Embedding State-Funded BH/IDD Services into Tailored Plans and More

The concept paper on State-funded BH/IDD services lays out a plan of action to create a more statewide, standardized approach to State funding. The paper indicates the State’s intent to move to a centralized decision-making process for eligibility, as reflected in the emphasis on the statewide structure described below.

In addition to state funded services, this concept paper also addresses supplemental support mechanisms in the BH/IDD Tailored Plan that will be available to all of their members.  Here are some of the details of the paper: 

Statewide Structure:

• Reiterates that State funds are only available through the BH/IDD Tailored Plan.
• Lays out responsibilities of the BH/IDD Tailored Plans for some of those functions that have, in the past, been the Local Management Entity part of the LME/MCO. 
• Proposes to create statewide eligibility criteria for State funds.
• States intent to create a statewide waiting list for State-funded services in all 3 disability areas—mental illness, substance use disorders and intellectual-developmental disabilities. 
• Notes the intent of NC DHHS to directly contract with providers to pilot “innovative approaches and administrative efficiency of certain State services”. 
• Charts the State-funded services.  Includes new focuses on recovery, meaningful day, peer support, high-fidelity wraparound for children, supported employment, residential and case management. 
• Continues expectations for quality improvement in BH/IDD Tailored Plan services with monitoring and oversight by the State.
• Differs from the Medicaid constructs of care management.  Uninsured individuals with mental illness and/or substance use disorders will receive case management and individuals with intellectual or developmental disabilities receiving State-funded services will receive care management. 

There were a few areas that were highlighted in the paper:

System of Care:  The paper endorses the continued use of the System of Care (SOC) model.  SOC is a mechanism to address the multiple needs of certain children.  The structure includes local collaboratives with members that have the children, youth and family perspective as well as others who are involved in the human service delivery system.  There is also a State collaborative, NC Collaborative on Children, Youth and Families, that looks at statewide mechanisms for producing the best outcomes for children and youth in the MH/SUD public system.  The coordination of the local collaboratives will fall with the BH/IDD Tailored Plans (as it has with LME/MCOs).  The paper notes this approach is for kids in the BH/IDD Tailored Plans. 

In-Reach, Transition and Diversion:  North Carolina’s Transition to Community Living Initiative (TCLI) will serve as a model to build upon the use of in-reach and transition services that will divert individuals from over/inappropriate use of institutional settings, including Adult Care Homes.  In-reach and transition are defined on the NC DHHS TCLI website as “Providing or arranging for frequent education efforts and discharge planning targeted to individuals in Adult Care Homes (ACHs) and state psychiatric hospitals.”  It is a part of a model that has been used since the inception of TCLI.  This paper proposes broadening the use of these services to include individuals who reside in ICF-MR facilities as well as children who are in specialized institutional settings.

Local Health Functions:   The paper defines this as prevention and promotion efforts that will be the responsibility of the BH/IDD Tailored Plans.  Several areas of local supports are specified as Local Health Functions and include:  crisis/involuntary commitments, disaster emergency response, collaboratives including Consumer and Family Advisory Committees, increased natural and community supports. 

Comments are due to NC DHHS by January 29 and can be sent to Medicaid.Transformation@dhhs.nc.gov. 

NC DHHS held a webinar on this paper on January 24^th.  When the handout and transcript are posted, they can be found at:  https://medicaid.ncdhhs.gov/providers/programs-and-services/behavioral-health-idd-tailored-plan

Tentative Timeline for the BH/IDD Tailored Plan Implementation:

In a recent meeting, representatives of the Division of Health Benefits offered the timeline in the chart below for the implementation of the BH/IDD Tailored Plan.  Keep in mind that there is legislation, S.L. 2018-48, which states that the BH/IDD Tailored Plan will begin no earlier than one year after the implementation of the Standard Plan.  In order to continue toward a July 2021 go-live date, the Standard Plan would have to begin on or before July 2020. 

Timeline	Milestone
March 2020	BH I/DD Tailored Plan request for applications released (tentative)
September 2020	BH I/DD Tailored Plan contracts awarded (tentative)
Fall-Winter 2020	BH I/DD Tailored Plans contract with providers and meet network adequacy (tentative)
July 2021	BH I/DD Tailored Plans launch (tentative)