Testing States

Colorado

Click Here for Updated State Plan
State's SIM website

  • The overarching goal of Colorado SIM is to improve the health of Coloradans by providing access to integrated primary care and behavioral health services in coordinated community systems, with value-based payment structures, for 80 percent of state residents by 2019. (p.2)
  • Mental health and substance abuse "winnable battles and targets." (p.3)
  • A Child Mental Health Coordinator will be tasked with developing targeted population health initiatives for prevention and early intervention of mental health problems in very young children. (p.6-7)
  • The Colorado Framework envisions three stages of integrated primary care and behavioral health (see Figure 1 on p.14)
  • Bidirectional approaches that bring primary care into behavioral health settings for those with severe and persistent mental illness are a priority. We will also spur integration in long-term services and supports (LTSS), schools and jails. (p.15)
  • The state has committed to integrating primary care across the behavioral health system, as demonstrated in the latest Behavioral Health Organization (BHO) RFP, where organizations were specifically asked to articulate their plans for integration, including care coordination and supportive services. (p.22)
  • As currently structured, the BHOs are contracted to cover Medicaid clients with a covered diagnoses of major mental illness, and they currently provide services to approximately 10% of the Medicaid-covered population (88,715 in 2012). Medicaid clients served by the RCCOs are also served by BHOs. Coordination of services in support of integration is currently a contract requirement for both BHOs and RCCOs, and future iterations of the RCCOs will enhance requirements for integration of care between the organizations. RCCOs and BHOs strive for ‘whole person care” by focusing on care coordination; bi-directional referrals; screening for major issues that fall under either provider; sharing information to coordinate care; alignment of some quality and performance measures such as reduction of ER visits, hospital readmissions, and increase in follow-up care; and sharing data. (p.23)

Connecticut

Click Here for Full State Plan
State's SIM website

Behavioral Health:
  • Integration of behavioral health (BH) within advanced primary care is a goal of the CT Plan. All quality and outcome measures developed by CT's SIM team will eventually include BH measures. (p. 24)
  • Looking at various policy levers to advance BH, including promoting integrated plans to be sold on the State Insurance Exchange, and reviewing current Medicaid policies that prohibit physical and BH services from being billed on the same day. (p.11 , 24)

Delaware

Click Here for Full State Plan
State's SIM website

  • Proposal compliments existing value-based models: “PROMISE” program for severe and persistent mental health, Medicaid managed care for long-term care, strengthened Home and Community Based Services. (p. 19)
  • Provide EHR adoption incentives to support integration of behavioral health. (p. 26)

Idaho

Click Here for Full State Plan
State's SIM website

  • The virtual PCMH model will also allow for integration of behavioral health services in remote communities via telehealth services. (p. 5)

Iowa

Click Here for Full State Plan
State's SIM website

  • Full Medicaid ACO contracts, using guidance from stakeholders during the SIM model design, will involve partnerships with a broad range of community-based providers moving to a more organized delivery system that includes other behavioral health providers (including both mental health and substance use). (p. 7-8)
  • Initially, ACOs will coordinate care with existing BH and LTCSS; over time, ACOs will as-sume financial and clinical accountability for BH and LTCSS services. Core sets of ACO quality measures will be expanded in phases and include BH and LTCSS quality of care, access, integration with physical health services, and ratio of community-based vs. institution-based services. (p. 8)
  • (Also aligns with workforce) - Iowa has developed three post graduate training programs to provide specialized training in mental health for Physician Assistants, Nurse Practitioners and Psychologists. Two programs funded by the state and administered through the IDPH involve post graduate training that enable these professions to have a certification in mental health. Practitioners who matriculate through these programs can provide mental health services in a variety of primary and mental health clinical settings. The third program works to provide a post graduate training program for doctoral level psychologists that meets their supervised rotation requirements similar to a residency. (p. 46)

Michigan

Click Here for Full State Plan
State's SIM website

  • Create financial incentives for plan for enrollees who demonstrate improved health outcomes or maintain healthy behaviors. (p.15)
  • CareConnect360 is a Medicaid web-based platform that is improving communication between behavioral health and physical health providers, and convening stakeholders to establish vendor-neutral behavioral health exchange. (p.15)
  • Behavioral Risk Factor Surveillance System will be used to monitor social determinants. (p. 27)

New York

Click Here for Full State Plan
State's SIM website

  • Integration of behavioral health (BH) is assumed in fully functioning APC. BH clinical info to be included in the Health Information Exchange (HIE). (p.16)

Rhode Island

State's SIM website
Click Here for Full State Plan

  • We will measure the transformation of the Behavioral Health system with several outcome measures. We will use the measures included in the report, Substance Use and Mental Health in Rhode Island; A State Epidemiological Profile,5 as the basis. (p. 27)
  • We will include measures of Population Health Plan and Behavioral Health Transformation interventions that will impact the health care payment and delivery system. These include Avoidable ED visits; 30 day all cause hospital readmissions; and Readmissions under the Medicare Payment Reduction Program for specific diagnoses. (p. 28)
  • We will hire a second vendor who will be responsible for ensuring our Population Health Plan explicitly recognizes the behavioral health needs of our residents. (p. 5)
  • The development of the Population Health Plan will be supported by several existing initiatives. Among these is a study on the demand, supply and cost of behavioral health treatment that will be completed within the pre-implementation period as well as existing and continuing community health assessments and already available data. (p. 6)
  • Existing and new payment and service delivery models will need to highlight how they will respond to a person’s behavioral health needs. (p. 8)
  • Behavioral Health Transformation Funding Request for $1,250,000. The Transformation Network will be responsible for the implementation of transformation efforts in the behavioral health system. This initiative would support the statewide implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) as a way to integrate substance abuse prevention and early treatment across the system. Additional activities will be identified in the planning process. (p. 10)
  • Child Psychiatry Access Program Funding Request: $750,000. These funds will be used to implement a pilot initiative for a children's mental health consultation team designed to help targeted primary care providers meet the needs of children with psychiatric problems. We will explore other funding through other sources such as the Department of Education or the Administration on Children and Families. (p. 10)


Tennessee

Click Here for Full State Plan
State's SIM website

  • Health homes: integrated, value-based behavioral and primary care services for people with Severe and Persistent Mental Illness (SPMI). (p. 7)

Washington

Click Here for Full State Plan
State's SIM website

  • Substance abuse and mental health integration within Medicaid by 2016 (see p.2 of financial analysis) and full integration by 2020 of Medicaid networks and reimbursement of behavioral health (BH) and physical care. Early adopter counties will get 10% of the resulting savings. (p.11)
  • Certificate of Need requirements suspended in FY 15 for hospitals seeking to shift to psych beds. (p.15)

Design States


American Samoa

More to come...

Arizona:
Click Here for Full State Plan
State's SIM website

  • A State Health Assessment and identified 15 leading health issues, including access to behavioral health services and others impacted by behavioral health needs, such as obesity, tobacco use, diabetes and unintentional injury. (p. 2)
  • Grants to major providers that partner with community-based behavioral health providers to improve the capability to integrate care. (p. 7)
  • State’s largest insurer – AHCCCS – was helpful in connecting existing efforts and identifying the missing link – behavioral health. (p. 20) Behavioral health is key in improving population health and decreasing per capita spending. (p. 4)

California

More to come...

District of Columbia

More to come...

Hawaii:
Click Here for Full State Plan
State's SIM website

  • Round Two proposal builds upon the behavioral health gap identified in Round One. (p. 1)
  • The PHP will include the payment and delivery model interventions and goals related to behavioral health. (p. 3)

Kentucky
Click Here for Full State Plan
State's SIM website

  • As of April 1, 2014, Kentucky has been developing a Health Home Planning Model and currently plans to include chronic disease(s) and behavioral health. (p. 16)
  • Balancing Incentive Program (BIP) enhanced match rate will fund a total of 1,203 1915(c) waiver slots serving individuals with intellectual or developmental disability, or acquired brain injury. (p. 16)

Illinois
Click Here for Full State Plan
State's SIM website
  • In their applications, integrated delivery systems will be evaluated on both their current state of progress toward Health homes: Primary care and behavioral health that meet Federal criteria. (p. 8)
  • Illinois will develop a common care IT platform during the pre-implementation year that includes all relevant data necessary and is accessible to all members of the patient care team. The common care platform will leverage the ILHIE services already in use by behavioral health and long-term care providers, and the Medicaid ACE requirements for connectivity across provider networks to expand the adoption of health IT among long-term care and behavioral health providers. (p. 18)

Maryland:
State's SIM website

More to come....

Montana

More to come...

Nevada
Click Here for Full State Plan
State's SIM website

  • The Governor's Behavioral Health Strategic Initiatives Council is reviewing initiatives on community capacity for mental health services, crisis prevention, adequate hospital beds, stable housing, and workforce development. (p. 15)
  • A plan will be developed to engage stakeholders to obtain data such as vital records, workforce development, and behavioral/mental health records. (p. 13)

New Hampshire:
Click Here for Full State Plan
State's SIM website

  • RHCEs will explore multiple determinants of health, including social, environmental and behavioral determinants and integrate health services and community resources in developing local strategies to improve population health. (p. 13)

New Jersey

More to come...

New Mexico
Click Here for Full State Plan
State's SIM website

  • Increased availability of behavioral health services for all age groups. The state will support integration of behavioral health services into primary care, in part through expanding programs like the NM Screening, Brief Intervention and Referral to Treatment (NM-SBIRT) Collaborative to more sites and partners and supporting training and education of the behavioral health workforce. (p. 4)

Commonwealth of the Northern Mariana Islands

More to come...

Oklahoma
Click Here for Full State Plan
State's SIM website

  • The Oklahoma Health Improvement Plan (OHIP) Coalition is chaired by Oklahoma’s Cabinet Secretary of Health and Human Services and includes representation by behavioral health providers (p. 3)

Pennsylvania
Click Here for Full State Plan
State's SIM website

  • Department of Public Welfare’s (DPW) Office of Mental Health and Substance Abuse Services (OMHSAS) is working with DOH to expand mental health and substance use screening strategies within PCMHs and establish PCMH options for individuals with serious mental illness (SMI) to improve the coordination of physical health and behavior health care for individuals with SMI and other behavioral health disorders. (p. 4)
  • Pennsylvania will create community-based care management teams to provide highly-coordinated behavioral and physical health services to high-risk Medicaid members. (p. 1)
  • The Department of Public Welfare’s (DPW) Office of Mental Health and Substance Abuse Services (OMHSAS) is engaged in a stakeholder-centered planning process to address behavioral health service needs including those identified in the SHA. (p. 3)
  • Behavioral health providers are piloting PCMH models that utilize nurse navigators, PCP co-location and physical health consultation. The State will continue to encourage these options to facilitate better integrated care coordination activities and the sharing of appropriate clinical data. (p. 6)
  • Support EHR functionality and connectivity for behavioral health and long-term care providers. (p. 7)
  • To meet the workforce needs of PCMHs and APOs, Pennsylvania will implement an enhanced Loan Repayment Program for geriatricians and behavioral health providers – physicians, nurse practitioners and physician assistants – serving underserved populations. (p. 8)
  • Within HealthChoices, DPW will start to align pay-for-performance measures so that both the physical and behavioral health MCOs share common quality parameters, including preventable readmissions. (p. 12)

Puerto Rico

More to come...

Utah

More to come...

Virginia

More to come...

West Virginia
Click Here for Full State Plan
State's SIM website

  • Promote team-based, patient-centered care; Emphasize full array of medical, social, behavioral, and oral health as well as cultural, environmental, and socioeconomic factors. (p. 6)

Wisconsin
Click Here for Full State Plan
State's SIM website

  • Behavioral health has been examined in Wisconsin through efforts that include nonprofit hospitals’ community health needs assessments, a special Assembly Speaker’s Task Force on Mental Health convened during the 2013-14 legislative session, and a recent investment of $30 million in Medicaid for mental health care redesign. As part of the development of aligned health improvement priorities, Wisconsin proposes to build on these efforts to develop a plan to close two major gaps: access to care and a lack of care coordination between behavioral health and medical care. (p. 5-6)
  • During the SIM design award year, the DHS and the SVC LC will identify possible solutions to expand access to clinical and community behavioral health services, including addressing workforce needs (including both para-professional and advanced licensed providers), expanding and enhancing the use of telehealth (e.g. supporting a Child Psychiatry Consultation Line) and identifying best practices in incorporating behavioral health screenings and trauma-informed care into primary care and other firstline care settings. (p. 6)
  • To improve care coordination across settings, the DHS and the SVC LC will identify best practices and models in incorporating both medical and behavioral health to ensure comprehensive care is delivered for patients. Wisconsin will identify barriers to sharing data across providers (including behavioral health providers in clinical and community settings) and will also develop strategies to accelerate adoption and implementation of these models with special emphasis on regional approaches. (p. 6)