Services and Medicaid in the OASAS Treatment System

Transcription

1 Services and Medicaid in the OASAS Treatment System Arlene Gnzález-Sánchez, Cmmissiner Rbert Kent, General Cunsel

2 General Patient Statistics 261,775 unique individuals were treated in the OASAS system in Many individuals were seen in multiple mdalities. 172,734 individuals received utpatient services 50,962 individuals received crisis (detx) services 45,631 individuals received utpatient Methadne services 34,212 individuals received inpatient rehabilitatin services 25,319 individuals received residential services

3 OASAS Treatment Mdalities All admissins are vluntary Crisis Services: medically managed detx; medically supervised withdrawal (inpatient/utpatient medically supervised withdrawal); medically mnitred. Inpatient Rehabilitatin: includes 12 state-perated ATCs, hspital-based, and freestanding prgrams Residential Rehab Services fr Yuth Chemical Dependence Outpatient Services Chemical Dependence Outpatient Services fr Yuth Residential Services: Intensive residential, Cmmunity residences, supprtive living Opiid treatment

4 Crisis Services Medically managed detx: Patients are acutely ill and may be experiencing severe withdrawal symptms and/r a risk f psychiatric cmrbid cnditins. Admissins t these prgrams may be invluntary, emergency admissins. Prgrams are dual certified as an Article 28 (DOH) service. 5-day average length f stay. Patients stabilized at this level step dwn t a medically supervised service. Medically supervised withdrawal and stabilizatin: Inpatient/Residential Medically supervised withdrawal: Patients have mild t mderate withdrawal, situatinal crises, and are unable t abstain withut withdrawal symptms. Services include medical supervisin and directin. Services may be prvided in intensive residential treatment and rehabilitatin, cmmunity residences, and supprtive living prgrams. Patients stabilized at this level step dwn t a medically supervised utpatient service. Outpatient Medically supervised withdrawal: Clients have mderate substance withdrawal and d nt meet admissin criteria fr medically managed detx. Clients may als have emtinal supprt frm a hme envirnment. Clients are seen by a medical prfessinal daily, receive cunseling, and may access a 24-hur htline. Medically mnitred withdrawal and stabilizatin: May be prvided in a free-standing cmmunity based setting r as an additinal service f an inpatient r residential prvider. Services d nt require physician directin. Patients have mild withdrawal symptms and prvide a safe envirnment t cmplete withdrawal.

5 Inpatient Rehabilitatin Chemical dependence inpatient rehabilitatin services prvide intensive management f chemical dependence symptms and medical management/mnitring f physical r mental cmplicatins frm chemical dependence t clients wh cannt be effectively served as utpatients and wh are nt in need f medical detxificatin r acute care. These services can be prvided in a hspital r free-standing facility, and spnsrship may be vluntary nt fr prfit, prprietary r State perated. Average length f stay is 21 t 28 days Certified prviders cnduct intensive evaluatin, treatment and rehabilitatin services in a medically supervised 24 hur/day, 7 days/week setting. Services are prvided accrding t an individualized treatment plan and under the supervisin f a Medical Directr.

6 Outpatient Services: Services fr Yuth: Residential and Outpatient Patients less than 18 years f age Range in intensity f clinical services apprpriate and necessary t an individualized treatment plan. Services may extend t significant thers r family members f all ages Supprt services including emergency services, medical/surgical treatment, residential services when apprpriate Residential Rehab Services:. Individual and grup cunseling Family cunseling, as apprpriate Recvery supprt services Educatin abut cmmunicable diseases Intrductin t peer-supprt and self-help grups Life skills training Hlistic health educatin Case management/cmmunity supprt services Vcatinal and educatinal assessment and referral Medical and psychiatric cnsultatin

7 Chemical Dependence Outpatient Services Chemical dependence utpatient services assist individuals wh suffer frm chemical abuse r dependence and their family members and/r significant thers. Outpatient services may be delivered at different levels f intensity respnsive t the severity f the prblems presented by the client and include utpatient rehabilitatin services which are designed t serve individuals with mre chrnic cnditins wh have inadequate supprt systems, and either have substantial deficits in functinal skills r have health care needs requiring attentin r mnitring by health care staff. These services may be prvided in a free standing setting, r may be c-lcated in a variety f ther health and human service settings including hspitals. Spnsrship may be vluntary, prprietary r cunty perated. The length f stay and the intensity f services as measured by frequency and duratin f visits varies frm ne categry f utpatient services t anther and intensity will vary during the curse f treatment within a specific categry. In general, persns are engaged in utpatient treatment up t a year and visits are mre frequent earlier in the treatment prcess becming less frequent as treatment prgresses.

8 Opiid Treatment Services Opiid treatment is a medical service designed t manage herin addictin. Opiid treatment prgrams administer medicatin, generally methadne by prescriptin, in cnjunctin with a variety f ther rehabilitative assistance, t cntrl the physical prblems assciated with herin dependence and t prvide the pprtunity fr patients t make majr life style changes ver time. Methadne treatment is delivered primarily n an ambulatry basis, with mst prgrams lcated in either a cmmunity r hspital setting. Sme specialized prgrams deliver services in a residential setting, while a few prgrams deliver services in a prisn setting. Rehabilitative assistance includes primary medical care, cunseling and supprt services: Methadne may be prescribed and administered thrugh a variety f medical prtcls, as per individual needs: including Maintenance, Methadne t Abstinence, Medically supervised Withdrawal, LAAM and Key Extended Entry Prgram (KEEP).

9 Residential Services Intensive Residential: in additin t all services required by residential prgrams, additinal intensive residential services include: vcatinal assessment, jb skills training, emplyment readiness, parenting, scial and cmmunity living skills; minimum f 40 hurs/week f prcedures within a therapeutic milieu. Persns in this service categry are unable t cmply with treatment utside f a 24 hur setting as evidenced by unsuccessful utpatient treatment. Cmmunity Residences: Structured therapeutic milieu. Residents are cncurrently enrlled in utpatient services prviding addictin cunseling. Other services include jb training, emplyment readiness. Persns in this service categry may be hmeless r with living situatins nt cnducive t recvery and abstinence maintenance. Supprtive Living: Minimum level f prfessinal supprt (weekly visit t resident by a clinical staff member). Persns in this service categry require supprt f fellw residents t maintain recvery but d nt require 24 hur n-site supervisin f clinical staff.

10 Hw much des NYS spend annually n substance use disrder treatment? Annual spending fr all treatment mdalities in is estimated t be $1.5 billin

11 Hw d we spend the mney? Net Deficit Funding Operating expenses fr vluntary funded prviders are paid thrugh state aid (Mental Hygiene Law Article 26) t cver the balance left after mnies are received by prviders frm ther surces. Where are the funding surces? $ 83.2 millin frm the Federal SAPT Blck Grant $297.6 millin frm the NYS General Fund $32.9 millin frm Lcal Gvernment maintenance f effrt $89.4 millin frm Public Assistance: cngregate care II, fd stamps, SSI & SSA $2.7 millin frm Medicare $883.4 millin frm Medicaid (50% is Federal match) $76.2 millin frm ther revenues that include additinal federal and state grants, vluntary lcal gvernment cntributins and ther third party revenues

12 Hw des Medicaid fit in the OASAS system? Nt all substance use disrder treatment services are eligible fr Medicaid reimbursement. What services are eligible? Outpatient Services including: Chemical Dependence Outpatient Treatment (including utpatient rehabilitatin) Opiid Treatment Medically Supervised Outpatient Withdrawal Outpatient Chemical Dependency fr Yuth Inpatient Rehabilitatin Services including Freestanding (funded with State nly Medicaid/n FFP) State Operated ATC s (funded with State nly Medicaid/n FFP) Hspital Based Residential Rehabilitatin Services fr Yuth Crisis Services/Detx including: Medically Managed Inpatient Withdrawal Medically Supervised Inpatient Withdrawal Hspital Based Freestanding (funded with State nly Medicaid/n FFP)

13 What is the current Medicaid Managed Care benefit package fr SUD services? OR What s Carved-In and What s Carved-Out (FFS)? Service Cvered by MMC Plan Additinal Cmments Medically Managed Detxificatin Yes fr all enrllees** Medically Supervised Inpatient Withdrawal Chemical Dependence Inpatient Rehabilitatin Opiid Treatment (MMTP) Chemical Dependence Outpatient Clinic Prgrams Medically Supervised Outpatient Withdrawal Outpatient Chemical Dependency fr Yuth Prgrams Yes fr all enrllees Yes fr Nn SSI enrllees N, fr SSI enrllees N N Yes fr all enrllees N Available thrugh Medicaid FFS fr SSI enrllees ** Carved-ut service, available thrugh Medicaid FFS fr all enrllees Carved-ut service, available thrugh Medicaid FFS fr all enrllees Carved-ut service, available thrugh Medicaid FFS fr all enrllees ** Hmeless individuals in NYC are exempt frm enrllment in managed care. Rest f the State is subject t the discretin f the LDSS

14 Hw much Fee Fr Service Medicaid is spent annually n SUD treatment services? SUD Service Type Dllars in Millins spent in SFY 2010 All SUD services $870.1 Crisis/Detx Services (all levels) $191.3 Inpatient Rehabilitatin Services $170.3 Outpatient Services $284.8 Opiid Treatment Services $202.4 Residential Rehab Services fr Yuth $ 21.3

15 OASAS Medicaid Fast Facts (based n SFY 2008,2009 and 2010 emedny data) SUD services were prvided t 159,429 unique Medicaid recipients in 2010 (FFS claims nly). Many recipients received services at multiple mdalities. The greatest number f recipients were served in utpatient prgrams (115,104), fllwed by Opiid Treatment (36,115), Crisis/Detx (25,102), inpatient (18,440) and Residential Rehab Services fr yuth (1,373) Over 1.75 billin dllars was spent t prvide nn-sud services t recipients f SUD services in SFY 2010 Of the apprximate 2.5 millin peple in NYS age 18 and ver eligible fr Medicaid, 5.5% received SUD services in SFY 2008 Statewide trends indicate the number f individuals served and Medicaid dllars spent n Crisis/Detx, Inpatient and Opiid treatment services has been steadily declining; while the units f service and Medicaid dllars spent n nn-sud services fr the SUD ppulatin has increased.

16 Where d we g frm here? MRT BHO s and the Behaviral Health Subcmmittee Phase 1 BHO s - In prgress RFP issued t award up t five reginal cntracts fr ASO level services fr 2 year perid Phase 2 - Design t be shaped by MRT Behaviral Health Subcmmittee Separate bid fr risk bearing managed care entity fr behaviral health. One f three reginal ptins Integrated Delivery System (IDS) r full carve in f SUD services. Special Needs Plan (SNP) which als manages physical health services fr enrlled beneficiaries BHO carve ut

17 Where d we g frm here? MRT BHO s and the Behaviral Health Subcmmittee Phases 1 and 2 Health Hmes Integrating and Expanding the OASAS Managed Addictin Treatment Services prgram (MATS) int Health Hmes while ensuring cntinuity f existing case manager and treatment relatinships. MATS is the OASAS care crdinatin/case management prgram which is nt currently funded by Medicaid and is available fr high cst/high need patients in NYC, Orange, Westchester, Dutchess, Sufflk and Erie cunties.