EPSDT Specialty Mental Health Services John Burton Foundation Lynn Thull, PhD California Alliance of Child and Family Services December 17 th, 2015 California Alliance

Agenda Overview of EPSDT Specialty Mental Health Services Certification Contracting Providing Services California Alliance

Children’s Mental Health Services History in California Delivered in silos Minimal until 1980’s – 1990’s 1915(b) waiver Litigation driven California Alliance

1915(b) waiver California administers a Section 1915(b) Freedom of Choice waiver to provide Specialty Mental Health Services (SMHS) using a managed care model of service delivery. The SMHS waiver program has been in effect since The new waiver term (July 1, 2015 through June 30, 2020) represents the ninth waiver renewal period. DHCS operates and oversees this waiver. California Alliance

Litigation Driven T.L. v. Belshe requiring that all federally mandated Medi-Cal programs be funded Emily Q. v Bonta among other things, the state was ordered to include therapeutic behavioral services (TBS) in the Medi-Cal program Katie A. v. Bonta improve the provision of mental health and supportive services for children and youth involved in foster care California Alliance

Overview of EPSDT Specialty Mental Health Services Entitlement Eligibility Funding Access Oversight/Accountability Additional Information California Alliance

Medi-Cal/EPSDT SMHS EARLY, PERIODIC, SCREENING, DIAGNOSIS, TREATMENT SPECIALTY MENTAL HEALTH SERVICES Shared responsibility CHDP (Child Health and Disability Prevention Program) Mental/Behavioral Health Plans Medi-Cal Managed Care Plans California Alliance

EPSDT Entitlement EPSDT is a federal entitlement that requires states and counties to provide comprehensive and preventative health care services to low-income children under 21 who are enrolled in Medicaid. (In California referred to Medi-Cal) Ensures that all children and adolescents have access to appropriate preventive, dental, mental health, and developmental, and other specialty services. All medically necessary diagnostic and treatment services (within the federal definition of Medicaid medical assistance) must be covered by EPSDT, regardless if these services are covered for adults 21 years or older through Medicaid. California Alliance

What are EPSDT SMHS? Specialty mental health services under EPSDT are provided as outpatient services and may include, but aren’t limited to: Assessment Plan development Rehabilitation Collateral Individual or group therapy Crisis intervention and stabilization Day treatment intensive services Medication support, Case management Therapeutic behavioral services Katie A. Specialized services (ICC, IHBS, and TFC) California Alliance

EPSDT SMHS Eligibility Full Scope Medi-Cal Medical Necessity Included Diagnosis Functional Impairment Anticipated Improvement with Treatment California Alliance

EPSDT SMHS Funding 50% Federal match for all eligible services Under 2011 realignment: Counties receive an annual allocation from the state based on historical spending and county demographics for EPSDT mental health services. County behavioral health departments are responsible for using this allocation to provide EPSDT mandated services. If counties spend above their allocation, the state has augmented the realigned amount with additional growth funds. California Alliance

Access to EPSDT SMHS A referral can be made by anyone involved with the child/youth. Access varies by county, but there are typically two methods: Centralized county access team County assessment Referral to contracted providers for assessment Direct contact with contracted providers Assessment completed by the provider then forwarded to the county for authorization California Alliance

Oversight Department of Mental Health Department of Health Care Services County Mental/Behavioral Health Plans California Alliance

EPSDT SMHS Additional Information County Access Teams v. Medi-Cal Managed Care Penetration Rates Intensity County Variances Staffing California Alliance

Provider Certification Each provider organization (both county run and contracted) must meet initial certification requirements and then be re-certified annually. Minimum certification requirements are provided by DHCS based on the need to comply with federal law. County mental health plans can include additional requirements to meet local initiatives and regulations. California Alliance

Organizational Provider Standard Certification Elements Posted Brochures and Notices Licenses or Certifications (i.e.: CCL) Fire Safety Inspection Physical Plan Review Tour “clean, sanitary, and in good repair” Policy and Procedures Additional Requirements Specific to Type of Services Provided California Alliance

Eligible Provider Workforce Licensed Professionals of the Healing Arts (LPHA) Mental Health Rehabilitative Specialists (MHRS) Other Eligible Providers Graduate Students Peer mentors Must work within their scope of practice California Alliance

Staff Credentialing Requirements Identification, degrees, experiences, and licenses must be verified NPI number must be obtained and verified Individual providers must be checked against: OIG Exclusion List Medi-Cal List of Suspended or Ineligible Providers Licensing Boards California Alcohol and Drug Programs (ADP) Certification/Registration lists Excluded Parties List System prior to assigning Staff IDs California Alliance

Contracting Generally developed in response to an RFP Often limited to type of services, geographic region, and population California Alliance

General Agency Infra-structure Requirements An understanding of MH language and rules Licensed Staff Administrative Staff: Data entry Compliance Fiscal Electronic Health Record HIPAA Compliance Policies and Procedures California Alliance

General Documentation Requirements Consents Releases of Information Assessment Client Plans Progress Notes California Alliance

Questions? California Alliance

Lynn Thull, PhD Mental Health Policy and Practice Improvement Consultant California Alliance of Child and Family Services (916) California Alliance