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MetroPlus Enhanced is managed care plan that manages physical health, mental health, and substance use services in an integrated way for adults with behavioral health needs. MetroPlus Enhanced is a Health and Recovery Plan (HARP) qualified by New York State and has specialized expertise, tools and protocols that are not part of most medical plans. This plan does not require you to change your current health care providers.
In addition to managing all of your current Medicaid Services, the HARP manages an enhanced benefit package of Home and Community Based Services (HCBS). HCBS provide opportunities for Medicaid recipients with behavioral health conditions to receive specialized support services in their home or community. In addition, the HARP provides enhanced care management for members to help you coordinate your physical health, behavioral health and non-Medicaid supports.
Health Home Care Managers help you make appointments with your providers, stay on top of your medications and coordinate care across all of your treating clinicians. They also assess need for Behavioral Health Home and Community Based Services (BH HCBS).Working with your Health Home care managers, you will be given the opportunity to complete an assessment to determine which Home and Community Based services you are eligible to receive.
List of approved HCBS services:
- Rehabilitation: Rehabilitation services are designed to restore an individual’s functional level to the highest degree possible and to facilitate integration into the community.
- Crisis Intervention: Crisis intervention services include short term and intensive crisis residential care for members who are experiencing challenges in daily life that make it difficult for them to remain at home or in the community.
- Habilitation: Habilitation services, which are typically provided on an individual basis, are designed to assist members in improving skills such as communications, activities of daily living, socialization, and use of community resources.
- Non-Medical Transportation: Non-Medical Transportation services are offered to members to access transportation to destinations that are related to achieving recovery such as a job interview, a college fare, a wellness seminar, or other relevant activities.
- Peer Supports: Peer Support services are delivered by peers with a recovery focus and promote skills for coping with one’s behavioral health condition(s).
- Support Services: Support services include family support and training in order to facilitate engagement and participation of the family in the recovery process. Family support services are provided only upon a member’s request.
- Individual Employment Support Services: Individual Employment Services include:
- Pre-vocational services that prepare individuals for employment.
- Transitional employment services are available to strengthen an individual’s work record and work skills.
- Supported employment services can be provided to assist members to obtain and maintain competitive employment.
- Educational Support Services: Educational Support Services are designed to assist individuals who want to start or return to school or formal training with a goal of achieving skills necessary to obtain employment. MetroPlus Enhanced’s HARP is designed to provide person-centered recovery services that emphasizes and supports an individual’s potential for rehabilitation by maximizing quality of life and reducing symptoms of behavioral health conditions. Through empowerment, choice, treatment and education MetroPlus Enhanced’s HARP promotes recovery, health and well-being.
WHO IS ELIGIBLE?
Medicaid recipients who are 21 or older with significant behavioral health conditions (mental illness and/or substance use disorders). Eligible members will be identified by the State on an ongoing basis and given the opportunity to enroll in MetroPlus Enhanced’s HARP. People who are eligible will get a letter in the mail informing of their eligibility and giving them the opportunity to opt out.
MetroPlus Enhanced Handbook
NY Health Access
NYS Office of Mental Health
NYS Office of Alcoholism and Substance Abuse Services
FOR PROVIDERS: MetroPlus Enhanced Plan (Health and Recovery Plan) & Medicaid Update
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- Behavioral Health Drug Coverage Changes (effective October 1, 2015)