access to web-based trainings, learning communities, health plan information, and other vital resources that will ensure readiness to deliver behavioral health managed care services. Visit MCATC’s website to access these resources and learn more about upcoming in-person and web-based events here: www.mctac.org.

Center for Practice Innovations (CPI) HCBS Training

In the anticipation of the HCBS rollout, it is important for all providers to have the capability to communicate the message of recovery and role of HCBS within behavioral health managed care. The CPI will deliver trainings to providers and health home managers designed to develop competencies for the delivery of person-centered, integrated care. HCBS providers, other network providers, and health home managers can receive training to increase their understanding of the scope and practice of HCBS, including information relating specifically to these services as well as collaboration with other providers and health homes. Training is set to begin Spring/Summer 2016.

Value Based Payment Bootcamp Series

The New York State Department of Health is rolling out the Value Based Payment (VBP) Regional Bootcamp learning series that offers an in-depth look at Value Based Contracting in the New York Medicaid System. These learning workshops will be held throughout the State from June through October, and are directed toward those with little experience in VBP Contracting. OMH strongly encourages providers to attend. To see the full schedule and begin registering for these regional events, please follow the link: http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_bootcamp/index.htm#R4.

Stakeholder Engagement

Regional Planning Consortium (RPC) Kickoff Events

OMH and OASAS, along with the Conference of Local Mental Hygiene Directors (CLMHD), are scheduling events to develop RPCs in accordance with the Rest of State behavioral health implementation. The RPCs will be a vehicle to promote the effective implementation of managed Medicaid behavioral health services and cross system/ community collaboration. In addition, they serve as the early warning system for issues occurring on the ground, such as lack of access to care, timeliness of eligibility determinations and engagement in care. Beginning in June 2016, these meetings will bring stakeholder groups together and provide an introduction to the RPCs. Please see the RPC Kickoff Invite Letter for specific dates and locations.

Consumer Forum Events

Consumer Forums are being scheduled across the state to educate Medicaid Managed Care enrollees about the changes to behavioral health care being implemented on July 1, 2016. These forums will allow consumers and their trusted representatives (e.g. family members, case managers, providers of services) to:

  • Learn how behavioral health care will be managed by Medicaid Managed Care Plans
  • Learn about new health plans called Health and Recovery Plans (HARPs) that are designed specifically to meet the needs of people with significant mental health and substance use disorder needs
  • Ask questions about these changes

Please see the Consumer Forums announcement for specific dates and locations.

Managed Care Questions/Issues: please contact us at [email protected] using this Managed Care Form.

Office of Mental Health
44 Holland Avenue
Albany, New York 12229
(518) 474-6911|www.omh.ny.gov

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