1. Interim Managing Entity (IME)
Roxanne Kennedy, MSW, LCSW –DMAHS
Vicki Fresolone, LCSW, LCADC – DMHAS
Nick Armenti – UBHC
NJAMHAA Conference
October 15, 2015

2. Managed Behavioral Health Goals
Integrate physical and behavioral health services
Develop innovative delivery systems
Reduce institutional placements
Provide opportunities for rate rebalancing
Increase focus on children, individuals needing substance abuse services and beneficiaries with developmental disabilities.

3. Behavioral Health and Managed Care
There is no longer an RFP for an ASO
DHS is completing an analysis of fiscal and utilization data to inform the decision to manage behavioral health care
Some options being considered for management of behavioral health services are:
a separate managed behavioral health care organization (MBHO)
a carve–in of behavioral health services into current Medicaid MCOs.

4. Interim Management Overview
Announced in January at Governor’s budget address
A step toward management of the entire behavioral health system
Only addictions treatment services included at roll out
Working with UBHC as an IME to manage state, block grant and NJ FamilyCare funds in addiction services with a start date of July 1, 2015
Provider network for the IME includes agencies that are licensed by DHS, contracted with DMHAS, and/or enrolled in NJFamilyCare

5. Interim Managing Entity (IME)
The IME is a step toward management of the entire system
Only addictions treatment services are managed by the IME in Phase I. Factors related to this are:
Increase in provider and client enrollment in Medicaid due to Medicaid Expansion
Expanded SUD treatment benefit in the ABP
Ability to increase some rates
IME will manage CSS upon regulation promulgation

6. Addiction Services IME
Division of Medical Assistance & Health Services
Division of Mental Health & Addiction Services
Rutgers University Behavioral Health Care (IME)
Coordinated Point of Entry for individuals seeking substance use disorders treatment
Remove Barriers to Treatment
The Right treatment to the Right person for the Right amount of time

7. Phase I -7/1/15
In July 2015 DMHAS, NJ FamilyCare, and UBHC launched Phase I.
Phase I includes 24/7 availability for callers, screening, referral, and care coordination and will provide limited utilization management activities.
Some Medicaid SUD rates have been increased to match the current state rates for outpatient and opiate treatment services.
Requirement for prior authorizations of client assessments for FFS initiatives.
Changes to NJSAMS, that include changes in the DASIE, the addition of screening tools, a notes module and a mandatory 24/7 availability for callers

8. Phase I - Rates 7/15 interim rate change for some services
Outpatient and methadone treatment Medicaid rates increased to the state fee-for-service rates (mental health outpatient rates increased also)
Other substance abuse treatment rates remained the same
Rate changes resulting from the Myers & Stauffer rate study are not included in this step

9. Phase II - 1/1/16 Phase II will begin January 2016
November DSM 5 available in NJSAMS
January LOCI 3 available in NJSAMS
January – Unmanaged Medicaid authorizations begin
authorize services for current clients (pending CMS approval)

10. Phase II - 1/1/16
April -May The IME will use ASAM criteria to approve treatment placements and continuing care stays for individuals being served through IME managed state initiatives and Medicaid covered services and providers
July convert current ambulatory contracts to FFS
Upon implementation of new rates, conversion of residential contracts to FFS

11. Provider Network The State will hold the provider network
The provider network consists of current Medicaid and State only funded SUD providers
Providers sign an Affiliation Agreement with UBHC and the Division of Mental Health and Addiction Services
UBHC is providing a service capacity management system that will be updated by providers to have current information about vacancies and service availability.

12. Preparation for Phase I:
UBHC staff have been trained
Medicaid and State only funded services management
Current system of care
Provider network
Specific MAT training
SUD providers trained on the IME process
Approximately 1,000 individuals were trained
IME Readiness Review Assessment completed by DHS staff, identified problems addressed by UBHC prior to roll out

13. Outcomes Calls Average time to answer 12 seconds
Average weekday call volume is 240 calls per day
On average the calls break down as follows:
42.6% Eligible calls
14.9% Admin calls
42.5% Turn away calls
Average weekend calls volume is 60 calls per day
Average call abandonment rate 1.4%.
Average time to answer 12 seconds
*Eligible are New Caller seeking treatment
**Turn away calls are Clients that are redirected, for example for individuals with private insurance or Medicare, family members, emergencies
***Admin calls refer to provider calls for issues such as Authorizations, questions, comments,
****A call is considered abandoned when the call successfully reaches the phone system but the caller hangs up/disconnects before the call can be answered by an agent. This includes situations where the caller hangs up while waiting in the queue or instances when the caller terminates as the call is presenting to an agent, but has not yet been answered.

14. Outcomes Referrals In August the IME made 635 referrals to treatment
The IME made approximately 48 referrals to the SAI

15. Outcomes Care Coordination
The IME provides Care Coordination including:
Facilitation of admissions from their referrals
Follow up on individuals that they have referred and been admitted to detox
Providing assistance with barriers to treatment such as transportation
Engagement and Management while individuals are waiting for admission to care
The assistance given by the IME to individuals to help facilitate access to the care and provide support as individual wait for admission has by far been the most popular component of the IME

16. Case Example
A 47 year old female called seeking detox for opiates and IV heroin use and has been battling her addiction for the last three years. She called while on the waiting list for detox treatment. IME staff have been following up with her often, giving support and encouragement, in addition to offering other treatment options. One day the IME staffer called the client who answered phone with this reaction, “I’m so glad you called. I was about to shoot up (heroin) when the phone rang. I knew it was you checking in on me.” She said that at any other time she would have continued to do her drugs, but at that moment knowing it was the IME, she decided to answer the phone and not do drugs.

17. Case Example
This client/caller was a middle aged male from Camden County who was seeking detox and was very motivated for treatment because of his family. Client had a very hard time getting into treatment and the IME started following up with him as part of the care coordination activities. The IME stayed in almost daily contact with him providing support and numbers for different providers and other resources. He was finally able to access detox treatment and he called to let the IME know and express his gratitude for all of the support he had received.

18. More Information… DMHAS Website
Question/Comment Mailbox:
IME Number effective 7/1/15: