Behavioral Health Organizations Implementation

In January 2011, Governor Cuomo created a Medicaid Redesign Team to find ways to increase quality and efficiency in the Medicaid program and reduce cost. One of the recommendations enacted into law gives the Commissioners of the Office of Mental Health (OMH) and the Office of Alcoholism and Substance Abuse Services (OASAS) the authority to contract jointly with Managed Behavioral Health Organizations (BHOs). These are entities with experience and demonstrated expertise managing behavioral health services for individuals with substance use and serious mental illness.

The BHO implementation will occur in two phases. Phase 1 consists of five regional BHOs that will monitor inpatient behavioral health services for Medicaid-enrolled individuals whose inpatient behavioral health services are not covered by a Medicaid Managed Care plan and who also are not enrolled in Medicare. Four of the BHOs became operational on January 1, 2012 (Long Island will be operational early in 2012). Phase 2 BHOs will begin in 2013 and will include some form of risk-bearing Medicaid managed care for adults and children with serious mental health issues or substance use disorders.

Phase 1 BHOs will be responsible for:

• Concurrent review of behavioral health inpatient length of stay;
• Reducing unnecessary readmissions;
• Improving rates of engagement in outpatient treatment following discharge;
• Gathering information on the clinical conditions of children with a Serious Emotional Disturbance who are covered by Medicaid Managed Care and receiving treatment in an OMH licensed specialty clinic;
• Profiling provider performance; and
• Facilitating cross-systems linkage.

To accomplish these goals, the BHOs will interact with providers to review treatment and discharge aftercare plans for Medicaid fee-for service admissions to inpatient mental health, detoxification, and substance use rehabilitation units.

Behavioral Health Organization (BHO) Phase 1 Update

On 9/14/12 OMH and OASAS hosted a public webinar to update providers and all other interested individuals regarding Behavioral Health Organization (BHO) phase 1 activities.

The transition of the public behavioral health system into managed care is underway in New York State. Preparation of providers, advocates, consumers and families began earlier this year with the first phase of BHO implementation. Timely development of the BHO infrastructure and collaborative work with providers are notable initial successes that we can build upon. Adjusting our focus "on the fly" is also an essential capability in the rapidly shifting current environment of health care reform. This webinar was scheduled to inform providers and all other interested individuals of planned modifications to BHO phase 1 activities.

• Webinar of BHO Phase 1 Update
• BHO Phase 1 Provider Update: Powerpoint slide (211kb)

Behavioral Health Benefit and Managed Care - Drafts

• Behavioral Health and Managed Care Agency Agreement for Special Needs Plans and Behavioral Health Organizations in New York City (129kb)
  The final recommendations of the Medicaid Redesign Team (MRT) Behavioral Health Reform Work Group expressed the intent for full-benefit (behavioral and physical health) Special Needs Plans (SNPs) to be the preferred managed care vehicle in New York City (NYC) for people with significant behavioral health conditions. This outlines the approach to be followed to achieve this goal.
  • Appendix: Strategies to Maximize Special Needs Plan (SNP) Enrollment in New York City (NYC) (29kb)
    New York State's Department of Health (DOH), OMH, and Office of Alcohol and Substance Abuse Services (OASAS) will work with NYC to develop strategies to promote and maximize SNP enrollment, to assure that the SNP model of integrated specialty care is the dominant approach in NYC. This outlines possible strategies.
• Behavioral Health and Managed Care Agency Agreement for Special Needs Plans and Behavioral Health Organizations Other Than New York City (71kb)
  In areas outside of NYC, it is expected that a mainstream plan/behavioral health organization (BHO) model will be the predominant approach. The viability of full benefit (behavioral and physical health) Special Needs Plans (SNPs) for regions of the State outside of NYC will be considered. This outlines the approach to be followed.
• Behavioral Health Benefit and Managed Care (217kb)
  Powerpoint reviewing the recommendations of the Medicaid Redesign Behavioral Health Reform Work Group recommendations and proposed changes to the New York State Behavioral Healthcare sytem.

General Information

• Behavioral Health Organizations (BHO) Disclosure of Protected Health Information (PHI) to OMH and OASAS licensed providers affected by Hurricane Sandy – Letter to all OMH and OASAS licensed providers (175kb) (November 13, 2012) Guidance Document #3 – Beginning November 13th, and for the duration of the emergency declaration, OMH has authorized BHO care managers to disclose PHI without individual consent for Medicaid beneficiaries to OMH and/or Office of Alcohol and Substance Abuses Services (OASAS) licensed providers who meet certain criteria.
• Parts 580, 582 and 587 - BHO Implementation
  This Notice of Adoption is needed to clarify the expectations of the Office of Mental Health with respect to the BHO implementation and to notify providers of services of their responsibilities as a result of the BHO implementation.
• Selection of Regional BHO
  The New York State Office of Mental Health in conjunction with the New York State Office of Alcoholism and Substance Abuse Services is accepting applications for regional behavioral health organizations (BHO) to provide Medicaid fee-for-service administrative and management services for the purposes of conducting concurrent review of inpatient behavioral health services and coordinating the provision of behavioral health services.

Guidance Documents

• SED Children (101kb)
  Provides guidance regarding the monitoring of outpatient services for children with a serious emotional disturbance (SED) who receive care in OMH-designated Specialty Clinics.
  Issued: January 30, 2012
• Court-Ordered Treatment (73kb)
  Provides clarification regarding individuals who are court-ordered to receive substance abuse services, but who do not meet medical necessity criteria (MNC).
  Issued: January 30, 2012
• Youth Admissions to OMH State-Operated Psychiatric Centers (125kb)
  Frequently Asked Questions and Answers regarding the review process for youth admissions to OMH Psychiatric Centers.
  Issued: January 26, 2012
• Comprehensive Psychiatric Emergency Program (CPEP) Emergency Observation Beds (EOBs) (144kb)
  Provides clarification regarding the reporting on the utilization of EOBs operated at CPEPs.
  Issued: January 13, 2012
• Confidentiality (173kb)
  Frequently Asked Questions and Answers concerning the exchange of behavioral health protected health information (PHI) between providers and the BHOs.
  Issued: December 28, 2011.
• Medicaid Eligibility (150kb)
  Provides information on how Medicaid eligibility determinations should be made.
  Issued: December 14, 2011.
• Task 2 Children/Youth SED (152kb)
  Provides clarification regarding the Appendix D Program Work Plan of Contractor Responsibilities, as it pertains to Task 2: Tracking of Children with SED.
  Issued: December 14, 2011.
• OMH-Designated Child SED Specialty Clinics (88kb)
  Provides clarification of expectations for providers operating OMH-designated outpatient specialty clinics for SED children.
  Issued: December 2, 2011.
• BHO Implementation (157kb)
  Provides details regarding timeframes and expectations for the BHOs and providers.
  Issued: December 1, 2011.

Comments or questions about the information on this page can be directed to the Bureau of Program and Policy Development.