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 “SPA services” for individuals under 21 years of age; 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.
New York State Plan Amendment (SPA) Services are now recognized as Children and Family Treatment and Support Services. These services are authorized under the Early and Periodic Screening, Diagnosis and Treatment benefits (EPSDT) and consist of an array of Medicaid benefits for children under the age of 21 years old. While EPSDT activities historically focused primarily on children’s preventive medical care, these new services under the Medicaid State Plan allow for a wider focus on prevention and early intervention activities that include the behavioral health needs of the child/youth.
Children and Family Treatment and Support Services allow for services in the home and the natural community-based settings that better meet the behavioral health needs during the early part of a child’s/youth’s life. Early invention services will reduce or prevent the onset or progression of behavioral health conditions that may latter require more restrictive and higher intensity services. The expanded access to services and wider range of services for an eligible child/youth include the following six services:
- Other Licensed Practitioner
- Crisis Intervention
- Community Psychiatric Supports and Treatment
- Psychosocial Rehabilitation Services
- Family Peer Support Services
- Youth Peer Advocacy and Training
“The implementation of the Children’s Health and Behavioral Health Services are designed to foster and promote the health and wellness of children/youth and their families/caregivers. As such, these services are guided by core principles inherent in the children’s behavioral health system, known to many as the CASSP Core Principles. The CASSP (Child and Adolescent Service System Program) is based on a well-defined set of principles for behavioral health services for children and adolescents with or at risk of developing severe emotional disorders and their families/caregivers. These principles are summarized in six core statements.”
- Culturally competent, and
- Least restrictive/least intrusive.
Check out some of our Issue Briefs:
- 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
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.
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.