Managed Care

Fully Integrated Duals Advantage (FIDA)

Care Management for All
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FIDA Fact Sheet
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Toolkit

ACL Managed Care TOOLKIT 5-2015

Managed Care

Managed Care Technical Assistance Center (MCTAC)
Managed Care Companies by Region
Behavioral Health Policy Guidance 10-1-15 FINAL
2015-10-1 NYS memo on billing unlicensed practitioners in behavioral health programs
OMH MMC Guidance 9-10-15
OMH Managed Care Question Form
HARP Plan Names
9-21-15 FINAL BHMC Carve-In FFS Edit
Grievance and Appeals Guidance for Providers 10_16_15
2015-10-16 Important OASAS OMH Behavioral Health Managed Care Carve-In Billing Guidance
Managed Care Updates – Oct. 23, 2015

 

Managed Care

  • The transition to Managed Care for Medicaid Behavioral Health Services presents serious challenges for the state and many, many concerns for providers that make up the safety net for people with serious illnesses, both medical and behavioral. 
  • The original plan was to contract with 5 regional Behavioral Health Organizations (BHOs) with experience and a positive track record in managed care for these populations.  Now the state intends to contract with mainstream managed care organizations (MCOs) that may or may not have any experience with the clients that have traditionally been served in the publicly funded mental health system.  They will have the option to contract with BHOs.  
  • Medicaid restorative services in residential programs are to be included in the benefit package.  These services are provided in residential settings that are people’s homes for a temporary period of time, which are often needed as housing until a person can find an alternative setting. If this experiment does not work, thousands of clients could have a very destabilizing experience and providers could go out of business jeopardizing the few beds in the state that serve a very challenging population that needs 24/7 staffed housing.   
  • We are concerned that:
    • MCOs will move people along too quickly;
    • MCOs will insist we move people even if the only alternatives are sub-optimal;
    • MCOs will be unwilling to pay providers enough to keep the services viable.
    • Added layers of administration will decrease the amount left for services, e.g. the state will contract with MCOs – MCOs may contract with BHOs that will then contract with Health Homes and other providers for services.
    • Providers that are responsible to manage 24/7 environments will have little control over who comes in, potentially destabilizing programs.
    • State contract providers that have very little in reserves will not be able to bridge the transition to managed care if there are cash flow interruptions.  
    • Providers do not have the infrastructure to contract with, or interface with, multiple plans nor do they have the reserves to invest in Information Technology.

ACL RECOMMENDS THAT RESIDENTIAL PROGRAMS INITIALLY BE CARVED OUT OF THE BENEFIT UNTIL THE STATE HAS A TRACK RECORD OF SUCCESS WITH OTHER PROGRAMS – THE STATE CAN BACKTRACK QUICKLY WITH PROGRAMS IN DAY SETTINGS BUT DESTABILIZING HOUSING COULD HAVE PERMANENT, NEGATIVE  EFFECTS TO CONSUMERS AND LOCAL SYSTEMS OF CARE.

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