Behavioral Health Payment and System Reform
This project was completed in September 2010
To best meet the increasing need for behavioral health services by adults with a severe mental illness and children who have a severe emotional disturbance, the NH Bureau of Behavioral Health (BBH) will seek to replace the existing Medicaid fee for service system with a prepaid health system. With funding from the Endowment for Health, the UNH Institute on Disability is providing the project coordination through September 30, 2010.
Establishing a prepaid health system will be accomplished with what is known as a 1915(b) Medicaid Waiver. 1915(b) Waivers allow states to develop managed care plans as a vehicle for providing services to Medicaid recipients.
Inclusive of Active Participation
- Recognizing the transformative nature of this process, consumers, family members, providers - inclusive of community mental health and peer support, policy leaders and other stakeholders will have an active role in providing input and guidance into the transformation of NH’s mental health system.
- Planning efforts will encompass the necessary changes needed to be successful - inclusive of programmatic, financial, regulatory, operational and cultural changes required in order to advance a successful implementation of a new payment and service model.
Funding for Services
- Will be based on the approved and verified cost of providing services, inclusive of funds necessary to improve quality and support the overall agency operations.
- Will allow for reinvestment into new services, with priority given to continued expansion of Evidence Based Practices, programs and services identified in the 10-year plan, and new and promising programs prioritized by consumers and families.
- Will be predictable and support the provision of services based on the consumer’s and family’s need.
- Will strive to balance the requirements of documentation and other administrative responsibilities that are tied into the provision of services, oversight of the system, and the measurement of outcomes, with the need to promote efficient operations, compliance with state and federal regulatory requirements, and ensuring capacity is maximized to provide services.
- Will assure that any opportunities under the Affordable Care Act to leverage additional funding for expanded services or to offset the costs of providing services are actively explored and incorporated into this initiative, as well as factoring in anticipated enrollment expansion to ensure that an adequate infrastructure is in place prior to anticipated increases in new individuals coming into services.
Services to the Uninsured who have a Severe Mental Illness
- Will be addressed as part of Payment and System Reform. New opportunities for revenues and federal participation will be explored as part of a broader policy initiative in conjunction with policy leaders, providers, consumers and families.
- Roles and responsibilities will be clarified as part of this work to ensure an appropriate balance of access to care with the overall financial responsibility of the state and provider system.
Improves Consumer Outcomes
- A transformed system of care will promote individual recovery goals in a manner that is measurable and understandable to all stakeholders, and provides information to the consumer, the clinician, and family to support a person-centered, consumer-driven treatment planning process.
- The overall quality of care provided will continue to improve over time.
- The system will increase community tenure, reduce the need for costly hospitalizations, provide access to employment, build on and improve upon an individual’s strengths, and build on personal recovery goals to improve functioning in an individual’s daily life.
Timely, Flexible, Responsive System of Care
- A transformed system will promote timely access to treatment for our current priority population, and will adjust for anticipated increases in demand for services in the coming years.
- Will provide flexibility to providers to create a stronger, more streamlined system to identify individual needs and develop service capacity in the local community to meet those needs in the right place at the right time.
Transparency to Consumers, the Public, and Stakeholders
- Individual, regional and statewide outcome measures will be collected and shared with our stakeholders to support informed data driven decision making.
Care is Driven Locally
- Care management decisions will be driven locally, in a collaborative process between the individual and the provider, utilizing a person-centered approach to prioritize an individual’s recovery goals.
Shared Risk Agreements
- Future payment models will be customized regionally and represent a shared risk between the state and the provider community around enrollment, utilization and the cost of providing services.
The Behavioral Health Payment and System Reform project is funded by a one-year, $100,000 grant from the Endowment for Health.