MEDICAID SECTION 1115 BEHAVIORAL HEALTH TRANSFORMATION DEMONSTRATION Alice Weiss and Taylor Woods; DC Department of Health Care Finance Trina Dutta, DC Department of Behavioral Health Medical Care Advisory Committee December 18 th , 2019
Overview 2 Behavioral Health Transformation Waiver Overview Waiver Rulemaking and Transmittals SUD Provider Capacity Grant Service Delivery and Billing Stakeholder Engagement
Waiver Overview 3
CMS Approved District’s 1115 Behavioral Health Transformation Waiver on November 6, 2019 4 Behavioral Health Transformation Waiver Advances District Goals: Cover a broader continuum of Medicaid behavioral health treatment 1. for individuals with serious mental illness (SMI)/serious emotional disturbance (SED) or a substance use disorder (SUD) Advance the goals of the District Opioid Strategic Plan by improving 2. outcomes for individuals with Opioid Use Disorder and other SUDs Support Medicaid’s movement towards more integrated medical and 3. behavioral health care to better coordinate prevention and treatment DHCF and DBH collaborating to develop and implement the waiver to promote a more accessible behavioral health system
Federal Goals Promote Community-Based Treatment, Reduction of Inpatient/ED Utilization 5 Key waiver goals include: Reduced utilization/lengths of stay in hospital emergency departments and inpatient hospital settings where preventable/unnecessary Reduced preventable admissions to acute/specialty/residential settings Serious Mental Illness (SMI) services only: Increased availability of crisis stabilization, including short-term residential crisis stabilization Increased access to community mental health services Improved care coordination, including continuity after hospital/residential stays Substance Use Disorder (SUD) services only: Increased rates of SUD identification, initiation, engagement and treatment adherence/retention Reductions in overdose deaths, including for opioids Improved access to treatment for physical health conditions for SUD beneficiaries
Waiver Services Include IMD Services and Community-Based Services and Supports 6 IMD Services Short-term, acute or stabilization inpatient or residential services provided by IMDs to non-elderly adults (21-65 years old) Community-Based Services Comprehensive Psychiatric Emergency Program Services; Mobile Crisis Intervention and Outreach Services; Psychiatric Crisis Stabilization Services; Transition planning services for individuals leaving a hospital, IMD, or other facility; Recovery support services for individuals with SUDs; Psychologist and other licensed behavioral health provider services for individuals with SMI/SED or SUD (excluding autism); Psychosocial rehabilitative services (also known as “Clubhouse”); Trauma-informed therapy services: TREM (Trauma Recovery and Empowerment Model) & TST (Trauma Systems Therapy); Supported employment services – vocational services for SMI; new services for SUD; and Removal of the $1 copayment for prescriptions for medication assisted treatment (MAT).
Waiver Services Beginning on January 1, 2020 Service Proposed Go-Live Date IMD Services January 2020 Clubhouse January 2020 Recovery Support Services (RSS) January 2020 Psychologists/Other BH Providers January 2020 Eliminate $1 Co-Pay for MAT January 2020
Waiver Services Beginning Later in 2020 Service Proposed Go-Live Date Supported Employment - SMI February 2020 Supported Employment - SUD March 2020 Trauma-Informed Care March 2020 Crisis Stabilization (CPEP, Psych Crisis Stabilization Beds, Mobile Crisis and Support June 2020 Services) Transition Planning Services June 2020
Waiver Rulemaking & Transmittals 9
Waiver Rulemaking Released on November 29 th - Available for Comment until 12/30/19 10 New Chapter 86 of Title 29 of the DCMR, entitled “Behavioral Health Transformation Demonstration Program” Corresponds to changes being proposed by DBH in the DCMR and related transmittals Purpose: Establish beneficiary eligibility, provider participation and requirements, and Medicaid fee-for-service reimbursement for services authorized under the demonstration program Available in November 29, 2019 DC Register and on DHCF website at https://dhcf.dc.gov/1115-waiver-initiative DHCF will accept public comments for 30 days, through December 30, 2019
DHCF Publishing Waiver Service Transmittals in December 11 DHCF transmittals and DBH Waiver guidance expected in December will cover: IMD Service Payments New Provider Enrollment – psychologists/other licensed behavioral health providers Removing $1 Prescription Drug cost sharing for medication assisted therapy (MAT) Recovery Support Services
SUD Provider Capacity Grant 12
DC Among 15 States Selected for a SUD Provider Capacity Grant 13 Federal SUPPORT Act Sec. 1003 created demonstration project grant to increase the treatment capacity of Medicaid providers to deliver substance use disorder treatment and recovery services. Collaborative funding from CMS, SAMHSA, AHRQ 2 Project phases: 18-month planning grant - $50 million awarded to 50 states – DC received $4.6 million 3-year demonstration grant – awarded to 5 planning grant states DHCF was awarded full amount requested ($4.6 million) Planning and 3-year grant opportunity complement DC Opioid Response and 1115 Waiver initiatives
SUD Provider Capacity Grant Components Focus on Building Core Infrastructure and Competencies 14 Comprehensive needs assessment of Medicaid provider capacity to diagnose and treat SUD, (*a required component of the grant) This builds on the Opioid Strategic Plan, Pew assessment, etc. DCPCA and JSI will lead this component (through Spring 2020) Education and technical assistance among Medicaid providers to build provider capacity to treat individuals with SUD in community settings . Prioritized providers include: My DC Health Homes My Health GPS Buprenorphine waivered providers Build critical infrastructure to support appropriate, privacy-preserving information exchange, including: Structured communication and referrals with District behavioral health providers; Development of consent management tools to facilitate appropriate exchange of 42 CFR part 2 data; and Pilot e-consult and telemedicine tools to provide access to addiction specialists on-demand who can support Medicaid providers.
Service Delivery and Billing 15
Provider Service Delivery and Billing Jan Feb March June 16 Service 2020 2020 2020 2020 • Bill MCO for "in lieu of" stays IMD Services (incl. of MCO members Psych. Hospitalizations/Residential Stays, • Bill DHCF for stays longer than Detox/Withdrawal Management and "in lieu of" for MCO members SUD Residential Services) • Bill DHCF for FFS enrollees • Bill MCO for MCO members Psychologists/OLPs • Bill DHCF for FFS enrollees $0 Copay for MAT Bill DHCF (for Rx) Clubhouse Bill DHCF RSS Bill DHCF Supported Employment - SMI Bill DHCF Supported Employment - SUD Bill DHCF Trauma-Informed Care Bill DHCF Transition Planning Bill DHCF
Stakeholder Engagement 17
District Will Host Behavioral Health System Performance Meetings, Send Quarterly Emails, and More Throughout Waiver Period 18 District will leverage existing meetings to inform and engage stakeholders Key meetings include: MCAC (Access and Delivery System Reform), DBH Provider CEO Network, MCO Health Plan Executive meetings, DBH Provider meetings, Wards 7 and 8 Health Council, etc. Periodic emails will be sent as new materials are posted – to subscribe, email dhcf.waiverinitiative@dc.gov Quarterly update emails from DHCF/DBH – starting ~Spring 2020 SUD provider capacity work –starting early 2020 Twice-yearly behavioral health system performance meetings – starting ~Summer 2020
Questions/Discussion 19 Waiver Materials available at https://dhcf.dc.gov/1115-waiver-initiative Waiver email mailbox: dhcf.waiverinitiative@dc.gov • DHCF: Alice Weiss, Director, Health Care Policy and Research Administration, DHCF, • alice.weiss@dc.gov DBH: • Trina Dutta, Director, Strategic Management & Policy Division, DBH, trina.dutta@dc.gov
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