OMH HCBS Waiver Updates Children’s Mental Health Staff Development Training Forum November 29-30, 2016 Division of Integrated Community Services for Children and Families NYS Office of Mental Health

HCBS Waiver Current State

HCBS Waiver Current State Application Status Updates CMS Discussions/Temporary Extension 1915(b)(4) Application Conflict Free Requirements CFR - Program Codes and Reporting Rates - Unbundling OHCDS – Provider Designation

Application Status Updates Temporary Extension to March 15, 2017; however, ongoing efforts to secure approval of application as soon as possible OMH/DOH still holding weekly calls with CMS to maintain momentum and keep process moving Developing interim rates with DOH to transition to MMC and Health Homes Working on addressing all remaining CMS questions and concerns

1915 (b)(4) Application Recap: The 1915(b)(4) application is to allow OMH to maintain the current ICC structure – ICC Agency designation by county (“Selective Contracting”) Application was re-submitted to CMS in October 2016 for their review Anticipating a discussion with CMS in next few weeks

Conflict Free Efforts are underway to address “conflict free” compliance in wake of moving to Health Homes and MMC in 10/2017 Regardless of decision, ICC Agencies will still be required to: Create administrative and supervisory firewalls between care coordination and HCBS Wavier services/functions Discontinue ICC from providing any other HCBS service Ensure family choice of HCBS service provider and right to change service provider if desired or dissatisfied Inform child/family of right to file complaint and/or grievance

CFR – Program Codes CMS is requiring providers to complete fiscal cost reporting by each service in the HCBS Wavier Effective 7/1/2016 (NYC) and 1/1/2017 (ROS) each service will need to be reported separately. Revised Fiscal Worksheets will be set out shortly Specific Fiscal questions - reach out to your Field Office Finance

New Program Codes 2230 Children’s HCBS Waiver Individualized Care Coordination 2240 Children’s HCBS Waiver Respite 2250 Children’s HCBS Waiver Family Support 2260 Children’s HCBS Waiver Crisis Response 2270 Children’s HCBS Waiver Skill Building 2280 Children’s HCBS Waiver Intensive In-Home 2350 Children’s HCBS Waiver Supported Employment 2360 Children’s HCBS Waiver Pre-Vocational Services 2370 Children’s HCBS Waiver Youth Peer Advocate 2300 HCBS Waiver will be deleted

Rates - Unbundling Continuing to unbundle rates & separate ICC role from other two waiver services (IIHS & CR) ICC Rate will continue to be a monthly PMPM; IIHS and CR rates will be billed in units (time intervals) when provided OMH/DOH working on developing rates to facilitate approval of Waiver renewal by CMS before transition to MMC/HH on 10/2017 Working on establishing service limitations for all HCBS services

OHCDS/Direct Medicaid Billing The OMH Wavier is unique and has an “OHCDS” billing structure (all services are billed through ICC Agency). This is not consistent with OHCDS guidelines HCBS Wavier service providers must have the option to either opt into the OHCDS structure OR direct bill Medicaid. Therefore, to allow for this, if currently subcontracted agencies want to continue to provide services and bill Medicaid directly, they should be sure to apply through the “Provider Designation Application” process outlined in slides below

Future of HCBS

Future of HCBS Transformation Timeline SPA Services HCBS Services Difference between SPA & HCBS Continuum of Care Provider Designation

Children’s Transformation Timeline From Children’s MRT Quarterly Meeting: November 3 2016 Children’s Transformation Timeline 2019 Mar May Jul Sep Nov Jan SPA OLP FFS statewide 03/01/2017 1915c Care Coordination transitions to HH for NYC and Nassau, Suffolk, and Westchester Counties Five Rehab Services to State Plan FFS (statewide) HCBS and certain BH services, including but not limited to new SPA services are carved in to MMMC in NYC and Nassau, Suffolk, & Westchester Counties Children in receipt of HCBS will be mandatorily enrolled in MMMC (previously exempt) 10/01/2017 1915c Care Coordination transitions to HH for ROS HCBS and certain BH services, including but not limited to new SPA services are carved in to MMC in ROS 01/01/2018 LON Community Medicaid Eligible HCBS group begins to receive HCBS/SPA 07/01/2018 LON Family of One eligibility group begins to receive HCBS/SPA Children in VFCA mandatorily enrolled in MMMC 01/01/2019 2017 2018

State Plan Amendment: Existing services moving into SPA 7 State Plan Amendment: Existing services moving into SPA Existing OMH Serious Emotional Disturbance (SED) Waiver Services Existing OCFS Bridges to Health (B2H) Waiver Services New SPA Service Immediate Crisis Response Services Crisis Response Services Crisis Intervention Crisis Avoidance, Management & Training Intensive In-Home Services Intensive In-Home Services Community Psychiatric Supports & Treatment Psychosocial Rehabilitation Services Family Peer Support Services Family Peer Support Services Youth Peer Advocate Services Youth Peer Support and Training LANA

1915c HCBS Alignment – Moving Existing Services into Single Children’s HCBS Array Habilitation Day Habilitation Respite (Planned and Crisis) Respite Crisis and Planned Respite Respite Care Prevocational Service Prevocational Services Supported Employment Community Self-Advocacy Training and Supports Special Needs Community Advocacy and Supports Caregiver/ Family Supports and Services Family/ Caregiver Supports and Services Existing Services OMH SED Waiver OCFS B2H Waivers CAH I/II Waiver Part One

1915c HCBS Alignment – Moving Existing Services into Single Children’s HCBS Array Habilitative Skill Building Skill Building Adaptive and Assistive Equipment Palliative Care Accessibility Modifications Home and Vehicle Modifications Non-Medical Transportation Existing Services OMH SED Waiver OCFS B2H Waivers CAH I/II Waiver

Current Continuum of Care

Intensity of Need Family Peer Support Youth Advocacy & Training RTF CR Inpatient Day Treatment Skill Building Respite Transportation Clinic School-Based Clinic Other Licensed Practitioner Mobile Crisis Community Psychiatric Supports and Treatment Psychosocial Rehabilitation Family Peer Support Youth Advocacy & Training Primary Care Co-Located Clinic Project TEACH Intensive Services HCBS Clinical Services Community Supports Support / Advocacy Integrated Care Here is a visual to depict the future, reformed system we are currently designing. The focus is on bolstering lower level of services to prevent the need for more restrictive settings – home and community based services are key to this – for example, before referring a child to day treatment, we could surround the child with blend of clinical services as well as home and community based support services. While the continuum may be linear, each child journey is unique and most often does not take a linear path.

SPA & HCBS Differences State Plan Services Home & Community Based Services Requires Medical Necessity Requires Eligibility Determination Recommended by licensed practitioner Application by current provider w/ required documentation Authorized on Treatment Plan Authorized by Plan of Care Person-centered plan signed by licensed practitioner & child/family Person-centered plan signed by Care Coordinator & child/family Available to ALL Medicaid enrollees who meet medical necessity Available to Medicaid enrollees ONLY if eligible for (and deemed Family of One) Accessible when a need has been determined and necessity met Accessible when “at risk” of institutional placement or out-of-home placement *Future system has no “slots”/waiting lists for access

Preparing for New Service Structure Moving from “programs” to services – available array of services for children who have varied needs Still MUST apply for designation to be able to provide SPA and HCBS services even if a HCBS Wavier provider today SPA/HCBS will be available to various “populations” of children; substance use, foster care, medically fragile, mental health – what populations are you qualified to serve? Need to indicate capacity/preference on Provider Designation application.

Preparing for New Service Structure When providing SPA services to a MH population, will need an authorization or licensure from OMH; may need the same from other State agencies for other populations (e.g. OASAS for SUD) For HCBS services, since many are moving to SPA, there will be no “grandfathering,” but “preference” given to providers doing services today Should review NEW SPA and HCBS Manuals* to review service definitions, provider qualifications and staffing qualifications for each service *Manuals will be available when Provider Designation Application becomes available

Provider Designation Process Qualifying Provider Agencies: “Any practitioner providing behavioral health services must operate within a child serving agency or agency with children’s behavioral health and health experience that is licensed, certified or designated by DOH, OASAS, OCFS, or OMH in settings permissible by that designation” Individual practitioners are not eligible to be designated as a SPA or HCBS provider; must be employed by a qualifying child-serving agency Agencies who are currently NOT licensed, certified or designated by OMH; will need to apply for a User ID to complete a Provider Designation Application (on-line)

Provider Designation Process Current HCBS subcontractors will also need to apply to be able to provide SPA and/or HCBS services If there are subcontractors who are not currently Medicaid enrolled providers, they will also have to follow steps for Medicaid provider enrollment As is required today, under MMC, all Family Peers (and Youth Peers in the future) will need to be credentialed to allow for billing of Medicaid for the services they provide

Provider Designation Provider ID for Non-OMH providers and pending application to be available soon. In anticipation of the release of the Children’s SPA/HCBS Provider Designation Application in the near future, we are alerting all New York State (NYS) providers who may wish to apply for designation to undertake a preparatory step to obtain a user ID.  The user ID, granted through the NYS Office of Mental Health (OMH), will enable the electronic application, once released, to be accessed and completed.  http://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/provider_de sign.htm When the Provider Designation Application becomes available – it will be accessible at the link provided above

Questions??

Contact Information For answers to your questions, contact: The OMH HCBS Wavier Unit Joyce Billetts Shannon Fortran Steve Vroman Email: dcfs@omh.ny.gov Phone: 518-474-8394