New Mexico Behavioral Health Purchasing Collaborative Meeting · Rose Baca-Quesada/MFA, Lupe...

Video Conference Sites

Farmington

Las Vegas

Las Cruces

Silver City

Roswell

Albuquerque

New Mexico Behavioral Health Purchasing Collaborative Meeting

Human Services Department

37 Plaza la Prensa

Santa Fe, NM

Thursday, July 14, 2011

AGENDA

Your Collaborative. Your Success! 1

New Mexico Behavioral Health Interagency Purchasing Collaborative

____________________ ________________________________________________

Thursday July 14, 2011 37 Plaza La Prensa

Santa Fe, New Mexico 1:30 p.m. – 4:00 p.m.

AGENDA

1. 1:30 – 1:35 p.m. Call to Order • Approval of the NM Behavioral Health Collaborative Meeting Minutes

from April 14, 2011 (Decision Item) • Collaborative Bylaws (Decision Item) • Announcement: Value Added Services

2. 1:35 – 1:55 p.m. Behavioral Health Planning Council (BHPC) Report

Chris Wendel, Behavioral Health Planning Council

3. 1:55 – 2:10 p.m. Directors Reports/Data Karen Meador, HSD/Behavioral Health Collaborative Geri Cassidy, HSD/Medical Assistance Division

4. 2:10 – 2:20 p.m. Prevention Dollars

Michael Evans, OptumHealth New Mexico

5. 2:20 – 2:40 p.m. OptumHealth Status – Directed Corrective Action Plan (DCAP and Sanction (Possible Decision Item) Linda Homer, HSD/Behavioral Health Collaborative CEO Alicia Smith and Associates

6. 2:40 – 2:50 p.m. Quality Performance and Accountability

Dr. Betty Downes, HSD/Behavioral Health Collaborative

7. 2:50 – 3:10 p.m. Public Expert Panel Taskforce Linda Homer, HSD/Behavioral Health Collaborative CEO

8. 3:10 – 3:30 p.m. Public Input 9. 4:00 p.m. Adjourn

Yolanda Berumen‐Deines NM Children Youth & Families Department

Secretary – Collaborative Co‐Chair

Sidonie Squier, NM Human Services Department Secretary – Collaborative Co‐Chair

Your Collaborative. Your Success! 2

New Mexico Behavioral Health Interagency Purchasing Collaborative

2011 Meeting Schedule

__________________________________________________ __________________

Month Day Location July Thurs 14th Collaborative Conference Room

37 Plaza La Prensa Santa Fe, NM 1:30pm – 3:30pm Video conferencing available at the following locations:

• Farmington CSED 1800 E. 30th Street Farmington, NM 87501

• Las Vegas CSED 2536 Ridge Runner Rd Las Vegas, NM 87701

• Las Cruces ISD 2121 Summit Ct. Las Cruces, NM 88011

• Silver City CSED 3088 32nd St. Bypass Road, Suite B Silver City, NM 88061

• Roswell CSED 2732 North Wilshire Blvd. Roswell, NM 88201

• Albuquerque South CSED 1015 Tijeras NW Ste 100 Albuquerque, NM 87104

Oct Tentative Thurs 13th Collaborative Conference Room

37 Plaza La Prensa Santa Fe, NM

1. Call to Order • Approval of April 14, 2011 Meeting Minutes

Behavioral Health Collaborative April 14, 2011 1

Meeting Minutes New Mexico Behavioral Health Collaborative

Meeting – April 14, 2011 1:30 p.m. – 4:00 p.m. Human Services Department – 37 Plaza La Prensa – Santa Fe, New Mexico Video Conference-Farmington NM, Las Vegas NM, Las Cruces NM, Silver City NM, Albuquerque NM

Handouts: Copies of the NM Behavioral Health Purchasing Collaborative Meeting public hand-outs may be obtained from the website www.bhc.state.nm.us Topic Discussion

Present were:

1. Call to Order

• Approval of the NM Behavioral Health Collaborative Meeting Minutes from December 9, 2010 (Decision Item)

• Discussion on Future Collaborative Meeting Dates (Decision Item)

2. Legislative Updates 3. Contract Language

(Decision Item)

4. Proposal for Value Added Services (Possible Decision Item)

Sidonie Squier/HSD, Dr. Catherine Torres/DOH, Dr. Edna Reyes-Wilson/CYFD, Linda Homer/BHC, Retta Ward/ALTSD, Arthur Allison/IAD, Kristine Meurer/PED, Ralph Vigil/DVR, Muffet Foy-Cuddy/DOT, Patrick Simpson/AOC, Jacqueline Cooper/PDO, Rose Baca-Quesada/MFA, Lupe Martinez NMCD, Angel Roybal/BHC Sidonie Squier, Chair called the meeting to order at 1:40 pm, with a quorum present. A MOTION was made by Rose Baca-Quesada to approve the Behavioral Health Collaborative future meeting dates which will take place on a quarterly basis. The MOTION was SECONDED by Dr. Catherine Torres and was PASSED unanimously. The residual calendar meeting dates are as follows:

• July 14, 2011 • October 13, 2011 • January 12, 2012

A MOTION was made by Dr. Catherine Torres to approve the minutes from the December 9, 2010 Behavioral Health Collaborative Meeting. The MOTION was SECONDED by Dr. Catherine Torres and was PASSED unanimously. Handout- Updated Behavioral Health Bills and Memorials 2011 Regular Legislative Session Karen Meador reported that the Behavioral Health Collaborative received a report on the bills signed by the Governor and memorials passed by the legislature. Of the 46 behavioral health related bills that were introduced, 11 were signed. Of 15 behavioral health related memorials that were introduced, 12 passed. House Joint Memorial 17 and House Bill 423 specifically name the Interagency Behavioral Health Purchasing Collaborative as the lead agency. Workgroups are being developed. Handout- State of New Mexico Human Services Department Professional Services contract Contract-Contract Amendment No. 8 A MOTION was made by Ralph Vigil to approve the contract language of the State of New Mexico Human Services Department Professional Services Contract No. 09-630-7903-0063-A8. The MOTION was SECONDED by Rose Baca-Quesada and was PASSED unanimously. Handout-OptumHealth New Mexico Value-Added Services Plan Non-Entitlement Services by Dr Dwight Holden/CMO OHNM and Noel Clark/CEO Carlsbad Mental Health Center The PowerPoint presentation was based on the following components:

• Value Added Services


Topic Discussion 5. Behavioral Health Planning

Council BHPC) Report

• Value Added Services Spend FY11 • Value Added Services Brainstorming Committee • Value Added Services-Non Entitlement Brainstorming FY12 • Value Added Services-Non Entitlement $$ Use FY11 • Value Added Services-Entitlement Funds Spent by Region and LC FY11 • Value Added Services Funding Proposal FY12 –Total • Request for Behavioral Health Collaborative Input • Value Added Funding FY11 Spend and FY12 Proposal-Youth • Value Added Funding FY11 Spend and FY12 Proposal-Adult • FY12 Pan Rollout: Implementation • Value Added Services Non-Entitlement Funds access by Youth CSA for Each Region/LCFY12 • Value Added Services Non-Entitlement Funds access by Adult CSA for each Region/LC FY12

Dr. Catherine Torres suggested that the Collaborative needs to have an emergency meeting in order to review all related correspondence in advance before making a final decision regarding the Value-Added Services Distribution Plan. MOVED, SECONDED AND CARRIED to lay the MOTION concerning the OptumHealth New Mexico Value-Added Services Distribution Plan Proposal on the TABLE. Handout-OptumHealth New Mexico Community Reinvestment FY 2012 by Dr. Jana A. Spalding/VP, Consumer & Family Affairs The PowerPoint presentation was based on the following components:

• Community Reinvestment Promoting Recovery-Expanding the Behavioral Health Service Array • Why Community Reinvestment? • Community Reinvestment Fast Facts

The Collaborative requested program summaries of the consumer-run organizations that received awards during the fiscal year 2011 and an outline of the Community Reinvestment awards from the previous year under the previous state wide entity. They will review prior to approving the Community Reinvestment Application Process which may be accomplished at the next Collaborative Executive Committee meeting. Handout-Behavioral Health Planning Council Report to the Purchasing Collaborative Thursday April 14, 2011 Handout-Budget Variance Handout-Local Collaborative Reports Behavioral Health Planning Council Chair Chris Wendel welcomed and congratulated the Collaborative members on their respective appointments and confirmations. As a point of reference, she has, over the last two years, developed a standard format for their reports which she will use in future meetings; however, she would like to deviate from that today as this is their first meeting, and she would like to give you more of and overview of your Behavioral Health Planning Council (BHPC).


Topic Discussion

So as to the why as well as the who, what ,when and where: WHY: They are the advisory body of Governor Martinez and to you on things related to mental health, substance abuse and developmental disabilities. They exist under the Statute as you, NMSA 1978; 24-1-8. They are also required per SAMHSA Community Health Services (CMHS) Block Grant. WHO: They are mostly volunteers from communities across this state bringing forward the voice of consumers, family members, advocates and providers; they work to improve the quality and availability of effective mental health and substance abuse prevention, treatment and recovery support services to help New Mexicans in every part of the state. It is important to stress that they represent communities from across New Mexico primarily through the Local Collaborative structure, which brings a geographic and cultural diversity to the table. As such, they act as a conduit and catalyst for information, etc. flowing up for communities to the Collaborative and correspondingly down from the Collaborative to communities. Also because some of their members represent respective Collaborative departments, they are able to have close relationships with the State agencies. In addition, the CEO of the Collaborative works very closely with the BHPC to maintain an open and meaningful dialogue. WHAT: They have advised on:

• Strategic Priorities (within the context of the Subcommittees) • Legislative Priorities • Sandoval County Jail Project • SAMHSA Grant Reviews:

Community Mental Health Services Block Grant Substance Abuse Prevention and Treatment Block Grant Substance Abuse Prevention Strategic Framework State Incentive Grant Screening, Brief Intervention, Referral and Treatment Grant Access to Recovery Total Community Approach Co-occurring State Incentive Grant

• Medicaid Cost Containment • Medication Fund • Collaborative Annual Conference Award Recipients • State-wide Entity Request for Proposal Review • Anti-Stigma campaign • Community Reinvestment • Children and Adult Systems of Care • CCSS • CADAC to LADAC legislation for Native Americans


Topic Discussion

• Letter of Support: Maternal Postpartum Depression Project Trust Success In Schools Partnership For Success Prevention Grant Infant mental Health SAMHSA Comprehensive Community Mental Health Services for Children And Their Families Program Grant School Mental Health Capacity Building Partnership Pilot Training Initiative Grant

In addition, they also represent not only do the Collaborative but also the State in various arenas, • Representing the Collaborative:

Senate and House Memorials Quality Services Review (QSR) Core Service Agency (CSA) Supportive Housing Child Youth and Family Involvement Guidelines Cultural Competency Workgroups

• Representing the State Annual SAMHSA Transformation State Incentive Grant Conferences Annual SAMHSA Community Mental Health Services Conferences Annual National Association of Mental Health Planning Councils

WHEN: The BHPC meets quarterly during the year. The four of the five Statutory Subcommittees (Adult, Substance Abuse, Children/Adolescents and Native American) meet monthly; the Medicaid Subcommittee meets quarterly. They believe that the work of the Council happens primarily in the Subcommittees – that is where they have the broadest base of local representation. Thanks to Deputy Sec Reyes-Wilson from CYFD for attending their Children/Adolescent Subcommittee and BHPC meeting in March. WHERE: Most of their meeting are conducted around the State either video, internet or teleconferencing. The host site is usually in the big conference room at BHSD. Ad Hoc Subcommittees- Finance Subcommittee: A couple of years ago, they instituted a Finance Subcommittee which meets monthly. They did this not only to have an accurate understanding of the costs of running BHPC but also to be prepared for the end of TSIG funding. She has included their most recent budget variance for your review. Local Collaborative Subcommittee: This Subcommittee Plans their Annual BHPC/Local Collaborative Summit as well as their Behavioral Health Day at the Legislature. They wish to extend not only their continued thanks to Senator Papen and Representative Edward Sandoval for their sponsorship of this event but also thank to Secretaries Squier, Deines and Torres as well as Governor Martinez’s Chief of Staff Gardner for joining us in February.


Topic Discussion

6. Directed Corrective Action Plan (DCAP) Monitor’s Update

7. OptumHealth Sanction Letter

For Clinical Triggers (Possible Decision Item)

Final Thoughts: All of our last Annual Reports and State of Council reports are available on the Collaborative website ([email protected]). All of them on them on the BHPC work to encourage and develop consumers and family members to bring forth their voices and to rise to places of leadership. To that end, there are many exciting events happening during the year throughout the State, such as Senior Jubilees, Sober Fest, Mental Health Month activities, and Recovery Month activities. The Council has worked to better define its role, to fulfill its commitments to the state and the people of New Mexico, and to plan for the future of the Council going forward. Over time, the role of the BHPC has evolved to become a strong advisory board for state agencies responsible for behavioral health services for children and adults. Although the Planning Council has no formal role in creating policy, direct interaction between state staff and Planning Council and its committees and members help shape policy as the state develops it. State staff has come to look to the BHPC when they need to know what the people of New Mexico think. Handout- OptumHealth New Mexico Monitor Status Report by Alicia Smith & Associates, LLC Alicia Smith provided an overview of the current status of the Directed Corrective Action Plan (DCAP): Claims Processing-

• Timeliness and accuracy of claim payments • Provider fee schedule and claim adjudication dispute process • Expedited payment reconciliation • Reimplementation of standard edits • Encounter data • Payment to non-contracted IHS providers

Claims Submission- • Service Registration • Authorization process and reporting

Financial Management- • Fund management and mapping • Financial reporting

Provider Relations- • Provider contracting

Provider council, call center and complaint monitoring Handout-February 16, 2011 NM Behavioral Health Purchasing Collaborative Sanction Letter to OptumHealth New Mexico and related correspondence regarding Clinical Triggers (Collaborative Member Packets only) Linda Homer reported that in January 2011, the State became aware that OptumHealth had implemented a set of clinical triggers designed to limit the units of service that providers are able to deliver without resort to clinical review. Neither the provider community nor the Sate was given adequate and appropriate prior notice of this significant change. Therefore, a Sanction Letter was issued to OptumHealth New Mexico on February 16, 2011. OptumHealth has since notified the Collaborative of its intent to pursue a formal dispute of the Sanction Letter.


Topic Discussion

8. Behavioral Health Collaborative Bylaws (Possible Decision Item)

9. Collaborative Taskforce (Possible Decision Item)

Mark Reynolds, acting General Council of HSD/Behavioral Health Collaborative stated that the contact between OptumHealth New Mexico and the Collaborative calls for the next appeal to be an informal hearing to the Co-Chairs. As the Council to the Collaborative, he advises that they follow the guidelines of the NM Attorney General Open Meetings Act by delegating to the Co-Chairs in open meeting, the authority to have an informal hearing which will also be in open meeting and report back the determination(s) made for adoption at the next Collaborative meeting. We will then be in compliance with the contract and the Open Meetings Act. A MOTION was made by Ralph Vigil to delegate the Collaborative Co-Chairs the authority to have an informal hearing in an open meeting regarding the OptumHealth NM appeal of the Collaborative Sanction Letter issued on February 16, 2011. The determination(s) will be reported back to the Collaborative at the July 14, 2011 meeting for adoption. The MOTION was SECONDED by Kristine Meurer and was PASSED unanimously. Handout- Bylaws of the New Mexico Interagency Behavioral Health Purchasing Collaborative Mark Reynolds reported that The Collaborative Executive Committee agreed that they require more time to determine what suggested items to be listed on the agenda now that meetings are held on a quarterly bases. The amendment has been presented to the Collaborative at this meeting and will be voted for adoption at the July 14, 2011 meeting. The recommended amendment to the Bylaws from the Collaborative Executive Committee is as follows: Article 7 Collaborative Procedures 7.3 The co-chairs shall set the agendas for meetings of The Collaborative. Any Collaborative member my request an item be placed on the agenda, so long as the request is received a least four business 21 calendar days before the scheduled meeting, except in an emergency. Linda Homer indicated that during the discussions with Executive Committee it has been decided that all presenters listed on the Collaborative agenda are required to provide any correspondence related to their presentation two week prior to the meeting. If a presenter does not fulfill this requirement, the topic will be removed from the agenda. It is important to distribute information for review to the Collaborative members prior to the meeting. Handout-Expert Panel Taskforce for Design of the Collaborative and Purchasing Structure for Behavioral Health GOALS The current Statewide Entity (SE) contract with OptumHealth expires June 30, 2013. The Statewide Entity contract needs to be rebid in 2012. The Collaborative will conduct a public process to obtain input for the next RFP and contract for the management and delivery of the public behavioral healthcare system in New Mexico. Additionally, as part of the public process, the Collaborative will review the current structure and operation of the Behavioral Health Purchasing Collaborative to get input and recommendations for future structure and operation. QUESTIONS TO ADDRESS

• What are the strengths and weaknesses of the current SE structure and contract? How should it be changed? • What is unique to New Mexico that we must address in any contract/RFP? • Where is the healthcare delivery system going in the next few years? How do we accomplish integrated care and assure a

strong behavioral health component? • How will behavioral Health fit within New Mexico’s Medicaid redesign?


Topic Discussion 10. Public Input

• What are the strengths and weakness of the current Behavioral Health Purchasing Collaborative model and operation? How should the Collaborative be changed?

Timeline Taskforce meets June, 2011-August, 2011. Recommendations due to the Collaborative and Interim Legislative Committees in September and October, 2011. Membership Consumers and Family Members selected from Behavioral Health Planning Council and Local Collaboratives New Mexico Providers: Adult, Child, Native American, Elderly, Corrections Psychiatry, Public Health Managed Care Organizations: Saluds and Behavioral Health University Representation: RWJ Policy Institute, Consortium for Behavioral Health Research and Training Advocates: New Mexico Family Network, NAMI; Protection and Advocacy Representatives of Collaborative Member Agencies: HSD, CYFD,PED, NMDOC, ALTSD, DOH Interaction with Legislative Interim Committees: TBD Secretary Dr. Torres recommends utilizing other universities, mental hospitals and detention centers for membership. Handout-Preliminary Process and Timeline for Rebid of statewide Entity Contract The current contract with the Behavioral Health Purchasing Collaborative’s Statewide Entity, OptumHealth New Mexico, ends June 30, 2013. The preliminary timeline for the rebidding of the RFP is as follows:

• Expert Panel Taskforce to provider recommendations for the next SE model, contract and RFP- May-September 2011. • Statewide Entity RFP Development – September, 2011-January, 2012. • Statewide Entity RFP Issued – February 2012 – Responses due by May, 2012. • Evaluation of response to Statewide RFP – May, 2012 – August, 2012. • Contract Award – August, 2012 – October, 2012.

Jim Ogle, National Alliance on Mental Illness-

• Asked the Collaborative to consider conducting a study regarding police involved shootings. • The police are conducting studies on their end regarding what they can do better or what they can do differently. • It is his understanding that 2/3 of the people involved in the shootings, are people living with mental illness. • Whether or not a police officer had crisis intervention training, it did not appear to make a difference. • He thinks the problem is on the behavioral health side. • Please consider a study on these particular cases with the understanding of private issues, to look for the root causes of

the incidents to help with future prevention. • Thank you


Topic Discussion

Regina Roanhorse, Chair of Local Collaborative 15 - • She has family member who suffers mental health issues and substance abuse which describes why she has been a

volunteer for over 3 ½ years. • Thank you to Governor Susana Martinez and her staff for supporting Senate Bill 417 to develop clearing house for Native

American consumer and family members on suicide prevention. The bill was based on a lot of work by a Laguna advisory group.

• They have experienced several suicides in their communities and have some of the highest rates in alcohol related deaths in the New Mexico.

• They have seen their state resources dwindle from $50,000 to zero within the last year. • Seven of their substance abuse prevention programs have not been funded. • Thank you to OptumHealth for filling a $2 million gap. • They still do not have substance abuse services in her community that were once funded by the state. • Because of their unique political status as tribes, there’s federal dollars that can be funneled through New Mexico without

any state funds and it is called Medicaid. • If we can protect the Medicaid services for our Native Americans we can build an infrastructure of our tribal programs and

Indian health services. • Please support the Medicaid waiver that they worked on last year. • She looks forward to meeting the Collaborative. • Thank you.

Kathleen Hunt, Border Area Mental Health-

• Thank you to the Collaborative for providing video conferencing which makes it easier to participate. • She is an advocate for consumer run services. • When we talk about essentially taking for from “Peter” to pay “Paul” regarding consumer run services, remember that

providers have already experience cuts. They are who support the consumer run services. • Regarding Value Added Services, please consider continuing family stabilization which is especially great to reach

consumers in rural and frontier areas in New Mexico. • Thank you for listening.

Amber Herndon, Consumer- On behalf of Amber Herndon, Gail Falconer read Amber’s letter to the members of the Behavioral Health Purchasing Collaborative as follows: I would have liked to deliver this message to you in person, bur am not able to attend tomorrows’ meeting. I have asked to share my experience with OptumHealth New Mexico, as outlined below with you.

• OptumHealth New Mexico knows about a lot of programs. • OptumHealth New Mexico is efficacious because they hired Eleanor Arntzen as a peer support specialist. • The social worker in the hospital where I was a patient a year ago referred me to Eleanor. • Eleanor came to see me in the hospital over a year ago, and then met with my daughter and myself one week after I was

discharged.


Topic Discussion

• Eleanor told me about DBSA, NHAMI and other places where there were support groups. • Eleanor spent time with me, listened, and talked to me. • Eleanor and I share the same diagnosis, and yet she seemed so steady. • Eleanor led me to DBT counseling, which I continue in, and has helped me tremendously. • OptumHealth New Mexico paid for the hospital; they paid for my therapy and are still paying for my psychiatrist. They are a

lifesaver—I would not have been able to make it without them. I am glad they were here and are still here. Delfy Roach, Brain Injury Association of New Mexico (BIAS)-

• We celebrate today because SAMSHA has finally recognized that brain injury and behavioral health go together. They did a very nice job with a document that has been given to Dr. Pam Martin, with OptumHealth for distribution to the substance abuse providers. The document will provide information on how to gear treatment towards those with brain injuries.

• BIANM would like to participate with the Collaborative Taskforce initiative because brain injury belongs with behavioral health and integrated care. Many are diagnosed with behavioral and mental health disorders. It’s really the brain injury that’s the primary but it is the behavioral health diagnoses that are treated and the brain injury is ignored. There is not a person that comes through their office that does not have both.

• They are glad that SAMSHA has finally recognized persons with brain injuries as having a co-occurring disorder as opposed to “we don’t belong in behavioral health”. It’s integrated and they thanked them for acknowledging that.

• Thank you the OHNM employee who presented earlier—Jana Spaulding, on behalf of the consumer. Consumer organizations do provide services. They are not paid for the services but they do provide services that are equally as effective as the services that are offered by providers.

• Thank you. Kayt Gutierrez, Self identified Consumer utilizing mental health and substance abuse services-

• She was asked by Dr. Spalding to share an answer to a question that was asked of her. The question is how has OptumHealth impacted your recovery?

• During her recovery, she thought she had hit a plateau place where she knew where she was going, was self-directed, and was community oriented. When OptumHealth came to their community, they brought a message that there is life after provider service. Recovery has different levels.

• Those of us in recovery need the option to continue recovery past therapy, interventions, and treatment options by going back to our community and giving back. This speaks to both the Community Reinvestment funds and community organizations.

• The possibility of allowing the single entity to become a provider organization is very frightening to her. As a consumer, she is frightened because the providers have power and control already. Do not give them the power and control over payment to someone who is invested vs. someone showing up to get paid. Please consider.

• It is extremely import ant to include consumers in the workforce to support peers and people in recovery. • Thank you.

Rick Vigil, Chair of Local Collaborative 18-

• Thanks to the Secretary of the Human Service Department and the Indian Affairs Department for their leadership in the


Topic Discussion

11. Adjourn

driven opportunities for Native community Local Collaboratives. • He recommends evaluating the collaborations as a mechanism to help bring Secretaries to the table. • He has been advocating a lot at the national level speaking with leadership from the Obama administration. • Report cards in Indian nations indicate large disparities in a lot of areas. • Regarding discussions about Value Added Services how do we partner as native communities to a CSA? How do we look

at partnering private industry? • Success story with the help of Optumhealth Dr. Morris- One placement adolescent who has had no parental involvement

went home from yesterday. Leadership is assisting this individual to help her transform her academics in order to reach the Santa Fe Indian school level so that she may attend in the fall.

• Many state agencies have a Native tribal liaison to communicate with. • As we move forward into the future, we must continue to decrease disparities.

Nancy Jo Archer, Hogares-

• She is delighted to meet the new Collaborative members. • CYFD assures that the TLS serves CYFD children both in protective services and juvenile justice. In the children’s and the

adolescent world, it is a big target population. • RE: Clinical Triggers-She urges the Collaborative to seek resolution as quickly as possible. This continues to be an issue

because of the delay in notifying that they received notification. Programs worked diligently to submit re-notifications

There being no further business, the meeting adjourned at 4:10 p.m.

1. Call to Order

• Collaborative Bylaws

Collaborative By-Laws/Proposed amendment 4/7/11 Page 1 of 5

Bylaws of the New Mexico Interagency Behavioral Health

Purchasing Collaborative These Bylaws were adopted by The Interagency Behavioral Health Purchasing Collaborative on April 24, 2008, at which time the previous Memorandum of Understanding, adopted by the Collaborative on June 11, 2004, and effective June 25, 2004, was rescinded. Article 1 Purpose and Objectives 1.1 The purpose of The Collaborative is to develop a statewide system of behavioral health care

that promotes the behavioral health and well-being of children, individuals and families; encourages a seamless system of care that is accessible and continuously available; and emphasizes prevention and early intervention, resiliency, recovery and rehabilitation.

1.2 The Collaborative has a vision of a single behavioral health delivery system in New Mexico in which available funds are managed effectively and efficiently; the support of recovery and development of resiliency is expected; mental health is promoted; the adverse effects of substance use and mental illness are prevented or reduced; and behavioral health services consumers and families are assisted in participating fully in the life of their communities.

1.3 The Collaborative is charged by law, in Section 9-7-6.1 NMSA 1978 as amended, with specific responsibilities and is directed to take into consideration specific principles, to the extent practicable and within available resources.

Article 2 Membership 2.1 Members of The Interagency Behavioral Health Purchasing Collaborative

[hereinafter “The Collaborative”] are those secretaries and directors (including the Governor’s Health Policy Coordinator) or their designees who are specified in Section 9-7-6.4 NMSA 1978 as amended and any Ex-Officio members.

2.2 The Secretary of the Higher Education Department, the Secretary of the Veterans Services Department, the New Mexico Public Defender, and the Children’s Cabinet Coordinator are Ex-Officio members of The Collaborative. The Collaborative may designate Ex-Officio members. Such designated Ex-Officio members shall serve as non-voting members, but are required to otherwise participate as full members of The Collaborative.

2.3 No decision of The Collaborative or of the Governor’s Office shall be binding on the Administrative Office of the Courts, which is otherwise a non-voting full member of The Collaborative.


2.4 A member of The Collaborative may designate an individual to represent him/her by written authorization. Written authorization must be submitted to the Chief Executive Officer prior to any meeting at which a designated proxy shall represent the statutory Collaborative member or Ex Officio member. Such a proxy authorized to vote, act or participate on behalf of the secretary or director shall be referred to as a Collaborative member.

Article 3 Chair, Co-Chairs, Executive Committee, Chief Executive Officer 3.1 The Collaborative shall be chaired by the Secretary of Human Services, with the Secretary of

Health and the Secretary of Children, Youth and Families alternating annually as co-chairs. “Annually” or “annual” wherever found in these Bylaws shall mean the New Mexico state fiscal year.

3.2 The Chair and serving Co-Chair in consultation with the Collaborative Chief Executive Officer or her designee shall:

a. take such operational and administrative decisions as are required on a day-to-day basis; b. set agendas for meetings of The Collaborative; c. appoint Collaborative members to any standing committees;

3.3 The Executive Committee of The Collaborative shall be comprised of the Chair of the Collaborative and the two Co-Chairs.

3.4 The Executive Committee will meet informally, including by telephone conference, to:

a. gather information and make recommendations to The Collaborative; b. appoint Ad Hoc Committees as needed; c. receive any reports or recommendations from Collaborative committees or sub-

committees; d. identify any policy recommendations requiring a decision by The Collaborative; e. may authorize proposals for rules or regulations as authorized by the Administrative

Procedure Act, recommend final rules to The Collaborative, and approve emergency rules on behalf of The Collaborative;

f. interview, select for hiring and conduct annual job evaluation reviews for the Collaborative Chief Executive Officer and her/his Deputy.

3.5 The “director” of The Collaborative as specified in law shall be called the Chief Executive Officer [CEO] of The Collaborative.

Article 4 Committees of the Collaborative 4.1 To facilitate its work, the Collaborative may designate such standing committees as are

annually required.

4.2 The Chair and Co-Chair of the Collaborative may appoint members to any such annual standing committees.


4.3 The duties and responsibilities of any standing committees shall include at least consulting with the Collaborative Chief Executive Officer or designee, gathering information, requesting advice from the Behavioral Health Planning Council, conferring with staff of Collaborative agencies and departments, and making recommendations for action by the Collaborative, the Chair and Co-Chair, or the Executive Committee. Public notice of such meetings may be given and public attendance and participation permitted as deemed appropriate by the committee chair.

4.4 The Executive Committee may from time to time appoint Ad Hoc Committees consisting of three or more Collaborative members to gather information and make recommendations to The Collaborative about specified matters. Public notice of such meetings may be given and public attendance and participation permitted as deemed appropriate by the committee chair.

Article 5 Exercise of Powers 5.1 The Collaborative shall work by consensus unless and until the Chair shall determine that a

vote is required.

5.2 A consensus shall be recognized by the Chair or Co-Chair of the Collaborative when all Collaborative members present are willing to be bound by the specific decision of the Collaborative being taken. Consensus may be assumed unless a member makes known his/her unwillingness to be bound by a proposed decision at the time the decision is taken.

5.3 In the absence of consensus, a majority vote of the voting members present shall constitute a final decision. A voice vote shall be taken for all decisions requiring a vote. Any member in attendance may request that a roll call vote be taken to confirm a voice vote.

5.4 A majority of voting members of The Collaborative shall constitute a quorum at any regular or special meeting. Once a quorum is established, the Collaborative may conduct business and make decisions as if a quorum still exists for that meeting.

Article 6 Responsibilities of Members and Committees

6.1 Members of the Collaborative are expected to prepare themselves for the issues coming before The Collaborative, to attend and to participate in meetings of The Collaborative and committees to which they are assigned.

6.2 Each Collaborative member shall participate in at least one standing or ad hoc committee.

6.3 Collaborative members shall assign staff or resources to standing and ad hoc committees and to any Steering or other work groups as requested by the CEO.

6.4 Collaborative members shall abide by Collaborative decisions and policies and shall give such directions to their agency or departmental staff as are needed to operationalize Collaborative decisions.

6.5 Collaborative members are expected to maintain the confidential nature of Collaborative deliberations held in closed session, including written and verbal communication.


Article 7 Collaborative Procedures

7.1 The Collaborative shall meet at least four times each year on dates and at times set by the co-chairs after consultation with the Collaborative.

7.2 The public shall be given notice of the dates and times of such meetings pursuant to the New Mexico Open Meetings Act requirements. Notice of regular meeting times shall be given seven business days in advance of the meetings; notice of special meetings shall be given three business days in advance of the meetings; and notice of emergency meetings shall be given twenty-four hours in advance of the meetings.

7.3 The co-chairs shall set the agendas for meetings of The Collaborative. Any Collaborative member may request an item be placed on the agenda, so long as the request is received at least four business 21 calendar days before the scheduled meeting, except in an emergency.

7.4 Agendas for any meeting of the Collaborative shall be sent via e-mail or facsimile to each member of the Collaborative at least three business days prior to the date of the meeting, except in an emergency. Each agenda shall indicate items that are probably decision items upon which a consensus may be reached or a vote taken. Items on the agenda not designated as decision items may result in a decision by The Collaborative after discussion at the meeting. Meeting agendas, except in the case of emergency, shall be available to the public by posting on the Collaborative website at least 24 hours prior to the meeting.

7.5 Minutes of the meetings of The Collaborative shall be maintained by the Office of the Chief Executive Officer of The Collaborative. The co-chairs may appoint counsel to The Collaborative for legal advice.

7.6 Each member of The Collaborative (except Ex Officio members) shall have one vote on any decision item.

7.7 Collaborative members, statutory or ex officio, may attend a meeting via telephone or video conferencing facilities, if available in the scheduled meeting place and with at least two weeks notice to the Collaborative CEO, and may vote on any decision item by voice vote when attending by telephonic device.

7.8 If a member voting in the negative on any decision item or any member not in attendance and not represented believes that the decision of The Collaborative is contrary to law, regulation, or a legislated budget directive, or is otherwise inconsistent with the legal or authorized duties of the member or her/his department or agency, the member shall so state and request an opportunity to explain why she/he so believes. Such request shall be made at the meeting in which the decision occurred or via e-mail or facsimile to the co-chairs no later than the close of the third business day following the distribution of the minutes of the meeting at which the decision occurred. The co-chairs shall place the matter on the next regular, special or emergency meeting of The Collaborative. Pending further action of The Collaborative, the decision shall not be implemented.


7.9 If a member requesting reconsideration still believes that the final decision is contrary to law, regulation or a legislated budget directive, or is otherwise inconsistent with the legal or authorized duties of the member or his/her department or agency, the member shall request a meeting with the co-chairs to determine whether there is any way to remedy the disagreement. Legal counsel for The Collaborative may be consulted as necessary. If the three members cannot reach resolution, the co-chairs and the member shall take the concern to the Governor’s Office for resolution. If the Governor or the Governor’s Chief of Staff on behalf of the Governor makes a decision contrary to the decision of the Collaborative, the co-chairs shall so inform The Collaborative and shall instruct the implementation of the decision made by the Governor’s Office. The minutes of Collaborative meetings and the public record shall reflect any final decision of the Governor’s Office.

Article 8 Amendments

8.1 These Bylaws may be amended at any regular meeting of The Collaborative by the affirmative vote of not less than two-thirds of the members of The Collaborative, provided that notice of any proposed amendment, including a draft thereof, shall have been given at the regular meeting of the Collaborative next preceding the meeting at which such amendment is voted upon.

1. Call to Order

• Value Added Services

VALUE ADDED SERVICES: FY 12 REPORT

DRAFT

Presented by Wendy Corry, OHNM Director of Disabilities on behalf of the VAS Taskforce

June 27, 2011

Page 2 of 15

VAS Taskforce members* Diana Lopez (YDI) Victoria Herrera (Streetwise) Angela Moore (Streetwise) Phyllis Marquez (Streetwise) Joe Harris (UNM) Michael Hubert (CEM/Advocate) Nancy Jo Archer (Hogares) (All Faiths Receiving Home) Wendy Corry (OHNM) Elizabeth Martin (OHNM) Rosemary Stunk (OHNM) Rich Patnaude (OHNM Bill Belzner (PMS) Mickey Curtis (FYI) Judy Bonnell (Family/BHPC) Gary Jackson (TLS, Inc.) Barbara Smith (TLS, Inc.)

Dr. Carolyn Morris (OH) Craig Pierce (SW Family Guidance) Shannon Freedle (Teambuilders) Noel Clark (Carlsbad Mental Health) Dee Wilson (Wilson Res.) Dana Wilson (Wilson Res.) Jennifer Sena (UNM) Roque Garcia (SWCC) Debra Russell (PRS) Margo Ganter (PRS) Kim Carter (Medicaid) Jeff Tinstman (CYFD) Donald Naranjo (Pathways) Fr. Rusty (St Martin’s) Goldie Lowry (St. Martin’s) Susannah Burke (PB &J) Rex Davidson (Las Cumbres)

Megan Delano (Las Cumbres) Bernadette Pina (SWCC) Ernie Holland (Guidance Center of Lea County) Craig Sparks (CYFD) Kathy Hunt (BAMH) Mike DiBernardi (LifeLink) Carol Luna Anderson (LifeLink) Mrs. Roy (OptiHealth) Erin Houlihan (Childhaven) Marti Everett (Counseling Assoc.) Pam Martin (OHNM), Chris Morris (OHNM), Troy Fernandez (OHNM), Tracy Townsend (OHNM), Wendy Corry (OHNM), Dr. Dwight Holden (OHNM)

* A good representation but not an exhaustive list of people actively participating in this process at various levels since Jan. 2011

Page 3 of 15

VALUE ADDED SERVICES FY 12 REPORT This report summarizes the updated Value Added Services plan for FY 12 which responds to specific questions that the Behavioral Health Purchasing Collaborative asked OHNM to address on April 14, 2011. The updated plan incorporates extensive provider, consumer and state input and collaboration. Since January 2011, OHNM, the provider community, state agencies and consumers have been working to plan a more effective, equitable method to manage the Value Added Service (VAS) dollars. These are non-entitlement services for Medicaid managed care consumers with a capped funding amount paid by OHNM pursuant to our contract, not part of the N.M. Medicaid core benefit package. The current estimate for total VAS dollars is $7,153,001.00. In FY11, almost 80 % of the VAS dollars were spent on services provided in Albuquerque, Santa Fe and Las Cruces. These figures are based on the billing location of the provider not the consumer but presents data that shows the lack of VAS services in many areas of the state. OHNM is committed to increasing VAS service access to people across N.M. VAS Non-Entitlement Funds Spent by Region and LC in FY11*

$0 $0

$583,243

$0 $53,040

$4,509,580

$542,820 $0 $0 $66,380 $17,565 $4,646 $0 $0 $0 $0 $0

$0.00$500,000.00

$1,000,000.00$1,500,000.00$2,000,000.00$2,500,000.00$3,000,000.00$3,500,000.00$4,000,000.00$4,500,000.00$5,000,000.00

Region1-LC11

Region1-LC13

Region2-LC1

Region2-LC4

Region2-LC8

Region3-LC2

Region4-LC5

Region4-LC9

Region4-LC10

Region5-LC3

Region5-LC6

Region5-LC7

Region5-LC12

Region6-LC13

Region6-LC14

Region6-LC15

Region6-LC16

* Dollars spent based on billing address of the provider not the location of service provision or on consumer residence.

Page 4 of 15

Additionally, almost 66% of all VAS funding for FY11 was spent on Transitional Living Services (TLS). In an effort to both broaden the geographical access to services more equitably across the state and the types of services utilized by this funding source, a plan has been jointly developed by OHNM and numerous providers and state agencies. VAS Non-Entitlement $ Spent Statewide in FY11

$7,679 $21,173 $10,527

$3,969,912

$52,098

$815,755$1,010,761

$527

$1,264,570

$-$500,000.00

$1,000,000.00$1,500,000.00$2,000,000.00$2,500,000.00$3,000,000.00$3,500,000.00$4,000,000.00

0126Inpatient

Detox

0901 Electro CT

90870Electro CT

H0019 Trans Liv

Svc

H0019 UNMMilagro

S9482 FamServ Int

T1005 Respite

T1016 SchoolBased

T1027 Infant MH

As you may recall from the Collaborative meeting on April 14, 2011, The VAS Brainstorming committee recommended to OHNM that the Core Service Agencies (CSA’s) be responsible for managing the services in their regions since the CSA’s are established in every region of New Mexico. Since that meeting, this group expanded (adding other key partners including additional CSA’s, non CSA providers, and consumers) and has had numerous meetings to further refine the details of the VAS plan for FY12 incorporating feedback from that meeting. To that end, we are happy to submit on the groups’ behalf, a revised VAS plan. It is important to note that while this plan represents the consensus of the overall group and all input was considered, several hard choices were made. There are some providers (both CSA and non CSA) and consumers who will be adversely affected

Page 5 of 15

by this change. Distributing service dollars across the state will inevitably result in fewer dollars in ABQ. This is not an easy choice, but we believe it is critical to open access to services to people across the state, not just the Rio Grande corridor. Several non CSA providers participated in the VAS brainstorming discussions and all non CSA providers (with the exception on TLS and IMH received notification of the VAS changes on June 7, 2011. TLS providers have been engaged in intense staffing with OHNM and are very aware of the financial difficulties posed by the long term nature of many TLS placements. Another hard choice will be for CSA’s to determine which services are most appropriate to serve the needs of their local communities. Initially there was discussion about the committee providing CSA’s with guidelines for which services they should prioritize. Once the decision was made for OHNM to continue managing the TLS and Infant Mental Health (IMH) services, it no longer made sense to direct the CSA’s to certain services. The CSA’s have the responsibility to determine the best use of these dollars in their region. This may have a negative impact on certain non CSA providers of services as the CSA’s have the choice of utilizing the non CSA services or not, depending on the local needs of consumers. CSA’s will also have limited dollars since the dollars will be distributed across the state. All CSA’s have been given contact information for all the non CSA providers. So again, hard choices will need to be made. We do believe the outcome is based on consumer need and putting the consumer first. FY 12 VAS Plan Beginning July 1, 2011 all VAS services with the exception of TLS and IMH will be managed by the CSA’s. Each CSA will receive a set allocation of funding based on the Medicaid Enrollment in their area. Every non-CSA provider (with the exception of TLS and IMH providers) will need to work directly with a CSA to receive payment through VAS funds. All CSA and non-CSA providers of VAS have been notified of this change. The CSA’s are encouraged but not required to partner with the non-CSA’s to provide the following services: Respite Services (T1005), Family Service Intervention (S9482), School-based Services (T1016), Inpatient Detoxification (0126), Electro-Convulsive Therapy (0901 and 90870), and UNM Milagro ( Substance Abuse Residential service (H0019 HD). Further discussion is needed on the possibility of adding new value added services. Allocations for CSA’s will be based on 5/5/11 Medicaid Enrollment data which will insure for the first time equitable distribution of VAS dollars across the state. Additionally these allocations will also ensure equitable distribution of funding for youth and adults based on the Medicaid Enrollment data. The Medicaid Enrollment data is broken down by county and by age (under 21 years old and 21 years and over). Following are estimated allocations to the youth CSA’s and the adult CSA’s. Please note the allocations are subject to change.

Page 6 of 15

Local Collab Counties *Medicaid

<21 % of Total

Funding Allocation Kids CSA

Rio Arriba 8,720 2.6% 53,856 TeambuildersLos Alamos 313 0.1% 1,933 TeambuildersSanta Fe 16,275 4.8% 100,516 TeambuildersBernalillo 23,486 6.9% 145,049 All Faiths

23,486 6.9% 145,049 UNM 23,486 6.9% 145,049 Hogares 23,486 6.9% 145,049 YDI

Dona Ana 22,492 6.6% 138,913 FYI22,492 6.6% 138,913 Southern NM Human Development

Mora 722 0.2% 4,459 TeambuildersSan Miguel 6,971 2.1% 43,054 TeambuildersGuadalupe 747 0.2% 4,614 TeambuildersEddy 9,093 2.7% 56,159 Carlsbad CMHCLea 11,515 3.4% 71,118 Lea County Guidance CenterChaves 13,755 4.0% 84,953 Counseling AssociatesHidalgo 798 0.2% 4,929 Border AreaLuna 5,996 1.8% 37,032 Border AreaGrant 4,669 1.4% 28,836 Border AreaCatron 297 0.1% 1,834 PMSSocorro 3,249 1.0% 20,066 PMSTorrance 4,108 1.2% 25,372 PMSSierra 1,777 0.5% 10,975 PMSTaos 4,957 1.5% 30,615 TeambuildersColfax 1,763 0.5% 10,888 TeambuildersUnion 509 0.1% 3,144 TeambuildersCurry 8,804 2.6% 54,375 TeambuildersRoosevelt 3,528 1.0% 21,789 TeambuildersDeBaca 296 0.1% 1,828 TeambuildersQuay 1,721 0.5% 10,629 TeambuildersHarding 48 0.0% 296 TeambuildersMcKinley 9,107 2.7% 56,246 PMS

9,107 2.7% 56,246 ChildhavenSan Juan 11,288 3.3% 69,713 PMS

11,288 3.3% 69,713 ChildhavenLincoln 2,905 0.9% 17,942 TeambuildersOtero 7,520 2.2% 46,444 TeambuildersSandoval 8,365 2.5% 51,663 PMS

8,365 2.5% 51,663 HogaresValencia 6,756 2.0% 41,723 PMS

6,756 2.0% 41,723 HogaresCibola 2,887 0.8% 17,827 PMS

2,887 0.8% 17,827 Hogares14-18 Native American 2,978 0.9% 18,392 Native American

Total 339,763 100% 2,098,417

*NM MAD Eligible <21 as of 5/5/11

11

3

8

9

10

5

VAS Kid CSA Allocation FY12

6

7

1

4

13

2

12

Page 7 of 15

Page 8 of 15

Local Collab Counties *Medicaid

= or >21 % of Total

Funding Allocation Adult CSA

Rio Arriba 2,318 1.4% 8,434 PMS2,318 1.4% 8,434 Life Link

Los Alamos 105 0.1% 380 PMS105 0.1% 380 Life Link

Santa Fe 3,564 2.1% 12,967 PMS3,564 2.1% 12,967 Life Link

Bernalillo 11,278 6.7% 41,031 Pathways 11,278 6.7% 41,031 UNM 11,278 6.7% 41,031 Partners in Wellness 11,278 6.7% 41,031 St. Martin's

Dona Ana 10,288 6.1% 37,430 Southwest Counseling10,288 6.1% 37,430 SNHD

Mora 643 0.4% 2,339 NMBHI/CBSSan Miguel 4,676 2.8% 17,013 NMBHI/CBSGuadalupe 550 0.3% 2,001 NMBHI/CBSEddy 4,504 2.7% 16,387 Carlsbad Mental HealthLea 4,336 2.6% 15,776 Guidance Center of Lea CountyChaves 6,523 3.9% 23,732 Counseling AssociatesHidalgo 456 0.3% 1,659 Border Area Mental HealthLuna 3,000 1.8% 10,915 Border Area Mental HealthGrant 2,596 1.5% 9,445 Border Area Mental HealthCatron 214 0.1% 779 PMSSocorro 2,090 1.2% 7,604 PMSTorrance 1,882 1.1% 6,847 PMSSierra 1,494 0.9% 5,436 PMSTaos 2,989 1.8% 10,875 Tri-County Community ServicesColfax 1,036 0.6% 3,769 Tri-County Community ServicesUnion 261 0.2% 950 Tri-County Community ServicesCurry 4,220 2.5% 15,353 Mental Health ResourcesRoosevelt 1,466 0.9% 5,334 Mental Health ResourcesDeBaca 194 0.1% 706 Mental Health ResourcesQuay 1,067 0.6% 3,882 Mental Health ResourcesHarding 40 0.0% 146 Mental Health ResourcesMcKinley 10,823 6.4% 39,377 PMSSan Juan 10,952 6.5% 39,846 PMSLincoln 1,355 0.8% 4,930 The Counseling CenterOtero 3,902 2.3% 14,197 The Counseling CenterSandoval 3,673 2.2% 13,363 PMS

3,673 2.2% 13,363 Valencia CounselingValencia 3,165 1.9% 11,513 PMS

3,165 1.9% 11,513 Valencia CounselingCibola 1,315 0.8% 4,783 PMS

1,315 0.8% 4,783 Valencia Counseling14-18 Native American 2,772 1.6% 10,085 Native American

Total 168,005 100% 611,247

*NM MAD Eligible = or >21 as of 5/5/11

12

8

9

10

11

13

5

VAS Adult CSA Allocation FY12

6

7

4

1

2

3

Page 9 of 15

Page 10 of 15

Native American VAS Dollars The proposal for utilization of the Native American VAS dollars is use this funding to transition people currently in residential placements back to their tribal communities and tribal funding. OHNM VAS dollars would provide payment for a transition period for the tribal provider to transition the person back to tribal funding in the community. FY 11 VAS Actual Spend as of 6/24/11

CODE

DESCRIPTION

UNIT

AMOUNT SPENT IN FY11*

0126 Inpatient Detoxification per diem $6,5000901 Electro-Convulsive Therapy - facility charge per diem $23,79090870 Electro-Convulsive Therapy single seizure $14,505H0019 BH Residential - Transitional Living Services per diem $5,608,257H0019 HD BH Residential - long term @ Milagro per diem $61,200S9482 Family Stabilization Services per 15 minute unit $941,148T1005 Respite Care per hour $1,120,839T1016 School-based Case Management per 15 minute unit $877

T1027 Infant Mental Health per hour $1,378,215

TOTAL $9,155,332*claims data run 6.24.2011 .

Page 11 of 15

Timeline Leading to the Final FY 12 VAS Budget

CODE DESCRIPTION

VAS FY 12 Estimate

Presented at 4/14/11 BH

Collaborative

VAS Taskforce Recommendation to OHNM 5/13/11

Actual Amount Spent

on Services 6/24/11

VAS FY 12 BUDGET

H0019 BH Residential-Transitional Living Services $2,838,250 $3,154,943 $5,608,257** $3,443,337* T1027 Infant Mental Health $1,605,087 $1,288,394 $1,378,215 $1,000,000* All OTHER VAS SERVICES $2,709,664 $2,709,664 $2,168,859 $2,709,664

TOTAL $7,153,001 $7,153,001 $9,155,331 $7,153,001 * TLS funds were increased to allow for consumers currently in TLS. IMH was decreased as the IMH providers will come into alignment with the IMH service definition on 1/1/12. ** Following are the TLS initiatives: Numerous initiatives have been implemented since January of 2011 to determine appropriate discharge planning for people currently in TLS. These initiatives have included:

Partnering with: o the Department of Health (DOH)-Developmental Disability Services Division (DDSD); o the Human Services Department (HSD)-Medical Assistance Division (Medicaid); o the HSD–Behavioral Health Services Division (BHSD); o the Children, Youth and Families Department (CYFD); o Core Service Agencies (CSAs); o Aging and Long-Term Services Division (ALTSD) o the Salud! Managed Care Organizations; o providers; o consumers; o consumer advocates and o family members

Implementing staffings with the consumer, family and/or guardian present to work on a transition plan that is effective and appropriate

Utilizing the Adult Targeted Case Management service (MAD and DOH/DDSD) to assist in discharge planning for people on the DD waiver Central Registry (waiting list)

Page 12 of 15

Completion by CSA’s of 29 CSA-eligibility evaluations for people with MI/DD Creation of a TLS Oversight Team, with the DOH/DDSD Deputy Director as the chair Referrals to the Collaborative's Multi-Disciplinary Team (MDT) chaired by Aging and Long Term Services Department

(ALTSD) Summary of VAS Budget for FY12*

VAS Population TLS Carve Out IMH Carve Out CSA Distribution Based on Medicaid Enrollment

FY12 Total VAS Allocation

Youth $ 1,100,000 $ 1,000,000 $ 2,098,417 $ 4,198,417

Adult $ 2,343,337 $ - $ 611,247 $ 2,954,584

Total $ 3,443,337 $ 1,000,000 $ 2,709,664 $7,153,001

*Estimated #’s based on FY11 VAS allotment of $7,153,001 and 5/11 Medicaid Enrollment #’s. The above is subject to change. VAS IMH and TLS Carve-out VAS IMH and TLS have been ‘carved out’ for OHNM to continue to manage directly. VAS IMH was set aside because of the time needed to develop additional IMH services across the state. Similarly more time is needed to develop community-based alternatives to facility-based TLS providers and to educate the provider community on appropriate criteria for admission and discharge activities. In addition the VAS Taskforce was not able to reach agreement on moving these services to the CSA’s at this time and the team wanted to move forward as much as possible this year to ensure equal access to services across the state. The VAS team will continue to meet in FY 12 to create a plan to develop more access to these services regionally TLS Dilemma TLS is defined as a Transitional Living Services for people with the ability to attain supported independence. Best practice for this service indicates a 3-6 month period is a reasonable time for people to utilize this service in order to transition to alternative living situations. Recent data accumulated by OHNM indicates this is not the reality of the adult TLS that is

Page 13 of 15

currently being provided in N.M. Currently the average length of stay for an adult without MI/DD is 321 days (over 10 months). The average length of stay for an adult with mental illness and developmental disabilities (MI/DD Following is the N.M data on TLS:

As you can see the data clearly shows that we are not utilizing adult TLS according to the definition of TLS. As we know N.M. has significant service gaps regarding people who have complex needs that touch multiple systems. There is a critical need to develop a unified system, including creative housing options, to support people. Specific to TLS the obvious dilemma, is there are many people currently in TLS that do not meet medical necessity but have very few if any options. This begs the question, is adult TLS providing transitional services for people to be independent or is it providing long-term care for people. There is no question that long term care is an important and necessary service but is TLS the appropriate service to meet this need. This presents an exciting opportunity for all stakeholders to explore permanent, collaborative solutions.

Average Length of Stay (ALOS)

0 100 200 300 400 500 600

with MI/DD diagnosis

without MI/DD diagnosis

with MI/DD diagnosis

without MI/DD diagnosis

Adults

Youth

ALOS

154

496

321

467

Page 14 of 15

OHNM’s for Management of IMH and TLS funds Based upon data and financial analysis and feedback received at the most recent Collaborative Meeting, below is a summary of the OHNM management of the VAS IMH and TLS funds: Infant Mental Health A total of $1,000,000 is in the VAS FY12 budget for IMH (VAS only). Current IMH providers will receive a total VAS capped amount of $900,000 for FY12. The providers are responsible to manage their funding amount throughout the entire year. There will also be $100,000 set aside for new providers of IMH services and treatment in FY12. At the end of six months, OHNM will conduct a VAS financial/utilization review on all IMH providers to determine if money needs to be re-distributed. It is important to note the inclusion of service code T1027HU (Infant Mental Health Treatment) was added to the existing T1027 IMH service code. This will allow for more treatment activities to take place statewide. Both of these service codes will be directed towards infants for 0 to 3 years old. The CYFD/OHNM sponsored Infant Mental Health Advisory Council was very active in this initiative. Additionally, in the state’s and OHNM’s review of the T1027 No Modifier Service Definition for Infant mental Health Services and utilization of this code for services delivered by the provider community, it was revealed that this code has been billed for what can be broadly described as therapeutic day care / school readiness services for 3 to 5 year olds who have behavioral health challenges. Currently the service definition for T1027 No Modifier is limited to children between the ages of birth and 2 years 364 days. CYFD and the Provider community believe that these services for 3 to 5 year olds are critical. At the same time, providers must get in compliance with current service definitions. The current plan is to allow providers to continue to bill T1027 No Modifier for services delivered to 3 to 5 year olds until 12/31/11 while they adjust their business practices to be in compliance. At the same time, CYFD is in the process of strategizing internally on how to address this gap. In conjunction with the CYFD / Provider Infant Mental Health Advisory Council, the Interdepartmental Service Definition Workgroup will be developing a service definition specific for the 3 to 5 year old population. It is everyone’s goal to transition to a comprehensive set of services for Infants and Toddlers without significant disruption of services currently in place. The goal is to have all changes in place for FY13. Transitional Living Services These funds have been allocated into two separate buckets: youth (under 21 years of age) and adult (21 years of age and over). New admissions for youth TLS will be capped at 120 days with a maximum 30 day extension after clinical quality review for a “hard cap” episode of care limit of 150 days. Current youth specific TLS providers will receive a capped amount to manage for the entire year.

Page 15 of 15

Currently, the entire capped amount for adult TLS ($2,343,337) has already been projected to be spent on the existing consumers. There are currently 60 adults in TLS and if they are maintained in the TLS setting for all of FY 12, the cost will be $2,628,000. OHNM will monitor the discharge process for each of these individuals very closely, ensuring that the staffing teams (which include the provider, consumer, family, guardian, OHNM, CSA’s, Adult Targeted Case Managers, DOH/DDSD ect.) are aggressively pursuing all resources. OHNM remains committed to working with providers and others to find appropriate discharge options. New admissions for adult TLS may be considered when there is funding available, based on the discharges. OHNM will monitor closely and re-evaluate with the ongoing VAS Committee. Challenges and Next Steps for FY12

1. Re-structuring the VAS system is new and different for everyone. CSA’s will need to operationalize managing these additional services and many CSA’s have never utilized VAS dollars.

2. Lack of service availability in rural areas including IMH providers is critical. 3. A few non CSA providers in Bernalillo County will be significantly impacted as dollars are moved to CSA management

and into rural areas. 4. IMH providers will need to come into alignment with the Medicaid service definition for Infant Mental Health (only

available to infants under 3 years of age) beginning Jan. 1, 2012 and this will be a significant change from the historic utilization of these dollars.

5. Appropriate use of TLS going forward and appropriate discharge for people currently in TLS is a huge challenge. The VAS committee will continue to brainstorm the viability of adult TLS going forward. Can the TLS model support adults in the true definition of TLS, transitional living services leading to independence? Is there a way to partner more effectively with housing resources and other agencies? What is the most effective use of these limited dollars to have the greatest impact on the greatest number of consumers?

6. Many members of the VAS Taskforce will continue meeting in FY 12 to explore creative options/ structures for VAS moving forward. VAS in general will be reviewed as well as VAS IMH and TLS. Current brainstorming ideas on TLS include utilizing performance based contracts, allocating a base rate for certain providers and providing a financial incentive to encourage appropriate discharge planning.

7. Several different state-wide committees are currently working to brainstorm placement issues for hard to serve people in N.M. The MDT, TLS Oversight Team, and Autism Oversight Team are all involved in staffing very complex people with many state agencies involved. While there are some differences in the challenges faced by these groups, there are many barriers that are shared by all. Additionally the Adolescents in Transition Workgroup have experience in the multiple barriers faced by young people transitioning for the youth world to the adult world. Representatives from each of these groups will meet for the next several months to explore possible recommendations to the Collaborative based on the shared experiences of all of these groups.

2. Planning Council

3. Director’s Reports/Data

Inpatient$25,192,698

10%

Residential$102,896,748

39%

Intensive Outpatient$10,555,781

4%

Recovery$41,030,345

15%

Outpatient$73,191,942

27%

VAS$10,377,821

4%

Outliers$3,748,349

1%

Collaborative Funding FY10 Based on Claims Paid thru 6/26/11

Inpatient

Residential

Intensive Outpatient

Recovery

Outpatient

VAS

Outliers

Service Dollar Amount PercentageInpatient $25,192,698 9.44%Residential $102,896,748 38.54%Intensive Outpatient $10,555,781 3.95%Recovery $41,030,345 15.37%Outpatient $73,191,942 27.41%VAS $10,377,821 3.89%Outliers $3,748,349 1.40%Total $266,993,684 100.00%

Total Expenditures ‐ $266,993,684

Data Source: OptumHealth NM FY10 CI‐09 Report

21 & Over43,34652%

18‐204,5476%

Under 1835,10442%

Collaborative Funding FY10Total Unduplicated Consumers by Age Group FY10

Based on Claims Paid as of 6/26/11

21 & Over

18‐20

Under 18

FY10 Total Unduplicated Consumers Served By Age GroupTotal Unduplicated Consumers by Age Group

% of Total Unduplicated Consumers

21 & Over 43,346 52.98%18‐20 4,547 5.56%Under 18 35,104 42.91%Total* 81,816 100%

*Total represents distinct consumers and may not equal the sum of the column.

Total Unduplicated Consumers ‐ 81,816Data Source: OptumHealth NM FY10 CI‐09 Report

21 & Over$76,030,425

29%

18‐20$10,945,136

4%

Under 18$180,018,123

67%

Collaborative Funding FY10Total Dollars by Age Group FY10


21 & Over

18‐20

Under 18

Total Dollars

% of Total Service Dollars

21 & Over $76,030,425 28.48%18‐20 $10,945,136 4.10%Under 18 $180,018,123 67.42%Total $266,993,684 100%

FY10 Total Dollars by Age Group

Total Dollars for All Age Groups ‐ $266,993,684Data Source: OptumHealth NM FY10 CI‐09 Report


14%


7% Intensive Outpatient$1,611,190

2%

Recovery$20,164,146

24%


44%

Outliers$2,121,872

2% VAS$5,500,315

7%

Collaborative Funding FY10FY10 Adult Total Dollar Amount & Percentage


Inpatient

Residential


Recovery

Outpatient

Outliers

VAS

FY10 Total Adult Expenditures ‐ $83,453,667

Service Dollar Amount PercentageInpatient $11,316,489 13.56%Residential $5,798,845 6.95%Intensive Outpatient $1,611,190 1.93%Recovery $20,164,146 24.16%Outpatient $36,940,810 44.27%Outliers $2,121,872 2.54%VAS $5,500,315 6.59%Total $83,453,667 100.00%

FY10 Adult Total Dollar Amount & Percentage

Data Source: OptumHealth NM FY10 CI‐09 Report

FY10 Total Adult Expenditures ‐ $83,453,667


7%


53%Intensive Outpatient$8,944,593

5%

Recovery$20,866,199

11%


20%

Outliers$1,626,476

1%

VAS$4,877,505

3%

Collaborative Funding FY10FY10 Child Total Dollar Amount & Percentage


Inpatient

Residential


Recovery

Outpatient

Outliers

VAS

Service Dollar Amount PercentageInpatient $13,876,209 7.56%Residential $97,097,902 52.90%Intensive Outpatient $8,944,593 4.87%Recovery $20,866,199 11.37%Outpatient $36,251,133 19.75%Outliers $1,626,476 0.89%VAS $4,877,505 2.66%Total $183,540,017 100.00%

FY10 Child Total Dollar Amount & Percentage

Data Source: OputmHealth NM FY10 CI‐09 Report

FY10 Total Child Expenditure ‐ $183,540,017

Contract Direct Service Dollar Amount

Under 18 Amount 18 - 20 Amount 21 - 64 Amount 65 and over Amount TOTAL

ConsumersClaims &

EncountersPharmacy

Invoice Billings/Flexible

Funding(Not Encountered)

Total Direct Service Amount Paid

Medicaid Managed Care 220,524,640$ 25,252 148,206,912$ 2,752 8,189,955$ 17,498 38,910,458$ 887 1,075,796$ 48,518 196,383,121$ 30,290,576$ -$ 226,673,697$ Medicaid Fee-for-Service 39,765,500$ 5,573 26,392,498$ 703 1,273,155$ 5,015 4,170,468$ 130 69,739$ 11,280 31,905,860$ 1,469,277$ -$ 33,375,138$ TANF 680,000$ 7 610$ 3 9,225$ 42 264,551$ - -$ 52 274,386$ -$ 320,711$ 595,097$ DOH 7,523,353$ - -$ - -$ - -$ - -$ - -$ -$ 7,279,081$ 7,279,081$ HSD/BHSD 45,669,963$ 79 241,229$ 1,133 1,139,825$ 21,419 28,356,610$ 815 938,431$ 23,279 30,676,096$ -$ 16,676,872$ 47,352,967$ CYFD 9,471,316$ 4,788 5,171,493$ 330 245,460$ 11 6,868$ 1 251$ 5,052 5,424,071$ -$ 3,205,507$ 8,629,578$ NMCD 6,395,705$ 19 5,380$ 179 87,517$ 3,546 2,204,225$ 34 33,027$ 3,750 2,330,149$ -$ 3,482,894$ 5,813,043$ MFA 641,400$ - -$ - -$ - -$ - -$ - -$ -$ 686,063$ 686,063$ ALTSD 66,401$ - -$ - -$ - -$ - -$ - -$ -$ 66,401$ 66,401$ Comm Reinvestment (3) -$ - -$ - -$ - -$ - -$ - -$ -$ -$ -$

TOTAL AMOUNT 330,738,278$ 180,018,123$ 10,945,136$ 73,913,181$ 2,117,244$ 266,993,684$ 31,759,853$ 31,717,529$ 330,471,066$

Behavioral Health Collaborative Directors' ReportReport Title: DRLC-02 Consumers Served and Expenditures by Fund (Green) Statewide

Reporting Period: 07/01/2009 - 06/30/2010Service Dates: 07/01/2009 - 06/30/2010

Paid Thru: 06/27/2011

TOTAL Unduplicated Consumers (1) 35,104 4,547 41,681 1,780 81,816 BHSD Medication Fund Consumers 2 18 349 - 369 ATR Consumers - 276 2,816 19 3,111 Sexual Assault Consumers (4) - - - - 568

*** Total Estimated Consumers including ATR, BHSD Medication Fund & Sexual Assault

35,106 4,841 44,846 1,799 85,864

Month Under 18 18-25 26-35 36-45 46-55 56+ Unknown TotalJuly 3 13 9 7 3 - 1 36

August 4 2 3 - - - - 9 September 17 10 16 11 7 4 - 65

October 6 8 12 6 5 6 - 43 November 15 5 7 5 7 1 - 40 December 4 5 15 12 6 5 - 47

January 6 9 16 8 7 1 - 47 February 13 10 13 5 4 3 - 48

March 19 7 12 16 6 1 - 61 April 20 10 13 9 8 5 - 65 May 21 12 8 11 10 1 - 63

June 15 7 6 4 5 7 - 44 Total 143 98 130 94 68 34 1 568

Sexual Assualt Consumers (4)

(1)

(2) Estimated Amounts (outstanding claims FY10 as of 05/31/11) - Finance $ 1,699,009

(3) Comm Reinvestment - This amount is embedded with MCO dollar.

(4) Sexual Assault consumer data is received from Providers in the aggregate using age categories that do not match the categories in the Directors Report.

*** Included within HSD/BHSD consumer served are the Sexual Assault and ATR consumers. These could be duplicated consumers within the age group category. Due to privacy constraints, the SE is not able to determine if these consumers are duplicated.

Consumer counts within each age group are unduplicated. However, due to consumer birthdates, the consumer may be counted in another age group as a unique consumer within that age group if their birthday during the year caused them to move into another age group category and they received services within that respective age group designation. Total consumers are unduplicated. If a consumer received services in multiple age group categories, they were not counted only once as a unique consumer in the overall total. As a result, the overall total consumer column will not equal the sum total of the age categories. Total consumers are duplicated across funding streams as a consumer may receive services from multiple funding streams.

Reviewed by: P. VanceReview Date: 06/27/11 Page 1 of 1

Judicial 01 Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 1,417 1,857 113 171 921 1,032 18 21 2,441 3,031 5,474 58.6%White (Non-Hispanic) 392 590 40 38 495 379 21 18 937 1,016 1,955 20.9%Native American 200 191 17 11 112 101 2 0 326 303 630 6.7%African American 25 52 1 2 18 19 0 0 44 73 117 1.3%Alaska Native 0 1 0 1 0 1 0 0 0 2 2 0.0%Asian/Pacific Islander 0 1 0 0 2 0 0 0 2 1 3 0.0%Multiracial 34 56 5 0 10 9 0 0 47 65 112 1.2%Other/Unknown 288 407 32 28 138 152 16 6 467 585 1,053 11.3%UnDuplicated Consumers 2,347 3,148 207 251 1,690 1,690 57 45 4,249 5,066 9,321

Behavioral Health Collaborative Directors' Report

Service Dates: 07/01/2009 - 06/30/2010Paid Thru: 06/27/2011

Report Title: Consumers Served by Ethnicity (Blue) by Judicial DistrictReporting Period: 07/01/2009 - 06/30/2010

Judicial 02 Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 2,805 3,722 313 325 2,337 2,210 90 56 5,455 6,206 11,661 42.4%White (Non-Hispanic) 1,288 1,732 161 204 1,905 1,811 146 72 3,455 3,746 7,203 26.2%Native American 374 415 50 54 453 284 8 6 872 744 1,616 5.9%African American 148 201 25 31 188 217 4 3 360 442 802 2.9%

Ethnicity is determined from Service Registration ethnicity/race information or from medicaid eligibility information. The mapping order is as follows:

1) Service Registration ethnicity of "Puerto Rican", "Mexican", "Cuban", "Other Specific Hispanic" or "Hispanic-Unknown Origin" or eligibility race of "Hispanic" are mapped to "Hispanic"2) Service Registration race of "American Indian" or eligibility race of "American Indian" are mapped to "Native American"3) Service Registration race of "African American" or eligibility race of "Black" are mapped to "African American"4) Service Registration race of "Alaska Native" is mapped to "Alaskan Native"5) Service Registration race of ""Asian" or "Native Hawaiian/PI" or eligibility race of :Asian/Pacific Islander" are mapped to "Asian/Pacific Islander"6) Service Registration race of "Two or more Races" is mapped to "Multiracial"7) Records not previously mapped that have Service Registration race of "White" or eligibility race of "Caucasian" are mapped to "White (Non-Hispanic)8) All records still remaining unmapped are mapped to "Unknown/Other"

Note: Totals represent distinct clients and may not equal sum of rows/columns. A client may receive services in two age groups because of a birthday. Medicaid eligibility may reflect different race codes at different times (e.g. Caucasian at one time and Hispanic or Unknown at another time) Gender is based upon sex code entered on claims. An insignificant number of anomalies have been known to occur where a client may be coded with different gender codes. Totals may differ slightly from other report, however, the difference is insignificant.

Alaska Native 3 4 0 0 5 4 0 0 8 8 16 0.1%Asian/Pacific Islander 6 11 0 0 12 11 1 1 19 23 42 0.2%Multiracial 98 150 6 10 61 42 3 1 166 197 363 1.3%Other/Unknown 1,236 1,626 216 144 1,571 1,052 34 22 3,002 2,801 5,808 21.1%UnDuplicated Consumers 5,944 7,839 769 767 6,510 5,626 285 161 13,298 14,139 27,444

Reviewed by: P. VanceReview Date: 06/27/2011 Page 1 of 10 DRLC-03 FY10 Judicial






Judicial 03 Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 1,602 2,093 198 202 1,348 1,020 67 30 3,158 3,276 6,434 58.7%White (Non-Hispanic) 401 605 58 78 876 663 58 25 1,379 1,348 2,728 24.9%Native American 64 53 8 7 35 27 2 0 105 86 191 1.7%African American 30 41 4 4 47 48 1 1 80 92 172 1.6%Alaska Native 0 0 0 0 0 0 0 0 0 0 0 0.0%Asian/Pacific Islander 0 2 0 0 6 3 0 0 6 5 11 0.1%Multiracial 18 20 4 0 19 11 0 0 41 31 72 0.7%Other/Unknown 407 478 43 41 259 131 7 6 701 645 1,346 12.3%UnDuplicated Consumers 2,513 3,288 311 331 2,586 1,899 134 62 5,453 5,474 10,928


1) Service Registration ethnicity of "Puerto Rican", "Mexican", "Cuban", "Other Specific Hispanic" or "Hispanic-Unknown Origin" or eligibility race of "Hispanic" are mapped to "Hispanic"2) Service Registration race of "American Indian" or eligibility race of "American Indian" are mapped to "Native American"3) Service Registration race of "African American" or eligibility race of "Black" are mapped to "African American"


Judicial 04 Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 208 232 33 36 605 634 47 30 888 919 1,810 59.0%White (Non-Hispanic) 30 41 7 11 140 126 7 9 183 184 367 12.0%Native American 0 3 1 1 7 15 0 0 8 18 26 0.8%

4) Service Registration race of "Alaska Native" is mapped to "Alaskan Native"5) Service Registration race of ""Asian" or "Native Hawaiian/PI" or eligibility race of :Asian/Pacific Islander" are mapped to "Asian/Pacific Islander"6) Service Registration race of "Two or more Races" is mapped to "Multiracial"7) Records not previously mapped that have Service Registration race of "White" or eligibility race of "Caucasian" are mapped to "White (Non-Hispanic)8) All records still remaining unmapped are mapped to "Unknown/Other"






African American 1 0 0 1 5 4 1 0 7 5 12 0.4%Alaska Native 0 0 0 0 0 0 0 0 0 0 0 0.0%Asian/Pacific Islander 0 0 0 0 0 0 0 0 0 0 0 0.0%Multiracial 1 3 0 0 5 1 0 0 6 4 10 0.3%Other/Unknown 18 31 18 21 346 337 49 29 428 416 845 27.5%UnDuplicated Consumers 258 308 58 70 1,106 1,115 103 68 1,516 1,542 3,062


1) Service Registration ethnicity of "Puerto Rican", "Mexican", "Cuban", "Other Specific Hispanic" or "Hispanic-Unknown Origin" or eligibility race of "Hispanic" are mapped to "Hispanic"2) Service Registration race of "American Indian" or eligibility race of "American Indian" are mapped to "Native American"

Judicial 05 Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 912 1,241 118 148 1,675 1,547 78 36 2,751 2,939 5,691 40.0%White (Non-Hispanic) 501 661 141 124 2,235 1,876 154 53 2,996 2,686 5,689 40.0%Native American 96 131 17 36 294 379 3 1 406 540 946 6.7%African American 33 42 6 6 79 87 10 2 123 136 259 1.8%Alaska Native 0 0 1 1 1 1 1 0 3 2 5 0.0%Asian/Pacific Islander 1 3 0 0 2 4 0 0 3 7 10 0.1%Multiracial 30 31 2 3 26 14 1 0 58 48 107 0.8%Other/Unknown 241 357 53 47 499 310 8 10 789 713 1,505 10.6%

2) Service Registration race of American Indian or eligibility race of American Indian are mapped to Native American3) Service Registration race of "African American" or eligibility race of "Black" are mapped to "African American"4) Service Registration race of "Alaska Native" is mapped to "Alaskan Native"5) Service Registration race of ""Asian" or "Native Hawaiian/PI" or eligibility race of :Asian/Pacific Islander" are mapped to "Asian/Pacific Islander"6) Service Registration race of "Two or more Races" is mapped to "Multiracial"7) Records not previously mapped that have Service Registration race of "White" or eligibility race of "Caucasian" are mapped to "White (Non-Hispanic)8) All records still remaining unmapped are mapped to "Unknown/Other"


/ ,UnDuplicated Consumers 1,808 2,463 338 364 4,804 4,216 255 101 7,116 7,064 14,192







Judicial 06 Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 249 298 33 52 408 483 25 9 708 830 1,538 50.0%White (Non-Hispanic) 85 130 21 25 457 388 43 27 600 565 1,167 37.9%Native American 5 5 1 0 6 6 1 0 12 11 23 0.7%African American 2 7 0 2 10 15 1 0 13 24 37 1.2%Alaska Native 0 0 0 0 0 0 0 0 0 0 0 0.0%Asian/Pacific Islander 0 0 0 0 1 1 0 0 1 1 2 0.1%Multiracial 8 8 2 0 3 0 0 0 12 8 20 0.6%Other/Unknown 88 118 8 6 50 23 1 0 145 146 291 9.5%UnDuplicated Consumers 436 565 65 85 935 916 71 36 1,490 1,584 3,076




Judicial 07 Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 186 227 26 30 264 272 12 9 483 530 1,013 46.5%White (Non-Hispanic) 122 159 19 36 289 228 21 16 447 433 880 40.4%Native American 22 36 5 3 45 27 0 2 71 68 139 6.4%







African American 2 3 0 0 6 5 0 0 8 8 16 0.7%Alaska Native 0 0 0 0 0 0 0 0 0 0 0 0.0%Asian/Pacific Islander 1 0 0 0 2 0 0 0 3 0 3 0.1%Multiracial 3 5 1 0 8 3 0 0 12 8 20 0.9%Other/Unknown 29 41 3 3 21 9 1 3 53 56 109 5.0%UnDuplicated Consumers 364 471 54 72 635 543 34 30 1,076 1,102 2,178



Judicial 08 Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 175 204 39 42 436 646 15 18 655 902 1,563 59.5%White (Non-Hispanic) 76 99 12 23 288 265 28 9 396 389 788 30.0%Native American 39 24 0 2 26 31 2 0 67 57 124 4.7%African American 2 2 0 3 4 2 0 0 6 7 13 0.5%Alaska Native 0 0 0 0 0 0 0 0 0 0 0 0.0%Asian/Pacific Islander 0 0 0 0 0 0 0 0 0 0 0 0.0%Multiracial 11 12 0 0 4 4 0 0 15 16 31 1.2%Other/Unknown 18 27 1 3 24 29 4 0 47 59 106 4.0%



/UnDuplicated Consumers 319 364 52 73 781 976 49 27 1,183 1,425 2,617







Judicial 09 Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 129 200 30 38 259 258 5 5 422 498 920 41.4%White (Non-Hispanic) 118 158 25 33 411 286 17 10 564 481 1,045 47.0%Native American 5 8 0 3 3 0 0 0 8 10 18 0.8%African American 8 18 1 1 33 20 1 0 42 38 80 3.6%Alaska Native 0 1 0 1 0 0 0 0 0 2 2 0.1%Asian/Pacific Islander 0 0 0 0 0 0 0 0 0 0 0 0.0%Multiracial 8 9 0 1 3 4 0 0 11 14 25 1.1%Other/Unknown 25 42 7 6 31 26 0 0 62 71 133 6.0%UnDuplicated Consumers 292 433 63 83 740 594 23 15 1,108 1,111 2,219




Judicial 10 Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 43 55 7 8 38 19 0 0 86 80 166 56.8%White (Non-Hispanic) 34 16 6 1 39 13 1 0 80 30 110 37.7%Native American 0 0 0 0 3 0 0 0 3 0 3 1.0%







African American 2 1 0 0 1 0 0 0 3 1 4 1.4%Alaska Native 0 0 0 0 0 0 0 0 0 0 0 0.0%Asian/Pacific Islander 0 0 0 0 0 0 0 0 0 0 0 0.0%Multiracial 0 0 0 0 0 0 0 0 0 0 0 0.0%Other/Unknown 3 3 0 0 2 1 0 0 5 4 9 3.1%UnDuplicated Consumers 81 75 13 9 83 33 1 0 176 115 291



Judicial 11 Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 223 266 12 17 74 94 2 0 309 373 682 15.0%White (Non-Hispanic) 242 308 22 18 183 147 1 4 441 472 913 20.1%Native American 619 795 69 89 475 502 3 3 1,149 1,370 2,520 55.5%African American 10 9 0 2 4 7 0 0 14 17 31 0.7%Alaska Native 0 3 0 0 1 0 0 0 1 3 4 0.1%Asian/Pacific Islander 0 3 0 1 0 0 0 0 0 3 3 0.1%Multiracial 27 36 1 0 3 4 0 0 31 40 71 1.6%Other/Unknown 74 160 5 7 47 23 1 0 126 189 315 6.9%



/UnDuplicated Consumers 1,194 1,577 109 133 786 776 7 7 2,069 2,462 4,532







Judicial 12 Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 318 496 37 36 269 211 10 4 627 739 1,367 36.8%White (Non-Hispanic) 262 344 50 46 537 406 27 15 865 800 1,669 45.0%Native American 47 55 12 8 45 28 0 0 100 90 190 5.1%African American 21 32 3 3 27 28 0 1 51 64 115 3.1%Alaska Native 0 2 0 1 1 0 0 0 1 2 3 0.1%Asian/Pacific Islander 1 0 1 0 0 0 0 0 2 0 2 0.1%Multiracial 9 22 1 1 10 9 1 0 20 32 52 1.4%Other/Unknown 54 83 8 11 101 48 5 3 168 143 312 8.4%UnDuplicated Consumers 712 1,033 112 106 990 729 43 23 1,834 1,868 3,708




Judicial 13 Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 414 455 61 88 694 744 41 31 1,199 1,300 2,499 41.4%White (Non-Hispanic) 265 318 45 34 614 442 55 35 964 821 1,787 29.6%Native American 218 258 29 20 199 172 7 3 447 446 893 14.8%







African American 14 20 1 1 10 29 1 1 25 51 76 1.3%Alaska Native 0 0 0 0 0 4 0 0 0 4 4 0.1%Asian/Pacific Islander 1 1 1 0 3 1 0 0 4 2 6 0.1%Multiracial 9 16 0 2 16 18 1 0 26 36 62 1.0%Other/Unknown 152 181 24 30 201 112 13 8 385 325 710 11.8%UnDuplicated Consumers 1,072 1,248 159 175 1,734 1,521 117 77 3,044 2,982 6,028



Unknown/Out of State Under 18 Females Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females 65 and over Males Total Females Total Males Total Consumers %Hispanic 111 169 8 23 28 11 0 1 144 196 340 26.6%White (Non-Hispanic) 73 144 6 11 32 19 0 1 109 170 279 21.9%Native American 82 111 3 5 26 10 0 0 110 124 234 18.3%African American 11 8 2 3 3 0 0 0 15 11 26 2.0%Alaska Native 0 1 0 1 0 0 0 0 0 2 2 0.2%Asian/Pacific Islander 0 0 0 0 1 0 0 0 1 0 1 0.1%Multiracial 8 4 0 0 0 0 0 0 8 4 12 0.9%Other/Unknown 97 215 8 11 34 22 2 0 140 242 382 29.9%



/UnDuplicated Consumers 382 652 27 54 124 62 2 2 527 749 1,276









Statewide Under 18 Females

Under 18 Males 18-20 Females 18-20 Males 21-64 Females 21-64 Males 65 and over Females

65 and over Males

Total Females Total Males

Total Consumers %

Hispanic 7,771 9,826 966 1,132 8,806 8,721 398 244 17,681 19,576 37,269 45.5%White (Non-Hispanic) 3,258 4,267 556 626 7,923 6,707 560 281 12,139 11,695 23,855 29.1%Native American 1,523 1,777 202 222 1,633 1,468 28 14 3,329 3,430 6,761 8.2%African American 247 359 40 56 407 457 19 8 699 864 1,563 1.9%Alaska Native 3 9 1 2 8 10 1 0 13 20 33 0.0%

Behavioral Health Collaborative Directors' ReportReport Title: Consumers Served by Ethnicity (Blue) Statewide

Reporting Period: 07/01/2009 - 06/30/2010Service Dates: 07/01/2009 - 06/30/2010

Paid Thru: 06/27/2011

Asian/Pacific Islander 10 18 2 1 25 20 1 1 37 39 76 0.1%Multiracial 233 309 20 16 159 110 6 1 412 430 843 1.0%Other/Unknown 2,363 3,229 385 326 3,092 2,151 135 86 5,870 5,700 11,581 14.1%UnDuplicated Consumers 15,364 19,745 2,162 2,377 22,009 19,625 1,144 633 40,081 41,680 81,808

Ethnicity is determined from enrollment ethnicity/race information or from medicaid eligibility information. The mapping order is as follows:

1) Enrollment ethnicity of "Puerto Rican", "Mexican", "Cuban", "Other Specific Hispanic" or "Hispanic-Unknown Origin" or eligibility race of "Hispanic" are mapped to "Hispanic"2) Enrollment race of "American Indian" or eligibility race of "American Indian" are mapped to "Native American"3) Enrollment race of "African American" or eligibility race of "Black" are mapped to "African American"4) Enrollment race of "Alaska Native" is mapped to "Alaskan Native"5) Enrollment race of ""Asian" or "Native Hawaiian/PI" or eligibility race of :Asian/Pacific Islander" are mapped to "Asian/Pacific Islander"6) Enrollment race of "Two or more Races" is mapped to "Multiracial"7) Records not previously mapped that have enrollment race of "White" or eligibility race of "Caucasian" are mapped to "White (Non-Hispanic)8) All records still remaining unmapped are mapped to "Unknown/Other"

Note: Totals represent distinct clients and may not equal sum of rows/columns. A client may receive services in two age groups because of a birthday. Medicaid eligibility may reflect diffferent race codes at different times (e.g. Caucasian at one time and Hispanic or Unknown at another time) Gender is based upon sex code entered on claims. An insignificant number of anomalies have been known to occur where a client may be coded with different gender codes.

Totals may differ slightly from other report however the difference is insignificant Totals may differ slightly from other report, however, the difference is insignificant.

Reviewed by: P. VanceReview Date: 06/27/2011 Page 1 of 1 DRLC-03 FY10 Statewide

4. Prevention Dollars

Substance Abuse/Suicide Prevention Initiative

OptumHealth New Mexico

Project Overview

The New Mexico suicide rate per 100,000 people is more than double the United States rate

fAmerican Indians continue to have the highest rate of suicide in New Mexico

OHNM released a request for proposals for $2,000,000 in funding over a three-year periody

– Year 1: $900,000– Year 2: $650,000– Year 3: $450,000

80% of funds allocated for Native American operated programs including Tribal Governments, Tribal 638 programs, tribal coalitions, tribal colleges

20% for Native Americans and other populations in rural areas with high suicide20% for Native Americans and other populations in rural areas with high suicide rates

Proposal due date was October 1, 2010

Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 2

39 proposals received

OHNM Progress To Date

Review deliberations: October 22, 2010– Review team: Consortium for Behavioral Health Training and Research, NM Department of Indian

Affairs, NM Department of Health, NM Human Services Division, Coop Consulting, NM Credentialing Board for Behavioral Health Professionals, Kamama Consulting, Tafoya Consulting and OptumHealth NMNM

13 awards were granted with the approval of the New Mexico Behavioral Health Purchasing Collaborative on October 28, 2010

Letter of Award: November 1, 2010

Payments for Fiscal Year 2011 (year 1) to all 13 providers: December 2010 to March 2011 upon contract finalizationsupo co ac a a o s

Recipient meeting held June 3, 2011– 2012 payment and billing process for providers utilizing a “workbook” to collect data, submit invoices

and collect program process and outcomes2012 i d ti Q t l– 2012 required meetings: Quarterly

– Capacity building opportunities: Additional training opportunities continuously available

Fiscal Year 2012– Contracts with providers in place


– Contracts with providers in place– Workbooks distributed to providers

Selected Providers

Coalition for Healthy & Resilient Youth, Inc.

– Crownpoint & Pueblo Pintado

Native American Community Academy– NACA student body--Southeast Heights

Albuquerque, New MexicoHealing Circle Drop-In Center

– Shiprock, Navajo NationInstitute of American Indian Arts

IAIA Student body Zuni Pueblo other

New Mexico Suicide Prevention Coalition

– Eastern New MexicoPojoaque Valley School District– IAIA Student body, Zuni Pueblo, other

Native American communitiesIsleta Behavioral Health Services

– Isleta Pueblo residents

Pojoaque Valley School District– Student body Pojoaque Valley Schools

Pueblo of Laguna– Pueblo of Laguna residents

Jicarilla Apache Nation– Jicarilla Nation residents

Mescalero Apache NationMescalero residents

Pueblo of Pojoaque– Pueblo of Pojoaque residents

Region IX Education CooperativeCarrizozo Capitan Hondo and Ruidoso– Mescalero residents

National Indian Youth Leadership Project

– Gallup Public Schools

– Carrizozo, Capitan, Hondo and Ruidoso


Evidenced-Based and Innovative Programs

CAST (Coping And Support Training) is a high school-based suicide prevention program targeting youth 14 to 19 years old. CAST delivers life-skills training and social support in a small-group format (6-8

Native American Life Skills Training is a school-based, culturally tailored, suicide prevention curriculum for American Indian adolescents. Tailored to American Indian norms values beliefs and attitudes thesupport in a small group format (6 8

students per group) Drop-in services including AA groups, coaching and life skills, meals and food service Keeping It REAL (refuse, explain, avoid,

norms, values, beliefs, and attitudes, the curriculum is designed to build self-esteem; identify emotions and stress; increase communication and problem-solving skills; and recognize and eliminate self-destructive behaviors N ti HOPE i l ll d l d i idKeeping It REAL (refuse, explain, avoid,

leave) is a culturally grounded, prevention intervention targeting substance use among urban middle-school children. The curriculum consists of 10 lessons promoting anti-drug norms and teaching resistance and other social skills

Native HOPE is a locally developed suicide prevention program committed to break the code of silence regarding suicide. The curriculum includes Native Culture, traditions, spiritually, ceremonies and humorand other social skills

Life Skills Training is a research-validated substance abuse prevention program proven to reduce the risks of alcohol, tobacco, drug abuse and violence by mitigating the major social and

humorProtecting You/Protecting Me is MADD’s innovative alcohol-use prevention curriculum for children in grades 1-5. Research shows that the risk for alcohol and other drug use skyrockets when children enter the sixth grade between theg g j

psychological factors that promote the initiation of substance use and other risky behaviors

children enter the sixth grade, between the ages of 12 and 13 Project Venture is an outdoor experiential youth development program designed for high-risk American Indian youth. PV has been recognized by SAMHSA as a


been recognized by SAMHSA as a evidence-based prevention program

Evidenced-Based and Innovative Programs (continued)

QPR stands for Question, Persuade and Refer: Three simple steps that anyone can learn to help save a life from suicide. Just as people trained in CPR people trained inas people trained in CPR, people trained in QPR learn how to recognize the warning signs of a suicide crisis and how to question, persuade and refer someone to helpRez Hope a promising program with a focus on helping youth develop leadership and service learning skillsSecond Step is a violence prevention universal curriculum designed to be used with all students in a school setting. Through use of the Second Step program students begin to raise their self-esteem and learn techniques to defuse potentiallyand learn techniques to defuse potentially violent situations


Fiscal Year 2011 Benchmarks

Staff hired and trainedCurricula purchasedServices implementation in progressServices implementation in progressEvaluation protocols in placeSuicide prevention campaigns implemented


In conclusion

Resources made available to providers

– OHNM training system– New Mexico Tribal Prevention Program (SAMHSA initiative)– Kamama Consulting services– Nadine Tafoya & Associates services– New Mexico Credentialing Board for Behavioral Health ProfessionalsNew Mexico Credentialing Board for Behavioral Health Professionals– Tribal Advisory Committee (TAC)

Providers will be required to attend two TAC meeting where they will receive technical assistance and have an opportunity to connect with other Native American behavioral health providers

Outcome reports are due from providers July 31, 2011. The reports will be summarized and presented to the Oversight Team


5. OptumHealth Status DCAP

900 Second Street NE Suite 221 Washington, DC 20002 Phone (202) 962-0900 Fax (202) 962-0905

www.aliciasmithassociates.com

To: Sidonie Squier, Co-Chair Dr. Catherine Torres, Co-Chair Linda Roebuck Homer, CEO New Mexico Interagency Behavioral Health Purchasing Collaborative

From: Alicia Smith Jason Coleman David Parrella Date: June 30, 2011 Re: OHNM Monitor status report

Background After the July 2009 go-live of the OHNM system, significant issues arose with claims processing, service registration, and other aspects of the operation. Efforts to correct these issues included, among other things, a significant outlay of ‘expedited payments’ to providers to mitigate the effect of unpaid claims, and the relaxation of several edits in the OHNM claims payment system to enable more claims to be systematically paid in a timely fashion. In October 2009, the Behavioral Health Collaborative of New Mexico (“the Collaborative”) imposed a Directed Corrective Action Plan (DCAP) on OHNM covering these and other issues related to performance under the contract. In November they retained Alicia Smith and Associates (ASA) to assist with implementation and oversight of the DCAP.

In November and December of 2009, ASA helped the Collaborative to engage in analysis of OHNM’s systems and operation, involving extensive work with Collaborative staff, behavioral health care providers, and OHNM staff. In January the DCAP was refined and expanded as a result of that analysis. ASA, as State Monitors, began oversee OHNM’s implementation of the DCAP; the Monitors were to stay in place until completion of the DCAP and up to six months afterward to assure continued “steady-state” performance. At this point, all requirements of the DCAP have not been fully completed; however, significant progress has been made towards stable operation and roadmaps are being followed toward satisfactory resolution of the remaining

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issues. This report summarizes the DCAP, the current status of its issues, and the anticipated continued actions towards those resolutions and may serve as a final report from ASA as State Monitors.

The DCAP

The original DCAP finalized by the Behavioral Health Collaborative in October 2009 was superseded by an amended DCAP in January 2010, referred to as the ‘Rainbow DCAP.’ Several additional provisions were added to the Rainbow DCAP in June 2010. The Rainbow DCAP categorized the Corrective Actions into four major areas: Claims Processing, Claims Submission, Financial Management, and Provider Relations. There are 12 subsections with several items in each subsection. A copy of the Rainbow DCAP is attached to this report.

DCAP Item Status

Claims Processing Issues

1. Timeliness and Accuracy of claim payments A host of issues caused delays and misprocessing of claims for the first few months of the OHNM contract after go-live, causing extensive frustration and damage to providers in lost time, delayed compensation, and inflated administrative costs. Numerous issues were identified and fixed by OHNM, including adjustments to the ‘United Front End’ portal that accepts claims payments, distribution of a new electronic claims submission system to providers, education and training of providers, and corrections to various system and configuration issues. The DCAP has quantifiable and defined methods of measurement to ensure that OHNM is meeting the contractual requirements for claims processing and that inappropriate denials are within acceptable limits. OHNM has met the contractual and DCAP defined standards for claims timeliness, denial accuracy, and accounting since January 2010. We continue to monitor these reports on a weekly basis. All DCAP items in this group are either closed or in ‘ongoing monitoring’ status (indicating that targets have been met but monitoring continues in order to verify stable operation).

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2. Provider fee schedule and claim adjudication dispute process At the time of go-live, there were no published protocols for providers to dispute claims adjudication or fee schedule accuracy and appropriateness. Protocols were accepted and published for fee schedule and claims adjudication in January 2010. All DCAP items in this group are closed.

3. Expedited payment reconciliation

Under pressure from the Collaborative and provider community in the first few months after go-live, resulting from claims payment problems, OHNM distributed ‘expedited payments’ – checks outside of the electronic claims adjudication system – to ease the burden on providers. These payments were made with the expectation that an eventual reconciliation would occur, enabling OHNM to process all claims correctly and recoup the expedited payments. All applicable claims have been reprocessed and adjudicated, and the effort to reconcile expedited payments with providers and recoup overpayments has been underway for many months and is almost complete. OHNM is currently maintaining and regularly reviewing a list of providers who still have not been reconciled fully and thus have not returned expedited payments; in the last few months ASA has facilitated face-to-face issue resolution meetings with OHNM and several of these providers. Excellent progress has been made on reconciling the remaining providers, and an effective claims analysis methodology has evolved that is quickly moving all of the outstanding expedited payment providers towards reconciliation of their outstanding SFY 10 and 11 claims so that all expedited payments can be recouped. Some DCAP items in this group remain open pending the completion of this recoupment. OHNM appears committed to continuing the process and highly tailored methodology until all remaining providers are reconciled.

4. Reimplementation of standard edits

In another effort to mitigate claim payments issues, OHNM relaxed several of the system edits that were causing claims to deny or be rejected inappropriately. This successfully reduced the claims payment problems, but had tremendous side effects in claims accounting including incorrect fund sources, inaccurate encounter data, and significant overpayments. OHNM has made system

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adjustments and repairs that allowed the reimplementation of standard edits; this process has been lengthy and complex, lasting from November of 2009 until November of 2010, and reconciliation and recoupment of overpayments is still ongoing although the vast majority of claims paid under relaxed edits have been reprocessed correctly. The edits were gradually re-implemented under Monitor oversight. The Wildcard edit (which allowed claims to pay under certain circumstances with questionable procedure code/modifier combinations) was last and went live in November, 2010. Claims that were processed under the wildcard edit require reprocessing, and in some cases, recouping of overpayment. Reconciliation requires extensive claims analysis and considerable back-and-forth with providers to establish the original intent of the billing party and ensure appropriate funding and payment. This reconciliation is expected to be completed in July, 2011, and the expedited payment reconciliation referenced above is intertwined with the relaxed edit recoupment for providers who are not complete. Some DCAP items in this group remain open pending completion of this reprocessing.

5. Encounter data

Claims payment issues, relaxed edits, and other factors greatly hampered OHNM’s ability to submit satisfactory encounter data and remediation has steadily progressed in the wake of the system corrections and reconciliations described above. OHNM has not yet satisfied the MMIS requirements for submission of encounter data; remediation is ongoing. This DCAP item remains open pending confirmation from Medicaid that encounter data requirements are being met.

6. Payment to non-contracted IHS providers

The process to enable payment of claims to non-contracted IHS providers was implemented in January 2010. This DCAP item is closed.

5

Claims Submission

1. Service Registration OHNM’s implementation included a Service Registration web portal which providers are required to use to establish appropriate fund mapping and consumer eligibility for the various braided funds available. The process was a huge change for providers, and had significant problems that further impacted the already difficult adoption of a new system. Several iterations of Service Registration enhancements have occurred to ease claim submission issues and minimize the administrative burden to providers. A plan to rework Service Registration as a more permanent solution has been presented to providers and the collaborative by OHNM, has been reviewed by the State, and is proceeding pending final submission by OHNM and approval by the State of the detailed work plan, test plan, and timeline for implementation. The proposal would largely disconnect the link between service registration and claims payments as it relates to fund mapping, and fund mapping would become retrospective instead of prospective. The DCAP item related to long-term remediation is open pending approval and implementation of that proposal.

2. Authorization process and reporting

The prior authorization process and protocols were approved, implemented and published in January 2010, and reporting of authorizations has been satisfactorily accomplished. All DCAP items in this group are closed.

Financial Management

1. Fund management and mapping

Internal and independent audits of fund mapping accuracy have occurred, and acceptable fund burn reports are being delivered. Fund mapping is not complete for Fiscal Year 2010, however, because of the remaining adjustments that will be caused by Wildcard edit claims reprocessing. Also, problems with correctly ‘cascading’ claims down funding allocation streams are not yet resolved. It is expected that a final FY 10 fund burn report will be delivered in the next few weeks as the reconciliation efforts described above approach conclusion.

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The DCAP item related to fund mapping reconciliation remains open pending resolution of these issues.

2. Financial reporting

Financial reports were accepted and have been satisfactorily delivered. The DCAP items in this group are closed.

Provider relations

1. Provider contracting

A contract and fee schedule audit was performed and all possible provider contracts have been completed. The process for fee schedule change orders has been defined and approved. The DCAP items in this group are closed.

2. Provider council, call center and complaint monitoring

The provider council has been operational since December 2009. Call Center and complaint monitoring and review of Regional Office operations is still in progress but continued resolution of provider issues in the Central Office has drawn focus away from Regional Office performance evaluation. Some DCAP items in this group remain open.

Open DCAP Items

1. Claims Processing: ongoing monitoring Our monitoring of the claims processing system reveals a stable rate of claims payments, denials, and timeliness since March 2010, with only minor fluctuations, mostly due to known events. While some providers continue to experience claims processing issues, the OHNM data does not portray systematic problems and provider complaints are being dealt with individually. The low auto-adjudication rate is of concern as manual processing is costly and error-prone, and should be monitored on an ongoing basis as the stability of the system allows increased rates of auto-adjudication.

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The following chart illustrates the progress in claims payment and auto-adjudication rates.

2. Expedited payment reconciliation

As of 6/29/11, most providers who received expedited payments have been reconciled and the outstanding ones are in process as described above.

$18,121,602.59 of $22,198,129 has been recouped $3,756,898 remains to be recouped

The recouped dollar value reflects actually collected dollars, and the remaining amount may include money that has been agreed to with providers but not yet collected due to recoupment payment plans OHNM has agreed to with providers.

The variance is slightly more in dollars than in claims, which is expected. The dip in January in dollars may reflect the clinical triggers.But dollar amounts can vary significantly so there is insufficient time since their implementation to draw that conclusion.Overall The trend is fairly flat in 2010 which seems to indicate a stable numbers of denials.In the last few months payments and auto-adjudication rates have risen signifigantly (post relaxed edits).

The lines show the percent of claims paid (blue) by number, the percent of billed dollars paid (red) for that month,and the auto-adjudication rate (green).

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

% paid by Claims

% paid by dollars

AA Rate Percentage

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3. Reimplementation of standard edits: Wildcard reprocessing and recoupment

OHNM delivered remediation reports to providers to review and correct in December

Providers were given about 6 weeks to review and return the corrected reports

Reprocessing of corrected claims is in process Reprocessing of claims from non-responsive providers is in process Providers who wish to appeal reprocessing results will use the standard

claim adjudication appeal process Reprocessing was largely complete by 3/31/2011, with a small set of

exceptions Remaining providers are in a reconciliation process on an individual basis

4. Encounter Data

OHNM is working with Medicaid on the remaining encounter data issues, and expects to reach full resolution in July 2011.

5. Service Registration

OHNM has presented a proposal to the provider council and the Collaborative to revamp Service Registration in the next few months, including the following:

Severing the connection between advanced fund determination and claims payment

Removing steps and questions from the Service Registration process to ease the administrative burden on providers

Normalizing the procedure code/modifier matrix across agencies Blending funding allocations per provider where possible

The Collaborative has submitted a response to OHNM including conditional approval of the plan, with some requests for more information and requirements for Collaborative review and approval of associated project plans, test plans, and timelines for implementation. The provider council has accepted the proposal. OHNM is working on the detailed project plans, test plans, and implementation timelines as requested by the Collaborative.

6. Fund management and mapping

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Wildcard reprocessing will continue to cause adjustments to FY 10 claims payment sources, but is almost complete

Resulting adjustments across funding agencies or into and out of Medicaid will affect fund reconciliation

Preliminary estimates received from OHNM indicate that no agency will be overspent after all wildcard adjustments are completed

Reprocessing was largely complete by the end of March Final fund burn data for FY 10 should be available in the next few weeks Problems with the ‘cascading’ of funds from exhausted fund allocations to

remaining sources in the same funding stream continue and may affect Fiscal Year 2011 fund burn reporting and reallocation

7. Call center and complaint monitoring

A complete review of the Regional Office operation, including call centers and complaint monitoring was intended, but the focus has remained on problem resolution in the central office and Regional Office performance has not been thoroughly evaluated. At this point, the Monitor’s are clear that while the Regional Office concept was a good one, its execution has not met the hopes for its effectiveness. At a minimum, all claims issues should be moved to the central office and be handled by one team with direct accountability to the CEO.

Conclusion and Recommendations

While DCAP items remain open, the most significant and impactful ones have been closed or are approaching satisfactory closure. We recommend the following actions moving forward:

Transfer of the DCAP to the Collaborative Oversight Committee: the Monitors is working with the Oversight Committee to transfer all Monitor reports to Oversight and to assist in streamlining the reporting process;

Continuation of the Service Registration rework project, and execution by the State of the corresponding procedure code/modifier analysis and simplification project that is related to that effort: it is critical that the State finalize its analysis and it is equally critical that any and all changes to Service Registration are thoroughly tested before implementation to prevent the kind of claims payment nightmare that plagued the initial implementation of this plan;

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A full analysis of the OHNM encounter data submission status by the State and a request that OHNM provide their own full report and plan to meet contractual requirements in this area: encounter data is the heart of critical reporting for the Medicaid program and Optum must be held accountable for timely, accurate reporting of encounters.

A rigorous examination of the performance of the Regional Office support system and call centers: regretfully, this was not something the Monitors were able to complete but need to be a joint undertaking by Optum and the Collaborative;

A concerted effort to achieve finalization of the FY 10 fund burn accounting between the State and OHNM; and

Continued scrutiny of the FY 11 burn rate and FY 12 allocation process

We respectfully submit this report and will provide any updates that have occurred between the filing of the report and the Collaborative meeting on July 14, 2011.

Color Key Completed Future Under Monitor review OHNM Closed Ongoing

Claims Processing (CP)

ItemsAction Completion Criteria Deliverable Next Deadline Estimated

green date Status Validation Notes

CP 1.1 Collaborative claims summary report

Weekly, Monthly report delivery claims summary report Completed Ongoing* This has been changed to weekly Report review Ongoing monitoring for up to 6 months

at state's discretion

CP 1.2 Provider report of all submitted claims

Online report refreshed daily

provider claims report available online 1/4/2010 1/18/2010 Closed Provider acceptance verification Report Approved

CP 1.3 Timely processingProcess 90% within 14

days, 98% within 30 days

criteria met NA NA This has been changed to a weekly report Ongoing claims monitoring Aging criteria met 1/22

CP 1.4 Manual review of sample of denials

<3% inappropriate denial criteria met NA NA December '10 report: 1.12% error Ongoing denial monitoring

3% threshold: if crossed, OHNM to propose CAP to be agreed upon with

State and Monitors

CP 1.4.5 Denial code review Denial codes reworked NA Closed Deemed unnecessary

CP 1.5Online realtime

provider access to claims data

Collaborative and Provider approval, provider education

Realtime claims lookup 4/31/2009 NA Closed Online Claim data review Report deemed acceptable

CP 2.1Fee schedule

dispute protocol for providers

Collaborative approval, provider education

fee schedule dispute protocol 1/11/2010 1/18/2010 Closed Protocol review Protocols approved and published

CP 2.2Claims dispute

protocol for providers

Collaborative approval, provider education claims dispute protocol 1/11/2010 1/18/2010 Closed Protocol review Protocols approved and published

CP 3.1 Full claims accounting

Resolution of Expedited Payment claims reconciliation

reports with providers

Reconciliation report In Process TBDReconciliation reports sent to

providers; reconciliation still in progress 6/10/11

Provider acceptance verificationReconciliation ongoing in a few cases

2/10/11 (outreach to providers to resolve any claims disputes)

CP 3.2

Reprocessing all pre-relaxed non-

expedited denials under relaxed edits

non-expedited claims reprocessed Rainbow report 1/4/2010 Closed Report review Report indicates that all nonexpedited

denials have been reprocessed

CP 3.3

Reprocessing all pre-relaxed expedited

denials under relaxed edits

expedited claims reprocessed

Expedited denial reprocess report

TBD by revised plan Closed Report review Report indicates that all expedited

denials have been reprocessed

CP 3.4 Reconciling expedited payments

All providers reconciled (overpayments

recouped)

Expedited payment recoupment report In Process TBD Recoupment still in process

6/10/11 Recoupment complete Recoupment ongoing

3.5

Non-expedited provider

reconsideration process

Enhanced Claims Summary report on

Provider portal

provider claims summary report TBD TBD

Optum to add to reconciliation data claims summary on portal, to make it useful as a reconciliation

tool as per expedited reconciliation reports

Report approval Need update from Optum 2/10/11

CP 4.1Remediating

provider claims submission issues

Outreach performed to all providers with

standard edit problems Outreach report In Process 1/21/2010 Closed Provider acceptance verification Claims submission issues appear to be

resolved

CP 4.2 Executing standard edit plan

All standard edits on, relaxed edit claims reprocessed as per

plan

Standard edit plan executed

starting after expedited denial reprocessing is

complete

Dependent on completion of

denial reprocessing

All edits in place, reprocessing of wildcard claims begun 2/7, post-

implementation monitoring ongoing

Standard edit verification Standard edits progressing

CP 4.3 Claims adjustment recoupment All providers reconciled Standard edit

reconciliation reportafter plan

completion

Dependent on standard edit plan start time

Recoupment began 2/7 Report review Recoupments only apply to 'wildcard' edit

CP 5 OHNM encounter data

All encounter data collected

837 file from July 1 processed

after standard edit plan

Dependent on completion of standard edit

plan

OHNM encounter data report and plan needed Report review

Encounter data plan to be delivered by OHNM, activity to begin after standard

edit plan completion

CP 5.1 Encounter data to MMIS

MMIS data receipt verification

837 file from July 1 processed

after standard edit plan

Dependent on completion of standard edit

plan

State analysis of encounter data status needed MMIS

Encounter data plan to be delivered by OHNM, activity to begin after standard

edit plan completion

CP 5.2 Non-contracted provider claims

Process for payment of non-

contracted claims: IHS

Collaborative approval, provider education

Noncontracted claims processing protocol 1/11/2010 1/31/2010 Closed Provider acceptance verification IHS non-contracted provider payment

process in place

Expanded Rainbow DCAP' 2/16/11

Ref

Timeliness and accuracy: Meet

SLA, provide verification,

provide adequate

reporting to collaborative and providers

Encounter Data

Return to standard edits

Provider dispute process

Pre-relaxed denial and expedited payment

reconciliation

Claims Submission (CS) Items

Action Completion Deliverable Deadline Estimated green date Status Validation Notes

CS 6.1Move facility

registration to OHNM

Service Registration changes SR release 1/4/2010 1/11/2010 Closed Deployment Fallout Report

ASA Review1.4: 'report' received, no problems

reported

CS 6.2 Remove multiple site registration

Service Registration changes SR release 1/4/2010 1/11/2010 Closed Deployment Fallout Report Report delivered

CS 6.3 Allow full contract service registration

Service Registration changes SR release 1/4/2010 1/11/2010 Closed Deployment Fallout Report Report delivered

CS 6.4 Short term SR remediations

Service Registration changes SR release 1/31/2010

TBD by requirements

researchClosed SR release review Deployed

CS 6.5 Long term SR redesign

Service Registration changes SR release TBD TBD OHNM to present detailed project

and test plan SR release review Monitors and state to meet to review SR plan

CS 7.1

Provide protocol for standard

authorization length and units by service

type

Collaborative approval, provider education Auth/reauth protocol 1/4/2010 1/18/2010 Closed Protocol review Alerts sent

CS 7.2

Collaborative authorization

exception frequency report

<10% exceptions Authorization exception report 1/4/2010 1/18/2010 Closed Report review

CS 7.3Criteria for changing

protocol based on exception data

Collaborative approval Protocol change criteria 1/4/2010 1/18/2010 Closed Criteria review

CS 7.4

Provide protocol for Peer to Peer

authorization by service type

Collaborative approval, provider education P2P auth protocol 1/4/2010 1/18/2010 Closed Protocol review

CS 7.5Collaborative P2P

auth frequency and outcome report

collaborative approval P2P auth report 1/4/2010 1/18/2010, Ongoing* Closed Report review Report received by monitors

CS 8.1Provide

authorization report for providers

Onlnine auth report refreshed daily Provider auth report 1/25/2010 1/25/2010 Closed Report review Report available online 1/15

CS 8.2

Provide authorization

outcome report for providers, including all requested auths

with status and outcome


Online auth report including all auth

requestsNA NA Closed Report review

Report published including provider-requested enhancements but not

denied or pending auths

CS 8.3

Provide online realtime

authorization outcome and status

lookup


online auth lookup NA NA Closed Online auth data review 8.2 report satisfies this

Ref

Authorizations

Service Registration

Fund Management

(FM) ItemsAction Completion Deliverable Deadline Estimated


FM 9.1Perform fund

mapping sample audit

Sample audit performed

Sample fund audit report 1/4/2010 1/18/2010 Closed Report review Approved

FM 9.2 Reconcile fund mapping errors

Fund reconciliation complete

Fund Reconciliation report 7/30/2011 TBD

Final 2010 Fund mapping reallocations to be copmleted after wildcard reprocessing, final FY10 burn reports to be produced July

2011FY 11 fund mapping in question --

Cascading pools, fund stream shutoff

Provider and Collaborative review and acceptance

Initial estimated wildcard adjustment report delivered 2/15/11

FM 9.3 Perform full independent audit

indpendent audit completion

Independent Audit Report NA NA Closed Provider and Collaborative review

and acceptance Audit concluded 8/12/10

9.4 Monthly Fund Burn rate report

Report received monthly Fund burn report NA NA Closed Report acceptance Fund burn report format accepted

FM 10.1Provide monthly direct services

report

Monthly report delivery, Collaborative approval of fund management

methodology

Direct Services report 1/22/2010 NA Closed Report review Report delivered for review

FM 10.2

Provide online fund status reporting, prospective and

historical

collaborative approval Online fund status report NA NA Closed Report review Superceded by new report 9.4

Provider Relations (PR)

ItemsAction Completion Deliverable Deadline Estimated


PR 11.1Perform contract and fee schedule

audit

Contract and fee schedule audit

performed

contract/fee schedule audit report 1/4/2010 1/18/2010 Closed Report review ok

PR 11.2Complete all

possible provider contracts

All providers contracted or

exceptions approved by collaborative

(dependent on provider cooperation)

Provider contract report 2/22/2010 2/28/2010 Closed Report review Report delivered for review

11.25 IHS contract closureAll IHS providers

contracted or 'officially' refuse contracting

TBD TBD Optum attempting to complete contracting

3 IHS providers still uncontracted 2/10/11

PR 11.3 Reduce denial codes Collaborative approval Denial code proposal NA NA Closed Proposal review Moved to Claims Processing section

1.4.5

PR 11.4Provide fee

schedule change order process

Collaborative approval, provider education Change order process 1/4/2010 1/18/2010 Closed Process review Process and Provider alerts approved

by monitors

PR 12.1 Form provider council

Council formed and functional Collaborative approval 12/28/2009 1/18/2010 Closed Provider acceptance verification Council meetings underway

PR 12.15 Provider Council review Review complete NA NA Closed Council charter revised and accepted

PR 12.2

Call Center monitoring and improvement as

necessary

Collaborative approval Call center logs TBD Ongoing* Independent 'secret shopper'

PR 12.3 Provider complaint monitoring Collaborative approval Complaint file TBD Ongoing* Ongoing compmlaint monitoring

PR 12.4 Regional Office review

Review of Regional Offices:roles, responsibilities, authority, policies,

procedures, job specs

Need to discuss call center monitoring mechanism

Provider Relations

Provider Contracts

Ref

Ref

Fund Management

Items

Financial Management

6. Quality Performance and Accountability

Behavioral Health Purchasing Collaborative

Quality Improvement Committee Committee members:

CYFD: Ken Warner, Kristin Jones BHSD: Daphne Rood-Hopkins, Marizza Montoya Gansel,

Nancy Michalk, Edna Ortiz ALTS Betty Betts, Fred Schaum Oversight: Karen Meador Quality Improvement: Betty Downes, Chair DOH Annette Salazar, Div Health Improvement Medicaid: Shirley Astilli, Geri Cassidy Optumhealth New Mexico:

Peter Vance, QI Director, and Karan Northfield

Quality Improvement Subcommittee: FY11 Priorities Topic Tracking Sheet

Priorities

Indicators

Program Quality

1. Appropriate Psychotropic prescribing practices for children

Agreed upon these indicator analyzed by age (under 5yrs, 6-12, 13-18 ) and gender: • Greater than 5 medications filled at the pharmacy in the past 30 days • Children less than or equal to 18 years of age. The results will be broken down by age groups 0-5

years, 6-12 years, and 13-18 years. It will also be broken out by gender • Agreed upon Psychiatric classes • A separate breakout will be for all cases where the child is receiving three or more antipsychotic

medications A separate breakout for all cases where a child 0-3 years receives any medication in the above classes

2. Successfully implement evidenced-based and practice-based treatment alternatives, specifically: • Adult: Substance Abuse IOP • Children: Substance Abuse IOP

Adults: For consumers who had been in 3 or more months of IOP services, what % have been admitted to a higher level of care within 30,60 90 days. Children: Approve 5 adolescent Substance Abuse IOP Providers by the end of FY11

Client Outcome 3. Increase in # and % of high

severity clients who categorically improve on the ASI drug & alcohol domains

• Clinical practice has incorporated the ASI findings into the treatment plans and CCSS service plans.

• Timely and accurate administration of the ASI-MV to all adult clients with substance abuse problems (both state general and Medicaid funded);

Service System Improvements 4. Successful implementation of the

Core Service Agencies (CSA) infrastructure

Indicators that a Quality Improvement System is operating: 1. The Quality Improvement System evidences detail structure, staffing and last Annual evaluation

and 2010 QM Plan report 2. Consumer and family participation is high in the Quality Improvement System. 3. There is recent successful measureable improvement and the steps that were taken to effect the

Priorities

Indicators

change are documented. 4. The System addresses all required elements and the relationship between these measures &

those in the CSA’s QMS are clear. Required elements include:

Referrals- no reject policy Intake: initial face to face within 24 hours Assessments and Service Plans: initiated within 72 hours of initial intake Enhanced Assessments: Use the format specified Each individual has access to a Community Support Worker Crisis Services: access to crisis stabilization services

5. Track and trending of CSA clients 6. All CSA clients have an individual Crisis plan. Once standards are adopted, all Crisis Plans will meet

standard within CSA’s. 5. Increase Provider competence in

building recovery & resiliency – oriented treatment systems at the provider level.

• Strengthen and expand the role of Family/Peer Specialist in agencies • Improve recovery-based practice with clinical staff in agencies • Clients’ satisfaction with their providers recovery –oriented services

6. Development a comprehensive continuum of care for adults, youth & children

Adults: Length of time to next appropriate level of care, specifically: What is the readmission rate to inpatient and residential care? Percent of clients who receive 7 and 30 day follow-up from:

Residential Substance Abuse to IOP Inpatient to CCSS

Children: Trend the number of children & youth served, unit of services and expenditures on a monthly basis. Length of time to next appropriate level of care

7. Improved access and availability of services to rural and frontier consumers through use of telehealth technology

Within the current sites, establish baseline data on: # clients served by teleheallth # units by type of service

Track expansion of sites and services. Qualitative measure for Client satisfaction

• Appropriate access to services

for older consumers with a behavioral health disorder.

Older Adults 1. Critical Incidents by type and age

2. Major Diagnostic Category

Improved access and availability of services to rural and frontier consumers through use of telehealth technology

In Q3FY11 (seventh quarter of program), 1,321 unique consumers residing in 27 New Mexico counties received Behavioral Health services via Telehealth resulting in claims paid by OptumHealth New Mexico.

253 219 244 255 288

606 587

707 710790

150 130189 160

212

0

100

200

300

400

500

600

700

800

900

Q3 FY10 Q4 FY10 Q1 FY11 Q2FY11 Q3FY11

Num

ber

of c

onsu

mer

s

Consumers utilizing telehealth by consumer county of residence, Q3 FY10 - 11

FRONTIERRURALURBAN

Prescriber types in BH system: (all of whom must be certified and/or licensed within their respective New Mexico board)

Psychiatrist Psychologist with prescribing privileges Nurse Practitioner Certified Nurse Specialist

Checklist of Accomplished Prescribing Practice Tasks:

Inform prescribers of targeted outliers

Create accurate data report of above target activities, run monthly

Identify consumers in one of three target areas

Identify prescriber engaged in targeted activity

Create mechanism for clinical consult with psychiatry and pharmacy to determine need to contact provider

Create three letters of prescriber contact

Alert Letter #1 – Notice of concern; request for clinical information Alert Letter #2 – Cease and Desist Alert Letter #3 – Resolution

___ Create connection with Pharmacy &Therapeutics Committee as ‘peer review’ of

prescribing practice ___ Communication to Consumers of prescribing practices within solid clinical judgment

___ Communication to other prescribers in NM of data and results of prescribing practice inquiry

Targeted Prescribing Practice ‘Outliers’: 1. Greater than three behavioral health medications prescribed 2. Two or more antipsychotic medications prescribed 3. Consumers within 0-5 years of age prescribed any behavioral

Prescribing Practice Outliers Greater than three behavioral health medications prescribed

Two or more antipsychotic medications prescribed

Consumers within 0-5 years of age prescribed any behavioral health medication

Monthly Report Reviewto alert OHNM Pharmacy of

consumers who fall within prescribing practice outliers

OK

Data Review to identify prescriber associated with identified prescribing practice outlier

Alert Letter #1 sent to prescriber

Alert Letter #2sent to prescriber

Peer Reviewthrough identified P&T

committee

Recommendation sent to Provider Services of need to

re-evaluate credential of prescribing practitioner

OK

6.27.2011DRAFT

Prescribing Practice Outliers: Identification & Intervention

Prescriber responds

with information/data for outlier

practice

Prescriber ceases outlier

practice

Prescriber continues

outlier practice

Approximate Timeline:

1st of month receipt of report

60 Days

50 Days

30 Days

90 Days

Consult with Dr. Brown of OHNM

Edit insertedin claims system for prescribing

practitioner for identified prescribing practice outlier event

Care Coordination offeredto consumer for 2nd prescriber

opinion

OK

Alert Letter #3sent to prescriber

7. Public Expert Panel

1

EXPERT PANEL FOR BEHAVIORAL HEALTH 2011

Susie Trujillo [email protected]

Kayt [email protected]

Dr. Deborah Clark [email protected]

Vincent D’Aloia [email protected]

Lisa Senazen‐[email protected]

Doug Smith c/o aracelli.mendoza@cai‐nm.com

Holly Spanks c/o [email protected]

Becky [email protected]

Shela Silverman [email protected]

Ana Whittemore [email protected]

Cari Washburn‐Chavez CWashburne‐[email protected]

Susan Casias [email protected]

Kathy Bruaw Sutherland [email protected]

Andrea Shije [email protected]

Bill Belzner [email protected]

Noel Clark [email protected]

Roque [email protected]

Beverly Nomberg ceo@la‐familia‐inc.org

Mickey Curtis [email protected]

David Ley [email protected]

Nancy Jo Archer [email protected]

Dr. George Davis [email protected]

Dr. Brooke [email protected]

David Graeber [email protected]

Donald Hume [email protected]

Ann [email protected]

Beaver Northcloud [email protected]

Gail Falconer [email protected]

Dolores [email protected]

Claire Leonard [email protected]

Norman Joe [email protected]

Patsy [email protected]

David Ley [email protected]

Rodney McNeese [email protected]

Cathy [email protected]

Karen Meador [email protected]

Betty Downes [email protected]

Harrison [email protected]

Geri Cassidy [email protected]

Bette Betts [email protected]

Mike [email protected]

Craig Sparks [email protected]

Diana McWilliams [email protected]

Chamisa [email protected]

Linda Mondy Diaz [email protected]

Gordon Egleheart 721 Georgia Street SE Albuquerque, NM 87108

Pamela HollandPO Box 986, Jamestown, NM 87347 fax 505 905‐4949

Julie Weinberg [email protected]

Brent Earnest [email protected]

Steve [email protected]

Sam Howarth [email protected]

Chris Wendel [email protected]

Behavioral�Health�Expert�Panel�Meeting�I��

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NEW MEXICO HUMAN SERVICES DEPARTMENT P.O. Box 2348 Santa Fe, New Mexico 87504-2348

Susana Martinez Sidonie Squier Governor Secretary Media contact: Matt Kennicott (505) 827-6236 June 14, 2011 For Immediate Release

NM Human Services Department Invites Public Input on

Medicaid Modernization

Hearings around the state are scheduled to begin on July 6th

Santa Fe – Today, the New Mexico Human Services Department released the full schedule of public input hearings on Medicaid modernization, scheduled to begin after the 4th

Six public input sessions and one state tribal consultation will be held at the following times and locations:

of July holiday. The hearings will take place at seven different locations throughout the state. These hearings are designed to solicit input from the public on how the state can continue to protect and improve Medicaid services for New Mexicans who depend on them the most.

• July 6, 2011, 11:00a.m. to 1:00 p.m. – Clovis – Clovis Civic Center, 801

Schepps Blvd. (Corner of Schepps & 7th

• July 12, 2011, 3:00 to 5:00 p.m. – Farmington – San Juan College, Room 7103, 4601 College Blvd., Farmington

)

• July 26, 2011, 11:00 a.m. to 1:00 p.m. – Roswell - Roswell Public Library, Bondurant Room, 301 N. Pennsylvania Ave., Roswell

• July 27, 2011, 9:00 a.m. to 11:00 a.m. – Las Cruces – NM Farm and Ranch Museum Theater, 4100 Dripping Springs Rd., Las Cruces

• July 28, 2011, 10:00 a.m. to 12:00 p.m. – Albuquerque – UNM Continuing Education Building, Rooms G & H, 1534 University Blvd NE, Albuquerque

• August 2, 2011, 1:00 p.m. to 3:00 p.m. – Santa Fe – Willie Ortiz Building, 2600 Cerrillos Road, Santa Fe

• August 3, 2011, 9:00 a.m. to 12:00 p.m. – Tribal Consultation , Albuquerque – Location TBD

“The discussions that we will undertake are a vital piece of our efforts and responsibility to ensure that Medicaid continues to serve New Mexicans well, both now and for generations to come,” said Human Services Department Secretary Sidonie Squier. “By including public input in the process, we ensure that our Medicaid system is tailored to meet the specific needs and challenges facing New Mexicans. We look forward to traveling the state and engaging in this important dialogue.” New Mexico’s Medicaid programs currently serve more than 550,000 New Mexicans, the majority of which (335,000) are children. The Fiscal Year 2012 budget is $3.75 billion dollars (state and federal funding). With the implementation of federal health care reform, it is estimated that an additional 130,000 to 175,000 will qualify for the program. “This process will build on the commitment Governor Martinez made to provide essential health care services to the most vulnerable in our state, as was demonstrated in her decision to increase Medicaid funding by $10 million in her executive budget earlier this year,” concluded Squier. A Frequently Asked Questions paper, with more details about the Medicaid Modernization Plan and next steps, along with the schedule of public input sessions, are posted on the HSD website at www.hsd.state.nm.us/MedicaidModernization.

###

http://www.hsd.state.nm.us/MedicaidModernization�

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