NJPRA Annual Conference11/22/13

Lynn A. KovichAssistant Commissioner

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Agenda

Update on the ASO/MBHO Process Update on Rate SettingMedicaid ExpansionHealth Home/Learning CollaborativeNewly Awarded Contracts and

Current RFP’sSystem HighlightsDMHAS Workplan Recovery and Rebuilding Post Sandy

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UPDATE ON THE ASO/MBHO PROCESS

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ASO/MBHO Process DMHAS continues to work with NJ Medicaid on the behavioral health

components of the Medicaid Comprehensive Waiver. New Jersey’s Waiver was approved by CMS on October 1, 2012. The CMS approval letter and Special Terms and Conditions are posted

at: http://www.state.nj.us/humanservices/dmahs/home/waiver.html. The DMHAS website provides updated information on the Waiver and

development of the MBHO at: http://www.state.nj.us/humanservices/dmhs/home/mbho.html.

RFP to procure a vendor for the MBHO developed collaboratively by DMHAS and DMAHS◦ Review/finalize design elements by DMHAS/DMAHS executive staff and

interdivisional/interdepartmental partners

◦ Review/content from Department of Banking and Insurance (DOBI)

◦ Review/approval by DHS Central Office Procurement

◦ Review/approval by Office of Information Technology (OIT), Office of Management and Budget (OMB), and the Office of the State Comptroller (OSC)

◦ RFP transmitted to Department of Treasury, Division of Purchase and Property (DPP)

◦ RFP published/posted by DPP

◦ Responsive bidder identified 4

Roles and Responsibilities in a Managed Behavioral Healthcare System

Eligibility Network Development and

ManagementAssessment and ReferralUtilization ReviewClaims AdministrationData AnalyticsCare ManagementQuality ManagementFinancial Management 5

UPDATE ON RATE SETTING

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Rate Setting

DMHAS has engaged Myers and Stauffer (M&S), a national CPA firm, to conduct the rate analyses for DMHAS services

Objectives:◦ Develop a fee schedule that is reflective of the costs

incurred in providing the services, which will be rolled out concurrent with ASO going live

◦ Encourage cost efficiencies through new payment system

◦ Provide equity in rates or “like rates for like services”◦ Promote access to community alternatives to

institutional placement◦ Maintain/increase access to services State-wide

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Practice Groups

A series of meetings were held 12/9-12/12 that included representatives from providers of mental health and substance abuse services, DMHAS staff, consumers and M&S◦ Outpatient◦ Partial Care◦ Residential◦ Supportive Housing◦ Methadone◦ Case Management◦ PACT

These meetings are a key opportunity for stakeholders to provide very specific feedback to both DMHAS and M&S on the costs required to deliver services to clients.

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Deliverables Preliminary Rates Fiscal Analysis:

◦ Aggregate Fiscal Impact Program Wide◦ Provider Level Fiscal Impacts◦ Federal / State Fiscal Impacts

Final Rates: ◦ Ready, with any adjustments from stakeholder review,

hopefully by end of 1st quarter of CY14. ◦ They will not be effective until ASO goes live.◦ They are for most services currently funded by DMHAS◦ A subset of services will remain under contract

reimbursement Certain services where State needs to buy overall capacity,

as opposed to utilization, such as Emergency Services, Intensive Family Support Services and PATH.

Inpatient psychiatric services paid exclusively by Medicaid are, for now, not part of this new rate-setting exercise.

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MEDICAID EXPANSION

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NJ FamilyCare SummaryNewly Eligible Populations

• Parents and Caretaker Relatives

• Single Adults and Childless Couples

Federal Share of Benefits

• January 2014: 100%• January 2017: 95%• January 2018: 94%• January 2019: 93%• January 2020: 90%

Increased Income Limits

• 133% of the Federal Poverty Level for most NJ Residents ($25,975 for a family of 3)

• Increased Limits for Children and Pregnant Women

Timetable

• Oct. 2013 – Applications begin

• Jan. 2014 – New benefits begin for an estimated 300,000 new Medicaid beneficiaries

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Overview

Before

NJ Family Care

• Families with income up to 133% of the federal poverty level (FPL)

• Children in families with incomes up to 350% FPL

• Pregnant Women up to 200% FPL

After

NJ Family Care

All Medicaid eligible populations

Medicaid• Aged, Blind and Disabled

up to 100% FPL• Childless Adults up to 25%

FPL 

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NEW FAMILYCARE IMPACT ON BEHAVIORAL HEALTH CARE

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Mental Health Parity and Addictions Equity Act (MHPAEA) in ACA

On October 3rd, 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was signed into law. This Federal law requires group health insurance plans (those with more than 50 insured employees) that offer coverage for mental illness and substance use disorders to provide those benefits in no more restrictive way than all other medical and surgical procedures covered by the plan.

Within the ACA, States who are implementing Medicaid Expansion need to provide the 10 Essential Health Benefits (EHBs) in the ABP that includes mental health and substance abuse services

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Benefit Plan

The Alternative Benefit Plan (ABP) needs to meet MHPAEA requirements

Plan D or General Assistance as parents or childless adults will be part of the ABP plan and receive a richer benefit then they have today.

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10 Essential Health Benefits

Ambulatory Patient Services

Emergency Services

Hospitalization

Maternity and Newborn Care

Mental Health and Substance Abuse Disorder Services

Pediatric Services (inc. Oral & Vision Care)

Preventive & Wellness Services and Chronic

Disease Management

Laboratory Services

Rehabilitative & Habilitative Services and

Devices

Prescription Drugs

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BH Services in the ABPBH services currently in the State Medicaid Plan

• Targeted Case Management (ICMS)

• Community Support Services (1/14)

• Behavioral Health Home (1/14)• MH Outpatient• SUD Outpatient (limited)• Adult Mental Health

Rehabilitation (group homes) • Inpatient psychiatric services• Opioid Treatment Services• Psychiatrist, Psychologist or APN• Partial Care/Hospitalization• Medical Detox• PACT

Additional BH services to be

covered in the ABP

• *Non-medical detox• SUD partial care• SUD IOP• *SUD Halfway House• SUD Outpatient• *SUD short term

residential• Psychiatric

Emergency Services/Affiliated Emergency Services

*Subject to IMD exclusionSUD - Substance Use Disorder 17

BEHAVIORAL HEALTH HOMES AND LEARNING COMMUNITY

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Behavioral Health Home SPABHH SPA will include children/ adolescents/

youth◦ DMAHS is working with DCF on the development of

the children’s program designTargeted to individuals with Serious Mental

Illness who are at risk for high utilization of services and children/adolescents/young adults with Severe Emotional Disturbances with a chronic medical condition

Plan to roll out the service county by county◦ Bergen and Mercer – calendar year 2014◦ DMHAS and DMAHS will measure outcomes and

impact on costs◦ Other counties to follow based on analysis of initial

homes and financial resources19

Behavioral Health Home Learning Community We have contracted with The National Council for

Behavioral Healthcare to develop and facilitate a Behavioral Health Home Learning Community

An RLI for Bergen County providers to join the Learning Community will be issued

Members of the Learning Community will develop a Behavioral Health Home implementation plan

Upon approval of the plan by DMHAS they will become certified Behavioral Health Homes and eligible to provide the service to Medicaid participants

Certified Behavioral Health Homes will have 2 years to become accredited as a Behavioral Health Home from a nationally recognized accrediting body 20

Behavioral Health Home ServicesComprehensive care managementCare coordinationHealth promotionIndividual and family support services

(including authorized representatives)Comprehensive transitional care

(including community and systems transitions)

Referral to community and social support services

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CURRENT RFP’S &NEWLY AWARDED CONTRACTS

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Current RFP’s

Expansion of existing PACT and RIST programs in Cumberland, Gloucester, Mercer, Middlesex, Monmouth, Morris, Ocean, Salem and Union counties. ◦ Issued – 10/15/13 ◦ Services will be targeted to facilitating the discharge of 70

persons on CEPP status at a state psychiatric hospital, for a total of up to $2.45 million

◦ Due Date - 11/22/13 with a 1/3/14 notification date

Supportive housing in Burlington, Camden, Cumberland, Gloucester, Hunterdon, Mercer, Morris, Passaic, Salem, Somerset, Sussex, and Warren Counties◦ Issued – 10/16/13◦ Targeted to service 52 adults diagnosed with a serious and

persistent mental illness whose homelessness or risk of homelessness places them at risk of psychiatric hospitalization, for annualized funding of up to $1.3 million

◦ Due Date - 11/26/13 with a 1/13/14 notification date23

Newly Awarded Contracts On 6/17/13 DMHAS issued an RFP for the provision of outpatient

mental health care and integrated co-occurring services to adult consumers age 21 and older presenting at mental health ambulatory care centers. ◦ Awards went to Greater Trenton Community Mental Health Center (Mercer),

Trinitas Regional Medical Center (Union), Eva’s Village (Passaic), CPC Behavioral Healthcare (Monmouth) and Inspira Health Network (Gloucester, Cumberland, Salem and Camden).

On 8/20/13 DMHAS issued an RFP to support the creation of long term residential, short term residential and halfway house beds in response to Phase 2 Drug Court expansion. ◦ Awards went to Maryville, John Brooks Recovery Center, Straight & Narrow,

United Progress Inc., Real House, Integrity, Inc., Community Recovery Services, RMS Housing Associates/Angel Hope House, CURA, Inc., and Urban Renewal Corp.

On 9/10/13 DMHAS was awarded a Strategic Prevention Framework - Partnerships for Success (SPF-PFS) cooperative agreement from the Center for Substance Abuse Prevention (CSAP). The agreement provides $2.2 million annually, renewable for five years. ◦ The SPF-PFS is designed to address two of the nation's top substance abuse

prevention priorities: 1) underage drinking among persons aged 12 to 20; and 2) prescription drug misuse and abuse among persons aged 12 to 25. The SPF-PFS is also intended to bring SAMHSA's Strategic Prevention Framework (SPF) to a national scale. 24

SYSTEM HIGHLIGHTS

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Admissions to NJ State Psychiatric Hospitals: SFY 2006-2013

(Excluding Ann Klein Forensic Center)

SFY 2006

SFY 2007

SFY 2008

SFY 2009

SFY 2010

SFY 2011

SFY 2012

SFY 2013

1,000

1,500

2,000

2,500

3,000

3,500

2,9382,811 2,763

2,2232,070 2,064

2,247

1,891

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NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems. November 2013.

SFY 2006

SFY 2007

SFY 2008

SFY 2009

SFY 2010

SFY 2011

SFY 2012

SFY 2013

1,000

1,200

1,400

1,600

1,800

2,000

2,2002,122 2,116

1,951

1,806

1,6711,591

1,5341,450

Total Average Census at NJ State Psychiatric Hospitals (excl. AKFC): SFY 2006 - 2013

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NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems. November 2013.

NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems. November 2013.

SFY 2006 SFY 2007 SFY 2008 SFY 2009 SFY 2010 SFY 2011 SFY 20120

1,000

2,000

3,000

4,000

5,000

6,000

2,136

2,534

3,051

3,4974,063

4,560

5,324

Clients Served by the SMHA in Supportive Housing (du-plicated) SFY 2006 – SFY 2012

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Clients Served by the SMHA in Supportive Housing (duplicated) and in the Non Forensic State Hospitals SFY 2006 – SFY 2012

SFY 2006 SFY 2007 SFY 2008 SFY 2009 SFY 2010 SFY 2011 SFY 20120

1,000

2,000

3,000

4,000

5,000

6,000

2,1362,534

3,0513,497

4,1004,474

5,324 5,205 5,095 5,008

4,120 3,818 3,652 3,802

# Served in Supportive Housing

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NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems. November 2013.

NJ Division of Mental Health and Addictions Services, Office of Research, Planning, Evaluation & Information Technology Systems. November 2013

SFY 2006 SFY 2007 SFY 2008 SFY 2009 SFY 2010 SFY 2011 SFY 2012220,000

230,000

240,000

250,000

260,000

270,000

280,000

290,000

300,000

310,000

253,439246,304

254,727 259,048

284,741 292,212

300,569

Total Adults Served by the SMHA in Community Services (duplicated) SFY 2006 to SFY 2012

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DMHAS WORKPLAN

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DMHAS 18-Month Workplan Four strategic planning sessions held in Spring 2013 centered

around:◦ workforce development◦ community integration◦ move to managed care

The feedback that was elicited is being used to generate tasks within the 18 month workplan (January 2014-June 2015)

The Parker Dennison workplan for the CSS was used as a template, with additional interdependent priorities added to create a division wide plan◦ Division projects that are independent are not included on the

workplan, but will continue to develop during this timeframe, such as suicide prevention, SBIRT, Sandy Initiative, etc.

DMHAS has identified team leads and workgroup members, which have begun meeting this fall to discuss tasks and timelines for the identified priority areas. 

The Communication Plan Workgroup, led by Susanne Mills, will communicate, at least quarterly, with stakeholders to keep them apprised of the status of the work being done on the priorities. Communication may come via the website, email announcements, meetings with providers, etc. 32

DMHAS Workplan Priorities The workplan, which is in the process of being

finalized, consists of 11 priority areas that include: ◦ Community Support Services Implementation◦ Rates and Financial Terms/Financial Impact Analysis◦ Centralized Housing Authority◦ ASO Procurement◦ Community Integration◦ Workforce Development◦ Standard Level of Care Determination◦ Changes to DMHAS Functions◦ Consumer and Stakeholder Communication Plan◦ Olmstead Compliance◦ ASO Readiness and Implementation

Each of these priority areas are tied to at least one of the three Strategic Planning Areas

There will be additional opportunities for stakeholder involvement 33

RECOVERY AND REBUILDING POST SANDY

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Social Services Block Grant This post Sandy recovery initiative includes the following services in the counties of

Atlantic, Bergen, Cape May, Cumberland, Essex, Hudson, Middlesex, Monmouth, Ocean and Union:

◦ MH and SA Outpatient ($5M)

◦ Early Intervention and Support Services ($4M)

◦ SA Detoxification & Short Term Residential ($7M)

◦ Supportive Housing & Career Services ($3.1M)

◦ Public Awareness Campaign ($2M)

Temporary staff have been hired, including Renee Burawski to manage the program

As of November 2013, UBHC is developing a panel of licensed clinicians to provide clinical mental health and substance abuse outpatient counseling to individuals who resided in the ten most impacted counties at the time of Sandy

◦ Individuals contacting the UBHC Access Center will be screened for services and provided appointments with clinicians or referred to Detoxification and Short term Residential as necessary

Substance abuse detoxification and short term residential were launched this month and are accepting referrals

◦ As of 11/21 there have been 115 total authorizations in the Recovery and Rebuilding Initiative including assessment (27), detoxification (47) and short term residential (41) authorizations.

DMHAS will expand EISS in Monmouth and Ocean counties as of December 2013

Services will be available through September 2015

As this is special federal grant funding, it will also be considered payor of last resort

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Department of Human Services

Division of Mental Health and Addiction Services

Supportive Housing 400 beds total

160 SUD and 240 SMI and Co-Occurring

Additional services include Supportive Employment and

Education Services, Housing Navigators

Short Term Residential and

Detox5 existing FFS

providers, 6 locations

Additional services include

comprehensive intake, family,

individual and group therapies, medication

monitoring, case management

Outpatient Counseling

UBHC/Rutgers Network of Private

Practitioners

Additional services include

psychiatric evaluation, medication

monitoring, tele-behavioral health

support

EISS expansion

(Monmouth and Ocean)

Media Campaign(MHANJ)

DMHAS Social Services Block Grant Sandy Initiatives

October 2013 to September 30, 2015