What to Expect: Transition to Managed Care for Providers Serving Children, Youth, and Families

The NYS Office of Mental Health (OMH) hosted a webinar last week entitled “Reimagining Children’s Mental Health Services” for New York providers serving children, youth, and families who are looking toward the impending transition to Medicaid Managed Care and per member per month reimbursement. This transition is expected to take place in NYC on January 1, 2016, and these reform efforts are designed to assist the State in moving towards the achievement of the Triple Aim: providing better care for lower costs to realize better health on behalf of children, youth, and families.

The webinar’s speaker, Donna Bradbury, is currently the Associate Commissioner for the Division of Integrated Community Services for Children and Families at OMH and is also chairing the Medicaid Redesign Team (MRT) Behavioral Health Workgroup for Children. This workgroup, consisting of a number of State leaders who have been working to create a managed care model specific to children, is focusing on the following key priorities:

  • Earlier interventions (i.e., preventing (where possible) crises through early identification and provision of support services);
  • Better coordination within and across systems;
  • Provision of a step down set of support services for children and their families living in the community to prevent (re)cycling to inpatient/residential level of care; and
  • Outcome accountability across all payers, including those in both the public and private systems;

A key difference between the transition to managed care for adults and that for children and youth is that while adults with behavioral health needs will be enrolled in a special needs plan (HARPs), all children and youth will be covered under the mainstream plan. This difference is due to the fact that the functioning of children and youth is thought to be more fluid than that of an adult based on each child’s growth and development stage.

During the webinar, OMH was clear that NYS providers serving children, youth, and families must start now to prepare for this transition in order to ensure success. Suggested steps that can be implemented now to prepare for January 1, 2016, include the following:

  1. Develop an agency-wide profile of the client population currently being served and their needs;
  2. Assess your current services to determine how they align with the new plan and determine gaps in your system of care that you can begin to fill through strategic partnerships and/or service additions;
  3. Evaluate the Home and Community Based Services (HCBS) currently provided to your clients by other providers (even those in other service sectors) in your community in order to identify the gaps and/or inform strategic partnerships; and
  4. Determine the types of insurance plans in which your clients are currently enrolled for both behavioral and physical health, and “get to the table” now to discuss the services you are currently providing to their members, as well as the outcomes and cost of these services.

To access the slides from this informative webinar, visit the CTAC-NY website here