JMOC Update: Behavioral Health Redesign September 22, 2016 1
Why is Ohio Changing? Current State Vision and Outcomes • Limited billing codes for all of behavioral health • Lack of detail on specific services rendered • All providers practice at the top of their scope of and reimbursed for professional practice • Outdated billing code structure • Integration of behavioral health & physical health • Not compliant with national coding services standards • High intensity services available for those with • Rates not tied to provider type SPMI and SED, and addiction • Improved health outcomes for Ohioans with • Little information regarding billing practitioner available mental illness and/or addictions • Limited ability of practitioners to practice • Services and supports available are sustainable with budgeted resources at the top of their scope of professional practice • Implementation of value-based payment • Historically Fee-for-Service methodology • Difficult to coordinate care • Coordination of benefits across payers • Physical and behavioral health treated separately • Difficult to transition to managed care 2
Behavioral Health Redesign Updated Timeline The BH Redesign is composed of numerous initiatives with different implementation dates and milestones JAN ANUARY Y 20 2017 17 JAN ANUARY Y 20 2018 18 Aug ugust t 2016 2016 JULY 20 2017 17 Opi pioid Treatment Spe Specialized Rec ecovery Ser Services Man anag aged Car are SFY 20 SFY 2019 19-202 020 Upd pdated Benefi fit Pack ackage • Peer Recovery Support Programs • Behavioral health services • Office and home-based primary care services • Individual Placement and Support – carved into Managed Care The following will be • Full range of psychotherapy services Supported Employment as of January 2018. available for opioid • Psychological testing and diagnostic assessment • Recovery Management • 12 month continuation of treatment programs (OTPs) • Mental health day treatment on January 1 st , 2017: behavioral health policies • Restructuring SUD benefit package according to ASAM levels of care • Daily and weekly • SUD residential treatment administration of Mental health rehabilitation services available: buprenorphine and • Assertive Community Treatment (for adults, includes peer support) methadone Continuous Training • Intensive Home Based Treatment – (for youth) • Naloxone – (Narcan) 2016 2016 • Therapeutic behavioral services and Stakeholder overdose rescue drug • Psychosocial rehabilitation • Injectable and oral Engagement Chi hildren Inte ntensi sive Behavioral al Serv Services naltrexone • Updating codes for services for children with autism spectrum disorders Req Require Ide dentification of of • Provided by Ohio-certified behavioral analysts and other qualified Rendering Provider Ren practitioners • Provider information Improvement of of Program Perf erformance . required on all claims per • Alignment of behavioral health with National Correct Coding federal statute. standards. • Rendering providers • Alignment of CPT and HCPCS codes with AMA standards associated with agencies. • Ensure Medicaid is payer of last resort (maximize TPL and Medicare Resp Respite cost-avoidance). • Respite care for families • Require Medicare participation for providers serving Medicare and caregivers of children enrollees . with severe emotional IMD Services disorder implemented by • Inclusion of IMD services for Managed Care regulations 3 managed care plans
Updated Benefit Package Expanded code set and practitioner list (e.g., Added evidence-based/state-best practices physician-administered J-codes) to more and associated payments accurately represent services and practitioners ACT and IHBT Expanded Code Set Inclusion of certain clinical Aligned SUD Benefit with ASAM levels of laboratory tests and vaccinations care Labs and Vaccines ASAM Levels of Care Registered Nurse and Licensed Practical No diagnosis edits for children’s services Nurse coding solution provided by licensed practitioners Compliance with national correct coding Children’s BH Services Medical Services MH para-professionals with 3+ years of experience (on or before June 30 th , 2017) will Monitoring of cardiac health for individuals receiving BH medications through use of EKG be able to provide Therapeutic Behavioral MH Professional Services Experience EKGs Covered entire psychotherapy code set, Added psychological testing codes including family psychotherapy. Psychological Testing Psychotherapy Codes 4
Updated Benefit Package ASAM Outpatient Level of Care is available to Expanded coverage to include everyone (not subject to prior authorization; buprenorphine-based medication limited only by total hours) dispensing and administration. SUD Basic OTPs Benefit Package Per diem payments are available for SUD Introduced peer recovery support as a residential levels of care, including withdrawal covered Medicaid service management. Providers only need access to a psychiatrist. SUD Residential Peer Support: Medicaid SUD and MH payment rates are the same Added MH day treatment hourly and per diem for common codes/activities (e.g., E&M, codes and rates as replacements to MH partial nursing, psychotherapy) hospitalization code and rate SUD and MH Code MH Day Treatment and Rate Alignment Added Screening, Brief Intervention and Referral Implementing Specialized Recovery Services to Treatment to the mental health benefit program for adults identified with a SPMI Specialized Recovery package as a best practice SBIRT Services (SRS) Program Total investment into the BH System of $37.5M above budget neutrality Rate Increases 5
BH Redesign Feedback & Training Timeline Stakeholders were given numerous opportunities to provide feedback as well as many training opportunities to understand the changes coming to Ohio’s BH system 2015 2016 2017 May - Aug - Nov – Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Oct. Nov. Dec. Jan. Jul Oct Dec Stakeholder Meetings B&SD meeting B&SD meeting B&SD meeting B&SD meeting Monthly meetings with the Benefit & Service Development Workgroup / Core Team between May 2015 – Jun 2016 8/23 11/30 early January 10/6 2017 Manuals & Coding Chart Revised Code Chart Final Code Jan. 1 Initial Revised Revised Stakeholder BH 201 Trainings & Draft Provider Chart Shared Manual Code Chart Version Version Feedback on Manual and Manual Shared 6/15 8/23 Finalized Coding chart Shared Shared Shared 3/9 2/24 2/12 Future Trainings Trainings As Needed BH Regional Trainings CPT code trainings CPT code BH 101 Trainings BH 201 Trainings 10 sessions in July & 3 sessions in August training 7 sessions in 8 sessions in October & August & September 4/14 April & May November 6
Stakeholder Engagement The Ohio Department of Medicaid and Department of Mental Health and Addiction Services has consistently and continually engaged stakeholders throughout the BH redesign process. Addiction Roundtable Co-Chair Clark County Department of Job and Family Services Aetna Coalition of Homelessness and Housing in Ohio Alcohol Drug and Mental Health (ADAMH) Board Common Ground Family Services BASIC Connections Cleveland Beech Brook Consumer Support Services Buckeye Health Plan CSAO Buckeye Ranch CSH Care Source Franklin County Children Services Care Star Greater Cincinnati Behavioral Health Services Case Western Reserve University Center for Evidence Based Hamilton County Job & Family Services Practices Catholic Charities Dioceses of Cleveland Harbor Cenpatico Behavioral Health Homes for Kids Children’s Advantage Family Behavioral Health Services Joint Medicaid Oversight Committee Children’s Home of Cincinnati Knox County Department of Job and Family Services Lake County Alcohol, Drug Addiction and Mental Health Cincinnati Children's Hospital Medical Center Services Board 7
Stakeholder Engagement The Ohio Department of Medicaid and Department of Mental Health and Addiction Services has consistently and continually engaged stakeholders throughout the BH redesign process. Magnolia Club House Ohio Association of Child Caring Agencies Mental Health & Recovery Board of Clark, Greene and Ohio Association of County Behavioral Health Authorities Madison Counties Mental Health and Addiction Advocacy Coalition Ohio Association of Health Plans Molina Healthcare Ohio Children’s Hospital Association Montgomery County Department of Job and Family Services Ohio Citizen’s Advocates Morrow County Public Children Services Agency Ohio Community Corrections Association Murtis Taylor Ohio Council of Behavioral Health & Family Services Providers NAMI Ohio Ohio Department of Developmental Disabilities National Association of Social Workers Ohio Department of Job and Family Services Nationwide Children's Hospital Ohio Empowerment Coalition NCH Ohio Family and Children First Northern Ohio Recovery Association OhioGuidestone Ohio Judicial Conference Ohio Hospital Association Ohio Alliance of Recovery Providers Ohio Hospital for Psychiatry 8
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