SB19-195 Enhancing Children and Youth Behavioral Health Services Susanna C. Snyder Child and Youth Behavioral Health Program Manager Maternal Child Health Policy Andrew Gabor Director of Child, Youth, and Family Behavioral Health Dec-19 1
Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2
Introductions 3
Today’s Meeting Objectives: 1.Explain components of SB19-195 2.Share updates from HCPF and OBH 3.Share next steps 4.Gather public comment 4
History of SB19-195 Spring 2018: Kick-Off • Summer – Fall 2018: Roadmap • building -> Bill drafting Spring 2019: Session work • Summer 2019: Signed into law • 5
Children and Youth with Complex Behavioral Health Needs Youth who are high intensity utilizers of mental health services are involved in multiple systems and have complex needs. Analysis of CO data showed: • Almost half of these youth had involvement in the child welfare system 1 in 5 had involvement with the juvenile justice system • 1 in 5 received substance use services • 3% received services from the Developmental/Intellectual Disabilities • Division • Over 60% were involved in at least 2 systems, with 6% involved in 4 different service systems Multi-system involvement leads to disjointed care, which is difficult to navigate, stressful, and inefficient. Johnson Nagel, N., & Fox, D. (2015). Colorado's High-Intensity Mental Health Service Utilizers: Overlap with Child Welfare, Juvenile Justice, Substance Abuse, and Developmental and Intellectual Disabilities Services. Report submitted to the Colorado Department of Human Services, Office of Behavioral Health. 6
Health First Colorado, Foster Care & Behavioral Health Services 40% 35% Percentage of Health First Colorado Clients 30% 25% 20% 15% 10% 5% 0% Behavioral/Mental Health Complexity Physical Health Complexity Foster Care Non-Foster Care Gritz, Mark. (2019). Comparison of Complexities between Foster Care and Non-Foster Care Population. From the HCPF-Farley Health Policy Center Analytics Project. 7
Investments in Children and Youth • Cost per Health First Colorado member for high utilizing youth was more that 5 times greater for the top spending 10% of youth than the remaining 90% • This top 10% of clients accounts for 40% of Medicaid spending within the group • Child welfare spending increases incrementally for each additional system (up to three systems) in which a youth is involved Fox, D., Johnson Nagel, N., Gallagher, K., & Brock-Baca, A. (2014). Youth with High Behavioral Health Needs in Colorado: Cross-System Utilization Patterns. Report submitted to the Colorado Department of Human Services, Office of Behavioral Health. 8
Tasks Dept of Health Care Policy & Financing Requirements Deadline High Fidelity Wraparound (HFW) -HCPF to implement HFW services to Medicaid Seek Federal Authority as part of System of Care eligible children and youth at risk of out-of- home placement or in out-of-home July 1, 2020 placement—through RAEs, may be contracted (Sent letter to CMS in out to third party Oct 2019) -Partner with DHS/OBH to • Ensure network adequacy Monitor and report annual cost savings • • Oversee fidelity to model -Stakeholder engagement statutorily required (RAEs included) Integrated Funding Pilot -Develop plan to integrate funding for Design and Recommend behavioral health (BH) intervention and treatment services across the state July 1, 2020 -Stakeholder engagement… 9
Tasks Dept of Human Services – Office of Behavioral Health Requirements Deadline High Fidelity Wraparound -Collaborate to “develop and oversee” Standardized Assessment Tool -Select a single standardized assessment tool to Select and plan identify BH issues & other related needs in children and youth July 1, 2020 -Develop a plan to implement the tool (CANS work) -Stakeholder engagement… Standardized Screening Tools -Select developmentally appropriate and culturally Select competent statewide BH screening tools for primary care providers and primary caregivers July 1, 2020 -May make available electronically -Stakeholder engagement… Statewide referral and entry -Develop a plan for establishing a single statewide Develop a plan point referral and entry point for children and youth who have positive BH screening and needs identified July 1, 2020 through assessment -Stakeholder engagement… 10
Startup Resources HCPF DHS - OBH 5 FTE 2 FTE • • Training and Monitoring Training and Monitoring $$$ • • $$$ to come from HCPF Contractor $$$ for Existing COACT infrastructure • • integrated funding pilot SAMHSA funding for 15 Communities of Excellence 11
Criminal Child Justice Welfare Referrals RAE Juvenile Referrals Justice RAE Contracted FFS Providers Department of Education Other High Fidelity Child/Family Intensive Coordination Behavioral Health Serving Wraparound & Systems System: Family Support Services Intensive Coordination Capitation (Enhanced PMPM) • Intensive in-home therapies Traditional • Peer Support Services care • Family Peer Support coordination (PMPM) High Fidelity Wraparound Defined: An evidence-based process led by a facilitator where multiple systems come together with the child, youth, and family to create a highly individualized plan to address complex emotional needs (National Wraparound Initiative, 2018) Graphic by J. Miracle and C. Zundel
State Examples (System of Care) State Population Served Authorities Other Details Texas Ages 3 to 18 1915(c) CANS assessment • (Youth Empowerment Serious emotional, mental, beh difficulties to determine • Services) • Qualifying MH diagnosis LOC Criteria for Psych Hospitalization • • Be at-risk of out-of-home placement Four levels of Medicaid eligible care • Recently moved from FFS to Managed Care New Jersey Ages 0-21 1115 waiver CANS assessment • (Children’s System of • Complex behavioral health challenges 2703 Health Care) Developmental disability track Home SPA • Substance use track Targeted Case • • Not only Medicaid Eligible Management Wraparound Ages 0-23 1915(a) CANS assessment • Milwaukee Serious Emotional Disturbance • • Imminent risk of placement Milwaukee Non-nursing home/psych hospital county • • Medicaid eligible Capitation + Case Rates
Integrated Funding Example Wraparound Milwaukee, (200). What are the pooled funds? Milwaukee, WI: Milwaukee County Mental Health Division, Child and Adolescent Services Branch 14
HCPF Progress to Date • Personnel Unit Supervisor: Susanna Snyder (11/1/19) • Project Coordinator: Jenna Kapp (9/13/19) • Stakeholder Specialist: Brett Snyder (11/4/19) • Office of Community Living Specialist: Hired (begins 12/9/19) • Children and Youth BH Specialist: Hired (begins 1/6/20) • Implementation Specialist: Pending • • Stakeholder Engagement Monthly meetings with OBH • Monthly newsletter • Website • Initiating public comment meetings • 15
Progress cont. • Federal Engagement Letter sent and received • Finalizing concept paper • • Contractor (integrated funding) Developing Statement of Work and timeline • • Literature Review Colorado state scan • National inventory • Phone conferencing (e.g. WI, NJ, TX) • 16
HCPF Next Steps • Personnel Finish hiring • • Stakeholder Engagement Determine meeting details moving forward • • Federal Engagement Submit concept paper • Begin regular calls as other projects transition • • Contractor for Integrated Funding Design Procure vendor • Formal timeline for high fidelity wraparound implementation pending CMS conversations 17
CDHS Tasks Screening Assessment Tools Tools Single Entry Point Crisis Services or Funders Services Mobile Response 18
Standardized Screening Tools What: CDHS to select developmentally appropriate and • culturally competent tools • Behavioral health focused Statewide • Who: Primary care serving children, youth, and • caregivers in the perinatal period including postpartum women How: CDHS will lead a public consultation process • When: by July 1, 2020 • 19
Standardized Screening Tools- Status Behavioral Health Task Force, Children’s • Subcommittee OBH stakeholder outreach • Design: • • Public domain Provider options • Normed to a variety of cultures, genders, economic • status • Schools? • MassHealth screening tools https://www.mass.gov/info-details/learn- • about-the-approved-masshealth-screening- tools 20
Standardized Assessment Tool • What: CDHS to select a single standardized assessment tool to facilitate identification of behavioral health issues and other related needs. • Develop a plan to implement the tool for programmatic utilization • Who: Children and youth • Focus on medium to high intensity services • How: collaboration with DCW, HCPF, Managed Care, Counties, Service Providers, Families • When: July 1, 2020 21
Standardized Assessment Tool- Status • Years of Review • Behavioral Health Task Force- Children’s Subcommittee • Family First Prevention Services Act • Children and Youth Mental Health Treatment Act • COACT Colorado • HCPF- Residential 22
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