Medicaid Financing for Family and Youth Peer Support: A Scan of State Programs

Transcription

1 Medicaid Financing for Family and Youth Peer Support: A Scan of State Programs National Federation of Families for Children s Mental Health 23 rd Annual Conference Washington, DC November 17, 2012 Dayana Simons, CHCS Dana McCrary, Georgia, DBHDD Jane Walker, Maryland Coalition of Families for Children's Mental Health This document was developed under grant CFDA from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. However, these contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government.

2 CHCS Priorities Our work with state and federal agencies, Medicaid health plans, providers, and consumers focuses on: Enhancing access to coverage and services Improving quality and reducing racial and ethnic disparities Integrating care for people with complex and special needs Building Medicaid leadership and capacity 2

3 Maryland, Georgia and Wyoming Collaborative CHIPRA Grant Project Goal: Improving the health and social outcomes for children with serious behavioral health needs by: Implementing and/or expanding a Care Management Entity (CME) provider model to improve the quality - and better control the cost - of care for children with serious behavioral health challenges who are enrolled in Medicaid or the Children s Health Insurance Program. 3

4 What Is A Care Management Entity (CME)? An organizational entity such as a non profit organization that serves as the locus of accountability for defined populations of youth with complex challenges and their families who are involved in multiple systems. An entity that is accountable for improving the quality, outcomes and cost of care for populations historically experiencing highcosts and/or poor outcomes. Pires, S Building systems of care: A primer, 2 nd edition. Georgetown 4

5 CME Core Services Intensive Care Coordination (at low ratios) Family and Youth Peer Support Mobile Crisis Response and Stabilization Intensive In-Home Services

6 CHCS Technical Assistance to the Collaborative: Background on the Matrix CHCS is: The coordinating entity for the states in the CHIPRA Collaborative Responsible for the Quality Framework and Internal Independent Evaluation The lead Technical Assistance Provider: Webinars 2010 Series, 2011 Series, 2012 Series Monthly individual technical assistance calls Quarterly all-states meetings Shared online resource space for collaborative states Fact sheets (e.g., Care Management Entities: A Primer) Matrix of standardized assessment tools used to guide clinical decision making Matrix of options for structuring a CME model Scan of states using Medicaid to finance family and youth peer support Learning communities (state and national) 6

7 Types of Medicaid Coverage for FYPS and States Using Them State Plan Amendment (SPA): AK, AR, AZ, KY, MA, MI, OK, WA Waiver: 1915(c) Home and Community Based Services PRTF GA, IN, MD, MT, SC SED KS, MI 7

8 Information in the Scan Medicaid funding source FYPS provider (service) title Definition Components of service Billing codes Billing amounts Qualifications, training and supervision requirements 8

9 Georgia: Growing the Family Movement Child & Adolescent State Infrastructure Grant (CASIG) System of Care (SOC) Grant Project Partnership with the Statewide Family Network (Georgia Parent Support Network (GPSN) Sue Smith, CEO) Invited families to the table Cultivated parents and youth through training, conferences and inclusion Aggressively grew Federation of Families chapters statewide Engaged/empowered youth through Youth Move 9

10 Georgia: Adult Certified Peer Specialist (CPS) In December, 2001 approximately 35 current and former mental health consumers completed training and examination to become Georgia's first class of Certified Peer Specialists (CPSs). Certified Peer Specialists: Are responsible for the implementation of peer support services, which are Medicaid reimbursable under Georgia's Rehab Option. Serve on Assertive Community Treatment Teams (ACT), as Community Support Individuals (CSI) and in a variety of other services designed to assist the peers they are partnered with in reaching the goals they wish to accomplish in their personal recovery journeys. Today there are over 700 Adult CPSs in Georgia. 10

11 DBHDD: Supporting the SOC Values Building Capacity for Family Involvement HTI Serving Transition Age Youth and their Families Growing Services to eliminate the gaps in our service delivery system Making Sure Georgia Youth/Families receive services the whole life cycle CBAY Develop CME Financing mechanism to support Parent Partners Embedded Parent Partners in High Fidelity Wrap Training SUICIDE PREVENTION Funding Adult & Youth Mental Health First Aid Train the Trainer for Parents ADDICTIVE DISEASE Integration of Training Inclusion of Clubhouse Parents /Youth & Staff ADULT CERTIFIED PEER SPECIALIST (CPS) Also Parents With Identical Values, Similar Experiences Strong Allies 11

12 Georgia CHIPRA Project: Medicaid-Funded Peer Support Services Research and synthesize national best practices for Parent/Youth Certified Peer Supports Coordinate the development of a training curriculum and certification for Parent & Youth Peer Specialist Develop training plan for Parent/Youth Peer Specialist Workforce Develop a Network of Credentialed Certified Parent/Youth CPS Partner with local family groups and organizations 12

13 Georgia s Process: Using the Matrix Working to change the shape of the table to a round table Building capacity Building relationships Building a network 13

14 Georgia s Process: Beauty of the Matrix CHCS Technical Assistance: Research Funding source Title Definition Components of service Billing codes/amounts Qualifications, training and supervision 14

15 Georgia s Process: Develop the Service Outline Duties What we must do Knowledge What we need to know Competencies What skills we need to be able to do it 15

16 Provide support to families based on similar experiences PURPOSE ROLE To create an environment for empowerment by listening to and sharing life experiences and information; developing one on one relationships; and improving the family s ability to connect and communicate RESPONSIBLE FOR ENSURING THAT No parent has to do it alone Parents have access to the right amount and type of information to make sense of their child s situation Supportive relationship built on encouragement exists between PPS and parent Parents are empowered and prepared to make the best use of any meetings or activities concerning them, including helping find ways to take care of themselves Parents can indentify and connect with their own supports Parents are able to navigate through the current services they receive 16

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18 Understanding the Medicaid Component is Foundational Parents don t think about understanding Medicaid, but it matters! Families, family organizations need to get training and build their understanding of it. 18

19 Maryland s Medicaid Experience Naïve is the word! MCF became a Medicaid provider in 2009 as part of a 1915(c) demonstration waiver Steep learning curve! Billing procedures Training Required documentation developing forms Administrative costs increased dramatically in order to bill Medicaid 19

20 Maryland s Medicaid Experience Adapting practice from whatever it takes to whatever I can bill for challenge to our values Financially devastating for the first 2 years and still difficult The good news being a Medicaid provider has not changed our mission or ability to advocate and in the end has strengthened our practice and stature staff view themselves as professionals 20

21 Considerations for FSOs: It s a Choice and a Decision Does it fit with your mission? Family Support Organizations (FSOs) often think becoming a Medicaid provider is the only way to achieve sustainability Important for FSOs to make an informed decision and choose whether or not to become a Medicaid provider Weigh the pros and cons 21

22 Considerations for FSOs (cont.): If You re Going to Do This, This Is What You Need to Know Focus on definitions How is your state defining family support? Rates What is the rate? How was it determined? 22

23 More Considerations for FSOs How many contacts can you have with a family? How many hours per day? How many times per week? Is there a limit? What other contacts can you bill for? Meetings Phone calls With the family With the Care Coordinators or others working with the family Finding resources for the family 23

24 Still More Considerations! Can you afford it?! What are your administrative costs for billing? Can you afford the cost for times when you cannot bill (i.e., supervision, training, holidays, sick leave)? How are you paying your staff? Salaried Per billable hour 24

25 How Will Being A Medicaid Provider Change Your FSO? How will it change your: Mission Practice (with limits on what you can and can t do) Partnerships (from being an FSO to being a provider) Advocacy role 25

26 Questions? 26

27 Visit CHCS.org to learn more about the CHIPRA CME Collaborative. Contact us: 27