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Designing Care Management Entities for Youth with Complex Behavioral Health Needs

Appendix B: Key CME Design Features in CHIPRA Quality Demonstration States, as of June 2014

Implementation Guide No. 2

  Marylanda Georgia Wyoming
Funding mechanisms
  • State general funds.
  • SAMHSA System of Care grants.
  • Medicaid 1915 (c) waiver.
  • Medicaid 1915 (i) waiver.
  • State Plan Amendment (adding as third tier of targeted case management).
  • Medicaid 1915 (c) waiver.
  • Money Follows the Person.
  • Balancing Incentives Program.b
  • SAMHSA State Mental Health Block grants.
  • Currently using Medicaid 1915(i) waiver.
  • State is planning to use a Medicaid 1915(a) waiver.
Management structure Governor’s Office for Children in the Children’s Cabinet (interagency State-level organization). Counties or groups of counties. State Medicaid office and managed care organization. State Medicaid office.
Eligibility criteria for services Different funding mechanisms use different eligibility criteria. Example criteria:
  • Youth with serious emotional disability who qualify for or are at risk for out-of-home placement by child welfare or juvenile justice.
  • Youth in foster care who receive a serious mental health diagnosis.
  • Youth who have multiple expulsions or suspensions, high absentee rate, and poor academic record.
 Medicaid-eligible youth with a serious mental health diagnosis that meets established thresholds on the Child and Adolescent Service Intensity Instrument or the Early Childhood Service Intensive Instrument.c Youth already served by CMEs or with a 90-day stay in a residential treatment facility with at least 1 day paid by Medicaid. Youth age 4-21 with a serious mental health diagnosis that meet established thresholds on the Child and Adolescent Service Intensity Instrument or the Early Childhood Service Intensive Instrument,c have conditions that can be expected to improve with appropriate treatment, and live in the seven-county area served by the CME.
Services
  • Providing intensive care coordination.
  • Managing a discretionary fund.
  • Providing intensive care coordination.
  • Providing intensive care coordination.
  • Contracting and paying for family support services.
  • Managing a discretionary fund.
  • Providing intensive care coordination.
  • Contracting and paying for family support services.
  • Will assume financial risk for behavioral health services.
Provider type (selected contractor) Local nonprofit organization (Choices, Inc.). Local targeted case management providers (to be determined). Local community service boardsd (Viewpoint Health and Lookout Mountain). Managed care organization (Colorado Access operating in Wyoming as Wyoming Access).
Provider training Training developed and delivered by State university. Training developed and delivered by State university. Current training developed and delivered by University of Maryland; transitioning to training developed and delivered by State. Current training developed by Wraparound Milwaukee and delivered by State; transitioning to training delivered by CME and overseen by State.
Payment model
  • Daily case rate for care coordination.
  • Limited discretionary fund.
  • Fee-for-service reimbursement for care coordination.
  • Monthly case rate for care coordination.
  • Hourly reimbursement for family support.
  • Limited discretionary fund.
  • Current monthly case rate for care coordination and family support.
  • Transitioning to also include all other Medicaid-financed behavioral health services with the exception of pharmacy.

Source: Interviews with CHIPRA quality demonstration staff and State semiannual progress reports to the Center for Medicare & Medicaid Services
Notes:
a Maryland plans to operate two CME models.
b Money Follows the Person and the Balancing Incentives Program are Medicaid programs to increase use of home- and community-based services for individuals otherwise served in long-term care facilities.
c Child and Adolescent Service Intensity Instrument (CASII) and the Early Childhood Service Intensive Instrument (ECSII) link clinical assessments with appropriate levels of care.
d Community service boards oversee the public mental health system.

Publication:
14-0009-2-EF

Page last reviewed September 2014
Page originally created September 2014

Internet Citation: Appendix B: Key CME Design Features in CHIPRA Quality Demonstration States, as of June 2014. Content last reviewed September 2014. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/implementation-guides/implementation-guide2/implguide2appb.html

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