NYAPRS Note: The below summary from OMH concludes with an announcement about the official delayed release of the final Request for Qualifications that will allow managed care companies to apply to manage the BH Medicaid benefit and the HARP specialty product. Ensuring that each detail is finalized before the final draft is released is imperative for the smooth transition of this project and for ensuring the safety and appropriate treatment of our community members. No indication of a delay in the implementation of BH managed care has been announced; we are still preparing for a January 2015 roll-out in NYC and July 1 2015 start date for upstate NY.

Behavioral Health Managed Care Phase 2

The vision for Phase 2 is to create a system that provides New Yorkers with fully integrated behavioral health and physical health services offered within a comprehensive, accessible and recovery oriented system. For adults 21 and older, the integration of all Medicaid behavioral health (BH) and physical health (PH) benefits under managed care will go into effect January 2015 in NYC and July 2015 in the rest of New York State and will be delivered through two BH managed care models:

• Mainstream Managed Care Organizations (MCOs): Qualified Mainstream MCOs will manage care for adults including services for mental illness, substance use disorders, physical health and pharmacy.
• Health and Recovery Plans (HARPs): HARPs will manage care for adults with significant behavioral health needs. They will facilitate the integration of physical health, mental health, and substance use services for individuals requiring specialized expertise, tools, and protocols which are not consistently found within most medical plans. In addition to the State Plan Medicaid services offered by mainstream MCOs, qualified Health and Recovery Plans will offer access to an enhanced benefit package comprised of 1915(i)-like Home and Community Based services designed to provide the individual with a specialized scope of support services not currently covered under the State Plan. In order to qualify to deliver BH services, Plans must demonstrate that they have the organizational capacity and culture to ensure the effective management of behavioral health care and facilitate system transformation. All applications will be reviewed against new behavioral health specific administrative, performance, and fiscal standards.

Stakeholder Engagement

In an effort to engage stakeholders in the design and delivery of the behavioral health managed care model, OMH, in partnership with DOH and OASAS, continues to meet with Managed Care Plans, Provider Associations, families and consumers regarding this important behavioral health transition from FFS to Medicaid Managed Care.

Additionally, OMH, OASAS, and DOH continue to meet with the MRT Behavioral Health Workgroup for input and feedback on the managed care design.

All Medicaid Redesign Team (MRT) Behavioral Health Managed Care updates can be found through the MRT Behavioral Health Reform website  .

Qualification Process

Before Phase 2 can be fully implemented, managed care plans will be required to submit applications to New York State demonstrating that they have the organizational capacity and culture to ensure the delivery of effective behavioral health care and facilitate system transformation. These applications will be reviewed against new behavioral health specific administrative, performance, and fiscal standards. The RFQ will qualify Plans to manage services on their own or in partnership with a BHO.

Behavioral Health Managed Care Phase 2 Update

New York State is delaying the release of the Request for Qualification regarding “New York’s Request for Qualifications (RFQ) for Behavioral Health Benefit Administration: Managed Care Organizations and Health and Recovery Plans”. Final release of the RFQ is scheduled for 3/21/14.

MRT Behavioral Health Reform Work Group  – This link provides the latest power point presentations and updates for the MRT Behavioral Health Reform Work Group.

Behavioral Health Transition Request for Information (RFI) package:

New York State released a Request for Information  regarding “New York’s Request for Qualifications (RFQ) for Behavioral Health Benefit Administration: Managed Care Organizations and Health and Recovery Plans.” This RFI is designed to solicit input concerning New York’s draft proposal to manage Medicaid substance use and mental health benefits.

http://omh.ny.gov/omhweb/bho/phase2.html#news