Full Integration/Early Adopter Work Group Adult Behavioral Health Task Force October 16, 2015 Presented by: Rick Weaver, Co-Chair

Membership Mental Health Treatment Providers Substance Abuse Treatment Providers Community Health Clinics NAMI County Representatives Regional Support Networks Local Public Health Health Plan Representatives Agency (DSHS/HCA) staff Legislative Staff

November Recommendations Executive agencies should build service reimbursement rates that support integrated care models. Agencies, purchasers, and providers should actively pursue statewide policies and funding to support the workforce development activities DSHS and HCA should share procurement documents and draft contracts developed for early adopter regions with the Early Adopter/Full Integration Work Group for comment before they are released

November Recommendations DSHS and HCA should lead a process to align regulations across CD/MH/primary care in order to reduce administrative burdens. The state should consider a phased approach to full integration that has timelines flexible enough to allow regions to proceed at various paces. State agencies should develop a data system/data sharing plan and funding mechanism to allow for real time data sharing.

June Recommendations There remain a wide range of concerns about timing in this journey. For example current plans call for contracting out of cycle with fiscal years. Sooner, rather than later the task force/legislature should review and make certain the timelines for this effort. There is a gap between the end of the task force and the current full implementation date (2020). The workgroup believes: There is a need for a forum for on-going into or oversight of the activities leading to full integration There is great value in the cross-sector interaction present in the workgroup to provide input to plans and to monitor/support the results as those plans are implemented. There is interest in continuing the workgroup for those purposes.

Current Recommendations The work group intends to further clarify its recommendations and to provide examples and potential action steps where those might not be clear Inadequate rates are a major challenge to the system While there are issue with reserves in some regions, cutting rates to the bottom of the rate band has serious implications for service delivery and in particular the ability to attract and retain workforce. MCO rates in the Apple Health program currently impair the ability to develop adequate networks and to provide behavioral health benefits to members

Current Recommendations Consistent with our June recommendation for clarity on process and timelines we recommend that the Task Force asks the HCA to provide a detailed roadmap that includes: An inventory of integration activities occurring statewide A phased timeline that acknowledges that: regions might lie to move to full integration later than the present early adopter timeline but sooner than the 2020 date Regions might want to move to full integration in phased steps rather than all at once Assesses the readiness of regions to meet the 2020 date and provides recommendations for new dates if there are regions that cannot meet that timeline. Outlines models that may be possible for those regions that wish to proceed earlier or in a more stepped manner

Current Recommendations We continue to believe that there is a continued need for this type of forum beyond the expiration of the task force. We are exploring possible synergy with the efforts of the HILN as one avenue for this to occur. We plan to further inform the Task Force of our thinking and recommendations on this topic at the November meeting.