STATE OF KANSAS – DEPARTMENT OF

SOCIAL AND REHABILITATION SERVICES

MEDICAID MENTAL HEALTH SERVICES

COMMUNITY BASED MANAGED CARE

Concurrent 1915 (b)(c) Waiver

September 26, 2010

Bobbie Graff-Hendrixson, LMSW in Collaboration with

Elizabeth Phelps, J.D., M.P.A.

History & Background

In the Spring of 2004, CMS notified SRS that portions of the current Medicaid State Plan governing mental health/behavioral health services were considered out of compliance with the current practice standards.

These specific areas were cited:

Any willing provider - any provider licensed in Kansas must be equally allowed to deliver a Medicaid service

Comparability of Services - all people who are Medicaid eligible must have equal access to service

Rehabilitation Services - must focus on restoration of best functioning level

Institutes for Mental Disease (IMDs)

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Responding to Concerns

The solutions were built on familiar, successful, co-created

values including…

Consumer Voice, Choice and Success

Optimizing the Community Mental Health Center (CMHC)

and substance abuse provider partnerships, as well as the

community focused history

Preserving the current infrastructure

Resource economy and efficiency

Kansas was committed to both meet or exceed federal

expectations and enhance these critical public health programs

for Kansans.

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Responding to Concerns

In 2006, SRS established and broadly published a set of guiding values that would

drive the readiness and operational activities for the public mental health and

substance abuse systems, while supporting strong and durable community-based

services and future transformation goals:

The existing public mental health and substance abuse treatment systems will be

supported.

Community Mental Health Centers (CMHCs) will retain primary responsibility for

meeting the needs of all Kansans accessing the public mental health system.

A single statewide substance abuse contractor will have primary responsibility

for meeting the needs of all Kansans accessing the public substance abuse

system.

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Responding to Concerns5

The public mental health and substance abuse systems will

make effective and efficient use of all treatment resources

available.

Stakeholders will be actively encouraged to participate in

shaping public policies and the functional design of these

public service systems.

The solutions we craft will be supportive of the goals and

recommendations identified in the New Freedom Commission

report, Achieving the Promise: Transforming Mental Health Care

in America.

The programs will be responsive to and build upon direction

from the 2006 Kansas Legislature.

Responding to Concerns

Kansas amended the current state plan and the

HCBS SED Waiver to address CMS concerns … and to

address the needs of Kansas consumers.

Applied for and received approval for a

1915 (b) managed care waiver to address CMS concerns

… and to preserve and efficiently manage the Kansas

system. The 1915(b) waiver is our “umbrella” for the

1915(c) or more correctly stated, Kansas has a concurrent

1915(b)(c) waiver.

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What Happened When Kansas

Responded – Stakeholder Input

In early 2007, SRS conducted a series of stakeholder information and input sessions across the state, including small group Q&A sessions, technology-based review sessions and town hall style meetings.

These interactions included providers, members, families, advocacy groups and others to explore core features of the programs and infrastructure.

SRS also provided information and updates to legislative bodies throughout the development and implementation of these programs.

Thousands of Kansans were able to participate in and provide feedback through these sessions, and via a dedicated email address for suggestions or questions.

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What Happened When Kansas

Responded– Stakeholder Input

To gain focused input as to building operational tools for the programs (including contracts, system management features, provider requirements and service descriptions), SRS sponsored broad-based stakeholder work sessions. These sessions were structured to include an educational portion so participants could focus on specific system issues (consumer rights, affiliate/subcontractor agreements, quality/access requirements, implementation priorities), with a facilitated discussion and input portion.

SRS developed a web-based stakeholder review and input process so key issues and substantive documents associated with the program could be posted at www.dbhsupdates.org , e-mail alerts could be sent to interested parties, information could be reviewed, and feedback could be readily and immediately provided.

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What Happened When Kansas

Responded

Licensed Practitioners were expanded to include all individuals in Kansas who are Licensed Mental Health Practitioners as defined by state licensing rules and regulations. This allowed for more customer choice in a managed care network. Customers have access to an expanded provider network for mental health therapy services.

All services in the Rehabilitation section of the State Medicaid Plan that were not rehabilitative in nature were moved to their appropriate section or eliminated from the State Plan. In addition, all restrictions or limitations based on beneficiary population designators were removed. Access to service continues to be based on medical necessity using functional measures.

Creation of Psychiatric Residential Treatment Facilities to serve youth with significant psychiatric treatment needs.

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Continual Stakeholder Input

As an example:

this chart

summarizes the

overall use of the

waiver/state plan

change materials

posted for review

and feedback on

this site, State

Fiscal Year 2010.

July 1, 2009-June 30, 2010 – Overall visitors to waiver/state plan

change review/feedback website

Visitors Total Visitors 8,190

Average Visitors Per Day 1,381

Average Page Views per

visitor

6.52

Average Downloads per

visitor

6.13

Pages Total Page Views 17,060

Average Page Views Per

Day 121

Pdf Documents Total Hits 125,698

Total File Downloads 3,592

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Collaboration

Collaboration continues with the Kansas Health Policy Authority (Medicaid Agency) and the MMIS Fiscal agent to develop/submit all related approval documents and make MMIS changes.

All of the prepayments for these programs are short handed in the functional lexicon as “capitation payments”. While some lexicon blurs the distinctions, the contractual and operational terms comply with applicable federal regulations.

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Accountability Is Us!

External Oversight & Monitoring

Kansas Foundation for Medical Care (EQRO)

CMS Managed Care Review (Spring 2008, Spring 2010)

Independent Assessment – TriWest Group (for first renewal application, and start date is October 2010 for second renewal)

CMS Program Integrity Review (November 2009)

Quarterly federal reporting

SED Waiver Review (Renewal October 1, 2010) and

PRTF CBA grant program review

Quarterly Managed Care Oversight committee

Quarterly Statewide (membership) Quality committee

Ongoing Medicaid Agency coordination and review activities

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Community Based Managed Care –

Prepaid Ambulatory Health Plan (PAHP)

The federal term for the community based managed care

plan is a PAHP.

Kansas Health Solutions (KHS) is the PAHP established as

the managed care entity in Kansas.

KHS ensures accessibility, quality, appropriateness and

responsiveness of mental health managed care.

Although not the focus of this presentation, it is important to

note under the Kansas 1915(b) is a Prepaid Inpatient Health

Plan (PIHP) for substance abuse treatment. The managed

care entity is Value Options.

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Programs managed with the State under the

Community Based Mental Health Program:

All outpatient mental health services to Medicaid members, including:

Traditional services -

outpatient therapy

medical services i.e. medication management

Rehabilitation /support services -

targeted case management

community psychiatric support and treatment

psychosocial group/individual

attendant care

peer support

crisis services

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Programs managed with the State under the

Community Based Mental Health Program:

Home and Community Based Services (HCBS) for children with a Serious Emotional Disturbance (SED) 1915(c) Waiver, includes these services:

Parent support and training

Independent living/skills building

Respite care

Wraparound facilitation

Professional resource family care

Attendant care

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Programs managed with the State under the

Community Based Mental Health Program:16

PRTF CBA Grant includes these services:

Parent support

Wraparound facilitation

Respite care

Professional resource family care

Attendant care

Independent living/skills building

Employment support

Assisted living funds

Role of Kansas Health Solutions

Role of KHS: Oversee, administer, and manage a comprehensive community mental health program network:

Protect Medicaid recipient rights

Hear and address grievances

Recruit and enroll a sufficient network of providers statewide to ensure timely access to quality, medically necessary community mental health services

Process, evaluate, monitor, adjudicate, and pay claims for medically necessary Medicaid funded community mental health services provided to Medicaid eligible recipients

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Role of Kansas Health Solutions18

Provide provider education that ensures compliance with all Medicaid requirements

Monitor and manage service utilization

Provider quality assurance oversight

Manage and administer with the state assigned portions of the SED Waiver and PRTF CBA grant

Monitor for fraud and abuse

Ensure corporate compliance of providers

Evidence Based Practices19

Supported training by the University of Kansas for CMHCs to meet fidelity on the following practices:

Supported Employment

Family Psychoeducation

Integrated Dual Diagnosis Treatment

Strengths Based Case Management

Evidence Based Practices20

Regardless of a service or practice reaching

fidelity, Kansas holds true to this guiding

principle –

“A strengths perspective arises from the commitment

of the profession of social work to social justice, the

dignity of every human being, and building on

people’s strengths and capacities rather than

focusing on their deficits, disabilities, or problems.”

Evidence Based Practice Newsletter

http://www.socwel.ku.edu/mentalhealth/EBP/EBP%20TIMES.htm

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Resources:

DBHS Updates Website:

www.dbhsupdates.org

News, updates and controlling documents,

including:

1915(b) Waiver Application (initial and renewal)

1915(c) SED Waiver Application/amendments

October 1, 2010 1915(c) Renewal

PAHP and PIHP contracts/amendments

Consumer Satisfaction Survey

Minutes from State Quality Committee meetings

Minutes from DBHS MCO Oversight meetings

CMS and external reports

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