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Care Management Entities for Children with Serious Behavioral Health Needs: A CMS CHIPRA Quality Demonstration Grant

Contact Info:

Jennifer Lowther
Project Director jlowther@ssw.umaryland.edu
410-706-6386

The Institute provides project management, evaluation, and implementation support for the CHIPRA Quality Demonstration Grant, a five-year grant awarded to the Maryland Department of Health and Mental Hygiene by the Centers for Medicare & Medicaid Services (CMS), U.S. Department of Health and Human Services. This grant is structured as a learning collaborative with the States of Maryland, Georgia and Wyoming, facilitated by the Center for Health Care Strategies (CHCS), with Maryland as the lead state. The collaborative has a collective goal to improve the quality and cost of care for children with serious behavioral health challenges by implementing and/or expanding a Care Management Entity (CME) provider model for children with serious behavioral health challenges who are enrolled in Medicaid or the Children's Health Insurance Program.

While the participating states represent diverse geographic areas and Medicaid structures, they share common goals in pursuing the CME provider model, namely to: (1) improve access to appropriate services; (2) employ health information technology to support data-driven, clinical decision-making; (3) reduce the unnecessary use of restrictive and costly services; (4) improve clinical and functional outcomes for children and youth with serious behavioral health needs; and (5) build resiliency in youth and families, strengthening their involvement both in their own care and in the design and implementation of the behavioral health care delivery system.

Each State has specific goals within the overall Final Operational Plan, in addition to the overarching goals of the Learning Collaborative. Maryland has multiple goal areas under this grant:

  • CME Populations: Sustain populations currently served by CMEs and explore expansion to include new populations of high utilizing Medicaid and SCHIP children with public child - and family-serving system involvement
  • Financing: Identify specific and comprehensive financing approaches for identified populations served by the CMEs
  • Utilization Management: Review and revise utilization management processes for the ASO, CME, and PMHS providers to be consistent with system of care values and based on functional criteria
  • Psychotropic Medication Prescribing Practices:Implement and ensure standards of care for psychotropic medication prescribing practices for CME youth
  • Improving Physical and Oral Health: Improve overall health of CME participants by ensuring access to and coordination with comprehensive physical and oral health services consistent with wellness and EPSDT standards of care
  • Peer Support: Establish a consistent model and a funding mechanism for peer support
  • Crisis Response & Stabilization: Identify a crisis response and stabilization model and financing structures for Maryland to support CME youth

Partners in this work include the Maryland Coalition of Families for Children's Mental Health (MCF), The Hilltop Institute at UMBC, and the University of Maryland, School of Pharmacy.

CHIPRA Evaluation Highlight Focuses on Practice-level Quality Measures
The first Evaluation Highlight from the national evaluation of the CHIPRA Quality Demonstration Grant Program is now available on the AHRQ Web site. It launches a series of Evaluation Highlights that report on descriptive and analytic findings from the evaluation. This Highlight describes the early accomplishments, challenges, and lessons learned from the following four States pursuing practice-level quality measurement: Maine, Massachusetts, North Carolina, and Pennsylvania.

Access Evaluation Highlight No. 1: How are CHIPRA demonstration States approaching practice-level quality measurement and what are they learning? as a PDF File at: http://www.ahrq.gov/chipra/demoeval/highlights/highlight01.pdf. Access the HTML version of Evaluation Highlight No. 1 at: http://www.ahrq.gov/chipra/demoeval/highlights/highlight01.htm. For more information on the CHIPRA Quality Demonstration Grant projects and the national evaluation, visit: http://www.ahrq.gov/chipra/demoeval/.

If you have any questions or comments regarding the evaluation of the CHIPRA Quality Demonstration Grant Program, please contact the national evaluation team by sending an email to: CHIPRADemoEval@ahrq.hhs.gov.