Lynn Kovich Assistant Commissioner NJAMHAA Annual Conference April 16,

Separation of Housing and Services Financing Services Preparation for Change 2

Pathways to Service Development and Implementation Governor’s Mental Health Task Force – 2005 Wellness and Recovery – 2006 Wellness and Recovery Transformation Action Plan NJ Olmstead Agreement – 2009 Medicaid Comprehensive Waiver Readiness Assessment – 2013 Strategic Planning –

Community Support Services (CSS) SPA Consistent with recommendations of the GMHTF, W&R Transformation Action Plan, NJ Olmstead Agreement, Recommendations from Strategic Planning Sessions, US Americans with Disabilities Act – Olmstead Decision Consistent with Federal Guidance, laws, decisions and policy Basis of NJAC 10:37B Initial roll-out limited to SH Identifies the services reimbursed, staffing roles and responsibilities by credential Regulations and CSS overview presentations can be found on our website under Information Center SPA may be viewed on the Medicaid website under Information for Providers and Stakeholders – Medicaid State Plan Amendment 4

Centralization of Housing DHS Office of Housing (OOH) DHS has centralized the management and oversight of DDD housing and DMHAS supportive housing OOH is led by Janel Winter. Funding for and management of the DMHAS Housing subsidies will move to housing clearinghouse known as Supportive Housing Connection (SHC) operated by the NJ Housing Mortgage and Finance Agency SHC responsibilities will include: Payment of housing subsidies to landlord Housing inspections Resident inquiry resolution services Rental and other housing assistance SHC has begun to process recycled subsidies and will provide subsidies for new initiatives coming online through recent RFP’s Additional information - 5

Funding Services – Medicaid & DMHAS State Contracts Community Support Services (CSS) will be the primary service offered to individuals in supportive housing CSS overview PowerPoint is available on our website under Information Center CSS consist of mental health rehabilitation services and supports necessary to assist consumers in achieving mental health rehabilitative and recovery goals. This includes achieving and maintaining valued life roles Services include: development of comprehensive rehabilitation needs assessment, individualized rehabilitation plan, skill development, illness management and recovery, crisis intervention and service coordination. Community Support Services are not based in a clinic setting, rather, services are provided in the individual’s natural environment.

Funding Services – Medicaid & DMHAS State Contracts DMHAS contract for state funding (of services provided to individuals in SH) will be deficit funded to start Reduce contract ceiling based on anticipated revenue Prior authorization of services (every six months) based on submission of Individualized Recovery Plan (IRP) First 60 days post enrollment does not require prior authorization State dollars will need to remain within contract ceiling Specifics pertaining to prior authorization will be provided in future meeting specific to billing 7

Funding – Medicaid & DMHAS State Contracts Contracts will be clustered until revenues stabilize Annex A will need to be revised to a CSS Annex A Medicaid billing based on face-to-face contact Medicaid Funding Individuals enrolled in the following cannot receive CSS: PACT, Residential Services, and ICMS can’t bill CSS while individual is in partial care program (during the day) 8

Funding – Medicaid and DMHAS State Contracts Time Study – in May 2015 Will identify volume of services each consumer receives Will identify volume of services provided by each staff person Following rule promulgation Agency licensure Non-Medicaid provider applies to become Medicaid Provider Assignment of Specialty Provider Code Phase-in of prior authorizations for consumers already living in supportive housing 9

Funding – Medicaid & DMHAS State Contracts Billed to Medicaid Paid with State Funding 10 CSS Non-CSS Medicaid Enrolled Non- Medicaid Enrolled

System Preparation for Change Training Current workforce – services, documentation and supervision 200 people completed training and 200 are currently being trained Medicaid billing Agency self-assessment and analysis Rate study/determination Time Study Town hall on regulations CSS Webinar Development of IRP for prior authorization Consumer / Family Member Communications Plan 11

Timelines 12 Webinar 2/23/15 Small workgroup to develop IRP: 4/2015 Volume of services time study: 4/2105 SHC Phase-in: 3/2015, 7/2015, 1/2016 Subsidy Survey: 1/2015 – 2/2015 CSS Training- Supervisor and direct care staff: 2/6/2015 and Fall 2015 CSS billing, Part 1 overview : 5/2015 CSS billing, Part 2 billing rules NJAC 10:37A and 10:37B: SFY 2016 Reduction of contract ceiling

Background Scope Structure Communication 13

Background Based on Administrative Services Organization (ASO) Planning for the ASO began FY 2012 Part of the Medicaid Comprehensive Waiver Need to manage the Medicaid benefit for behavioral health similar to the physical health benefit Limited resources High demand Improve access Joint project of NJ FamilyCare and DMHAS 14

Interim Management The IME is a step toward management of the entire system Will include only addictions treatment services at roll out Increase in provider and client enrollment in Medicaid due to Medicaid Expansion Expanded SUD treatment benefit in the ABP 15

Scope DHS will partner with and fund Rutgers University Behavioral Health Care (UBHC) as an IME to manage state, block grant and NJ FamilyCare funds in addiction services with a projected start date of July 1, 2015 This is the first phase of managing adult behavioral health services All levels of care will be managed Ability to improve rates with a managed system UBHC will manage addiction treatment services provided by agencies that are licensed by DHS, contracted with DMHAS, and enrolled in NJFamilyCare 16

Scope- UBHC Why UBHC? State clinical academic entity – Clinical provider, not an insurance company Experience managing care Sophisticated technology infrastructure – ability to start quickly with minimal investment Strong knowledge of state resources Ease of procurement with another state entity Call center 17

Scope- Rates 2016 budget request to make an interim rate change for some services Outpatient and methadone treatment Medicaid rates to be increased to the state fee-for-service rates Mental health outpatient rates will also be increased for certain individual and group therapy and family conference services Other substance abuse treatment rates to remain the same Rate changes resulting from the rate study are not included in this interim step 18

Scope- Provider Contract Structure Residential services will remain in contract Ambulatory services will transition to FFS in January

Scope- Publicly Funded Initiatives 20 MANAGED BY THE IMENOT MANAGED BY THE IME NJ FamilyCare (Medicaid) Child Welfare/Department of Children and Families programs Driving Under the Influence Initiative (DUII) County funds Medication Assisted Treatment Initiative (MATI) Department of Corrections Mutual Agreement Program (DOC-MAP) South Jersey Initiative (SJI)Drug Court/Administrative Office of the Courts Substance Abuse Prevention and Treatment Block Grant (currently in cost reimbursement/slot contracts) Prevention services Recovery Centers Recovery and Rebuilding Initiative (RRI) Screening, Brief Intervention, Referral to Treatment (SBIRT) State Parole Board Mutual Agreement Program (SPB- MAP) Substance Abuse Initiative (SAI)/Division of Family Development

Accessing Care Two ways to enter treatment: UBHC will perform telephone screening and refer to a provider for full assessment when indicated Provider does screening The assessment will drive a treatment recommendation which will then be reviewed by the IME for an authorization determination 21

Accessing Care Provide an excellent consumer experience Utilization Management will be performed by addiction trained clinicians Care coordinators will be available to help remove barriers to treatment All processes will be designed to minimize red tape and administrative cost Continue to use NJSAMS Agencies will be required to update an on-line list of treatment availability in order to get referrals Streamline process for referrals Maximize capacity Will seek input into this process 22

Authorizations for Payment IME treatment authorizations will drive FFS payments Reauthorizations will be necessary to continue treatment beyond prior authorized lengths of stay Payments will continue from current sources for both Medicaid and non-Medicaid claims 23

Benefits of an IME Care coordinators will work to remove barriers to treatment and assist clients in moving to other levels of care Centralization of access maximizes the impact of available resources Using a managing entity creates a more organized and coherent system of care IME will help ensure the right treatment to the right person for the right length of time 24

Person seeks addictions treatment Calls IME toll-free number Walks into a licensed agency Screening No need for assessment Other actions? Refer to insurance company Provide treatment thru self pay or insurance Assessment authorized Private insurance or self pay Choice of provider and referral with warm handoff if possible Assessment not authorized Assessment authorized Agency assesses and completes ASI and LOCI IME review & makes Tx Authorizatio n Decision Authorization Approved Authorization Approved IME Continuing Care Review Appeal Process Authorization denied at requested LOC Treatment provided Demographics Income and Program Eligibility Assessment needed IME facilitates to another level of care Care Coordination Contact IME Approved Denied IME & Providers IME Providers Contact IME Care Coordination Contact IME for Continuing care

Communications DMHAS Website Question/Comment Mailbox: Addictions Professional Advisory Committee and invited guests On-line procedure manual hosted by UBHC Training and information sessions run by UBHC and DMHAS 26