June 24, 2013

OMH, OASAS and DOH Unveil Behavioral Health Managed Care Update

Earlier this week a team from New York State’s Office of Mental Health (OMH), Office of Alcoholism and Substance Abuse Services (OASAS) and the Department of Health (DOH) presented a webinar describing progress made on managed care program design activities intended to bring behavioral health into Care Management for All. Care Management for All is a program proposed by the Medicaid Redesign Team (MRT) that is supposed to improve benefit coordination, quality of care, and patient outcomes over a range of health care services.

Behavioral health will be managed by special needs Health and Recovery Plans (HARPs) for individuals with significant behavioral health needs or mainstream managed care plans that may provide services directly if they have met rigorous standards. Plans that cannot meet these standards or opt not to offer in-Plan capacity must partner with an approved Behavioral Health Organization (BHO) that has demonstrated that it can meet these rigorous standards. HARPs will be organized as separate product lines.

Greg Allen, the Director of the Division of Financial Planning and Policy at the New York State Department of Health, estimated that there are 140,000 individuals who will be eligible for a HARP. A Request for Qualifications from Plans (RFQ) will be released this Fall. The RFQ review process will determine whether Plans qualify alone or in partnership with a qualified BHO. Plans applying to develop HARPs must be qualified via the RFQ process and will need to meet some additional program and clinical requirements that will be reflected in the premium. A Plan’s HARP coverage must match that of their affiliated  mainstream Plan.  The expectation is to have Plans operational in the Spring of 2014 for adults in New York City and by the Fall of 2014 for the rest of the State.

This post was contributed by Carla Williams. Carla can be reached at cwilliams@oalaw.com.