Medicaid Mental Health Managed Care Transition

Picture of mom with kids The Idaho Medicaid program was directed by the 2011 Legislature to develop a managed care program for mental health services. Over 35 other states utilize managed care administration for their mental health programs to improve quality, ensure access for enrollees, and maximize the cost-effectiveness of taxpayer dollars being spent for Medicaid mental health services.

Idaho is unique with its small population, rural nature and geographic diversity. Because Idaho is vastly different than many other states, Idaho Medicaid issued a Request for Information (RFI) in May 2011 to ascertain whether managed care organizations would be interested in a single, statewide contract for Medicaid mental health services.

The response from the managed care industry was very encouraging. With this positive feedback, Idaho Medicaid has begun the process to define the specifics of a contract proposal, commonly called a Request for Proposal, or RFP. The mental health managed care RFP will provide the contract requirements for the main elements, which include:

Participant Assessment and Eligibility--What is the best way to assess needs and determine mental health program eligibility?
Benefits--What services must be included? Can you describe other types of services you feel would enhance the benefit package?
Provider Qualifications and System Delivery Standards--Who should be able to provide services and what standards should be established?
Quality Assurance--What data should the managed care entity provide regarding outcomes?
Local Community Engagement--How should the managed care entity work with local communities to address conflicts, complaints and obtain feedback?

Developing a mental health managed care program is a statewide effort of Medicaid staff, mental health and medical providers, community partners, participants and families. Idaho Medicaid held a statewide meeting of these stakeholders to gather specific recommendations and priorities for the main requirements for an RFP on August 30, 2011. Over 75 people participated in the meeting, which was video-conferenced at 10 sites throughout the state. This stakeholder input is being used to develop the RFP, which the state intends to release in June 2012.

A panel of stakeholders presented ideas on development of an RFP for a mental health managed care system. Members of the panel presented powerpoint presentations, which are available by clicking the name of each stakeholder.

Dr. John Hanks, D.O., Pediatrician

Kathie Garrett, Regional Director for West NAMI-Idaho

Jeff Wright, President of the Idaho Mental Health Providers Association

Martha Ekhoff, Office of Consumer Affairs

Teresa Wolf, Chair of the State Mental Health Planning Council

A summary of the recommendations and input from the August 30 stakeholder forum is available here. If you were unable to attend the forum but wish to submit ideas on development of the RFP for mental health managed care, please share your thoughts through the form below.

Share Your Ideas!

We are interested in receiving your comments, recommendations and questions as we work to develop a contract proposal for Medicaid mental health managed care. Comments will be reviewed and then posted below. Questions will be considered and answered in the FAQ on the right, which will be updated periodically. There is a 150 word limit on suggestions submitted through this form. If you would like to be notified when this webpage is updated, please sign up to "Monitor this Page" on the right.

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All submissions will be reviewed and considered for publication. Medicaid may not be able to acknowledge or respond to individual posts. Any offensive or inappropriate comments will be deleted. Your comments from the feedback form will be displayed below.

Feedback Comments

Anonymous 1/4/2012 12:53 PM
Benefits

I think the current array of services needs to be maintained. Many clients need the services they currently have and would not be able to be independent without them. I do think that some oversight would be good as far as clients ending services when they no longer need them and ensuring that workers and agencies are actually working toward successful discharge from high cost services. No one should have the same services for 1o years in a row without somebody calling into question whether the service providers are doing their jobs and whether the services are really appropriate for the client.

Michael Hinman 12/6/2011 3:30 PM
Local Community Engagement

How does the contractor plan to work with the Regional Board to ensure local priorities will be met. Supportive housing is a priority and no medicaid funding is going towards it. How about assessments for people who aren't on medicaid but may meet SSI criteria but can't wait the 2 years it takes to get on SSI. Also, how do we ensure ongoing family and consumer inputThe system needs to focus more on prevention and early identification and less costly alternatives to crisis response and hospitals or jails. How does the contractor plan to do that. thanks

Roma Hawkins 11/16/2011 7:16 AM
Local Community Engagement

How will this system engage the rural communites of Idaho? I have recently heard from several local medicaid agencies that they are not even aware that this process is happening. Needs to be discussed in the media and face to face contacts with with providers. We seem to be setting up a conflict between the local boards and this new managed care provider. I think the local boards should be involved in picking providers.

Nancy Lopez 11/16/2011 7:16 AM
Local Community Engagement

The Managed Care Organization service providers should meet the needs of the local communities as identified by the local Behavioral Health Boards. The local Behavioral Health Board should receive regular outcome reports on data that is mutually agreed upon between the MCO and the community Behavioral Health Boards. The MCO should view the Behavioral Health Boards as the local voice that is able to identify unmet needs and gaps in service in each local community, and should work jointly with the Behavioral Health Boards to build prevention services, recovery support services and housing services in each area of the state as the need is identified.

Eric F. Jones 11/16/2011 7:16 AM
Provider Qualifications & Syst. Delivery Standards

Managing costs is important to all providers. Keeping staff is essential to deliver services. Our sttaff offers the following ideas: 1- Use the current certification of mental health clinics and allow Idaho licensed clinicians to supervise PSR's through same process as Licensed clinicians are (verified CEU's annually); 2- Keep PSR services in place - greater ability to change beahviors occurs when there is access to family system environment; 3- Encourage providers to build into their services multiple venues which is happening nation wide. This provides consumers with access to mulitple treatment options with the least amount of travel and keeps communications between treatment providers more accessible.

Chad L Murdock MD, President Idaho Psychiatric Association 11/16/2011 7:16 AM
Benefits

Managed care mental health benefits should include home based preventative services supporting and strengthening early parent-child relationships characterized by nurturing, bonding, and attachment. These services maximize parents’ capacities to respond appropriately to stresses of parenthood and lessen the impact of previous deprivations or traumas and/or current difficult life situations. Home visitors trained and endorsed as infant/early childhood mental health specialists by the new Idaho Association for Infant/Early Childhood Mental Health (AIM Early Idaho) would provide these services. Training and endorsement to certify these providers and maintain competency and certification at four different levels has already begun--two levels of certification for home visitors and two levels for supervisors and administrators. These infant/early childhood mental health specialists from multi-disciplinary backgrounds are experienced working with young children and their parents. Some are l

Deric Ravsten, DO 11/16/2011 7:16 AM
Other

Managed care considerations The liabilities and pitfalls of any third party payor system are many. Cost control needs to be balanced with effective, efficient and careful allocation of resources to those most in need. With that in mind, the common ground for all patients, families, providers, taxpayers and state agencies might consider the following standards of care as a managed care system is contemplated. Standards of Care 1. Ready access for persons with mental health disorders 2. Clear, transparent criteria for admission for services based on risk assessment factors 3. Allocation of services in graduated, coordinated and measured manner 4. Quality care monitoring and application of evidenced based interventions 5. Creation of tiered levels of service: Specialty care service and Primary care service 6. Creation of state mental health director (psychiatrist or psychologist) Safeguards need to be built in to t

JKelly Keele 11/16/2011 7:17 AM
Local Community Engagement

I represent community mental health providers on the Region 7 Mental Health Board. It is very important the RFP include language which requires the successful contractor to develop service systems, as identified as appropriate and necessary, by the Regional Mental Health Boards.

Jane Roberts 11/16/2011 7:17 AM
Quality Assurance

I agree with Tracey that "the MCO should view the Behavioral Health Boards as the local voice that is able to identify unmet needs and gaps in service in each local community. The MCO should work jointly with the Behavioral Health Boards to build: prevention services, recovery support services and housing services..." This includes ensuring that MH consumers receive transitional services when moving between one program and another. Programs cannot just provide information and expect the consumers to follow through on it. Programs need to follow-up with the consumer to ensure that the transition has been successfully completed and, if not, then work with them to complete it. This includes transitions from one level of care to another, i.e, SHS/ACT/jail to community or family services.

Jane Roberts 11/16/2011 7:17 AM
Participant Assessment & Eligibility

Our son, like other people with mental health problems, has been in and out of jail. Please include provisions for identifying new people with mental health issues in the community and in the jails (whether adult or juvenile). These people often end up in jail due to self-medication/substance abuse issues long before they are finally diagnosed as having a mental illness. We need to identify them earlier so they can begin receiving treatment earlier. Often early treatment can reduce more severe manifestations of their illnesses.

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