Redesign Medicaid in New York State
February 13 th 2014

 Project update/timeline
 Preliminary summary of RFI comment themes
 Questions
2

 RFI comments received from 48 entities: Plans, Providers,
Advocacy Groups, Local Governments, and other
Stakeholders
 All comments logged and sorted into categories
 Possible change to RFQ; No change; Update guidance documents
 Common themes were identified across submissions

 Some themes were universally supported across submitters
 Need coordination between PH and BH Providers;
 Clarification on Health Home and Plan roles;
 Plans need to understand NY and local BH and non-Medicaid systems of care
 On some issues there was no consensus between responders

 Plan experience/ Staffing Flexibility
 Health Homes
 Integrating BH Services in Managed Care
 Information Technology Requirements
 Network Standards
 Utilization Management
 Performance Measurement
 Plan Reimbursement for Services

 Focus on the experience of Plan BH staff
 Sharing of staff between Mainstream and HARP
 How much sharing is allowed?
 Ensure coordination of BH expertise between Mainstream and HARP
 Staffing sufficiency
 How does the State evaluate adequate number of staff?
 Differentiate between smaller and larger Plan sizes by allowing flexibility in staffing ratios based on need

 Clarification needed on
 Plan/Health Home role and functions regarding care plan development and implementation
 Health Homes performance standards
 Health Home capacity
 Care Management
 1915(i) Functional Assessments
 Standardized Plan/ Health Home contracts?

 Common concerns:
 Availability of new 1915(i)-like services providers
 Capacity to perform 1915(i)-like functional assessments
 Pricing 1915(i)-like services
 Plan familiarity with NY service system including non-Medicaid services
 Challenge of linking Plans to crisis and emergency response services

 Balancing need to exchange and integrate data (RHIOs) with fiscal cost and existing technical capability
 Mixed recommendations on requirements to join RHIOs
 Availability of IT resources – essential for Providers to be managed care IT ready
 Need for initial and ongoing Plan billing system support/training
 Multiple requests for Plan web-based billing capacity

 Plans and providers expressed general support for:
 Facilitating co-located Article 28 services/BH services
 Ensuring adequate and coordinated mobile crisis across Plans
 Mandating contracting for after hour and weekend services
 General provider support and mixed Plan support on proposed
RFQ network standards
 Contracting with providers serving 5 or more members

 Utilization Management Comments
 Plans reported on current process – need to adjust UM for1915(i)-like services
 UM should reflect need for ongoing treatment and not just stabilization
 Need for the State to approve UM criteria and for Plans to inform
Providers and the public of these criteria

 Common concerns from both Plans and Providers
 Need to know what Performance Measures are
 Don’t use measures for Pay for Performance in year 1- only establish baseline data

 Overall comments supportive of regulatory flexibility
 Recommendation to develop Regulatory Workgroup in first year
 Support for integrated licensing
 Few specific changes recommended

 Overall need to develop sound payment and rate structure on both Plan and Provider level
 Plans and Providers supported:
 Innovative Plan/ Provider network partnerships – including subcontracting for Plan functions
 BH specific Medical Loss Ratio

 State will conduct a survey to identify providers interested potential 1915i providers
 State is developing guidance for 1915(i)-like services
 Meeting with MRT BH Workgroup on 2/26/14
 Revise RFQ based on feedback
 State will discuss relevant RFI issues with Plans and Health Home
 Post RFQ early March
 Preliminary Premium and Databook shortly after
 Implement Start-Up Activities (with funding in 2014-15 Executive Budget)