WellCareLink < Clinical Services < Behavioral Health Department < Team Folders < Multi-State Market < New York Market < Supporting Materials. NYS is transitioning certain behavioral health services (mental health and substance abuse) from FFS to managed care. This transition impacts WellCare of New York's current adult, Medicaid membership, also known as NMD.
Where: New York City Area (Bronx, Kings, Queens, .. New York) Where: New York City Area (Bronx, Kings, Queens,.. WellCare of New York is considered a master plan, NOT a HARP and will only be providing Mainstream Service Array BH plus Peer Support.
You should now be able to identify
In this section we will be covering the following
Meet the member’s Medical and Behavioral needs in one system
This model enables us to organize the delivery of our care management for our members. The Plan provides comprehensive care management services to facilitate member assessment, planning and advocacy to improve health outcomes. WellCare's care management teams are led by registered nurses and licensed mental health professionals to include all relevant participants to meet the member's needs and develop an appropriate person-centered service plan.
This assessment will be completed by the BH Care Manager upon identification of members with complex behavioral health conditions. BH Care Management Managing the use of BH Complete Complete BH Assessment BH Authorization decisions for complete. continuity of MOH/SA services for. adults, covered by the Master Plan Coordination of active care, transition and.
Where Do I Engage A Member?
How Do I Engage A Member?
Care management activities require a focus on members with SMI, SUD, co-occurring physical health, co-occurring MH and/or SUD disorders, and I/DD when appropriate. Please see the Health Home MCO and Standards Draft Guidance for additional details on Health Homes, Care Management Providers and MCOs. This can be found on the WellCare website under Supporting Materials and at WellCare University for staff.
The Mainstream Plan will utilize a robust system of resources, including a range of case management services. Care Coordination: Services include case management, geriatric concierge and mental health/physical health programs, home and community-based coordination, homeless placement and transition services. Case management: Promotes optimal health and well-being for adults diagnosed with serious mental illness and children and youth diagnosed with serious emotional disorders.
Blended (BCM): BCM enables a team approach to case management services by combining the workloads of multiple intensive case managers (ICMs) and/or care coordinators. The Intensive Care Manager (ICM) and Care Coordinator lead the coordination of resources for individuals eligible for mental health services. A score of less than 2 means there is no problem and no action is currently proposed - the member is managed by the Health CM.
Follow-up on Psyk IP & housing discharges/Secure members have access to follow-up treatment within the NCQA guidelines. Serve as an SME resource to medical to help them address Quadrant 1-3 member needs Behavioral Health Care Management Triggers. Fast Readmission Hours Readmission • FUH Treatment Barriers That May Prevent Member From Receiving Follow-up Treatment After IP, Detox, Residential Discharge • Member/Provider Request • Crisis Call Follow-ups.
BH Populations Details
Individuals under age 23 transitioning to the adult system from an OMH, OASAS or OCFS licensed, certified or funded pediatric program (additional training available on WellCare U and on WellCare.com). - recommended participation in outpatient services for certain people with serious mental illness who, given their treatment history and current circumstances, are unlikely to survive safely in the community without it. First episode psychosis (FEP) Members who have exhibited psychotic symptoms indicative of recent onset schizophrenia.
Additional training available on WellCare U, and WellCare.com) I/DD requires BH Services Persistent Developmental Disorder + Schizoaffective Disorder. Allow user to exit quiz: After user completes quiz. User can view slides after quiz: After passing quiz. WellCare UM managers will receive additional training on how to apply medical necessity criteria (Interqual, LOCADTR, LOCUS, Clinical Coverage Guidelines).
Medical necessity criteria used to determine the level of care for mental health clinics (OMH) and inpatient mental health services in hospitals. A methodology for quantifying service needs assessment to reliably place a customer along the service continuum. NYS level of care placement tool that guides the placement, continued stay, and transfer/discharge of patients within the New York State system of OASAS certified programs.
The use of LOCADTR is required within New York State for all Medicaid substance use disorder member placements. All substance use disorder (SUD) services require the use of the LOCADTR tool for making prior authorization and continuing care decisions. Clinical Standards of Care Anchor Element WellCare has adopted the following standards in its plan.
Clinical Standards of Care Anchor Element WellCare has adopted the following standards into its plan
WellCare has followed OASAS clinical standard guidelines in its plan related to prior authorization, concurrent or.
WellCare has followed OASAS clinical standard guideline into its plan related to prior authorization, concurrent or
If successful, 'Finish' button: goes to next slide. If failed, 'Finish' button: goes to next slide. WellCare conducts inter-rater reliability testing and monitors individual clinical raters who make medical necessity determinations on a UM or appellate basis. The following table aligns new BH services (including OASAS and OMH certified programs) with the UM criteria and the associated authorization types to use.
Additional information about BH Services, including service descriptions, POS and applicable criteria, can be found on the BH Services Crosswalk. This is included in the Supporting Materials folder on WellCare University and on the WellCare.com website.
Contract / Rules and Regulations
On pass, 'Finish' button: Go to next slide On failure, 'Finish' button: Go to next slide Allow user to exit quiz: Anytime. User can view the slides after the quiz: After taking the quiz User can try to take the quiz: Unlimited times. WellCare of New York includes a number of community contracted providers (Article 28, 31, and 32) that provide MH and SUD services.
The NY Office of Mental Health publishes a New York Resource Directory, which includes crisis response resources and support materials.
Contracted and Credentialed with
Free and confidential 24/7 mental health and substance abuse information, referral and crisis hotline services for NY residents. They respond to persons in the community and typically in their homes, and provide a wide range of services including. Parachute NYC offers free, community-based options that focus on overall wellness, recovery and hope.
WellCare subcontracts with Health Integrated for our 24/7 BH Crisis Line, which is staffed with licensed BH Crisis Counselors. Calls to the BH Crisis Line are answered by specially trained non-clinicians within the designated call handling time frames. WellCare Customer Service Representatives (CSRs) are trained in the BH crisis process and are educated on BH conditions.
We will partner with the community and community providers and work together to develop specific programs and services (ie, E.R. Diversion) as we require teams to work with and build relationships with community providers. agency. Behavioral health is part of a strong system of care, with available resources and supports found in the community. Baseline: “6-12 years old from IPSD with an outpatient prescription for ADHD medication” who had a follow-up visit with a physician within 30 days.
Continuation and maintenance phase: “6-12 years old as the IPSD with an outpatient prescription issued for ADHD who has remained on the medication for at least 210 days and who, in addition to the initiation phase, has had at least two follow-up visits with a practitioner within 270 days (9 months) after the start-up phase has ended.”. Patients who are discharged from an inpatient mental health assessment receive: One follow-up meeting with a mental health provider within 7 and 30 days after discharge. Initiation and Initiation of Alcohol and Other Drug Dependence Treatment - Patients diagnosed with alcohol and/or other drug dependence who begin treatment within 14 days of diagnosis and who receive two additional services within 30 days of the initial visit.
Health Care Quality and Access in New York
Direct Mailers Member Welcome Calls
Frequently Asked Questions (FAQ)
Member Portal
Behavioral Health Team Sharepoint Site
Below is a growing list of materials that are or will be available on the WellCare website for Providers and others. List of MCO Operating Principles Health Home Standards and Requirements Care Management Expectations BH Job Aid.
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New York defines Cultural Competence as the ability to function effectively within the context of cultural beliefs, behaviors, and needs presented by consumers and their communities. Given the growing diversity of New York's population, cultural competence (CC) must be at the forefront of health care initiatives and activities. CC activities are important to improve member engagement and retention, particularly in behavioral health care.
The practitioner's ability to understand the meaning of what the patient presents. WellCare has created a separate training module for staff who will need to know more about this topic and the specifics of the New York City cultural competency market. TAYs are members who are under 23 years of age and transitioning into the adult health care system from any OMH, OASAS, or OCFS-licensed, certified, or funded children's program.
WellCare has created a separate training module for staff who will need to know more about this topic and availability of community resources and information for TAY members. In New York, FEP training is also available through the Centers for Practice Innovation or CPI and members with FEP can refer to OnTrackNY. WellCare has created a separate training module for staff who will need to know more about this topic.
AOT is court-ordered to participate in outpatient services for certain people with serious mental illness who, given their treatment history and current circumstances, are unlikely to survive safely in the community without supervision. Diagnosed with a mental illness and unlikely to live safely in the community under supervision. WellCare has created a separate training module for employees who want to know more about this subject.