NextGen Healthcare

Medicaid Redesign Will Help Children and Families Get the Right Services at the Right Time

New York State embarked on a large-scale effort in 2011 to restructure the State’s Medicaid program based on recommendations from the Governor-appointed Medicaid Redesign Team (MRT). The MRT was comprised of a wide variety of stakeholders, including State agencies, providers, advocates, consumers and family members, charged with identifying how best to improve health outcomes, garner sustainable cost savings, and yield administrative efficiencies.

The MRT’s subcommittees included the Children’s Medicaid Redesign Team, focused on guiding and informing the State on the development of children’s redesign initiatives, including the transition of behavioral health and other services to managed care, the transition of children in foster care to managed care, and the integration of the delivery of Health Home care management model for children.

The Children’s Medicaid Redesign process forged a deep partnership between a variety of the State’s child-serving Agencies, including the Department of Health (DOH), the Office of Mental Health (OMH), the Office of Alcoholism and Substance Abuse Services (OASAS), the Office of Children and Family Services (OCFS), and later, the Office of Persons with Developmental Disabilities (OPWDD).

The guiding ideal behind the Medicaid restructuring was for children and their families to receive the right services, at the right time and in the right amount. To accomplish this, the Children’s MRT and the State agencies identified a variety of goals to be achieved through the redesign efforts, including:

  • earlier identification of needs of children and families,
  • intervening earlier to prevent the onset or progression of behavioral health needs,
  • providing services in the most natural and least restrictive setting, and
  • maintaining children and youth in their homes and community with adequate services and supports.

Furthermore, as a cross-agency effort, the goal was also to allow for equal access to services regardless of the “door” a child and family used to enter the healthcare system. As a result, the design was predicated on any child in need, regardless of their disability, having access to the same array of services as long as they met the eligibility criteria.

To effectively improve the continuum of services that can both prevent and address behavioral health conditions, a wider array of services available earlier in a child’s developmental trajectory was needed. Therefore, the redesign includes a significant expansion and enhancement of the existing children’s behavioral health service continuum that provides the range, flexibility, and capacity to individualize service provision in accordance with the unique needs and preferences of each child, youth, and family.

A large part of the redesign is focused on making services, known to work well, more readily available to a broader population of children. As such, services that once were only accessible through a Home and Community Based Services (HCBS) Waiver for children at risk of hospitalization, were developed as State Plan services for all children eligible for Medicaid. Furthermore, the services were included as a part of Early, Periodic, Screening Diagnostic and Treatment (EPSDT) services, directed to all children under the age of 21 years of age as long as they were in need of the service(s) and met medical necessity. This offers a greater opportunity to achieve the goal of integrated care of behavioral health services with physical health care, and the chance to intervene earlier in the lives of children in a more preventive and proactive way.

NYS established six new children’s behavioral health Medicaid State Plan services to benefit children from birth to 21 years of age. The six services, called Children and Family Treatment and Support Services (CFTSS), are for any child identified as having a behavioral health need who meets medical necessity. The aim of CFTSS is to more effectively meet the needs of children, youth and families by not only expanding access but enhancing the array of clinical treatment and rehabilitative supports available for children and youth from infancy through young adulthood. CFTSS are intended to be delivered primarily in nontraditional settings, allowing interventions to take place in the home and other natural community-based locations where children/youth and families live, attend school or engage in services.

The six Children and Family Treatment and Support (CFTSS) services include:

  • Other Licensed Practitioner (OLP) – a reimbursement mechanism through EPSDT for clinical services provided by specific categories of Non-Physician Licensed Behavioral Health Practitioners within their scope of practice, for children/youth in need of behavioral health assessment and/or treatment provided in flexible venues, for whom an office based setting may not be effective.
  • Crisis Intervention (CI) – mobile response for children/youth experiencing an acute psychological or emotional change which exceeds the abilities and the resources of those involved to effectively resolve it.
  • Community Psychiatric Supports & Treatment (CPST) – a comprehensive array of interventions that includes intensive rehabilitative interventions, as well as supports to educate and assist families regarding behavioral health challenges and barriers.
  • Psychosocial Rehabilitation Services (PSR) – a skill building service to restore, rehabilitate, and support a child’s developmentally appropriate functioning to enhance community integration by assisting the child to develop and apply skills in natural settings.
  • Family Peer Support Services (FPSS) – activities and supports provided by NYS Credentialed Family Peer Advocates (FPA) to families for the benefit of a child experiencing mental health challenges in their home and/or community.
  • Youth Peer Support and Training (YPST) – activities and supports provided by NYS Credentialed Youth Peer Advocates (YPA) to children who are experiencing mental health challenges in their home, and/or community.

CFTSS may be provided individually or as a coordinated, comprehensive package of treatment and rehabilitative supports, depending upon the unique needs of a child/youth and family, and may compliment the provision of other traditional treatment services the child/youth may be receiving. The service need will vary depending upon the child’s age, developmental stage, needs of the family/caregiver, whether the child has an identified behavioral health need and degree of clinical complexity. To promote wellness and recovery particularly for children/youth with multi-system involvement or higher intensity service needs, this expanded array of service options may help prevent the need for more restrictive and intensive levels of care.

The implementation of CFTSS will be according to a planned phased roll out. On January 1, 2019, the first three services will be implemented, including OLP, CPST and PSR. The second phase of the roll out will occur July 1, 2019, at which time FPSS will be implemented. The remaining services of YPST and CI will phase in January 1, 2020.

  • Expanding and enhancing the children’s behavioral health service array will help us to achieve a number of goals for the children, youth and families of New York State, including: increased capacity and access to care for a broader expanse of children and families;
  • Greater flexibility and choice for individualized care unique to the child and family’s needs and preferences;
  • Increased focus on prevention and early interventions to include infant and early childhood mental health capacity;
  • Reduction in traditional barriers to services and the associated stigma through the delivery of services in natural settings;
  • Expanded range and scope of services that can be easily increased or decreased in accordance with a child and family’s changing needs; and finally,
  • The prevention or reduction in the need for restrictive, higher levels of care through the utilization of comprehensive service packages available within the home and community.

By providing this new array of Children and Family Treatment and Support Services, NYS hopes to achieve the guiding ideal behind the Medicaid benefit redesign, for children and their families to receive “the right services, at the right time and in the right amount.”

To learn more about NYS Children’s Medicaid Redesign, please go to:  https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/index.htm.

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