State Team Members
- NH Bureau of Developmental Services
- NH Bureau of Elderly and Adult Services
- Community Support Network Inc. (CSNI) – representing the 10 Area Agencies in NH
- Disability Rights Center
- Community Bridges (Region 4 Area Agency)
- NH Legal Assistance
- Granite State Case Management (services to people who are elderly and/or disabled)
Achievements & Successes, as of August 2018
NH’s stakeholder group has expressed interested in strengthening Business Acumen across the state.
Value Based Contracting and Payment:
- To harness that interest, New Hampshire established four working committees to support their work. The committees assisted in establishing and implementing strategies and action steps for their area of focus. The committees are aligned with their priority areas and include:
- Performance and Value Based Contracting and Payment Process
- Utilization Review Process
- Linkages between CBOs and Integrated Healthcare Organizations
- Information Technology System Development
Value Based Contracting and Payment:
- Provider Selection Subcommittee – developing a statewide process to identify provider agencies to deliver waiver services to adults with DD. This will address capacity issues in the State as well as accountability for provider organizations. This committee is underway and has recently identified 5 workgroups which are focusing on the following areas:
- Develop a list of AA contacts for provider selection process
- Develop a list of vendor agencies. Include services they provide and what regions they serve. Include out of state providers.
- Develop a template for the Provider Selection Process and implement statewide
- Develop a Provider Agency Outcomes Report / Probation Process
- Develop a process on what to do if there are no provider agencies available in the region
- State agency discussion on implementation of 525 contracts (Participant Directed and Managed Services) and comparison of performance statewide. BDS offered statewide training offered by Applied Self Direction, a National Expert on implementing Participant Directed and Managed Services. Approximately 70 participants attended ranging from Service Recipients to Service Coordinators.
- Governance Audit: Three year review of Area Agency performance as required by annual contracts was published and shared with Area Agencies.
- Intensive Treatment Services (ITS) Metrics: For those agencies that provide ITS, the top 3 utilizers were identified. Agencies were asked to submit to BDS metrics that will be used to determine if the individuals are getting the services that were offered in the original proposals, and it will be determined if they need to step up / step down based on the outcomes. This process is currently underway.
- Implemented the High Cost Budget Call Review Process – for any high cost budget, a high cost budget call must occur. 3 – 6 – 9 month review is scheduled after the initial call to discuss utilization of the initial budget amount and any potential adjustments up or down. These calls occur weekly and have been effective in managing, tracking and re-assessing high cost budgets.
- Service Audit and Post Payment Reviews: The months of April/May/June involve BDS Liaisons visiting each Area Agency to review 25 randomly selected files to review services that were provided, and compare the services provided to the annual service agreement. Outcomes will be reviewed and future audits will be modified based on feedback.
- Wait List Registry Tracker: This tracks money that has been allocated to individuals that are receiving wait list dollars. Funding is tracked through a formula that takes into account “date services needed”, “projected start date” and “actual start date”. This formula identifies areas of “lapse” due to delays in start dates, which allows for reallocation of funds.
- This workgroup will make recommendations to NH CBO’s regarding best practice as it relates to Utilization Review. Some Area Agencies and Provider Agencies are managing utilization very closely.
- Trainings will be made available to key transition staff for DD, ABD and CFI waivers as well as to schools regarding identifying people who will be in need of services to reduce instances of underutilization and to assist CBOs in planning ahead for people in need of services.
- BDS is exploring rate setting with Human Services Research Institute (HSRI) to offer a consistent approach to service rates across the state. Currently reviewing SIS and HRST scores and conducting a comparison with individualized budgets to determine trends.
- IDN Training – Held on 1/23/18 and 1/25/18. This was an education session for Integrated Delivery Networks (IDNs) to educate them on Medicaid Services and how Medicaid works.
- Interagency Integration Team Meetings occur monthly at the State level to include the following services:
- Bureau of Drug and Alcohol Services
- Quality Assurance and Improvement
- Bureau of Developmental Services
- Bureau of Mental Health Services
- Bureau of Elderly and Adult Services
- Other Relevant Department Staff
- ED Protocol is recommended for people who are in the Emergency Department for 24 hours or more for behavioral vs. medical needs. Protocol requires a case conference with all members of the individual’s support team, including MCOs, primary care, psychiatric, etc.
- Workgroup will make recommendations to NH CBO’s regarding best practice as it relates to building relationships with local school districts to assist with better planning for people coming into the system.
- BDS will work with Department of Education to offer training to local CBOs on IEP planning and preparation for students turning 18-21 and how to proceed with services.
- Recommendation around comprehensive discharge planning and what to consider when individuals are transitioning from one level of service to another.
- IT Core Team – This team is working on the development of IT System to streamline various applications that are being used: BTS, Wait List Registry, New HEIGHTS, MMIS (Medicaid Billing) and Service Link (eligibility).
- RFI for consultant has been published – 8 applicants replied. Review of Proposals is complete - Announcement of selected applicant will be soon. Consultant will assist with RFP development.
Lessons Learned, as of August 2018
- It is difficult to move forward when there are so many voices at the table – start with a framework and ask people for their input on what has already been determined as the plan.
- Breaking down silos between services and identifying opportunities for collaboration is important.
- Communication with all parties from the beginning is essential to ensure trust and collaboration throughout the process.
- Flexibility is essential, as the initial plan may change over time as New Hampshire works toward fulfilling the goals that they had set out to achieve.
Do you have questions for the New Hampshire state team? Please email your questions to email@example.com.