Single Point of Access-SPOA New York State Office of Mental Health Division of Integrated Community Services for Children and Families Children’s Mental Health Services Staff Development Training Tuesday, November 30, 2016

Introductions NYS Office of Mental Health Meredith Ray- LaBatt, Deputy Director, Division of Integrated Community Services for Children and Families Michelle Wagner, Mental Health Program Specialist, Division of Integrated Community Services for Children and Families Charlotte Carito, Deputy Director, Division of Managed Care NYS Department of Health Lana I. Earle, Deputy Director, Division of Program Development and Management, Office of Health Insurance Programs Colette Poulin, HHSC Program Director, Office of Health Insurance Programs

Agenda Designated Health Home Care Management Agency for Children with SED Role of SPOA SPOA Assignments New requirements for Serving Children with SED in a Designated Health Home Care Management Agency Tracking SPOA assignments Upcoming Changes

Health Homes Serving Children with Serious Emotional Disturbance

Prior to Health Home Launch After HHSC Launch-December 8, 2016 Designated Health Home Care Management for SED Children Prior to Health Home Launch After HHSC Launch-December 8, 2016 Targeted Case Management Provider Designated Health Home Care Management Agency for Children w/SED

Number of Medicaid Funded SPOA Assignments (July 2016) Designated Health Home Care Management Agency for SED OMH Region Number of Medicaid Funded SPOA Assignments (July 2016) NYC 1,095 LI 186 CNY 456 WNY 697 HR 395 Total: 2,829 State will provide data that aligns each Designated Health Home Care Management Agency for SED with its number of SPOA assignments, Health Home, Plan, SPOA, and County

New Requirements for Serving SED Children in Health Home Care Manager Qualifications Current Health Home Requirements: Care Managers that serve children with an acuity level of “high” as determined by the CANS-NY are required to have: A Bachelors of Arts or Science with two years of relevant experience, or A License as a Registered Nurse with two years of relevant experience, or A Masters with one year of relevant experience. Providers may seek a waiver qualifications waiver from the State New Requirements: Designated HH CMAs for SED serving children with medium acuity that do not have CMA qualifications of at least an associates degree with one year of relevant experience must notify the State and seek a waiver from such qualifications

New Requirements for Serving SED Children in Health Home Case Load Sizes for Designated HH CMAs for SED Current Health Home Requirements: Health Homes are required to provide a level of service, (e.g., number of contacts and methods of contact), that support the needs of the child and the family and meet the Health Home core requirements Health Homes and care managers serving children with high acuity per the CANS-NY are required to keep their case loads mix predominantly to children of the High acuity level Children with High and Medium acuity per the CANS-NY are required to receive two Health Home services per month, one of which must be a face-to-face encounter with the child Case load sizes have been built into the development and calculation of the Health Home rates for children – presumption is CMAs will manage case loads around these assumptions The rates assume underlying case load ratios of 1:12 for “High”, 1:20 for “Medium” and 1:40 for “Low” New Requirements: Designated HH CMAs for SED will be required to maintain the case load ratios built into the rates for children that are referred by the SPOA 1:12 for High 1:20 for Medium 1:40 for Low

New Process for Serving SED Children in Health Home Role of the SPOA and Health Home Care Manager Assignments Current Health Home Requirements: Health Homes and Care Management Agencies are required to ensure that CMAs providing Health Home care management are qualified to meet the needs of the child and family (e.g., be able to meet the care management needs of a child with SED, that has HIV, or has multiple chronic conditions) New Process: Beginning in December, Children that are identified to be eligible for Health Home because they have or potentially have an SED through the SPOA process will be referred by the SPOA to a “Designated Health Home Care Management Agency (CMA) for SED” Designated HH CMAs for SED will be existing OMH TCM Programs that are transitioning to Health Home SPOA will assign SED children to Designated HH CMA for SED SPOA assignments must reflect alignment between Health Home, Designated HH CMAs for SED, and Managed Care Plans for children enrolled in Plans Health Home has BAA with Designated HH CMA for SED, Plan the child is enrolled in has ASA in place with that same Health Home

New Process for Serving SED Children in Health Home Role of the SPOA and Health Home Care Manager Assignments SPOA assignments are limited, on a Designated HH CMA for SED basis, to the current capacity for Medicaid children served by the existing TCM, (i.e., 3,000 children statewide) - “SPOA Assignment” Designated HH CMA for SED will “assign” children with a CANS-NY acuity of High or Medium to a SPOA Assignment Children with CANS-NY acuity of low or that step down from High or Medium to Low will continue to be served by HH CMA for SED but does not count towards SPOA Assignment SPOA will track and report the number of assignments made to each Designated HH CMA for SED to OMH and DOH and each Lead Health Home – this will be a manual process that will occur outside of the MAPP HHTS SPOAs will only use the MAPP HHTS to make a referral for assignment through the MAPP HHTS Children’s Referral Portal if the Designated HH CMA for SED does not have capacity to serve that child (i.e., their SPOA Assignments are filled) or for other non-SED referrals

New Process for Serving SED Children in Health Home Role of the SPOA and Health Home Care Manager Assignments SPOA recommendation is subject to family/child choice, family may choose and be informed of other Health Homes CMAs non-designated for SED Health Homes may also make assignments to Designated HH CMAs for SED HH CMAs non-designated for SED that may be working with children and families with SED Children may continue to directly enroll such children through the MAPP HHTS Children’s Referral Portal

Case Example: SPOA* refers to Designated HH CMA for SED Designated CMA has Capacity – CANS-NY is High or Medium SPOA determines child has an SED and is eligible for Health Home and gets verbal consent from parent or guardian to make referral for Health Home (Children in Foster Care can only be referred by the LDSS) SPOA refers to Designated HH CMA for SED where there is HH, Plan and CMA Alignment Designated HH CMA for SED has SPOA Assignment Capacity and accepts assignment Designated HH CMA obtains consent to conduct CANS-NY assessment and enroll the child in Health Home Designated HH CMA enrolls the child in Health Home through MAPP HHTS Children’s Referral Portal and conducts the CANS-NY CANS-NY algorithm is High or Medium – child occupies a SPOA Assignment Designated HH CMA for SED provides care management to High or Medium acuity child Designated HH CMA for SED continues to provide care management when the child steps down from High or Medium to Low *or Lead Health Home

Case Example: SPOA* refers to Designated HH CMA for SED Designated CMA has Capacity – CANS-NY is Low SPOA determines child has an SED and is eligible for Health Home and gets verbal consent from parent or guardian to make referral for Health Home (Children in Foster Care can only be referred by the LDSS) SPOA refers to Designated HH CMA for SED where there is HH, Plan and CMA Alignment Designated HH CMA for SED has SPOA Assignment Capacity and accepts assignment Designated HH CMA obtains consent to conduct CANS-NY assessment and enrolls the child in Health Home Designated HH CMA enrolls the child in Health Home through MAPP HHTS Children’s Referral Portal and conducts the CANS-NY CANS-NY algorithm is Low – child does not occupy a SPOA assignment Designated HH CMA for SED provides care management to that Low acuity child *or Lead Health Home

Case Example: SPOA refers to Designated HH CMA for SED Designated TCM does not have Capacity SPOA determines child has an SED and is eligible for Health Home and gets verbal consent from parent or guardian to make referral for Health Home (Children in Foster Care can only be referred by the LDSS) SPOA refers to Designated HH CMA for SED operating in the county where there is HH, Plan and CMA Alignment Designated HH CMA for SED does not have any SPOA assignment capacity SPOA may refer to another Designated HH CMA if practical and if available If there are no other Designated HH CMAs for SED with SPOA assignment capacity, the SPOA makes a referral through the MAPP HHTS Children’s Referral Portal The child is assigned by Health Home to a HH CMA with experience in serving SED children

WORKFLOW: Referral to Designated HH CMA for SED Low Acuity Agrees to HH HH CMA for SED has SPOA Assignment Capacity No Refuses HH Yes SPOA refers to other services SPOA referral –service need reviewed SED and HH appropriateness assessed CMA Completes the CANS-NY Educate Family regarding HH and obtain verbal consent for services Outside of MAPP SPOA Assignment Count Referral to HH CMA for SED MAPP HHTS Referral and Enrollment Verify child eligible for HH, Educate Family about HH and obtain enrollment, sharing information and assessment consents H or M Acuity MAPP HHTS Referral Made Non-SPOA Assignment

Tracking SPOA Assignments to Designated Health Home CMAs for SED SPOAs will submit a monthly roster to State and each Lead Health Homes that tracks : Children for which there was capacity and assignment accepted by Designated CMA Name and CIN of child assigned to Designated HH CMA for SED, Date of child assigned and accepted by Designated HH CMA for SED Name and MMIS number of Designated HH CMA for SED and name and MMIS of Health Home Children for which there was no capacity and referral was made through the MAPP HHTS Name(s) and MMIS of Designated HH CMAs for SED and name and MMIS of Health Home for which there was not capacity at time of SPOA assignment Name and CIN of child referred through the MAPP HHTS Children’s Referral Portal - DOH/OMH will provide, to SPOAs, the MMIS of Health Homes and Designated HH CMA for SED for their County

Tracking SPOA Assignments to Designated Health Home CMAs for SED Data Elements for all children accepted for assignment (high, medium or low) by the Designated HH CMA for SED County in which the Designated HH CMA operates Name and CIN of Child assigned to designated HH CMA for SED Date of HHSC Enrollment Name and MMIS number for Designated HH CMAA for SED and MMIS of Health Home Date of completion of CANS-NY Acuity Score based on completed CANS-NY Date of transition out of SPOA assignment to low acuity caseload

Tracking SPOA Assignments to Designated Health Home CMAs for SED Data Elements for children where there was no capacity and referral was made through the MAPP HHTS Children’s Referral Portal County in which the Designated HH CMA operates Name and CIN of Child referred through the MAPP HHTS Children’s Referral Portal Name and MMIS number for Designated HH CMA for SED and MMIS of Health Home for which there was not capacity at time for a SPOA assignment

SPOA Readiness Activities: How to prepare for Health Home transition Prior to December 8, 2016, SPOAs need to collect baseline data Gather a list of ALL active TCM children in their county including demographics, Medicaid CIN number, and current TCM provider SPOAs should continue to meet with the Health Homes serving their counties If you have not spoken to the HH about the other county available services, the State encourages you to meet

Next Steps Week of December 5th – Posted on the Health Home Webpage DOH/OMH will provide SPOAs and Designated HH CMA for Children w/SED of the number of SPOA assignments by County and Agency DOH/OMH will provide, to SPOAs, the MMIS of Health Homes and Designated HH CMA for SED for their County DOH/OMH will provide, to SPOAs,  HH, Plan and CMA Alignment for their County DOH/OMH will provide the initial roster data collection tool Week of December 12th – Webinar and Web Posting DOH/OMH will provide the SPOAs with the SPOA tracking form SPOA training Webinar on Data Collection and use of tracking form

Questions

Non–Medicaid Children

Care Coordination for Children without Medicaid OMH will continue to provide LGUs with State Aid for the TCM Legacy program to be used towards providing care coordination to children with SED that are not Medicaid eligible, and thus cannot be enrolled in Health Home. SPOA continues to be the referral source Reporting in CAIRS will continue to be required CANS-NY will be completed to identify needs and strengths and guide the plan of care, will be entered into CAIRS. OMH recognizes that , current funding may not be enough to support care-coordination for t he non-Medicaid population Currently working on revised funding methodology to financially support care coordination for the non-Medicaid population

Care Coordination for Children without Medicaid OMH will be issuing guidance to counties and former TCM providers on serving Non-Medicaid children Program expectations will mirror those as in Designated Health Home CMAs serving Children with SED State Aid funds for service dollars will also be maintained and available for use for all children with SED in Designated Health Home CMAs – Medicaid and Non-Medicaid

Questions?

Pending Changes

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

OMH HCBS SED Waiver Role of SPOA in accessing the OMH HCBS Waiver will not change until the transition to MMC in 10/2017 SPOA will retain the responsibility of determining HCBS eligibility as it does today until MMC SPOA can utilize the “SPOA Assignment” process in Health Homes to continue to manage access to the continuum of care SPOA can serve as a resource to Health Homes and CMAs in how and where to access high end mental health services for children with SED who are in need

Resources Monthly OMH HCBS Waiver Webinars OMH TCM Listserv- Email Michelle Wagner- Michelle.Wagner@omh.ny.gov Children’s Medicaid Managed Care Transition- http://www.omh.ny.gov/omhweb/childservice/ DOH Health Homes for Children Webpage http://www.health.ny.gov/health_care/medicaid//program/medicaid_health_homes/health_homes_and_children.htm

Contact Information NYS Office of Mental Health Division Of Integrated Community Services for Children and Families Michelle Wagner, SPOA, TCM, Health Homes, Waiver Support Main Number: 518-474-8394 Michelle.Wagner@omh.ny.gov