Managed Care Readiness
Children's Behavioral Health Transition to Managed Care
The New York State vision for the Medicaid System for Children is undergoing a substantial transformation. Child-/Youth-focused organizations are expected to be prepared for the following:
- enrollment of children in foster care into Medicaid Managed Care plans;
- additional inclusion of specialty behavioral health services in Medicaid Managed Care plans;
- enrollment of children into Health Homes for care coordination under the State Medicaid Plan;
- establishment of the six new Medicaid State Plan Amendment (SPA) services for individuals under 21 years of age (crisis intervention; community psychiatric support and treatment; psychosocial rehabilitation services; other licensed practitioner; family peer support services; and youth peer training and support); and
- consolidation and change in the Children's Waiver Program.
In response to the system transformation, SAE has assembled a team of professionals to assist agencies with the policy and operational decisions, fiscal modeling, and changing EHR needs under children's Managed Care. By now, you may have read our recent Issue Brief on the six new State Plan Amendment (SPA) services for children and youth. We will continue to develop and release resources to serve as guides for your organization's transition to Medicaid Managed Care.
Check out our recent Issue Briefs:
- Financial Issues to Highlight When Launching a Care Coordination Program
- Integrated Care for Children: Prevention and Screening at the Earliest Stage
- Application of the System of Care Approach to Children's Mental Health Homes
- 6 New State Plan Amendment (SPA) Services
To learn about SAE's financial modeling approach for child- and youth-focused services, check out SAE's PowerPoint: Kids Health Homes and Care Coordination Modeling!
Financial Viability Planning
SAE & Associates has worked with providers in crafting detailed fiscal viability plans.
SAE works with the provider for each step by providing tailored and “hands-on” mentorship to ensure the fiscal viability plan is as accurate as possible.
- We analyze each agency’s expenses to ensure the expense budget is as accurate as possible.
- We use a conservative approach to new business development, ensuring that whenever possible, existing resources are utilized first.
- We highlight hidden costs.
During the Implementation Phase, SAE ensures that the provider achieves the financial plan it has developed. We provide quantitative reports, indicate when course corrections are required, and identify unanticipated growth opportunities.
Clinical Management & Utilization Review
- Our detailed clinical mapping will help verify and report treatment and support the care management functions required for Health Home referrals.
- We use a tailored approach specific to your agency’s treatment culture, unique engagement strengths, client needs, and current services documentation procedures; we identify evidence-based practice protocols most congruent with the service population at hand and recognize the uniqueness of the provider approach in implementing evidence-based practices.
- We use a step-by-step approach to change management practices, developing strategic steps that address operational, administrative, clinical, and fiscal changes required to align with the new model of care.
Home and Community-Based Services (HCBS)
Home and community-based services (HCBS) provide opportunities for Medicaid beneficiaries to receive services in their own home or community. These programs serve a variety of targeted population groups, such as people with mental illnesses, intellectual or developmental disabilities, and/or physical disabilities.
HCBS is a unique area of potential growth for providers to develop a performance based revenue stream.
SAE aims to ensure that a provider successfully launches and sustain its HCBS initiative.