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Medicaid Rate Setting and PsyR Practices

Medicaid Rate Setting and PsyR Practices. Thoughts for NJPRA advocacy: Changing bottom up granularity to top down strategy. Thinking Like A Systems Coach. What’s The Goal?. How To Get There?. 4 Parameters . Phases of Care Elements of Care Evidence Based Practices Aspects of Need.

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Medicaid Rate Setting and PsyR Practices

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  1. Medicaid Rate Setting and PsyR Practices Thoughts for NJPRA advocacy: Changing bottom up granularity to top down strategy

  2. Thinking Like A Systems Coach

  3. What’s The Goal?

  4. How To Get There? 4 Parameters Phases of Care Elements of Care Evidence Based Practices Aspects of Need

  5. Parameters: 6 Phases

  6. Parameters: 6 Phases3 Elements

  7. Parameters: 6 Phases3 ElementsSeveral EBPs

  8. Parameters: 6 Phases3 ElementsSeveral EBPs15 Aspects

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  24. What EXACT Service Steps For Each EBP?

  25. For example…ACT(SAMHSA, 2008)

  26. Supported Housing Services…(SAMHSA, 2008) • Mental Health Services • Psychological assessment • Counseling • Group therapy • Support groups • Recovery classes • Peer mentoring • Psychoeducation • Psychiatry appointments • Therapy • Substance Abuse • Stages-of-change assessment • Motivational interviewing • Relapse prevention • Counseling • Methadone services • AA/NA groups • Sober recreation

  27. Supported Housing Services…(SAMHSA, 2008) • Health and Medical Services • Routine medical care • Medication management • Health/wellness education • Nurse care • Home health aide • HIV/AIDS services • Physical therapy • Pain management • Vocational and Employment • Job readiness training • Job retention classes • Job development services • Job skills training • Education • Onsite employment

  28. Supported Housing Services…(SAMHSA, 2008) • To Support Retention • Tenant orientation • Tenant councils • Case management • Psychosocial assessment • Service planning • Counseling • Referrals • Crisis intervention • Peer mentoring • Support groups • Independent Living Skills • Communication skills • Conflict resolution • Budgeting • Representative payee • Cooking • Personal hygiene • Self care • Housekeeping

  29. Medicaid: How To Pay? • Now… “Medical Necessity” • Should be… “Recovery Necessity”

  30. What Is Paid Now?... 33

  31. What Is Paid Now?... 34

  32. What Necessary Services NotPaid By Medicaid?

  33. Can NJPRA…? • Establish all the steps necessary in our EBPs? • Determine which steps are and are not paid by NJ Medicaid? • Present this “gap analysis” to NJ Medicaid? • Propose and advocate for a such a “top down” strategy for Medicaid rate setting?

  34. References Substance Abuse and Mental Health Services Administration. (2008). Assertive community treatment: Evidence-based practices (EBP) kit. (DHHS Pub. No. SMA-08-4344). Rockville, MD: Center for Mental Health Services Retrieved from http://store.samhsa.gov/product/Assertive-Community-Treatment-ACT-Evidence-Based-Practices-EBP-KIT/SMA08-4345. Substance Abuse and Mental Health Services Administration. (2010). Permanent supportive housing: Evidence-based practices (EBP) kit. (HHS Pub. No. SMA-10-4509). Rockville, MD: Center for Mental Health Services.

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