Behavioral Health Organization Phase 1
Phase I began in January 2012 when OASAS and OMH contracted with five Behavioral Health Organizations (BHOs) to help prepare the substance use disorder and mental health service systems for the transition from a fee-for-service environment to care management. The BHOs began working with providers and monitoring inpatient behavioral health services for Medicaid-enrolled individuals whose inpatient behavioral health services were not covered by a Medicaid Managed Care plan and who also were not enrolled in Medicare. They began collecting and submitting data; utilizing Medicaid data to inform treatment and care planning; developing and testing metrics for monitoring behavioral health system performance; and identifying improvements in inpatient discharge planning and ambulatory engagement/continuity of care.
The role of the BHOs was refined in 2012 to focus on identifying new approaches and evidence-based practices that would: facilitate the transition from inpatient care to the community; sustain engagement in community-based care; and address co-morbid medical problems and co-occurring substance use and mental health disorders. In addition, the state narrowed the focus of the BHOs to fee-for-service populations with “complex needs” that met certain incident threshold criteria. BHOs would also more actively work with inpatient providers on care coordination, peer and system supports, outreach, and follow-up.
Specifically, five regionally appointed BHOs were responsible for:
- Monitoring provider performance
- Managing a network of providers
- Testing metrics of system performance and facilitating the flow of communication between all stakeholders including behavioral health inpatient providers (Article 28, 31, and 32), behavioral health outpatient providers, consumers, peers and family peer advocates, child/adolescent clinical experts/advocates, and representatives from other related systems (e.g., Administration for Children’s Services, the Office for People with Developmental Disabilities)
- 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
To accomplish these goals, the BHOs were contracted to 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
Effective December 31, 2013 BHO Phase 1 operations are being phased out and lessons learned will be applied to BHO Phase 2.
Please contact OMH Managed Care with any questions, comments, or problems you may be experiencing with this site. If you would like to file a complaint about behavioral health managed care, please visit the Information on Filing a Complaint page. Providers, if you have any questions about the managed care implementation, please complete and send a question form.