CMS Approves New York’s “HARPs” for Adults with Serious Mental Illness and Substance Use Disorders
The Centers for Medicare and Medicaid Services (CMS) have approved an amendment to New York's Medicaid waiver to enhance the availability of comprehensive behavioral health benefits through managed care plans and plans' capacity to address physical and behavioral health needs in an integrated fashion. Notably, the waiver amendment addresses coverage of behavioral health benefits through managed care plans for adults who are not dually eligible for Medicaid and Medicare. The signature element of the amendment is the creation of Health and Recovery Plans (HARPs), a new type of managed care plan for eligible adults with specified Serious Mental Illness (SMI) and Substance Use Disorder (SUD) diagnoses. HARPs will offer an enhanced benefit package of home and community based services (HCBS) to eligible enrollees to support integration into the community and achievement of recovery-oriented life goals. These services will also be available to enrollees in HIV Special Needs Plans who meet the SMI and SUD targeting criteria and risk factors. All HARP enrollees will receive assessments and care management through Health Homes. HARP enrollment letters will be mailed in phases, beginning this month in New York City, with enrollment commencing in October.
In addition, the waiver amendment provides for an expansion of the benefit package of Mainstream Medicaid Managed Care (MMMC) plans to include additional behavioral health services. Under the amendment, SSI-eligible adults will receive their Medicaid behavioral health benefits through MMMC plans, rather than on a fee-for-service basis. This shift is expected to commence on October 1, 2015. As a whole, the waiver amendment is intended to improve outcomes for individuals with behavioral health conditions, reduce avoidable emergency and inpatient care, and increase capacity to deliver community-based, recovery-oriented services and supports.
More information is available here and here.
Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124.