The Louisiana Department of Health (LDH), Office of Behavioral Health (OBH) may have a requirement for a Coordinated System of Care (CSoC) Program.

The following was taken from the Request for Information (RFI) document and is subject to change upon the release of a formal solicitation.

The mission of the Office of Behavioral Health (OBH) is to work collaboratively with partners to develop and implement a comprehensive, integrated system of behavioral health and healthcare, social supports, and prevention services that promote recovery and resilience for all citizens of Louisiana. OBH ensures public behavioral health services are accessible, family-driven, have a positive impact, are culturally and clinically competent, and are delivered in partnership with all stakeholders. OBH also delivers direct care through hospitalization and has oversight of behavioral health community-based treatment programs through the human services districts and authorities. Services are provided for Medicaid and non-Medicaid eligible populations. The agency acts as a monitor and subject matter expert for the Coordinated System of Care (CSoC) contract.

The CSoC program is a research-based model that is part of a national movement to develop family and youth-driven care and to keep children with severe behavioral health needs at home, in school, and out of the child welfare and juvenile justice system. The CSoC program also creates partnerships with public and private providers to form a multi-agency, multi-disciplinary system of care. The system of care model requires collaboration among agencies, families, and youth for the purpose of improving access and expanding the array of coordinated community-based, culturally and linguistically competent services for CSoC youth and families. More information on the CSoC program can be found at https://ldh.la.gov/index.cfm/subhome/49.

The following was taken from the Request for Information (RFI) document and is subject to change upon the release of a formal solicitation.

Scope of Services

Covered Benefits and Services Provided To Program Participants

The potential contractor for CSoC services shall be able to provide for all members those core specialized behavioral health benefits and services specified in the Medicaid State Plan and its amendments, administrative rules, LDH policy and procedure manuals, and services specified in the 1915(c) and 1915(b) waivers. The proposer shall possess the expertise and resources to ensure the delivery of quality behavioral healthcare services and shall make medical necessity determinations to members in accordance with Louisiana Medicaid program and prevailing industry standards.

The full range of required core benefits and services must be available statewide through a contracted network of providers that have been credentialed by the CSoC contractor. Specialized Behavioral Health covered services are:

• Psychiatric services
• Licensed Practitioner Outpatient Therapy Services
  • Parent-Child Interaction Therapy (PCIT)
  • Child Parent Psychotherapy (CPP)
  • Preschool PTSD Treatment (PPT) and Youth PTSD Treatment (YPT)
  • Triple P Positive Parenting Program
  • Trauma-Focused Cognitive Behavioral Therapy
  • Eye Movement Desensitization and Reprocessing (EMDR) Therapy
  • Dialectical Behavior Therapy (DBT)
• Mental Health Rehabilitation Services
  • Psychosocial Rehabilitation (PSR)
  • Crisis Intervention
  • Community Psychiatric Support and Treatment (CPST)
  • Evidence-Based Programs (EBPs) specialized for high-risk populations. This includes:
    • Functional Family Therapy (FFT)
    • Multisystemic Therapy (MST)
    • Homebuilders
    • Assertive Community Treatment (limited to 18 years and older)
• Crisis Stabilization
• Inpatient Hospitalization for Behavioral Health Services
• Outpatient Substance Use Disorder Services and Opioid Treatment Programs (OTPs) in accordance with the American Society of Addiction Medicine (ASAM) levels of care
• Crisis Response Services
  • Mobile Crisis Response (MCR)
  • Community Brief Crisis Support (CBCS)

The CSoC contractor shall use the State Medicaid definition of “medically necessary services” in a manner that is no more permissive or restrictive than the State Medicaid program. All services for which a member is eligible shall at a minimum cover:

• The prevention, diagnosis, and treatment of behavioral health impairments.
• The ability to achieve age-appropriate growth and development.
• The ability to attain, maintain, or regain functional capacity.

The CSoC contractor shall be responsible for ensuring wraparound facilitation is provided to all members of the 1915(c) Children’s CSoC Serious Emotional Disturbance (SED) Home and Community-Based waiver using high-fidelity wraparound practice consistent with the National Wraparound Initiative standards and principles. National Wraparound Initiative standards are available at https://nwi.pdx.edu/pdf/Wraparound-implementation-and-practice-qualitystandards.pdf and principles at https://nwi.pdx.edu/NWI-book/pgChapter2.php.

Waiver services for the individuals that meet 1915(c) eligibility currently include Youth Support and Training (YST), Parent Support and Training (PST), Short-term Respite (STR), and Independent Living/Skills Building (ILSB).

The CSoC contractor shall be responsible for administration of 1915(b)(3) specialized behavioral health services which will serve eligible individuals who meet the level of care (LOC) of a Psychiatric Residential Treatment Facility (PRTF) or Therapeutic Group Home (TGH), or who meet the LOC for 1915(c), but temporarily reside in an excluded HCBS setting. The contractor shall be responsible for ensuring that wraparound facilitation is provided to all members of the 1915(b)(3) waiver.

Administrative Services

The potential proposer shall be able to provide management of administrative services, including but not limited to:

• 24 hours, 7 days a week, 365 days a year, toll-free telephone access line for providers and members;
• Member services;
• Care management (CM);
• Utilization management (UM);
• Quality management (QM);
• Grievances and appeals process;
• Provider network management, including provider training;
• Primary care coordination; and
• Claims management.