Wednesday, July 16, 2008

EOHHS Update: How Goes the Children's Behavioral Health Initiative

The Executive Office of Health and Human Services (EOHHS) announces the first in a series of provider-focused meetings to communicate current information about the Children’s Behavioral Health Initiative (CBHI) and to provide all interested parties an opportunity to share their views on activities related to CBHI.  The meeting will be held on Wednesday, July 16, 2008, at the University of Massachusetts Medical School, Hoagland-Pincus Conference Center, 222 Maple Street, Shrewsbury, MA. The meeting will begin at 2:00 p.m. and conclude at 4:00 p.m. No registration is necessary. Attendance at the meeting is limited only by the space available. The EOHHS welcomes continued and meaningful input from all stakeholders and interested parties on the Children’s Behavioral Health Initiative. Individuals and organizations unable to attend this meeting are encouraged to mail comments to:

Children’s Behavioral Health Initiative
Executive Office of Health and Human Services
1 Ashburton Place – 5th floor
Boston, MA 02108

Got this in the "e-mail" the other day, and, since it is a local event, I thought I would sit in.  The room filled up pretty well, although I think that "provider" in this case means mental health provider.  I'm blogging live;  please remember that these are my impressions, and are subject to all of the biases that I bring with me to the table.  I may have things out of context, and I have definitely misspelled(sic) some names.  It is interesting to remember that the implementation of reform for children is preceding apace, independent of the legislative process over which I have been obsessing for the last few weeks.

Jackie Galb (Strategic Planning Consultant) opened and seemed to be the facilitator of the while process.   She described this as the first of a series of provider forums and family forums.  
Goals are the process are clear:
  • Share what we know
  • Clarify the process and timeline
  • Hear your ideas, questions and concerns
  • Establish an ongoing forum.

Overview of the Planning Process:  Emily Sherwood (Director, CBHI). The administration is looking at the lawsuit response as an opportunity to remake the nature of services for children, beyond the realm of MassHealth alone.  They have has an Executive Team (Leaders from within the administration), an Advisory Council (25 people from around the state) and the legal process (Plaintiffs, court monitor and federal Medicaid stuff).  The legal process is the one that is a bit different;  everything is a negotiation.  Much of the time pressure comes out of the negotiation.  This structure has made it tricky to incorporate much of the input from around the State;  they have done so through meetings, the RFR (and yes, all of that information has been processed and incorporated into the process through a series of position papers).  Given the constraints of the legal process, the CBHI is trying really hard to make this a broad-based and inclusive process.
CBHI Service Development, Suzanne Fields (Mass Medicaid).  The time clock is ticking;  all remedy services must be up and running by June 30, 2009.  They want providers to have 6 months to ramp up to provide the new programs.  They know that this will be complicated.  This has led to a time-line that is very short.  The other constraint is the approval of the new services by the Federal CMS, and need to be completed by December 2008.  This process is a window;  the negotiation will be done sometime between October and December.  To get through the CMS negotiations, the plaintiffs have to agree with what the remedy will look like by October.  
To meet all of these requirements, the Court Monitor (Karen Snyder) has brought in consultants to help both sides agree on a system that will work:
Feedback from Advisory Council and from the RFIs is actively involved in the information flow.
Current thoughts about the timeline for RFRs:
Intensive Care Coordination:  MBHP and 4 other service providers will procure ICC services.  RFR in October, awards in December.
Mobile Response Teams:  MBHP procurement with be part of the Emergency Services Program.   RFR in October, awards in December.
All other services:  Network Development and Provider Readiness Activities through the Managed Care Entities WITHOUT a specific RFR process.
There will be some "ramp-up" dollars available for agencies who are taking on these new roles.  They will also be providing some training for folks taking on the ICC and Home-based services, and they are actively involved in workforce development with the schools of social work and other training sites.  There will also be a CBHI Institute in October or November, whose intent is provide all interested providers in activities that will "level the playing field".
At this point, there were questions:  How much will the providers be paid?  How are the pieces going to fit together?  How will crisis stabilization interact with the emergency response parts of the system?   Will ICC services be able to support families to help the child?  How do the services play out for the kids transitioning out the "class"-  the 16-21 year olds?  Ms. Fields addressed them clearly, and directly, told us what she knows and what she doesn't yet know, and remained calm throughout the process.  
One key question that was raised is the younger kids:  they have convened a group called the "0-5 Working Group" to look at  how does one get services to kids who need them without labeling them.  
CANS Implementation: (Jack Simons, Associate Director) There are a lot of questions about the CANS, and there will be a lot more information over the next few months.  The assessment is already out there and people are starting to be trained.  He wanted to discuss three points:
1)  You can start using the CANS prior to the November 30, 2008 deadline, and that you must be trained (face-to-face) or on-line (but you need to register to use it) and you can bill at the enhanced rate when you do so.
2)  We will be using one of two forms (0-5) and (5-21) age range.  Training will get you through both.
3)  It is not clear how the "redundant" use of the CANS is playing out, as that is being negotiated  with the plaintiffs.
The examination is a scoring of a CANS assessment, to see how you compare to other "raters".

Integration Across State Agencies.  Department of Children and Families (formerly DSS) Bob Wentworth. DSS has changed its name.  I didn't know that.   "We are now the Department of Children and Families".  He pointed out that the CANS has been used within the old DSS, as a way of giving families a change to really tell their stories.   It has allowed DSS to move to a community of practice that included family strengths in the process.   He was initially pleased with the choice of the CANS for this new service, but quickly realized that this could end up with "too many CANS" in the system.  They are trying to match their version with the one being used by the CBHI.
Again, we broke for questions.  The opening question made one wonder what the overarching goal of of the program;  what is the end that you have in mind?  What are the outcomes that we have in mind?  They are thinking of system, community, family and child level outcomes;  how will this be integrated into the RFP process?  The questions quickly moved back to the functional:   how can you make this work?  Can our masters level interns do this sort of work?  What about the redundancy of entering the CANS into the Virtual Gateway and into their own EMR?  How is this process going to integrate with the DSS/DCF program of family-focused integrated levels of care?  How are we going to support the family team meetings?  (Medicaid can't pay for this)

Excellent session from our colleagues on the hot seat-  they gave us real insight into the process and details underlying the tremendous process that is laid out before us over the next 11 months.  There will be a similar meeting for families in August-  check out the CBHI website for details.

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