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Collaboration to Strengthen Management of Psychotropic Medications for Children in Foster Care. Maximizing Opportunities to Increase Child and Family Well Being Through Innovative Funding Approaches. A Look at Massachusetts Angelo McClain, Ph.D., LICSW - PowerPoint PPT Presentation


  • Maximizing Opportunities to Increase Child and Family Well Being Through Innovative Funding Approaches

    A Look at Massachusetts

    Angelo McClain, Ph.D., LICSWCommissioner, Massachusetts Department of Children and Families Collaboration to Strengthen Management of Psychotropic Medications for Children in Foster Care

  • Childrens Behavioral Health InitiativeHow it came about:Federal Medicaid program mandates Early Periodic Screening Diagnosis and Treatment (EPSDT) for children under 21. Class action suit filed in Massachusetts in 2001, court found in 2006 that Massachusetts in violation of EPSDT provisions of the Federal Medicaid ActOrders State to develop in-home services, including comprehensive assessments, case management, behavior supports, and mobile crisis services

    Who is Eligible:Children with SED, In addition to any other disabling condition, such as autism spectrum disorders, developmental disability o substance abuse


  • Childrens Behavioral Health Initiative Service ArrayIntensive Care Coordination (ICC; Wraparound)Family Support & Training (FS&T; Family Partners)In-Home Therapy (IHT)In-Home Behavioral Services (IHBS)Therapeutic Mentoring (TM)Mobile Crisis Intervention (MCI)Crisis Stabilization (CS) ( Approval denied by CMS)


  • **

    Intensive Care Coordination(Wraparound)

    Clinical Assessment inc. CANSSED determination for eligibilityMedical Necessity determinationCare coordination

    In-Home Therapy

    Clinical Assessment inc. CANSMedical necessity determinationCare coordination available

    Outpatient Therapy

    Clinical Assessment inc. CANSMedical necessity determinationCare coordination availableFamilies decide on most appropriateinitial serviceindependently or in consultation with helping professions such as: primary care,mental health clinicians schoolscase workerscommunity orgsfaith leadersothers

    EmergencyServices Mobile Crisis InterventionCrisis Stabilization


    (accessedthrough core clinicalservices)

    Behavior Management Therapy & Monitoring

    Family Partners


    Childrens Behavioral Health InitiativeSystems OverviewHUB SERVICES

  • Leveraging FundingThe Rosie D Judgment: Included language that required MassHealth to pay for the new services, to the degree that Federal approvals are obtained and Federal Financial Participation is available MassHealth sought maximum clarity from CMS by seeking to add the remedy services to its Medicaid State Plan, through State Plan Amendments (SPAs)


  • Financing Through State Plan AmendmentOpportunities and RisksPros:Financial Partner to share cost.not only state contributionsProvide clear authority, not dependent upon periodic waiver renewalsCons:Can be costly to implementServices must be available statewideMust meet medical necessity criteria6

  • Seeking Approval of SPAsis an art and a scienceYou need your Medicaid staff who regularly work with CMSThere are often policy and financial contexts, strategic considerations, for every request and every decision, no matter how minorValue of Subject Matter Experts (SMEs), e.g. a consultant with recent experience working on CMS submissionsCMS staff in different regions can make different decisions stay connected to your networks 7

  • Caring Together Strengthening Children and Families Through Community-Connected Residential TreatmentJoint partnership between the Massachusetts Department of Mental Health & Department of Children and Families A bold new approach to delivering residential services for children and youthIntegrated placement & community treatmentServices flex to meet childs changing needsParent Partners IV E WaiverApplication PendingUse $$ currently reimbursing placement to purchase Residential Level of Service in the community.


  • DCF Area Offices (29)DMH Area Offices (6)DMH Entrance RequirementsDMH DoorDCF DoorDCF Entrance RequirementsProvider AONE DOORJOINT ENTRANCE REQUIREMENTSJoint System ManagementTRADITIONAL SERVICE SYSTEM Residential Level of ServiceTransition ServicesCase ManagementCARING TOGETHER SERVICE SYSTEM Behavioral HealthSame Clinical TeamProvider BProvider CProvider DChildFamilyMultiple doors$$$$Improved access to seamless residential treatment and community based services for children and families

  • Benefits to Children and FamiliesIntegrates the way service are delivered to better respond to families needsMaximizes flexibility of services and resourcesShifts paradigm to recognize the importance of delivering clinically intensive services primarily within a childs home communityKeeps more families together; and reunites others more quickly10

  • Paying for PerformanceYear 1 Unbundled PaymentsImplement IV E Waiver Program (pending approval)Gather Data While Providers Learn New BusinessBuild Consensus on Performance MeasuresYear 2 Establish Case RateBlended Placement & Non-PlacementEx. 30 Placement; 20 Community = $240 / dayIncentive to Increase Community TenureYear 3 Establish Well-Being IncentivesStrengthening Families / Positive Youth DevelopmentEx. Reduce Repeat Maltreatment; Educational / Vocational Success; Reduce Reliance on Psychotropic Medication


  • Multiple Payers One Integrated ServiceCHILD WELFAREState Appropriation(FFP Goes to General Fund)MENTAL HEALTHState AppropriationMEDICAIDCBHI$200M$40MEDUCATIONSpecial Education ServicesCOMMUNITY SERVICESFRC; Informal SupportsCARING TOGETHERIntegrated Residential TreatmentFor Children and Families

  • Family Partner Braiding the Funds to Change Payer, Not Partner

    CTFPS Payment Flow Chart


    Family Partner Eligible

    Insurance Status?

    Want FP?

    Have FP?

    DCF $$$


    Want FP?

    CBHI ServicesContinues with Resi?

    DCF $$$

    Masshealth $$$


    Private Insurance










    DMH $$$

    DMH $$$



    Note here the option of adding ONE service to your state plan reference costs that will be reviewed later


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