Presentation to the National Association of Medicaid Directors Nancy SmithLeslie Director Medical Assistance Division November 14 2018 Behavioral Health Integration In 2014 New Mexico launched its fullyintegrated managed care program Centennial Care through a Section 1115 waive ID: 733540
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Behavioral Health Integration in Centennial CarePresentation to the National Association of Medicaid Directors Nancy Smith-Leslie, Director, Medical Assistance DivisionNovember 14, 2018 Slide2
Behavioral Health Integration In 2014, New Mexico launched its fully-integrated managed care program, Centennial Care through a Section 1115 waiverIntegrates physical, behavioral and long-term care services delivered by three managed care organizations (MCOs)Includes robust care coordination requirements for the MCOs with specific member touch pointsMCOs required to conduct a health risk assessment with every member and a more comprehensive needs assessment for members identified as needing a higher level of care coordination2Slide3
Comprehensive Delivery System
Established a care coordination infrastructure for members with more complex needs that coordinates the full array of services in an
integrated,
person-centered model of care
Care coordination
850 care coordinators
37,013 in care coordination L2 and L3
Focus on high cost/high need members
Health risk assessment
Standardized HRA across MCOs
753,564 HRAs conducted
Increasing number of members served by Patient Centered Medical HomesApproximately 400,000 members receiving services through a PCMHExpanding Health Homes—adults and children with co-occurring behavioral health diagnosesExpanding home and community based services 30,000 members receiving HCBS
Centennial Care
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4Centennial Care Contract
Defined care coordination requirements for specific populations, including members with complex behavioral health needs
Contractual Requirements
Populations to receive care coordination include:
Individuals with a behavioral health diagnosis including substance abuse disorders;
Members experiencing transitions of care including from residential or institutional facility to community placement; and
Members transitioning from incarceration to community
MCOs must have designated care coordinators with relevant expertise to meet the needs of specific populations, including members with complex behavioral health needs, members with housing insecurity needs and justice-involved membersSlide5
Delivery System Improvement Targets
Sets targets for the MCOs to achieve improvements in specific areas of the delivery system
Centennial Care Contract
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Must increase use of community health workers
Today, 100 employed or contracted by MCOs
Must increase telemedicine office visits in rural areas by 15% annually for behavioral healthSlide6
Centennial Care ContractContract also requires the MCOs to employ a justice-involved liaison to facilitate care coordinationBenefits are systematically suspended for individuals after 30 days of incarcerationBenefits are automatically reactivated when the inmate is released from prison/jail upon receipt of release data from the facilityPursuing an interface with APRISS for real-time booking/release data at facilities6Slide7
Participating Counties/Agencies:7Slide8
Health HomesLaunched in 2016 and expanded in 2018 for:Adults with serious mental illness (SMI)Children/adolescents with severe emotional disturbance (SED)Serving 2,000 members in 10 counties with seven providers, including one Tribal 638 providerMandates Six Core Services:Comprehensive care managementIntensive care coordination Prevention, health promotion, disease managementComprehensive transitional careIndividual and family support servicesReferral to community and social support services
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Pre-Tenancy and Tenancy ServicesNew supportive housing services for members with Serious Mental Illness (SMI) to assist with acquiring, retaining and maintaining stable housing;Plan to use existing infrastructure and network of provider agencies associated with the Linkages Supportive Housing Program to deliver services; andLinkages will be expected to utilize peers for service delivery.9Slide10
Substance Use Disorder Continuum of Care ServicesExtend Screening, Brief Intervention, and Referral to Treatment (SBIRT) services through primary care, community health centers and urgent care facilitiesProvide SUD treatment in accredited residential treatment centers for adults who require an enhanced level of care New inpatient services as part of our 1115 waiver renewal in Institutes for Mental Disease (IMDs)for members with an SUD diagnosis10Slide11
Super Utilizer InterventionBegan July 2015Followed 35 top ED utilizers from each MCOTracked each member’s ED visits, participation in care coordination, comprehensive needs assessment, and other social determinants of health on a monthly basis MCOs required to implement specific interventions to reduce ED visits, including11Slide12
Assign to Community Health Worker;Pilot programs with Emergency Medical Technicians to visit members in their homes;Purchase EDIE software that provides instant notification when a member is in the ER; Patient Navigator program—hospital staff contacts the MCO’s navigator to help triage the member (directing to more appropriate setting such as Urgent Care facility and/or scheduling an appointment with the member’s PCP);Launch of “Video Visits” with physicians—members access through an app on smart phone12Slide13
Average Monthly ED Visits Per Super Utilizer on a Quarterly BasisData include members who were active during each reporting period