Customizing Medicaid Managed Care for Children, Youth and Young Adults with Behavioral Health Challenges

 2016 Meeting Resources

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Federal Resources

• Access to Mental Health Services for Children in Rural Areas

• The National Institute of Mental Health (NIMH) – Pediatrics-based Brief Therapy Outdoes Referral for Youths with Anxiety and Depression

• Medicaid and CHIP Managed Care Final Rules

• CMCS Informational Bulletin - Prevention and Early Identification of Mental Health and Substance Use Conditions

• Joint CMCS and SAMHSA Informational Bulletin: Coverage of Behavioral Health Services for Children, Youth, and Young Adults with Significant Mental Health Conditions  

• CMCS Informational Bulletin: Clarification of Medicaid Coverage of Services to Children with Autism  

• Joint CMCS and SAMHSA Informational Bulletin: Coverage of Behavioral Health Services for Youth with Substance Use Disorders

• CMS Informational Bulletin: Medicaid Payment for Services Provided without Charge (Free Care)

• CMS Managed Care Information

• CMS MCO Contract Approval

• CMS Rate Development Guide

• State Guide to CMS Criteria for Managed Care Contract Review and Approval

• HHS Trauma Letter to Medicaid State Directors 7-11-2013

• AHRQs Child Quality Tool Box

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Setting the Stage: Brief Overview of the Population and Public Managed Care Issues

Powerpoint Presentation

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Panel #1: Network Development, Network Contracting Requirements, Network Monitoring

Powerpoint Presentation

Related Resources:

• Louisiana

  • Louisiana SBHS Provider Network Monitoring Plan

  • RFP for Statewide Management Organization For The Louisiana Behavioral Health Partnership

• Wisconsin

  • Milwaukee County DHS BH Division Community Access to Recovery Services Wraparound Milwaukee Year 2015 RFP

• Community Catalyst: Network Adequacy Checklist

 

Panel #2: Improving Children’s Behavioral Health through a Focus on Quality Metrics and Alternative Payment Arrangements

Powerpoint Presentation

Related Resources:

• Louisiana

  • Louisiana CSoC Quality Dashboard

• Oregon

  • Health Authority Measure Sets: November 2014

• Wisconsin

  • 2015 Quality Assurance/Quality Improvement Annual Report

  • Tracking and Measuring Program and Fiscal Outcomes

  • Wraparound Milwaukee Annual Performance Report

• Performance Measurement

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Panel #3: Health Integration and Complex Populations

Powerpoint Presentation

Related Resources:

• Colorado

  • Youth with High Behavioral Health Needs in Colorado: Cross-System Utilization Patterns

• New Jersey

  • Section 1115 Demonstration Comprehensive Waiver

  • CSoC Perform Care Assistive Tech Facts

  • CSoC Perform Care Best Practice Protocol

• Wisconsin

  • Milwaukee Child Welfare Contract

• Medicaid Coverage of Social Interventions: A Road Map for States

• Making Medicaid Work for Children in Child Welfare: Examples from the Field

• Child Wellbeing Assessment in Child Welfare

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Addressing Health Disparities

Powerpoint Presentation

Related Resources:

• Medicaid Managed Care & Cultural and Linguistic Competency Resources

• The Role of Data in Health Care Disparities in Medicaid Managed Care

• Addressing Health Care Disparities – AHRQ Archives – Quality Improvement Efforts

• Medicaid Managed Care for Members with Mental Health Conditions and/or Substance Use Disorders: Connecting Members to Social Supports

• Massachusetts:

  • CME RFP

Standardization of Cultural Data to Reduce Health Disparities and Advance Health Equity:

• A Framework for Stratifying Race, Ethnicity and Language Data

• Implementing Multicultural Health Care Standards: Ideas and Examples

• Capturing Social and Behavioral Domains and Measure in Electronic Records

• Guide to Preventing Readmissions and among Racial and Ethnically Diverse Populations Medicare Beneficiaries

• Building an Organizational Response to Health Disparities

• Compendium of Resources for Standardized Demographic and Language Collection Data

Quality Metrics for Family Engagement and Satisfaction:

• Consumer Assessment for Healthcare and Provider Systems (CAHPS) Cultural Competence Data Set

Kansas System of Care Diverse Advisory Board Development:

• Tips on adding diversity to Cultural and Linguistic Competency committees and/or Advisory Boards

Integration of Cultural and Linguistic Competence and Wraparound:

• Why Cultural Competence is One of Wraparound’s Greatest Strengths and Most Persistent Challenges

• Implementing Culture-Based Wraparound

• Statewide Children’s Wraparound Initiative Biennial Legislative Report - Oregon Health Report

 

Role of Families in System Design, Implementation, and Quality Oversight of Medicaid Managed Care Initiatives

Powerpoint Presentation

Related Resources:

• Louisiana

  • State of Louisiana Executive Order Coordinated System of Care Governance Board

  • RFI for Provision of Statewide Family Support Services

  • Coordinated System of Care Community Application (RFA)

• New Jersey

  • CSOC Youth and Family Guide

• Guide for Family Run Organizations Becoming a Medicaid Provider

• Guide for Family and Consumer Run Organizations Seeking to Expand their Funding

• Utilizing Medicaid to Build Family Support Programs

• FRO - Caterogies of Service and Definitions

• FFCMH National Certification for Parent Support Providers

• Youth Engagement - Stipending Youth and Young Adults

• Youth Engagement - Youth-Driven Organizational Purpose Areas

• Peer support in mental health care: is it good value for money?

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Resources around certification and roles played by parent peer support providers:

• Basic Parent Peer Support (PPS) Certification Process

• Necessary Components: Best Practice - Parent Peer Support Certification; Parent Peer Support Competency Training

• State of Indiana - Certified Parent Support Provider Application

• Tennessee Parent Peer Support Certification Process

• Idaho Application for Certified Family Support Partner

• Roles for Parent Peer Support Providers Based on Intensity Level of Service Need/Use

 

Panel #4: Stratification of Populations for Care Coordination and Rate/Risk Structuring

Powerpoint Presentation

Related Resources:

• Maryland

  • 1915i regs

  • TCM regs

  • CCO Draft RFP

  • 1915i State plan HCBS Administration and Operation

  • Targeted Case Management Services: Care Coordination for Children and Youth

• New Jersey

  • NJ DCF RFP Unified CMO for Burlington County

  • CSOC CMO Service Guidelines: Moderate  

  • CSOC CMO Service Guidelines: High

• New Mexico

  • New Mexico Children, Youth & Families Department

  • New Mexico - Communities of Care

• Centers of Excellence Roadmap

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Other Resources

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Analyses:

• Children's Faces of Medicaid Resources

• Looking at the New Medicaid/CHIP Managed Care Regulations Through a Children's Lens

• Final Regulation on Mental Health Parity in Medicaid - NAMD Summary

• Return on Investment in Systems of Care for Children With Behavioral Health Challenges

• Potential Funding Sources for SOC

• Faces of Medicaid: Children's Behavioral Health Care Utilization & Costs - Infograph

Intensive Care Coordination Related Resources:

• Intensive Care Coordination Using High-Quality Wraparound for Children with Serious BH Needs: State and Community Profiles

• Intensive Care Coordination Using High-Quality Wraparound: Care Coordinator to Child and Family Ratios

• Intensive Care Coordination Using High-Quality Wraparound: Supervisor to Care Coordinator Ratios

• Intensive Care Coordination Using High-Quality Wraparound: Rates and Billing Structure

• ICC Wraparound Quick Reference Snapshots

• Case Rate Scan for Care Management Entities  

• Case Management vs Care Coordination

• Determining Care Management Entity Costs to Inform Financing - CHCS & Choices Webinar

Managed Care System Reform Resources:

• Moving Toward Value-Based Payment for Medicaid Behavioral Health Services

• Connecticut Medicaid Outpatient Behavioral Health Clinic Services

• Behavioral Health Integration in Pediatric Primary Care: Considerations and Opportunities for Policymakers, Planners, and Providers

• Integrating Behavioral Health into Medicaid Managed Care: Design and Implementation Lessons from State Innovators

• Value Based Payment Models for Medicaid Child Health Service

• Customizing Health Homes for Children with Serious BH Challenges

• CHCS Reengineering Residential Treatment Webinar

• State Approaches to Providing Health-Related Supportive Services through Medicaid

• Increasing Access to Behavioral Healthcare: Managed Care Options and Requirements

Other:

• Big Data in Human Services Brief

• Flexible Funds for Customized Goods and Services Brief

• Walk to Beautiful: The Power of Love and a Homeless Kid Who Found the Way by Jimmy Wayne

• TennCare Transformation with the Introduction of Tennessee Health Link

• Colorado - Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

 

Other State Resources

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State Plan Amendments/Waivers:

• Massachusetts

  • Targeted Case Management SPA

• Montana

  • 1915i HCBS State Plan Program for Youth with SED 2015

Quality Measurement:

• Lousisiana

  • CSoC Quality Report Status (December 2016 – November 2017)

  • CSoC Quality Dashboard

• New Jersey

  • CSOC Annual Report  for NJ's 1115 Waiver

  • CIACC Data Dashboard

Policy & Regulation:

• Louisiana

  • Louisiana  CSoC Areas of Focus Priority Report Requests

  • Louisiana CSoC Quality Measures Document

  • Louisiana Concept Paper

• New Jersey

  • CMO regs

  • New Jersey Concept Paper

  • TCOM Conference - "Transforming Children's Behavioral Health: The NJ Experience"

RFP/Contracts:

• Louisiana

  • Statewide Management Organization RFP

  • RFA to select regions for phase 1 of implementation

• New Jersey

  • RFP for ASO

  • Contracted System Administrator for the Children’s System of Care

• Wisconsin

  • Medicaid Contract (July 1, 2013-June 30, 2015)

Service Definitions:

• Louisiana

  • Louisiana Behavioral Health Partnership (LBHP) Service Definitions Manual

• Massachusetts

  • Targeted Case Management Services: Intensive Care Coordination Performance Specifications

  • Family Support & Training Performance Specifications

  • Mobile Crisis Performance Specs

  • In Home Therapy Performance Specs

  • Therapeutic Mentoring Performance Specs

• New Jersey

  • Division of Medical Assistance and Health Services Case Management Service Manual

  • Mobile Response and Stabilization Services Clinical Criteria

• Wisconsin

  • Wraparound Milwaukee Service Description List

Medical Necessity Criteria:

• Louisiana

  • Who might the CSoC be right for?

• Massachusetts

  • MNC: TCM Services ICC

  • MNC: Family Support and Training

  • Mobile Crisis MNC

  • In Home Therapy MNC

  • Therapeutic Mentoring MN

• Wisconsin

  • Provider Practice Guidelines

Operational Documents:

• Hawaii

  • Memorandum of Understanding

• Louisiana

  • LA CSoC Standard Operating Procedures

• Massachusetts  

  • CSA ICC and Family Support and Training Program Description and Operations Manual

  • Rates for CBHI Services

  • MCO Authorization Parameters for CBHI Services

• New Jersey

  • Division of Medical Assistance and Health Services Case Management Service Manual  

  • DHS Children’s System of Care Initiative: CMO Standards of Operation Manual

  • PerformCare Provider Service Code Guidelines

  • Mobile Response and Stabilization Services Training and Certification Process

  • Mobile Response and Stabilization Services Core Competencies Worksheet

• Wisconsin

  • Policies and Procedures

  • Wisconsin Emergency Mental Health Service Programs Benefit