Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and...

18
Colorado Department of Healthcare Policy and Financing Colorado Department of Healthcare Policy and Financing Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 1 The Medicaid Community Behavioral Health Services Program Comprehensive behavioral health services to Medicaid members in Colorado

Transcript of Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and...

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing

Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources

1

The Medicaid Community Behavioral Health Services Program

•Comprehensive behavioral health services to Medicaid members in Colorado

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing

Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources

2

Orange: Access Behavioral Care (ABC) Green: Behavioral Healthcare Inc (BHI) *Pink: Northeast Behavioral Health Partnerships (NBHP) -> June 30 th. *Yellow: Colorado Health Partnerships (CHP) *Blue: Foothills Behavioral Health Partnerships (FBHP)

Behavioral Health Organizations (overview)

*Value Options

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing

Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources

3

• Behavioral Health Organizations (BHOs) then contract with their own network of behavioral health providers, including individual practitioners and community mental health centers in order to offer services to all those in need.

Individual providers

Federally Qualified Health Centers

Community Mental Health Centers

BHO

Methadone ClinicsDetox facilities

Hospitals

Specialists

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing

Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources

4

BHOs have large and varied provider networks

Single case agreements

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing

Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources

5

Access to care standards BHOs are required to complete an intake and initial

assessment of any Medicaid client requesting routine

services within seven business days of the initial request.

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing

Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources

6

•Placing Medicaid clients on waitlists to be seen for an initial appointment outside of the seven day timeframe is

not acceptable.

Access to care standards

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

Can anyone receive services?

• Anyone can be assessed Covered diagnosis Covered procedure Medically necessary

7

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

A note about medical necessity

• “Medically Necessary” describes a service that, in a manner in accordance with professionally accepted clinical guidelines and standards of practice in behavioral health care:

– Is reasonably necessary for the diagnosis or treatment of a covered mental health disorder or to improve, stabilize or prevent deterioration of functioning resulting from such a disorder; and

– Is clinically appropriate in terms of type, frequency, extent, site and duration;

– Is furnished in the most appropriate and least restrictive setting where services can be safely provided; and

– Cannot be omitted without adversely affecting the Member’s mental health and/or physical health conditions associated with the Member’s covered mental health diagnosis, or the quality of care rendered.

8

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

Behavioral Health

• In addition to comprehensive mental health services, effective 1/1/2014, BHOs now manage substance use disorder (SUD) services.

• SUD services were previously offered in Fee-For-Service Medicaid on a limited basis.

9

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

SUD services available through the BHO program

• Alcohol and/or drug assessment • Detoxification services (includes: physical assessment of detoxification progression

including vital signs monitoring; safety assessment; provision of daily living needs including hydration, nutrition, cleanliness and toiletry for clients; Level of motivation assessment for treatment evaluation)

• Individual and group therapy• Targeted case management• Drug screening and monitoring• Peer advocate services* • Medication Assisted Treatment*

10

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

11

What medications are covered in association with chemical dependency?

• Methadone*• Suboxone (buprenorphine and naloxone) • Subutex (buprenorphine) • Revia (naltrexone) • Vivitrol (naltrexone) • Antabuse (disulfiram)

*Methadone maintenance is covered by the BHOs. The rest of the medications are medical/pharmacy benefits.

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

12

What mental health services are available?

Inpatient hospital psychiatric care Outpatient hospital psychiatric services Psychiatrist services Individual and group therapy Medication management Case management services Emergency services Vocational services Clubhouse/drop-in centers Residential services Assertive Community Treatment Recovery services Respite services Prevention/early intervention activities School-based and day treatment services for children/youth

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

13

What else is new for the upcoming contract?

Focus on integration

Focus on care coordination• Department of Corrections Nursing facilities• Department of Human Services (child welfare) • Program Improvement Advisory Committee (PIAC)

Increased requirement of consistent trainings

Increased access to care standards• 4 services within 45 days

Focus on trauma informed care

Clarifying language for Brain Injury clients

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing

Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources

14

If issues arise……

•Office of Member and Family Affairs

•Quality Director

→Remember, the BHOs are ultimately responsible for enforcing the standards of

care

Colorado Department of Healthcare Policy and FinancingColorado Department of Healthcare Policy and Financing

Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources

http://www.colorado.gov/cs/Satellite?c=Page&cid=1212398231156&pagename=HCPF%2FHCPFLayout

15

How do I contact the BHO or find a BHO provider?

www.colorado.gov/hcpf -> Benefits -> Medicaid Managed Care -> Behavioral Health Organizations

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

16

BHO contact numbers:

Access Behavioral Care (ABC) 720-751-9030Behavioral Healthcare Inc (BHI) 720-490-4400Foothills Behavioral Health Partnerships (FBHP) 303-432-5970Colorado Health Partnerships (CHP) (800) 432-9553Northeast Behavioral Health Partnerships (NBHP) 970-347-2374 (effective now until June 30, 2014)Access Behavioral Care Northeast (844)-880-8508 (effective July 1, 2014)

Helpful resources

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

17

Questions?

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

Matt UllrichContract Performance & Operations [email protected]

Nikki LemmonBehavioral Health Specialist

[email protected]