AFFORDABLE CARE ACT UPDATE & EXPANSION OF MENTAL HEALTH SEMINAR

Size: px
Start display at page:

Download "AFFORDABLE CARE ACT UPDATE & EXPANSION OF MENTAL HEALTH SEMINAR"

Transcription

1 AFFORDABLE CARE ACT UPDATE & EXPANSION OF MENTAL HEALTH SEMINAR

2 Paul Jaconette Chief Operating Officer CenCal Health

3 Progress of Medi-Cal Expansion How is enrollment going? Approx. # of adults receiving CenCal Health eligibility: 1,400 in January (500 in SB and 900 in SLO County) 3,300 February (1,350 in SB and 1,950 in SLO County) Potential 6,500 individuals in CalFresh eligible (both Counties) Patients being fast tracked. State FFS Medi-Cal eligible initially and then CenCal Health eligible (processing backlog at DSS). Enrollment above projections. Good news = patients enrolled. Bad news = specialty access for FFS Medi-Cal members. Who is assisting? Certified Enrollment Counselors and Department of Social Services are working quickly to enroll patients

4 Enrollment in Covered CA How is it going? January (state-wide): 728,410 enrollment (85% eligible for subsidies) January (state-wide) 1.5M enrolled in Medi-Cal What type of coverage? Patients eligible for a subsidy (federal government) selected the Silver Plan 67% of the time Patients not eligible for a subsidy selected the lowest cost selected Bronze, Silver, Platinum and Gold Plans (depending on the cost sharing they preferred in deductible/copay ratio) Covered CA campaigns bringing awareness Over 3,000 patients eligible for traditional Medi-Cal in January and February (6,000 total) both Counties enrolled in CenCal Health

5 Up Next What to expect in the future? Additional services for Medi-Cal members, including Mental Health and Substance Use Disorder Services Integration of Mental and Physical Health services Why is this so important? What services are available? Who will be providing them?

6 The Impact of Mental Illness A major impact on an individual s overall health status and quality of life. Estimated that, on average, people with serious mental illness die 25 years earlier than the general population. Unaddressed mental illness impacts overall health care costs. For Medi-Cal patients with chronic conditions, health care costs are up to 75% higher w/ mental illness. National Association of State Mental Health Program Directors, Morbidity and Mortality in People with Serious Mental Illness (October 2006). Cynthia Boyd et al., Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services for Medicaid Populations, Center for Health Care Strategies (December 2010)

7 Prevalence of Mental Illness in CA In California, about 16% of adult population (more than 4 million people) have mental health care needs. Of those, 1 million adults have a severe mental illness that impairs their daily functioning. About 4% of the population has conditions that are severely disabling and 7% are seriously emotionally disturbed. Significantly higher %s in lower income populations. Human Services Research Institute, Technical Assistance Collaborative, and Charles Holzer, California Mental Health Prevalence Estimates (February 2012), accessed January 30, 2013,

8 Prevalence in Low Income Populations

9 Profound Lack of Coverage A large proportion of Californians lack access to mental health services and may now be eligible. According to the CA Health Interview Survey, less than half of California adults with mental health needs received treatment. Of those who did, less than one-quarter reported that the treatment met their needs. Of the respondents with mental health needs who were uninsured, 69% received no treatment at all. UCLA Center for Health Policy Research, Half a Million Uninsured California Adults with Mental Health Needs Are Eligible for Health Coverage Expansions (November 2012).

10 Is Health Coverage Available? Until passage of 2008 federal Mental Health Parity and Addiction Equity (MHPAE) Act, private health insurance coverage for mental health benefits was significantly more limited than coverage for medical and surgical benefits. Historically, even Medicare required higher cost sharing for mental health services than for medical services.

11 Historical Medi-Cal Coverage In 1991, CA transferred financial and administrative responsibility for mental health programs to Counties. (Carve Out) Public mental health services in CA have been delivered through county systems that operate separately from other publicly funded health care services. (Severe Conditions) Medi-Cal beneficiaries with less severe mental health conditions face significant gaps both in coverage and in access to services. Technical Assistance Collaborative, California Mental Health and Substance Use Needs Assessment.

12 Mental Health and the ACA Under ACA, health plans in Covered CA must cover 10 Essential Health Benefits, including mental health and substance use disorder services. These services must be provided at parity with medical and surgical benefits, in accordance with the 2008 federal Mental Health Parity Act. Benefits to Medi-Cal patients also must meet these requirements, offering mild to moderate coverage. Kirsten Beronio et al., ASPE Issue Brief: Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans, US Department of Health and Human Services (February 20, 2013).

13 Why CenCal Health? Ensuring access to coordinated mental health and physical health services is imperative to improving population health outcomes.

14 Expansion of Behavioral Health CenCal Health now offers mental health services for eligible Medi-Cal members: Services for the severely and chronically ill will continue to be provided through County Mental Health Departments Psychological services for less severe disorders are covered by CenCal Health (Individual/Group Psychotherapy/Counseling Services, Psych Medication Consults, Testing) Expanded substance abuse services available through County Programs

15

16 New Partner: The Holman Group CenCal Health partnered with The Holman Group to administer the new mental health benefits on our behalf The Holman Group, based out of Northridge, CA, is a well-established Managed Behavioral Health Organization Arranges for quality mental health services. Holman has developed a contracted network of mental health providers available -- now. Holman offers these services to CenCal Health members and provides support to PCPs.

17 How do patients get access? CenCal Health will continue to cover outpatient lab, supplies and drugs (excluding anti-psychotic drugs) through our lab and pharmacy network. We will also cover mental health services within the scope of PCP practice. Services for mild to moderate conditions will be provided through The Holman Group s provider network. PCPs may refer members for mental health services by accessing Holman Group 24 hours a day, 365 days a year via their toll-free number (800) Members may also self refer by calling directly.

18 How are services arranged? The Holman Group will conduct initial screening and then Arrange for face-to-face assessment w/ mental provider or refer to another appropriate resource or Coordinate with County Mental Health for Specialty Mental Health services on the PCP s behalf if member has severe mental illness. No defined limits on # of visits w/ mental health provider. Benefits are provided based on the level of care needed to make progress towards treatment goals. Note: Couples counseling or family counseling for relational problems are not covered. Medi-Medi members have Medicare Insurance as Primary (seek care through Medicare benefit first)

19 A different type of referral No RAF necessary, just the call Regulations that govern sharing of information related to mental health services more restrictive If PCP needs psychiatric medical consult, information provided over the phone If PCP calls Holman to refer and treat with LCSW/MFT, very little information can be shared (no progress notes) Remember: Patients must agree to seek treatment If PCP and Psychiatrist are co-managing patient, info. on treatment, medication, necessary labs can be shared. CenCal working with Holman to get info. on our website

20 Liz Santillan, Provider Relations Supervisor Jenny Sanchez, Quality Improvement Coordinator

21 Who we are? For over 35 years, Holman has been providing the most comprehensive services in the least restrictive setting We hold one of the oldest specialty behavioral health Knox-Keene licenses in the mental health and substance abuse in CA.

22 What do we offer? Holman s Behavioral Health Benefits Administration Services include the facilitation of all levels of care, including: Individual/group mental health evaluation, screening, testing and brief treatment (psychotherapy) Crisis Intervention and Crisis Stabilization Psychological testing when clinically indicated to evaluate a mental health condition Outpatient services for the purposes of monitoring drug therapy Outpatient services that include lab work, drugs, and supplies Psychiatric consultation Referrals to Other Medi-Cal/Community/County Resources

23 About Holman Holman Healthcare Advisors are compassionate licensed professionals, Range from masters level to psychiatrists who ensure that the appropriate level of treatment is authorized and that the member is progressing. Holman s care management team consists of two Medical Directors and outpatient and inpatient health care advisors.

24 Provider Network The Holman Group has a dynamic global provider network with over 36,000 licensed clinicians. Network providers, accessible to program participants, are licensed professionals experienced in counseling people of all ages and ethnic groups on a full spectrum of issues. Our therapists offer up-to-date therapeutic approaches, such as Cognitive-Behavioral and Solution-Focused therapies.

25 We know what a comforting feeling it is to know that there is someone available every hour of every day of the year. That s why we have the following features in place which set us apart from similar organizations, but, most importantly, keep our members feeling safe is our Nationwide toll-free number with access to Crisis Intervention 24 hours a day, 365 days a year. Provides after-hours services via a Medical Answering service with access to one of our licensed counselors who are on call to assist in crisis situations.

26 Our Member Count 500,000+

27 County of San Luis Obispo Behavioral Health Department Greg Vickery, LMFT Behavioral Health Quality Support Team Division Manager & Compliance Officer

28 Target Population Welfare & Institutions Code Adults with Serious Mental Illness (SMI) ( Serious = severe & persistent) Included diagnosis Substantial functional impairment or imminent risk of decompensation Disabled to the degree public assistance, services or entitlements would be required

29 Target Population Welfare & Institutions Code Seriously Emotionally Disturbed (SED) Youth Included diagnosis Substantial functional impairment in two areas (self-care, school, family, community) And Risk of or removed from home Or Impairments x 6 months or 1 year w/o treatment Or Psychotic features, suicide risk, violence risk

30 Medical Necessity CCR, Title 9,

31 Specialty Mental Health Services Specialty Mental Health Services Medication Support Therapy Case Management & Rehabilitation Services Day Treatment/Day Rehabilitation Crisis Intervention Crisis Stabilization/Crisis Residential (Coming soon!) Adult Residential Treatment Psychiatric Inpatient/Psychiatric Health Facility (PHF) Therapeutic Behavioral Services (TBS) Katie A services: Intensive Care Coordination (ICC) In Home Behavioral Services (IHBS)

32 To access mental health services, or for immediate help, such as Mobile Crisis Services, call (24 hours/7 days a week)

33

New Medi-Cal Behavioral Health Benefits

New Medi-Cal Behavioral Health Benefits New Medi-Cal Behavioral Health Benefits Brief History 2004 2008 2010 1/1/2014 ACA Medi-Cal Expansion & LIHP Transition 1 Eligible Populations Traditional Medi-Cal Age 65 or older Under age 21 An adult,

More information

Kansas Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Kansas

Kansas Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Kansas Mental Health and Substance Abuse Services in Medicaid and SCHIP in Kansas As of July 2003, 262,791 people were covered under Kansas's Medicaid and SCHIP programs. There were 233,481 enrolled in the Medicaid

More information

Maryland Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland

Maryland Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland As of July 2003, 638,662 people were covered under Maryland's Medicaid/SCHIP programs. There were 525,080 enrolled in the Medicaid

More information

The Maryland Public Behavioral Health System

The Maryland Public Behavioral Health System The Maryland Public Behavioral Health System Arleen Rogan, Ph.D. Division Director, Integrated Health Services Family Services, Inc. Arleen.rogan@fs-inc.org Behavioral Health includes: Mental health conditions

More information

Florida Medicaid: Mental Health and Substance Abuse Services

Florida Medicaid: Mental Health and Substance Abuse Services Florida Medicaid: Mental Health and Substance Abuse Services Beth Kidder Assistant Deputy Secretary for Medicaid Operations Agency for Health Care Administration House Children, Families, and Seniors Subcommittee

More information

The Field of Counseling. Veterans Administration one of the most honorable places to practice counseling is with the

The Field of Counseling. Veterans Administration one of the most honorable places to practice counseling is with the Gainful Employment Information The Field of Counseling Job Outlook Veterans Administration one of the most honorable places to practice counseling is with the VA. Over recent years, the Veteran s Administration

More information

SUBSTANCE USE DISORDER (SUD)BENEFIT UNDER MEDICAID EXPANSION

SUBSTANCE USE DISORDER (SUD)BENEFIT UNDER MEDICAID EXPANSION A statewide coalition of consumers, providers, educators, and advocates representing the voice for alcohol and drug abuse services SUBSTANCE USE DISORDER (SUD)BENEFIT UNDER MEDICAID EXPANSION The Coalition

More information

OUTPATIENT SERVICES. Components of Service

OUTPATIENT SERVICES. Components of Service OUTPATIENT SERVICES Providers contracted for this level of care or service are expected to comply with all requirements of these service-specific performance specifications. Additionally, providers contracted

More information

Integrating Behavioral Health into Medi-Cal. July 15, 2015

Integrating Behavioral Health into Medi-Cal. July 15, 2015 Integrating Behavioral Health into Medi-Cal July 15, 2015 Agenda 1. Beacon Health Options Overview 2. California s and San Francisco s Behavioral Health Context 3. Mental Health Coverage and the Affordable

More information

MEDICAL ASSOCIATES HEALTH PLANS HEALTH CARE SERVICES POLICY AND PROCEDURE MANUAL POLICY NUMBER: PP 27

MEDICAL ASSOCIATES HEALTH PLANS HEALTH CARE SERVICES POLICY AND PROCEDURE MANUAL POLICY NUMBER: PP 27 POLICY TITLE: RESIDENTIAL TREATMENT CRITERIA POLICY STATEMENT: Provide consistent criteria when determining coverage for Residential Mental Health and Substance Abuse Treatment. NOTE: This policy applies

More information

http://www.bls.gov/oco/ocos067.htm Counselors

http://www.bls.gov/oco/ocos067.htm Counselors http://www.bls.gov/oco/ocos067.htm Counselors * Nature of the Work * Training, Other Qualifications, and Advancement * Employment * Job Outlook * Projections Data * Earnings * OES Data * Related Occupations

More information

The Field of Counseling

The Field of Counseling Gainful Employment Information The Field of Counseling Job Outlook Veterans Administration one of the most honorable places to practice counseling is with the VA. Over recent years, the Veteran s Administration

More information

Florida Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida

Florida Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida As of July 2003 2,441,266 people were covered under Florida's Medicaid and SCHIP programs. There were 2,113,820 enrolled in the

More information

Las Encinas. Behavioral Healthcare - Treatment - Rehabilitation - Recovery. Compassion. Community. Collaboration

Las Encinas. Behavioral Healthcare - Treatment - Rehabilitation - Recovery. Compassion. Community. Collaboration Las Encinas Behavioral Healthcare - Treatment - Rehabilitation - Recovery Behavioral Healthcare Over 100 Years of Care The Joint Commission Top Performer on Key Quality Measures 2012 and 2013 Compassion

More information

SECTION VII: Behavioral Health Services

SECTION VII: Behavioral Health Services OVERVIEW Behavioral Health Services (mental health and/or substance abuse services) are covered for all members except those enrolled in family planning services only. Care1st manages the delivery of select

More information

Mode & Service Function Information

Mode & Service Function Information Mode & Service Function Information 20 S/D Mode 05 = 24-Hour Services SD/MC Mode 05 = Residential/PHF SD/MC Mode 07 = General Hospital SD/MC Mode 08 = Psych Hospital: Age < 21 SD/MC Mode 09 = Psych Hospital:

More information

Behavioral Health Provider Training: Substance Abuse Treatment Updates

Behavioral Health Provider Training: Substance Abuse Treatment Updates Behavioral Health Provider Training: Substance Abuse Treatment Updates Agenda Laboratory Services Behavioral Health Claims Submission Process Targeted Case Management Utilization Management eservices Claims

More information

The Louisiana Behavioral Health Partnership

The Louisiana Behavioral Health Partnership The Louisiana Behavioral Health Partnership Transforming the lives of our youth Supporting adults in need Keeping families together Kathy Kliebert Deputy Secretary What is the Louisiana Behavioral Health

More information

HEALTH CARE REFORM IMPLICATIONS & CONSIDERATIONS FOR MENTAL HEALTH

HEALTH CARE REFORM IMPLICATIONS & CONSIDERATIONS FOR MENTAL HEALTH HEALTH CARE REFORM IMPLICATIONS & CONSIDERATIONS FOR MENTAL HEALTH PRESENTATION TO CALIFORNIA WELFARE DIRECTORS ASSOCIATION 2013 CONFERENCE OCTOBER 3, 2013 Molly Brassil Associate Director, Public Policy

More information

Mental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005

Mental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005 Mental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005 By April 1, 2006, the Department, in conjunction with the Department of Corrections, shall report the following

More information

Building on a century of compassionate care, shaping the future of behavioral health.

Building on a century of compassionate care, shaping the future of behavioral health. Carrier Clinic has earned The Joint Commission s Gold Seal of Approval. Building on a century of compassionate care, shaping the future of behavioral health. For more than a century, Carrier Clinic has

More information

Addressing Medical Necessity for Medicaid Funded Mental and Behavioral Health Services for Persons with Dual Diagnoses

Addressing Medical Necessity for Medicaid Funded Mental and Behavioral Health Services for Persons with Dual Diagnoses Addressing Medical Necessity for Medicaid Funded Mental and Behavioral Health Services for Persons with Dual Diagnoses Contract Number 732HC08B Prepared by Human Systems and Outcomes, Inc. Edited by Celeste

More information

Sacramento County Medi-Cal Mental Health Services

Sacramento County Medi-Cal Mental Health Services GUIDE TO Sacramento County Medi-Cal Mental Health Services Important Telephone Numbers Emergency 911 ACCESS (916) 875-1055 ACCESS toll free/24-hours (888) 881-4881 Psychiatric Emergency/Urgent Services

More information

Counselors. Significant Points

Counselors. Significant Points Counselors (O*NET 21-1011.00, 21-1012.00, 21-1013.00, 21-1014.00, 21-1015.00, 21-1019.99) Significant Points A master s degree generally is required to become a licensed counselor. Job opportunities for

More information

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE Brief Coverage Statement Outpatient Substance Use Disorder (SUD) Fee-For-Service (FFS) Treatment Services are available for the treatment of substance

More information

Illinois Insurance Facts Illinois Department of Insurance Mental Health and Substance Use Disorder Coverage

Illinois Insurance Facts Illinois Department of Insurance Mental Health and Substance Use Disorder Coverage Illinois Insurance Facts Illinois Department of Insurance Mental Health and Substance Use Disorder Coverage Revised October 2012 Note: This information was developed to provide consumers with general information

More information

Redesigning the Publicly-Funded Mental Health System in Texas

Redesigning the Publicly-Funded Mental Health System in Texas Redesigning the Publicly-Funded Mental Health System in Texas Access to care when services are needed Choice in health plans for consumers and providers Integration of care at the plan and provider level

More information

Summary of the Major Provisions in the Patient Protection and Affordable Health Care Act

Summary of the Major Provisions in the Patient Protection and Affordable Health Care Act Summary of the Major Provisions in the Patient Protection and Affordable Care Act Updated 10/22/10 On March 23, 2010, President Barack Obama signed into law comprehensive health care reform legislation,

More information

NJ FamilyCare Expansion and Provider Enrollment FAQs

NJ FamilyCare Expansion and Provider Enrollment FAQs NJ FamilyCare Expansion and Provider Enrollment FAQs Roxanne Kennedy MSW, LCSW Project Officer, Managed Behavioral Health Division of Medical Assistance and Health Service January 17, 2014 1 Expansion

More information

Optum By United Behavioral Health. 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines

Optum By United Behavioral Health. 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines Optum By United Behavioral Health 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines is a behavioral intervention program, provided in the context of a therapeutic milieu,

More information

Public Act No. 15-226

Public Act No. 15-226 Public Act No. 15-226 AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR MENTAL OR NERVOUS CONDITIONS. Be it enacted by the Senate and House of Representatives in General Assembly convened: Section 1. Section

More information

What is CCS? Eligibility

What is CCS? Eligibility What is CCS? Department of Health Services Division of Mental Health and Substance Abuse Services Bureau of Prevention, Treatment and Recovery Services Comprehensive Community Services (CCS) Comprehensive

More information

Department of Mental Health

Department of Mental Health 332401 Forensic Services $4,319,519 $4,328,547 $4,371,610 $4,323,287 $3,089,969 $3,244,251 0.2% 1.0% -1.1% -28.5% 5.0% Section 335.10.10 of Am. Sub. H.B. 1 of the 128th G.A. (originally established by

More information

Telemedicine services. Crisis intervcntion response services, except

Telemedicine services. Crisis intervcntion response services, except Approved: MAY 2 4 2010 ATTACHMENT 3.1 -A Page 54j 4. Consultation with relatives, guardians, friends, employers, treatment providers, and other significant people, in order to change situations and allow

More information

Getting Medi-Cal Outpatient Specialty Mental Health Services

Getting Medi-Cal Outpatient Specialty Mental Health Services California s Protection & Advocacy System Toll-Free (800) 776-5746 Getting Medi-Cal Outpatient Specialty Mental Health Services August 2010, Pub #5084.01 I was told that I need Medi-Cal specialty mental

More information

Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals

Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals The purpose of this document is to clarify who can provide which outpatient services to Iowa Plan Medicaid members.

More information

Treatment Services for Individuals with Co-Occurring Mental Health and Intellectual Disability/Developmental Disabilities

Treatment Services for Individuals with Co-Occurring Mental Health and Intellectual Disability/Developmental Disabilities Two types of individuals 1. People with primary diagnosis of intellectual disability/developmental disability Mental health diagnosis is secondary Primary services through ID/DD system Residential/Housing

More information

Psychiatric/Mental Health Nurse Practitioner. Graduate Nursing Program

Psychiatric/Mental Health Nurse Practitioner. Graduate Nursing Program Psychiatric/Mental Health Nurse Practitioner Graduate Nursing Program Program Options University of California, San Francisco School of Nursing https://nursing.ucsf.edu Psychiatric Mental Health Nursing

More information

other caregivers. A beneficiary may receive one diagnostic assessment per year without any additional authorization.

other caregivers. A beneficiary may receive one diagnostic assessment per year without any additional authorization. 4.b.(8) Diagnostic, Screening, Treatment, Preventive and Rehabilitative Services (continued) Attachment 3.1-A.1 Page 7c.2 (a) Psychotherapy Services: For the complete description of the service providers,

More information

WORKERS COMPENSATION PROTOCOLS WHEN PRIMARY INJURY IS PSYCHIATRIC/PSYCHOLOGICAL

WORKERS COMPENSATION PROTOCOLS WHEN PRIMARY INJURY IS PSYCHIATRIC/PSYCHOLOGICAL WORKERS COMPENSATION PROTOCOLS WHEN PRIMARY INJURY IS PSYCHIATRIC/PSYCHOLOGICAL General Guidelines for Treatment of Compensable Injuries Patient must have a diagnosed mental illness as defined by DSM-5

More information

Children s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT

Children s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT Children s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT Please fax with CCHP prior authorization form to 608-252-0853

More information

San Diego County Managed Care Behavioral Health Overview. Presented by George Scolari, Chair Healthy San Diego Behavioral Health Work Group

San Diego County Managed Care Behavioral Health Overview. Presented by George Scolari, Chair Healthy San Diego Behavioral Health Work Group San Diego County Managed Care Behavioral Health Overview Presented by George Scolari, Chair Healthy San Diego Behavioral Health Work Group 1 Healthy San Diego Overview Healthy San Diego is the collaborative

More information

California Mental Health and Substance Use System Needs Assessment and Service Plan

California Mental Health and Substance Use System Needs Assessment and Service Plan California Mental Health and Substance Use System Needs Assessment and Service Plan Volume 2: Service Plan September 30, 2013 Submitted to: The California Department of Health Care Services California

More information

Care and EHR Integration Connecting Physical and Behavioral Health in the EHR. Tarzana Treatment Centers Integrated Healthcare

Care and EHR Integration Connecting Physical and Behavioral Health in the EHR. Tarzana Treatment Centers Integrated Healthcare Care and EHR Integration Connecting Physical and Behavioral Health in the EHR Tarzana Treatment Centers Integrated Healthcare Outline of Presentation Why Integrate Care? Integrated Care at Tarzana Treatment

More information

SENIOR MENTAL HEALTH COUNSELOR I/II

SENIOR MENTAL HEALTH COUNSELOR I/II SENIOR MENTAL HEALTH COUNSELOR I/II DEFINITION To perform a variety of complex professional duties in the provision of outpatient and crisis mental health services to individuals and groups. DISTINGUISHING

More information

COMMUNITY MENTAL HEALTH RESOURCES

COMMUNITY MENTAL HEALTH RESOURCES COMMUNITY MENTAL HEALTH RESOURCES (Adult Mental Health Initiative) Ramsey & Washington Information gathered by: MN. State Advisory Council on Mental Health 17-25 Year Old Committee Mental Health Services

More information

GUIDE TO Medi-Cal Mental Health Services

GUIDE TO Medi-Cal Mental Health Services GUIDE TO Medi-Cal Mental Health Services If you are having an emergency, please call 9-1-1 If you or visit are having the nearest an emergency, hospital please emergency room. call 9-1-1 or visit the nearest

More information

Connecticut Data as of July 2003

Connecticut Data as of July 2003 Mental Health and Substance Abuse Services in Medicaid and SCHIP in Connecticut As of July 2003, 378,961 people were covered under Connecticut Medicaid/SCHIP programs. There were 364,692 enrolled in the

More information

Behavioral Health Policy in Illinois: Major Policy Initiatives in 2013 and Beyond

Behavioral Health Policy in Illinois: Major Policy Initiatives in 2013 and Beyond : Major Policy Initiatives in 2013 and Beyond P R E S E N T A T I O N T O T H E M E D I C A I D A D V I S O R Y C O M M I T T E E N O V E M B E R 7, 2 0 1 3 L O R R I E R I C K M A N J O N E S, P H. D.

More information

SAN MATEO COUNTY BEHAVIORAL HEALTH & RECOVERY SERVICES DOCTORAL LEVEL PRACTICUM PLACEMENTS 2015-2016

SAN MATEO COUNTY BEHAVIORAL HEALTH & RECOVERY SERVICES DOCTORAL LEVEL PRACTICUM PLACEMENTS 2015-2016 SAN MATEO COUNTY BEHAVIORAL HEALTH & RECOVERY SERVICES DOCTORAL LEVEL PRACTICUM PLACEMENTS 2015-2016 San Mateo Behavioral Health and Recovery Services (BHRS) is a comprehensive county behavioral health

More information

Butte County Behavioral Health. Anne Robin, MFT Director

Butte County Behavioral Health. Anne Robin, MFT Director Butte County Behavioral Health Anne Robin, MFT Director Behavioral Health 101 Provides and monitors services Countywide Mental health and substance abuse disorder prevention, treatment, and rehabilitation

More information

HOPE HELP HEALING. A Place of Hope, Help and Healing Since 1910

HOPE HELP HEALING. A Place of Hope, Help and Healing Since 1910 HOPE HELP HEALING A Place of Hope, Help and Healing Since 1910 For more than a century, Carrier Clinic has opened its hearts and its doors as a trusted, sought-after place of hope, help and healing for

More information

HOPE HELP HEALING. A Place of Hope, Help and Healing Since 1910

HOPE HELP HEALING. A Place of Hope, Help and Healing Since 1910 HOPE HELP HEALING A Place of Hope, Help and Healing Since 1910 For more than a century, Carrier Clinic has opened its hearts and its doors as a trusted, sought-after place of hope, help and healing for

More information

Performance Standards

Performance Standards Performance Standards Outpatient Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best practice performances,

More information

Behavioral Health Centers of Excellence & the Future of Health

Behavioral Health Centers of Excellence & the Future of Health Behavioral Health Centers of Excellence & the Future of Health -draft concept paper- Healthcare reform is creating tremendous disruption in nearly all aspects of healthcare. As many industries have already

More information

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 12, 2014 Status: Current Summary of Changes Clarifications: Pg 4, Description, updated

More information

An Overview of Arizona Enrollment in the Affordable Care Act (ACA) Marketplace. Presented by: Jaime Perikly, Health Choice

An Overview of Arizona Enrollment in the Affordable Care Act (ACA) Marketplace. Presented by: Jaime Perikly, Health Choice An Overview of Arizona Enrollment in the Affordable Care Act (ACA) Marketplace Presented by: Jaime Perikly, Health Choice Affordable Care Act The Patient Protection and Health Care Law of 2010, amended

More information

OPTUM By United Behavioral Health OPTUM GUIDELINE EVIDENCE BASE: Level of Care Guidelines

OPTUM By United Behavioral Health OPTUM GUIDELINE EVIDENCE BASE: Level of Care Guidelines OPTUM By United Behavioral Health OPTUM GUIDELINE EVIDENCE BASE: Level of Care Guidelines Guideline Evaluation and Treatment Planning Discharge Planning Admission Criteria Continued Stay Criteria Discharge

More information

Issuance of this June 16, 2014 Technical Assistance Guide renders all other versions obsolete.

Issuance of this June 16, 2014 Technical Assistance Guide renders all other versions obsolete. DEPARTMENT OF MANAGED HEALTH CARE HELP CENTER DIVISION OF PLAN SURVEYS TECHNICAL ASSISTANCE GUIDE ACCESS AND AVAILABILITY OF SERVICES ROUTINE MEDICAL SURVEY OF PLAN NAME DATE OF SURVEY: PLAN COPY Issuance

More information

Affordable Care Act: Health Coverage for Criminal Justice Populations. Colorado Center on Law and Policy Colorado Criminal Justice Reform Coalition

Affordable Care Act: Health Coverage for Criminal Justice Populations. Colorado Center on Law and Policy Colorado Criminal Justice Reform Coalition Affordable Care Act: Health Coverage for Criminal Justice Populations Colorado Center on Law and Policy Colorado Criminal Justice Reform Coalition Who we are CCJRC and CCLP have partnered to help Colorado

More information

MI HEALTH LINK ACRONYMS AND KEY TERMS

MI HEALTH LINK ACRONYMS AND KEY TERMS MI HEALTH LINK ACRONYMS AND KEY TERMS MI Health Link - New program that will integrate Medicare and Medicaid benefits, rules and payments into one coordinated delivery system DOCUMENT FORMAT Acronym/Key

More information

The Collaborative Models of Mental Health Care for Older Iowans. Model Administration. Collaborative Models of Mental Health Care for Older Iowans 97

The Collaborative Models of Mental Health Care for Older Iowans. Model Administration. Collaborative Models of Mental Health Care for Older Iowans 97 6 The Collaborative Models of Mental Health Care for Older Iowans Model Administration Collaborative Models of Mental Health Care for Older Iowans 97 Collaborative Models of Mental Health Care for Older

More information

Oregon Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Oregon

Oregon Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Oregon Mental Health and Substance Abuse Services in Medicaid and SCHIP in Oregon As of July 2003, 398,874 people were covered under Oregon s Medicaid/SCHIP programs. There were 380,546 enrolled in the Medicaid

More information

From: Odonnell, Mark [mailto:mark.odonnell@dhhs.nc.gov] Sent: Monday, November 24, 2014 3:44 PM To: 'John Shuford' Subject: RE: First Commitment

From: Odonnell, Mark [mailto:mark.odonnell@dhhs.nc.gov] Sent: Monday, November 24, 2014 3:44 PM To: 'John Shuford' Subject: RE: First Commitment LICENSED PROFESSIONAL COUNSELORS AND LICENSED MARRIAGE AND FAMILY THERAPISTS SHOULD BE INCLUDED AS PROVIDERS WHO CAN CONDUCT FIRST EVALUATIONS FOR INVOLUNTARY COMMITMENT In 2011, the North Carolina General

More information

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE BRIEF COVERAGE STATEMENT This benefit coverage standard describes outpatient Substance Use Disorder services (known as SUD Fee-For-Service (FFS)

More information

Creating Linkages Between Child and Adolescent Services

Creating Linkages Between Child and Adolescent Services Creating Linkages Between Child and Adolescent Services Lynn Thull, PhD of Child & Family Services 1 Publically Funded Children s Mental Health Services Hospital Association Lynn Thull, PhD December 7

More information

MEDICAL POLICY No. 91607-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD AND ADOLESCENT

MEDICAL POLICY No. 91607-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD AND ADOLESCENT Summary of Changes MEDICAL POLICY MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD ADOLESCENT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 14, 2014 Status: Current Clarifications:

More information

How Health Reform Will Help Children with Mental Health Needs

How Health Reform Will Help Children with Mental Health Needs How Health Reform Will Help Children with Mental Health Needs The new health care reform law, called the Affordable Care Act (or ACA), will give children who have mental health needs better access to the

More information

Co occurring Disorders Treatment Integration. Kitsap County Substance Abuse Advisory Board Cheryl Mogensen MA, MHP, CDP December 10, 2013

Co occurring Disorders Treatment Integration. Kitsap County Substance Abuse Advisory Board Cheryl Mogensen MA, MHP, CDP December 10, 2013 Co occurring Disorders Treatment Integration at KMHS Kitsap County Substance Abuse Advisory Board Cheryl Mogensen MA, MHP, CDP December 10, 2013 Kitsap Mental Health Services Bremerton, Washington Comprehensive

More information

Behavioral Health Provider Implementation of Whole Health Integrative Treatment Services

Behavioral Health Provider Implementation of Whole Health Integrative Treatment Services Behavioral Health Provider Implementation of Whole Health Integrative Treatment Services Maryland Integrative Learning Community Lynn H Albizo, Director of Public Affairs Maryland Addictions Directors

More information

GUIDE TO. Medi-Cal Mental Health Services

GUIDE TO. Medi-Cal Mental Health Services GUIDE TO Medi-Cal Mental Health Services If you are having an emergency, please call 9-1-1 or visit the nearest hospital emergency room. If you would like additional information to help you decide if this

More information

An Overview of Mental Health in Colorado. Amanda Callahan, Policy & Advocacy Manager

An Overview of Mental Health in Colorado. Amanda Callahan, Policy & Advocacy Manager An Overview of Mental Health in Colorado Amanda Callahan, Policy & Advocacy Manager Overview of presentation CO public mental health system Mental Health & Substance Abuse Insurance Parity MH in the ACA

More information

Classification Appeal Decision Under section 5112 of title 5, United States Code

Classification Appeal Decision Under section 5112 of title 5, United States Code U.S. Office of Personnel Management Division for Human Capital Leadership & Merit System Accountability Classification Appeals Program Chicago Field Services Group 230 South Dearborn Street, Room 3060

More information

Behavioral Health Rehabilitation Services: Brief Treatment Model

Behavioral Health Rehabilitation Services: Brief Treatment Model Behavioral Health Rehabilitation Services: Brief Treatment Model Presented by Allegheny HealthChoices, Inc. 444 Liberty Avenue, Pittsburgh, PA 15222 Phone: 412/325-1100 Fax 412/325-1111 April 2006 AHCI

More information

Certified Addiction Counselor INTERNSHIP PROGRAM

Certified Addiction Counselor INTERNSHIP PROGRAM Certified Addiction Counselor INTERNSHIP PROGRAM Updated: January 2016 ASPENPOINTE The AspenPointe family of organizations has provided healthcare solutions to Southern Colorado residents for over 130

More information

PARTNERSHIP HEALTHPLAN OF CALIFORNIA MEDI-CAL PROVIDER MANUAL CLAIMS DEPARTMENT

PARTNERSHIP HEALTHPLAN OF CALIFORNIA MEDI-CAL PROVIDER MANUAL CLAIMS DEPARTMENT PARTNERSHIP HEALTHPLAN OF CALIFORNIA MEDI-CAL PROVIDER MANUAL CLAIMS DEPARTMENT X.J. Mental Health Services 1. For claims with dates of service on or before January 1, 2014: Mental Health Services are

More information

GUIDE TO Medi-Cal Mental Health Services

GUIDE TO Medi-Cal Mental Health Services GUIDE TO Medi-Cal Mental Health Services Revised March 2009 If you are having an emergency, please If you are having an emergency, call 9-1-1 or visit please the call nearest 9-1-1 hospital or visit the

More information

LEVEL III.5 SA: SHORT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE)

LEVEL III.5 SA: SHORT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE) LEVEL III.5 SA: SHT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE) Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders

More information

PROTOCOLS FOR OCCUPATIONAL THERAPY PROVIDERS

PROTOCOLS FOR OCCUPATIONAL THERAPY PROVIDERS PROTOCOLS FOR OCCUPATIONAL THERAPY PROVIDERS Type of Services Provided Services provided by Occupational Therapy providers are covered for Santa Barbara Health Initiative (SBHI), San Luis Obispo Health

More information

PROTOCOLS FOR PHYSICAL THERAPY PROVIDERS

PROTOCOLS FOR PHYSICAL THERAPY PROVIDERS PROTOCOLS FOR PHYSICAL THERAPY PROVIDERS A Member may access Physical Therapy services (PT) when treatment is prescribed by a physician to restore or improve a person s ability to undertake activities

More information

Population Health Management For Behavioral Health. MHA s 2015 Annual Conference June 3, 2015

Population Health Management For Behavioral Health. MHA s 2015 Annual Conference June 3, 2015 Population Health Management For Behavioral Health MHA s 2015 Annual Conference June 3, 2015 Goals of the Affordable Care Act Improve the health of populations Lower per capita costs Improve the patient

More information

Targeted Case Management Services

Targeted Case Management Services Targeted Case Management Services 2013 Acronyms and Abbreviations AHCA Agency for Health Care Administration MMA Magellan Medicaid Administration CBC Community Based Care CBH Community Behavioral Health

More information

COMPARISON OF KEY PROVISIONS House and Senate Comprehensive Mental Health Reform Legislation

COMPARISON OF KEY PROVISIONS House and Senate Comprehensive Mental Health Reform Legislation COMPARISON OF KEY PROVISIONS House and Senate Comprehensive Mental Health Reform Legislation Note: A full title-by-title summary of H.R. 2646, the Helping Families in Mental Health Crisis Act of 2015 (Murphy/Johnson)

More information

Keep Your Mind and Body Healthy: Understanding Mental Health Providers, Care and Coverage

Keep Your Mind and Body Healthy: Understanding Mental Health Providers, Care and Coverage Keep Your Mind and Body Healthy: Understanding Mental Health Providers, Care and Coverage Our mental health is a vital part of our overall well-being. It affects how we think, how we feel, and how we act.

More information

Division of Behavioral Health. Requirements for Program Staff

Division of Behavioral Health. Requirements for Program Staff Division of Behavioral Health Requirements for Program Staff Integrated BH Regulations Training 1 Program Staff Program Staff are professionals who render behavioral health services directly to a recipient.

More information

Optum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines

Optum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Therapeutic group care services are community-based, psychiatric residential treatment

More information

Producer FAQs. Is the Maryland Health Benefit Exchange an insurance company?

Producer FAQs. Is the Maryland Health Benefit Exchange an insurance company? Producer FAQs Question Is the Maryland Health Benefit Exchange an insurance company? What types of coverage will Maryland Health Connection offer? How do I know that this is legitimate health coverage?

More information

Governor s Access Plan for the Seriously Mentally Ill (GAP)

Governor s Access Plan for the Seriously Mentally Ill (GAP) Department of of Medical Medical Assistance Assistance Services Services Governor s Access Plan for the Seriously Mentally Ill (GAP) Sherry Confer, Special Projects Manager Virginia Department Of Medical

More information

Alcohol and Drug Rehabilitation Providers

Alcohol and Drug Rehabilitation Providers June 2009 Provider Bulletin Number 942 Alcohol and Drug Rehabilitation Providers New Modifier and s for Substance Abuse Services Effective with dates of service on and after July 1, 2009, eligible substance

More information

Using Home-Based Programs in Other States to Support a Medicaid Claim to Intensive Home-Based Services Under EPSDT

Using Home-Based Programs in Other States to Support a Medicaid Claim to Intensive Home-Based Services Under EPSDT Using Home-Based Programs in Other States to Support a Medicaid Claim to Intensive Home-Based Services Under EPSDT December 2005 QA Center for Public Representation I. Introduction Because EPSDT requires

More information

2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA

2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA 2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA Overview Psychcare strives to provide quality care in the least restrictive environment. An

More information

Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals

Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals IOWA PLAN F BEHAVIAL HEALTH RE: Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals The purpose of this document is to clarify who can provide which outpatient services

More information

AMENDMENT PRUDENT BUYER PLAN BENEFIT BOOKLET UC LOS ANGELES. to the UNIVERSITY OF CALIFORNIA STUDENT HEALTH INSURANCE PLAN (UC SHIP)

AMENDMENT PRUDENT BUYER PLAN BENEFIT BOOKLET UC LOS ANGELES. to the UNIVERSITY OF CALIFORNIA STUDENT HEALTH INSURANCE PLAN (UC SHIP) AMENDMENT to the UNIVERSITY OF CALIFORNIA STUDENT HEALTH INSURANCE PLAN (UC SHIP) PRUDENT BUYER PLAN BENEFIT BOOKLET UC LOS ANGELES The provisions of your Benefit Booklet are amended as described herein.

More information

Managed Behavioral Health in PPO100 and Keystone

Managed Behavioral Health in PPO100 and Keystone Managed Behavioral Health in PPO100 and Keystone Benefit Plan Summary for PPO100 Service IBH Network Non-Network Pre-Certification Inpatient Psychiatric Care 100%! 80% of IBH allowable after $500 Mental

More information

CAREER SERVICES. So You Want To Be A Therapist UCSB

CAREER SERVICES. So You Want To Be A Therapist UCSB So You Want To Be A Therapist Compiled by Micael Kemp; revised by Maya Salmon Introduction Careers Requiring An M.D. Careers Requiring a Doctoral Degree Careers Requiring A Master s Degree Other Careers

More information

TN No: 09-024 Supersedes Approval Date:01-27-10 Effective Date: 10/01/09 TN No: 08-011

TN No: 09-024 Supersedes Approval Date:01-27-10 Effective Date: 10/01/09 TN No: 08-011 Page 15a.2 (iii) Community Support - (adults) (CS) North Carolina is revising the State Plan to facilitate phase out of the Community Support - Adults service, which will end effective July 1, 2010. Beginning

More information

Family Guide: Children s Mental Health Services. Texas Resilience and Recovery

Family Guide: Children s Mental Health Services. Texas Resilience and Recovery Family Guide: Children s Mental Health Services Texas Resilience and Recovery This Family Guide to Children s Mental Health Services was created to help you navigate the Children s Mental Health System

More information

Strategies For Improving Access To Mental Health Services In SCHIP Programs

Strategies For Improving Access To Mental Health Services In SCHIP Programs May 2006 Strategies For Improving Access To Mental Health Services In SCHIP Programs Prepared by: Jennifer May Children and adolescents experience substantial barriers to obtaining needed mental health

More information

Federal Health Reform FAQs

Federal Health Reform FAQs Federal Health Reform FAQs Individuals 1. What is an exchange? An exchange, as created under the Affordable Care Act (ACA), is a place where consumers can purchase subsidized health insurance coverage.

More information

Page 1 of 6 Fresno County Substance Abuse Treatment and Mental Health Services KEY STAFFING STANDARDS

Page 1 of 6 Fresno County Substance Abuse Treatment and Mental Health Services KEY STAFFING STANDARDS Page 1 of 6 Substance Abuse and Mental Health Services seeks a multidisciplinary team that includes an array of services organized to treat the interaction of mental health and substance use disorders

More information