Children's Health and Behavioral Health MRT Subcommittee

Quarterly In–Person Meeting

  • Presentation also available in Portable Document Format (PDF)

September 28, 2017

Agenda

Transition Plan Updates

  • Transition Plan was developed to describe the activities related to the transition of the children´s 1915(c) Waivers to the 1115 Waiver authority.
  • Transition Plan was released on 8/15/17 for stakeholder feedback
    • Comments were due to the State on 9/8/17
    • Comments were categorized into major themes
  • The objective of the Transition Plan is to provide a road map for the process under which the providers, Medicaid clients (children/families) and the State will smoothly transition children to the 1115 Waiver while maintaining continuity of care.
  • The Transition Plan needs to be finalized to reflect comments and approved by CMS - Goal is to finalize by the end of October
  • When the Transition Plan is finalized, it will be further synthesized and operationalized into step– by–step processes, including work flows, supported by clear guidance, webinars, and access to the State for assistance - State will continue to seek stakeholder input throughout the development of these processes.
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Transition Plan Stakeholder Feedback Themes

  • Stakeholders have identified that clarity needed in many areas, including:
    • Roles of Health Homes, Managed Care Plans, and the Independent Entity
    • Role of the State Enrollment Broker and Medicaid Managed Care enrollment
    • Transition of children in Voluntary Foster Care Agencies (VFCAs)
    • HCBS workflow (Plan of Care process, reviews, approvals, timeframes, etc.)
    • HCBS eligibility determination criteria and documentation required for HCBS eligibility
      • DD eligibility process
    • CFCO services
  • Concerns around billing transition

State Working With CMS to Address Complexities in Transition Plan

  • The Transition Plan includes an Interim Transition Period
  • The Interim Transition Period is from January 1, 2018 to June 30, 2018 (i.e., 1915(c) to the 1115 waiver but prior to the transition to Managed Care, availability of newly aligned HCBS services and State Plan services) introduces a level of complexity to the transition
  • State received several stakeholder comments and questions about the processes and procedures that would be in place during the period and complexity of those processes
  • State is working with CMS to address complexities to streamline billing, rates, ensure access to current 1915(c) HCBS services, and to avoid transitional work that would only remain in effect for a short period of time
  • The Transition to Health Home for 1915(c) providers and children will still begin in April 2018
  • Final Transition Plan will reflect outcome of those discussions

HCBS Eligibility Determination Process

  • August 24, 2018 Transition Plan Webinar provided additional details on LOC and LON HCBS eligibility determination process (Target Population, Risk Factors, and Functional Criteria) – See Appendix for
  • How is CANS–NY used to Determine HCBS Eligibility?
    • A subset of questions of the CANS–NY is used to determine the functional criteria component of the HCBS eligibility determination process
      • For children who are I/DD and Foster – Functional Criteria determined by OPWDD Front Door ICF–IDD LOC tool applied
      • For children who are I/DD and MFC
        • Functional criteria determined by OPWDD Front Door ICF–IDD LOC tool applied OR
        • Qualify under MFC LOC Target Population and Risk Factors MFC CANS–NY algorithm
  • The State has completed testing with the data available and current 1915(c) providers
  • Algorithms/questions developed in consultation with John Lyons, Chapin Hall
  • State committed to closely monitoring data on HCBS determinations
  • Children already enrolled in a 1915(c) Waiver will remain HCBS eligible for one year after their initial Health Home CANS–NY is signed and finalized (first possible date to sign and finalize a CANS–NY is April 1, 2018)

Role of Independent Entity

  • State is working through approach to procurement of Statewide Independent Entity – will update accordingly
  • IE must have a statewide presence (in every county with regional oversight)
  • The goal of using an Independent Entity is to centralize the administration of processes and quality oversight activities related to children´s HCBS to ensure a consistent, standardized Statewide implementation
  • Current assumption is State will pay the IE directly
  • Key responsibilities of IE include:
    • ✓ A possible venue and front door for children to determine HCBS eligibility
      • ✓ Direct referrals to Health Homes by community providers and plans should be made for children likely eligible for Health Home or HCBS (Children eligible for HCBS are eligible for Health Home)
    • ✓ For children eligible for HCBS, IE will:
      • ✓ Educate children and families about the benefits of comprehensive Health Home care management
      • ✓ Make referrals to Health Homes to develop comprehensive Health Home care plan that includes HCBS and meets HCBS requirements
      • ✓ Develop HCBS plans of care for children that may opt out of Health Home
      • ✓ Work with OPWDD Front Door for ICF–IDD LOC determination
    • ✓ IE will be a front door for children not now enrolled in Medicaid but that may be eligible for HCBS and hence eligible to apply for Medicaid (community eligible determination or Family of One)
    • ✓ Assisting children and families with gathering information to apply for Medicaid either through LDSS or NYSoH
    • ✓ Monitoring HCBS care plan and access to HCBS for children that opt of Health Home and that are not in Managed Care Plan
    • ✓ Assisting the State with oversight, monitoring and reporting of Statewide access and use of Children´s HCBS
    • ✓ Obtaining proper consents to perform duties of IE

HCBS Plans of Care and Health Home Plans of Care

  • The Goal and Design of the Children´s Transformation is to ensure all children that are eligible for HCBS services receive comprehensive care management for all the services the child needs through the person–centered comprehensive Health Home care management program
  • Children eligible for HCBS and who enroll in Health Home will receive comprehensive Health Home care management and an integrated care plan which incorporates HCBS and meets the requirements for HCBS plans of care AND all other comprehensive services the member needs
  • Children who opt out of Health Home will receive an HCBS Plan of Care that includes HCBS and meets the requirements for HCBS plans of care
    • IE may make referrals to other services that may benefit the child and the family

Enrollment in a Medicaid Managed Care Plan

  • The State´s Enrollment Broker, New York Medicaid Choice, is responsible for the outreach and enrollment into Medicaid Managed Care Plans.
  • The Enrollment Broker will be noticing children who will be required to enroll in managed care prior to 7/1/18 to allow a 60–day choice period for the child and family for choosing a Managed Care Plan.
  • The Enrollment Broker has information about managed care plan networks to be able to assist children and families in choosing the plan that best matches their needs based on their current providers.

HCBS and the Roles of Health Homes, Managed Care Plans, and Independent Entity

  HCBS Eligibility Determination Eligible for HCBS? Plan of Care Care Management Monitor Access to Services
Child in MMC
In Health Home Health Home Yes HH Comprehensive POC with HCBS Health Home MMCP
Not yet in Health Home IE Yes, elects HH HH – Comprehensive POC with HCBS Health Home MMCP
IE Yes, Opts out of HH IE – HCBS POC MMCP MMCP
IE No, but eligible for and elects HH HH – Comprehensive POC w/o HCBS Health Home MMCP

Direct referrals to Health Homes by community providers and plans should be made for children likely eligible for Health Home or HCBS (Children eligible for HCBS are eligible for Health Home)


  HCBS Eligibility Determination Eligible for HCBS? Plan of Care Care Management Monitor Access to Services
Child in MMC
In Health Home Health Home Yes HH Comprehensive POC with HCBS Health Home Health Home
Not yet in Health Home IE Yes, elects HH HH – Comprehensive POC with HCBS Health Home Health Home
IE Yes, Opts out of HH IE – HCBS POC   IE
IE No, but eligible for and elects HH HH – Comprehensive POC w/o HCBS Health Home Health Home

Direct referrals to Health Homes by community providers and plans should be made for children likely eligible for Health Home or HCBS (Children eligible for HCBS are eligible for Health Home)

  HCBS Eligibility Determination Eligible for HCBS? Plan of Care Care Management Monitor Access to Services
Child not yet in Medicaid
Not yet in Health Home IE Yes –opts out of HH IE – initial HCBS POC See MMC or FFS See MMC or FFS
IE Yes elects HH HH Comprehensive POC with HCBS Health Home Health Home
IE No      

  HCBS Eligibility Determination Eligible for HCBS? Plan of Care Care Management Monitor Access to Services
Child in Foster Care
In Health Home Health Home w/DDRO Yes Health Home Comprehensive POC with HCBS Health Home Health Home or if enrolled, MMCP
Not yet in Health Home IE w/DDRO Yes See MMC or FFS See MMC or FFS See MMC or FFS

  HCBS Eligibility Determination Eligible for HCBS? Plan of Care Care Management Monitor Access to Services
Child MF/DD
In Health Home Health Home, and if elected, DDRO Yes Health Home Comprehensive POC with HCBS Health Home Health Home or if enrolled, MMCP
Not yet in Health Home IE and if elected, DDRO Yes See MMC or FFS See MMC or FFS See MMC or FFS

B2H and DD Population

  • Many questions on how a child with a developmental disability as determined by OPWDD and in B2H Waiver (i.e., in Foster Care) can transition to Health Home when Health Home eligibility criteria has not yet been approved via State Plan to include DD conditions
  • Within the 1115 waiver, a child that has a DD and is in Foster Care and meets HCBS LOC criteria for that Target Population is eligible for Health Home – a narrow exception prior to expansion of Health Home chronic conditions list to include I/DD conditions

HCBS LOC Determination for DD MFC and HCBS LOC Determination for MFC

  • Children who are Medically Fragile with a DD which has not yet been determined by OPWDD may access HCBS services using the Target, Risk and Functional Criteria for LOC for children with DD and MFC or just MFC
  • The CANS–NY is used to determine LOC functional criteria under the HCBS LOC Medically Fragile Eligibility Determination Criteria
  • However, to ensure the child has access to adult HCBS services provided under the OPWDD HCBS Waiver and other State plan clinic services, the child should also subsequently seek a determination of DD eligibility from the OPWDD via the and ICF–DD LOC – this should occur well before the child´s 21st birthday
  • As part of providing comprehensive transitional care, Health Home care managers should ensure that this referral and determination is made for its MFC DD children

Transition of Children in Voluntary Foster Care Agencies

  • Transition Date remains January 1, 2019
  • DOH and OCFS are working on several products
    • 29–I VFCA Health Facilities regulations
    • 29–I VFCA Health Facilities application and guidance
    • Residual Rate build
    • Guidance regarding MCO enrollment

State Plan Amendments for SPA Services

  • We are wrapping up discussions with CMS on the two SPAs to implement the six new State Plan Services
  • We remain on track to designate providers beginning in November
  • Upon CMS approval State will finalize DOH regulations
  • OMH Part 511 Regulation update: public comment period ended 9/16/17, comments are under review
  • OASAS Part 823 Children´s Services Regulation is at the Governor´s Office

Psychosocial Rehabilitation (PSR)

  • Psychosocial Rehabilitation (PSR) now includes previously described Habilitative Skill Building that is covered under today´s 1915c waiver as skill building.
  • Reference to Habilitative Skill Building will be eliminated from the Provider Designation applications and the HCBS manual to reflect this change.
  • Guidance for provider designation is forthcoming

Update on Plan Standards and Requirements

Children´s Health and Behavioral Health Medicaid Managed Care Organization Qualification Timeline Date
Released New York State Children´s Health and Behavioral Health Benefit Administration: Medicaid Managed Care Organization Children´s System Transformation Requirements and Standards July 31, 2017
MMCO Children´s Transition Webinar and Readiness Review Walkthrough August 24, 2017
Applicant´s Conference to respond to MMCO questions on Children´s Plan Standards September 15, 2017
Transformation 101 Webinar September 18, 2017
Submission from Plans Due To NYS October 31, 2017
NYS Confirms Receipt of Submission from MMCOs November 15, 2017
Interim Report Issued to Plans Mid–January 2018
Conduct Onsite Readiness Reviews March–April 2018
MMCOs will begin claims testing with providers April 2018
State Distributes Findings from Onsite Readiness Review to MMCOs May 2018
MCOs member service staff begin responding to questions related to the expanded children´s benefits and provider network participation May 2018
MMCOs Begin to Manage the Children´s Benefit Statewide July 1, 2018

Funding Related to Managed Care Implementation to Date

  • ✓ HIT funding–one time purchase of software/hardware and/or training
  • ✓ CANS–NY–Training and Certification
  • ✓ Rate Ramp Up (start up for the first year–not yet approved by CMS)
  • ✓ Provider Training–operational and clinical
  • ✓ RTF Pilots–transition from inpatient to outpatient

HCBS and SPA Rates

  • Stakeholders had questions about the HCBS and SPA rates
  • DOH will hold webinars to review methodology and rates
    • ✓ October 10, 2017 and October 24, 2017, Webinar to Review HCBS and SPA Rates
  • SPA Rates currently posted
  • HCBS and SPA Rates subject to approval by CMS
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Next Steps for Transition Plan

  • The State is working to develop FAQs in response to questions raised through stakeholder feedback
  • The State will be finalizing the Transition Plan for submission to CMS by late October
  • The State will provide detailed guidance, work flows, webinars, to operationalize the Transition Plan – Stakeholders will have opportunity to comment on work flows and processes
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Upcoming Guidance

  • Post Final Transition Plan – Guidance to operationalize transition will begin to be issued when Transition Plan is Final and State has concluded its discussions with CMS to streamline interim transition period – anticipated to begin in November
  • Guidance and Materials Under Development Include:
    • Finalizing provider manuals for SPA and HCBS (now available in draft)
    • Operations Manual with procedural instructions and role descriptions for activities related to the transition
    • Prepare consumer and family educational materials
    • Draft Children´s HCBS workflow for stakeholder comment and finalize
      • ✓ The State is working to develop a children´s HCBS workflow that includes the steps that children and families, providers, and managed care plans will go through to access HCBS, including assessments, plan of care development, service authorization, etc.
      • ✓ The State is thoughtfully trying to look at lessons learned on the adult HCBS implementation to avoid barriers and ensure that children can access necessary services quickly

Stakeholder Question: When will training begin on UAS and MAPP?

Training has already begun!!

DOH Health Home Children´s team is currently working with 1915(c) providers to ensure system access and connectivity to Health Homes

By November 2017 – 1915(c) waiver providers should complete activities that will provide access to required Health Home systems

  • Organizations need access to the Health Commerce System (HCS) and a role type of Health Home Care Management Agency (CMA)
    • All staff who will be working within MAPP HHTS and the UAS–NY MUST have active HCS accounts

MAPP HHTS

  • The Organization will then be entered into MAPP HHTS
  • The Organization assigned Gate Keeper will receive an email for training on MAPP roles
  • The Gate Keeper will assign staff roles within MAPP
  • Staff will then receive an email regarding on–line MAPP HHTS training – you can begin training now

UAS–NY

  • The designated HCS Coordinators can assign staff roles within the UAS–NY
  • When staff have an active HCS account and an assigned a role within the UAS–NY, staff will receive an email regarding access to online training – you can begin training now

Additional in–person trainings will be available 2017–2018 for CANS–NY tool

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Upcoming Technical Assistance and Training

MCTAC trainings

  • Medicaid provider enrollment
    • September 29, 2017
  • Overview on draft SPA & HCBS Rates (Led by DOH)
    • October 10, 2017
  • Provider contracting fairs
    • November 6, 2017 – Albany
    • November 8, 2017 – NYC
    • November 16, 2017 – Rochester
  • Revenue cycle management
    • December 6, 2017 – Rochester
    • December 12, 2017 – Albany
    • December 15, 2017 – NYC
  • In–depth service specific training, utilization management, HCBS workflow, etc. – TBD

More information from MCTAC to follow – http://www.ctacny.org/

State Partner Led Trainings

  • First Monthly Children´s Medicaid Transformation Webinar – September 29, 2017 from (10am – Noon)
    • Subsequent Monthly Webinars – Second Wednesday of every month from 3–5 pm
    • October 11, 2017
    • November 8, 2017
    • December 13, 2017
  • October 24, 2017, Webinar to Review Draft HCBS and SPA Rates
  • Consumer and family education – more information to come
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Upcoming MRT Subcommittee Meeting Topics

  • First 1,000 Days on Medicaid
  • Value–Based Payment for children´s services
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Resources to Keep Informed

DOH Transition Mail Log
BH.Transition@health.ny.gov

Health Home Bureau Mail Log
https://apps.health.ny.gov/pubdoh/health_care/medicaid/program/medicaid_health_homes/emailHealthHome.action

OMH Managed Care Mail Log
BHO@omh.ny.gov

Children´s Designation Mail Log
OMH–Childrens–Designation@omh.ny.gov

Subscribe to DOH Health Home listserv
http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/listserv.htm

Subscribe to children´s managed care listserv
http://www.omh.ny.gov/omhweb/childservice/

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