Fully Integrated Medicaid Purchasing: “Early Adopter” Regional Service Areas Adult Behavioral Health Task Force July 18, 2014 Nathan Johnson, HCA, Director of Policy, Planning & Performance Jane Beyer, DSHS, Assistant Secretary, Behavioral Health & Service Integration Administration
Overview of Today’s Topics Integrated purchasing paths “Early Adopter” overview Timeline 2
Parallel Paths to Purchasing Transformation 2020: 2014 Legislative Action: E2SSB 6312 Fully Integrated Purchasing Across the State By January 1, 2020, the community behavioral health program must be fully integrated in a managed care health system that provides mental health services, chemical dependency services, and medical care services to Medicaid clients T r ansition Pe r iod Healthy Integrated Purchasing in Behavioral Options “Early Adopter” RSAs , with Health Managed Care 2016 shared savings incentives Organizations Plans Re gional Se r vic e Ar e as (RSAs)
2016 Medicaid Purchasing Context “Early adopter” regional service areas Managed care plans contract for full physical and behavioral health risk “Other” regional service areas Managed care plans contract for physical health for all and mental health for individuals who do not meet access-to-care standards AND Behavioral health organizations provide substance use disorder services for all and mental health for individuals who do meet access-to-care standards Medical managed care opt-out continues for exempt populations Tribal members Individuals not yet attached to a managed care plan Individuals with medical or other reasons to opt-out of managed care Individuals with 3 rd party coverage 4
Purchasing in “Early Adopter” RSAs Standards developed jointly by the HCA and DSHS Agreement by county authorities in a regional service area Compliance with Medicaid and State managed care contracting requirements Shared savings incentives Payments targeted at 10% of savings realized by the State Based on outcome and performance measures Available for up to 6 years or until fully integrated purchasing occurs statewide Models currently being vetted 5
Fully Integrated Physical and Behavioral Health Purchasing Strawman Model A – Basic Managed Care Arrangements in Early Adopter RSAs DRAFT DRAFT Early Adopter agreement State Counties Collaboration Accountable Communities of Health e.g., Consumers • Local Governments Licensed Risk- • Health Care Providers • Bearing Managed Managed Care Organizations • Care Organizations Long-Term Supports & Services • Housing • Transportation • Education • Public Health • Tribes • Business • Community/Faith-Based Organizations • Jails • Philanthropic Organizations • Physical Health, Mental Health and Chemical Carve-Out Etc… • Services & Tribal Dependency Providers Programs Individual Client
Integrated Physical and Behavioral Health Purchasing Model B – Managed Care Arrangements in Other RSAs DRAFT DRAFT State Collaboration Accountable Communities of Health Counties e.g., Consumers Behavioral Health • Healthy Options Local Governments • Organizations Managed Care Organizations Health Care Providers • Serious mental illness - • Physical health • Managed Care Organizations • access to care (ACS) standards Mental illness (non-ACS) • Long-Term Supports & Services Substance use disorders • • Housing • Service coordination Transportation • Standard benefits Education • Common performance measures Public Health • Outcome incentives Tribes • Business • Community/Faith-Based Organizations • Jails • Philanthropic Organizations • Mental Health & Carve-Out Physical Health, & limited Mental Etc… • Services & Tribal Chemical Dependency Health (non-ACS) providers Programs Providers Individual Client
“Early Adopters”: Community Planning Interest Community of Health Planning Regions 8 8
Me dic a id Re g iona l Purc ha sing T ime line Early Adopter Regions NOV JUL DEC JAN JUN JUL NOV DEC JUN SEP Model RF_ CMS County Full Final early Draft Final CMS Preliminary Vetting responses approval/ letters of adopter managed managed approval JAN models integration readiness interest RSAs care care complete RF_ Fully review contracts contracts integrated begins coverage begins 2014 2015 Common Elements OCT: DSHS/HCA RSAs JUN: DEC: MAR: JUL: SEP: 2016 2016 SPAs SB 6312; Preliminary Final CMS Common DSHS/ sent to CMS HB 2572 County Task Force approves HCA integrated enacted RSAs RSAs 2016 SPAS purchasing policy JAN BHO detailed plans reviewed JAN JUL OCT DEC Other Regions Other BHO d etailed BHO CMS Revised HO RSAs plan detailed approval/ managed care (BHO/HO) requirements plan readiness contracts responses review Draft BHO begins APR MAR managed 2016 HO CMS approval care MCOs complete contracts confirmed RSA – Regional service areas CMS – Centers for Medicare and Medicaid Services APR Final BHO and MCO – Managed Care Organization HO – Healthy Options (medical managed care) revised HO BHO – Behavioral Health Organization SPA – Medicaid State Plan amendment contracts Early Adopter Regions: Fully integrated purchasing Other Regions: Separate managed care arrangements for physical & behavioral health care
Contacts for More Information Nathan Johnson, HCA, Policy, Planning & Performance Director nathan.johnson@hca.wa.gov l 360-725-1880 Jane Beyer, DSHS, Assistant Secretary, Behavioral Health & Service Administration beyerjd@dshs.wa.gov l 360-725-2260 10
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