Behavioral Health Organizations (overview)

1. The Medicaid Community Behavioral Health Services Program •Comprehensive behavioral health services to Medicaid members in Colorado

2. Behavioral Health Organizations (overview) Orange: Access Behavioral Care (ABC) Green: Behavioral Healthcare Inc (BHI) *Pink: Northeast Behavioral Health Partnerships (NBHP) -> June 30th. *Yellow: Colorado Health Partnerships (CHP) *Blue: Foothills Behavioral Health Partnerships (FBHP) *Value Options

3. Methadone Clinics Detox facilities Hospitals Federally Qualified Health Centers BHO • Behavioral Health Organizations (BHOs) then contract with their own network of behavioral health providers, including individual practitioners and community mental health centers in order to offer services to all those in need. Specialists Individual providers Community Mental Health Centers

4. So what happens if a client wants services in a different BHO region? BHOs have large and varied provider networks Single case agreements

5. Access to care standards BHOs are required to complete an intake and initial assessment of any Medicaid client requesting routine services within seven business days of the initial request.

6. Access to care standards •Placing Medicaid clients on waitlists to be seen for an initial appointment outside of the seven day timeframe is not acceptable.

7. Can anyone receive services? • Anyone can be assessed Covered diagnosis Covered procedure Medically necessary

8. A note about medical necessity • “Medically Necessary” describes a service that, in a manner in accordance with professionally accepted clinical guidelines and standards of practice in behavioral health care: • Is reasonably necessary for the diagnosis or treatment of a covered mental health disorder or to improve, stabilize or prevent deterioration of functioning resulting from such a disorder; and • Is clinically appropriate in terms of type, frequency, extent, site and duration; • Is furnished in the most appropriate and least restrictive setting where services can be safely provided; and • Cannot be omitted without adversely affecting the Member’s mental health and/or physical health conditions associated with the Member’s covered mental health diagnosis, or the quality of care rendered.

9. Behavioral Health • In addition to comprehensive mental health services, effective 1/1/2014, BHOs now manage substance use disorder (SUD) services. • SUD services were previously offered in Fee-For-Service Medicaid on a limited basis.

10. SUD services available through the BHO program • Alcohol and/or drug assessment • Detoxification services (includes: physical assessment of detoxification progression including vital signs monitoring; safety assessment; provision of daily living needs including hydration, nutrition, cleanliness and toiletry for clients; Level of motivation assessment for treatment evaluation) • Individual and group therapy • Targeted case management • Drug screening and monitoring • Peer advocate services* • Medication Assisted Treatment*

11. What medications are covered in association with chemical dependency? • Methadone* • Suboxone (buprenorphine and naloxone) • Subutex (buprenorphine) • Revia (naltrexone) • Vivitrol (naltrexone) • Antabuse (disulfiram) • *Methadone maintenance is covered by the BHOs. The rest of the medications are medical/pharmacy benefits.

12. What mental health services are available? • Inpatient hospital psychiatric care • Outpatient hospital psychiatric services • Psychiatrist services • Individual and group therapy • Medication management • Case management services • Emergency services • Vocational services • Clubhouse/drop-in centers • Residential services • Assertive Community Treatment • Recovery services • Respite services • Prevention/early intervention activities • School-based and day treatment services for children/youth

13. What else is new for the upcoming contract? • Focus on integration • Focus on care coordination • Department of Corrections Nursing facilities • Department of Human Services (child welfare) • Program Improvement Advisory Committee (PIAC) • Increased requirement of consistent trainings • Increased access to care standards • 4 services within 45 days • Focus on trauma informed care • Clarifying language for Brain Injury clients

14. If issues arise…… • Office of Member and Family Affairs • Quality Director →Remember, the BHOs are ultimately responsible for enforcing the standards of care

15. How do I contact the BHO or find a BHO provider? http://www.colorado.gov/cs/Satellite?c=Page&cid=1212398231156&pagename=HCPF%2FHCPFLayout www.colorado.gov/hcpf -> Benefits -> Medicaid Managed Care -> Behavioral Health Organizations

16. Helpful resources BHO contact numbers: Access Behavioral Care (ABC) 720-751-9030 Behavioral Healthcare Inc (BHI) 720-490-4400 Foothills Behavioral Health Partnerships (FBHP) 303-432-5970 Colorado Health Partnerships (CHP) (800) 432-9553 Northeast Behavioral Health Partnerships (NBHP) 970-347-2374 (effective now until June 30, 2014) Access Behavioral Care Northeast (844)-880-8508 (effective July 1, 2014)

17. Questions?

18. Matt Ullrich Contract Performance & Operations Specialist 303-866-6232 Matthew.ullrich@state.co.us Nikki Lemmon Behavioral Health Specialist 303-866-4711 nikki.lemmon@state.co.us