november 2011 october 20, 2011 chris spanos1. health & human service programs october 20, 2011...
TRANSCRIPT
Chris Spanos 1
A Look Forward - Publically Funded
Behavioral Health Care In Virginia
November 2011
October 20, 2011
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Local GovernmentHealth & Human Service
Programs
October 20, 2011
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State moving to a managed care model for:
◦ Delivery of Medicaid Services
◦ Delivery of Comprehensive Services Act services
October 20, 2011
A Changing Landscape for Local Government
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A Changing Landscape for Local Government
State Medicaid Funding Local Responsibility
Behavioral Health Care
Local Social Services
Comprehensive Services Act (CSA)
Community Services Boards
October 20, 2011
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Who will be affected:◦ Individuals eligible to receive Medicaid services
Persons needing Behavioral Health care Foster Care children and their families Others covered by the CSA
What Local Agencies will be effected:◦ Community Services Board Delivery of Services◦ Local Social Services Delivery of Services◦ Local Comprehensive Services Act (CSA) program
October 20, 2011
A Changing Landscape for Local Government
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A Changing Landscape for Local Government
Local – State - Federal Funding
Local - State – Federal Funding
Local Social Services
• Child Welfare Programso Foster Care Program
CSA Program• Foster Care Children• Children with an IEP• Children under Juvenile
Justice court order
October 20, 2011
Local Community Services Board (CSB)• Services provided by the
local Community Services Boards using Medicaid funding
Private Providers • All fee-for-service
providers, providing Behavioral Health Care Services, will go to rate setting
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McDonnell Administration Initiative
Virginia Medicaid Program
October 20, 2011
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Use a “Risk Model” for the provision of publically funded behavioral health care funded by the Virginia Department of Medical Services (DMAS)
Currently Virginia Medicaid uses a fee-for-service model for Behavioral Health services out side of the Medicaid CO enrollees.
October 20, 2011
McDonnell Administration InitiativeVirginia Medicaid Program
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Behavioral Health Services◦ Move from a fee-for-service model to a Care Coordination model
• Under a single Contractor
◦ Fee-For-Service enrollees will receive Behavioral Health Services under a Care Coordination Contractor Beginning July 1, 2012,
Contractor: ASO (Administrative Services Only model) Move to a Risk Model in third year
October 20, 2011
McDonnell Administration InitiativeVirginia Medicaid Program
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Medicaid/FAMIS/FAMIS Plus members who are in FFS (Fee-for-Service) receive and who receive traditional and non-traditional mental health and substance abuse treatment services from the FFS system will be the responsibility of the BHSA (Behavioral Health Services Administrator). DMAS will continue to be responsible for pharmacy services for these members.
October 20, 2011
Who will be covered by Care Coordination
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Medicaid/FAMIS/FAMIS Plus member who are enrolled in a Managed Care Organization (MCO) will continue to receive
traditional mental health services and pharmacy from the MCO. Non traditional mental health and substance abuse treatment services will be the responsibility of the BHSA.
October 20, 2011
Who will be covered by Care Coordination
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Anticipated:
◦ Non Risk Administrative Services Only (ASO) Contact for two years
◦ Third Year move to a full risk model ◦ (explain risk model and what it means to local
government)
October 20, 2011
Medicaid Funding
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Services Under Comprehensive Services Act
October 20, 2011
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Medicaid Funding of CSA Services
◦ CSA Pool funded services by Medicaid
CSA is the only Medicaid for which Local Government pay a match on Medicaid services
October 20, 2011
CSA Comprhensive Services Act
for At-Risk Families and Children
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Time Line for Implementation
Of a Care Coordination Model for Delivery of Behavioral Health Care Services
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Time Line
Local Program Key Dates
Medicaid◦ Behavioral Health Care
Coordination Fee-for-Services is moved
to Contractor managed program
November 2011◦ RFP Released
January 2012 ◦ Contractor Chosen
July 2012◦ Care Coordination model
implemented through a Contractor
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Time Line
Local Program Key Dates
Comprehensive Services (CSA)◦ Care Coordination Model
Local CSA services
December 2011◦ Government presents
Executive Budget to the General Assembly
January to March 2012◦ General Assembly considers
the Governor’s recommendation for a Care Coordination model
July 2012◦ implemented through a
Contractor
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What Does all this Mean to
Local Elected Officials
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Who will pay for services if a judge orders a specific service or provider not covered/recognized by the care coordination provider?
Will all community-based services under CSA be covered under a care coordination contract, whether or not the children or families are Medicaid-eligible?
How does utilization review mesh with care
coordination? Will there be more than one hoop to jump through?
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Questions for local government officials to consider:
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What about crisis stabilization or emergency placements? Will a care coordinator have to approve services before they are rendered? What about weekends and holidays?
How will care coordination affect the FAPT
process and workload?
How will disagreements between a local government and the care coordination provider be handled?
October 20, 2011
Questions for local government officials to consider:
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How will care coordination affect the workload and administrative burden on CSA coordination's?
Will this diminish the array of community-based
services allowed for under CSA?
Will this affect early intervention/prevention (i.e., less intensive) services used to prevent higher end placements under CSA?
October 20, 2011
Questions for local government officials to consider:
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Will this affect local government’s funding of CSA?
Will this affect the sum-sufficiency of the program?
Who will pay for this contract?
October 20, 2011
Questions for local government officials to consider:
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State AgenciesInvolved
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Medicaid Enrollee Services
◦ VA Department of Medical Assistance Services◦ VA Department of Social Services
Local Social Services Departments◦ VA Department of Behavioral Health &
Development Disabilities Community Service Boards
October 20, 2011
State AgenciesImplementation of a Care Coordination
Model
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Comprehensive Services Program
◦ Office of Comprehensive Services◦ Supreme Court of Virginia
Executive Secretary◦ VA Department of Social Services
State Department Central Office Local Departments of Social Services
◦ VA Department of Education Local School Divisions
◦ VA Department of Juvenile Justice Court Services Units
◦ VA Department of Medical Assistance Services◦ VA Department of Health
October 20, 2011
State Agencies Implementation of a Care Coordination Model
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Local Government Involvement
Comprehensive Services Act for At-Risk Families & Children
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Local Government Agencies
Locality Regional
Governing Body◦ Chief Administrator◦ Fiscal Agent◦ CPMT Chair/FAPT◦ CSA Coordinator
Board/Dept of Social Services Community Services Board
◦ single jurisdiction
Court Services Unit Dept of Juvenile Justice
◦ Single jurisdiction
School Division◦ School Board◦ School Superintendent
Community Services Board◦ multi-jurisdictional
Court Service UnitDept of Juvenile Justice
Dept of Health ◦ multi-jurisdictional
Board/Dept of Social Services◦ multi-jurisdictional
October 20, 2011
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State Executive Council (SEC) for the Comprehensive Services Act
Local Government County Representative on SEC
Local Government CitiesRepresentative on SEC
◦ Sherrin C. AlsopMember, King and Queen County Board of Supervisors13325 Newtown RoadNewtown, VA 23126804 296-6804 [email protected] 1, 2009 – June 30, 2012
◦ Joseph PaxtonRockingham County AdministratorRockingham County Administration Center20 East Gay StreetHarrisonburg, VA 22802540 564-3011 [email protected] July 1, 2009 – June 30, 2012
◦ Mary BuntingCity ManagerCity of Hampton22 Lincoln Street 8th Floor, City HallHampton, VA 23669757 727-6392 757 728-3037 – [email protected] July 1, 2009 – June 30, 2012
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Local Government OrganizationsStaff with Responsibility for CSA
VACO VML
Virginia Association of Counties
◦ B.R. "Beau" Blevins, III Government Relations Liaison (education, health and human services)
804-343-2503 [email protected]
Virginia Municipal League
◦ Janet Areson, ◦ Director of Policy
Development 804-523-8522 [email protected]
October 20, 2011
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◦Chris Spanos
Christopher J. SpanosLegislative & Pubic Affairs Counselor
Virginia League of Social Services Executives
◦ Spanos Consulting Group LLC707 Keats Road, Richmond, Virginia 23229Telephone Direct Dial (804) 282-0278E-mail [email protected]
October 20, 2011
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