Nevada Selects Magellan For Care Management Of Behavioral Health Services For Children, Youth & Families

The Nevada Department of Health and Human Services awarded Magellan Healthcare, Inc. a contract valued at nearly $23 million for the first two years as statewide care management entity (CME) for the DHHS Division of Child and Family Services (DCFS). The CME is responsible for care coordination for Medicaid and non-Medicaid children and youth, ages three to 20, with complex behavioral health needs who are at risk for placement outside of their homes or communities. The initial contract term runs for 24 months, including a six-month start-up period. The contract has an option of two, one-year extensions through December 31, 2026.

The CME services are intended for youth who may have severe emotional disturbance (SED) and may be involved in multiple systems including behavioral health, juvenile justice, and child welfare. The CME will accept referrals based on the referral process, plan for outreach, and marketing plan developed within the start-up period. DCFS will not transfer a caseload to the CME. The CME will coordinate and provide for access to intensive care coordination (ICC) using High Fidelity Wraparound, Intensive Home-Based Treatment (IHBT), emergency and planned respite, and family and youth peer support based on a robust, evidence-based assessment of need. The state anticipates that the CME will directly provide ICC and High Fidelity Wraparound, and that the CME will subcontract with community-based provider organizations for IHBT, emergency and planned respite, and youth peer support.

The populations to be served by the CME will include:

• Children and youth at risk of custody relinquishment due to their behavioral health needs because the family has not been able to obtain necessary treatment for the child/youth.
• Medicaid fee-for-service (FFS) enrolled or eligible and under or uninsured children and youth with serious behavioral health needs who are in or at-risk of out-of-home placement, which includes a range of placements, including kinship care. Out-of-home placements may be in- or- out-of-state.
• Medicaid FFS enrolled or eligible and under and uninsured children and youth who currently meet medical necessity criteria for a psychiatric residential treatment facility (PRTF) or psychiatric hospital level of care or are placed in a residential treatment facility.
• Medicaid FFS enrolled or eligible and under and uninsured children and youth. The criteria for children ages 3 to 5 include having an Early Childhood Services Intensity Instrument (ECSII) score of 4 or greater; having a family member involved with two or more systems, or having a family member with a history of two or more intervention attempts. The criteria for children ages 6 to 20 include having a qualifying risk score on various assessments, having current or historic involvement with two or more child serving systems, current or past (previous 12 months) intervention attempts (such as residential treatment, mobile crisis response, school-based services, outpatient therapies), have a Caregiver Strain Questionnaire score of 42 or greater.

Other populations to be served but that are not eligible based on the criteria above, choose not to engage in ICC, include the following:

• Children and youth enrolled or eligible for Medicaid MCO. The CME will refer these youth the appropriate Medicaid MCO.
• Children and youth not eligible for ICC. The CME will refer these children to family and youth peer support provided by Nevada Parents Educating Parents (Nevada PEP) through a contract with DCFS.
• Children and youth eligible but not interested in ICC. The CME will use a targeted case management model with this population. Families will have quarterly contact with the CME. The CME will track use of services and will track discharge status.
• Families in acute crisis. The CME will refer the family to necessary services and will continue contact with families for outcome of services and eligibility for ICC.

The CME will determine eligibility for services using existing assessments, by completing new assessments, or by coordinating an evaluation by an external provider. The CME will bill Medicaid and/or private insurance for all eligible children, youth, and families for eligible services and utilize budgeted funds for uninsured and underinsured children, youth, and families or services that are not covered by private insurance and/or Medicaid.

The state released a request for proposals (RFP 40DHHS-S2278) on March 13, 2023, with responses due by May 1, 2023. This is a new contract; there is no incumbent. The state has not reported how many proposals were received. The proposals were evaluated on five factors, with a maximum of 210 points. The points were allocated as follows:

• 55 for the description of the bidder’s readiness to provide wraparound and systems of care
• 70 for program capacity
• 40 for cultural and linguist capacity and responsiveness to underserved populations
• 35 for infrastructure capacity
• 10 for the cost proposal

The RFP listed the following funding amounts available for the contract through December 2026:

• High Fidelity Wraparound ICC: $14.40 million
• IHBT: $4.74 million
• Emergency and planned respite: $2.76 million
• Youth peer support: $1.00 million

Magellan Healthcare, Inc. is a subsidiary of Magellan Health, Inc. Magellan’s customers include health plans and other managed care organizations, employers, labor unions, various military and governmental agencies, and third-party administrators.

The RFP is available for download at no charge to OPEN MINDS Circle subscribers at https://openminds.com/rfp/nevada-seeks-care-management-services/.

OPEN MINDS last reported on Nevada’s services for children in the following articles:

• “More Than $45 Million Approved To Support Nevada’s Children’s System Of Care,” which published on August 31, 2022, at https://openminds.com/market-intelligence/news/more-than-45-million-approved-to-support-nevadas-childrens-system-of-care/
• “Nevada Awards Medicaid Managed Care Contracts To Anthem, Centene, Molina & UHC,” which published on September 21, 2021, at https://openminds.com/market-intelligence/news/nevada-awards-medicaid-managed-care-contracts-to-anthem-centene-molina-uhc/

For more information, contact:

• Karla Delgado, Public Information Officer, Nevada Division of Child & Family Services, 4126 Technology Way, 3rd Floor, Carson City, Nevada 89706; 775-684-4400; Fax: 775-684-4455; Email: kdelgado@dcfs.nv.gov; Website: https://dcfs.nv.gov/Programs/JJS/Overview/
• Lilly Ackley, Vice President of Corporate Communications, Magellan Health, Inc.; Email: ackleyl@magellanhealth.com; Website: https://www.magellanhealth.com/