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Brief & Report

The 22nd annual Medicaid budget survey released: pandemic continues to shape priorities

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The 22nd annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and Health Management Associates (HMA) was released on October 25, 2022, in the report: How the Pandemic Continues to Shape Medicaid Priorities: Results from an Annual Medicaid Budget Survey for State Fiscal Years 2022 and 2023.

The report was prepared by Kathleen Giff­ordAimee Lashbrook, and Matt Wimmer from HMA; Mike Nardone; and by Elizabeth Hinton, Madeline Guth, Jada Raphael, Sweta Haldar, and Robin Rudowitz from the Kaiser Family Foundation. The survey was conducted in collaboration with the National Association of Medicaid Directors (NAMD).

Blog

HMA consultants pen Health Affairs blog post, “Advancing Health Equity And Integrated Care For Rural Dual Eligibles”

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HMA Consultants Ellen Breslin, Samantha Di PaolaSusan McGeehanRebecca Kellenberg, and Andrea Maresca recently wrote the Health Affairs blog post, “Advancing Health Equity And Integrated Care For Rural Dual Eligibles.”

This article was the latest in the Health Affairs Forefront series, Medicare and Medicaid Integration which features analysis, proposals, and commentary that inform policies on the state and federal levels to advance integrated care for those dually eligible for Medicare and Medicaid.

Read the full article here.

Brief & Report

System integration across child welfare, behavioral health, and Medicaid

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Children and families involved in the behavioral health and child welfare systems are often the most vulnerable and in need of intensive supports. Fragmented systems of care across child welfare, behavioral health, and Medicaid often cause families “to fall through the cracks,” leading to increased use of high-cost services that separate families and results in poorer outcomes.  These siloed approaches perpetuate and exacerbate trauma to children and families. In the second in a series of briefs focused on enhancing the youth behavioral health system, the HMA team of Uma Ahluwalia, Caitlin Thomas-Henkel, Roxanne Kennedy, and Courtney Thompson propose four core design elements – and related KPIs – for establishing a high-functioning integrated system of care for children, youth, and their families, child welfare, Medicaid, and behavioral health systems.

Blog

West Virginia releases RFP for foster children, youth in Medicaid Managed Care

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This week, our In Focus section reviews the Mountain Health Promise request for proposals (RFP) released by the West Virginia Department of Health and Human Resources on September 30, 2022, for specialized Medicaid managed care for children and youth in foster care.

Mountain Health Promise RFP

The selected managed care organization (MCO) will provide physical and behavioral health services to children and youth in the foster care system, individuals receiving adoption assistance, youth formerly in foster care up to age 26 who aged out of foster care while on Medicaid in the state of West Virginia, and children eligible under the children with serious emotional disorders (CSED) waiver. Potential expansions could include, but are not limited to, children at risk for foster care placement and the family of youth in crisis. Additionally, the MCO will act as an administrative services organization (ASO) and provide statewide administrative services for all individuals accessing socially necessary services (SNS).

Some of the goals of the program include:

  • Enhance coordination and access to services
  • Enhance quality of care and minimize barriers for youth and families/improve access to treatment
  • Reduce fragmentation and offer seamless continuity of care
  • Improve health and social outcomes for youth and impacts on families
  • Help reduce the number of children removed from the home and reduce lengths of stay per episode of care through increased family-centered care that provides necessary and coordinated services to all members of the family
  • Decrease children involved with the juvenile justice and corrections systems
  • Reduce out-of-home and out-of-state placements
  • Develop new or enhance existing services, such as children’s mobile crisis response (CMCR), inState Psychiatric Residential Treatment Facilities (PRTF) to reduce the need for out-of-state placements, and intensive home-based treatment

Physical and behavioral health services will be reimbursed through a Medicaid per member per month (PMPM) capitation payment. For SNS administration, the Bureau for Social Services (BSS) will provide a fixed monthly rate. The PMPM capitation rate will not include carved out SNS costs.

It is encouraged, but not required, that the MCO subcontract with regional child welfare organizations, residential mental health treatment facilities (RMHTFs), and organizations that provide home and community-based services for children with serious emotional disorders to assist in the care coordination of services for this population.

Market

There are nearly 28,000 individuals currently enrolled in Mountain Health Promise, with about 13,000 eligible for SNS. Enrollment, however, is expected to decrease following the end of the Public Health Emergency (PHE). CVS Health/Aetna is the incumbent plan. Aetna had contracted with Kepro to serve as the ASO for SNS.

Timeline

Proposals are due November 1, 2022. The contract is anticipated to run from July 1, 2024, through June 30, 2025, with three one-year options.

Evaluation

The winning MCO will be chosen based on the highest score of a possible total 1,000 points. The technical evaluation will be a total of 700 of 1,000 points. Cost represents 300 of 1,000 total points.

Mountain Health Promise RFP

Blog

SAMHSA releases CCBHC planning grants opportunity for states

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Today, the Substance Abuse and Mental Health Services Administration (SAMHSA) released the highly anticipated Cooperative Agreements for Certified Community Behavioral Health Clinic (CCBHC) Planning Grants Notice of Funding Opportunity (NOFO). The NOFO can be found here.

The CCBHC model provides integrated and coordinated community-based care for individuals across the lifespan with and at risk for behavioral health conditions, with a focus on adults with serious mental illness, those with any mental illness, children with serious emotional disturbance, and those with substance use disorders. The model is designed to increase access to behavioral health services; provide a comprehensive range of services, including crisis services, that respond to local needs; incorporate evidence-based practices; and establish care coordination as a linchpin for service delivery. To date, CCBHCs have demonstrated[1]:

  • Significant reductions in client hospitalizations
  • Increased access to high quality community-based care, including services like Medication Assisted Treatment and care coordination
  • Reduced impact of the mental health and substance use care workforce shortage
  • Innovative and strengthened partnerships with cross-system partners, including law enforcement, schools, and hospitals

About the Planning Grants

These CCBHC Planning Grants are established to support states to develop and implement certification systems for CCBHCs, establish Prospective Payment Systems (PPS) for Medicaid reimbursable services, and prepare an application to participate in a four-year CCBHC Demonstration program. Through this opportunity, SAMHSA anticipates making 15 Planning Grant awards of up to $1 million per award. Awarded states will have 12 months to use their Planning Grant dollars to accomplish the following:

  • Solicit input for the development of a state CCBHC Demonstration program from consumers (including youth), family members, providers, tribes, and other key stakeholders.
  • Create and finalize application processes and review procedures for clinics to be certified as CCBHCs.
  • Assist clinics with meeting certification standards by:
    • facilitating access to training and technical assistance;
    • providing workforce supports, including assisting CCBHCs to improve the cultural diversity and competence of their workforce; and
    • facilitating cultural, procedural, and organizational changes to CCBHCs that will result in the delivery of high quality, comprehensive, person-centered, and evidence-based services that are accessible to the population(s) of focus.
  • Certify an initial set of clinics as CCBHCs, including those that represent diverse geographic areas, including rural and underserved areas. As an option, states can also develop a process for bringing additional clinics into the State CCBHC Demonstration program to reach the desired geographic spread by the end of the four-year CCBHC Demonstration.
  • Establish a PPS for behavioral health services furnished by a CCBHC in accordance with the original PPS Methodology Guidelines developed by CMS. A statement indicating that the State agrees to pay for services at the rate established under the PPS during the CCBHC. Demonstration program must be attached with the application.
  • Develop or enhance statewide data collection and reporting capacity.
  • Submit a proposal to participate in the CCBHC Demonstration Program no later than March 20, 2024.

The Planning Grant project period is anticipated to begin on March 30, 2023. As a Cooperative Agreement, SAMHSA anticipates having substantial federal programmatic participation, including providing input to selected states in the planning, implementation, and evaluation of the program.

These planning grants are the first phase of a two-phase process of the expansion of the CCBHC Demonstration, authorized by the Bipartisan Safer Communities Act.[2] Beginning July 1, 2024, and every two years thereafter, 10 states that have completed planning grants and submitted successful applications to participate in the CCBHC Demonstration will be eligible to join the program for a four-year period.

Eligibility to Apply

Eligibility for this Planning Grant opportunity is limited to the State Mental Health Authorities, Single State Agencies, or State Medicaid Agencies that are located in the 41 states, including the District of Columbia, that were not previously selected to participate in the CCBHC Demonstration Program. Regardless of which state entity ultimately serves as the applicant, each application must include a signed Memorandum of Agreement between the Director of the State Mental Health Authority, the Director of the Single State Agency, and the Director of the State Medicaid Agency demonstrating a partnership to fulfill the requirements of the award.

Updates to CCBHC Certification Criteria and PPS Guidance Expected but Not Before Application Deadline

Updates are expected to both the CCBHC Certification Criteria and PPS Guidance in the coming months, but the NOFO is clear that these updates will not be available during the application period for these Planning Grants. Specifically:

  • SAMHSA is in the process of updating the CCBHC Certification Criteria through a process which will include a significant opportunity for public comment. SAMHSA intends to keep the existing framework for the criteria, which is included in the authorizing statute. SAMHSA does not intend to make major changes to the scope and shape of the Certification Criteria.
  • CMS is also working to update the CCBHC PPS guidance. Any PPS changes will be made available prior to the planning grant execution period and included as part of technical assistance provided to states during the planning grant execution period.

Because neither of these updates will be released prior to the application submission deadline, applicants will use the existing CCBHC Criteria and PPS Guidance to inform their applications.

Next Steps for Interested State Stakeholders

Applications for this opportunity are due December 19, 2022 at 11:59 pm. Each application will be scored on their 30-page narrative submission, which includes significant emphasis on each applicant’s approach to CCBHC planning (including both certifying CCBHCs and establishing the PPS rates) and the state’s experience with the model to date (including the steps already taken to develop a CCBHC program in their state).

HMA and the National Council for Mental Wellbeing will host a joint webinar about this NOFO on Monday, November 7, 2022 at 1-2 pm ET. Register here.

In addition, in anticipation to the NOFO’s release, HMA and the National Council hosted a webinar on October 6, 2022, on “Developing a Strategy for the CCBHC State Demonstration RFP.” During this webinar, we engaged representatives from New York and Michigan to share information about their Demonstration program implementation to date. View the recording.

Should you have questions or want to learn more about HMA’s available support related to this and other CCBHC opportunities, contact Kristan McIntosh at kmcintosh@healthmanagement.com.  


[1] https://www.thenationalcouncil.org/wp-content/uploads/2022/06/22.06.06_HillDayAtHome_CCBHC_FactSheets.pdf

[2] https://www.congress.gov/117/plaws/publ159/PLAW-117publ159.pdf

Webinar

Webinar replay: state strategies for the certified community behavioral health clinic demonstration planning grant opportunity

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This webinar was held on November 7, 2022.

The Bipartisan Safer Communities Act offers new funding for states to develop a Certified Community Behavioral Health Clinic (CCBHC) Demonstration program. A new CCBHC Planning Grant Notice of Funding Opportunity (NOFO) for states has just been released with a deadline of Monday December 19, 2022. During this webinar – a follow up to our October 6 webinar – experts from HMA and the National Council for Mental Wellbeing provided an overview of the CCBHC Demonstration program NOFO, offered strategies for using CCBHC as a strategic transformational opportunity for systems improvement, reviewed the NOFO requirements and key changes from previous opportunities, and outline strategies for developing a successful response.

Learning Objectives

  • Review requirements of the new CCBHC Demonstration Planning NOFO for states and how it varies from previous efforts.
  • Understand the importance of aligning the CCBHC model within a larger state behavioral health and integrated care strategy.
  • Learn key considerations for states in responding to the opportunity and steps to improve the quality of a response.

Speakers

Kristan McIntosh, Principal, HMA

Heidi Arthur, Principal, HMA

Josh Rubin, Principal, HMA

Rebecca Farley-David, Senior Advisor, Public Policy and Special Initiatives, National Council for Mental Wellbeing

 

Did You Miss Part 1 of our CCBHC Planning Grant Webinar Series?

In case you missed it, experts from HMA and the National Council for Mental Wellbeing were joined by state leaders from New York and Michigan (two current CCBHC Demonstration states) for a pre-NOFO release discussion on October 6, 2022. During this prior webinar, we shared lessons learned and strategies states have used to successfully plan for the CCBHC Demonstration Program and leverage the CCBHC initiative as a transformation opportunity that can help behavioral health care systems achieve their broader health quality and access goals. The recording, slide deck, and an associated Q&A document from that previous session can be found here.

Blog

HMA identifies key trends for emerging Medicaid Section 1115 demonstration proposals

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This week, our In Focus explores a new trend to watch in Medicaid Section 1115 waiver demonstration programs. As discussed in our previous In Focus, state Medicaid agencies are exploring pathways and concepts to address the historic inequities and health disparities laid bare and exacerbated by the COVID-19 pandemic. These efforts are closely aligned with the Centers for Medicare and Medicaid Services’ (CMS) policy objectives for the Medicaid program, specifically:

  1. Addressing health inequities
  2. Improving access and coverage
  3. Promoting whole person care

Teams of experts from across the HMA family of companies are supporting state agencies, counties, health plans, providers, community and consumer organizations, and other stakeholders with translating federal goals and parameters into concrete proposals for new demonstration programs. HMA’s experts assist stakeholders with proposals as they move through the stages of concept paper, application, negotiation, approval, and implementation. Demonstrations will reflect each state’s unique political and policy landscapes, but the programs will be grounded in certain federal goals and expectations to enhance accountability and improve outcomes.

In the earlier In Focus, our experts shared initial insights and considerations for stakeholders about one of the emerging trends: state Medicaid leaders are seeking to improve health equity in communities by providing health-related social services and engaging community organizations. Building on this and informed by our collective “on the ground” expertise we are writing this week about a second emerging trend we see across states’ Section 1115 activities:

Trend #2: States are seeking to use Medicaid demonstration programs to build essential capacity and infrastructure at the community and organizational levels.

The recently approved and submitted demonstration proposals signal CMS’ willingness to allow states to support some limited capacity building for community-based organizations. Several state 1115 demonstration proposals describe the state-specific types of community-based organizations and other entities that Medicaid programs want to engage to address the social and health-related drivers of health outcomes. This requires augmenting the existing workforce, providing training on Medicaid health plan contracting requirements, and building an infrastructure platform and systems that will support efficient communications and service delivery.

CMS has indicated a strong interest in advancing states’ community-based activities. This is evident in CMS’ decision to revise the federal framework used to determine whether a state’s Section 1115 demonstration program is budget neutral for the federal government. CMS has also decided to reopen the opportunity for states to propose Designated State Health Programs (DSHPs) under more limited size and scope parameters. CMS articulated these updated policies in the recent approval letters for Section 1115 demonstration programs in Massachusetts and Oregon. The federal reinterpretation provides states significantly more flexibility relative to the prior policy to use federal Medicaid funding to do the following:

  • Design and implement a broader set of health-related service need (HRSN) initiatives,
  • Make investments in the infrastructure to support HRSNs; and
  • Invest in building workforce capacity.

States will continue to act on these shifts in federal priorities and policies, crafting proposals aligned with their state-specific environments and goals. However, CMS’ willingness to support capacity building as part of state demonstration programs will need to adhere to certain scope and financing parameters. These guardrails are articulated in more detail in the approval letters for Massachusetts and Oregon. States and stakeholders will also want to be responsive to CMS’ expectations that its investments will be sustainable over time. They may need to plan and develop additional capacity to utilize non-Medicaid sources of federal and non-federal funding in tandem with the demonstration initiatives.

Importantly, the terms of the approved demonstration projects reinforce the need for states, managed care plans, and providers engage in new partnerships with community leaders and ensure the perspectives and experiences of consumers are continuously reflected in programs. Examples of proposed capacity building partnerships include:

Massachusetts’ recently secured CMS approval for a Section 1115 demonstration program which will fund a variety of health-related service needs (HRSN) initiatives. As part of the HRSN initiatives, CMS is allowing the state to receive federal Medicaid funding to support capacity-building, infrastructure, and operational costs for these activities. For example, under the demonstration federal funding will be available for participating “community partners” to pay for health information technology system investments, expand workforce capacity, manage startup costs, and enhance operational infrastructure such as system change resources. Additionally, the state will be able to receive federal Medicaid funding for provider workforce recruitment and retention activities, specifically primary care and behavioral health provider student loan repayment programs and a family nurse practitioner residency program.

In September 2022, Oregon received approval for a Section 1115 demonstration program to provide increased coverage of certain services that address HRSN. These services include critical nutritional services and nutrition education, as well as transitional housing supports for individuals with a clinical need or transitioning out of institutional care, congregate settings, out of homelessness or a homeless shelter, or the child welfare system. Additionally, the state will be able to receive federal Medicaid funding to make infrastructure investments to support those services, such as cultural competency training, trauma-informed training, traditional health worker certification, accounting and billing systems among others.

New York State envisions that Social Determinant of Health Networks (SDHNs) will work to organize and coordinate small neighborhood organizations familiar with their communities’ needs and the capacity to address multiple social risk factors as well as larger county or regionally focused entities. The state aims to allow SDHNs to receive Medicaid funding to invest in developing the infrastructure they need to assist Medicaid enrollees, such as the IT and business processes and other capabilities. Alongside this, the state is proposing a minimum fee schedule for certain services addressing social care needs. In addition, New York is requesting support for a statewide social services referral technology platform.

Washington state has a proposal pending with CMS that builds on its earlier demonstration program to further invest in multi-sector, community-based partnerships and approaches using Accountable Communities of Health (ACH). Specifically, the state is proposing to invest in the development and operation of Community Hubs and a Native Hub, which will serve as centers for community-based care coordination. These hubs will focus on health-related social needs (HRSNs) that provide screening for and referral to community-based services for Medicaid enrollees. These hubs will also distribute funding to build capacity among community-based organizations (CBOs) and community-based providers.

New Jersey has designed an 1115 demonstration proposal focused on the lack of stable housing as a driver of unnecessary hospitalization, institutionalization, or other avoidable instances of high-cost care, negative clinical outcomes, and worsening of chronic conditions. While it does not plan to make direct investments in community-based entities, the state aims to enhance contractual requirements with its Medicaid managed care organizations around housing specialists. This includes requiring health plans to have their housing specialists coordinate with community-based organizations that provide housing services or other related services to address social drivers of health. Its proposal also is designed to facilitate coordination across state and community resources that are essential to the provision of health and housing services.

Conclusion

The Massachusetts and Oregon demonstration programs provide important insight on CMS’ willingness to support state investments in HRSN and the state and local infrastructure to support delivery of culturally appropriate services.

Stakeholders will want to monitor these and other proposals as they move forward, particularly to understand the conditions and timing for funding to flow to community entities. Additionally, each state demonstration will have reporting and accountability structures that could impact payment and future investments made by Medicaid health plans, providers, CBOs and other stakeholders.

HMA’s interdisciplinary teams of Medicaid, human services, and actuarial experts are assisting states as well as stakeholders as they conceptualize, develop, and implement Section 1115 programs. To learn more about our work and connect with an HMA expert in your state please contact Andrea Maresca.

Webinar

Webinar replay: equity-centered approaches to supporting community prevention and treatment

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This webinar was held on November 15, 2022. 

Deeply rooted structures, systems, and beliefs have perpetuated racial inequities within substance use and mental health treatment and recovery settings. Racism and associated traumas add to these injustices and may influence how people of color experience and seek help for behavioral health needs. During this webinar, hear from community-based practitioners, who are leveraging evidence-based practices centered in equity, to provide support to our most vulnerable through harm reduction, overdose prevention and linkage to community treatment services.

Learning Objectives

  • Learn about the importance of centering your approaches in equity.
  • Obtain concrete examples of specific equity practices for harm reduction and overdose prevention.
  • Develop an understanding of national efforts that can support prevention in communities, driven by communities.

Speakers

Juleigh Nowinski Konchak, MD, Attending Physician, Behavioral Health, Department of Family and Community Medicine and Center for Health Equity and Innovation, Cook County Health
Rashad Saafir, PhD, President, CEO, Bobby E Wright Comprehensive Behavioral Health Center

Moderators

Michelle Ford, Principal, HMA
Leticia Reyes-Nash, Principal, HMA

Webinar

Webinar replay: collaborating with faith-based organizations on reducing overdose deaths and addressing stigma

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This webinar was held on November 8, 2022.

Substance and opioid use disorders (S/OUD) affect people from all walks of life, including those active in faith communities. Yet many faith leaders do not know how to effectively support members of their congregations and their families who are struggling with these diseases. Faith groups and faith leaders from all denominations can be critical allies in addressing the stigma of S/OUD and building safe, compassionate spaces for individuals to get spiritual support along with the physical, mental, and emotional help they need to recover from S/OUD.

Presenters led participants through the myths and facts about S/OUD most relevant to faith communities and how to create faith-based prevention initiatives that can work in collaboration with other state S/OUD prevention and harm reduction strategies.

Learning Objectives

  • Find out how Faith-based Organizations (FBOs) can play an important role in helping individuals and families affected by S/OUD.
  • Learn how to encourage collaboration between faith communities and systems of care.
  • Understand key myths and facts related to S/OUD to share with FBOs.
  • Learn how to help FBO start prevention and harm reduction strategies in their communities.
  • Find out how to leverage FBOs to expand education about SUD and reduce stigma.

Speakers

Amy Bechtol, West Tennessee Faith-Based Community Coordinator with the Tennessee Department of Mental Health & Substance Abuse Services
Ana Bueno, Senior Associate, HMA
Stephanie Denning, Principal, HMA

 

Related Video

Our Resilient Communities In the Opioid Epidemic: Partnering for Equitable Solutions

Webinar

Webinar replay: industry-specific outreach and education for reducing overdose deaths

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This webinar was held on October 25, 2022. 

Industry stakeholders are non-traditional partners who can be effective in supporting and expanding opioid overdose prevention efforts. During this webinar, attendees heard about one state’s experience using data to identify and target stakeholders in high-risk industries, including construction and food services. We shared a framework for industry-specific prevention efforts—including use of data; identification of key partners; engagement strategies, and education; stigma reduction, and harm reduction activities—that other locales can adapt and integrate into their overall opioid prevention and response strategies. In addition, we identified possible funding opportunities to support this type of effort.

Learning Objectives

  • Learn about effective ways to build non-traditional, industry-specific partnerships to support communities to reduce overdose deaths.
  • Understand how data can help target and engage stakeholders in outreach, education, stigma reduction, and harm reduction.
  • Obtain concrete examples of industry-specific engagement and education activities that have been impactful in the restaurant and construction industries.

Speakers

Kate Brookins, Director, Office of Health Crisis Response, Delaware Department of Health and Social Services Division of Public Health
Mayur Chandriani, Associate, HMA
Kristan McIntosh, Principal, HMA