1. Children’s Managed Care Design Update
Children’s MRT Behavioral Health Subcommittee
March 24, 2014
10:00 – 11:00 AM

2. Call Agenda Welcome & Roll Call (Donna Bradbury)
Review of Proposed Model & Service/Acuity Tiers (Angela Keller)
Goals of Transformation (Angela Keller)
Other Design Activities (Linda Kelly)
Proposed New State Plan Services (Steve Hanson)
Proposed New 1915i-like Services (Mimi Weber)
Request (Angela Keller)

3. Proposed 2016 Children’s Medicaid Managed Care Model
For all children 0-20 years old
Service Provider Network
Mainstream Medicaid Managed Care Organization: Benefit Package*
All Health & Pharmacy Expanded Benefits
Behavioral Health State Plan Services
Potential Children’s 1915i – like Services
Children’s 1915c HCBS Waivers (OMH and OCFS B2H)
Required to contract
Pediatric Specialty Health Care Providers
Pediatric Health Care Providers
Children’s Behavioral Health Providers
Community Based Providers (e.g., family support/peer services)
Required to have MOUs and/or working relationships
Foster Care Providers
School Districts,
CSEs & EI
Care Management for All
Care Management will be provided by a range of models that are consistent with a child’s needs (e.g., Managed Care Plans, Patient Centered Medical Homes and Health Homes (HH). Health Homes will serve children with the highest level of need.)
Local Government (LDSS, LGU, SPOA, Probation)
(Angela)
Community Services & Support s (non-Medicaid)
Regional Planning Consortiums
Juvenile Justice/
Criminal Justice System
*MCOs may opt to contract with other entities (e.g., BHOs)
to manage behavioral health benefits

4. (Angela)

5. Overarching Goals of Transformation
More children receive screening and services earlier (including prevention and mental health promotion)
Provide a step down set of services for children discharged from Residential, Waiver or Inpatient
Provide a richer array of services to prevent escalation into high level services
Infusion of System of Care values into the design – family driven, strengths based, individualized and system focused
Having better coordinated care, within and across systems.
(Angela)

6. Other Design Activities
Review of EPSDT benefits & early behavioral health screening data in PCPs with DOH
Continued exploration of overlay of High Fidelity Wraparound within managed care and health home designs for high need children with multi- system involvement
Development of State credentialing process for evidence-based practices
OASAS consideration of rehab option for youth SUD services
The State workgroup will move on to eligibility criteria at the conclusion of benefit package development
(Linda)

7. Proposed New State Plan Services
Mobile Crisis Intervention
Community Psychiatric Supports & Treatment
Other Licensed Practitioner
(Steve)

8. Proposed New 1915i-Like Services
(Care Coordination)
Skill Building
Family and Caregiver Support Services
Youth Support and Training
Crisis and Planned Respite
Prevocational Services
Supported Employment Services
(Education Support Services)
Residential Supports
Non-Medical Transportation
(Mimi)

9. Feedback and Input to Proposed Benefit Package
Full proposed list and definitions to come out by and listserv today, along with a copy of these Power Point slides.
Please return any written comments within two weeks (Monday, April 7) to Angela Keller at