1. Medicaid Redesign Team Update and Next Steps Jason A. Helgerson, Medicaid Director NYS Department of Health Redesign Medicaid in New York State Rising to the Challenge The Coalition of Behavioral Health Agencies, Inc. January 23, 2014

2. Agenda 1) MRT Implementation to Date  Lowering Costs  Improving Quality 2) Looking Ahead - Major Implementations 3) Q & A Redesigning Medicaid in New York State 2

3. MRT Implementation to Date Are We Lowering Costs and Improving Outcomes?

4. The MRT is Bending the Cost Curve o Lowered total Medicaid spending by $4 billion in Year 1. o Lived within the Global Spending Cap for two full years. o Finished Year Two $200 million under the Global Spending Cap. o Thanks to the MRT the state was able to absorb a $1.1 billion federal revenue loss due to a change in Medicaid financing for DD services. o Savings has been especially significant in New York City. Redesigning Medicaid in New York State 4

5. NY Total Medicaid Spending Statewide for All Categories of Service Under the Global Spending Cap (2003-2012) 2003200420052006200720082009201020112012 # of Recipients 4,266,535 4,593,5664,732,5634,729,1664,621,9094,656,354 4,910,511 5,211,511 5,396,521 5,578,143 Cost per Recipient $7,635$7,658$7,787$7,710$8,158$8,464$8,493$8,379$8,261$7,864 Projected Spending Absent MRT Initiatives * *Projected Spending Absent MRT Initiatives was derived by using the average annual growth rate between 2003 and 2010 of 4.28%. $4.6 billion Estimated Savings Aggregate Spending for all Programs (in Billions) 2011 MRT Actions Implemented Year

6. NYS Managed Care Plans #2 in the Nation o National Committee for Quality Assurance (NCQA) analyzed New York’s Medicaid health care plans against 76 different quality measures. o NYS plans are especially successful when it comes to offering the right type of care for common, costly diseases, for example:  Diabetes;  Childhood obesity;  Smoking cessation;  Follow-up care for the mentally ill. o NCQA found that New York is a national leader, second only to Massachusetts. Source: NCQA: http://www.ncqa.org/Newsroom/NYStateofHealthCare.aspx Redesigning Medicaid in New York State 6 Example #1

7. Health Homes Are Reducing Inpatient Utilization & ER Use o Health Homes are in their early days. o Patients with little or no historic connection to traditional health care are benefiting the most. o Preliminary results are for Phase 1 and Phase 2 counties. Redesigning Medicaid in New York State 7 Example #2

8. HH Performance Inpatient and ED Down Primary Care Up

9. Looking Ahead: Major Implementations

10. Significant Implementations 1) Affordable Care Act 2) MRT Waiver Amendment 3) FIDA Demonstration 4) Behavioral Health Carve-in/HARP Redesigning Medicaid in New York State 10

11. Affordable Care Act (ACA)

12. ACA Implementation & Medicaid Administration Reform o The Affordable Care Act (ACA) is a tremendous opportunity for New York State: One million New Yorkers will gain access to health insurance; Additional federal financing for Medicaid will help ensure program sustainability; Building a new health insurance exchange will allow the state to phase-out the out-of-date WMS eligibility system. o New York operates its own exchange and we are using the launch of the exchange to also facilitate the state takeover of Medicaid administration from counties. Redesign Medicaid in New York State 12

13. ACA Implementation & Enrollment to Date o 587,486 New Yorkers have completed their applications and 328,796 have enrolled for coverage since the launch of the Marketplace on October 1, 2013. o New Yorkers continue to enroll each day through the Marketplace, and individuals who purchase their coverage directly are seeing premium rates that are 53 percent lower than the rates in effect in 2013 for comparable coverage. o The NY State of Health open enrollment period runs through March 31, 2014. New York is on track to meet or exceed its enrollment goal of 1.1 million people by the end of 2016. o NY State of Health Customer Service Center representatives have answered nearly 463,000 calls since the launch of the Marketplace. Redesign Medicaid in New York State 13

14. MRT Waiver Amendment

15. o We currently have a waiver amendment pending with CMS that would allow us to reinvest $10 billion in MRT generated federal savings back into New York’s health care delivery system. o The amendment is essential to both fully implement the MRT action plan as well as prepare for ACA implementation. o The amendment, which requires federal approval, is a unique opportunity to address the underlying challenges facing NYS health care delivery: Lack of primary care; Weak health care safety net; Health disparities; and Transition challenges to managed care. Redesign Medicaid in New York State 15

16. Behavioral Health Opportunities in Medicaid Waiver DSRIP Program Opportunities to Reduce Avoidable Hospitalizations Implementation of transitional care programs. Integrated Delivery System focused on Evidence-Based Medicine and Population Health. Expand Use of Telemedicine and Telepsychiatry to underserved areas. Integration of Behavioral Health into Primary Care setting (collaborative care etc). Increase access to specialty care (including mental health). Development of evidence based medication adherence programs. Development of Ambulatory Detoxification programs. Development of inpatient transfer avoidance programs for nursing homes. Redesign Medicaid in New York State 16

17. Managed Care Contracting Opportunities Development of 1915i programs including: Psychosocial rehab; Community Psychiatric Support and Treatment (CPST); Crisis and Mobile Crisis; Empowerment services including Peer Supports; Habilitation; Respite; Family Support and Training; Employment and Education Support Services; and Self Directed Services (Pilot). Behavioral Health Opportunities in Medicaid Waiver Redesign Medicaid in New York State 17

18. State Plan Opportunities Health Home Development Fund including:  Member Engagement and Health Home Promotion;  Workforce Training and Retraining;  HIT Implementation – Clinical Connectivity; and  Joint Governance Technical Assistance and Implementation Funds. Health Home Development Funds will be distributed through an application process.  Similar to the process employed for the Vital Access Program. Behavioral Health Opportunities in Medicaid Waiver Redesign Medicaid in New York State 18

19. FIDA Demonstration

20. Redesign Medicaid in New York State 20 o A key step in the move to “care management for all” is the proposed Fully Integrated Dual Advantage (FIDA) demonstration project. o Through this effort, over 120,000 dually eligible members (Medicaid and Medicare) will be enrolled into full-integrated managed care products. o The enrollment process will rely on a “conversion in place” approach under which duals enrolled in MLTCP plans will see their Medicare benefit added to their managed care plan’s portfolio.

21. Behavioral Health Carve-In/ HARP

22. Goals: Behavioral Health Transition o Key MRT initiative to move fee-for-service populations and services into managed care. o Care Management for all. o The MRT plan drives significant Medicaid reform and restructuring. o Triple Aim:  Improve the quality of care;  improve health outcomes; and  Reduce cost and right size the system. Redesign Medicaid in New York State 22

23. Behavioral Health Transition: Project Status o Draft RFI/RFQ released (Adults) http://www.health.ny.gov/health_care/medicaid/redesign/b ehavioral_health_transition.htm Comments were due 1/17/14 o 1115 BH Waiver Amendment (Adults) o Final amendment submitted to CMS December, 2013 o Final RFQ scheduled for release February 2014 (Adults) Redesign Medicaid in New York State 23

24. Behavioral Health Transition: Project Status o Public Outreach  Meet with MRT BH Workgroup early 2014.  Provider/plan readiness meetings anticipated:  February in NYC  March/April ROS o Implementation  Adults in NYC - January 2015  Adults in Rest of State - July 2015  Children - January 2016 Redesign Medicaid in New York State 24

25. Redesign Medicaid in New York State 25

26. Next Steps o RFI comments were due January 17, 2014. o Performance metrics are in development and will be shared with stakeholders in future. o Final RFQ scheduled for release February 2013 (Adults). o Implementation:  Adults in NYC - January 2015  Adults in Rest of State - July 2015  Children - January 2016 Redesign Medicaid in New York State 26

27. Reinvestment of Medicaid Savings and Rate Protection to Preserve Capacity and Access to Community-Based Services o 2014-15 Executive Budget proposes to reinvest Medicaid savings for Behavioral Health services to expand community-based services. Pre Managed Care - Reinvestments for behavioral health programs (target - critical inpatient programs) that may close, or have already closed, will ensure that capacity is preserved in the impacted communities as the State prepares for the transition to Managed Care. Post Managed Care - Reinvestment under Managed Care for any behavioral health savings for inpatient and other reductions to expand community based services under HARPs/Managed Care including the development of 1915(i)-like services. o The Budget also extends clinic rate protection and allows for flexible rate alternatives if the plans, providers and the state agree. 2014-15 Executive Budget Redesign Medicaid in New York State 27

28. $120 Million In Medicaid Investments for Behavioral Health Transformation Initiatives Investment MC Start-Up Funds: Funding for system readiness activities to develop the infrastructure and capacity to facilitate the transition of behavioral health services for adults and children into managed care $20M Integrated Care Initiatives: Enhancement to clinic reimbursement to support the integration of behavioral and physical health and the implementation of collaborative care model $15M Preserve Critical Access: Targeted Vital Access Provider (VAP) program to preserve critical access to behavioral health inpatient and other services in certain geographic areas $40M OASAS Residential Restructuring: Establish a Medicaid service for clinical care provided in OASAS Residential settings $5M Health Home Plus for AOT: Health Home Plus reimbursement for individuals receiving care management under a court order for Assisted Outpatient Treatment (AOT) $10M 1915(i)-like Services under HARPS: Funding for new 1915(i)-like services under the Health and Recovery Plans (HARPs) based on a functional assessment including rehabilitation, peer supports, habilitation, respite, non-medical transportation, family support and training, employment supports, education, and supports for self-directed care $30M TOTAL$120M 2014-15 Executive Budget

29. Questions?

30. Contact Information We want to hear from you! ‘ Like’ the MRT on Facebook: http://www.facebook.com/NewYorkMRT Follow the MRT on Twitter: @NewYorkMRT Subscribe to our listserv: http://www.health.ny.gov/health_care/medicaid/redesign/listserv.htm MRT website: http://www.health.ny.gov/health_care/medicaid/redesign/ Redesign Medicaid in New York State 30