Piecing Together the Puzzle: The Implementation of Behavioral Healthcare Reform BHSAC April 2018 Meeting Ann Sullivan, M.D., OMH Commissioner April 26, 2018
April 26, 2018 2 Gathering the Pieces New York’s public mental health system is in the midst of comprehensive reform. OMH is supplying the pieces, but it is up to all stakeholders to help complete the picture.
April 26, 2018 3 Putting Vision in Action: Major efforts in next 3-5 years to transform the MH system • Recovery-oriented program design and financing: Managed care/HARP, HCBS services, care management, value-based payment • Reinvestment: Paving pathways from State inpatient and residential to independent community living , reducing avoidable hospital use increasing integrated care • System and regulatory redesign to strengthen access, increase efficiency, and quality of care: comprehensive and flexible crisis services and intensive wrap around and treatment services, expanded clinic services • Promoting population health and prevention
April 26, 2018 4 Reinvestment • To date, $78M State PC RIV and $19M Article 28 reinvestment issued to State Aid Letter, RFP, and State-operated community service expansion. • 50,000 new individuals served through 2017. • Counties have been key planning partners. • Now implemented for multiple years, opportunity to evaluate success and opportunities for reform. Field Offices working to reprogram funds as needed. • 2018-19 Budget includes additional $11M annualized reinvestment. • Bed reductions to date approximately 650 since 2014-15 SFY = $71.5M at the statutory RIV formula of $110,000/bed. Current RIV in the community exceeds this amount, honoring “pre-investment” concept. • While RIV continues, systems planning with existing $ is equally important to reducing IP and ED use, and allowing continuation of RIV.
April 26, 2018 5 ACT Expansion 20 new ACT teams implemented in 2017-2018. • New team locations based on waitlists and need in counties where teams currently exist and in counties without existing teams. • NYC : 14 new ACT Teams; LI : 1 new ACT Team; Westchester, Warren/Washington, Niagara, Cattaraugus, Fulton/Montgomery : 1 new ACT Team each. • 10 of the new NYC ACT Teams have shelter focus. All teams are licensed, working with 27 mental health shelters in NYC, paired with 1-4 shelters based on location and size. DOHMH, DHS, OMH, shelters and providers collaborating to serve high need individuals. • OMH is looking at outcome data and best practices for specialized ACT teams including shelter-focused and forensic-focused teams. • Working closely with Center for Practice Innovations, ACT Institute for training, research, consultation. • In addition to the nearly 600 ACT slots from reinvestment since 2014.
April 26, 2018 6 Intensive Outpatient Program Creating an alternative to inpatient hospitalization or shorten a hospital stay and reduce readmissions by intensive outpatient treatment as a transition to more independent living. • Target individuals are those with severity of symptoms who without intensive outpatient services would otherwise be referred to an inpatient setting, who require a level of structure beyond a standard clinic program, and who can be effectively treated at this level of care. Ideal treatment timeframe is six weeks, 2-3 hours per day, 2-3 days per week. • 24 clinics/satellites currently approved to offer IOP via 501 waiver. • Central New York- Onondaga: 1 • Long Island- Nassau: 2, Suffolk: 3 • Mid-Hudson- Orange: 2, Putnam: 1, Ulster: 1, Westchester: 6 • New York City- 7 • Western New York- Erie: 1
April 26, 2018 7 HARP, Health Homes, HCBS: Working to Expand the Pipeline HARP Enrolled 106,975 HH Enrolled 35,474 HCBS Assessed 16,387 HCBS Eligible 14,973 LOSD Requested 5,777 HCBS Authorized 2,342 HCBS Dashboard Data- March 20, 2018 HCBS Claimed 1,714
April 26, 2018 8 HARP, Health Homes, HCBS • Nearly 107,000 HARP-eligible are now enrolled, with more on way via NY State of Health • 33% HARP members enrolled in Health Homes • HARP Health Home enrollees with HCBS assessment increased to 46% • Approximately 91% of HCBS assessments are HCBS eligible • $75 million for HCBS Quality/Infrastructure Funds • $25M in MCO quality funding to reward MCOs that invest in BH HCBS provider systems. • $50M in BH HCBS infrastructure funding to improve capacity, connectivity and service delivery systems. • As of April 6, CMS has confirmed that individuals who are considered street homeless and/or who are residing in homeless shelters are allowed access to HARP HCBS. • Counties and providers to push HCBS assessments as we pursue alternative path to HCBS for those without Health Home enrollment.
April 26, 2018 9 State Designated Entity • SDE is good example of integrating implementation feedback into responsive solutions – thank you for your involvement. • Currently, 66% of HARP enrollees are not enrolled in HH. MCOs will contract with eligible entities to provide assessment and care planning of BH HCBS for HARP enrollees not enrolled in a Health Home. • HARP members who are not enrolled in HH will have their NYS Eligibility Assessment and HCBS Plan of Care done through the State Designated Entity contracted with the MCO as an Recovery Coordination Agency (RCA) for BH HCBS. • HARP members who are not HH-enrolled may best engage with providers who have existing therapeutic and supportive relationships. These providers may be best at identifying recovery goals and linking the member to HCBS.
April 26, 2018 10 Consumer Education Efforts OMH offers a wide variety of promotional and outreach materials for our stakeholders, available on our website and YouTube channel, helping consumers access and understand HARP and HCBS services. NYAPRS Peer-to-Peer New Choices Program provides consumers with a working knowledge of HARP, HCBS and other essential components of the behavioral health system. RPC Training and Networking events create opportunities to share valuable information on improving access to HARP and HCBS.
April 26, 2018 11 Health Home Plus Eligibility Health Home Plus (HH+) previously limited to active AOT, CNYPC prison releases, and State PC discharges. Using what worked from TCM model while allowing flexibility such as mixed caseloads, team approach, with experienced care managers, face to face engagement. • As of May 1, 2018, HH+ will include additional high need individuals with SMI, including: individuals stepping down from ACT; multiple inpatient hospitalizations with no connection to outpatient care; AOT step down; AOT diversion; homeless; other individuals with forensic history/at risk of incarceration, SPOA and MCO Discretion. • HH+ Stakeholder workgroup has been very effective in helping to develop flexible but accountable care management models. Thank you! • Also beginning May 1, 2018, eligible non-legacy Care Management providers will be able to serve HH+ with appropriate qualification. • Eligibility for HH+ rate is 12 months or length of AOT order.
April 26, 2018 12 Crisis Services System Vision for a coordinated behavioral health crisis response system available to all New Yorkers, regardless of ability to pay. Integrates existing crisis infrastructure with newly available resources in managed care, DSRIP, and VBP. • Using the 1115 Crisis Intervention Benefit, the impetus for sustaining and expanding crisis services. • County Crisis Plans- • Counties/regions submit plans for review and approval, working with OMH and OASAS. • Identify gaps and areas for improvement, possible expansions and linkages to next levels of care. • Include DSRIP and PPS crisis projects, such as intensive crisis respite and stabilization projects. CCBHCs involved in crisis planning. $50 million to help develop residential crisis programs statewide.
April 26, 2018 13 Growing Forensic Capacity • OMH and counties both recognize the pressure of CPL 730s on our systems. Working to expand options/capacity for restoration. • New 25-bed 730 restoration unit at Kirby FPC in Manhattan. It is on track to open in May. • Will help eliminate backlog of patients waiting to get into forensic hospitals, serving an estimated 70 admissions per year and reducing admission wait time to two weeks. • Looking at new options to reduce burden and pressure on local jails. • Exploring an additional unit for CL 508 patients. • Piloting jail diversion programs, linking pre-trial supervision with intensive wraparound programming with transitional housing. • Increasing outpatient restoration in conjunction with forensic hospitals. • Housing • Prison to Community • Prison to State PC
April 26, 2018 14 Law Enforcement Training • In 2017-2018 budget, 8 counties in Western New York received support for Crisis Intervention Training • 2018-2019 budget increased funding from $400,000 to $925,000 • OMH will be working with Senate as they designate jurisdictions for new trainings. • New funding for mobile app/tablets enabling law enforcement to directly connect with clinicians in responding to individuals with SMI. • OMH and DCJS are offering free Fundamental Crisis Intervention Skills for Law Enforcement Training for mental health professionals and law enforcement to become certified to instruct the mental health module of the basic police recruit curriculum. • First session already occurred, upcoming sessions available.
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