2016 Managed Care Resources
Federal Resources
- Access to Mental Health Services for Children in Rural Areas
- The National Institute of Mental Health (NIMH) – Pediatrics-based Brief Therapy Outdoes Referral for Youths with Anxiety and Depression
- Medicaid and CHIP Managed Care Final Rules
- CMCS Informational Bulletin - Prevention and Early Identification of Mental Health and Substance Use Conditions
- Joint CMCS and SAMHSA Informational Bulletin: Coverage of Behavioral Health Services for Children, Youth, and Young Adults with Significant Mental Health Conditions
- CMCS Informational Bulletin: Clarification of Medicaid Coverage of Services to Children with Autism
- Joint CMCS and SAMHSA Informational Bulletin: Coverage of Behavioral Health Services for Youth with Substance Use Disorders
- CMS Informational Bulletin: Medicaid Payment for Services Provided without Charge (Free Care)
- CMS Managed Care Information
- CMS MCO Contract Approval
- CMS Rate Development Guide
- State Guide to CMS Criteria for Managed Care Contract Review and Approval
- HHS Trauma Letter to Medicaid State Directors 7-11-2013
- AHRQs Child Quality Tool Box
Setting the Stage: Brief Overview of the Population and Public Managed Care Issues
Panel #1: Network Development, Network Contracting Requirements, Network Monitoring
Related Resources:
Louisiana
Wisconsin
Community Catalyst: Network Adequacy Checklist
Panel #2: Improving Children’s Behavioral Health through a Focus on Quality Metrics and Alternative Payment Arrangements
Related Resources:
Louisiana
Oregon
Wisconsin
- 2015 Quality Assurance/Quality Improvement Annual Report
- Tracking and Measuring Program and Fiscal Outcomes
- Wraparound Milwaukee Annual Performance Report
Panel #3: Health Integration and Complex Populations
Related Resources:
Colorado
New Jersey
- Section 1115 Demonstration Comprehensive Waiver
- CSoC Perform Care Assistive Tech Facts
- CSoC Perform Care Best Practice Protocol
Wisconsin
- Milwaukee Child Welfare Contract
- Medicaid Coverage of Social Interventions: A Road Map for States
- Making Medicaid Work for Children in Child Welfare: Examples from the Field
- Child Wellbeing Assessment in Child Welfare
Addressing Health Disparities
Related Resources:
- Medicaid Managed Care & Cultural and Linguistic Competency Resources
- The Role of Data in Health Care Disparities in Medicaid Managed Care
- Addressing Health Care Disparities – AHRQ Archives – Quality Improvement Efforts
- Medicaid Managed Care for Members with Mental Health Conditions and/or Substance Use Disorders: Connecting Members to Social Supports
Massachusetts:
Standardization of Cultural Data to Reduce Health Disparities and Advance Health Equity:
- A Framework for Stratifying Race, Ethnicity and Language Data
- Implementing Multicultural Health Care Standards: Ideas and Examples
- Capturing Social and Behavioral Domains and Measure in Electronic Records
- Guide to Preventing Readmissions and among Racial and Ethnically Diverse Populations Medicare Beneficiaries
- Building an Organizational Response to Health Disparities
- Compendium of Resources for Standardized Demographic and Language Collection Data
Quality Metrics for Family Engagement and Satisfaction:
Kansas System of Care Diverse Advisory Board Development:
Integration of Cultural and Linguistic Competence and Wraparound:
- Why Cultural Competence is One of Wraparound’s Greatest Strengths and Most Persistent Challenges
- Implementing Culture-Based Wraparound
- Statewide Children’s Wraparound Initiative Biennial Legislative Report - Oregon Health Report
Role of Families in System Design, Implementation, and Quality Oversight of Medicaid Managed Care Initiatives
Related Resources:
Louisiana
- State of Louisiana Executive Order Coordinated System of Care Governance Board
- RFI for Provision of Statewide Family Support Services
- Coordinated System of Care Community Application (RFA)
New Jersey
- CSOC Youth and Family Guide
- Guide for Family Run Organizations Becoming a Medicaid Provider
- Guide for Family and Consumer Run Organizations Seeking to Expand their Funding
- Utilizing Medicaid to Build Family Support Programs
- FRO - Caterogies of Service and Definitions
- FFCMH National Certification for Parent Support Providers
- Youth Engagement - Stipending Youth and Young Adults
- Youth Engagement - Youth-Driven Organizational Purpose Areas
- Peer support in mental health care: is it good value for money?
Resources around certification and roles played by parent peer support providers:
- Basic Parent Peer Support (PPS) Certification Process
- Necessary Components: Best Practice - Parent Peer Support Certification; Parent Peer Support Competency Training
- State of Indiana - Certified Parent Support Provider Application
- Tennessee Parent Peer Support Certification Process
- Idaho Application for Certified Family Support Partner
- Roles for Parent Peer Support Providers Based on Intensity Level of Service Need/Use
Panel #4: Stratification of Populations for Care Coordination and Rate/Risk Structuring
Related Resources:
Maryland
- 1915i regs
- TCM regs
- CCO Draft RFP
- 1915i State plan HCBS Administration and Operation
- Targeted Case Management Services: Care Coordination for Children and Youth
New Jersey
- NJ DCF RFP Unified CMO for Burlington County
- CSOC CMO Service Guidelines: Moderate
- CSOC CMO Service Guidelines: High
New Mexico
Other Resources
Analyses:
- Looking at the New Medicaid/CHIP Managed Care Regulations Through a Children's Lens
- Final Regulation on Mental Health Parity in Medicaid - NAMD Summary
- Return on Investment in Systems of Care for Children With Behavioral Health Challenges
- Potential Funding Sources for SOC
- Faces of Medicaid: Children's Behavioral Health Care Utilization & Costs - Infograph
Intensive Care Coordination Related Resources:
- Intensive Care Coordination Using High-Quality Wraparound for Children with Serious BH Needs: State and Community Profiles
- Intensive Care Coordination Using High-Quality Wraparound: Care Coordinator to Child and Family Ratios
- Intensive Care Coordination Using High-Quality Wraparound: Supervisor to Care Coordinator Ratios
- Intensive Care Coordination Using High-Quality Wraparound: Rates and Billing Structure
- ICC Wraparound Quick Reference Snapshots
- Case Rate Scan for Care Management Entities
- Case Management vs Care Coordination
- Determining Care Management Entity Costs to Inform Financing - CHCS & Choices Webinar
Managed Care System Reform Resources:
- Moving Toward Value-Based Payment for Medicaid Behavioral Health Services
- Connecticut Medicaid Outpatient Behavioral Health Clinic Services
- Behavioral Health Integration in Pediatric Primary Care: Considerations and Opportunities for Policymakers, Planners, and Providers
- Integrating Behavioral Health into Medicaid Managed Care: Design and Implementation Lessons from State Innovators
- Value Based Payment Models for Medicaid Child Health Service
- Customizing Health Homes for Children with Serious BH Challenges
- CHCS Reengineering Residential Treatment Webinar
- State Approaches to Providing Health-Related Supportive Services through Medicaid
- Increasing Access to Behavioral Healthcare: Managed Care Options and Requirements
Other:
- Big Data in Human Services Brief
- Flexible Funds for Customized Goods and Services Brief
- Walk to Beautiful: The Power of Love and a Homeless Kid Who Found the Way by Jimmy Wayne
- TennCare Transformation with the Introduction of Tennessee Health Link
- Colorado - Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
Other State Resources
State Plan Amendments/Waivers:
Massachusetts
Montana
Quality Measurement:
Louisiana
New Jersey
Policy & Regulation:
Louisiana
New Jersey
RFP/Contracts:
Louisiana
New Jersey
Wisconsin
Service Definitions:
Louisiana
Massachusetts
- Targeted Case Management Services: Intensive Care Coordination Performance Specifications
- Family Support & Training Performance Specifications
- Mobile Crisis Performance Specs
- In Home Therapy Performance Specs
- Therapeutic Mentoring Performance Specs
New Jersey
- Division of Medical Assistance and Health Services Case Management Service Manual
- Mobile Response and Stabilization Services Clinical Criteria
Wisconsin
Medical Necessity Criteria:
Louisiana
Massachusetts
- MNC: TCM Services ICC
- MNC: Family Support and Training
- Mobile Crisis MNC
- In Home Therapy MNC
- Therapeutic Mentoring MN
Wisconsin
Operational Documents:
Hawaii
Louisiana
Massachusetts
- CSA ICC and Family Support and Training Program Description and Operations Manual
- Rates for CBHI Services
- MCO Authorization Parameters for CBHI Services
New Jersey
- Division of Medical Assistance and Health Services Case Management Service Manual
- DHS Children’s System of Care Initiative: CMO Standards of Operation Manual
- PerformCare Provider Service Code Guidelines
- Mobile Response and Stabilization Services Training and Certification Process
- Mobile Response and Stabilization Services Core Competencies Worksheet
Wisconsin