4/7/2016 Provider Leadership Update The Managed Care Technical Assistance Center of New York Housekeeping: • Slides are posted at MCTAC.org • Questions not addressed today will be: • reviewed and incorporated into future trainings and presentations • added to Q&A resources when possible. • Feedback forms Reminder: Information and timelines are current as of the date of the presentation MCTAC is a training, consultation, and educational resource center that offers resources to all mental health and substance use disorder providers in New York State. MCTAC’s Goal Provide training and intensive support on quality improvement strategies, including business, organizational and clinical practices to achieve the overall goal of preparing and assisting providers with the transition to Medicaid Managed Care . 1
4/7/2016 CTAC & MCTAC Partners Agenda • Introduction and Welcome Remarks • State Presentation • Vision & Goals • Transition to Managed Care • SPA Services & HCBS • Q&A and Break • Implementing Managed Care Readiness in your organization • Contracting, Billing/Finance, Evaluation, Communication/Level-of-Care • Change Management and Leadership • Lessons Learned from Adult Transition • Regional Planning Consortiums • Q&A and wrap-up MCTAC Kids Leadership Team Reps Agency Staff/Reps RPCs Families Together 2
4/7/2016 The Managed Care Technical Assistance Center of New York What it is and what it means for providers The Managed Care Technical Assistance Center of New York 9 Vision for Medicaid Reform “It is of compelling public importance that the State conduct a fundamental restructuring of its Medicaid program to achieve measurable improvement in health outcomes, sustainable cost control and a more efficient administrative structure.” Governor Andrew Cuomo (1/5/2011) EXPECTED OUTCOMES: ○ Improved Health Status ○ Improved Quality of Care ○ Reduced Costs Care Management For All! 3
4/7/2016 Redesigning the Delivery of Medicaid Services for Children • MCTAC Sessions Held on January 27, February 11, and February 25, 2016; provided overview of key Children’s Medicaid Redesign Initiatives: http://www.mctac.org/page/events/past-events • The State is continuing to work on the details of the Medicaid Redesign for Children • The overall design includes moving benefits and populations to Medicaid Managed Care and will impact the way providers deliver services, manage their business operations, and use the tools and services they have to improve health outcomes of the Medicaid children they serve • Today’s training will provide background information on what Managed Care is and what providers need to be thinking about to become ready to operate in a Managed Care environment Goals of Redesigning the Delivery of Medicaid Services for Children Get children in receipt of Medicaid back on their developmental trajectory: • Identify needs early • Maintain the child at home with support and services • Maintain the child in the community, in least restrictive settings • Prevent longer term need for higher end services Focus on recovery and building resilience! Children Impacted by the Medicaid Redesign Initiative • Youth diagnosed with Substance Use Disorders • Children and youth diagnosed with Serious Emotional Disturbance (SED) • Children and Youth served by Voluntary Foster Care Agencies • Children and Youth in foster care who have experienced abuse, neglect and maltreatment, and • Medically fragile children with complex conditions, requiring significant medical or technological health supports 4
4/7/2016 How the Children’s Medicaid Redesign will Achieve its Goals The State is continuing to work on the details of the following Key Features of the Children’s Medicaid Redesign • Expanding access to care management for children with chronic conditions under the Health Home program, or for children with lesser needs through Managed Care plans or other vehicles – a key to integrating care planning and service provision – September 2016 • Creating New State Plan Services – January 2017 • Transitioning existing children’s behavioral health benefits from fee- for-service to managed care – a key to integrating behavioral health and physical health - January/July 2017 • Providing greater access to an aligned array of Home and Community Based Services , beginning in 2017 • Shifting the voluntary foster care “per diem” population to managed care , January/July 2017 Principles for Serving Children in Managed Care and Health Homes • Ensure managed care and care coordination networks provide comprehensive, integrated physical and behavioral health care that recognizes the unique needs of children and their families • Provide care coordination and planning that is family-and-youth driven , supports a system of care that builds upon the strengths of the child and family • Ensure managed care staff and systems care coordinators are trained in working with families and children with unique, complex health needs • Ensure continuity of care and comprehensive transitional care from service to service (education, foster care, juvenile justice, child to adult) Principles for Serving Children in Managed Care and Health Homes (cont.) • Incorporate a child/family specific assent/consent process that recognizes the legal right of a child to seek specific care without parental/guardian consent • Track clinical and functional outcomes using standardized pediatric tools that are validated for the screening and assessing of children • Adopt child-specific and nationally recognized measures to monitor quality and outcomes • Ensure smooth transition from current care management models to Health Home, including transition plan for care management payments 5
4/7/2016 The Managed Care Technical Assistance Center of New York Two Payment Systems for NYS Medicaid Services Medicaid Managed Care System – a managed care organization 1. authorized by NYS receives a monthly premium from NYS Medicaid for an enrolled individual and manages the individual’s care within a specific comprehensive benefit package. The Plan assumes risk, provides care management and applies utilization management methods for each member. When providers in the Plan’s network (i.e., hold a contract with the Plan) provide a service to the individual, the provider bills the Plan and is paid funds from the premium. Fee-for-Service Delivery System – a provider is authorized by NYS to 2. deliver a Medicaid service. If delivered to a Medicaid enrolled individual, the provider bills Medicaid through the eMedNY billing system. NYS pays the provider directly through eMedNY, for each Medicaid service delivered. Managed Care: Definition ○ An integrated system that manages health services for an enrolled population rather than simply providing or paying for the services ○ Services are usually delivered by providers who are contracted under a capitated payment structure or employed by the plan ○ Value of services vs. volume of services 6
4/7/2016 Managed Care: Goals Control Costs Health care costs growing faster than Gross Domestic Product • (GDP) Reduce inappropriate use of services • Increase competition: focus on value • Improve Service Quality Improve Population Health Increase Preventive Services: Promote Health (not just treat illness) Managed Care: Key Ingredients Care “management” Utilization management • Health management • Vertical service integration and coordination Financial risk sharing with providers Managed Care: Key Components Network of providers created via contracting Prior approval required for some services. Benefits package with a defined set of covered services Contained list of covered pharmaceuticals (Formulary) Utilization review practices to manage level of care and length of stay Credentialing Outcomes & data driven decision making 7
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