August 28, 2015 Agenda Purpose of - PowerPoint Presentation

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August 28, 2015

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Agenda

Purpose of Behavioral Health Managed Care TransitionBehavioral Health (BH) Managed Care Program Design and TimelineState Plan and Behavioral Health Home and Community Based Services (BH HCBS)BH HCBS Designation StatusHealth and Recovery Plan (HARP) Enrollment and AssessmentRest of State RFQ Questions Received to Date

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Medicaid Redesign Team: Objectives

Fundamental restructuring of the Medicaid program to achieve:Person-centered recovery oriented careMeasurable improvement in health outcomesSustainable cost controlMore efficient administrative structureBetter integration of care

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Why we need to transform care:

The 30-day readmission rate for NYC is 25% and 20% for Rest of state.

Outpatient Mental Health (MH) or

Substance Use Disorder

 (SUD) treatment within 7 days of discharge is 35% for NYC and 42% for Rest of State.

Two or more Mental Health (MH) outpatient visits within 30 days of discharge in NYC is 32% and 40% for Rest of State.

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Why we need to transform care:

BHO Phase 1 post-discharge outcomes for

Substance Use Disorder (SUD) discharges, CY 2012

45-Day

readmission rate for NYC

is about 45%

and

about 18%

for Rest of state.

Lower level of SUD service or MH outpatient care within 14 days of discharge is about 31%

for NYC and

48%

for Rest of State.

Three or more SUD lower level services within 30 days of discharge in

NYC is

20 %

and

35%

for Rest of State.

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Integrated Care: In BHO Phase I, how often did behavioral health inpatient providers identify general medical conditions requiring follow-up, and did they arrange aftercare appointments?

Based upon 56,167 statewide behavioral health community discharges (all service types) January 2012—June 2013

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July 2015 – NYS received CMS approval for the 1115 Waiver Amendment expanding behavioral health services in Medicaid Managed Care.

Federal Approval of Behavioral Health Managed Care Design

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Principles of BH Benefit Design

Person-centered care managementIntegration of physical and behavioral health servicesRecovery oriented servicesPatient/Consumer Choice Ensure adequate and comprehensive networksTie payment to outcomesTrack physical and behavioral health spending separatelyReinvest savings to improve services for BH populationsAddress the unique needs of children, families & older adults

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Behavioral Health Managed Care Design

Behavioral Health will be managed by:Managed Care Organizations (MCO) meeting rigorous standards (perhaps in partnership with a Behavioral Health Organization (BHO))All Plans MUST qualify to manage newly carved inbehavioral health services and populationsPlans can meet State standards internally or contract with a BHO to meet State standardsHARPs for adults with significant behavioral health needs MCOs may choose to apply to operate a HARP product with expanded benefitsHIV SNPs will include HARP benefits for eligible members

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MMC Plan vs. HARP

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Medicaid Managed Care Plan

Health and Recovery Plan

Medicaid EligibleBenefit includes Medicaid State Plan covered servicesOrganized as Benefit within Managed Care Organization (MCO)Management coordinated with physical health benefit managementPerformance metrics specific to BHBH annual expenditure minimum

Medicaid eligible adults

Specialized integrated product line for people with significant behavioral health needs

Eligible based on utilization or functional impairment

Enhanced benefit package - All

MMC covered benefits PLUS

access to

HCBS

to help individuals meet their goals (employment, independent living, education, etc.)

Specialized medical and social necessity/ utilization review for expanded recovery-oriented benefits

Benefit management built around higher need HARP patients

Enhanced care coordination - All may be in Health Homes

Performance metrics specific to higher need population and BH HCBS

Integrated medical loss ratio

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September 18, 2015 – MCOs submit ROS Adult RFQ application (Full and Expedited Versions)November 2015 – Anticipated MCO conditional designationMid-November 2015 – Individual NYS/MCO RFQ follow-up discussionDecember-March 2016 –Readiness Reviews (Desk Audit/On-site) April-June 2016 – Final MCO Designation and HARP Certificate of AuthorityJuly 2016 – Mainstream and HARP behavioral health management begins

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Adult Rest of State (counties outside NYC) Behavioral

Health Managed Care

Timeline

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Implementation Schedule of the Key Elements of Children’s Medicaid Redesign Plan (the “How”)

Anticipated

Schedule for Implementing Children’s Medicaid Redesign Plan

Health Homes for Children

Enrollment begins for Eligible Children, OMH TCM Program Transitions to Health Home

Opportunity

: CAH I & II providers may provide care management for children not enrolled in waivers

January 1, 2016

Transition Care Coordination Service

of CAH I & II,

and other 1915c Waiver Programs to Health Home (OMH SED, OCFS B2H)

January 1, 2017

Expanded

Array of State Plan Services for

All Children

Early in 2016

Transition existing Behavioral Health Benefits to Managed Care

Transition Foster Care Children (those which are currently

subject to Agency Based Medicaid Per Diem) to Managed Care

Expand Array of Home and Community Based Services

January 1, 2017

(NYC and Long Island)

July 2017

(Rest of State)

Maintain

Access to Services for Children without Medicaid/Family of One-continues for LOC children with 2017 transition; begins for Level of Need children in 2018

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Expansion of Behavioral Health in Medicaid Managed Care

The expansion of BH in Medicaid managed care is two-pronged:Benefit ExpansionBH services expanded for MMC enrollees HARP implementation

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Substance Use Disorder (SUD) and Mental Health (MH) State Plan Services-Adults

MMC Covered BH Services for all enrollees:

Inpatient

– SUD

and MH

Clinic – SUD and MH

Personalized Recovery Oriented Services (PROS)

Intensive Psychiatric Rehabilitation Treatment (IPRT)

Assertive Community Treatment (ACT)

Continuing Day Treatment (CDT)

Partial Hospitalization

Comprehensive Psychiatric Emergency Program (CPEP)

Opioid treatment

Outpatient chemical dependence rehabilitation

Rehabilitation Services for Residents of

C

ommunity Residences

(

Not initially in

the benefit

package)

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Expansion of BH Services in Services Medicaid Managed Care Benefit Package

Expanded services are available to all Medicaid Managed Care enrollees

Mental Health Services

Licensed Mental Health

Practitioner

Services (Off-site services that may only be provided by OMH licensed clinics)

Behavioral

Health Crisis Intervention

Substance Use Disorder Services

Residential Redesign - Three phases: OASAS Intensive Residential, Community Residential, Supportive Living and Medically Monitored Detox

Reassignment of SUD clinic to State Plan “Rehab Option” to permit off-site delivery of

services

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HARP, Health Home and BH HCBS

All HARP members will be offered Health Home care management services All HARP members will be annually assessed for eligibility for BH Home and Community Based Services. The Community Mental Health (CMH) suite of the interRAI has been customized for NYS and includes:Brief Assessment to determine HARP and BH HCBS eligibilityFull Assessment to identify needs and assist in the development of a care planHealth Homes will conduct the NYS Community Mental Health AssessmentHealth Homes will develop person-centered care plans that integrate physical and behavioral health service, include BH HCBSHARPs will need to approve Health Home plans of care to comply with HCBS conflict-free requirements

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Home and Community Based Services for HARP enrollees and HARP eligible HIV-SNP enrollees

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RehabilitationPsychosocial RehabilitationCommunity Psychiatric Support and Treatment (CPST)HabilitationRespiteShort-Term Crisis RespiteIntensive Crisis RespiteEducational Support Services

Individual

Employment Support Services

Prevocational

Transitional Employment Support

Intensive Supported Employment

On-going Supported Employment

Peer Supports

Support Services

Family Support and Training

Non-

Medical

Transportation

Self

Directed Services

Pilot (pending CMS approval)

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Rest of State HCBS Designation Process

The BH HCBS application is available on the OMH website and application are due 9/14/2015Providers must complete an application to be identified as a “State designated BH HCBS provider” for each service they plan to deliver A provider attestation form is required, indicating that the provision of the service is consistent with the standards included in the HCBS provider manualOMH/OASAS will compile a list of all providers that have completed an application and attested to meeting the service standardsIn order to retain their “BH HCBS designation” providers must demonstrate on-going staff development competency for certain services

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HARP Enrollment

All HARP eligible individuals identified by NYS will be offered an opportunity to enroll into a HARP

HARP eligible members will be passively enrolled in a HARP if they are enrolled in a Plan

whose MCO offers

a

HARP product

These members will have the choice to opt out

Individuals initially identified as HARP eligible who are enrolled in an MCO without a HARP will

not

be passively enrolled

They will be notified of their HARP eligibility and referred to the NYS Enrollment Broker (New York Medicaid Choice) for education about enrollment options

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HARP Choice

Ability to opt-out of HARP or choose different Plan:Individuals identified for passive enrollment will be notified by the NYS Enrollment BrokerThey will be given no less than 30 days to opt out or to select another HARPOnce enrolled in a HARP, members are allowed 90 days to choose another HARP or return to Medicaid Managed CareAfter 90 days, they are locked into the HARP for 9 additional months (after which they are free to change Plans at any time)

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Provider Technical Assistance

NYS is funding the Managed Care Technical Assistance Center (www.mctac.org) to offer support and capacity building for providers. Subject areas include:Contracting Business & Clinical Operations InnovationHome and Community Based ServicesEvaluating, measuring, & communicatingBilling, Finance & Revenue CycleUtilization ManagementAdditional BH HCBS provider trainingsBH HCBS (with Center for Practice Innovation)Business Practices (targeted at small providers)

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Provider Start-Up Assistance

Funding available for up to two yearsPriority given to BH HCBS providers and agencies with little or no Medicaid or Medicaid Managed Care experienceKey areas for Start-Up assistance include:Health Information Technology (HIT) NYS is developing a process to assist behavioral health providers who currently do not have the technological infrastructure to efficiently transition to a managed care system HCBS provider Start-Up grantsProviders must demonstrate a contractual relationship (or letters of intent) with HARPs

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Draft Rest of State Rates PM/PM by Region

Central $1,907.10Finger Lakes$1,690.93Long Island$2,493.08Mid-Hudson$2,355.14Northeast$1,887.45Northern Metro$2,515.26Utica-Adirondacks$1,717.78Western$1,899.84

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Draft Rest of State HARP Rates can be found on the OMH website:

http://

omh.ny.gov/omhweb/bho/harp-ros-draft-rates.pdf

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RFQ Questions and Answers

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FAQ Review Process

NYS will review questions received to date and provide answersComplete RFQ questions first followed by expedited RFQ questionsNYS verbal responses to additional questions received today must be considered preliminary answersFinal answers will be posted as soon as possible on the DOH, OMH, and OASAS websites

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Complete RFQ: General

Question: Would the State please share the Q&A prepared for the downstate RFQ? Response: FAQs from the NYC applicants conference can be found online at: http://www.omh.ny.gov/omhweb/bho/faq.pdf Note: Answers to some of these questions have changed. NYS is in the process of reviewing these FAQs and will update as appropriate in the near future.

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Complete RFQ: General

Question: Please confirm the State requires 4 complete hardcopies of the response. In addition, please clarify whether the electronic submission (PDF and Word) should include attachments or just the narrative response to Section A through K.Response: RFQ responses requires 4 complete responses and the PDF/Word versions should include attachments where possible.

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Complete RFQ Section 1.5.A.ii Program Design

Question: If the member refuses a Health Home, is the HARP allowed to provide case management? If so, how is that funded?Response: The HARP is responsible for care coordination, either though a Health Home or other State-designated entities. This service is included in the PMPM capitated rate.If a person refuses Health Home enrollment, the HARP must contract with a Health Home (or other state designated entity) to complete the assessment and develop the HCBS plan of care (POC).

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Complete RFQ Section 1.5.A.ii Program Design Cont’d

The Health Home must bill the HARP for delivery of these two services at the rates established by the State. Once the BH HCBS POC has been developed, the Health Home care manager forwards it to the HARP which is responsible for monitoring and implementing the POC. The HARP will not be paid an additional fee for monitoring and implementing POCs for their members who choose not to enroll in Health Homes.

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Complete RFQ Section 1.5.A.ii.b Program Design

Question: What are the metrics for BH HCBS and Health Home providers, or is it up to the HARPs and MCOs to determine the performance metrics per their contracts with those Health Homes and BH HCBS providers?Response: For BH HCBS, the Federal assurance and sub assurance requirements are being finalized. Additional information will be forthcoming.

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Complete RFQ Section 1.7.C System Goals, Operating Principles, Requirements and Outcomes

Question: Are there standard reporting requirements/monitoring mechanisms or processes Plans are expected to use? Also, are these general outcomes or specific to HARP members/MMC members who access BH services?Response: Plans will continue to be responsible for reporting requirements in QARR. NYS will issue additional guidance regarding required transitional monitoring reports specific to BH service utilization.

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Complete RFQ Section 1.8.E.vi Covered Populations and Eligibility Criteria

Question: Please clarify what entails a significant change in an individual’s circumstances or needs.Response: Significant change is when an individual experiences an acute episode, is re-hospitalized or experiences an event where additional support is required to live safely in the community.

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Complete RFQ Section 1.10.E Covered Populations and Eligibility Criteria

Question: What are the authorization requirements related to BH HCBS?Response: NYS is working in collaboration with the Health Plan Association to develop a uniformed UM policy for BH HCBS and plan of care.

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Complete RFQ Section 3.1.I Organizational Capacity

Question: Is the Plan required to comply with 8am-6pm hours of operation for core business operations if this varies from existing Plan hours?Response: Yes, Plans must comply with all standards reflected in the RFQ.

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Complete RFQ Section 3.2.A.iv.b Experience Requirements

Question: Please clarify the Plan’s responsibility to deliver cultural competency training directly to provider staff vs. establishing a monitoring mechanismResponse: This RFQ requires Plans to monitor compliance with these training requirements, including cultural competence. Whenever possible, training and education for providers should be provided in coordination with the Regional Planning Consortiums (RPCs).

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Complete RFQ Section 3.3.L.vi Contract Personnel

Question: As a small HARP (under 4,000 members), an MCO would be allowed to share key staff across products (e.g., MMC and HARP). If an MCO with a small HARP delegates services to a BHO, can key BHO staff (e.g., CMO, Med Director) serve more than one Plan within the BHO’s book of business?Response: Yes, this is correct.

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Complete RFQ: Section 3.9.E.ii Utilization Management

Question: What are authorization requirements related to LOCADTR services?Response: LOCADTR is for initial and ongoing level of care determinations tool for all OASAS certified program types. LOCADTR is a patient placement criteria system designed to assure that a client in need of substance use disorder services is placed in the least restrictive, but most clinically appropriate level of care available that is to be used in making all initial and ongoing level of care decisions in New York State.   LOCADTR is developed and updated, as appropriate, by OASAS, and is the clinical level of care tool that assesses the intensity and need of services for an individual with a SUD.

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Complete RFQ: Section 3.9.E.ii Utilization Management Cont’d

The Contractor shall ensure that its’ Participating Providers and/or Contractor’s utilization management staff use the LOCADTR 3 assessment tool to make initial and ongoing level of care determinations for SUD services. Please note that while OASAS encourages Plans to identify individual or program service patterns that fall outside of expected clinical practice OASAS does not permit Plans to request / require from providers regular treatment plan updates for otherwise routine outpatient and opioid service utilization.

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Complete RFQ Section 3.10.G.i Clinical Management

Question: What is the State’s expectation as it relates to the Plan developing definitive strategies to promote BH/medical integration that include co-location of BH practitioners in primary care and primary care into BH locations? Performing Provider Systems (PPS) will lead efforts in this area, bolstered by the commitment of DSRIP funding and the State’s support for regulatory relief. Short of lending guidance/input and support for the PPSs, it’s not clear what the State’s assumption is for a Plan role in this integration.

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Complete RFQ Section 3.10.G.i Clinical Management

Response: Plans should describe new processes and procedures they can implement that promote BH/Medical integration given the multiple statewide initiatives and resources available in Health Homes, DRSIP, etc.

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Complete RFQ Section 4.0.A.5 Organization, Experience, and Performance

Question: Does the page limit apply to each government/public sector customer that the Plan/delegate has (i.e., one page per customer), or will the Plan/delegate need to list all of its government/public sector customers on one page.Response: Plans/delegate must submit 1 page per each government/public sector customer.

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Complete RFQ Section 4.0.A.5 Organization, Experience and Performance

Question: Please clarify that this question is only for a BHO responding on behalf of a health plan. We otherwise assume that a Plan’s own experience in managing the BH population and benefits will be answered in A.4.Response: If the Plan is contracting with a BHO to meet the experience requirements both the Plan and the relevant delegate must respond to questions A.4 and A.5.

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Complete RFQ Section 4.0A.7 Organization, Experience and Performance

Question: Please clarify whether this question applies only to BHO applicants or whether Plans proposing to manage without BHO assistance should nonetheless provide details about their current key staff.Response: The RFQ allows the Plan to meet experience requirements by either contracting with a BHO or using experience of key and managerial BH staff. This question pertains to Plans using experience of key and managerial staff.

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Complete RFQ Section 4.0A.12: Organization, Experience and Performance

Question: Please clarify whether this question applies only to a BHO. If it applies to an MCO applying without BHO assistance, has DOH provided the current rate components that comprise the BH portions of a Plan’s rate? It’s not currently clear in a Plan’s rate sheets what proportion of its revenue is for the BH service continuum.Response: This question applies to the MCOs and HARPs. This question only applies to the amount the Plan paid in calendar years 2013 and 2014.

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Complete RFQ Section 4.0.B.4 Personnel

Question: Please clarify whether it is acceptable to include total FTE counts in some service areas of a Plan if all FTEs in the service area will be trained and otherwise be available for carve-in or HARP services.Response: Any staff working on the product line must be trained and reflected in the HARP and MMC Personnel Requirements Table. This table must identify the percentage of time that the staff will work on the MMC and the HARP.

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Complete RFQ Section 4.0.B.9 Personnel

Question: Are completed training materials required to be submitted with the RFQ response, or will the training plan be sufficient? Some materials are still in process and will not be completed until DOH releases further guidance to upstate Plans.Response: A training plan is sufficient as long as it addresses the criteria in Question B.9. Specific training materials will be reviewed during the Readiness Review process.

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Complete RFQ Section 4.0.C.1 Member Services

Question: Is it acceptable to maintain two member services call functions – a Plan’s general member services line (with increased training on carve-in and HARP services) and a BH service line for assistance in accessing care, speaking to a care manager, seeking urgent assistance? The BH line would not be used to handle typical member issues, such as requesting a replacement ID card, a replacement copy of a handbook, etc. The process for hand-offs to the BH line would be described in order to show how the two centers work together.

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Complete RFQ Section 4.0.C.1 Member Services

Response: It is acceptable to maintain two member services call functions, as long as the BH services call center staff are knowledgeable about: i. Covered services; ii. NYS managed care rules; iii. Approved BH UM criteria; iv. Approved BH HCBS rules and requirements (for HARPs); and v. Provider networks. The Plan must describe how the two lines work together and how physical and behavioral health data will be integrated and available to both behavioral health and general member services personnel.

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Complete RFQ Section 4.0.D.1 Network Management

Describe the specific service area [county or counties] in the responder’s current Medicaid Managed Care contract with NYS including anticipated enrollment and utilization, and the cultural, linguistic and other demographic information that will influence network development. Question: Can you please provide guidance on the best approach for responding to this question?

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Complete RFQ Section 4.0.D.1 Network Management

Response: The State recommends outlining the response as follows:

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Service Area Population

Characteristics

 

Percentage of Service Area Population

Gender

 

Male

 

Female

 

Race/Ethnicity

 

White non-Hispanic

 

Black non-Hispanic

 

Asian

 

Other non-Hispanic

 

Hispanic

 

Limited English Proficiency

 

Lesbian, Gay, Bisexual, Transgender (LGBT), Heterosexual, and Other/Non-conforming

 

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Complete RFQ Section 4.0.D.2 Network Management

Question: Please clarify the page limit for Question 2.Response: The page limit for this question is one (1)

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Complete RFQ Section 4.0.D.10 Network Management

“Describe at least one (1) goal, strategy, and measureable outcome, from a public sector client, where improvements occurred in the availability of and member engagement in culturally appropriate BH services (as defined in Section 2.0 of the RFQ). Identify the customer reference(s) that can verify this experience…”Question: Please clarify if MCOs applying without a BHO are to respond to this question.Response: Yes, this question applies to all Plans.

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Complete RFQ Section 4.0.D.12.b Network Management

Question: This RFQ question implies Plans must make completion of cultural competency training required for successful credentialing. While an admirable goal, this would have a negative impact on network adequacy for Plans whose providers do not timely complete such training. Also, since this RFQ does not permit a Plan to credential individual providers in state clinics, by default this provision would only apply to non-clinic providers. It would then be inequitably applied to BH providers. At this time, please clarify whether completion of such training could be reworded in the RFQ as a goal, not a requirement.

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Complete RFQ Section 4.0.D.12.b Network Management

Response: NYS expects Plans to train all BH providers, including OMH/OASAS licensed and certified credentialed providers, but this is not a condition of the credentialing process. Plans should work together to develop a unified training curriculum.

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Complete RFQ Section 4.0.D.16 Network Management

Question: “Provide an example of how the responder has assisted another government/public sector managed BH or similar client to successfully move from fee-for-service to managed care/capitation or to implement payment reform with network providers. Include the challenges and strategies to overcome those challenges. Identify the customer reference(s) that can verify the experience described.” Please clarify if this question is only for BHOs applying on behalf of an MCO.Response: This question applies to all Plans.

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Complete RFQ Section 4.0.D.19 Network Management

Question: Please provide an anticipated release date for the crisis services guidance that the RFQ indicates is in development.Response: NYS will provide information on network requirements for crisis services in the near future.

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Complete RFQ Section 4.0.D.26 Network Management

Question: Please clarify if MCOs intending to manage the BH services without a BHO should also answer this question and provide information on their current network and any augmentation efforts.Response: Yes, Plans claiming staff experience and Plans utilizing a BHO must respond to this question. Please include either specific staff that meet the experience requirement and their role in the MMC plan and HARP or describe the planned approach to achieve the systems goals in this RFQ and any anticipated challenges.

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Complete RFQ Section 4.0.E.3 Utilization Management

Question: Would the State clarify that denials of services for HCBS would be administrative denials with grievance appeal rights. Response: Appeals of the BH HCBS assessment are through the State’s fair hearing process. Appeals for denials of access to individual BH HCBS are through the grievance and appeals process. UM guidelines being developed by NYS and the Health Plan Association will address questions related to prior authorization, denials, and appeal processes.

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Complete RFQ Section 4.0.E.3.a Utilization Management

Question: Please indicate the anticipated release date for the uniform criteria/guidance for PROS and BH HCBS referenced in this section.Response: NYS issued guidance related to UM for PROS on August 6th, 2015. NYS continues to work with the Health Plan Association on the UM guidance for BH HCBS. This information will be posted on the State agency websites.

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Complete RFQ Section 4.0.F.2.j Clinical Management

Question: F.2.j- “Which providers (both inpatient and outpatient) will receive performance reports and how often?”What are the expectations for such reporting. While billable screenings are identifiable in Plans’ claims records, referrals to other services would not be readily accessible without medical record review?Response: NYS is not issuing specifications for such reports. Plans should propose a process for monitoring provider performance including how information will be relayed to the provider.

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Complete RFQ Section 4.0.F.2.g Clinical Management

Question: Please clarify that guidance for integrated treatment can be required by Plans via policy (and inclusion in the provider manual) rather than in contract. Plan contracts already contain provisions binding providers to Plan policies.Response: In the response to the RFQ the Plan should describe what guidance they propose for their provider contracts versus policy conveyed in the provider manual.

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Complete RFQ Section 4.0.F.7 Clinical Management

Question: Please clarify that references to contract requirements can be met with the institution of new policies. Contracts currently contain provisions that bind providers to Plan policies, including the topics/areas included in this section.Response: The Plans will need to amend their provider contracts to conform with the requirements in the Managed Care Contracts with the State.

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Complete RFQ Section 4.0.I.1.b Reporting and Data Management

I.1.b.-“Describe an experience with receiving and loading provider information to accommodate a State’s BH provider network. If staff experience is claimed, please note this and answer accordingly.”Question: Please clarify if this question is applicable only to BHOs. Plans load and submit provider data regularly to the State currently. Is that what a health Plan applying on its own should describe?Response: Yes, Plans claiming staff experience and Plans utilizing a BHO should respond to this question.  

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Complete RFQ Section 4.0.J.1 Claims Administration

J.1- “Describe the responder’s experience for processing Medicaid claims specific to those services being added under the RFQ, including prior and current clients, type of claims administration (ASO or at risk), and the number of covered lives.”Question: Please clarify how a Plan applying without a BHO should respond to this question. While Plans process considerable BH claims now, the new services to be carved in may not have been part of its current claims experience. Should Plans report on their current claims processing capabilities?

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Complete RFQ Section 4.0.J.1 Claims Administration

Response: Yes, Plans should report on their current claims processing capabilities and changes necessary for BH services claims to be processed. Plans not using a BHO should indicate how they will bring in the expertise to understand new behavioral health programs and their reimbursement.

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Complete RFQ Section 4.0.K Financial Management

Question: Please clarify whether risk mitigation for Upstate HARPs will include risk corridors in addition to stop loss.Response: Yes, the same general provisions as for the NYC HARPs will apply. NYS will be issuing guidance in the near future.

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Complete RFQ Section 4.0.K.4 Financial Management

Question: Please clarify if this section applies only to HARP applicants. Response: Yes, this question applies only to HARP.

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Complete RFQ Section 4.0.K.5 Financial Management

Question: Please clarify if this section applies only to HARP applicants.Response: Yes, this question applies only to HARP.

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Complete RFQ Attachment B

Question: Reporting requirements including CMS assurances/subs for Health Home (HH) and BH HCBS: How will Homeless, TAY, FEP, AOT, Criminal Justice cases be defined and how will the Plan be notified?Can the State provide clarity on actual reporting requirements with definitions?What are the implications for reporting on the BH HCBS? Any additional detail the State can provide?Response: Detail for reporting requirements is not yet available. The Federal assurance and sub assurance requirements are being finalized. Additional information will be forthcoming.   

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Expedited RFQ Section 1.5.A.iv Program Design

Question: While the RFQ clearly states that managed care excludes reimbursement for inpatient care for persons 21-61 in state operated psychiatric inpatient hospitals, it further goes on to state that OMH and DOH will work with the MCOs to make the Plans accountable financially and programmatically for continuing admissions/transfers of their members to the State facilities. Can you please clarify the intent of this requirement?

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Expedited RFQ Section 1.5.A.iv Program Design

Response: The objective of this provision is recognition that inpatient admissions to OMH are short term. Therefore despite the Plans not being financially responsible, the State wants the Plans and HH to understand the patient will be discharged back into the community and will generally be enrolled in the same MCO/HARPs and HH. NYS is developing strategies to link the Plans and HHs during OMH inpatient admission.

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Expedited RFQ Section 1.12 Historical Utilization and Cost

Question: The data book issued for the ROS and NYC is the same. Mercer and DOH have stated in the past that the data book includes costs for some BH services that are already part of existing services covered by the MCOs. We requested a breakout of estimates for the costs currently covered by the MCOs from Mercer and DOH so we could isolate the marginal costs for the new benefit in the data book. Is it possible for this information to be released so MCOs can assess the marginal cost of providing services for the BHO carve-in?

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Expedited RFQ Section 1.12 Historical Utilization and Cost

Response: Rest of State Behavioral Health Funding$646M in BH funding is being moved into the Medicaid Managed Care Plans.Of that $646M, $404M in BH funding is being moved into the HARPs.Draft Rest of State HARP Rates can be found on the OMH website: http://omh.ny.gov/omhweb/bho/harp-ros-draft-rates.pdfPlease refer to the MMC and HARP Data books for more information. http://omh.ny.gov/omhweb/bho/data-book.pdf

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Expedited RFQ Section 1.11 and 1.12 Historical Utilization and Cost

Question: DOH has said the rates for the NYC BHO carve-in will be released to Plans in late July. Will Mercer and DOH use a similar approach to rate development for the ROS as they did for NYC? If Mercer intends to use different key rating assumptions (i.e., such as administration and retention elements, managed care savings, etc.) for the ROS than what it publishes for NYC, can MCOs receive guidance during the rate setting process so an accurate assessment of the expectations underlying the rate can be made?

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Expedited RFQ Section 1.11 and 1.12 Historical Utilization and Cost

Response: Yes. A similar approach to NYC will be utilized for Rest of State rates. All rate assumptions and other information will be shared with Plans via a rate briefing with Mercer.

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Expedited RFQ Section 3.3.N.i Contract Personnel

Question: Please confirm that staffing positions dedicated solely to the performance of work "under the RFQ" means that the individuals need to be dedicated to the BH and HARP product lines in general rather than just to these product lines outside of NYC. Plans must hire incremental staff to support the products in the ROS; however, if Plans can provide rationale showing that existing staff dedicated to BH/HARP in NYC can support the additional membership, it would not be necessary to hire duplicative staff.

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Expedited RFQ Section 3.3.N.i Contract Personnel

Response: Plans can propose which lines would have responsibilities for both NYC and ROS. If such proposals indicate that an individual’s NYC time will be reduced from the level approved by NYS during the NYC readiness reviews, the Plan must propose a clear rationale for the change that explains how the Plan will ensure the individual can adequately meet responsibilities in both NYC and ROS.

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Expedited RFQ Section 3.5. Table 3 Network Service Requirements

Question: Please indicate how regions are defined for rural county access standards. Are these the OMH/OASAS regions? Response: NYS public health law defines a rural county as any county having a population of less than 200,000. These regions are not coterminous with OMH/OASAS regions.

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Expedited RFQ Section 3.11 Cross Systems Collaboration

Question: Can you please clarify the number of Regional Planning Consortiums (RPCs) and the counties that each of the RPCs will cover?Response: There will be 10 RPCs covering the counties throughout NYS, plus an RPC for NYC.

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Expedited RFQ Section 4.0

Question: The RFQ requests that "Proposal materials shall be organized into 4 3‐ring binders with tab dividers corresponding to headings in Section 4.0." Is the Respondent expected to provide one complete response in no more than four 3‐ring binders or four copies of a complete response, using only 3‐ ring binders?Response: Complete Expedited RFQ responses should be in 1 3-ring binder and there should be 4 sets of complete responses.

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Expedited RFQ Section 4.0

Question: The RFQ released on 7/10 states that “Plans must complete all HARP questions in the Behavioral Health Managed Care RFQ released on 7/03.” The 7/10 RFQ also contains HARP questions (some of which are duplicates of the 7/3 version). Should Plans respond to the HARP questions from both RFQs or only the HARP questions from the 7/3 RFQ?Response: Plans that submitted a HARP application during the NYC designation process should only respond to the HARP questions in the Expedited RFQ. These instructions pertain to Plans that applied for the HARP benefit in NYC.

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Expedited RFQ Section 4.0

Question: Does the 12 pt font requirement apply to tables as well? We have found that tables and graphics are often much clearer when using 10 pt font.Response: 10 point font is acceptable for the tables.

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Expedited RFQ Section 4.0

Question: For Plans that have already qualified for HARP in NYC, are they required to answer the HARP only questions in the Behavioral Health Managed Care Request for Qualification Application released on 7/3/2015 or just Section 4.0 in the Expedited RFQ?Response: Yes, NYC HARPs must complete the HARP questions in the Expedited RFQ Application.

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Expedited RFQ Section 4.0

Question: Please confirm that the option to submit "No change since NYC designation" indicates no change since materials were approved as part of the most recent readiness review to serve Adult Behavioral Health and as a HARP in NYC.Response: If response has been addressed through submissions from the NYC readiness review process Plans may respond “no changes since NYC readiness review process”

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Expedited RFQ Section 4.0.A.3 Organization, Performance and Experience

Question: Section A.3 directs respondents to “Identify any change of entity, including a parent, subsidiary, or other related organization, with which the responder intends to delegate, through a partnership or subcontract, any administrative or management services required under the RFQ.” If there is no change, Section A.3 gives respondents the opportunity to indicate “no change since NYC designation.”Please confirm that the opportunity for “no change since NYC designation” applies to each subcontractor individually and not section A.3 in total.Response: This is correct. Please provide information requested in A.3 for each new subcontractor.

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Expedited RFQ Section 4.0.A.3 Organization, Performance and Experience

Question: For response to section A.3, page 84, if there has been no “change of entity” but certain information about a partner/subcontractor has changed, i.e. its legal name, is the respondent required to provide a new response for partner/subcontractor, or should they only identify the new name (or other information that may have changed), but otherwise indicate “no change since NYC designation?”Response: Please provide information if there have been any changes to an existing subcontractor. For example if the name of the subcontractor changed since the NYC RFQ, please include the original name and the new name.

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Expedited RFQ Section 4.0.A.3 Organization, Performance and Experience

Question: If there has been no change in a subcontractor/partner, should respondents submit updated Business Continuity, Disaster Recovery, and Emergency Response Plans from the subcontractor/partner?Response: If there has been no change in the Business Continuity, disaster recovery, and emergency response plans no additional information is necessary and the Plan can indicate “no change.”

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Expedited RFQ Section 4.0.C Network Management

Question: In the identification of the specific counties to be served, if Plans have applied to DOH to expand their service area should this be indicated? Response: Yes, Plans should indicate which counties are pending DOH approval.

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Expedited RFQ Section 4.0.C.6 Network Management

Question: Does the State have a list of existing crisis providers for each of the counties?Response: A list of OMH crisis providers can be found at the following link: http://bi.omh.ny.gov/bridges/directory?region=&prog_selection=03 A full searchable list of all OASAS programs types, including crisis services, by county may be found at the following link:https://www.oasas.ny.gov/providerDirectory/index.cfm?search_type=2

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Expedited RFQ Section 4.0.C.6 Network Management cont’d.

Response: The CMS 1115 waiver approval authorizes the State to require all MCOs to include Crisis Intervention services in their networks.These network requirements are expected to develop as a comprehensive local crisis intervention system is established throughout the State. To meet current standards for Crisis Intervention adequacy, the network should be comprised of existing providers of the following crisis services: OMH Clinics, Comprehensive Psychiatric Emergency Programs (CPEPs), and designated BH HCBS Mobile Crisis providers.

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