About the Statewide Management Organization (SMO)
The Louisiana Behavioral Health Partnership managed by DHH-OBH oversees the Behavioral Health Statewide Management Organization (SMO). The SMO will manage behavioral health services for Medicaid and Non-Medicaid eligible populations served by the Office of Behavioral Health (OBH), Department of Children and Family Services (DCFS), the Department of Education (DOE) and Office of Juvenile Justice (OJJ) and funded through state general funds and block grants, including services for individuals with co-occurring mental health and addictive conditions.
The SMO will help improve access, quality and efficiency of behavioral health services for children not eligible for the Coordinated System of Care (CSoC), and adults with Serious Mental Illness (SMI) and Addictive Disorders. Also, the SMO will develop a qualified provider network to offer a full array of services to meet the needs of people with behavioral health challenges.
The selected SMO will be a qualified behavioral health managed care organization (BH-MCO) with experience and demonstrated success in providing managed behavioral health care services with complex, publicly-funded behavioral health programs, to operate a pre-paid inpatient health plan (PIHP), as defined in 42 CFR 438.2, for behavioral health services provided to children, youth, and adults.
The procurement of a BH-MCO, to be known as the SMO, is necessary to assist with the State's system reform goals to:
1. Foster individual, youth, and family-driven BH services.
2. Increase access to a fuller array of evidence-based home- and community-based services that promote hope, recovery, and resilience.
3. Improve quality by establishing and measuring outcomes.
4. Manage costs through effective utilization of State, federal, and local resources.
5. Foster reliance on natural supports that sustain individuals and families in homes and communities.
Pending approval from the Centers for Medicare & Medicaid Services (CMS) of submitted State Plan Amendments (SPA) and concurrent Sections 1915 (b), (c), and (i) authorities, the SMO shall:
a. Manage care for eligible children/youth in need of MH and AD services, including children eligible for the CSoC, on a non-risk basis, effective on or about January 1, 2012, utilizing Medicaid, DCFS, DHH-OAD, DHH-OBH, DOE, and OJJ State General Funds (SGF) and federal block grant financing.
b. Manage behavioral health services for Medicaid adults with addictive disorders as well as adults with functional behavioral health needs, including: persons with acute Stabilization Needs; Persons with SMI (federal definition of Serious Mental Illness); and adults who have previously met the above criteria and need subsequent medically necessary services for stabilization and maintenance on a risk basis, effective on or about January 1, 2012;
c. MH and AD services for adults funded through SGF, MH and the Substance Abuse Prevention and Treatment (SAPT) Block Grant will be managed by the SMO under terms in the contract.
