FAMILY DRIVEN CHILD AND ADOLESCENT HEALTH HOME SYSTEM DEVELOPMENT - - PowerPoint PPT Presentation

JUNE 1 0 , 2 0 1 4

FAMILY DRIVEN CHILD AND ADOLESCENT HEALTH HOME SYSTEM DEVELOPMENT

Confe r e nc e of L

• c al Me ntal

Hygie ne Dir e c tor s

Childr e n and F amilie s Committe e

PURPOSE

PURPOSE

• Sha re the wo rk c urre ntly unde rwa y b y le a de rs fro m

Hillside F a mily o f Ag e nc ie s a nd No rthe rn Rive rs F a mily Se rvic e s to a sse ss the fe a sib ility o f c re a ting a re g io na l F a mily Drive n Child a nd Ado le sc e nt He a lth Ho me to c o ve r multiple c o untie s a c ro ss Upsta te Ne w Yo rk.

• T

his He a lth Ho me wo uld:

• He lp a ssure q ua lity o f fa mily drive n, yo uth g uide d c a re

ma na g e me nt to c hildre n a nd yo uth with ne e ds in the re g io n

• He lp a ssure a c c e ss to the se rvic e s within the c hildre n’ s syste m
• f c a re
• Suppo rt c o st e ffe c tive ma na g e me nt o f the Childre n’ s He a lth

Ho me thro ug h sha ring infra struc ture

PRESENTERS

PRESENTERS

• T

he Ro llo ut o f Adult He a lth Ho me s:

• Jo hn L

e e , He a lth Ho me s o f Upsta te Ne w Yo rk (HHUNY)

• Pla nning fo r Childre n’ s He a lth Ho me s in NYS:
• E

liza b e th No la n, Hillside F a mily o f Ag e nc ie s

• Hillside - No rthe rn Rive rs Childre n’ s He a lth Ho me

Mo de l:

• Ra y Sc himme r, CE

O, No rthe rn Rive rs

• Q a nd A

STATUS: ROLL OUT OF NYS ADULT HEALTH HOMES

WHAT IS A HEALTH HOME?

• I

t is a pro g ra m tha t pro vide s Car

e Manage me nt to High Ne e d Me dic aid Re c ipie nts

• All o f the pro fe ssio na ls invo lve d in a me mb e r’ s c a re

c o mmunic a te with o ne a no the r so tha t a ll ne e ds a re a ddre sse d in a c o mpre he nsive ma nne r.

• Me dic al, be havior

al he alth and soc ial se r vic e ne e ds a re to b e a ddre sse d

HEALTH HOME SYSTEM

Co mmunity Re so urc e s

Individual & Car e Manage r

He a lth Ca re Pro vide rs Se rvic e s Ag e nc ie s E duc a tio n Vo c a tio na l Se rvic e s Ho using

WHAT IS A HEALTH HOME?

De sire d Outc ome s:

• I

mpro ve he a lth c a re a nd he a lth

• utc o me s
• L
• we r Me dic a id c o sts
• Re duc e pre ve nta b le ho spita liza tio ns a nd

E R visits

• Avo id unne c e ssa ry c a re fo r Me dic a id

me mb e rs

NYS ADULT HEALTH HOMES

Who qua lifie s?

• Me dic a id re c ipie nt:
• Ma y b e a Me dic a id Ma na g e d Ca re Me mb e r o r

re c e iving se rvic e s o n a F F S b a sis.

• Ma y ha ve b o th Me dic a id a nd Me dic a re
• Must ha ve o ne o f the fo llo wing :
• T

wo o r mo re c hro nic he a lth c o nditio ns (suc h a s a sthma , dia b e te s, he a rt dise a se , BMI > 25, SUD, me nta l he a lth c o nditio n)

• SMI

, o r

• HI

V/ AI DS

NYS ADULT HEALTH HOMES

Prog ra m Size :

• Appro xima te ly o ne millio n Me dic a id re c ipie nts

(o ut o f 5 millio n) me e t the fe de ra l c rite ria fo r He a lth Ho me s

• T

a rg e t e nro llme nt fo r NYS:

• 2013-2014= 151,000
• 2014-2015= 225,000

T he re a re c urre ntly 49 de sig na te d He a lth Ho me s (33 uniq ue e ntitie s) se rving 58 c o untie s in the Sta te .

NYS ADULT HEALTH HOMES

Who Is Providing He a lth Home Ca re Ma na g e me nt?

• T

a rg e te d Ca se Ma na g e me nt Slo ts a re b e ing c o nve rte d to He a lth Ho me Ca re Ma na g e me nt

• COBRA Ca re Ma na g e me nt slo ts a re b e ing c o nve rte d a s

we ll.

• Ne w a g e nc ie s ha ve a g re e d to pro vide He a lth Ho me Ca re

Ma na g e me nt to e xpa nd c a pa c ity

• Ca pa c ity will b e drive n b y ne e d, no t limite d to a spe c ific

numb e r o f a ppro ve d slo ts

NYS ADULT HEALTH HOMES

What make s this c ar e manage me nt diffe r e nt fr

• m ICM/ SCM?
• Slo t c a pa c ity is no t c a ppe d. Ca pa c ity is drive n b y ne e d
• Ac c e ss is no t limite d to tho se in the Me nta l He a lth syste m.

T ho se with SU ne e ds a nd c hro nic physic a l he a lth ne e ds a re e lig ib le

• T

he HH c a re ma na g e rs a re a ske d to suppo rt the me dic a l, b e ha vio ra l he a lth a s we ll a s so c ia l ne e ds o f the individua l

• Sho rte r a pplic a tio n a nd simple r pro c e ss tha n use d fo r SPOA

sub missio ns

• Ac c e ss pro c e ss ha s b e e n simplifie d with input fro m e a c h

c o unty.

NYS ADULT HEALTH HOMES

Wha t ma ke s this c a re ma na g e me nt diffe re nt from ICM/ SCM?

• Ca re ma na g e rs a re e nc o ura g e d to visit the individua l if

ho spita lize d a nd to wo rk c lo se ly with the ho spita l / fa c ility to suppo rt a suc c e ssful disc ha rg e to a fte r c a re .

• Pe r Me mb e r Pe r Mo nth (PMPM) pa yme nts drive n b y a c uity

e sta b lishe d b y DOH

• 3 mo nths a re g ive n fo r Outre a c h& E

ng a g e me nt (pa id a t 80% o f the PMPM fo r a c tive me mb e rs)

• Re po rting o f me mb e r sta tus a nd HH CM a c tivitie s a re

ro utine ly re po rte d up thro ug h the Sta te ’ s He a lth Co mme rc e Syste m (HCS).

• Use o f He a lth I

nfo rma tio n te c hno lo g y is re q uire d

NYS ADULT HEALTH HOMES

Wha t ma ke s this c a re ma na g e me nt diffe re nt from ICM/ SCM?

• Ca re Pla n is to b e sha re d with o the r me mb e rs o f the Ca re

T e a m a nd re -sha re d a ny time the re a re c ha ng e s

• Ca se lo a d re q uire me nts a re hig he r in HH CM tha n I

CM (40-50 c o mpa re d to 12-16).

• NYS re q uire s a sta nda rd a sse ssme nt b e use d fo r a ll individua ls:

F ACT

• GP a nd HH F

unc tio na l Asse ssme nt

• Numb e r o f visits pe r mo nth de live re d sho uld b e b a se d upo n

ne e d, unlike I CM whic h re q uire d 4 pe r mo nth.

NYS ADULT HEALTH HOMES HEALTH HOMES OF UPSTATE NEW YORK

He a lth Home s of Upsta te Ne w York (HHUNY) c o ve rs 22

c o untie s in We ste rn, So uthe rn T ie r a nd Ce ntra l Ne w Yo rk

• Ca re ma na g e me nt se rvic e s a re de live re d b y

a ppro xima te ly 50 do wn-stre a m c a re ma na g e me nt a g e nc ie s

• Administra tive func tio ns suc h a s ma king a ssig nme nts,

sub mitting re q uire d tra c king a nd CMART info rma tio n, b illing (fo r no n-c o nve rting a g e nc ie s), q ua lity a ssura nc e a nd MCO re la tio nships a re ha ndle d b y HHUNY in a c e ntra lize d, c o st e ffe c tive fa shio n.

• HHUNY c urre ntly ha s a ppro xima te ly 10,000 a c tive

me mb e rs.

NYS ADULT HEALTH HOMES

Why a re He a lth Home s Importa nt ?

• Offe rs a dditio na l re so urc e s in suppo rting the ne e ds o f

c o mple x, ha rd to se rve Me dic a id c lie nts

• I

mpro ve s pro vide r c o mmunic a tio n

• He lps ma ke c e rta in tha t so c ia l ne e ds o f individua ls a re

me t

• Assists in a vo iding unne c e ssa ry re -a dmissio ns
• Assists in a vo iding unne c e ssa ry E

me rg e nc y De pa rtme nt visits

• Pa rtne r in re duc ing he a lth syste m c o sts
• I

mpo rta nt c o mpo ne nt o f the ro ll o ut o f Ma na g e d Ca re fo r a ll

PLANNING FOR IMPLEMENTATION OF CHILDREN’S HEALTH HOMES

CHILDREN’S HEALTH HOME IMPLEMENTATION

T

• pic s to c ove r:
• Ho w do we se e the c hildre n’ s a ppro a c h ne e ding to

b e diffe re nt fro m the a dult a ppro a c h?

• T

he Sta te ’ s visio n a nd pla n fo r Childre n’ s He a lth Ho me a nd the g o o d wo rk the y a re do ing

• T

ime ta b le

CHILDREN’S HEALTH HOME IMPLEMENTATION

How do we se e the c hildr e n’s a ppr

• a c h ne e ding to be diffe r

e nt fr

• m the

a dult a ppr

• a c h?
• Childre n a nd yo uth ha ve diffe re nt c a re ne e ds tha n a dults
• A fo c us o n c hro nic c o nditio ns is mo re a pplic a b le to a dults
• Childre n a re still de ve lo ping . E

ve n se rio us BH c o nditio ns ide ntifie d in e a rly c hildho o d c a n o fte n b e re so lve d whe n tre a te d a ppro pria te ly

• Childre n with se rio us BH c ha lle ng e s do no t ha ve the sa me hig h ra te s o f

e xpe nsive c o -mo rb id physic a l he a lth c o nditio ns a s fo und in a dults with SMI .

• Childre n with se rio us BH c o nditio ns te nd to ha ve dia g no se s diffe re nt fro m

tho se o f a dults with SMI (ADHD, e tc .)

• Ne e d to c o nside r invo lve me nt o f c hild we lfa re a nd / o r juve nile justic e .
• Ca re ma na g e me nt ne e ds to fo c us o n b o th the c hild a nd his / he r

fa mily/ c a re g ive rs… A fa mily drive n yo uth g uide d syste m o f c a re is e sse ntia l.

• Ca re ma na g e me nt tha t wo rks fo r c hildre n ma y b e mo re c o mple x tha n

tha t whic h wo rks fo r a dults … Invo lving fa mily, DSS, e tc .

HEALTH HOMES ARE A CRITICAL PART OF MRT ACTION PLAN TO FUNDAMENTALLY REFORM THE MEDICAID PROGRAM

21

HE AL T H HOME S MRT MUL T I-YE AR ACT ION PL AN

GL OBAL SPE NDING CAP T ARGE T ING SOCIAL DE T E RMINANT S OF HE AL T H UNIVE RSAL ACCE SS T O HIGH QUAL IT Y PRIMARY CARE CARE MANAGE ME NT F OR AL L

NEW YORK STATE HEALTH HOME MODEL

Ne w York Sta te De sig na te d L e a d He a lth Home s

Ad ministra tive Se rvic e s, Ne two rk Ma na g e me nt, HIT Suppo rt/ Da ta E xc ha ng e

He alth Home Car e Manage me nt Ne twor k Par tne r s (inc lude s for

me r T CM Pr

• vide r

s)

Co mpre he nsive Ca re Ma na g e me nt Ca re Co o rdina tio n a nd He a lth Pro mo tio n Co mpre he nsive T ra nsitio na l Ca re I ndividua l a nd F a mily Suppo rt Re fe rra l to Co mmunity a nd So c ia l Suppo rt Se rvic e s Use o f He a lth I nfo rma tio n T e c hno lo g y to L ink Se rvic e s (E

le c tro nic Ca re Ma na g e me nt Re c o rds)

Manage d Car e Or ganizations (MCOs)

Ac c e ss to Re quir e d Pr imar y and Spe c ialty Se r vic e s (Coor dinate d with MCO)

Physic a l He a lth, Be ha vio ra l He a lth, Sub sta nc e Use Diso rd e r Se rvic e s, HIV/ AIDS, Ho using , So c ia l Se rvic e s a nd Suppo rts

He a lth Ho me Po rta l RHI O

PRINCIPLES FOR SERVING CHILDREN IN HEALTH HOMES AND MANAGED CARE

• E

nsure ma na g e d c a re a nd c a re c o o rdina tio n ne two rks pro vide c o mpre he nsive , inte g ra te d physic a l a nd b e ha vio ra l he a lth c a re tha t re c o g nize s the uniq ue ne e ds o f c hildre n a nd the ir fa milie s

• Pro vide c a re c o o rdina tio n a nd pla nning tha t is fa mily-a nd-yo uth

drive n, suppo rts a syste m o f c a re tha t b uilds upo n the stre ng ths o f the c hild a nd fa mily

• E

nsure ma na g e d c a re sta ff a nd syste ms c a re c o o rdina to rs a re tra ine d in wo rking with fa milie s a nd c hildre n with uniq ue , c o mple x he a lth ne e ds

• E

nsure c o ntinuity o f c a re a nd c o mpre he nsive tra nsitio na l c a re fro m se rvic e to se rvic e (e duc a tio n, fo ste r c a re , juve nile justic e , c hild to a dult)

• I

nc o rpo ra te a c hild/ fa mily spe c ific a sse nt/ c o nse nt pro c e ss tha t re c o g nize s the le g a l rig ht o f a c hild to se e k spe c ific c a re witho ut pa re nta l/ g ua rdia n c o nse nt

• T

ra c k c linic a l a nd func tio na l o utc o me s using sta nda rdize d pe dia tric to o ls tha t a re va lida te d fo r the sc re e ning a nd a sse ssing o f c hildre n

• Ado pt c hild-spe c ific a nd na tio na lly re c o g nize d me a sure s to mo nito r

q ua lity a nd o utc o me s

• E

nsure smo o th tra nsitio n fro m c urre nt c a re ma na g e me nt mo de ls to He a lth Ho me , inc luding tra nsitio n pla n fo r c a re ma na g e me nt pa yme nts

23

NEW YORK STATE HEALTH HOME MODEL FOR CHILDREN

Health Home

Administrative Services, Network Management, HIT Support/Data Exchange HH Care Coordination  Comprehensive Care Management  Care Coordination and Health Promotion  Comprehensive Transitional Care  Individual and Family Support  Referral to Community and Social Support Services  Use of HIT to Link Services

L e a d He a lth Ho me

Downstr e am & Car e Manage r Par tne r s

Prima ry, Co mmunity a nd Spe c ia lty Se rvic e s

Managed Care Organizations (MCOs)

Note: While leveraging existing Health Homes to serve children is the preferred option, the State may consider authorizing Health Home Models that exclusively serve children.

**Foster Care Agencies Provide Care Management for Children in Foster Care

Ne two rk Re q uire me nts

DOH AI/ COBRA Waive r s (OMH SED, CAH & B2H) OMH T CM (SCM & ICM) Pe diatr ic He alth Car e Pr

• vide r

s OASAS/ MAT S

Car e Manage r s Se r ving Childr e n

Ac c e ss to Ne e de d Pr imar y, Community and Spe c ialty Se r vic e s(Coor dinate d with MCO) Pediatric & Developmental Health, Behavioral Health, Substance Use Disorder Services, HIV/AIDS, Housing, Education/CSE, Juvenile Justice, Early and Periodic Screening Diagnosis and Treatment (EPSDT) Services, Early Intervention (EI), and HCBS /Waiver Services (1915c/i)

OCF S F

• ste r

Car e Age nc ie s and F

• ste r

Car e Syste m**

Car e Manage r s Se r ving Adults (Will support transitional care)

2 4

TAILORING NEW YORK’S HEALTH HOME MODEL FOR CHILDREN

• Childre n’ s He a lth Ho me Wo rk Gro up
• Wo rk Gro up will de ve lo p re c o mme nda tio ns (e .g .,

ne two rk re q uire me nts, e lig ib ility, tra nsitio na l pa yme nt a nd po lic y pro visio ns, c o nse nt) to pre se nt to He a lth Ho me / Ma na g e d Ca re Wo rk Gro up

• Me mb e rs o f MRT

Childre n’ s Be ha vio ra l He a lth Wo rk Gro up

• Me mb e rs o f Me dic a lly F

ra g ile Childre n Wo rk Gro up

• Ma na g e d Ca re Pla ns

25

TAILORING HEALTH HOME NETWORK FOR CHILDREN

• In o rd e r to ta ke a d va nta g e o f the c o nsid e ra b le infra struc ture tha t ha s

a lre a d y b e e n d e ve lo pe d fo r a d ults, e xisting He a lth Ho me s will b e g ive n a n

• ppo rtunity to a pply with an e xpande d ne two rk to se rve c hild re n.
• Co nve rsa tio ns b e twe e n c hild re n’ s pro vid e rs a nd e xisting he a lth ho me s a re

stro ng ly e nc o ura g e d no w.

• It is e xpe c te d tha t c hild re n’ s he a lth ho me s wo uld b e re g io na l (e g . We ste rn,

L I , Bro nx/ Uppe r Ma nha tta n) inste a d o f c o unty b a se d like the e xisting he a lth ho me s.

• If ne e d e d in a g ive n re g io n, a d d itio na l a pplic a tio ns fro m ne w le a d

e ntitie s/ HHs with e xpe rtise in se rving c hild re n wo uld b e c o nsid e re d b a se d o n c a pa c ity o r ne e d fo r a c c e ss to spe c ia lty se rvic e s.

• Applic a tio ns will b e re vie we d b y a b ro a d sta te / lo c a l te a m: DOH (inc lud ing

OHIP, AI DS Institute , Pub lic He a lth a nd OHI T T ), OCF S, OMH, OASAS a nd NYC DOHMH

26

TAILORING HEALTH HOME NETWORK FOR CHILDREN

• HH Applic a nt must De mo nstra te Ca pa c ity a nd

Ab ility o f Ne two rk to :

• Me e t c hild spe c ific He a lth Ho me q ua lific a tio ns a nd

sta nda rds (de ve lo pe d b y sta te te a m with input fro m Childre n’ s He a lth Ho me Wo rk Gro up a nd He a lth Ho me Ma na g e d Ca re Wo rk Gro up) a nd to a b ide b y the princ iple s fo r se rving c hildre n a nd fa milie s

• Me e t the ne e ds o f c o mple x po pula tio ns (e .g ., c hildre n

with c hro nic c o nditio ns, tho se with SE D/ SUD, c hildre n in the F

• ste r Ca re a nd Juve nile Justic e syste ms)
• Pa rtne r with sc ho o l distric ts a nd the e duc a tio n syste m
• Re q uire me nt to pa rtne r with a nd use F
• ste r Ca re

a g e nc ie s fo r c a re ma na g e me nt whe n a c hild e nte rs F

• ste r Ca re

27

TAILORING HEALTH HOME NETWORK FOR CHILDREN

• E

xpa nd Ne two rk Re q uire me nts to I nc lude :

• Pe rso ns a nd e ntitie s tha t ha ve e xpe rie nc e in pro viding

c a re ma na g e me nt fo r c hildre n (i.e ., F

• ste r Ca re

a g e nc ie s, B2H, T CM fo r Childre n, HCBS)

• Pe dia tric He a lth Ca re Pro vide rs a nd Spe c ia lty Pro vide rs–

Prima ry Ca re , De ve lo pme nta l He a lth, Be ha vio ra l He a lth, Sub sta nc e Use Diso rde r Se rvic e s, HI V/ AI DS, De ntists

• Vo lunte e r F
• ste r Ca re Ag e nc ie s a nd F
• ste r Ca re Syste m
• F
• ste r Care Ag e nc ie s pro vide c are manag e me nt fo r c hildre n

in F

• ste r Care
• Yo uth a nd F

a mily Pe e r Suppo rts

• E

a rly I nte rve ntio n (E I )

• E

duc a tio n – Pre sc ho o l Spe c ia l E duc a tio n a nd Co mmitte e

• n Spe c ia l E

duc a tio n

• Juve nile Justic e
• Wa ive r Se rvic e s [1915(c )]
• Othe r ? ?

28

Six Cor e Re quir e me nts of He alth Home s – Dr aft fo r Disc ussio n 1) Compr e he nsive Car e Manage me nt -

E xa mple s o f Se rvic e s a nd Ac tivitie s

Applic a nts De monstra te Ability to T a ilor the De live ry of Core Re quire me nt to Childre n’s Ne e ds

• Co mple te a c o mpre he nsive he a lth a sse ssme nt,

inc lusive o f me dic a l, b e ha vio ra l, re ha b ilita tive a nd lo ng te rm c a re a nd so c ia l se rvic e ne e ds

• Co mple te a nd re vise , a s ne e de d, a n

individua lize d pa tie nt c e nte re d pla n o f c a re with the pa tie nt to ide ntify pa tie nt’ s ne e ds a nd g o a ls, a nd inc lude fa mily me mb e rs a nd o the r so c ia l suppo rts a s a ppro pria te

• Co nsult with multidisc iplina ry te a m, prima ry c a re

physic ia n, spe c ia lists o n c lie nt’ s c a re pla n ne e ds g o a ls

• Co nsult with prima ry c a re physic ia n a nd/ o r

spe c ia lists invo lve d in the tre a tme nt pla n

• Co nduc t c linic o utre a c h a nd e ng a g e me nt

a c tivitie s to a sse ss o n-g o ing a nd e me rg ing ne e ds a nd to pro mo te c o ntinuity o f c a re a nd impro ve d he a lth o utc o me s

• Pre pa re c lie nt c risis inte rve ntio n pla n
• T

ra nsitio n to Sta nda rdize d Asse ssme nt to o l fo r Childre n (e .g . CANS)?

• Pa tie nt c e nte re d pla n is

fa mily drive n a nd yo uth- g uide d

• Invo lve me nt a nd ro le o f

pa re nt/ g ua rdia n/ fa mily in de ve lo pme nt o f c a re pla n

• Inte ra c tio n b e twe e n c a re

ma na g e r a nd syste ms – E duc a tio n, Juve nile Justic e a nd F

• ste r Ca re

(Re q uire me nt to use F

• ste r c a re a g e nc ie s a s

do wnstre a m c a re ma na g e r whe n a c hild e nte rs fo ste r c a re )

29

Six Cor e Re quir e me nts of He alth Home s – Dr aft fo r Disc ussio n

2) Ca re Coordina tion a nd He a lth Promotion - E xa mple s of Se rvic e s a nd Ac tivitie s Applic a nts De monstra te Ability to T a ilor the De live ry

• f Core Re quire me nt to

Childre n’s Ne e ds

• Co o rdina te with se rvic e pro vide rs a nd

he a lth pla ns to se c ure ne c e ssa ry c a re , sha re c risis inte rve ntio n a nd e me rg e nc y info rma tio n

• Co o rdina te with tre a ting c linic ia ns to a ssure

tha t se rvic e s a re pro vide d a nd to a ssure c ha ng e s in tre a tme nt o r me dic a l c o nditio ns a re a ddre sse d

• Co nduc t c a se re vie ws with inte rdisc iplina ry

te a m to mo nito r/ e va lua te c lie nt sta tus/ se rvic e ne e ds

• Crisis inte rve ntio n – re vise c a re pla n/ g o a ls

a s re q uire d

• Advo c a te fo r se rvic e s a nd a ssist with

sc he duling o f se rvic e s

• Mo nito r, suppo rt, a c c o mpa ny the c lie nt to

sc he dule d me dic a l a ppo intme nts

• Pro vide c o nflic t fre e c a se ma na g e me nt
• T

ra nsitio n to Hig h F ide lity Wra pa ro und mo de l o f c a re c o o rdina tio n a nd pla nning fo r c hildre n

• E

nsure c a re g ive rs a re tra ine d to wo rk with c hildre n a nd fa milie s

• Crise s inte rve ntio n/ de -

e sc a la tio n fo r c hildre n/ fa mily/ g ua rdia n 30

Six Cor e Re quir e me nts of He alth Home s – Dr aft fo r Disc ussio n 3) Compr e he nsive T r ansitional Car e - E xample s

• f Se r

vic e s and Ac tivitie s Applic ants De monstr ate Ability to T ailor the De live r y of Cor e Re quir e me nt to Childr e n’s Ne e ds

• F
• llo w up with ho spita ls/ E

R upo n no tific a tio n o f c lie nt’ s a dmissio n a nd/ o r disc ha rg e to / fro m a n E R, ho spita l/ re side ntia l/ re ha b ilita tive se tting

• F

a c ilita te disc ha rg e pla nning a nd fo llo w up with ho spita ls/ E R upo n no tific a tio n o f a c lie nt’ s a dmissio n a nd/ o r disc ha rg e to / fro m E R, ho spita l, re side ntia l a nd re ha b ilita tive se tting

• L

ink c lie nt with c o mmunity suppo rts to e nsure tha t ne e de d se rvic e s a re pro vide d

• F
• llo w up po st disc ha rg e with c lie nt a nd fa mily

to e nsure ne e de d se rvic e s a re pro vide d

• No tify c o nsult with tre a ting c linic ia ns, sc he dule

fo llo w up a ppo intme nts, a s a ssist with me dic a tio n re c o nc ilia tio n

• E

xisting HHs tha t a re ta ilo re d to e nro ll c hildre n ha ve b uilt-in a b ility to fa c ilita te tra nsitio n o f c hild to a dult c a re

• Shift in a nd o ut o f F
• ste r

Ca re

• Shift in a nd o ut o f

Juve nile Justic e

• Shift in a nd o ut o f

spe c ia l e duc a tio n

• Shift in a nd o ut o f

sc ho o l distric ts

• Shift fro m o ut o f ho me

pla c e me nt to fa mily/ ho me 31

Six Cor e Re quir e me nts of He alth Home s – Dr aft fo r Disc ussio n 4) Individual and F amily Suppor t - E xample s

• f Se r

vic e s and Ac tivitie s Applic ants De monstr ate Ability to T ailor the De live r y of Cor e Re quir e me nt to Childr e n’s Ne e ds

• De ve lo p, re vie w, re vise individua l’ s pla n o f

c a re with c lie nt a nd fa mily to e nsure pla n re fle c ts individua ls pre fe re nc e s, e duc a tio n, a nd suppo rt fo r se lf ma na g e me nt

• Co nsult with c lie nt/ fa mily/ c a re ta ke r o n

a dva nc e d dire c tive s a nd e duc a te o n c lie nt rig hts a nd he a lth c a re issue s a s ne e de d

• Me e t with c lie nt a nd fa mily, inviting a ny
• the r pro vide rs to fa c ilita te ne e de d

inte rpre ta tio n se rvic e s

• Re fe r c lie nt a nd fa mily to pe e r suppo rts,

suppo rt g ro ups, so c ia l se rvic e s, e ntitle me nt pro g ra ms a s ne e de d

• Build pla n o f c a re

a ro und stre ng ths o f yo uth a nd fa mily

• Ro le o f a nd fo c us o n

pa re nts/ fa mily/ le g a l g ua rdia ns in pla n o f c a re a nd c o nse nt

• I

nc lude pe e r a nd fa mily suppo rts in c a re pla n

• Skill b uilding fo r

fa mily/ pa re nts/ le g a l g ua rdia n 32

Six Cor e Re quir e me nts of He alth Home s – Dr aft fo r Disc ussio n 5) Re fe r r al to Community and Soc ial Suppor t Se r vic e s - E xample s of Se r vic e s and Ac tivitie s Applic ants De monstr ate Ability to T ailor the De live r y of Cor e Re quir e me nt to Childr e n’s Ne e ds

• I

de ntify re so urc e s a nd link c lie nt to c o mmunity suppo rts a s ne e de d

• Co lla b o ra te a nd c o o rdina te with

c o mmunity b a se d pro vide rs to suppo rt e ffe c tive utiliza tio n o f se rvic e s b a se d

• n c lie nt/ fa mily ne e d
• F

a mily a nd yo uth fo c use d

• rg a niza tio ns
• E

xpe rie nc e d yo uth a nd fa mily pe e r suppo rts

• L

inka g e s to so c ia l suppo rt in ho me , c o mmunity a nd sc ho o l (a fte r sc ho o l pro g ra ms, spo rts, yo uth g ro ups)

• Skill Building Se rvic e s fo r

c hildre n ’ s ne e ds (c o mple ting ho me wo rk, so c ia lizing , skills to tra nsitio n fro m c hild to a dult) 33

• Re sourc e s to Assist Childre n’s Provide rs a nd He a lth Home s with HIT

a nd Conne c tivity

• 2014- 15 E

xe c utive Budge t Initiative s

• Pro vide s funds to vo lunta ry fo ste r c a re a g e nc ie s to c o lle c t e nc o unte r da ta to

a na lyze utiliza tio n o f se rvic e s, a nd de ve lo p infra struc ture re q uire d to e le c tro nic a lly sha re he a lth info rma tio n ($5 millio n 2014-15 a nd $15 millio n 2015- 16)

• Pro vide funds to vo lunta ry pro vide rs o f b e ha vio ra l he a lth se rvic e s to c hildre n

a nd a dults to de ve lo p infra struc ture re q uire d to e le c tro nic a lly sha re he a lth info rma tio n ($20 millio n in 2014-15)

• He alth Home De ve lopme nt SPA (par

t of MRT Waive r ) - $525 millio n o ve r five ye a rs

to b e a llo c a te d unde r a pplic a tio n pro c e ss

• Me mb e r E

ng a g e me nt a nd He a lth Pro mo tio n

• Wo rkfo rc e T

ra ining a nd Re tra ining

• Clinic a l Co nne c tivity a nd He a lth I

nfo rma tio n T e c hno lo g y I mple me nta tio n

• Jo int Go ve rna nc e T

e c hnic a l Assista nc e a nd I mple me nta tio n F unds

Six Cor e Re quir e me nts of He alth Home s – Dr aft fo r Disc ussio n 6) He alth Infor mation T e c hnology Applic ants De monstr ate Ability to T ailor the De live r y of Cor e Re quir e me nt to Childr e n’s Ne e ds

• De mo nstra te c a pa c ity to use HI

T to link se rvic e s fa c ilita te c o mmunic a tio n a mo ng the ne two rk a nd individua l a nd fa mily c a re g ive rs

• Use HI

T to c re a te , do c ume nt, e xe c ute a nd upda te a pla n o f c a re fo r e ve ry pa tie nt tha t is a c c e ssib le to the ne two rk pro vide rs

• Use HI

T to fa c ilita te c o nne c tivity to syste ms (e duc a tio na l a nd juve nile syste ms)

34

CONSIDERATIONS FOR MODIFYING ELIGIBILITY CRITERIA TO BETTER SERVE CHILDREN

• Re q uire s Sta te Pla n Ame ndme nt/ CMS Appro va l
• Crite ria fo r de fining c urre nt HH e lig ib le po pula tio n ha s b e e n c hro nic

c o nditio n b a se d

• Ca nno t ta rg e t b y a g e (c hild o r a dult)
• Ca nno t ta rg e t b y type o f g ro up (e .g ., c hildre n e nro lle d in F
• ste r c a re , c hildre n in

juve nile justic e )

• CAN ta rg e t b y Chro nic Co nditio n o r Ge o g ra phy
• F

e de ra l Ma tc h will like ly b e 50/ 50 (no t 90/ 10)

• Se rio us E

mo tio na l Disturb a nc e (SE D) wo uld like ly b e a dde d a s sing le HH q ua lifying c o nditio n (c o mpa ra b le to SMI in c urre nt c rite ria )

• Othe r sing le q ua lifying c hro nic c o nditio ns fo r c hildre n?
• CMS wo uld like ly re q uire mo dific a tio ns to HH q ua lifying

c o nditio ns to b e unive rsa lly a pplie d (i.e ., a lso a pply to a dults)- impo rta nt whe n thinking thro ug h “a t risk o f” c o nditio ns.

35

OPTIONS FOR MODIFYING ELIGIBILITY TO TAILOR HEALTH HOMES TO CHILDREN

• Curre nt He a lth Ho me e lig ib ility re q uire me nts c o ntinue to

a pply to c hildre n (2 c hro nic c o nditio ns, SMI , HI V)

• All c hildre n with Se rio us E

mo tio na l Diso rde r (SE D) (a s

• ppo se d to Se rio us Me nta l I

llne ss)

SED (Federal Waiver Definition): means a child or adolescent has a designated mental illness diagnosis according to the most current DSM of Mental Disorders AND has experienced functional limitations due to emotional disturbance over the past 12 months on a continuous or intermittent basis. The functional limitations must be moderate in at least 2 of he following areas or severe in at least on of the following areas:

• (i) ability to care for self (e.g. personal hygiene; obtaining and eating food; dressing;

avoiding injuries); or

• (ii) family life (e.g. capacity to live in a family or family like environment;

relationships with parents or substitute parents, siblings and other relatives; behavior in family setting); or

• (iii) social relationships (e.g. establishing and maintaining friendships; interpersonal

interactions with peers, neighbors and other adults; social skills; compliance with social norms; play and appropriate use of leisure time); or

• (iv) self-direction/self-control (e.g. ability to sustain focused attention for a long

enough period of time to permit completion of age-appropriate tasks; behavioral self- control; appropriate judgment and value systems; decision-making ability); or

• (v) ability to learn (e.g. school achievement and attendance; receptive and expressive

language; relationships with teachers; behavior in school).

36

OPTIONS FOR MODIFYING ELIGIBILITY TO TAILOR HEALTH HOMES TO CHILDREN

• All Childre n in F
• ste r Ca re (ha ve to think thro ug h ho w to ta rg e t)
• Me dic a lly F

ra g ile Childre n

Me dic ally F r agile Childr e n (De finition fr

• m F

e br uar y 2013 MF C Re por t):

An individua l who is unde r 21 ye a rs o f a g e a nd ha s a c hro nic de b ilita ting c o nditio n o r c o nditio ns*, who ma y o r ma y no t b e ho spita lize d o r institutio na lize d, a nd is:

• te c hno lo g ic a lly-de pe nde nt fo r life o r he a lth-susta ining func tio ns, a nd/ o r
• re q uire s a c o mple x me dic a tio n re g ime n o r me dic a l inte rve ntio ns to ma inta in
• r to impro ve the ir he a lth sta tus, a nd/ o r
• in ne e d o f o ng o ing a sse ssme nt o r inte rve ntio n to pre ve nt se rio us de te rio ra tio n
• f the ir he a lth sta tus o r me dic a l c o mplic a tio ns tha t pla c e the ir life , he a lth o r

de ve lo pme nt a t risk. *Chro nic de b ilita ting me dic a l c o nditio ns inc lude , b ut a re no t limite d to , b ro nc ho pulmo na ry dyspla sia , c e re b ra l pa lsy, c o ng e nita l he a rt dise a se , mic ro c e pha ly, a nd musc ula r dystro phy.

• Othe r Crite ria (sing le c o nditio ns), Juve nile Justic e o r Crimina l Justic e

Syste ms

• Mo dific a tio ns to Appro pria te ne ss Crite ria fo r HH E

nro llme nt

Cha lle ng e : ho w do we de ve lo p a fe de ra lly a ppro va b le c o nditio n b a se d

c rite ria tha t c o ve rs F

• ste r Ca re Childre n (tra uma ? ), Me dic a lly F

ra g ile Childre n a nd OMH a nd B2H Wa ive r Childre n

37

38

E xisting and Modifie d E ligibility Options

T ar ge t Conditions (2011 Me dic aid Data) Numbe r

• f

Childr e n

Childr e n that Me e t E xisting HH E ligibility Cr ite r ia

F

• ste r Ca re (With SMI*, HIV o r 2 o r mo re Chro nic Co nd itio ns)

6,152 Me d ic a lly F ra g ile Child re n (With SMI*, HIV o r 2 o r mo re Chro nic Co nd itio ns) 3,558 F

• ste r Ca re a nd Me d ic a lly F

ra g ile Child re n (With SMI*, HIV o r 2 o r mo re Chro nic Co nd itio ns) 64 All Othe r Child re n (With SMI*, HIV o r 2 o r mo re Chro nic Co nd itio ns) 80,112

T

• tal

89,886 Pote ntial E ligibility Modific ations

F

• ste r Ca re no t E

lig ible und e r E xisting Crite ria 27,070 Me d ic a lly F ra g ile Child re n no t E lig ible und e r E xisting Crite ria 8,393 E xpa nd e d MH De finitio n SE D-L ike 63,344 F

• ste r Ca re a nd Me d ic a lly F

ra g ile Child re n no t E lig ible und e r E xisting Crite ria 131 F

• ste r Ca re a nd SE

D –L ike no t E lig ible und e r E xisting Crite ria 3,459 SE D L ike a nd Me d ic a lly F ra g ile Child re n no t E lig ible und e r E xisting Crite ria 173 F

• ste r Ca re , SE

D a nd Me d ic a lly F ra g ile Child re n no t E lig ible und e r E xisting Crite ria 4 ADHD 42,243

T

• tal

144,817 T

• tal Childr

e n that Me e t Cur r e nt and Pote ntial E ligibility Modific ations 234,703 *SMI: Sc hizo phre nia , Bi-Po la r Diso rde r, De pre ssive Psyc ho sis ** E xpa nde d MH De finitio n – Sing le c o nditio n o f e a ting diso rde r; c o nduc t, impulse c o ntro l, o the r disruptive b e ha vio rs, ma jo r pe rso na lity diso rde rs, c hro nic me nta l he a lth dia g no se s, de pre ssio n, c hro nic stre ss a nd a nxie ty, po st tra uma tic stre ss diso rde r) T

• ta l F
• ste r Ca re Childre n: 36,830

T

• ta l Me dic a lly F

ra g ile Childre n: 12, 868

CONSENT AND MONITORING QUALITY OUTCOMES

• Conse nt
• E

nro llme nt in He a lth Ho me is vo lunta ry

• HH Co nse nt fo rms a nd pro c e dure s a re in pla c e
• Me mb e r sig ns c o nse nt fo rm a t e nro llme nt to a llo w PHI to b e

sha re d with ne two rk pro vid e rs

• I

nc o rpo ra tio n o f pro c e dure s fo r a sse nt a nd c o nse nt fo r c hildre n in the He a lth Ho me mo de l – ro le o f pa re nt/ g ua rdia n ne e ds to b e disc usse d/ c o nside re d

• Monitoring Qua lity Outc ome s
• Sta te must me e t CMS a ppro ve d q ua lity me a sure s. T

he se will ha ve to b e ta ilo re d fo r c hildre n.

• Sta te is b uilding a ro b ust pro vide r/ pla n po rta l to ma na g e

q ua lity.

39

40

10.16.13

Antic ipate d Sc he dule for E nr

• lling Childr

e n in He alth Home s Re vie w He a lth Ho me Childre n’ s Mo de l with Sta ke ho lde rs - MRT Childre n’ s Wo rk Gro up, HH-MCO Wo rk Gro up Oc to b e r 2013 Co lla b o ra te with Sta ke ho lde rs to Re fine He a lth Ho me Mo de l a nd De ve lo p He a lth Ho me Applic a tio n fo r Childre n No ve mb e r 2103 - Ma rc h 2014

Dr aft Applic atio n fo r He alth Ho me s Se r ving Childr e n Made Available – Wo r king Do c ume nt – Oppo r tunity to Pr

• vide

F e e dbac k May/ June 2014

Co mme nts o n Dra ft Applic a tio n July 2014 F ina l Applic a tio n fo r He a lth Ho me s Se rving Childre n Ma de Ava ila b le Aug ust 2014 Antic ipa te d Due Da te fo r Sub missio n o f Applic a tio ns fo r He a lth Ho me s Se rving Childre n Se pte mb e r 2014 He a lth Ho me Sta te Ag e nc y T e a m Re vie w a nd Appro va l o f Applic a tio ns Oc to b e r 2014 Be g in E nro lling Childre n in He a lth Ho me s Pha se -in b a se d o n Applic a tio n Appro va ls a nd Ne two rk Re a dine ss Ja nua ry 2015 Be ha vio ra l He a lth Se rvic e s fo r Childre n in Ma na g e d Ca re Ja nua ry 2016

STATE’S NEXT STEPS

• Re c e ive fe e db a c k / c o mme nts o n:
• E

lig ib ility

• Ne two rk Re q uire me nts
• Ca re Ma na g e me nt mo de l
• Ne xt Ste ps
• Do a dditio na l da ta a na lysis o n mo difie d e lig ib ility

re q uire me nts

• Disc uss T

ra nsitio n Rule s (po lic y a nd pa yme nt) fo r T CM a nd Wa ive rs (OMH a nd B2H)

• Dra ft He a lth Ho me Applic a tio n fo r Childre n
• De ve lo p Co nse nt F
• rms fo r Childre n
• Sta te wide We b ina r fo r Sta ke ho lde rs o n Dra ft De sig n
• De ve lo p/ Sub mit Sta te Pla n Ame ndme nt

41

HILLSIDE- NORTHERN RIVERS FAMILY DRIVEN CHILD AND ADOLESCENT HEALTH HOME

A C O NC EPT FO R DISC USSIO N

HILLSIDE-NORTHERN RIVERS FAMILY DRIVEN HEALTH HOME

• Hillside & No rthe rn Rive rs a ppre c ia te s the tho ug htful

a ppro a c h tha t the Sta te is ta king to the imple me nta tio n

• f a the c hildre n’ s He a lth Ho me
• Co lle c tive ly o ur o rg a niza tio ns wo uld like to b e a pa rt o f

the Sta te ’ s so lutio n to suc c e ssful imple me nta tio n

• We will sha re with yo u o ur tho ug hts fo r the c re a tio n o f a

F a mily Drive n Child a nd Adole sc e nt He a lth Home tha t

will:

• He lp a ssure q ua lity o f fa mily drive n, yo uth g uide d c a re

ma na g e me nt to c hildre n a nd yo uth with ne e ds in the re g io n

• He lp a ssure a c c e ss to the se rvic e s within the c hildre n’ s syste m
• f c a re
• Suppo rt c o st e ffe c tive ma na g e me nt o f the Childre n’ s He a lth

Ho me thro ug h sha ring infra struc ture

H-NR FAMILY DRIVEN HEALTH HOME

Hillside F a mily of Ag e nc ie s Ba c kg round:

F

• r o ve r 175 ye a rs, Hillside Childre n’ s Ce nte r ha s pro vide d a n

inte g ra te d c o ntinuum o f c o mmunity-b a se d a nd re side ntia l se rvic e s de sig ne d to me e t the b e ha vio ra l he a lth, c hild we lfa re

a nd OPWDD ne e ds o f a wide ra ng e o f c hildre n, a do le sc e nts,

a nd fa milie s. Hillside Childre n’ s Ce nte r is a n a ffilia te o f Hillside F a mily o f Ag e nc ie s. Hillside , in pa rtne rship with yo uth, fa milie s a nd c o mmunitie s, is a le a de r in tra nsla ting re se a rc h into e ffe c tive pra c tic e so lutio ns tha t c re a te va lue . Hillside 's missio n is to pro vide individua lize d he a lth, e duc a tio n, a nd huma n se rvic e s in pa rtne rship with c hildre n, yo uth, a dults, a nd the ir fa milie s thro ug h a n inte g ra te d syste m o f c a re . Hillside pro vide s se rvic e s in 31 c o untie s a nd e mplo ys a ppro xima te ly 2300 individua ls.

H-NR FAMILY DRIVEN HEALTH HOME

Northe rn Rive rs F a mily Se rvic e s Ba c kg round:

No rthe rn Rive rs F a mily Se rvic e s is the pa re nt c o mpa ny fo r Pa rso ns Child a nd F a mily Ce nte r a nd No rthe a st Pa re nt a nd Child So c ie ty. No rthe rn Rive rs wa s e sta b lishe d in 2012 to c o o rdina te the a c tivitie s o f the two a ffilia te d se rvic e a g e nc ie s, e a c h o f whic h ha s b e e n o pe ra ting in the Ca pita l Distric t o f Ne w Yo rk Sta te fo r we ll o ve r a c e ntury. T he g o a l o f the a ffilia tio n is to impro ve b o th the e ffic a c y a nd e ffic ie nc y o f o ur c hild we lfa re , spe c ia l e duc a tio n a nd c hild a nd fa mily b e ha vio ra l he a lth se rvic e s b y c o nso lida ting re so urc e s a nd b y inte g ra ting o ur se rvic e s o n b e ha lf o f c lie nts a nd c usto me rs. T he two a ffilia te d a g e nc ie s a re a c tive in o ve r 30 c o untie s a nd in a ppro xima te ly 45 lo c a l sc ho o l distric ts, a nd e mplo y a ppro xima te ly 1,200 sta ff me mb e rs.

H-NR FAMILY DRIVEN HEALTH HOME

T

• ge the r

… …

No rthe rn Rive rs a nd Hillside a re pursuing a sig nific a nt ro le in the de ve lo pme nt o f Ne w Yo rk Sta te ’ s c hildre n’ s he a lth ho me b e c a use we b e lie ve tha t a c c e ss to q ua lita tive he a lth c a re is e sse ntia l to the stre ng th o f a fa mily a nd to the g ro wth o f its c hildre n. We think tha t

• ur lo ng e xpe rie nc e with the situa tio ns o f c hildre n a nd fa milie s will

a llo w us to b ring spe c ia l va lue to the pro c e ss o f he a lth c a re re fo rm in g e ne ra l, a nd to the tra nsitio n o f c hildre n’ s Me dic a id a c tivity into a ma na g e d c a re e nviro nme nt. I t is a lso c le a r tha t this visio n fo r a Childre n’ s He a lth Ho me is sha re d b y ma ny o the r o rg a niza tio ns a nd suc c e ss will o nly b e a c hie ve d thro ug h pa rtne rships with o the r c o mmitte d pro vide rs a c ro ss Upsta te Ne w Yo rk.

FIRST: WHY A SPECIALTY CHILDREN'S HEALTH HOME?

• Missio n – a fa mily drive n, yo uth-g uide d, tra uma

info rme d, c ultura lly c o mpe te nt he a lth ho me

• Visio n – we se e k to c re a te a c a re ma na g e me nt

a ppro a c h tha t b uilds ro b ust fa mily te a ms who , using the Hig h F ide lity Wra p-Aro und a ppro a c h, b e c o me the ir o wn na tura l c a re c o o rdina tio n ne two rk with the pa id c a re c o o rdina to r a s c o a c h. F a mily F inding is use d whe n yo uth ha ve b e e n disc o nne c te d fro m the ir b ro a d ra ng e o f fa mily me mb e rs.

• Childre n a re diffe re nt:

– T

he se rvic e syste ms a re dive rse a nd diffe re nt.

• Na tio na lly, 2/ 3 o f c hildre n in inte nsive c a re c o o rdina tio n a re a lso

se rve d b y o the r syste ms (OCF S, OPWDD, SE D, e tc .)

• T

he g a te s to tho se syste ms a re c o mple x a nd re q uire so phistic a te d syste m o f c a re kno wle dg e a nd linka g e s.

47

H-NR FAMILY DRIVEN HEALTH HOME

CHILDREN ARE DIFFERENT

• T

hre a ts to the e ffic a c y o f fa mily-pro vide d he a lth c a re ma na g e me nt c o nstitute a pro fo und risk to the imme dia te a nd lo ng -te rm he a lth o f c hildre n. T hre a ts to fa mily c a pa b ility po se d b y po ve rty, b e ha vio ra l he a lth issue s o r sub sta nc e a b use c a n c re a te he a lth c a re pro b le ms tha t ma y b e life -lo ng a nd irre ve rsib le .

• Co -mo rb id physic a l he a lth c o stly c o nditio ns a re c o nside ra b ly le ss

in c hildre n – c o nse q ue ntly c o st sa ving s a re in c ro ss-syste m utiliza tio n a nd pre ve ntio n o f mo re se rio us future pro b le ms a nd no t in sho rt te rm me dic a l c o st re duc tio n.

• Dia g no sis in c hildre n is no t a g o o d c o st pre dic to r a s it is in a dults.

F unc tio na l a nd b e ha vio ra l c ha lle ng e s a re mo re c ritic a l. CANS-NY ma y ha ve a ro le he re .

• ACE

S de mo nstra te s tha t inc re a sing tra uma e ve nts ha s a life lo ng e ffe c t o n ne e ds a nd c o sts.

• Pe rma ne nc y ma tte rs – c hildre n ne e d ro b ust fa mily ne two rks to

thrive a nd b uilding tho se ne two rks is a de lic a te pro c e ss.

48

H-NR FAMILY DRIVEN HEALTH HOME

WHY ONE STRUCTURE FOR UPSTATE?

• Re duc e c o mple xity
• One c a re ma na g e me nt de sig n
• One se t o f po lic ie s a nd pro c e dure s
• One b illing struc ture
• One I

T struc ture

• Curre nt a dult he a lth ho me s a ll o pe ra te diffe re ntly, re q uiring

c a re c o o rdina tio n a g e nc ie s to me e t a ll o f the spe c ific re q uire me nts fo r re po rting , b illing , I T syste ms (e xc e pt fo r the 4 HUNY he a lth ho me s).

49

H-NR FAMILY DRIVEN HEALTH HOME

WHY ONE STRUCTURE FOR UPSTATE?

• Childre n’ s se rvic e s a re b o th c o unty-b a se d a nd

re g io na l – so c a re c o o rdina tio n must think b o th lo c a lly a nd re g io na lly.

• Hillside a nd No rthe rn Rive rs ha ve o ffic e s lo c a te d in

29 c o untie s to da y (o nly 1 o ve rla p).

– We wo uld a sk re g io na l a g e nc ie s to ta ke the le a d in b uilding

ne two rks with us in a re a s whe re we do no t ha ve lo c a l kno wle dg e .

• T

he o nly wa y a ll c o untie s c o uld b e se rve d is to c o mb ine the e nro llme nt numb e rs so it is la rg e e no ug h to wo rk.

50

THE BASIC DESIGN FOR A FAMILY- DRIVEN UPSTATE HEALTH HOME

• HF

A/ NR o pe ra te o ne o r two (linke d) c hildre n’ s He a lth Ho me s fo r a ll c o untie s no rth o f We stc he ste r a nd Ro c kla nd a nd b uilds a full ne two rk o f Ca re Co o rdina tio n a nd T re a tme nt a nd Co mmunity Suppo rt Pro vide rs.

• We o pe ra te using the HUNY/ NYCCP struc ture a nd

de sig n, b illing , I T e tc .

• HHUNY a ssig ns a ll c a re ma na g e me nt re fe rra ls

(Switze rla nd)

• Adviso ry g ro up ( HF

A/ NR, Re g io na l CMs, NYCCP, COF CCA, NYSCMHC, Co untie s, F a milie s-Yo uth, Othe rs T BD) to b e sure a ll inte re sts a re re pre se nte d in de sig n a nd o pe ra tio ns.

51

POSSIBLE UPSTATE NY CHILDREN’S HEALTH HOME MODEL

H-NR FAMILY DRIVEN HEALTH HOME

POSSIBLE ROLE FOR THE ADULT HEALTH HOME SERVICES ADVISORY COUNCIL

Composition: Pro vide r Hub pa rtne rs, six CHH Re g io na l Pro vide r

L e a ds a nd six re pre se nta tive s o f Upsta te Ne w Yo rk Adult He a lth Ho me s.

Role :

• De ve lo ps the po lic ie s, pra c tic e s a nd pro c e sse s to a ssure a

smo o th a nd re spe c tful tra nsitio n fro m the c hild/ yo uth se rving syste m o f c a re to the a dult syste m o f c a re

• De ve lo ps the po lic ie s, pra c tic e s a nd pro c e sse s to a ssure tha t

c a re ma na g e me nt is re spo nsive to the ne e ds o f the fa mily a s a who le fo r c hildre n / yo uth a nd the ir fa milie s whe n b o th a re re c e iving c a re ma na g e me nt suppo rt.

• Re vie ws a nd a ddre sse s issue s ide ntifie d a s c a re ma na g e me nt

is de live re d b y b o th the c hild/ yo uth se rving syste m a s we ll a s the a dult se rving syste m in o rde r to a ssure the b e st po ssib le

• utc o me s.

53

H-NR FAMILY DRIVEN HEALTH HOME

POSSIBLE ROLE FOR THE CHILDREN’S HEALTH HOME

PLANNING ADVISORY COUNCIL

Composition: Pro vide r Hub pa rtne rs, Sta te o ffic ia ls fro m DOH,

OMH, OASAS, OT DA a nd Co unty OMH o ffic ia ls.

Role :

• Re vie ws a ny c ha ng e s in Childre n’ s He a lth Ho me Sta te po lic y
• r pra c tic e a nd disc usse s impa c t o f c ha ng e s o n the wo rk o f

the CHH.

• Assists in a ssuring c o o pe ra tio n a nd c o mmunic a tio n in a re a s o f

mutua l inte re st b y Sta te a nd Co unty o ffic ia ls

• Re vie ws CHH pe rfo rma nc e re po rts a nd o ffe rs g uida nc e fo r

impro ving CHH pe rfo rma nc e tie d to NY Sta te He a lth Ho me

• utc o me s
• Pro vide s g uida nc e a s T

hre e Ye a r Pla ns fo r the CHH a re de ve lo pe d

• Pro vide s no n-b inding b ut info rme d g uida nc e to the UNY CHH

in the q ue st fo r e xc e ptio na l c a re ma na g e me nt se rvic e de live ry.

54

H-NR FAMILY DRIVEN HEALTH HOME

POSSIBLE ROLE FOR THE CHILDREN’S HEALTH HOME

COMMUNITY AND FAMILY ADVISORY COUNCIL

Composition: Pro vide r Hub pa rtne rs, F

a milie s T

• g e the r, NYS

Co unc il o f Be ha vio ra l He a lth, Ne w Yo rk Suc c e ss a nd o the r

• rg a niza tio ns ide ntifie d b y the Pro vide r Hub pa rtne rs.

Role :

• Pro vide s a fo rum fo r sta te -wide c o mmunity g ro ups a nd

a sso c ia tio ns to le a rn mo re a b o ut the wo rk o f the UNY Childre n’ s He a lth Ho me thro ug h se mi-a nnua l re po rts.

• Se c ure s fe e db a c k c o nc e rning the wo rk o f the UNY CHH

thro ug h info rma tio n o b ta ine d fro m c o nstitue nts a nd sha re s the fe e db a c k during the a dviso ry c o unc il me e ting s.

• Pro vide s no n-b inding b ut info rme d g uida nc e to the UNY CHH

in the q ue st fo r e xc e ptio na l c a re ma na g e me nt se rvic e de live ry.

55

H-NR FAMILY DRIVEN HEALTH HOME

POSSIBLE ROLE FOR THE CHILDREN’S HEALTH HOME

COUNCIL

Composition: Co mprise d o f the Pro vide r Hub (Hillside -No rthe rn Rive rs)

pa rtne rs a nd the Syste m o f Ca re Pro vide r le a d fro m e a c h Re g io n.

Role :

• Re vie ws q ua rte rly CHH pe rfo rma nc e re po rts whic h inc lude

e nro llme nt fig ure s, fina nc ia l re po rts a s we ll a s q ua lity a ssura nc e re po rts.

• Re vie ws a nd a ppro ve s wo rk pla ns to a ddre ss ide ntifie d a re a s fo r

impro ve me nt

• He a rs a nd re spo nds to a ny re g io na l c o nc e rns a s pre se nte d b y the

Re g io na l SOC Pro vide r L e a ds.

• Disc usse s Sta te le ve l initia tive s tha t ma y impa c t the wo rk o f the

Childre n’ s He a lth Ho me .

• Sha re s a c tio ns fro m the Co unc il me e ting with the me mb e rs o f the

Re g io na l SOC pro vide r ne two rk a nd so lic its fe e db a c k.

• Advo c a te s with Sta te a nd lo c a l g o ve rnme nt in suppo rt o f the ne e ds

a nd the CHH a nd its c a re Ma na g e me nt Ag e nc ie s

• 56

H-NR FAMILY DRIVEN HEALTH HOME

CARE COORDINATION APPROACH

• We suppo rt the NYS DOH “Princ iple s fo r Se rving

Childre n in He a lth Ho me a nd Ma na g e d Ca re ”. I n a dditio n, DOH is a sking the rig ht q ue stio ns re g a rding ho w to ta ilo r the “Six Co re Re q uire me nts o f He a lth Ho me s” to me e t the ne e ds o f c hildre n. Our pro po se d mo de l (to b e distrib ute d) a tte mpts to

• pe ra tio na lize the princ iple s a nd c o re

re q uire me nts. We kno w ho w to do the wo rk…

57

H-NR FAMILY DRIVEN HEALTH HOME

CARE COORDINATION APPROACH

• High F

ide lity Wr apar

• und: A hig h fide lity wra pa ro und a ppro a c h

sho uld b e imple me nte d fo r tho se c hildre n a nd fa milie s who se a c uity

• f ne e d is hig he st. I

n the se c irc umsta nc e s, the c a se lo a d sho uld b e 1:10 to a llo w fide lity to the a ppro a c h, inc luding the e xte nsive pa pe rwo rk a nd fide lity me a sure s. T his is c ritic a l to a c hie ving the de sire d o utc o me s fo r the se mo st a t-risk fa milie s.

• I

n c a se s o f lo we r a c uity, whe re c a se lo a ds ma y b e a s hig h a s 1:20, pra c tic e sho uld b e info rme d b y the T

e n Wr apar

• und Pr

inc iple s:

(i) F a mily Vo ic e a nd Cho ic e ; (ii) T e a m b a se d; (iii) Na tura l Suppo rts; (iv) Co lla b o ra tio n; (v) Co mmunity Ba se d; (vi) Cultura lly Co mpe te nt; (vii) I ndividua lize d; (viii) Stre ng ths Ba se d; (ix) Pe rsiste nc e ; (x)Outc o me Ba se d

• Use of a Multi- Disc iplinar

y T e am: T

• a llo w the rig ht e xpe rtise a t the

rig ht time , the Ca re T e a m must inc o rpo ra te pa rtic ipa nts fro m a multitude o f syste ms a nd o rg a niza tio ns, a s de te rmine d b y the fa mily, inc luding fa mily a nd yo uth pe e r suppo rts.

58

H-NR FAMILY DRIVEN HEALTH HOME

CARE COORDINATION APPROACH

• De te r

mination of ac uity: I

nso fa r a s a c uity is use d to de te rmine le ve l o f se rvic e inte nsity a nd ra te s, the “a ssig ne d” a c uity must ta ke fa mily struc ture a nd func tio ning into a c c o unt. T he stre ng th o f the fa mily syste m will impa c t ho w muc h time a nd e ne rg y will g o into c a re ma na g e me nt to me e t the c hild’ s ne e ds. A to o l like the CANS-NY will a llo w fo r c o nside ra tio n o f the wide ra ng e o f e c o lo g ic a l fa c to rs.

• Mode l that builds on str

e ngths: T

he to o ls se le c te d fo r the a sse ssme nt o f ne e d must b e drive n b y a stre ng ths-b a se d a ppro a c h. T he a sse ssme nt to o l must e nsure e ng a g e me nt b y suppo rting fa milie s to te ll the ir sto ry in a wa y tha t ho no rs the ir c ulture , histo ry a nd visio n. T

• e nsure the c hild/ fa mily’ s stre ng ths

a re in the fo re fro nt, sta ff me mb e rs sho uld b e tra ine d a nd ha ve the time to write the Hi F ide lity Wra p-Aro und “”Stre ng ths, Ne e ds a nd Culture Disc o ve ry”, o r o the r simila r do c ume nt, with the fa mily.

59

H-NR FAMILY DRIVEN HEALTH HOME

CARE COORDINATION APPROACH

• Cultura l a nd ling uistic c ompe te nc e : Ag e nc ie s,

pro g ra ms, a nd se rvic e s ma de a va ila b le within the pro vide r ne two rk re fle c t the c ultura l, ra c ia l, e thnic , a nd ling uistic diffe re nc e s o f the po pula tio ns the y se rve to fa c ilita te a c c e ss to a nd utiliza tio n o f a ppro pria te se rvic e s a nd suppo rts a nd to e limina te dispa ritie s in c a re .

Co mmunitie s e mb ra c e a nd va lue the dive rse c ulture s o f the ir c hildre n, yo uth a nd fa milie s. E ve ryo ne who c o nne c ts with c hildre n, yo uth a nd fa milie s c o ntinua lly a dva nc e the ir c ultura l a nd ling uistic re spo nsive ne ss a s the po pula tio n se rve d c ha ng e s (Co nsiste nt with SAMHSA’ s SOC g uiding princ iple s fo r F a mily Drive n Ca re ).

60

H-NR FAMILY DRIVEN HEALTH HOME

CARE COORDINATION APPROACH

• F

a mily drive n, youth- g uide d pla nning within a c ha ng ing e nvironme nt: T

he mo de l must a llo w time a nd to o ls to e na b le the fa mily, thro ug h the Ca re Ma na g e r, to c le a rly a rtic ula te the ir spe c ific ne e ds, a s o ppo se d to the tra ditio na l a ppro a c h o f ide ntifying a le ve l o f se rvic e . I n to da y’ s c ha ng ing e nviro nme nt o f re duc e d re side ntia l a nd inpa tie nt pla c e me nts a nd inc re a sing c o mmunity-b a se d a lte rna tive s, fa milie s ne e d o ppo rtunitie s to ide ntify inno va tive so lutio ns a nd suppo rts. Cre a ting a nd c o o rdina ting suc h inno va tive a ppro a c he s re q uire suffic ie nt time b e b uilt into the mo de l fo r this e le me nt o f c a re pla nning .

• F

unds for sta biliza tion: Curre nt c a se ma na g e me nt mo de ls inc lude funds to

me e t the imme dia te c o nc re te ne e ds tha t must b e a ddre sse d b e fo re a c hild a nd fa mily c a n c o nc e ntra te o n o the r he a lth issue s, b o th physic a l a nd b e ha vio ra l. T he ne w syste m must inc lude c o mpa ra b le a c c e ss to fle xib le do lla rs a nd e nsure a ro b ust se rvic e ne two rk.

• Child- spe c ific , na tiona lly re c og nize d me a sure s to monitor qua lity &
• utc ome s: T

he sta nda rd c o st, utiliza tio n, a nd c linic a l me a sure s use d fo r a dult c a re ma na g e me nt ne ithe r fully no r a ppro pria te ly c a pture sa ving s a nd impro ve d o utc o me s fo r c hildre n AND the ir fa milie s. Outc o me me a sure s must e xte nd b e yo nd Me dic a id to o the r re la te d syste ms, a s we ll a s b e yo nd the individua l c hild to the fa mily syste m. CANS-NY mig ht b e a g o o d sta rt, b ut we sho uld c o ntinuo usly a sse ss o the r to o ls.

61

H-NR FAMILY DRIVEN HEALTH HOME

CARE COORDINATION APPROACH

• F

amilie s as manage r s of the ir

• wn c ar

e: He a lth Ho me Ca re

Ma na g e rs sho uld c o a c h a nd suppo rt pa re nts/ c a re g ive rs to b e the primary c o o rdinato rs fo r the ir c hildre n’ s c a re . Altho ug h the Ca re Ma na g e r ultima te ly re ta ins the a c c o unta b ility a nd re spo nsib ility fo r e nsuring the pro visio n o f the c o re He a lth Ho me se rvic e s, pa re nts/ c a re g ive rs, a lo ng with the yo uth, must b e e mpo we re d to mo ve to wa rd se lf-ma na g e me nt a nd “re c o ve ry”.

• F

amily- F inding: Ca re c o o rdina tio n c a nno t b e suc c e ssful fo r

c hildre n unle ss a ro b ust life time ne two rk is a b le to suppo rt the ne e ds o f the c hild a nd the ir fa mily. F a mily F inding sho uld b e use d to de ve lo p this life time ne two rk fo r c hildre n who ha ve no pe rma ne nt a dult in the ir live s. F a mily F inding c a n a lso b e use d to de ve lo p a ne two rk o f suppo rt fo r pa re nts/ c a re g ive rs who a re no t a b le to c o o rdina te the ir c hildre n’ s c a re o n the ir o wn.

62

Q AND A