HHS Committee to Hear Updates on MECMS, Mental Health Managed Care
The Joint Standing Committee on Health & Human Services has scheduled a briefing on several key state health care initiatives for Tuesday, June 27. 2006 from 10:00 a.m. to 3:00 p.m. The meeting will take place in the Committee's regular room, Room 209 of the Cross State Office Building. The Committee's schedule for the day is:
10:00 a.m.: Riverview Psychiatric Center
11:00 a.m.: Mental Health Managed Care
1:00 p.m.: Maine Quality Forum
1:30 p.m.: MECMS
2:15 p.m.: Medicare Part D
DHHS Commissioner Harvey continues to communicate regularly with behavioral health care providers about the status of the State's behavioral health managed care initiative. The following is a memo to members of the Appropriations and HHS Committees dated June 21, 2006.
June 21, 2006
TO: Arthur F. Mayo, III, Co-Chair
Hannah Pingree, Co-Chair
Members of the Joint Standing Committee on Health and Human Services
Margaret Rotundo, Co-Chair
Joseph C. Brannigan, Co-Chair
Members of the Joint Standing Committee on Appropriations and Financial Affairs
FROM: Brenda M. Harvey
SUBJECT: Behavioral Health Managed Care
This is to update you regarding our efforts to implement managed care for behavioral health and to identify issues that cause us to delay the issuance of an RFP.
Highlights of Events to Date
Feb. 2006: Because of significant comments from providers, consumers and families, the Department proposed implementing managed care on a phased-in basis, starting with an Administrative Services Organization (ASO) model that would accomplish prior authorization for selected behavioral health services and utilization review for all behavioral health services. This was to be accomplished through a sole source contract with Beacon Health Strategies effective July 1, 2006.
April 2006: As a result of further concerns expressed by providers. DHHS did not pursue prior authorization or utilization review which were the key components of the ASO prior to January 1, 2007.
May 2006: The Department shifted to a “service review” model of selected behavioral health services. This was in response to providers’ request for a “readiness review.” This contract was effective May 1, 2006 and awarded on a sole source basis, continuing our work with Beacon Health Strategies.
This shift in plans requires the Department to issue an RFP to implement a risk based managed care program.
Challenges to Awarding a Managed Care Contract by January 1, 2007 (current date in LD 1968)
There are significant challenges to awarding a managed care contract by January 1, 2007.
Assessing stakeholder involvement: Consumers and families continue to press for more involvement in the development of the RFP. The Department has created a stakeholder group, subgroups and some smaller working groups to assist in drafting language for the RFP, but more involvement is being requested, even by the Court Master in his May report to the court. We have promised to hold statewide forums and the Court Master expects these to happen. To include consumers and families in more significant ways requires more time.
Managing funds: Because the Department will be paying a managed care vendor on a prospective basis, we are accountable for assuring that we manage the funding for all parties. It is critical that we develop an RFP detailing the requirements for service delivery, solvency, financial and other reporting, etc.
Capitation rates: The capitation rate setting is anticipated to be available in October, rather than the spring, as originally anticipated. DHHS staff and Muskie staff have held weekly conference calls with Mercer since January in order to identify all of the data necessary for the development of the capitation rates and the cost neutrality section of the Medicaid Waiver. This process has taken longer than anticipated because of the complexity of codes and funding mechanisms supporting the behavioral health system. Because of this significant change from our original work plan, the capitation rates are significantly delayed.
Time to review bids: We expect to receive at least three proposals in response to the RFP. This definitely signals that the savings we are projecting can be achieved even with what we have already stated as our requirements. The review of these proposals is a very complex process that requires adequate time.
CMS approval: Complicating all of our planning efforts is the fact that our overall implementation schedule is contingent upon CMS approval of the Waiver and the final managed contract. While we plan to have informal submissions to minimize the time necessary for the formal approval process, CMS has 90 days to approve, deny, or ask questions (thus stopping the clock) on the waiver. Once DHHS responds to questions, another 90 day clock starts.
The Department will also have to seek expert assistance in a number of additional areas.
Financial Management: Financial staff within DHHS will be shifting some of their activities to financial oversight of the managed care organization. They need to identify the reports required of the managed care organization; they need to know how to analyze these reports and how to recognize early warning signs.
Federal requirements: There are also a number of federal requirements under managed care waivers that we did not anticipate. These include an External Quality Review and an Independent Assessment. These will review both the operation of the managed care vendor as well as the Department’s oversight of the vendor in the areas of quality, access and cost.
MCO readiness: Prior to implementing managed care, the Department must assess the readiness of the chosen vendor.
DHHS continues to believe strongly that our plans to manage behavioral health care will result in greater access for consumers and enhanced quality of care. This delay will only serve to make the full implementation of managed care a smoother process.
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