NEW MEXICO

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NEW MEXICOS INTERAGENCY BEHAVIORAL HEALTH
PURCHASING COLLABORATIVE TRANSFORMING THE SYSTEM

• Transforming Childrens Mental Health States
  on the Cutting Edge
• National Alliance for the Mentally Ill
• Austin, Texas
• June 20, 2005

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BACKGROUND

• September 2003-Governor Richardson announced the
  Behavioral Health Purchasing Collaborative
• Better services
• Better access
• Better use of taxpayer dollars
• HB 271A bipartisan effort, effective May 19,
  2004
• Goal is single behavioral health delivery system
  across multiple state agencies and multiple
  funding sources for all publicly funded
  populations

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PROBLEMS TO BE SOLVED

• Lack of common agreement about goals and outcomes
• Fragmentation (per Presidents New Freedom
  Commission Report), i.e., multiple approaches,
  plans, service definitions, billing processes,
  reporting requirements for similar or related
  services
• Duplication of effort and infrastructures at
  state and local levels
• Higher administrative costs for providers due to
  multiple state approaches and multiple
  contracting entities
• Insufficient oversight of providers and services
• Confusion for families and consumers
• Insufficient services inappropriate services
• Not always maximizing resources across funding
  streams
• Multiple disconnected advisory groups and
  processes working toward a different, sometimes
  disconnected goals

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Interagency Behavioral Health Purchasing
Collaborative

• Children, Youth and Families Department
• Department of Health
• Human Services Department (Medicaid State Agency)
• Department of Corrections
• Aging and Long Term Services Department
• Public Education Department
• Department of Finance and Administration
• Department of Transportation
• Department of Labor

• Division of Vocational Rehabilitation
• Administrative Office of the Courts
• Mortgage Finance Authority
• Indian Affairs Department
• Health Policy Commission
• Developmental Disabilities Planning Council
• Governors Commission on Disability
• Governors Health Policy Coordinator

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STATUTORY PURPOSE

• To develop a statewide system of behavioral
  health care that promotes 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

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STATUTORY DUTIES

• Identify behavioral health needs statewide
• Give special attention to regional differences,
  including cultural, rural, frontier, urban and
  border issues
• Inventory all expenditures for mental health and
  substance abuse services
• Plan, design and direct a statewide behavioral
  health system
• Contract for operation of one or more behavioral
  health entities to ensure availability of
  services throughout the state
• Develop a comprehensive statewide behavioral
  health plan
• Seek and consider suggestions of Native Americans

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VISION

• 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 are
  expected mental health is promoted the adverse
  effects of substance abuse and mental illness are
  prevented or reduced and behavioral health
  customers are assisted in participating fully in
  the life of their communities

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PRINCIPLES AND VALUES

• Commitment to recovery and resilience
• Consumer/family directed
• Result is quality of life
• Commitment to high quality services with system
  performance and consumer/family outcomes
• Commitment to diversity and cultural
  responsiveness
• Commitment to integrated, community-based
  services, respecting community differences

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DESIRED RESULTS

• Braided flexible funding
• Single billing process and consistent data
  collection and management
• Common age-appropriate assessment process used in
  all service settings
• Smooth transition from current systems to single
  system
• Local Collaboratives are active participatory
  local voice attention to rural and frontier
  areas
• Attention to persons with unique service or
  access needs

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DESIRED RESULTS

• Uniform program standards, including common
• service definitions and requirements
• utilization management requirements/criteria
• system performance measures
• consumer/family outcomes expectations
• credentialing of providers
• Sufficient number and distribution of providers
• A comprehensive and coordinated benefit package,
  within available funding
• Emphasis on evidence-based, best practices and
  practice based evidence

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Players

• Interagency Behavioral Health Purchasing
  Collaborative (Purchasing Collaborative)
• Statewide Entity-ValueOptions
• Local Collaboratives
• Behavioral Health Planning Council (BHPC)

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Interagency Behavioral Health Purchasing
Collaborative

• All involved state agencies operating as one, and
  retaining responsibility for agency specific
  funds, reporting, planning, etc.
• Memorandum of Understanding signed by all state
  agencies to establish process for decision-making
• First formal meeting held June 11, 2004
• BH Design Work Group (BHDWG) for day-to-day staff
  work
• Cross Agency Coordinating Teams with specific
  tasks/responsibilities (e.g., Oversight Team,
  Local Collaboratives Team, Administrative Support
  Services Team, Policy and Planning Team and
  Workforce, Program Development and Research Team)

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FUNCTIONS IN ADDITION TO STATUTORY DUTIES

• Keeper of the values and philosophy
• Collective oversight of statewide entity
• Address system and individual problems that
  cannot be resolved at the local level
• Assure consumer and family voice in governance,
  planning, implementation and evaluation

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Statewide Entity

• Not just a vendor a partner to help the
  Purchasing Collaborative implement the law and
  achieve its purpose and vision

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RESPONSIBILITIES

• Contracting with and paying providers or provider
  groups
• Helping to braid blend or coordinate
  multiple funding streams increasing flexibility
  and maximizing resources
• Credentialing and quality oversight of providers
• Utilization review (UR) and management (UM)
• Assuring care coordination
• Assisting with development and nurturing of Local
  Collaboratives
• Consumer/family/youth relations
• Collecting, managing and reporting data

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PROCUREMENT PROCESS

• Single RFP to select the statewide entity
• Open competitive procurement process pursuant to
  state procurement law
• Draft RFP (Concept Paper) for stakeholder input
• Consumer/family involvement in drafting of RFP
  and review of proposals
• Joint selection and negotiation by Purchasing
  Collaborative agencies
• Single contract with multiple agencies

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LOCAL COLLABORATIVES

• Local community groups developed in areas
  consistent with each of the States 13 judicial
  districts and grouped into 5 geographic regions
  and 1 non-geographic Native American Region for
  the 22 Tribes and Urban Indian populations
• Based on Childrens Systems of Care Model and
  Principles, they consist of consumers, families,
  youth, providers, advocates, and other system
  representatives, such as courts, schools,
  churches, child welfare, juvenile/criminal
  justice, health improvement councils, tribes,
  vocational/ employment providers, housing
  authorities, area agencies on aging, local DWI
  councils, civic organizations, primary care
  providers, local government officials, and other
  interested individuals or groups

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RESPONSIBILITIES

• Identifying gaps and needs
• Recommending service array
• Capacity building and program development
• Proposals to funding bodies
• Evaluation of local providers and services
• Agreeing on common protocols for referrals and
  follow-up of persons in need of multiple services

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BEHAVIORAL HEALTH PLANNING COUNCIL

• Single statewide behavioral health advisory group
  appointed by the Governor with 51 or more
  consumer/family/youth membership and having the
  following standing subcommittees
• Adults, Children/Adolescents, Substance Abuse
  (including DWI), Medicaid, Native Americans,
  Criminal/Juvenile Justice, Employment, Housing,
  Neurobehavioral issues
• Replaced all previously existing behavioral
  health advisory councils and structures that were
  set up by statute or as part of grant
  requirements

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STATUTORY DUTIES

• Advocate for children, adolescents and adults
  with behavioral health needs
• Report annually to the Governor and Legislature
• Encourage development of a comprehensive,
  integrated, community-based behavioral health
  system
• Advise the Collaborative agencies statewide
  entity
• Review and make recommendations for the
  comprehensive mental health plan, mental health
  and substance abuse block grant applications,
  Medicaid state plan, and all other by plans and
  applications

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PROCESS

• The Behavioral Health Planning Council and Local
  Collaboratives will be active partners with the
  Purchasing Collaborative and the statewide entity
  in evaluating services, monitoring trends and
  making recommendations for improvement
• Contracts with the statewide entity and with
  providers will include performance and outcome
  requirements, with enforceable consequences for
  not meeting requirements and/or incentives for
  exceeding requirements

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ROLES OF CONSUMERS, FAMILIES AND ADVOCATES

• The Behavioral Health Planning Council which
  reports to the Collaborative and the Governor is
  the formal voice of consumers, families and
  advocates who make up a majority of the Council
  membership
• Members in turn represent constituencies in their
  local communities
• Consumers and families have had and will continue
  to have meaningful roles that will make a
  difference in governance, design, implementation
  and evaluation of services

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TRIBAL ISSUES

• Service dollars currently dedicated to tribal
  populations and communities will continue to be
  so dedicated
• IHS and tribal providers will be considered
  essential providers with whom the statewide
  entity has to contract, if they meet criteria
• Use of culturally appropriate and traditional
  healing services will be encouraged
• On-going tribal input as Advisors, on BH
  Planning Council, in tribal input meetings,
  during statewide planning process

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CHILD SERVING SYSTEMS

• Eight months prior to the formation of the
  Collaborative, the child serving systems were
  involved in planning a re-design of the
  childrens behavioral health system which
  transitioned into the Collaborative process
• Childrens behavioral health, child welfare,
  juvenile justice (all within the Children, Youth
  and Families Department) and education have all
  been active contributors to the design and
  implementation of the new system through the
  Collaborative
• Providers/advocates of childrens services have
  been actively involved in Local Collaborative
  development, work groups and public meetings

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TRANSFORMATION PROCESS

• Extremely inclusive process from the beginning
  through public involvement in work groups, local
  and regional stakeholder meetings and BHP Council
  meetings, that included consumers/
  families/youth, advocates, providers, state
  agency staff, legislators and others
• Double duty of State agency staff during past
  year
• No new money or resources
• Re-training/re-tooling of existing State agency
  staff to assume new roles and job duties

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KEYS TO A CULTURAL TRANSFORMATION

• Leadership
• Political will
• Inclusiveness
• Stakeholder buy-in
• A strong values base
• Dedicated resources
• Timing

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CHALLENGES

• Time
• Anxiety/fear about change
• Culture shift - letting go of turf, fear of
  losing control over services/money/methods of
  accessing services or funds/livelihoods
• Managing expectations-satisfying everyone all the
  time

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ADDITIONAL INFORMATION
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SERVICE DEFINITIONS

• Exhaustive process of collapsing all pre-existing
  service definitions and codes from all State
  agencies into one definition and code for each
  service
• Common HIPAA compliant definitions and service
  requirements for all services funded through or
  coordinated with the statewide entity using CPT
  and HCPCS Codes was a 3 year process that
  preceded the Collaborative but is ready for
  implementation July 1, 2005
• Will relieve significant burden from providers
  who have had to deal with multiple funding
  streams, management information systems and
  billing mechanisms in the past

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SERVICE REQUIREMENTS for each covered service

• Definition
• Billing code
• Target population
• Service exclusions
• Program requirements
• Staffing requirements
• Documentation requirements

• Admission requirements
• Continuing service criteria
• Discharge criteria
• Service authorization periods
• Service authorization units
• Benefit limits

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TARGET DATES

• September 2003 March 2004 Organizing,
  Planning and Concept Paper Development
• Spring/Summer 2004 Public Stakeholder Meetings
  (including tribal meetings)
• July, 2004 Draft Request for Proposals out for
  review and comment
• November, 2004 Request for Proposals Released
• Spring 2005 Vendor Selection
• Spring 2005 Transition and Contracting
• July 1, 2005 New System Begins Operating

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PHASES

• Pre-planning and transition
• September 2003 July 1, 2005
• Designing
• Planning
• Massive Public input
• Federal approvals sought
• Local Collaboratives criteria determined and
  development begun
• Releasing RFP and selecting partner
• Transition

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PHASES

• July 1, 2005 to June 30, 2006
• Services provided providers paid
• Transition continued
• Expectations refined
• Data systems refined
• Identification of ways to maximize funding
• Local Collaboratives developed further
• Implement statewide behavioral health plan
• Goals for Phase Two set

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PHASES

• July 1, 2006 to June 30, 2008
• more blending and flexibility of funding
• additional funding streams added
• Local Collaboratives refined
• development of additional evidence-based, best
  and promising practices, practice based evidence
• additional consumer/family operated services
• performance expectations and consumer/family
  outcomes refined, measured and reported
• additional resources sought (e.g., grants)