available here - NYS Council for Community Behavioral Healthcare


Redesign Medicaid in New York State

Implementing Medicaid Behavioral Health

Reform in New York

February 13 th 2014


 Project update/timeline

 Preliminary summary of RFI comment themes

 Questions


Project Update/timeline


Comment Summary

RFI Comments

 RFI comments received from 48 entities: Plans, Providers,

Advocacy Groups, Local Governments, and other


 All comments logged and sorted into categories

 Possible change to RFQ; No change; Update guidance documents

 Common themes were identified across submissions

RFI Comments

 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

Common RFI Themes

 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

Plan Experience/ Staffing


 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

Health Homes

 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?

Integrating BH Services

 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

IT Requirements

 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

Network Services

 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

 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

Performance Management

 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

Regulatory Flexibility

 Overall comments supportive of regulatory flexibility

 Recommendation to develop Regulatory Workgroup in first year

 Support for integrated licensing

 Few specific changes recommended

Plan Reimbursement for


 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

Next Steps

 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)