State policymakers must often take action during an emerging crisis even when evidence identifying the best policy approach is not be available. This report, Evidence-Based Policymaking Is an Iterative Process: A Case Study of Antipsychotic Use among Children in the Foster Care System, explores successful state responses to dramatic increases in antipsychotic prescription rates in Medicaid-enrolled children in foster care. It highlights several strategies, including payment reforms, delivery system innovations, and quality supports for clinical care.
The report results from a convening by the National Academy for State Health Policy of researchers and state officials with expertise in financing and operating Children’s Health Insurance Program and Medicaid programs, children’s health, and health policy and pharmacy research. The meeting preceded the release of a Patient-Centered Outcomes Research Institute-funded study, which examines the comparative effectiveness of state oversight systems in Ohio, Texas, Washington, and Wisconsin.
Thursday, August 16th
10:00am – 11:30am
Transitioning from youth to adulthood requires increased responsibility for many areas of life, including managing one’s health. This can be particularly challenging for children with a range of social and health care needs, particularly children with special health care needs. Policymakers from several states, including Georgia and Wisconsin, discuss innovative approaches to support young adults’ transitions to adult health care services and programs through managed care, quality improvement, family engagement, care coordination, and interagency collaboration and cooperation.
This session is supported by the Lucile Packard Foundation for Children’s Health
ModeratorsLori Abramson, Director-Georgia Families 360, Georgia Department of Community Health
Lori Abramson, LCSW is Director of the Georgia Families 360° program at the Georgia Department of Community Health. She ensures that children in foster care, adoption assistance, and youth in the juvenile justice system receive medical, dental, and behadvioral health care without barriers. Lori has 38 years’ experience in clinical practice, advocacy, collaboration building, and the managed care environment. Lori’s professional focus is about leveraging that experience on behalf of Georgia’s children and families.
Donna Bradbury, Associate Commissioner, NYS Office of Mental Health
Donna Bradbury directs the Division of Integrated Community Services for Children and Families at the Office of Mental Health. She oversees all community-based children’s mental health programs in New York State. She is currently leading the effort to transition children’s behavioral health services into Medicaid managed care as part of the larger Medicaid Redesign project.
Prior to state service, Donna worked for twelve years for the Rensselaer County Department of Mental Health. She delivered clinical services to children and their families, served as a consultant to Family Court as well as county-operated human service departments and schools, ran a specialized treatment program which successfully prevented institutional placement for many youth, and assisted in the creation and implementation of several interagency initiatives that resulted in children and their families having easier access to better quality services.
SpeakersBecky Burns, Statewide Coordinator, Wisconsin Children and Youth with Special Health Care Needs Program
Becky’s career centers on supporting children and families whose lives have been affected by unanticipated journeys through the world of disability services. She treasures the opportunities to work with these families whose resilience and growth continues to astound her. With a Master’s of Science in Social Work, she has used her education along with her personal experience of being raised in a family with a child who has a disability to influence her work with families. She has worked in one capacity or another for the state of WI for over 18 years.
Gordon Lee, Health Program Administrator, KY Office for Children with Special Health Care Needs
Peggy McManus, President, The National Alliance to Advance Adolescent Health
Peggy McManus is President of The National Alliance to Advance Adolescent Health and Co-Director of Got Transition. With Dr. White, she led the revision of the Six Core Elements of Health Care Transition, developed new transition quality improvement and consumer feedback measurement tools, published systematic reviews on transition outcomes and measures, and published extensively on transition quality improvement, payment options, state Title V transition efforts, and the status of transition preparation in the US.
State Medicaid agencies, which fund half of all births in the United States, are increasingly looking for ways to improve birth outcomes and maternal health while reducing costs by improving medical care and avoiding medically unnecessary cesarean sections. Two case studies from Wisconsin and Oklahoma show how these states successfully improved health care access and quality by creating pregnancy-focused medical homes and developing provider education and incentives to reduce unnecessary C-sections. The studies were developed in partnership with the National Institute for Children’s Health Quality with support from the Health Resources and Services Administration’s Maternal and Child Health Bureau.
Case Study: Oklahoma’s Cesarean Section Quality Initiative Promotes Improved Birth Outcomes
Case Study: Wisconsin’s Obstetric Medical Home Program Promotes Improved Birth Outcomes
Crisis services for behavioral health emergencies have the potential for significant cost savings by reducing inpatient hospitalization and emergency department utilization and encouraging more appropriate use of community-based behavioral health services. Traditionally, individuals experiencing a behavioral health crisis have been initially treated in a general hospital emergency department or admitted to a hospital and then receive limited outpatient treatment. This approach has been neither cost effective nor consistent with clinical best practice. As a result, several states have developed a continuum of crisis intervention services to provide less expensive, community based alternatives. The research base on the effectiveness of crisis services is growing and states now have experience using different payment mechanisms to support a comprehensive crisis system.
This webinar will provide an overview of the evidence base on clinical and cost effectiveness of different types of crisis services, as detailed in a new report from Truven Health Analytics and the Substance Abuse and Mental Health Services Administration (SAMHSA). State officials from Tennessee, Washington, and Wisconsin will then share strategies used to coordinate, consolidate, and braid funding services in order to provide a full continuum of services to individuals experiencing a behavioral health crisis.
- Joyce Allen, Director of the Bureau of Prevention, Treatment, and Recovery, Wisconsin Department of Health Services
- Jane Beyer, Assistant Secretary for Aging and Disability Services, Behavioral Health and Service Integration Administration, Washington
- Suzanne Fields, Senior Advisor to the Administrator on Health Financing, SAMHSA
- Neva Kaye, Managing Director for Health System Performance, National Academy for State Health Policy
- Julie Seibert, Research Leader, Truven Health Analytics
- Mary Shelton, Director of Behavioral Health Operations, Bureau of TennCare
Support for this webinar was provided by the Substance Abuse and Mental Health Services Administration through a contract with Truven Health Analytics.
|Click to Download Webinar Transcript||230 KB|
Federal Support: On January 29, 2013, the Centers for Medicare & Medicaid Services (CMS) approved Wisconsin’s state plan amendment (SPA) to implement Section 2703 of the Affordable Care Act, creating health homes for Medicaid enrollees with an HIV diagnosis and at least one other diagnosed condition or a risk of developing a second condition. AIDS Service Organizations in four counties are eligible to serve as health homes under this SPA, serving large urban areas including Green Bay, Madison, and Milwaukee. The SPA became effective on October 1, 2012. Wisconsin was a recipient of a planning grant from CMS to develop its state plan amendment. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.
Wisconsin has also received a duals demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to “coordinate care across primary, acute, behavioral health and long-term supports and services for dual eligible individuals.”
Last updated: April 2014
|Defining & Recognizing a Medical Home||
Recognition: AIDS Service Organizations participating in Wisconsin’s ACA Section 2703 Health Homes program must integrate medical, behavioral, pharmacy, and oral health care. Wisconsin also expects health homes to either obtain national patient-centered medical home accreditation (e.g., NCQA) or provide written support that they meet the state’s health home standards, which include:
|Aligning Reimbursement & Purchasing||
Wisconsin pays AIDS Service Organizations participating in the state’s ACA Section 2703 Health Homes program a monthly case rate for care management activity and an annual fee for completing an assessment and developing or updating a care plan.
Wisconsin has identified two specific goals for its ACA Section 2703 Health Homes program:
Wisconsin will use public health surveillance data, claims data from the state’s Medicaid Management Information System, and enrollees’ medical records to track the state’s performance on these goals.
The state’s Medicaid agency and the Wisconsin Division of Public Health (DPH) will collaboratively assess program implementation.
Costs savings will be calculated using a pre/post analysis of Medicaid claims data for health home enrollees, as well as comparing the costs for Medicaid enrollees with HIV that are not participating in the health home program.
The eight states participating in the Maximizing Enrollment program aimed to simplify and streamline enrollment and renewal policies, systems and processes for Medicaid and CHIP and prepare for ACA implementation. These state profiles offer a snapshot of the states’ work within the program by highlighting the following:
- Where states started;
- Major Simplifications Implemented as a result of Maximizing Enrollment; and
- Lessons Learned
|New York||2.1 MB|
- Most Medicaid services are delivered primarily through Medicaid Health Maintenance Organizations (HMOs). When families are enrolled in ForwardHealth (the state Medicaid program) they are also enrolled in an HMO. If there are multiple HMOs available in the area where the family resides they are able to select between them. Once families are enrolled the HMO sends them an enrollment packet with information related to the services they can receive. Medicaid will cover certain services – such as behavioral or oral health services – if they are not among those provided by the HMO in which the beneficiary is enrolled.
- There were a total of 1,173,355 beneficiaries enrolled in Wisconsin’s Medicaid program as of July 2011. Of these 747,046 were enrolled in managed care. 366,441 beneficiaries were enrolled in Commercial MCOs, 344,602 were enrolled in Medicaid-only MCOs, and 34,975 were enrolled in a Prepaid Inpatient Health Plan (PIHP) to receive either Long Term Care services (33,990) or Mental Health wraparound services (985). Wisconsin delivers mental health and substance abuse wraparound services to children with severe emotional disturbances through two programs called Children Come First and Wraparound Milwaukee.
Under Wisconsin’s administrative code (DHS 101.03(96m)), medical necessary services are:
“(a)Required to prevent, identify or treat a recipient’s illness, injury or disability; and
(b) Meets the following standards:
|Initiatives to Improve Access
|Reporting & Data Collection||Managed care contracts in Wisconsin require that enrolled children receive at least 80% of the expected number of HealthCheck screens; managed care organizations that fail to meet this metric face recoupment of some of their capitation payments.|
Children are screened for behavioral health issues during HealthCheck preventive visits.
Managed care contract language requires that managed care organizations develop relationships—through memoranda of understanding or contracts—with community agencies that deliver behavioral health services to Medicaid beneficiaries.
Wisconsin Medicaid covers Screening, Brief Intervention, and Referral to Treatment (SBIRT) services for enrollees 10 years of ago and older. Substance abuse screening tools approved for use by the state are:
Wisconsin Medicaid is a partner to two initiatives called Children Come First and Wraparound Milwaukee. These are multi-agency, community based programs of mental health and other drug abuse services for children with severe emotional disturbances (SED). The goal of the programs is to both keep children with SED out of institutions, and to reallocate resources previously used for institutionalization of SED children into community-based services.
|Support to Providers and Families||
Support to Providers
Wisconsin Medicaid maintains a ForwardHealth Portal, which provides provider information (including provider handbooks) and serves as an interface to the MMIS. The portal also includes a page with useful links for Managed Care Organizations (MCOs).
Support to Families
Wisconsin has a program called Healthy Start, Grow Smart. This initiative created a series of fourteen free booklets, starting with Pregnancy and running through Twelve Months. These booklets are available in English and Spanish, and help new parents with developmental milestones, and information that is relevant for doctor visits during the child’s first year. Wisconsin also has a HealthCheck toll free hotline for families that have questions or problems with the program.
Managed care contracts in the state encourage managed care organizations to “assist with the coordination of covered mental health services” by establishing contractual relationships with community-based mental health agencies and school-based providers.
The Wraparound Milwaukee program contacts with eight community agencies for over 100 care coordinators to facilitate the delivery of services to the SED children in the program using an individualized wraparound approach.
Children are given mouth exams as part of a HealthCheck preventive care exam. Children who need additional dental care are referred to a dental provider and these services are covered by HealthCheck.
HealthCheck nursing agencies are reimbursed by Medicaid for providing dental sealants to Medicaid beneficiaries under age 21.
Of the 22 million uninsured expected to gain coverage under the Affordable Care Act in 2014, more than 4 million projected to take-up coverage will have mental health or substance use disorders. On this webinar, after a brief overview of new data made available by SAMHSA, state and local officials and other experts will talk about how states are preparing to ensure service access for these individuals newly covered through Medicaid and Health Insurance Exchanges. The panelists will answer questions about how this data will help to inform state decisions on issues like:
- The mix of benefits and services that enrollees may need;
- Ensuring workforce and provider capacity;
- Readying managed care plans in Medicaid and/or the qualified health plans on the exchange for the service needs of enrollees;
- Supporting eligibility and enrollment s for populations that may be hard to reach;
- The financial impact on state and local programs.
By Scott Holladay
The goal of evidence-based supported employment is to place individuals with serious mental illness in real, competitive jobs. This evidence–based practice (EBP) is highly effective, resulting in competitive employment at nearly three times the rate of other vocational services. Studies comparing supported employment with day treatment have shown similar results. Despite this strong evidence, the practice has been slow to take hold, but 17 states are now using Medicaid to expand its availability. As a major payer for behavioral health services, Medicaid support is crucial to implementation of EBPs.