Piecing Together the Puzzle: The Implementation of Behavioral - - PowerPoint PPT Presentation

April 26, 2018

Piecing Together the Puzzle: The Implementation of Behavioral Healthcare Reform

BHSAC April 2018 Meeting

Ann Sullivan, M.D., OMH Commissioner

2 April 26, 2018

Gathering the Pieces

New York’s public mental health system is in the midst of comprehensive reform. OMH is supplying the pieces, but it is up to all stakeholders to help complete the picture.

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• Recovery-oriented program design and financing: Managed

care/HARP, HCBS services, care management, value-based payment

• Reinvestment: Paving pathways from State inpatient and

residential to independent community living, reducing avoidable hospital use increasing integrated care

• System and regulatory redesign to strengthen access, increase

efficiency, and quality of care: comprehensive and flexible crisis services and intensive wrap around and treatment services, expanded clinic services

• Promoting population health and prevention

Putting Vision in Action: Major efforts in next 3-5 years to transform the MH system

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• To date, $78M State PC RIV and $19M Article 28 reinvestment issued to

State Aid Letter, RFP, and State-operated community service expansion.

• 50,000 new individuals served through 2017.
• Counties have been key planning partners.
• Now implemented for multiple years, opportunity to evaluate success and
• pportunities for reform. Field Offices working to reprogram funds as needed.
• 2018-19 Budget includes additional $11M annualized reinvestment.
• Bed reductions to date approximately 650 since 2014-15 SFY = $71.5M at

the statutory RIV formula of $110,000/bed. Current RIV in the community exceeds this amount, honoring “pre-investment” concept.

• While RIV continues, systems planning with existing $ is equally important to

reducing IP and ED use, and allowing continuation of RIV.

Reinvestment

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20 new ACT teams implemented in 2017-2018.

• New team locations based on waitlists and need in counties where teams

currently exist and in counties without existing teams.

• NYC: 14 new ACT Teams; LI: 1 new ACT Team; Westchester,

Warren/Washington, Niagara, Cattaraugus, Fulton/Montgomery: 1 new ACT Team each.

• 10 of the new NYC ACT Teams have shelter focus. All teams are licensed,

working with 27 mental health shelters in NYC, paired with 1-4 shelters based

• n location and size. DOHMH, DHS, OMH, shelters and providers

collaborating to serve high need individuals.

• OMH is looking at outcome data and best practices for specialized ACT

teams including shelter-focused and forensic-focused teams.

• Working closely with Center for Practice Innovations, ACT Institute for

training, research, consultation.

• In addition to the nearly 600 ACT slots from reinvestment since 2014.

ACT Expansion

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Creating an alternative to inpatient hospitalization or shorten a hospital stay and reduce readmissions by intensive outpatient treatment as a transition to more independent living.

• Target individuals are those with severity of symptoms who without intensive
• utpatient services would otherwise be referred to an inpatient setting, who

require a level of structure beyond a standard clinic program, and who can be effectively treated at this level of care. Ideal treatment timeframe is six weeks, 2-3 hours per day, 2-3 days per week.

• 24 clinics/satellites currently approved to offer IOP via 501 waiver.
• Central New York- Onondaga: 1
• Long Island- Nassau: 2, Suffolk: 3
• Mid-Hudson- Orange: 2, Putnam: 1, Ulster: 1, Westchester: 6
• New York City- 7
• Western New York- Erie: 1

Intensive Outpatient Program

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HARP, Health Homes, HCBS: Working to Expand the Pipeline

HARP Enrolled 106,975 HH Enrolled 35,474 HCBS Assessed 16,387 HCBS Eligible 14,973 LOSD Requested 5,777 HCBS Authorized 2,342 HCBS Claimed 1,714

HCBS Dashboard Data- March 20, 2018

8 April 26, 2018

• Nearly 107,000 HARP-eligible are now enrolled, with more on way via NY

State of Health

• 33% HARP members enrolled in Health Homes
• HARP Health Home enrollees with HCBS assessment increased to 46%
• Approximately 91% of HCBS assessments are HCBS eligible
• $75 million for HCBS Quality/Infrastructure Funds
• $25M in MCO quality funding to reward MCOs that invest in BH

HCBS provider systems.

• $50M in BH HCBS infrastructure funding to improve capacity,

connectivity and service delivery systems.

• As of April 6, CMS has confirmed that individuals who are considered street

homeless and/or who are residing in homeless shelters are allowed access to HARP HCBS.

• Counties and providers to push HCBS assessments as we pursue

alternative path to HCBS for those without Health Home enrollment.

HARP, Health Homes, HCBS

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• SDE is good example of integrating implementation feedback into responsive

solutions – thank you for your involvement.

• Currently, 66% of HARP enrollees are not enrolled in HH. MCOs will contract

with eligible entities to provide assessment and care planning of BH HCBS for HARP enrollees not enrolled in a Health Home.

• HARP members who are not enrolled in HH will have their NYS Eligibility

Assessment and HCBS Plan of Care done through the State Designated Entity contracted with the MCO as an Recovery Coordination Agency (RCA) for BH HCBS.

• HARP members who are not HH-enrolled may best engage with providers

who have existing therapeutic and supportive relationships. These providers may be best at identifying recovery goals and linking the member to HCBS.

State Designated Entity

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OMH offers a wide variety of promotional and outreach materials for our stakeholders, available on our website and YouTube channel, helping consumers access and understand HARP and HCBS services. NYAPRS Peer-to-Peer New Choices Program provides consumers with a working knowledge of HARP, HCBS and other essential components of the behavioral health system. RPC Training and Networking events create opportunities to share valuable information on improving access to HARP and HCBS.

Consumer Education Efforts

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Health Home Plus (HH+) previously limited to active AOT, CNYPC prison releases, and State PC discharges. Using what worked from TCM model while allowing flexibility such as mixed caseloads, team approach, with experienced care managers, face to face engagement.

• As of May 1, 2018, HH+ will include additional high need individuals with

SMI, including: individuals stepping down from ACT; multiple inpatient hospitalizations with no connection to outpatient care; AOT step down; AOT diversion; homeless; other individuals with forensic history/at risk of incarceration, SPOA and MCO Discretion.

• HH+ Stakeholder workgroup has been very effective in helping to develop

flexible but accountable care management models. Thank you!

• Also beginning May 1, 2018, eligible non-legacy Care Management providers

will be able to serve HH+ with appropriate qualification.

• Eligibility for HH+ rate is 12 months or length of AOT order.

Health Home Plus Eligibility

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Vision for a coordinated behavioral health crisis response system available to all New Yorkers, regardless of ability to pay. Integrates existing crisis infrastructure with newly available resources in managed care, DSRIP, and VBP.

• Using the 1115 Crisis Intervention Benefit, the impetus for sustaining and

expanding crisis services.

• County Crisis Plans-
• Counties/regions submit plans for review and approval, working with

OMH and OASAS.

• Identify gaps and areas for improvement, possible expansions and

linkages to next levels of care.

• Include DSRIP and PPS crisis projects, such as intensive crisis

respite and stabilization projects. CCBHCs involved in crisis planning. $50 million to help develop residential crisis programs statewide.

Crisis Services System

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Growing Forensic Capacity

• OMH and counties both recognize the pressure of CPL 730s on our systems. Working to

expand options/capacity for restoration.

• New 25-bed 730 restoration unit at Kirby FPC in Manhattan. It is on track to open in May.
• Will help eliminate backlog of patients waiting to get into forensic hospitals, serving an

estimated 70 admissions per year and reducing admission wait time to two weeks.

• Looking at new options to reduce burden and pressure on local jails.
• Exploring an additional unit for CL 508 patients.
• Piloting jail diversion programs, linking pre-trial supervision with intensive wraparound

programming with transitional housing.

• Increasing outpatient restoration in conjunction with forensic hospitals.
• Housing
• Prison to Community
• Prison to State PC

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Law Enforcement Training

• In 2017-2018 budget, 8 counties in Western New York received support for Crisis

Intervention Training

• 2018-2019 budget increased funding from $400,000 to $925,000
• OMH will be working with Senate as they designate jurisdictions for new trainings.
• New funding for mobile app/tablets enabling law enforcement to directly connect with

clinicians in responding to individuals with SMI.

• OMH and DCJS are offering free Fundamental Crisis Intervention Skills for Law

Enforcement Training for mental health professionals and law enforcement to become certified to instruct the mental health module of the basic police recruit curriculum.

• First session already occurred, upcoming sessions available.

15 April 26, 2018

What’s Next

Fundamental Crisis Intervention Skills for Law Enforcement Training for new Instructors.

• Local buy-in with training law enforcement recruits at local police academies.
• Integrating CIT with local crisis plans.
• Need county involvement in planning to support outpatient restoration and

developing collaborations with DA’s, jail diversion models

• Enhance clinic and residential skills in working with the criminally justice involved

individuals and increase special wrap around services for reentry and community stabilization.

16 April 26, 2018

2018 Medicaid Best Practices Project

Crisis Transition Interventions and Clozapine for High-Need Individuals with SMI

2018-19 Goal: Increase new clozapine starts by 300-400 within one year, make Critical Time Intervention services available to hospitalized individuals, and decrease inpatient bed days. Will engage MCOs and adapt approaches used in prior PSYCKES Learning Collaboratives. Project begins October 2018.

• Targets MMCO and HARP enrollees with 4 or more mental health ED or

inpatient visits in past year; estimated cohort of 6-10,000 enrollees.

• OMH will work with MCOs to identify high needs individuals (PSYCKES flag

and admission notifications), prompt providers to identify clozapine candidates, and identify providers of intensive care transition interventions and link with hospitals.

• Savings targets being developed; MMCOs, HARPs and providers

will share savings linked to outcomes.

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2018 Medicaid Best Practices Project

Clozapine Candidates: Individuals with a diagnosis of schizophrenia and refractory illness as evidenced by high utilization of ER/inpatient services (4+ in past year)

18 April 26, 2018

Behavioral Health Care Collaboratives will help integrate care across the entire spectrum of physical and behavioral health services while helping providers prepare for a VBP business model.

• Identify gaps in the continuum of care, to better connect the patient to

the next level of integrated healthcare.

• Ensure ongoing monitoring of care planning, to avoid unnecessary costs

and avoidable complications.

• Identify opportunities for performance improvement and cost reduction.
• Improve IT capabilities to more efficiently share data with other providers

and partners.

• Develop a quality improvement process for responding when issues are

not being addressed or quality indicators are not being met. BHCCs should be working with counties and partners across the system of care in planning and gap analysis. We understand some of the concerns related to the rollout. We are listening.

VBP and BHCCs

19 April 26, 2018

Clinic Service Integration

Integrated Outpatient Services Licensure: Improve the quality of care provided to consumers with multiple needs by improving the overall coordination and accessibility of care, while reducing the administrative burden on providers.

• 78 approved Integrated Outpatient Services clinic sites statewide.
• 51 OMH host sites. 41 with Substance Use Disorder, 7 with Primary

Care, 3 with both. DSRIP 3.a.i. Integrated Licensure: An additional avenue for clinics within PPS to integrate care. OMH, OASAS, DOH agreed to raise clinic licensure thresholds to allow secondary and tertiary services at existing clinics part of DSRIP Project 3.a.i. (chosen by all 25 PPSs).

• 34 approved DSRIP 3.a.i. clinic sites statewide.
• 22 OMH host sites. 12 with Substance Use Disorder, 8 with Primary

Care, 2 with both.

20 April 26, 2018

New York was one of eight states selected for CCBHC demonstration projects. Program began July 2017 with 13 providers. OMH’s focus is continuous quality improvement.

CCBHCs

Engage with your CCBHCs, find out where areas of collaboration can occur. Learn with them and apply those lessons in local service development.

21 April 26, 2018

Collaborative Care

Beginning in 2013, NYS DOH’s Medical Home Grant Program established Collaborative Care programs in academic medical centers. In 2015, OMH launched the Medicaid Collaborative Care Program.

• More than 100 sites currently participating
• Over 2,000 patients enrolled each quarter
• Providing value based reimbursement, creating better outcomes and reducing

the cost of care on the inpatient side.

• Addressing regulatory and reimbursement barriers, improving access for both

providers and consumers.

• DSRIP: all PPS’s initiating collaborative care in their primary care settings

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OnTrackNY is an innovative treatment program addressing first episode psychosis in adolescents in young adults. 21 sites statewide, current census of 530.

• County role in integrating OnTrackNY with existing community systems of

care and referral sources.

OnTrackNY

23 April 26, 2018

New Yorkers Advancing Suicide Safer Care (NYASSC): Implementing Zero Suicide in health systems in all mental health service regions, to elevate the standard of care for suicidal individuals age 25+.

• Only state in the nation to receive this grant from SAMHSA
• Goal of assessing 280,000+ people over five years and providing nearly 200,000

suicide specific interventions

• Strong Memorial Hospital, Samaritan Hospital, Bronx-Lebanon Hospital, Stony

Brook University Hospital, Upstate Medical University and St. Joseph’s Hospital Health Center. OMH’s Suicide Prevention Office is also developing a “Zero Suicide Safety Net” demonstration project in Onondaga County to link all levels of healthcare

• system. Once implemented, will look to share best practices across NYS.

Community:

• Seeking to demonstrate a 20% decrease in suicide attempts and deaths
• Extensive Community based suicide prevention trainings and school based

prevention programs ongoing

Suicide Prevention: NYASSC

24 April 26, 2018

The Suicide Prevention Continuous Quality Improvement (CQI) project for clinics was launched in 2016 and is the largest implementation of Zero Suicide in the USA, with a goal of reducing suicide attempts and deaths by suicide through the implementation of suicide safer care practices.

• Clinical Model: Assess, Intervention & Monitor for Suicide Prevention (AIM-

SP): Screening, HH referral, Suicide Care Pathway with Enhanced Interventions including Stanley-Brown Safety Plan, PSYCKES used to identify risk, and positive screening scores and safety plans made available to other providers. 165 participating clinics, 280 associated satellites, in 37 counties.

• 101 freestanding
• 61 state-operated
• 3 hospital-based

Suicide Prevention: CQI Project

25 April 26, 2018

The Governor’s Suicide Prevention Task Force was formed last year and is charged with identifying current gaps in suicide prevention and will make recommendations later this year, with emphasis on

• Increasing access, awareness and support for children, adolescents

and adults in need of assistance, prevention of bullying and cyber bullying, and buffering high-risk groups (e.g. LGBT, Veterans, Latina adolescents) The Task Force has received exemplary presentations from Erie County, Chemung County and NYC. In the near future, OMH will be sharing best practices and encourage the adoption of Suicide-Safer Communities practices across NYS. Upcoming Zero Suicide Leadership Summits in Rensselaer, Onondaga, and Monroe Counties. DCS are encouraged to attend. Contact OMH Suicide Prevention Office for more info. NYS Suicide Prevention Conference, September 20-21, in Albany

Suicide Prevention: What’s Next

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Transformation Opportunities: Housing

27 April 26, 2018

Housing Update

• Third round of Empire State Supportive Housing Initiative will include funding for at

least 1,200 units of housing for homeless individuals and families with disabilities or other life challenges.

• Of the 977 ESSHI Round One units, 288 are targeted to individuals with SMI.
• ESSHI Round Two units, 5,453 conditionally awarded, 34.7 % for individuals with
• Budget 2019 : 1,724 new units:
• 500 for Adult Home transition
• 140 ESSHI
• 282 NY/NYII
• 802 other including reinvestment

Currently there are more than 42,923 OMH-housing units in New York State and we’re continuing statewide efforts to increase this number.

28 April 26, 2018

Forensic Housing

Two forensic housing initiatives to support successful transitions to the community which offer participating providers enhanced services funding, dedicated transitional forensic case management or ACT, dedicated mental health parole officers and specialized staff training. Phase 1- Prison-to-Community Supportive Housing Beds

• For individuals with SMI being released directly from New York State prisons.
• 100 in NYC catchment area
• 65 in ROS

Phase 2- Prison-to-State Psychiatric Center-to-Community Supportive Housing Beds

• Serving individuals discharged from a psychiatric center. Individuals from all psychiatric

center inpatient or residential programs are eligible.

• 121 in NYC catchment area
• 64 in ROS

These beds will complement 269 SH beds from previous initiatives which specifically serve a forensic population, including a 16-unit SP-SRO

29 April 26, 2018

Targeted Rate Increases, Pipeline, Budget

Supportive Housing Rate Increase:

• $600 for NYC ($17,375)
• $300 to Long Island ($17,133)
• $300 for ROS ($8,131 to $17,184)

SRO, applicable to homeless and non-homeless CR-SROs and SP-SROs Rate Increase:

• $500 for NYC ($17,275-$17,621)
• $450 to Long Island/ROS ($4,374-$16,506)

2018-2019 State Budget includes:

• $50 million capital initiative to develop residential crisis programs. RFP in development.
• $10 million in capital funds to support children’s behavioral health services. An enhancement

to the $10 million in SFY 17-18. RFP expected in near future to make $20 million available to RTFs and clinics serving children.

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Transformation Opportunities: Children and Families

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Children’s Managed Care and HCBS

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Transition Age Youth

OMH, with a view toward better meeting the needs of transition-aged youth ages 16 to 24, recognizes that there are different needs and resources regionally. The plan, currently in beginning stages, will be based on the following:

• Population-The number of individuals receiving services
• Current Resources and Utilization- Devoted to, available for and currently used by

transition-aged youth.

• High Utilizers- Transition-aged youths using the most expensive services, identification of

patterns to develop services for earlier intervention.

• Youth/Young Adult and Family Input – Current recipients are in best position to discuss what

is working, what isn’t, and what’s needed.

• Stakeholder Input – Many transition-aged youth have multi-system involvement. Dialog will

be sought regarding their needs of the and how to best meet them. CLMHD focus group will be essential to this effort.

OMH welcomes Nancy Hollander, who will be moving this plan forward.

33 April 26, 2018

Project TEACH

Project TEACH provides rapid consultation, education and training, and referral/ linkage services to pediatric PCPs statewide who provide care for children and adolescents with mental health disorders. New initiatives include collaboration with OnTrackNY and FTNYS, and expanded availability of training for pediatric PCPs.

2,870 Pediatric PCPs Enrolled 12,395 Phone Consultations 1,866 In-Person Consultations 4,322 Linkages & Referrals

34 April 26, 2018

HealthySteps

HealthySteps integrates family and development professionals into pediatric and family medicine practices to help identify, monitor, and address emerging behavioral or developmental health concerns in young children.

• Evidence-based prevention

program aimed at prevention through anticipatory guidance, universal screening, promotion of health lifestyles and support of family relationships.

• 17 participating practices, over

$6.5M in 3-year grant funding.

35 April 26, 2018

Systems of Care-ACHIEVE

New York’s Advancing Care through Health Integration and Evidence-based Effort (ACHIEVE) pilot program integrates evidence-based High Fidelity Wraparound model with Health Homes Serving Children.

• Now expanded to include seven counties: Cayuga, Chautauqua, Erie, Orange, Rensselaer,

Rockland, and Westchester. 130 family capacity.

• By the end of 2018, pilot will include NYC and three to five additional counties.
• Wraparound Training and Implementation Institute- Two pilot cohorts of the six month

learning collaborative model. Work to help customize the of the model throughout all ACHIEVE counties. Two additional cohorts joining in 2018.

• NYS System of Care Conference: September 26-27, 2018 in Albany- SAMHSA’s TA

Network to facilitate share information and planning around SoC framework. Thank you for your work on pushing this forward!

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School-Based Behavioral Health

School-based Clinics, Promise Zones, Education

• Expanding school-based clinics statewide, more to come.
• Promise Zones operating in Broome County, Buffalo, NYC and

Syracuse.

• Partnership to improve school culture, student and family

engagement, academic achievement, dropout prevention, social and emotional competence and school safety. All partners reporting positive outcomes on key indicators of student success.

• Effective July 1, 2018, New York State will become the first state

in the nation to require mental health instruction as part of the K- 12 curricula.

• OMH is actively working with NYSED and stakeholders to

provide recommendations and guidance.

• $1.5 million in this budget to develop a web based school

mental health resource and training center.

OMH School-Based Mental Health Clinic Satellites

2015 2016 2017 *2018

% Change 2015 to2017 NYC 168 212 214 221 31.5% ROS 359 448 464 507 41.2% Total 527 660 678 728 38.1%

NYC by Borough 2015 2016 2017 *2018

% Change 2015 to2018 Bronx 21 35 36 36 71.4% Brooklyn 64 83 82 81 26.6% Manhattan 50 56 58 59 18.0% Queens 27 32 31 33 22.2% Staten Island 6 6 7 12 100.0% Total NYC 168 212 214 221 31.5%

ROS by Region 2015 2016 2017 *2018

% Change 2015 to2018 Central 134 158 163 177 32.1% Hudson River 95 115 120 131 37.9% Long Island 8 11 11 11 37.5% Western 122 164 170 188 54.1% Total ROS 359 448 464 507 41.2% * As of 2/16/18

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Transformation Opportunities: Workforce

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Work Force

Budget:

38.2M to fully annualize and support the workforce salary enhancements for direct care and clinical staff and minimum wage adjustments

Peers:

Peers are leading New York’s mental health system to a better place, using shared personal experiences to build lasting recovery for others.

• Adult Peer Specialist Certification: 1362 Certified and able to bill for Medicaid services.
• NYC: 561
• ROS: 801
• Family Peer Advocate and Youth Peer Advocate
• Currently supported by State Aid, OMH Direct Contracts, OMH Waiver Subcontracts
• Moving towards a billable Medicaid service July 2019
• Ongoing planning efforts: build FPA/YPA provider capacity, build YPA

infrastructure at local, regional and state level, expand the FPA/YPA workforce, and increase provider readiness to bill Medicaid and support workforce

39 April 26, 2018

New CPI Modules

CPI offers a wide range of learning opportunities- modules and certificate programs

• Improve service quality and retention
• Potential to stand out when contracting with MCOs

Visit the CPI website to access! http://www.practiceinnovations.org

40 April 26, 2018

Seeing the Big Picture

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Questions and Discussion