Karen E. Kimsey Deputy Director of Complex Care and Services Virginia Department of Medical Assistance Services 2014 NAMI Virginia State Convention June 8, 2014 www.dmas.virginia.gov 1 Department of Medical Assistance Services Changes to Medicaid Behavioral Health Programs and Services
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Changes to Medicaid Behavioral Health Programs …2014/06/08 · 2014 NAMI Virginia State Convention June 8, 2014 1 Department of Medical Assistance Services Changes to Medicaid Behavioral
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Karen E. Kimsey Deputy Director of Complex Care and Services Virginia Department of Medical Assistance Services 2014 NAMI Virginia State Convention June 8, 2014
www.dmas.virginia.gov 1
Department of Medical Assistance Services
Changes to Medicaid Behavioral
Health Programs and Services
Overview
Virginia Medicaid Behavioral Health Service Delivery Systems
Objectives of the Service Delivery Systems
DMAS Behavioral Health Covered Services
DMAS Behavioral Health Services Administrator (Magellan of Virginia)
DMAS Managed Care Behavioral Health Programs
DMAS Commonwealth Coordinated Care
On the Horizon
Virginia Medicaid Behavioral Health
Service Delivery Systems
DMAS
FFS/Magellan Traditional &
Non-traditional Services
Managed Care (Medallion II)
Traditional Services (7 Health Plans)
Commonwealth Coordinated Care
(April 2014)
Traditional & Non-traditional
Services (3 Health Plans)
3
Improve timely access to quality behavioral health
services through qualified (credentialed) providers
(helping members in need get the right care at the right
time)
Improve health outcomes for members
Ensure efficient utilization of services
Develop quality and outcome measures
Promote member engagement.
Objectives of Virginia Medicaid
Behavioral Health Delivery Systems
4 4
Behavioral Health Covered Services
Non-Traditional Services Intensive In-Home (IIH)
Therapeutic Day Treatment (TDT)
Mental Health Skill-Building
Psychosocial Rehabilitation
Crisis Intervention Services
Crisis Stabilization Services
Intensive Community Treatment
Mental Health and Substance Abuse
Targeted Case Management and Foster
Care Case Management
EPSDT Behavioral Therapy
Residential Treatment (Levels A, B, & C)
Substance Abuse Community Treatment
Traditional Services
Inpatient mental health services
Traditional outpatient mental health
and substance abuse treatment
services: Medication management, and
individual, family, and group
psychotherapy
Psychological/
neuropsychological testing
Pharmacy services
Temporary Detention Order (TDO)
Substance Abuse Treatment
Services (outpatient/opioid
medication treatment)
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Coverage for non-traditional services under the FAMIS MCO benefit plan is limited to: Mental Health Case
Management, IIH,TDT, and Mental Health and Substance Abuse Crisis Intervention services.