Embed Size (px)
Citation preview
Medicaid Financing for Family
and Youth Peer Support:
A Scan of State Programs
National Federation of Families for Children’s Mental Health
23rd Annual Conference
Washington, DC
November 17, 2012
Dayana Simons, CHCS
Dana McCrary, Georgia, DBHDD
Jane Walker, Maryland Coalition of Families for
Children's Mental Health This document was developed under grant CFDA 93.767 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid
Services. However, these contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not
assume endorsement by the Federal Government.
2
CHCS Priorities
Our work with state and federal agencies, Medicaid
health plans, providers, and consumers focuses on:
2
Integrating care for people with
complex and special needs
Improving quality and
reducing racial and ethnic disparities
Building Medicaid leadership and capacity
Enhancing access to coverage and services
Maryland, Georgia and Wyoming
Collaborative CHIPRA Grant Project
• Goal: Improving the health and social outcomes
for children with serious behavioral health needs
by:
► Implementing and/or expanding a Care Management
Entity (CME) provider model to improve the quality -
and better control the cost - of care for children with
serious behavioral health challenges who are enrolled
in Medicaid or the Children’s Health Insurance
Program.
3
4
What Is A Care Management Entity (CME)?
• An organizational entity – such as a non profit
organization – that serves as the “locus of
accountability” for defined populations of
youth with complex challenges and their
families who are involved in multiple systems.
• An entity that is accountable for improving the
quality, outcomes and cost of care for
populations historically experiencing high-
costs and/or poor outcomes.
Pires, S. 2010. Building systems of care: A primer, 2nd edition. Georgetown
University
CME Core Services
• Intensive Care Coordination (at low ratios)
• Family and Youth Peer Support
• Mobile Crisis Response and Stabilization
• Intensive In-Home Services
CHCS Technical Assistance to the
Collaborative: Background on the Matrix
CHCS is:
• The coordinating entity for the states in the CHIPRA Collaborative
• Responsible for the Quality Framework and Internal “Independent”
Evaluation
• The lead Technical Assistance Provider:
► Webinars
2010 Series, 2011 Series, 2012 Series
► Monthly individual technical assistance calls
► Quarterly all-states meetings
► Shared online resource space for collaborative states
► Fact sheets (e.g., Care Management Entities: A Primer)
► Matrix of standardized assessment tools used to guide clinical decision‐making
► Matrix of options for structuring a CME model
► Scan of states using Medicaid to finance family and youth peer support
► Learning communities (state and national)
www.chcs.org
6
Types of Medicaid Coverage for
FYPS and States Using Them
• State Plan Amendment (SPA):
► AK, AR, AZ, KY, MA, MI, OK, WA
• Waiver:
► 1915(c) Home and Community Based Services
PRTF – GA, IN, MD, MT, SC
SED – KS, MI
7
Information in the Scan
• Medicaid funding source
• FYPS provider (service) title
• Definition
• Components of service
• Billing codes
• Billing amounts
• Qualifications, training and supervision
requirements
8
Georgia:
Growing the Family Movement
• Child & Adolescent State Infrastructure Grant (CASIG)
• System of Care (SOC) Grant Project
• Partnership with the Statewide Family Network
(Georgia Parent Support Network (GPSN) Sue Smith,
CEO)
► Invited families to the table
► Cultivated parents and youth through training,
conferences and inclusion
► Aggressively grew Federation of Families chapters
statewide
► Engaged/empowered youth through Youth Move
9
Georgia:
Adult Certified Peer Specialist (CPS)
• In December, 2001 approximately 35 current and former mental
health consumers completed training and examination to become
Georgia's first class of Certified Peer Specialists (CPSs).
• Certified Peer Specialists:
► Are responsible for the implementation of peer support services, which
are Medicaid reimbursable under Georgia's Rehab Option.
► Serve on Assertive Community Treatment Teams (ACT), as Community
Support Individuals (CSI) and in a variety of other services designed to
assist the peers they are partnered with in reaching the goals they wish
to accomplish in their personal recovery journeys.
• Today there are over 700 Adult CPSs in Georgia.
10
DBHDD: Supporting the SOC Values
Building Capacity for Family Involvement
11
HTI Serving Transition
Age Youth and their Families
Growing Services to eliminate the gaps in our service delivery
system
Making Sure Georgia
Youth/Families receive services the
whole life cycle
CBAY
Develop CME
Financing mechanism to support Parent
Partners
Embedded Parent Partners in High
Fidelity Wrap Training
SUICIDE
PREVENTION
Funding Adult & Youth Mental Health
First Aid Train the Trainer for Parents
ADDICTIVE
DISEASE
Integration of Training
Inclusion of Clubhouse Parents
/Youth & Staff
ADULT CERTIFIED
PEER SPECIALIST
(CPS)
Also Parents With Identical Values,
Similar Experiences
Strong Allies
Georgia CHIPRA Project:
Medicaid-Funded Peer Support Services
• Research and synthesize national best practices for
Parent/Youth Certified Peer Supports
• Coordinate the development of a training curriculum and
certification for Parent & Youth Peer Specialist
• Develop training plan for Parent/Youth Peer Specialist
Workforce
• Develop a Network of Credentialed Certified Parent/Youth CPS
• Partner with local family groups and organizations
12
Georgia’s Process: Using the Matrix
• Working to change the shape of the table to a
round table
• Building capacity
• Building relationships
• Building a network
13
Georgia’s Process: Beauty of the
Matrix
CHCS Technical Assistance: Research
• Funding source
• Title
• Definition
• Components of service
• Billing codes/amounts
• Qualifications, training and supervision
14
Georgia’s Process:
Develop the Service Outline
• Duties
► What we “must” do
• Knowledge
► What we need to know
• Competencies
► What skills we need to be able to do it
15
16
PURPOSE
• Provide support to families based on similar experiences
ROLE
• To create an environment for empowerment by listening to and sharing life experiences and information; developing one on one relationships; and improving the family’s ability to connect and communicate
RESPONSIBLE FOR ENSURING
THAT
• No parent has to do it alone
• Parents have access to the right amount and type of information to make sense of their child’s situation
• Supportive relationship built on encouragement exists between PPS and parent
• Parents are empowered and prepared to make the best use of any meetings or activities concerning them, including helping find ways to take care of themselves
• Parents can indentify and connect with their own supports
• Parents are able to navigate through the current services they receive
17
Understanding the Medicaid
Component is Foundational
“Parents don’t think about
understanding Medicaid, but it matters!
Families, family organizations need to
get training and build their
understanding of it.”
18
Maryland’s Medicaid Experience
• Naïve is the word!
• MCF became a Medicaid provider in 2009 as
part of a 1915(c) demonstration waiver
• Steep learning curve!
► Billing procedures
► Training
► Required documentation – developing forms
• Administrative costs increased dramatically in
order to bill Medicaid
19
Maryland’s Medicaid Experience
• Adapting practice from “whatever it takes” to
“whatever I can bill for” – challenge to our values
• Financially devastating for the first 2 years and
still difficult
• The “good news” – being a Medicaid provider
has not changed our mission or ability to
advocate and in the end has strengthened our
practice and stature – staff view themselves as
professionals
20
Considerations for FSOs:
It’s a Choice and a Decision
• Does it fit with your mission?
► Family Support Organizations (FSOs) often
think becoming a Medicaid provider is the
only way to achieve sustainability
► Important for FSOs to make an informed
decision and choose whether or not to
become a Medicaid provider
• Weigh the pros and cons
21
Considerations for FSOs (cont.):
If You’re Going to Do This,
This Is What You Need to Know
• Focus on definitions
► How is your state defining “family support?”
• Rates
► What is the rate?
► How was it determined?
22
More Considerations for FSOs
• How many contacts can you have with a family?
► How many hours per day?
► How many times per week?
► Is there a limit?
• What other contacts can you bill for?
► Meetings
► Phone calls
With the family
With the Care Coordinators or others working with
the family
► Finding resources for the family
23
Still More Considerations!
• Can you afford it?!
► What are your administrative costs for billing?
► Can you afford the cost for times when you cannot bill
(i.e., supervision, training, holidays, sick leave)?
► How are you paying your staff?
Salaried
Per billable hour
24
How Will Being A Medicaid
Provider Change Your FSO?
How will it change your:
• Mission
• Practice (with limits on what you can and
can’t do)
• Partnerships (from being an FSO to being
a provider)
• Advocacy role
25
Questions?
26
Visit CHCS.org to learn more about the
CHIPRA CME Collaborative.
Contact us:
www.chcs.org
27
