2011 Session

Budget Amendments - SB800 (Member Request)

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Chief Patron: Howell
Replace Proposed Language Regarding Care Coordination for Community-based MH Services (language only)

Item 297 #28s

Item 297 #28s

Health And Human Resources
Medical Assistance Services, Department of

Page 266, line 33, after "and services," insert
"with the exception of Mental Health and ID Targeted Case Management,".
Page 267, strike lines 10 through 23, and insert:
"e. In fulfillment of this item, the department, in conjunction with the Department of Behavioral Health and Developmental Services and the Community Services Boards, and in consultation with appropriate stakeholders, shall develop a blueprint for the development and implementation of a care coordination model(s) for individuals in need of behavioral health services not currently provided through managed care.  The overall goal of the project will be to curb Medicaid expenditure growth in the long run without compromising access to behavioral health services for vulnerable populations.  
The blueprint shall: (i) describe the steps for development and implementation of the program model(s) including funding, populations served, services provided, time frame for program implementation, and education of clients and providers; and (ii) include the following principles:  
1. Improves value so that there is better access to care while improving equity.
2. Engages consumers as informed and responsible partners from enrollment to care delivery.
3. Provides consumer protections with respect to choice of providers and service plans.
4. Improves satisfaction among providers and provides technical assistance and incentives for quality improvement.
5. Improves satisfaction among consumers and involves consumers in governance and planning proposals and decisions.
6. Improves quality, recipient safety, health outcomes, and efficiency.
7. Develops direct linkages between acute and behavioral services in order to make it easier for consumers to obtain timely access to care and assure appropriate management of services for fragile individuals.
8. Builds upon current best practices in the delivery of behavioral health services.
9. Accounts for local circumstances and reflects familiarity with the community where services are provided.
10. Develops steps to avoid involuntary treatment and prevent default placement in state hospitals.
11. Reduces and improves the interface of vulnerable populations with local law enforcement, courts, jails, and detention centers.
12. Supports the responsibilities defined in the Code of Virginia relating to Community Services Boards and Behavioral Health Authorities which includes but is not limited to: emergency services, pre-admission screening for involuntary detention, crisis stabilization, mandatory outpatient treatment, discharge planning for discharge from state facilities, and monitoring of individuals adjudicated not guilty by reason of insanity upon release to the community.
13. Assures that the department and the Department of Behavioral Health and Developmental Services (DBHDS) jointly shall set criteria for medical necessity for community mental health rehabilitation services.
14. Promotes availability of access to vital supports such as housing and supported employment funded through state and local funds.
15. Achieves cost savings through decreasing avoidable episodes of care and hospitalizations, improving adherence to medication regimens, and utilizing community alternatives to hospitalizations and institutionalization.
16. Simplifies the administration of acute psychiatric, community behavioral health services and primary care services for any coordinating entity, providers, and consumers.
17. While the State clearly needs to articulate desired outcomes and performance measures in the contract, the organization needs the flexibility to offer the full continuum of necessary services so that the consumer gets the right service, in the right setting at the right time.
18. Requires standardized data collection, outcome measures, and reports to track costs, utilization of services, and outcomes.
19. Provides actionable data and feedback to providers.
f. The department may seek the necessary waiver(s) and/or State Plan authorization under Titles XIX and XXI of the Social Security Act to develop and implement a care coordination model for individuals in need of behavioral health services, with the exception of Mental Health Targeted Case management,  not currently provided through managed care to be effective July 1, 2012.  The department may consider innovative approaches such as provider sponsored managed care models as proven successful in states such as Kansas and Colorado.  The model(s) shall build upon current local strengths, utilize existing data, maintain access to the publicly-funded community system and increase access, quality, positive health outcomes and consumer satisfaction. This model may be applied to individuals on a mandatory basis. The department shall have authority to promulgate emergency regulations to implement this amendment within 280 days or less from the enactment date of this act.
Page 267, strike lines 30 through 35.

(This amendment modifies language included in the proposed budget related to the development and implementation of care coordination services for individuals in need of behavioral health services that are not receiving them through managed care organizations. The proposed replacement language requires the development of a blueprint in consultation with the Department of Behavioral Health and Developmental Services, the Virginia Association of Community Services Boards and other stakeholders. The blueprint shall include details on funding, populations served, services provided, time frame for program implementation, and education of clients and providers. In addition, the blueprint requires the inclusion of 19 principles for care coordination. The proposed language builds upon approaches that have been successful in moderating costs while assuring access and seamlessness of community mental health rehabilitation services and exploring their adaptations in Virginia. Also, it ensures that the models developed and implemented do not result in more expensive and less appropriate placements. Language that would implement care coordination for individuals receiving services in the Mental Retardation/Intellectual Disabilities (MR/ID) waiver is also eliminated in order to develop a plan for implementation.)