1 Medicaid Managed Care Behavioral Health Information Technology (BHIT) Grant Program.

1

Medicaid Managed Care Behavioral Health Information Technology (BHIT)

Grant Program

June 2015 | Page 2 Behavioral Health Information Technology Grant Program (BHIT) -

Agenda

• Introduce members of the Team• Overview of the Project• New York City Department of Health and Mental Hygiene (NYC DOHMH)

Experience• Project Road Map: 10,000 Feet Overview• Proposed Structure• Roles• Working Mechanism• Addendums

2


Introduction of Team Members

• Advocacy Groups• New York State Office of Mental Health (NYS OMH) – Information Technology

(IT)• NYC DOHMH• New York State Office of Alcohol and Substance Abuse Services (NYS OASAS)

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New York State Department of Health (NYS DOH) – Office of Health Insurance Program (OHIP) contract with NYC DOHMH

• Priority Near Term Deliverable is to assure that all Home and Community Based Services (HCBS) providers are ready to bill for Medicaid Managed Care (MMC) services upon implementation of 1115 Waiver services in New York City - January 1, 2016

• Selection of HCBS providers most in need of support through objective criteria.

• Health Information Technology (HIT) scoping and vendor qualifications.

• Initial purchase of licenses, system upgrades, and/or implementation and technical assistance for Electronic Health Records (EHR) and/or Electronic Billing Systems (EBS).

Overview - Behavioral Health Information Technology Grant Program (BHIT)


Succeeding in Medicaid Managed Care

To remain viable, providers must:

• Input data into Electronic Health Records (EHR)• Access data from EHR• Share health information among providers to improve integrated services, sustain financial

viability, and reduce health care costs via reduction in Emergency Room (ER)/Inpatient services• Align with:

• Delivery System Reform Incentive Payment (DSRIP) Performing Providers System (PPS)• Health Homes (HH)• Regional Health Information Organizations (RHIO)• State Health Information Network of New York (SHIN-NY)


NYC DOHMH Experiences and Successes in HIT Adoption and Implementation Programs

NYC DOHMH achieved high levels of success in at least 6 Office of the National Coordinator for HIT (ONC)/NYS DOH/NYC DOHMH sanctioned and supported HIT/Health Information Exchange (HIE) programs.

1. National Regional Extension Center Program - ONC designated Regional Extension Center (REC) entity in NYC.

2. Primary Care Information Project - eClinicalWorks licenses for Primary Care Providers

3. Health Care Efficiency and Affordability Law for New Yorkers (HEAL) – HEAL 17 was a $120 million awarded to community-based HIT projects to build a more streamlined approach to sharing patient information consistent with a Patient Centered Medical Home Model (PCMH). Focus on hardware, software, HIE.

4. HEAL 22 - Provided TA to BH providers participating in Medicaid HHs, Behavioral Health Organizations (BHO) and Developmental Disabilities Individual Support and Care Coordination Organizations (DISCO). Focus on adoption and use of EHR for integrated care and HIE.

5. Medicaid Specialist Program-Eligible Providers 2 - Expansion of the REC Program to include Medicaid Specialists and some additional PCPs.

6. Interconnectivity Initiative - Interconnectivity Initiative facilitates practices in connecting subsidized EHR systems with one of the four local Regional Health Information Organizations (RHIOs) that link to their participating hospitals, nursing homes, homecare agencies, physician practices, and diagnostic centers.

http://www.nycreach.org/

http://www.nyc.gov/html/doh/html/hcp/pcip.shtml

https://www.health.ny.gov/technology/efficiency_and_affordability_law/heal_ny_17.htm

https://www.health.ny.gov/technology/efficiency_and_affordability_law/heal_ny_17.htm

http://scholar.google.com/scholar?q=patient+centered+medical+home&hl=en&as_sdt=0&as_vis=1&oi=scholart&sa=X&ved=0CCMQgQMwAGoVChMI5P_i-6OKxgIV07KACh14CwBU





http://www.nycreach.org/heal22

http://www.nycreach.org/medicaidspecialist



http://www.nycreach.org/otherprograms


BHIT Grant Program Priority Providers

Selected behavioral health HCBS providers serving adults, transitioning into the

MMC program under the New York State 1115 waiver program.


BHIT Grant Program Priority ProvidersAdults:

• October 2015 – Behavioral health services managed by Mainstream Managed Care Organizations in NYC

• October 2015 to January 2016– Enrollment begins for individuals eligible to join a Health and Recovery Plan (HARP) in NYC

• January 1, 2016– Home and Community Based Services are made available to individuals who choose to join a HARP

• July 1, 2016- Behavioral health services managed by Mainstream Managed Care Organizations and HARPs outside of NYC

Children:

• January 1, 2017- Behavioral health services for children managed by Mainstream Managed Care Organizations in NYC and Long Island

• July 1, 2017- Behavioral health services for children managed by Mainstream Managed Care Organizations throughout NYS


Priority HCBS Providers Who Serve Adults

• Little or no experience billing Medicaid

• Provider has no EHR to document these new services

• Provider has an EHR that does not suffice in documenting these new services

** HCBS providers serving adults have not had to develop robust level of HIT required to engage in a managed care environment**


Additional Resource Availability??

BHIT support may be extended to non-HCBS providers serving adults with:

• Limited or no implemented EHR/EBS systems


Funding Mechanisms

• Adult services are currently funded through several sources including state grants

• Newly designated HCBS services providers may:• Be new to Medicaid• Participate in Medicaid under fee for service or case rate arrangement


Contract between NYS and NYC DOHMH/Fund for Public Health of New York (FPHNY)

6/1/2015-5/30/2017

• Costs not to exceed $9,970,670

• Contractor (NYC DOHMH/FPHNY) duties:• Determine system capabilities for qualified Behavioral Health EHR and Electronic Billing System

(EBS) vendors• Acquire necessary initial or upgraded licenses• Provide technical assistance to 100-200 eligible HCBS BH agencies serving adults in New York

City and potentially other BH providers in New York City (Minimum: 2,000 individual providers)• Provide education, outreach, and technical assistance in adoption of Behavioral Health EHR

Software (BHS) and EBS technologies


Long-Term Goals

• Increase patient satisfaction and quality of care

• Improve coordination of care

• Improve health outcomes

• Reduce healthcare costs


Proposed StructureBHIT-Technical Assistance (TA) Steering

CommitteeComprised of Provider and Consumer Agencies,

Advocacy Groups, OASAS, OMH and DOHMH

Key areas to be addressed byAd-Hoc Work Groups

• Provider Selection based on Medicaid billing experience and capacity

• Vendor Selection based on functionality, integration with care management software, quality and preventive and chronic care capabilities, billing specifications & interoperability, documentation of HCBS services, billing/patient portal

• Software Upgrade based on to be determined criteria

• Practice management and workflow assessments for specifications

• DSRIP, HH, RHIO membership and interfaces with HH care management

• Privacy and Security

• Quality and Compliance

• Children’s Issues


Roles

Strategic Steering Committee

• Establish Guidelines for Process• Provide Leadership• Represent Providers

Ad-Hoc Work Groups• Focus on Specific Issues• Provide Concrete Guidelines• Validate IT and TA Efforts

Operational Teams

• Focus on Implementation

• Work closely with: • Providers • Vendors• MCOs

• LGUs• Consumers


Program Implementation Modalities

• Scheduling of meeting frequency

• Determination of HIT steering committee involvement• Action plan development• Completed and pending actions• Next steps• Roadblocks and lessons learned

• Ad Hoc meetings to cover specific issues


Development of BHIT-TA Advisory Groups/Subcommittees:

• Provider selection: Establishing selection criteria and selecting qualified providers for the BHIT project.

• Group may consist of organizations that represent Behavioral Health (BH) providers, consumers, and government agencies

• Use of objective criteria/methodology for start-up grants

• Vendor selection and Upgrades - Clinical and Consumer Access: • Developing specifications/criteria for Request for Proposal (RFP)

• Clinical documentation criteria• Selecting IT system vendors• Consumer Portal


Development of IT-TA Advisory Groups/Subcommittees:

• Practice and Workflow Management:• Human Factors current experience• EHR/EBS configuration• documentation requirements• Revenue Cycle Management (RCM)

• DSRIP, HH, RHIO membership and interfaces to HH care management systems:• For MMC payer models under HH/DSRIP success - interoperability with care planning and access to RHIO/SHIN-NY

dial tone services. • Critical for:

• Patient Record Lookup• Subscribe and Notify• Direct Messaging


Development of IT-TA Advisory Groups/Subcommittees:

Privacy and Security Review:

• HIT/HIE overall model and program implementation• Protection of PHI• Review of Health Information Technology for Economic and Clinical Health

(HITECH)/Health Insurance Portability and Accountability Act (HIPAA) implementation guidelines


Timeline for HCBS Provider Scoping of HIT needs

Q1Jun-Aug

Q2Sep-Nov

Q3Dec-Feb

Q4Mar-May

Q5Jun-Aug

Q6Sep-Nov

Q7Dec-Feb

Q8Mar-May

Staffing DOHMHTechnical Specifications & Use Cases

Workflow

Billing Conditions

Reports

Provider Qualification

Provider Survey Current Capacities

Tiers & Priorities

Provider Outreach & Enrollment

Assignment of TA Services & Licensing

Handling of Special Cases (as needed)

Year 12015-2016

Year 22016-2017

Qualifying Providers

Onsite Scoping of HCBS Provider

Needs

GANTT chart: illustrates timeframe for completion of HCBS provider scoping.

Outcome of scoping: rank providers in terms of need for additional HIT resources.


Addendum

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Office of the National Coordinator (ONC)

• The Office of the National Coordinator for Health Information Technology (ONC)/Health IT.gov

• Staff division of the Office of the Secretary, within the U.S. Department of Health and Human Services.

• ONC leads national HIT efforts, charged as the principal federal entity to coordinate nationwide efforts to implement and use the most advanced HIT and the electronic exchange of health information.

• Position of National Coordinator was created in 2004, through an Executive Order, and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act of 2009.

http://www.healthit.gov/newsroom/about-onc



http://en.wikipedia.org/wiki/Health_Information_Technology_for_Economic_and_Clinical_Health_Act

http://en.wikipedia.org/wiki/Health_Information_Technology_for_Economic_and_Clinical_Health_Act


ONC Mission and National Guidance in 2015

ONC Mission:• Building an interoperable, private and secure nationwide health information system and supporting the

widespread, Meaningful Use (MU) of HIT.

• ONC is working to improve these five areas:• Adoption: increase end user adoption of EHRs and HIT to capture and use the information• Standards: establish standards so the various technologies can speak to each other• Incentives: provide the right incentives for the market to drive financial and clinical advances• Privacy and security: make sure protected (personal) health information remains private and secure• Governance: provide governance and structure for the exchange of health information

• The concerted initiative on interoperability in 2014 seeks to achieve the ability of two or more systems to exchange health information and use the information once received.

http://en.wikipedia.org/wiki/Meaningful_Use

http://en.wikipedia.org/wiki/Health_information_technology

June 2015 | Page 24 Behavioral Health Information Technology Grant Program (BHIT) - ONC Regional Extension Centers Program Goals and NYC

DOHMH/REACHRegional Extension Centers (REC) NYC DOHMH:

• Established HIT REC to offer TA, guidance and information on best practices to support and accelerate health care providers’ efforts to become meaningful users of EHRs.

• The REC for NYC was FPHNY/NYC REACH.

• The REC for Rest of State (ROS) was run through the New York eHealth Collaborative (NYeC).

• The REC program goals were

• To enroll 100,000 Primary Care Providers, along with critical access hospitals.

• Help them Go Live on EHRs, and

• Help them demonstrate Meaningful Use.

• As of January 2014, among all providers, 149,315 enrolled with RECs, 132,989 achieved Go Live on EHRs, and 89,299 demonstrated Meaningful Use.

• NYC DOHMH completed all milestones for enrollment, adoption, go live, and meaningful use in NYC.


HEAL 22 ScopeHEAL 22: Adoption and implementation of behavioral health (BH) EHR for:

• Integration of Care among BH Health Home and DISCO Providers

• Treatment and/or Care Coordination capabilities

• HIE

• Implementation and effective utilization of an EHR by BH providers.

• The provider/site was responsible for financial obligations that related to software, hardware, and connectivity requirements.

• NYC REACH provided technical services as necessary to assist the provider/site in achieving an established level of HIT/HIE functionality

The BHIT Grant continues in this effort by focusing on new licenses, upgrades and billing capability for the new HCBS providers including Mental Health (MH) and Substance Use Disorder (SUD) agencies and programs.

http://www.nycreach.org/heal22


BH IT-TA Steering CommitteeNYC DOHMH/REACH and NYS OMH/OASAS

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IT-TA Steering Committee, Provider and Consumer Advocacy, O-Agencies, DOH, DOH-MH

Provider selection HCBS/non-HCBS

designation, Medicaid

experience, case rates vs. Fee for

Service (FFS), volume

Vendor Selection and Upgrades-Financials EBS

billing implementation

Financials, Coding and Billing

specifications, 3rd party, Management

Services Organization (MSO)

billing

Vendor Selection and Upgrades – HCBS

Services, Consumer: EHR ease of use and

consumer portals. Quality, preventive and

chronic care capabilities, reporting, integration

with care management software (Medicaid

Analytics Performance Portal (MAPP), etc.)

Practice and Workflow Management- Human

Factors, scheduling, current experience, EHR/EBS

configuration, patient flow, documentation

requirements, integration of plan information.

DSRIP, HH, RHIO membership and

interfaces to HH care management (CM),

configuration of dial-tone services, Patient Record

Lookup (PRL), Alerts

Issues in the Development of IT-TA Advisory Groups/Subcommittees


Questions???

Contact:Tom UttaroNYS [email protected]

Eric WeiskopfNYS [email protected]

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1 Medicaid Managed Care Behavioral Health Information Technology (BHIT) Grant Program.

Documents