InvisALERT Solutions – ObservSMART

Driving System Success During Times of Change

The adult New York State Behavioral Health System recently transitioned to Medicaid Managed Care. While everyone would acknowledge initial challenges and ongoing issues to be resolved, overall, the transition has been successful. This article will highlight the positive aspects of the transition and key challenges that remain with an emphasis on applying lessons learned to bolster additional system transformations.

More than a year after the Managed Care transition for New York City and six months for the rest of the state, the service system has remained largely intact. Consumers are receiving care, providers have not closed their doors en masse, and the foundation has been laid for a value-based payment environment.

Still, as with any system or policy change, New York’s adult behavioral health system transition was not challenge-free. Adult behavioral health Home and Community Based Services, designed to meet the challenges faced by consumers with the most severe behavioral health needs, have encountered significant start up difficulties; there have been varying levels of success around consumer education across services; providers are managing an increased administrative burden; and billing issues emerged early-on and, while largely resolved, persist for some services.

As stakeholders at all levels work to remedy these issues, it is important to take a step back and consider how New York’s adult behavioral health system made it through this remarkable period of transition and transformation largely intact. Other states have seen choppier waters during their respective health system transitions, specifically when shifting Medicaid behavioral health services into Managed Care. Learning from those who have gone before, New York State layered in robust policy and support efforts.

It is the authors’ opinion that the following things led to the successful adult behavioral health system transition to Managed Care: stakeholder collaboration, government protections, open channels of communication, information dissemination, training and education, and starting early and proactive problem-solving.

Stakeholder Collaboration

Stakeholders worked together during each step of the transition process to ensure widespread coordination and thorough consideration of details. Regular meetings occurred between the NYS Office of Mental Health, Office of Alcoholism and Substance Abuse Services, Department of Health (OMH, OASAS, and DOH, respectively), and Managed Care plans. OMH and OASAS solicited input while working out service logistics, even releasing the draft adult Mainstream and HARP Provider manual for feedback. Providers, as well as advocacy and training groups, contributed valuable perspectives throughout the process.

Government Efforts

Local and state officials worked determinedly in conjunction with CMS to shape regulations that would help, not hinder, while protecting providers and consumers alike. Specifically, New York State established consumer and provider protections including setting guaranteed rates for some services for two years, defined and required plans to contract with essential community behavioral health providers including Opioid Treatment Programs, required the use of state approved level of care criteria including the OASAS LOCADTR 3.0, and established a Medical Loss Ratio of 89%. Where possible, officials worked to minimize unnecessary or overwhelming regulatory work for providers. To this end, uniform billing and a 90-day transitional grace period for authorization for existing consumers were established. In addition to existing organizations and groups that support providers, the state recognized the need for specific Managed Care focused training and technical assistance and created the Managed Care Technical Assistance Center (MCTAC) to serve as a training and educational resource for all behavioral health agencies navigating system transformation.

Open Channels of Communication

Throughout the transition, providers and plans knew where to turn with their questions. State agencies created managed care teams and mailboxes which fielded and addressed concerns in a timely matter. MCTAC answered thousands of questions submitted to and several hundred more at or following up from training events. Regional Planning Consortiums (RPCs) led by Conference Local Mental Hygiene Directors (CLMHD) provided another resource and forum for questions and problem-solving.

Information Dissemination

Participants were kept informed through regular policy updates including what had been finalized as well as what decisions required further discussion or approval. MCTAC worked with stakeholders to disseminate a weekly clearinghouse with information about regulations, trainings, and resources. Managed Care plans worked with and shared information with MCTAC and directly with providers, including making representatives available at numerous public forums and training events. Finally, through tool and resource development, critical information was distributed widely, including tips for contract negotiation, utilization management requirements, submitting clean claims, and Medicaid Managed Care plan contact information. This prevented duplication of work so that provider resources and time could be more valuably allocated.

Training and Education

Education efforts helped people understand the influx of information being provided to them. Based on provider feedback and need, MCTAC worked with government officials and Managed Care plans to create tools, trainings, and other educational resources including a Managed Care readiness assessment. The readiness assessment allowed providers to benchmark their internal strengths and needs while in-person and web-based trainings helped them understand the transition and how best to adapt.

Starting Early and Proactive Problem-Solving

Last but certainly not least, success hinged on the incredible efforts of providers and managed care plans. As encouraged by the state, getting an early start proved to be a critical component for individual agencies and plans alike. Many who opened channels of communication early found that the contracting process went more smoothly. Agencies that participated in claims testing identified and worked out some common problems before Managed Care went live. Organizations that created integrated transition specific teams to spearhead organizational and clinical changes improved internal efficiency and knowledge. Overall, the providers that believed the transition was closer than it appeared and who acted on that belief better understood and adapted to the changes.

In closing, while substantial work remains, behavioral health providers, managed care plans, government officials, and consumers can look with cautious optimism toward further system changes on the horizon. The lessons learned and commitment to a strong behavioral health system through collaboration, communication, and education give great hope as future transitions including the Children’s Behavioral Health System and Value Based Payment, get underway.

Credits: Andrew Cleek, PsyD, is the Executive Officer; Boris Vilgorin, MPA, is the Health Care Strategy Officer; Caitlin Cronin, BA, is a Project Associate; Dan Ferris, MPA, is the Assistant Director, Policy and External Affairs; and Meaghan Baier, LMSW, is a Research Scientist. All authors are affiliated with the McSilver Institute for Poverty Policy and Research at NYU Silver School of Social Work. Our apologies that a photo of Meaghan Baier was not available by the press date of this issue.

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