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���������� Begins Readiness Reviews For Integrated Medicaid Medical/Behavioral Managed Care Plans Outside ���������� City

Open Minds News Report |March 13, 2016

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During March 2016, the ���������� State Office of Mental Health (OMH) is starting on-site readiness reviews for Medicaid managed care organizations (MCOs) that will provide integrated medical and specialty behavioral health services to Medicaid beneficiaries living outside the ���������� City (NYC) area. The state is in the process of ending its Medicaid behavioral health carve out for specialty services. The integrated plans went live in ���������� City in January 2016. The MCOs are slated to begin providing services outside the NYC area on July 1, 2016.

As part of the move to integrate behavioral health, all Medicaid mainstream managed care plans (MMC) in the state have had to demonstrate capacity to provide behavioral health services, either on their own, or by partnering with a behavioral health organization (BHO). The MMC plans could also apply to establish specialized Health and Recovery Plans(HARP) for their members with serious mental illness (SMI) or addiction disorder. For the plans serving the rest of the state, the OMH accepted applications through September 18, 2015, from designated MCOs serving ���������� City.

According to a recent notice issued by Health Management Associates (HMA), the plan designations were announced in ���������� City in the fall of 2015. The current announcement addresses plans that do not operate in the city, as well as plans that had been approved in the city that are seeking approval to operate in non-NYC counties.

New York Medicaid MCO Preliminary Plan Designations
Region	Plan Name	Designation Status	BHO
NYC and Upstate	Affinity Health Plan Inc	Conditional HARP	Beacon Health Options
NYC and Upstate	Empire Blue Cross Blue Shield HealthPlus (Formerly Amerigroup)	HARP	None
NYC and Upstate	Health Insurance Plan of Greater ���������� (Emblem)	HARP	Beacon
NYC and Upstate	HealthFirst PHSP Inc	HARP	None
NYC and Upstate	NYS Catholic Health Plan Inc (Fidelis)	HARP	None
NYC and Upstate	United Healthcare Of NY Inc.	HARP	Optum
NYC and Upstate	WellCare of ����������	Mainstream	None
NYC Only	AmidaCare Inc	HIV-SNP	Beacon
NYC Only	MetroPlus	HIV-SNP and HARP	Beacon
NYC Only	VNS Choice Select Health SNP	HIV-SNP	Beacon
Upstate Only	Capital District Physicians Health Plan	Conditional HARP	None
Upstate Only	Crystal Run	Conditional Mainstream	Beacon
Upstate Only	Excellus	Conditional HARP	Centene
Upstate Only	HealthNow	Conditional Mainstream	Health Integrated
Upstate Only	Independent Health Association	Conditional HARP	Beacon
Upstate Only	MVP	Conditional HARP	Beacon
Upstate Only	TotalCare (A Today’s Option)	Conditional HARP	Beacon
Upstate Only	YourCare (Fomerly Univera)	Conditional HARP	Beacon

Mainstream MCOs are ����������’s name for health plans that provide services to individuals not requiring long-term services and supports. Currently, Medicaid MCOs do not provide specialty behavioral health services; but the state is working to transition behavioral health services to the MCOs. In order to continue providing Medicaid services, mainstream MCOs were required to prove that they are able to provide all behavioral health services to adults.

HARPs are a Medicaid Special Needs Plan (SNP) operated by ����������’s Medicaid MCOs. The HARPs have a specialized staff with behavioral health expertise, and the plan provides all covered services available through Medicaid managed care, in addition to an enhanced benefit package that includes BH HCBS for eligible enrollees. HARP eligibility criteria has been determined by the state. HARP eligibles cannot be dual enrolled (receiving both Medicare and Medicaid) or participating in a program with the Office for People With Development Disabilities (OPWDD).

HARPS in ���������� City began implementing BH HCBS on January 1, 2016, three months after the mainstream Medicaid managed care organizations (MCOs) began covering non-HCBS behavioral health services. In the rest of the state outside ���������� City, the mainstream Medicaid managed care plans will begin non-HCBS behavioral health services on July 1, 2016. The delay to launch the BH HCBS for the HARP population is intended follow the ���������� City roll-out and maintain a three month window between the two types of plans.

The plans for each region can be viewed online at(accessed March 9, 2016).

OPEN MINDSlast reported on this topic in “���������� Medicaid Delays Statewide Launch Of Behavioral Health Home & Community Based Services For HARP Population,” which published on January 24, 2016. The article is available at.

For more information, contact: Benjamin Rosen, Director, Public Information, ���������� State Office of Mental Health, 44 Holland Avenue, Albany, ���������� 12229; 518-474-6540; Fax: 518-473-3456; Email;Benjamin.rosen@omh.ny.gov; Website:.