1. NYS HCBS Waiver

2. Services Process: NYS OMH solicited input from both children’s mental health services providers and families across NYS Sample of providers were asked to consult with families and develop recommendations for services

3. Services From this, six services were identified: Respite, Skill Building, Family Support, Intensive In Home, Crisis Response and Individualized Care Coordination In addition, consumer service dollars (flex dollars) were identified as needed to help support on-going and emergency needs when other resources were unavailable

4. Services: Guiding Principles Implementation of Child & Adolescent Service System Principles (CASSP) Individualized, strength-based service plans Youth focused Family driven Community based Multi-system collaboration Culturally and linguistically competent workforce Least restrictive environment

5. Services Services are designed to: Address age appropriate emotional and social development and learning Provide enhanced engagement of families to cultivate resiliency and promote parenting skills for raising children with emotional health needs Assure availability of the right services at the right time in the right amount in the right venue

6. Services Ensure integrated and effective services through one family/one plan Support therapeutic processes and models and Provide continuity of care through the care coordinator

7. Development of Capacity 1996 began with 125 slots in 5 boroughs of NYC and 6 counties Gradual growth to current capacity of 1506 slots in 61 out of 62 counties Ratios and rates were individualized per provider for many years 2006 implemented standardized operational elements such as:  6:1 enrollee to care coordinator ratio  5:1 care coordinator to supervisor  Standard upstate and downstate rates

8. Development of Capacity For determining slot allocation per county: US General Population Statistics for population of children shows population of children aged 0 to 17 years by county; a % estimate of children with SED is then applied; slots are assigned per county accordingly

9. Strategies for Provider and Network Development Establishing ICC agency: LGU announces availability of program and invites interested agencies to submit criteria LGU reviews and makes recommendation to OMH OMH reviews for existing contracts with OMH and related standing; consults with OMH Field Offices regarding standing OMH approves and enters contractual agreement with the new ICC agency authorizing billing of Medicaid for approved number of slots; renewed annually

10. Strategies for Provider and Network Development Other than ICC, remaining 5 services may be subcontracted out by ICC agency (required to offer all 5 services) To establish subcontractors: LGU issues Request for Services, reviews these and submits recommendation to OMH Waiver Coordinators OMH Waiver Coordinators check for other pre- existing contracts and agency standing and determine approval

11. Structure for Provider Network ICC agencies (the lead agencies) are considered Organized Health Care Delivery Systems. This enables them to: enter into contracts with the providers of the five non- care coordination services bill Medicaid for six Waiver services monitor qualifications of subcontracted workers as well as agency staff and complete Incident Reports.

12. Structure LGU can recommend that ICC agency provide all 6 services as well as use sub-contractors Providers can be private voluntary agencies or for profit agencies LGU can recommend to OMH that an agency be discontinued as a service provider for cause and can also recommend an addition of an ICC agency (more than one are allowed per county)

13. Lessons Learned ICC should not be defined as primary clinician Network cannot develop without a critical mass (assurance needed that enough work will be generated to make it fiscally viable) Standardization of case load size and rates for services is desirable Need for accurate assessment tool (CANS) integrated into service plan

14. Lessons Learned Standardize case record forms wherever possible Standardize required training curricula and be attentive to evolution of training over time Directly inform ICC agency fiscal officers as well as program managers of billing rules and rates Provide clear, distinct service definitions and monitor the provider’s understanding of them

15. Greatest Successes Implementing individualized, strength based, family driven model and influencing a cross systems adaptation of this model On-going effective engagement of children and families throughout enrollment Dis-enrollment from Waiver to less intensive levels of care (75-79%) Adoption of CANS and consequent integration across OMH children’s programs

16. Most Problematic Challenges to developing sufficient critical mass in subcontractors Adapting to change on the provider level Implementation of standardization is an on-going challenge