NYC BHO Phase 1 Review Modifications and NYC BHO Phase 1 Review Modifications and ProviderConnect System™ TrainingProviderConnect System™ Training

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Training Objectives

• Today’s WebEx presentation is to inform you about the BHO Phase 1 modifications as defined by the Office of Mental Health (OMH) and the Office of Alcohol and Substance Abuse Services (OASAS) and to demonstrate our ProviderConnect™ system.

• How will the modifications impact your work?

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NYC BHO PHASE 1 Modifications

Why is this change happening?

1. To increase attention, resources and collaboration on improving discharge plans and transition to community based care for those Complex Need individuals who require this collaborative clinical approach.

2. To reduce the administrative burden on inpatient providers.

3. To broaden the focus of outreach/follow-up with outpatient providers in the BHO scope of work.

4. To develop enhanced activities that emphasize using the BHO as a learning tool for identifying trends and key service gaps/needs.

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How will this approach be different from what we have been doing to this point?

–Up until October 1, 2012, we have been doing admission, concurrent reviews and discharge reporting for all consumers admitted under FFS Medicaid.

–As of October 1, 2012, we will continue to do admission and discharge reporting for all Medicaid FFS admissions, but will only be doing concurrent reviews for “Complex Need” populations.

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Complex Needs Admissions

All Others

Provider notifies BHO of admission within 24 hours/1st business day Yes Yes

Phase 1 Modifications Effective 10/1/12Phase 1 Modifications Effective 10/1/12

BHO ensures prior service information shared by 72 hours/3rd business day Yes Yes

Determine if Health Home eligible/enrolled;

Determine if under current or prior AOT orderYes Yes

Concurrent review weekly Yes No

Provider submits discharge plan within 24 hours/ 1st business day following discharge Yes Yes

BHO issues Notification of Preliminary Finding/ Notice of Clinical Determination if MNC not met

No No

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Initial Notification: “Routine” Cases

• The Provider will receive written notification that a case is routine

• This will assist the provider in tracking their routine cases

• Routine cases will not be reviewed again until:

1. The discharge information is received by the provider.

2. The routine case reaches a long stay threshold

3. The provider requests that the case be reviewed as a complex needs case

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Initial Notification: “Complex” Need Cases

• The provider will receive written notification of Complex Need designation

• Complex Need cases will be reviewed with provider on a weekly basis

• BHO conducts comprehensive reviews, which may include:

– Clinical rounds

– Targeted discharge planning

– Discharge Specialists

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Criteria for Complex Needs Cases

• High Need (as identified by the Offices)• Active AOT • Adult (over 21) MHIP admitted within 30 days of previous admission• Youth (under 21) MHIP admitted within 90 days of previous admission • Individuals (all ages) with SUD admission within 90 days of previous SUD

admission (not detox to rehab)• 3 or more detox admissions in 12 month period

• Provider requested

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Will we still have long-stay designation?YES, we will still have this designation. HOWEVER, rather than a designation applied based on clinical or discharge status, it will be based on TIME THRESHOLDS.

An admission will be designated as a Long Stay episode of care when the length of stay exceeds the region’s 90th percentile threshold for length of stay (LOS) for that sub-population. The BHO will initiate concurrent reviews for all individuals remaining hospitalized beyond the LOS threshold. The BHO care manager will determine the frequency of concurrent reviews for Long Stay cases and there will be no minimum review frequency interval.

Level of Care Setting CategoryNYC LONG STAYThreshold (Days)

Inpatient Mental Health Treatment

Adult 42

Youth-Art.28 and 31 49

Youth-SPC 451

Substance Use DisorderInpatient Detoxification New York City Adult 7

Substance Use Disorder Inpatient Rehabilitation New York City Adult 28

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BHO reporting will standardize reasons for Long Stay into 12 categories

1. Clinically unstable

2. Awaiting AOT Order

3. Awaiting transfer to State Psychiatric Center

4. Awaiting Mental Hygiene court appearance

5. Awaiting Residential Services

6. Awaiting OPWDD services/placement

7. Awaiting Nursing Home screening and placement

8. Awaiting case management assignment

9. Awaiting foster care placement

10. Awaiting educational services/placement

11. Awaiting transfer to substance use residential treatment

12. Other reason for Long Stay designation

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What enhanced activities will the Optum NYC BHO be involved in moving forward?

Additional activities moving forward will focus on resources and interventions for “Complex Needs” consumers & will involve:

• Increasing outreach and follow-up with outpatient providers and FFS individuals following an inpatient episode of care to ensure ongoing engagement.

• Implementing and enhancing specialized workgroups focused on detox, children and adolescents, and housing issues.

• Working with providers to identify and engage individuals with multiple detox stays who leave the inpatient unit before care coordination efforts are initiated.

• Assisting the Offices in identifying gaps in care and developing “system support processes” that improve efficiency of care coordination referrals and follow-up.

• Aligning activities with Health Home care coordination efforts.

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OptumHealth NYC BHO Provider Portal

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OptumHealth NYC BHO Provider Portal Page

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Next Steps• Complete and submit Facility Information Form, if not yet submitted, to NYC BHO via:

– Fax at: (877) 450-6020– email at NYCBHO.general@optum.com– Mail at: 22 Corporate Woods Blvd., Albany, NY 12211

• Providers who select ProviderConnect as their submission option should contact the Optum Help Desk to request a User ID/Password at (866) 505-3398/prompt 4

• Optum information, resources and contact information on our Provider Portal at:

– www.optumhealthnyc.com

• Start to notify Optum of admissions as of 1/3/2012.– Fax - Clinical Fax: (877) 283-0555– Telephonic - (866) 505-3398– Provider Portal (ProviderConnect) - www.optumhealthnyc.com

• If you are using the Optum Provider Portal ‘ProviderConnect’ and have technical questions or encounter a problem, contact Optum (866) 505-3398/prompt 4 or email us at NYCBHO.tech@optum.com.

Questions?