The Future of Mental Health and Intellectual Disabilities Services

Welcome to a ride with more ups and downs than a rollercoaster. --Ms. Frizzle

Customer Satisfaction Triple Aim Quality Outcomes Customer Satisfaction Reasonable Cost Episode Storyline

Episode Location: Texas Medicaid

Managed Care is Texas Medicaid 82% This is about financing and integration of healthcare services.

Where does the bar move next? Stage 1 Statewide STAR+PLUS Acute Care Services for all Medicaid Habilitation/ Attendant Care MH Rehab/CM September 2014 Stage 2 Texas Home Living Services September 2017 Stage 3 HCS, ICF, CLASS, DBMD Voluntary Program for persons currently enrolled September 2020 STAR Kids

How do we design benefits to promote quality care at lower cost?

Attendant/Habilitation Services become part of the Medicaid State Plan Assistance with activities of daily living provided to an individual because of a physical, cognitive or behavioral limitation related to disability or chronic health condition. Habilitation Assistance provided to an individual acquiring, retaining or improving: skills related to activities of daily living; and social and adaptive skills necessary to live and fully participate in the community. Attendant/Habilitation Services become part of the Medicaid State Plan under the Community First Choice option

Carve-in Medicaid covered MH into STAR and STAR+PLUS Psychiatric Services Licensed Professional Counseling Inpatient Psychiatric Care (state/private hospital; children and adults) ECI Services Outpatient Substance Use Disorder Treatment including assessment, detoxification services, counseling treatment and medication assisted therapy Residential Substance Use Disorder Treatment services including detoxification, substance use disorder treatment including room and board Mental Health Rehabilitation Services, including Targeted Case Management

How do we know someone needs a covered benefit?

Comprehensive Assessment and Resource Allocation Tool Evidence-based Comprehensive Assessment and Resource Allocation Tool Appropriate Tool for Authorization Evidence Based Nationally Recognized Nationally Recognized Comprehensive

Coordination of Care: What does the alphabet soup have in common? ACO PCMH Health Home HCIA Patient Navigator ISC Customer Local Provider

IDD system redesign includes the promotion of independent service coordination, ombudsman services and the prevention of inappropriate institutionalization. DADS to contract with LIDDA for the independent service coordination function in the new program designed to provide basic attendant and habilitation services. Service Coordination and Care Planning for Individuals with IDD Assessment of need provided to MCO Recommended plans of care provided to MCO and DADS LIDDA-MCO written agreement on coordination of care Annual report to MCO and DADS on outcomes based on an individual’s plan

New Requirement for STAR and STAR+PLUS Requires 2 health home pilots in 2 service areas for people with Serious Mental Illness and at least one other chronic condition

Paying for Value not Volume

Performance and Quality Outcomes for Payment SB 7 SB 58 1115 Transformation Waiver DSHS Rider 78 HHSC MCO Contracts Medicaid and Medicare Hospital Payment

Customer Satisfaction Customer Engagement Intellectual and Developmental Disability System Redesign Advisory Committee STAR+PLUS Quality Council STARKids Managed Care Advisory Committee Behavioral Health Integration Advisory Committee

Are we all on the same bus? Senate Bill 7 Senate Bill 58 SYSTEM DESIGN Managed Care BENEFIT DESIGN Attendant/Habilitation Rehabilitation/Case Management ASSESSMENT Comprehensive and Resource Allocation Appropriate Authorization PATIENT COORDINATION Independent Service Coordination Health Home QUALITY OUTCOMES Quality Based Payment; Provider Performance Performance and Quality Outcomes CUSTOMER ENGAGEMENT Advisory Committee

Step inside this wild ride. --Ms. Frizzle

DISCUSSION

Melissa Rowan Healthcare Policy Director Texas Council of Community Centers mrowan@txcouncil.com 512.794.9268 ext 109