Nevada Certified Community Behavioral Health Clinics Planning Grant Division of Public and Behavioral Health Division of Health Care Financing and Policy March 2,

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC CCBHC Technical Assistance Purpose of Meeting The technical assistance webinar is in response to provider questions The state is receiving guidance throughout the planning grant process –For answers to questions, the state reaches out to SAMHSA –FAQs will be updated when answers are available 2

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC Webinar Presenters Stephanie Woodard, Psy.D., Nevada Division of Public and Behavioral Health, CCBHC Project Director Alexis Tucey, Nevada Division of Health Care Financing and Policy, Social Services Program Specialist III, Clinical Policy Team - Behavioral Health Supervisor Kyle Devine, Nevada Bureau of Health Care Quality and Compliance (HCQC), Bureau Chief Terry Moritz, Myers and Stauffer, Senior Manager Jason McNamara, Myers and Stauffer, Director 3

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC What are Certified Community Behavioral Health Clinics (CCBHCs)? CCBHC Services delivered within a “behavioral health home” model Outpatient BH services / primary care screenings and monitoring for children, adults, and families Emphasize quality of care in the support of optimal patient-centered outcomes Provides 9 core services “Whole” person orientation to address patient‘s needs and families needs Person-centered, family-centered, culturally and linguistically competent, trauma- informed Care coordinated and integrated across the health care system and patient‘s environment 4

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC Which Populations do CCBHCs Serve? CCBHCs serve any individual in need of care, regardless of the ability to pay: –Adults with SMI –Children with SED and their families –Individuals with SUD –Individuals with co-occurring behavioral health disorders –Individuals who are insured, uninsured or on Medicaid –Members of the armed forces and veterans 5

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC 6 CCBHC Services

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC Who Can be a CCBHC or DCO? 7 Non-profit organization Part of a local government behavioral health authority Operated under the authority of the Indian Health Service (IHS), an Indian Tribe, or Tribal organization pursuant to a contract, grant, cooperative agreement, or compact with the IHS Applicants must have established clinical operations prior to 4/1/14 CCBHC A private, for-profit clinic or organization can enter into a formal agreement with a CCBHC Must be enrolled in Nevada Medicaid Services are an extension of CCBHC services Existing state-sanctioned BH crisis services network can act as a DCO DCO

More About DCOs DCOs are different from contracted staff The state will assist in helping prospective CCBHCs identify DCOs that have submitted interest in participation through the RFA process 8 The state will assist DCOs in connecting with CCBHCs

More About DCOs Capabilities of the DCO should be considered when the CCBHC completes the Readiness Tool The CCBHC maintains clinical responsibility for the services provided by both the CCBHC and DCO Payment for DCO services is included within the scope of the CCBHC PPS rate 9

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC CCBHC Model 10

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC CCBHC/DCO Model and Quality Bonus Payments 11

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC Development of CCBHC Model 12

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC The Needs Assessment will be performed prior to certification and will influence Nevada’s planning grant Required Certification Activities Create and finalize application processes and review procedures Assist with improving cultural diversity and competence of workforces Assist clinics with meeting certification standards by facilitating access to training and technical assistance Measure readiness of clinics to meet basic requirements Facilitate cultural, procedural, and organizational changes to CCBHCs to achieve: High quality Comprehensive Person-centered; and Evidence-based services Verify that CCBHCs have meaningful input by consumers 13

Community Based Needs Assessment Convene key community partners and providers, as well as individuals served and family members Describe the nature of the problem, including service gaps Document the need (i.e. current prevalence rates or incidence data) for the population(s) of focus based on data 14

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC Certification Criteria: Program Requirements 15

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC CCBHC Certification and State Flexibility States have a degree of flexibility based on state specifics Example: The state has the ability to define alternative solutions to the 51% requirement of individuals served on the CCBHC governing Board –Based on provider circumstance The state will work with providers as needed 16

Certification Checklist Become familiar with Certification Criteria Complete the Readiness Tool to identify technical assistance needs necessary to be ready to implement by January 1,

Certification Checklist Determine current capability to furnish at a minimum, the nine required services to the target populations –Adults with SMI, children with SED and their families, those with long term and serious SUD, and others with mental illness and SUD –Members of armed services and veterans Assist the state in identifying a minimum set of evidence based practices (EBPs, especially those EBPs that have been adapted to best meet the populations that CCBHCs serve 18

Certification Checklist Complete the Request for Application (RFA) in accordance with requirements described in the RFA Participate in focused interviews during the CCBHC selection process Sign Letter of Intent to participate in the CCBHC model 19

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC CCBHC Provider Readiness Provider: Identify services and technical assistance needs Providers don’t have to be 100% ready to provide all nine services 20

Prospective Payment Structure 21 In the development of the PPS rate, the possibility of Quality Bonus Payments is being explored by the state

PPS Rate Setting PPS-1, daily visit rate selected in Nevada Rate is determined from the submitted CCBHC cost report DCO costs and visits are to be included in the CCBHC's cost report submission 22

PPS Preliminary Rate Setting Costs: Obtained from CCBHC Cost Report Visits: Reported in CCBHC Cost Report and obtained from CCBHC records and MMIS data (if available) 23 Total Allowable CCBHC Costs Total Allowable CCBHC Visits Inflationary Factor utilized to determine final PPS Rate for Demonstration Year (DY) 1

Costs Attributable to CCBHC Services Direct Costs may include:Indirect Costs may include: CCBHC health care staff costs (compensation) Rent Reference the CCBHC cost report template and instructions at the following link for further guidance on CCBHC direct and indirect cost allocations: edicaid-chip-program- information/by- topics/financing-and- reimbursement/223- demonstration-for- ccbhc.html Costs of services under agreement with DCOs Insurance Medical suppliesUtilities Professional liability insuranceAdministrative office salaries Medical equipment depreciationOffice supplies Professional services (i.e., legal, accounting, etc.) Phone/internet Building depreciation Housekeeping Maintenance 24

PPS Rate Setting NV CCBHC cost report training will be provided. This will include: –A listing of NV allowable CCBHC services –Identification of which of those services constitute a CCBHC visit MCO implementation - The state is currently reviewing whether to incorporate the PPS rate into the capitation rate or to make wrap payments 25

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC State Technical Assistance State identifying areas for Technical Assistance –PPS and cost reporting –Workshops TBD based on provider needs and feedback Additional TA will be scheduled as the state goes the planning process 26

Quality Bonus Payment (QBP) The possibility of QBPs is being explored Based on six required quality measures State is currently reviewing additional measures for inclusion into the QBP including those listed as optional Measures are derived primarily from the Medicaid adult and child core set measures QBP Methodology details include payment triggers, amount and frequency 27

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC 11 Quality Bonus Payment Measures Required: 1.Follow-Up After Hospitalization for Mental Illness (adult age groups) 2.Follow-Up After Hospitalization for Mental Illness (child/adolescents) 3.Adherence to Antipsychotics for Individuals with Schizophrenia 4.Initiation and Engagement of Alcohol and Other Drug Dependence Treatment 5.Adult Major Depressive Disorder (MDD): Suicide Risk Assessment 6.Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment 28

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC 11 Quality Bonus Payment Measures Optional: 7.Follow-Up Care for Children Prescribed Attention Deficit Hyperactivity Disorder (ADHD) Medication 8.Screening for Clinical Depression and Follow-Up Plan 9.Antidepressant Medication Management 10.Plan All-Cause Readmission Rate 11.Depression Remission at Twelve Months-Adults 29

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC Quality Measures and Reporting Data collection Focus on limiting duplicate data entry by providers Quality Measures Programmatic minimum of 32 total measures are required (17 CCBHC site reported, 15 state performance collected) Technical Assistance will be provided Reporting Requirements Requirements will depend greatly on quality measure specifications Expectation of EHR/HIT Requirement of the program to use Certified EHR Technology 30

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC Questions? 31

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC Contact Information Stephanie Woodard, Psy.D., DPBH, CCBHC Project Director: Dennis Humphrey, Project Manager: Mailbox: Web page: Under development LISTSERV: 32

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC Additional Resources 223 Demonstration Program to Improve Community Mental Health Services: program-information/by-topics/financing-and-reimbursement/223- demonstration-for-ccbhc.htmlhttps:// program-information/by-topics/financing-and-reimbursement/223- demonstration-for-ccbhc.html SAMHSA’s main CCBHC web page: SAMHSA’s Grant Page: announcements/sm http:// announcements/sm

DHHS, DPBH - Nevada CCBHC Planning Grant Prepared by Myers and Stauffer LC Additional Resources CCBHC Cost Report and Instructions: information/by-topics/financing-and-reimbursement/223- demonstration-for-ccbhc.html National Council for Behavioral Health: