Preliminary working draft; subject to change 0 BH Health Home October 18, Commission Meeting DRAFT PRELIMINARY WORKING DRAFT, SUBJECT TO CHANGE

Preliminary working draft; subject to change 1 Episode-based care delivery2Reimbursement adjustments3Reimbursement for new services4Health homes (& link to medical homes)1 PRELIMINARY Policy changes/enabling initiatives6 Reimbursement for pharmacy (including polypharmacy) 5 Potential payment initiatives to address issues within the BH system Focus of today’s conversation

Preliminary working draft; subject to change 2 Total Medicaid behavioral health beneficiaries “Core” behavioral health spend “Halo” spend Pharmacy spend of behavioral health clients (BH and halo) 2 ~110,000 recipients ~$550 M ~$380 M ~$150 M Key facts in behavioral health for the Medicaid population 1 Details of BH spend: ICD9 291 – 314 excluding autism (299) and dementia codes in 294, excludes pharmacy 2 Pharmacy includes some spend from some DD and dementia clients that has not yet been excluded SOURCE: 2011 Medical claims for behavioral health diagnosis codes. Does not include pharmacy, crossover or third party liability PRELIMINARY NOTE: Does not include those funded solely from state general revenue. Analysis underway to incorporate broader behavioral health programs Definitions of key termsEarly facts in Arkansas “Core” behavioral health spend 1 : ▪ Includes behavioral health services delivered to the client, (e.g., services for ADHD or depression) ▪ Does not include direct dementia or DD costs, but does includes BH spend from these populations Halo: ▪ Includes non-behavioral health services (e.g., medical, support services) delivered to people who also use BH services

Preliminary working draft; subject to change 3 Goals of the behavioral health health home To deliver integrated care coordination in a manner that facilitates quality care and positive outcomes through: Providing care coordination ▪ Providing clients with integrated care coordination within and across BH, medical health, long-term supports, and other systems Managing core care delivery ▪ Ensuring effective treatment of behavioral health (BH) conditions, including pharmacy effects How can we design health home criteria and corresponding payment model to achieve these goals? PRELIMINARY

Preliminary working draft; subject to change 4 Guiding principles for health home development ▪ Health homes must address comprehensive needs of individuals by utilizing a “whole person” and “person centered” approach while ensuring personal choice assurances through service planning and delivery ▪ Health homes will provide services that address issues of access to care, accountability, and active participation on behalf of both providers and individuals/families receiving services, continuity of care across all medical, behavioral, and social supports, and comprehensive coordination/integration of all needed services ▪ Health homes will provide services that seek to align a fragmented system of needs assessment, service planning, care coordination, transitional care, and direct care service delivery ▪ Health homes must demonstrate the use of health information technology as a means to improve service delivery and health outcomes of the individuals served

Preliminary working draft; subject to change 5 Key steps for BH health home design Early list of activities from the BH health home workplan ▪ Defining which behavioral health clients will benefit from health homes ▪ Developing a methodology to identify the people who will likely have health homes ▪ Determining applicability of assessment tools for health homes Target client population Health home activities ▪ Defining health home activities ▪ Integrating BH (includes mental health and substance abuse) and primary care, medical care, and long term services and supports ▪ Addressing the needs of people with multiple diagnoses ▪ Aligning the behavioral health homes with (i) delivery and payment for the delivery of core BH services (e.g., via episodes) and (ii) patient-centered medical homes Provider participation requirements ▪ Outlining health home provider requirements ▪ Developing provider certification criteria ▪ Creating milestones for providers to transform practices and build health home capabilities Payment model ▪ Which payment mechanisms can best incentivize system change (e.g., performance payments, care coordination fees)? ▪ Considering how health home models will impact overall costs Performance measures ▪ Developing ways to encourage positive performance in client care spanning core care delivery and care coordination ▪ TBD Implementation & administration ▪ Identifying external stakeholders and outline stakeholder (e.g., clients, providers, families) engagement activities ▪ Identifying support and infrastructure required by behavioral health homes ▪ Assessing system changes, state regulations, and internal DHS policies impacted by the implementation of a health homes Medicaid state plan option ▪ Aligning health homes planning initiative with current health homes planning efforts in development by the DDS and the LTSS ▪ Aligning health homes planning with PCMH planning efforts Elements in health home implementation PRELIMINARY Technology and infrastructure