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Managed Systems of Care

Managed Systems of Care

In 2009 WNYCCP contracted with Beacon Health Strategies, LLC to develop managed local/regional systems of care for delivery of behavioral health services and for coordination of physical and behavioral health services for adults with serious behavioral health conditions. Beacon is a NCQA / URAC accredited managed behavioral health organization, founded in 1996 to serve Medicaid populations.

SPOA OnlineApplication

After a review of WNYCCP's report on the Operation of County Single Point of Access (SPOA) programs and its recommendations for standardiziation of SPOA operations, WNYCCP participating counties and Beacon have worked to improve SPOA practices. Beacon modified its existing FlexCare system to allow providers, consumers, and families to complete and submit a SPOA application online. The online capability allows SPOA staff to complete SPOA evaluations via the internet, with all evaluation and placement information being collected in a centralized database. Beacon has made this system available on a secure basis to SPOA staff in each participating county. The online SPOA application can be accessed at https://wnyccp.beaconhs.com.

Complex Care Management

Beacon provides a combination of both technical and clinical assistance to WNYCCP and participating providers in the delivery of complex care management services for 200 individuals with high risk needs including co-occurring mental health, substance use and physical health conditions.  Identified individuals may have had a history of high utilization of inpatient mental health and/or physical health services and who are not enrolled in a current ACT or case management program. Beacon case managers partner with agency based care coordinators to work with behavioral health providers, primary care physicians and, if the individual is enrolled in an HMO, the HMO case manager to arrange assessments, develop an integrated person-centered plan of care, arrange access to needed services, and monitor the individual.  Beacon has assigned two clinical case managers to this project; they work collaboratively with a specially selected and trained group of eight provider based care coordinators.  A more detailed description of this program can be found at: Complex Care Management Brochure

Level of Care Criteria

In collaboration with providers, consumers and Beacon, Level of Care Criteria consistent with NYS OMH and NYS OASAS regulations have been developed. These criteria will be used by participating providers for purposes of determining the appropriateness of admission to, continued treatment, and appropriate discharge for individuals at various levels of care. The level of care document can be accessed at: Level of Care Document

Non Binding Service Review

Using the WNYCCP/Beacon Level of Care Criteria, Beacon offers voluntary, provider-initiated, non-binding service reviews to help participating providers prepare for managed care and avoid Medicaid disallowances. Information is shared with participating providers about the consistency of provider practice with level of care/medical necessity criteria. At this time, Beacon does not have authority to approve or deny approval of payment of Medicaid benefits.

Gap Analysis

Beacon and WNYCCP will cooperatively evaluate the behavioral health services available in each participating county for purposes of informing Beacon efforts to develop a robust network of contracted providers. This analysis will evaluate provider network capacity by level of care. Beacon will consult with participating counties regarding county service needs, the results of the gap analysis and constitution of provider networks in each county.