Ohio Behavioral Health Redesign Stakeholder Work Group Meeting #1. July 15, 2015, Lazarus Building Columbus

Transcription

1 Ohio Behavioral Health Redesign Stakeholder Work Group Meeting #1 July 15, 2015, Lazarus Building Columbus M a k i n g Ohio B e tter

2 Purpose of Work Group Meetings The Ohio Department of Medicaid and Ohio Department of Mental Health and Addiction Services have formed five work groups to:» Seek stakeholder feedback regarding the implementation of a revised set of MH and SUD services and supports for Ohioans with a behavioral health conditions» Work groups will focus specifically on the redesign of the Medicaid behavioral health benefit.» 1915(i) project is not part of work group focus; on a separate track 7/23/2015 2

3 Goals of the BH Redesign Modernize Ohio Medicaid BH benefit; align with national correct coding standards Improve integration of physical and behavioral health care Add services targeted at those in greatest need: ACT, IHBT, SUD residential Invest in non-medicaid services: housing, employment Prepare OH s BH network for carve in to managed care Create special benefit/eligibility category for adults with SPMI at risk of losing Medicaid coverage Move beyond fee for service payment to episodes of care & reward desired treatment outcomes 7/23/2015 3

4 Timelines for BH Redesign Revised / Extended due to complexity and stakeholder feedback: Implement by July : New Ohio Medicaid eligibility criteria for people with disabilities New Medicaid BH Benefit Package 1915(i) eligibility and benefits for adults with SPMI at risk of losing Medicaid Coverage Implement by January 1, 2018: Carve in to Medicaid managed care all BH benefits 7/23/2015 4

5 BH Stakeholder Work Groups Co-Led by Ohio Dept of Medicaid & OhioMHAS Benefit and Service Development Documentation, Billing & Regulatory Requirements Reimbursement Technical Assistance & Learning Collaboratives Engagement of Individuals with Lived Experience & Family Members 7/23/2015 5

6 Benefit & Service Development Feedback on: Clinical, non-clinical, care management services & recovery supports Additional services for people with need for high intensity support Provide feedback on certification, licensure, national accreditation standards Feedback on quality and outcome measures Advice on staffing and workforce capacity 7/23/2015 6

7 Documentation, Billing, Regulatory Req. Feedback on: Alignment of OH documentation with national standards to support integration, parity & coordination of benefits Changes to billing & admin requirements to support benefit redesign Operational definitions and framework for quality & outcomes ID data sources to support measures & establish reporting system ID changes needed to IT systems 7/23/2015 7

8 Reimbursement Feedback on: Payment methods and policies Coverage policies Strategies to link payment to quality and outcome measures 7/23/2015 8

9 Technical Assistance/Learning Collaboratives Feedback on: Preparing the BH provider network for new BH benefit package Provider education, outreach & communication Assuring choice and diversity in services and supports Building needed workforce Integrating physical and behavioral health care 7/23/2015 9

10 Individuals with Lived Experience & Families Feedback on: How to best engage individuals who will benefit from services & their families How to communicate about the BH benefit How to share information to various audiences How to assure sensitivity to the needs of consumers How to measure and achieve satisfaction How to best use peers 7/23/

11 Common Work Group Features Membership from broad stakeholder community Meetings will occur approx. every two weeks in Columbus (TBD by each group) Telephone bridge lines will be provided but in person participation is strongly encouraged Groups will be sequenced to build on one another (e.g. benefit package before reimbursement and regulatory requirements) Meetings will conclude by October 2015 Final decisions will be made by Directors Moody, McCarthy and Plouck 7/23/

12 Please: Participate actively Consult with your peers to represent their interests Do your homework Provide feedback in line with overall project principles THANK YOU!!! 7/23/

13 Resources for Provider Organizations Medicaid provider manuals will accompany each new section of benefit package» SUD draft available» MH Not yet drafted Technical Assistance/Learning Collaboratives 7/23/

14 Technical Assistance/Learning Collaboratives Building on Health Homes Experience» Continuation of Learning Collaboratives Model» Focus on realigning various aspects of business including clinical & financing» Focus on identification and replication of Best Practices & Evidence based practices OhioMHAS has committed funding to continue existing consultation contract Ohio Medicaid considering more active partnership, TBD 7/23/

15 Our request of you Give us your ideas for: The curriculum for Technical Assistance / Learning Collaborative Determining the most important topics The best methods for provider outreach and engagement 7/23/

16 Discussion Questions What are the key competencies to prepare Ohio Behavioral Health Providers for a new BH benefit package? (A first cut )» Fundamentals of practice management» Integration of physical and behavioral health» Electronic health records» Using informatics for population management & decision support» Measuring outcomes and performance; evidence based practice» Contracting with new partners: primary care, FQHCs, managed care plans, etc» Meeting required accreditation standards» Case management, care coordination making sense of different models» Preparing for new payment methodologies: case rates, episodes of care, risk sharing» Billing, CPT coding & benefits coordination» Using telehealth & technology 7/23/

17 Discussion Questions, 2 2. Are there variations among different cohort groups? Youth vs adult providers SUD vs MH providers Providers aimed at integrating with Physical Health vs those specializing Providers already contracted with Medicaid Managed Care Plans vs providers for whom this is new territory Geographic location Urban, rural, suburban Other? 7/23/

18 Discussion Questions, 3 3. What types of professionals will we need more of/less of» How to develop contractual relationships» How to recruit new staff» How to retrain existing staff in need of new skills/credentials» How to retain staff & not lose them to other employers Other Discussion Questions??? 7/23/

19 Next Steps More detailed discussion of key competencies Variations among different cohorts Needed professionals» Development, retraining» Recruitment» Contracting Other 7/23/

20 Set Next Meeting & Agenda Early August? Agenda? Nominative Group Process to ID priorities Take stock and set future agendas 7/23/