1. Behavioral Health Integration in Centennial Care
Presentation to the National Association of Medicaid Directors
Nancy Smith-Leslie, Director, Medical Assistance Division
November 14, 2018

2. Behavioral Health Integration
In 2014, New Mexico launched its fully- integrated managed care program, Centennial Care through a Section 1115 waiver
Integrates physical, behavioral and long-term care services delivered by three managed care organizations (MCOs)
Includes robust care coordination requirements for the MCOs with specific member touch points
MCOs required to conduct a health risk assessment with every member and a more comprehensive needs assessment for members identified as needing a higher level of care coordination

3. Comprehensive Delivery System
Centennial Care
Comprehensive Delivery System
Established a care coordination infrastructure for members with more complex needs that coordinates the full array of services in an integrated, person-centered model of care
Care coordination
850 care coordinators
37,013 in care coordination L2 and L3
Focus on high cost/high need members
Health risk assessment
Standardized HRA across MCOs
753,564 HRAs conducted
Increasing number of members served by Patient Centered Medical Homes
Approximately 400,000 members receiving services through a PCMH
Expanding Health Homes—adults and children with co-occurring behavioral health diagnoses
Expanding home and community based services
30,000 members receiving HCBS

4. Centennial Care Contract
Contractual Requirements
MCOs must have designated care coordinators with relevant expertise to meet the needs of specific populations, including members with complex behavioral health needs, members with housing insecurity needs and justice-involved members
Defined care coordination requirements for specific populations, including members with complex behavioral health needs
Populations to receive care coordination include:
Individuals with a behavioral health diagnosis including substance abuse disorders;
Members experiencing transitions of care including from residential or institutional facility to community placement; and
Members transitioning from incarceration to community

5. Centennial Care Contract
Delivery System Improvement Targets
Sets targets for the MCOs to achieve improvements in specific areas of the delivery system
Must increase use of community health workers
Today, 100 employed or contracted by MCOs
Must increase telemedicine office visits in rural areas by 15% annually for behavioral health

6. Centennial Care Contract
Contract also requires the MCOs to employ a justice-involved liaison to facilitate care coordination
Benefits are systematically suspended for individuals after 30 days of incarceration
Benefits are automatically reactivated when the inmate is released from prison/jail upon receipt of release data from the facility
Pursuing an interface with APRISS for real-time booking/release data at facilities

7. Participating Counties/Agencies:

8. Health Homes Launched in 2016 and expanded in 2018 for:
Adults with serious mental illness (SMI)
Children/adolescents with severe emotional disturbance (SED)
Serving 2,000 members in 10 counties with seven providers, including one Tribal 638 provider
Mandates Six Core Services:
Comprehensive care management
Intensive care coordination
Prevention, health promotion, disease management
Comprehensive transitional care
Individual and family support services
Referral to community and social support services

9. Pre-Tenancy and Tenancy Services
New supportive housing services for members with Serious Mental Illness (SMI) to assist with acquiring, retaining and maintaining stable housing;
Plan to use existing infrastructure and network of provider agencies associated with the Linkages Supportive Housing Program to deliver services; and
Linkages will be expected to utilize peers for service delivery.

10. Substance Use Disorder Continuum of Care Services
Extend Screening, Brief Intervention, and Referral to Treatment (SBIRT) services through primary care, community health centers and urgent care facilities
Provide SUD treatment in accredited residential treatment centers for adults who require an enhanced level of care
New inpatient services as part of our waiver renewal in Institutes for Mental Disease (IMDs)for members with an SUD diagnosis

11. Super Utilizer Intervention
Began July 2015
Followed 35 top ED utilizers from each MCO
Tracked each member’s ED visits, participation in care coordination, comprehensive needs assessment, and other social determinants of health on a monthly basis
MCOs required to implement specific interventions to reduce ED visits, including

12. Assign to Community Health Worker;
Pilot programs with Emergency Medical Technicians to visit members in their homes;
Purchase EDIE software that provides instant notification when a member is in the ER;
Patient Navigator program—hospital staff contacts the MCO’s navigator to help triage the member (directing to more appropriate setting such as Urgent Care facility and/or scheduling an appointment with the member’s PCP);
Launch of “Video Visits” with physicians— members access through an app on smart phone

13. Average Monthly ED Visits Per Super Utilizer on a Quarterly Basis
Data include members who were active during each reporting period