Medicaid RedesignRecommendations and Response to the Navigant Report

Georgia Association of Homes and Services for Children

February 28, 2012

The Georgia Association of Homes and Services for Childrenwelcomes this opportunity to respond to the Navigant Report on Medicaid and PeachCare Redesign. We know Georgia faces expansive growth in the Medicaid rolls under the Affordable Health Care Act. We need a sustainable health care system for Georgia, and its vulnerable citizens. This system shouldpromote the ends of the Navigant Report for cost containment, increased access to services and promotion of increased consumer health outcomes.

In this spirit, we offer the following recommendations:

  1. Do a “carve out”of services to children and adults and their families who have or are at-risk of significant mental illness or severely emotionally disturbed or have significant behavioral health care and developmental disabilities This “carve out” would include foster children for their behavioral health care needs. A separate Managed Behavioral Health Organization (MBHO) would manage these services apart from a Managed Care Organization (MCO) whose primarily responsibility would be to managed primary physical health care.
    This is a proven approach demonstrated across many states. (See Sheila Pires report, “HCRTP Promising Approaches for Behavioral Health Services to Children and Adolescents and Their Families in Managed Care Systems.”)
  1. Do a phased in approach to build needed capacity. The lack of service capacity will challenge all providers both public and private. We need to identify the services that we need and build that capacity.
  1. Build a Value Based System that incorporates principles of systems of care and are relevant to children and their families. This approach recognizes that the system is built with the family in mind. Family partnerships are a fundamental design feature deliberately structured at policy, management, and service delivery levels with resources devoted to building the capacity of families.
  2. Use multiple funding streams that are blended or braided. Innovative and collaborative thinking should allow for multi-departmental approach that would blend funding from DFCS, MHBHDD, DJJ, and DPH to utilize current funding appropriated for the same purposes of improving the wellbeing of children and families.
  3. Build a flexible and broad benefit design utilizing multiple resources and community-based resources. These services should include community crisis stabilization, community case management, rehabilitation and skill building, family and consumer education, assertive community treatment, peer support, in-home family intervention services,family preservation and reunification work and other recovery-oriented services.
  4. Incorporate individualized service planning for children with serious disorders, using a “wraparound” approach and utilizing clinical decision-making tools and criteria designed for children and adolescents. Flexible prior authorization requirements are also critical to allowing for the provision of needed services that will save money or produce better outcomes, even when such services are outside ofthe standard benefit. Many MBHOs have developed flexible prior authorization requirements that allow them routinely to authorize such services. An example of flexible authorization processes is the ability of most MBHOs to authorize wraparound services for children with SED to ease and support the child’s transition from a residential setting to home, school and community.
  5. Use a single care management entity statewide to create a place of accountability or unify the authorization processes and access for services for consumers. Any system should simplify paperwork, reduce regulatory oversight and ease access to services.

For providers this would mean similar processes for authorizations credentialing, and billing/payments. For the consumers it would mean the availability of the same or similar access to services, eligibility requirements and service arrays. Both consumer and provider satisfaction surveys need to be a part of any quality assurance matrix.

  1. The new system should encourage MBHO’s to contract with providers who can provide a multi-disciplinary and comprehensive service array either on their own or through collaboration with other providers. The practitioners delivering services may include psychiatrists, psychiatric nurses, psychologists, licensed masters level clinicians, addiction counselors, paraprofessionals, and peer support staff. The MBHO should credential and contract with these providers as an organization. Credentialing community behavioralproviders as organizations allows for important case management, peer support, and other supportive services needed by people with severe emotional disturbance and significant mental illness.
  2. Use evidence-based, research-driven, and best practice technologies and practices.
  3. Use quality improvement processes relevant to children and families and use performance management tools to assure outcomes. Use data to guide policy and service decision-making. The State should consider a type of arrangement found in other states that allows MBHO to take on risk if it can demonstrate that it can reduce costs and hospitalizations. Performance incentivesbased on improving access to care and outcomes with consumers that are carefully measured and incentivized have proven beneficial in other states.
  4. Above all, any redesign should involve a thorough and thoughtful process. It should allow for enough time to implement without harm to the vulnerable citizens that this redesign is directed to serve.

The following sources are cited:

 HCRTP Promising Approaches (part 1 of 2)HCRTP Promising Approaches (part 2 of 2)
 Increasing Access to Behavioral Health/Managed Care Options and Requirements (part 1 of 2) Increasing Access to Behavioral Health/Managed Care Options and Requirements (part 2 of 2)  Integrating Behavioral Health and Primary Care Services: Opportunities for State Mental Health Authorities
 Texas Foster Care Carve Out PP
 National Council on Disability Recommendations for Managed Care

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Medicaid Redesign Recommendations and Response to the Navigant Report

Georgia Association of Homes and Services for Children

February 28, 2012

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