John R. Kasich, Governor Tracy J. Plouck, Director Tracy J. Plouck, Director Tracy J. Plouck, Director

Continuum of care update Medicaid behavioral health redesign Recovery services partnership with DRC OhioMHAS support for community partnerships Questions & answers 2

Effective September 15, 2016, the following new changes will be mandatory, per the legislature’s passing of the budget this year: Adds sub-acute detoxification, intensive and other supports, recovery support, prevention and wellness management, and an array of treatment and support services for all levels of opioid and co-occurring drug addiction to the definition of addiction and mental health services Adds departmental oversight to adding any additional components to establish the continuum of care 3

OhioMHAS is targeting January 1, 2016, to have proposed changes in place to meet the statutory deadline of September 15, Three teams have been formed around topical areas identified in statute: 1.Budget and Compliance 2.Waiting List Management 3.Access and Capacity/Services and Supports 4

ORC: We are working with external partners via the committees and hope to have a consensus package of proposed legislative modifications this fall We are available to provide training on this topic, now and/or once process is finalized 5

Behavioral Health System Redesign Add new services to the Medicaid behavioral health benefit High intensity services are available for those most in need All providers follow National Correct Coding Initiative (NCCI) All providers practice at the top of their scope of practice Behavioral health and physical health integration opportunities are maximized All behavioral health services in managed care by January 2018 Implement value-based payment methodologies (e.g., episode- based and PCMH payment models) by January 2018 Coordination of benefits across payers 6

▪ Ensure continued access to care for ~4-6K adults with SPMI who meet *financial and **clinical / needs criteria and who are at risk of potential loss of eligibility for Medicaid ▪ Cover new services such as ***Recovery Management, IPS Supported Employment, Peer Recovery Support *300% of SSI, includes $20 personal needs disregard ($2,219 in CY 2015); Clinical includes diagnostic (diagnostic (schizophrenia, bipolar or major depressive affective disorders-severe) and score on Adult Needs and Strengths Assessment) tool **Assertive Community Treatment, Intensive Home Based Treatment, residential treatment for substance abuse *** RM&BPHC is now called Recovery Management and the SPA has been updated to reflect this change ▪ Recode Medicaid BH services to achieve alignment with national coding standards (AMA, HCPCS, Medicare, NCCI/MUE) ▪ Disaggregate certain existing services (Community Psychiatric Supportive Treatment, Case Management and Health Home services) and provide for lower acuity service coordination and support services ▪ Develop new services for people with high intensity needs under the Medicaid Rehabilitation Option: Assertive Community Treatment, Intensive Home Based Treatment, residential treatment for substance abuse ▪ Achieve cost neutrality in making these changes ▪ Addition of BH services to Managed Care Plan contract, with specific requirements for MCPs to delegate components of care coordination to qualified Community Behavioral Health providers ▪ Design and implement new health care delivery payment systems to reward the value of services, not volume ▪ Develop approach for introducing episode based payment for BH services P AYMENT I NNOVATION M ANAGED B EHAVIORAL H EALTH C ARE R EBUILDING C OMMUNITY BH S YSTEM C APACITY 1915( I ) P ROGRAM F OR A DULTS W ITH SPMI Ohio’s Priorities for Behavioral Health (BH) Redesign 7

OUTCOMES & VISION: » All Providers: Follow NCCI & practice at the top of their scope of practice » Integration of Behavioral Health & Physical Health services » High intensity services available for those most in need » Services & supports available for all Ohioans with needs: Services are sustainable within budgeted resources » Implementation of value-based payment methodology » Coordination of benefits across payers Behavioral Health Redesign Timeline 5

JULY 2016 Substance Use Disorder: Simplify coding New Services: 1915(i): - Peer support - Supported employment - Case & recovery management Assertive Community Treatment (for adults, includes peer support) Youth & Family Evidence-Based Practices (e.g. IHBT) – focus on outcomes. Other services – labs, etc. National Correct Coding Initiative [NCCI]: Training begins & new codes accepted. One year to submit old codes. Evaluation & Management codes Alignment: CPT & HCPCS codes to align with American Medical Association standards. MCP concerns: all coding concerns addressed. Inclusion of unlicensed practitioners must bill w/ HCPS codes Maximize TPL Medicare cost avoidance – Medicaid is payer of last resort. Alignment of fee schedules: services billed & paid for consistently across systems. Require Identification of Rendering Provider: Rendering Provider identification required on all claims. Rendering providers must be associated with one or more agencies Coordination of Benefits: Medicare certification for providers of dual eligibles, including licensed practitioners. NCCI Continues: Provider Training and stakeholder education continues through Old codes no longer accepted. JULY 2017 Finalize CPST Changes: Targeted Case Management: Change Community Psychiatric Supportive Treatment Services into more appropriate services and targeted services to meet needs. JULY 2018 Payment Innovation BH Services now covered by Managed Care 2019 & 2020 Value – Based Purchasing: Residential services for Substance Use Disorder. Services for Children Examine & redesign residential services for children. Specialized Services in Nursing Homes JAN 2018 Evaluate Waiver Options Implement Waivers (TBD) OUTCOMES & VISION: » All Providers: Follow NCCI & practice at the top of their scope of practice » Integration of Behavioral Health & Physical Health services » High intensity services available for those most in need » Services & supports available for all Ohioans with needs: Services are sustainable within budgeted resources » Implementation of value-based payment methodology » Coordination of benefits across payers Discontinuing Health Home Payment Methodology Intensive Behavioral Service: Includes ABA, CPT codes Telemedicine: Implement Q codes with episodes of care. 6

Budget as enacted: $27.4 million in FY 16 $34.3 million in FY 17 Within Ohio’s state-run prisons: More offenders access addiction treatment while in prison Transferred ~120 recovery services positions from DRC to OhioMHAS (completed) Hiring ~60 recovery services positions to increase access (anticipated completion – December 2015) Outsourcing OASIS, the therapeutic community at Pickaway Correctional Institution (RFP recently awarded to CompDrug) 10

Community Transition Initiative: Encourage better connection to services upon release to further lower the rate of recidivism, including: Provider & other partner in-reach prior to release Connection to the Medicaid program to ensure continued clinical services where applicable Access to recovery supports such as employment support, peer, and/or recovery housing upon release to ensure stable recovery and even further lower the recidivism rate 11

Strong Families, Safe Communities - $3 million/year Recovery Housing - $2.5 million/year Community Innovations: behavioral health and criminal justice (jails, CBCFs) - $3 million/year Specialty dockets: Addiction Treatment Project - $5.5 million/year Administrative support for courts - $5 million/year 12

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