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PBH Local Business Plan 2007 New services and supports have been developed (Medicaid Alternative Services - B-3 authority) based on evidence based practices which support achievement of positive outcomes for people with needs in the areas of behavioral health and developmental disabilities. These alternatives will provide the tools needed to reduce and redirect reliance on high cost institutional and facility care and offer a greater range of community services. PBH hopes to receive approval to begin to offer these services on April 1, 2007. Current Status PBH is just completing the third year of operating with single stream State Funding, and its second year in the management of the 1915(b) (c) Medicaid Waivers. The past four years have been characterized by instability and fragmentation of services statewide. PBH has been able to minimize this effect in the PBH counties, though we have not been insulated from its inFluence. Certainly our providers, most of which provide services in other parts of the state, have been significantly affected. Our focus since ]uly 2003 has been on developing our management capacity, maintaining access to care and continuity of services for consumers, and reducing the destabilizing effects of divestment and privatization, while growing a healthy network of providers. We believe that we have effectively accomplished these modest goals. We also believe that our local system is "settling down" and that conditions are now emerging that will provide us the opportunity to achieve the goals described in the 2007 Local Business Plan. Man _ agement Tools Uniqu ~.ut e to the PBH De ..,, ~ ; monstration ,~ ~..a. s- Services organized according to Minimizes random access and Organized level of care needed by utilization of services Service consumer (basic, basic Continuum augmented, enhanced) Supports providers in understanding authorization decisions and assists Utilization Management criteria them in requesting more appropriate determined by PBH; criteria for Authorization and levels of care. levels of care and amount of utilization review split service guide authorization between LME's and PBH providers are aware of preferred determinations. Value Options. Each treatment methods and have uses different criteria guidance in preparation of treatment Clinical Pathways provide for determining need plans. guidance to providers in the for services. delivery of services in Consumer service plans are accordance with best practice integrated; not based on funding and evidenced based practices, streams Authorizatirion of services based on consumer need not funding source Right to determine the number LME endorsement, Management of market share to Network of providers; ability to match state enrollment. balance both consumer choice and Management: needs for services with provider provider health. available tools recruitment and enrollment. LME's can determine network of state Prevents the phenomenon of provider Right to set provider enrollment service providers. driven service utilization that is and com eten standards. characteristic of lar a rovider C~ - ~