UNITED STATES DISTRICT COURT DISTRICT OF MASSACHUSETTS, WESTERN DIVISION ROSIE D., et al., Plaintiffs, v. DEVAL PATRICK, et al., Defendants. CIVIL ACTION NO. 01-30199-MAP DEFENDANTS’ REPORT ON IMPLEMENTATION OF PROJECT ONE The Defendants hereby submit this Report on Implementation of Project One (“Report”) pursuant the Court’s Remedial Order dated February 22, 2007.1 This Report details the steps that the Defendants have taken to date to implement the tasks comprising Project One of the Defendants Remedial Plan in the form of the [Proposed] Judgment submitted by the Defendants on March 23, 2007. For this purpose, the Defendants construe Project One to include all tasks described in paragraphs 2-12 and 36 of the [Proposed] Judgment. Pursuant to the Remedial Order, the Defendants have until December 31, 2007, to complete Project One. Taking each paragraph of the [Proposed] Judgment describing Project One in turn, the Defendants hereby report as follows: 1 By submitting this Report in accordance with the Remedial Order, Defendants do not waive, in whole or in part, any of their rights under any final judgment entered in this case. Judgment ¶ number Text of Judgment ¶ Steps Taken by Defendants to Implement Judgment ¶ Title A. Informing Families, Providers, and Others of EPSDT Services for SED Children -- Education and Outreach and Screening 2 As set forth below, the Defendants will improve their methods for notifying Medicaid-eligible individuals enrolled in Mass Health (“Mass Health Members”) or “Members”), Mass Health providers, public and private child-serving agencies, and other interested parties about the availability of behavioral health services, including the services described in Section I.D. below, and behavioral health screenings in primary care settings. Not applicable. This paragraph is introductory. Title 1. Education and Outreach 3 The Defendants will inform all The Defendants have updated the EPSDT-eligible MassHealth three notices that MassHealth sends Members (Members under age 21 (in English and Spanish) to enrolled in MassHealth Standard or MassHealth members under age 21 CommmonHealth) and their families to notify them about preventive about the availability of EPSDT health-care, including EPSDT services (including services focused services These notices are sent to on the needs of children with SED) members (1) when they are first and the enhanced availability of enrolled in MassHealth (2) when screening services and Intensive members are reenrolled in Care Coordination as soon as the MassHealth after any break in EPSDT-eligible child is enrolled in MassHealth coverage and (3) MassHealth. annually, on or around the member’s birthday. > These notices have been revised to specifically inform members that behavioral health screens are included as part of routine well-child care visits. > Members will begin receiving these updated notices in June 2007, upon 2 Judgment f number Text of Judgment^ Steps Taken by Defendants to Implement Judgment f production of the June 2007 notices mailing file. > MassHealth plans to further revise these notices in the future (i) to provide members more detailed information about standardized behavioral health screens when those screens are implemented; (ii) to provide members more detailed information about the standardized assessment process using the Child and Adolescent Strengths and Needs (CANS) tool when that process has been developed; and (iii) to describe to members the new services focused on the needs of children with SED and Intensive Care Coordination (ICC), including how to access those services, when MassHealth implements those services. 4 The Defendants will take steps to publicize the program improvements they are required to take under the terms of this Judgment to eligible MassHealth Members (including newly-eligible MassHealth Members), MassHealth providers, and the general public. As part of this effort, the Defendants will take the actions described below and will also provide intensive training to MassHealth customer service representatives, including updating scripts used by such representatives to facilitate timely and accurate responses to inquiries about the program improvements described in The Defendants are drafting language to include in EOHHS’ contract with its Customer Services vendor, MAXIMUS, Inc., to specifically require MAXIMUS, Inc. to: > Train new Customer Services Representatives (CSRs) as they are hired and to provide ongoing trainings for its existing CSRs about (i) EPSDT services, including information about the standardized behavioral health screens when those screens are implemented, (ii) the standardized 3 Judgment f number Text of Judgment^ Steps Taken by Defendants to Implement Judgment f this Judgment. assessment process using the Child and Adolescent Strengths and Needs (CANS) tool when that process has been developed, and (iii) the new services focused on the needs of children with SED and ICC, including how to access those services, when MassHealth implements those services. EOHHS will provide direction about the details of the training process. > Update the MAXIMUS, Inc. Knowledge Center, which is accessed by CSRs, to include information about (i) the standardized behavioral health screens when those screens are implemented, (ii) the standardized assessment process using the Child and Adolescent Strengths and Needs (CANS) tool when that process has been developed, and (iii) the new services focused on the needs of children with SED and ICC, including information how to access those services, when MassHealth implements those services. > Update the PCC Plan member handbook, and the MassHealth managed care enrollment guide to include information about (i) the standardized behavioral health screens when those screens are implemented, (ii) the standardized assessment process using the Child and Adolescent Strengths and Needs (CANS) 4 Judgment Text of Judgment^ Steps Taken by Defendants to f number Implement Judgment f tool when that process has been developed, and (iii) the new services focused on the needs of children with SED and ICC, including information how to access those services, when MassHealth implements those services. EOHHS will provide direction about the content of these publications. Also, the Defendants have drafted language to include in EOHHS’ contracts with the Massachusetts Behavioral Health Partnership (MBHP) and the four MassHealth- contracted Managed Care Organizations (MCOs) to specifically require them to establish a schedule of intensive training for newly-hired and current CSRs about (1) when, where and how Members may obtain EPSDT screenings and diagnosis and treatment services, and (2) the Rosie D. lawsuit. EOHHS will provide direction about the details of the training process, including a written curriculum. The Defendants expect the MBHP contract amendment to be effective on or soon after 7/1/07., and the MCO contract amendments to be effective on or soon after August 15, 2007. 5 MassHealth Members - The Defendants will take the following actions to educate MassHealth Members about the program improvements they are required to take under the terms of this Judgment: 5 Judgment Text of Judgment^ Steps Taken by Defendants to f number Implement Judgment f a. Updating and distributing EPSDT a. See information reported in notices to specifically refer to the Paragraph #3 above. Also, the availability of behavioral health Defendants are drafting a member screening and services and to notice to inform enrolled members describe other program about the program improvements improvements set forth in this described in the Proposed Judgment. Judgment, and are developing a process for distributing this notice to members. b. Updating and distributing (in the b. The Defendants are in the normal course of communications process of updating and distributing with MassHealth Members) the following: Member education materials, i. PCC Plan Member including Member handbooks Handbook created by MassHealth and > The Defendants are nearly MassHealth’s contracted managed finished updating the care entities, to include description Handbook to inform of these improvements, and how to members in more detail access behavioral health screenings about EPSDT services, and services including the home- including the fact that a based services described in Section behavioral health screen is ID. included as part of routine well-child care visits. > The updated Handbook is expected to be available to members in September 2007. > The Defendants plan to further revise this handbook in the future (i) to provide members more detailed information about standardized behavioral health screens when those screens are implemented; (ii) to explain the standardized assessment process using the Child and Adolescent Strengths and Needs (CANS) tool when that process has been developed; and (iii) to describe to members the 6 Judgment Text of Judgment^ Steps Taken by Defendants to f number Implement Judgment f new services focused on the needs of children with SED and ICC, including how to access those services, when MassHealth implements those services. ii. MBHP Member Handbook > The Defendants have drafted language to be included in EOHHS’ contract with MBHP to specifically require MBHP to publish, update, and distribute an MBHP Member Handbook for members who are enrolled in MBHP but not the PCC Plan, as further directed by EOHHHS. This contract language is expected to become effective on, or soon after, July 1, 2007. > MBHP has nearly finished developing this Handbook with input from EOHHS. The Handbook is expected to be available to members in September 2007. > The current version of the Handbook will inform members in more detail about EPSDT services, including the fact that a behavioral health screen are included as part of routine well-child care visits. > The Defendants plan to direct MBHP further revise these handbooks in the future (i) to provide members more detailed information about standardized behavioral 7 Judgment Text of Judgment^ Steps Taken by Defendants to f number Implement Judgment f health screens when those screens are implemented; (ii) the standardized assessment process using the Child and Adolescent Strengths and Needs (CANS) tool when that process has been developed; and (iii) to describe to members the new services focused on the needs of children with SED and ICC, including how to access those services, when MassHealth implements those services. iii. MCO Member Handbooks > The Defendants have drafted language to be included in the MCO contracts to specifically require them to update their Member Handbooks as directed by EOHHS. This contract language is expected to become effective on, or soon after August 15, 2007. > The Defendants will soon begin working with the MCOs to begin updating their Member Handbooks. These Handbooks are expected to be available to members before the end of the year. > The update will inform members in more detail about EPSDT services, including the fact that a behavioral health screen are included as part of routine well-child care visits. 8 Judgment Text of Judgment^ Steps Taken by Defendants to f number Implement Judgment f > The Defendants plan to direct the MCOs to further revise their Member Handbooks in the future (i) to provide members more detailed information about standardized behavioral health screens when those screens are implemented; (ii) the standardized assessment process using the Child and Adolescent Strengths and Needs (CANS) tool when that process has been developed; and (iii) to describe to members the new services focused on the needs of children with SED and ICC, including how to access those services, when MassHealth implements those services. c. Amending Member regulations, c. The Defendants are in the process as necessary, to describe the of revising EOHHS regulations to services described in Sections I. C describe program improvements. and D below and other program > The Defendants expect that improvements. amendments to 130 CMR 450.000 will become effective before the end of the calendar year. See Paragraph # 6(a) below. > The regulations that become effective this calendar year will not describe the new services focused on the needs of children with SED and ICC. The Defendants plan to further revise EOHHS regulations to describe to members the new services focused on the needs of children with SED 9 Judgment f number Text of Judgment^ Steps Taken by Defendants to Implement Judgment f d. Participating in public programs, panels, and meetings with public agencies and with private advocacy organizations, such as PAL, the Federation for Parents of Children with Special Needs and others, whose membership includes MassHealth-eligible children and families. and ICC, including how to access those services, when MassHealth implements those services. d. The Defendants have taken the following steps with respect to participating in public programs, panels, and meetings with public agencies and with private advocacy organizations: i. PAL - The Defendants’ Compliance Coordinator met with Lisa Lambert, the Executive Director of The Parent/Professional Advocacy League on May 9, 2007 to discuss strategies to inform the parents of MassHealth-enrolled children about the Rosie D. remedy, screenings, assessments, and services. Ms. Lambert invited the Compliance Coordinator to speak to a meeting of statewide PAL stakeholders on May 30, 2007. ii. Mental Health Task Force - In May 2007 the Compliance Coordinator addressed the Mental Health Task Force of the Massachusetts Chapter of the American Academy of Pediatrics about the planning that is underway to determine how best to implement the remedy screenings, assessments and services. iii. Federation for Parents of Children with Special Needs -The Compliance Coordinator has meetings scheduled with the 10 Judgment f number Text of Judgment^ Steps Taken by Defendants to Implement Judgment f Federation for Parents of Children with Special Needs to discuss collaboration on outreach and education. iv. Adoptive Families Together – The Compliance Coordinator has meetings scheduled with Adoptive Families Together to discuss collaboration on outreach and education. v. Additional Contacts - The Compliance Coordinator will seek a variety of public forums at which to present information on the remedy screenings and plans for assessments and services, beginning in September, 2007. 6 MassHealth Providers - The Defendants will take the following actions to educate MassHealth providers about the program improvements they are required to take under the terms of this Judgment: a. Updating EPSDT regulations to reflect the program improvements described in this Judgment. a. The Defendants are drafting amendments to its All Provider regulations at 130 CMR 450.000, which include the EPSDT regulations (130 CMR 450.140-150). > These amendments will include a specific clarification that behavioral health screens are included as part of routine well-child care visits and will mandate that primary care providers screen and refer children under 21 for treatment and use a standardized behavioral health screening tool when 11 Judgment Text of Judgment^ Steps Taken by Defendants to f number Implement Judgment f administering a behavioral health screen. > MassHealth will promulgate these regulations, incorporating the opportunity for public comment, in a timeframe that allows the regulations to be promulgated and any necessary operational changes to become effective no later than December 31, 2007. b. Updating Appendix W of the b. The Defendants have drafted MassHealth Provider Manual, which updates to Appendix W of the describes medical protocols and MassHealth All Provider periodicity schedules for EPSDT Regulations to include a list of services, to reflect the program MassHealth-approved standardized improvements related to screenings behavioral health screening tools, for behavioral health described in from which primary care providers Section I.A.2 below. must select a tool when administering behavioral health screens for MassHealth enrolled children. > MassHealth will publish updated Appendix W in a timeframe that allows the any necessary operational changes to become effective no later than December 31, 2007. c. Drafting and distributing special c. The Defendants will develop a provider communications related to new stand-alone guide for the program improvements MassHealth providers on how to described in this Judgment, access behavioral health services including how to assist MassHealth for children enrolled in MassHealth, Members to access the home-based but not enrolled in the PCC Plan or services described in Section I.D. in a MassHealth-contracted MCO, which will be updated as remedy screenings, assessments and services become available. > MassHealth will publish and distribute this guide no later 12 Judgment f number Text of Judgment^ Steps Taken by Defendants to Implement Judgment f d. Updating and distributing existing provider education materials to reflect the program improvements described in this Judgment. than December 31, 2007. Updates will be made after December 31, 2007 as assessments and services become available. d. The Defendants have identified the following materials that currently are distributed to providers which they will update (or require the contractor responsible for their publication to update) to inform providers about using standardized behavioral health screens, when those screens are implemented: > PCC Plan provider newsletters; > MCO provider newsletters > MassHealth “Update” provider newsletters > EPSDT billing guidelines brochure > PCC Plan provider contract > PCC Plan provider handbook The Defendants are developing a process and timeframe for updating each of these materials, which will occur no later than December 31, 2007 The Defendants also plan to identify materials that are distributed to providers that will be updated to inform providers about the standardized assessment process using the Child and Adolescent Strengths and Needs (CANS) tool when that process has been developed, and about the new services focused on the needs of children with SED and ICC,_______ 13 Judgment Text of Judgment^ Steps Taken by Defendants to f number Implement Judgment f including how to access those services, when MassHealth implements those services. Also, the Defendants have drafted language to include in contracts with MBHP and the MCOs to require them to communicate information on the Rosie D. program improvements to their provider networks. The Defendants expect the MBHP contract amendment to be effective on or soon after July 1, 2007, and the MCO contract amendment to be effective on, or soon after, August 15, 2007. e. Expanding distribution points of e. The Defendants will consider existing materials regarding EPSDT how to expand distribution points generally, including the program for the materials described in “d” improvements described in this above as updates to those Judgment. documents are implemented. f. Implementing any other f. The Defendants are identifying operational changes required to changes to the Medicaid implement the program Management Information System improvements described in this (MMIS) that will be help to track Judgment. the rate at which providers are utilizing a standardized behavioral health screening tool when administering behavioral health screens. The Defendants plan to develop a work plan and process for implementing such changes. Also, the Defendants will implement other operational changes that are identified as necessary to implement Project One and will implement further operational changes as part of other projects described in the Proposed 14 Judgment f number Text of Judgment^ Steps Taken by Defendants to Implement Judgment f g. Holding special forums for providers to encourage clinical performance activities consistent with the principles and goals of this Judgment. h. Amending MassHealth’s managed care contracts to assure that all such entities educate the providers in their network about the program improvements described in this Judgment, as described in Paragraphs 6.a.-g. above. Judgment. g. The Defendants have drafted language to include in contracts with MBHP and the MCOs to specifically require each of them to conduct at least one forum per year for primary care providers to educate these providers about the importance of behavioral health screenings and appropriate referrals to behavioral health providers. (MBHP will perform forums for PCCs). Additionally, the Defendants have drafted contract language for contracts with MBHP and the MCOs to require them to implement at least one quality forum per year for behavioral health providers to encourage clinical performance activities consistent with the principles and goals of the Rosie D. lawsuit. EOHHS will provide further direction about the details of these forums. > The Defendants expect the MBHP contract amendment to be effective on or soon after July 1, 2007, and the MCO contract amendment to be effective on, or soon after, August 15, 2007. h. The Defendants have drafted language to include in contracts with MBHP and the MCOs to require them to educate the providers in its networks about the program improvements described in sections a through g of this Paragraph. The Defendants expect the MBHP contract amendment to be effective on, or soon after July 1, 2007, and the MCO contract_______ 15 Judgment f number Text of Judgment^ Steps Taken by Defendants to Implement Judgment f i. Coordinating these efforts with the “Virtual Gateway,” which is the EOHHS system for web-based, online access to programs, including MassHealth and related benefit programs such as food stamps, and which allows a wide array of hospitals, community health centers, health and human services providers, and other entities to assist children and families in enrolling in MassHealth. amendments to be effective on, or soon after, August 15, 2007 i. The Defendants have begun to develop a strategy and implementation plan for using the Virtual Gateway to inform MassHealth providers, the broader community of human services providers, and members of the public about Rosie D. remedy services and how to obtain them. The Defendants are exploring whether to develop a link on the Virtual Gateway that points to a website containing information about screenings, assessments, and the new services focused on the needs of children with SED and ICC. 7 The Public - To improve public information about the program improvements the Defendants are required to take under the terms of this Judgment, the Defendants will take the following actions to present the terms of this Judgment to public and private agencies that serve children and families: a. Presenting the Judgment to appropriate Commonwealth officials in the Executive Branch and the Legislature. a. The Defendants have conveyed copies of the Remedial Plan or Proposed Judgment senior managers in: > the Executive Office of Administration and Finance, > the Executive Office of Health and Human Services, > the Office of Medicaid, and > the Departments of Mental Health, Mental Retardation, Public Health, Social Services and Youth Services. Informal conversations regarding 16 Judgment Text of Judgment^ Steps Taken by Defendants to f number Implement Judgment f the Proposed Judgment have been had with several Legislative Leaders or their staff. Once a final judgment has been entered, the Defendants will convey it to: > the Senate President; > the Speaker of the House; > the Chairs of the Senate and House Committees on Ways and Means and the Senate and House Chairs of the Joint Committees on: Health Care Financing; Mental Health and Substance Abuse; and Children and Families; > the Secretary of Administration and Finance; > the Secretary of Health and Human Services and her senior management staff; > the Medicaid Director; > the Commissioner of the Division of Health Care Finance and Policy; and > the Commissioners of the Departments of: Education, Early Education and Care, Mental Health, Mental Retardation, Public Health, Social Services and Youth Services. b. Creating new pamphlets, b. The Defendants envision informational booklets, fact sheets, developing new materials for the and other outreach materials public about new services focused describing these improvements. on the needs of children with SED and ICC in the form of “fact sheets”. > ‘Fact Sheet 1’ would be a high-level overview for the general public, which would be used to at public meetings of various stakeholders and interested parties; 17 Judgment Text of Judgment^ Steps Taken by Defendants to f number Implement Judgment f > ‘Fact Sheet 2’ would be slightly more in-depth and would be provided to other agencies/groups whose staff work with children and who likely help parents to access needed screenings, assessments and services for their children; and > ‘Fact Sheet 3’ would contain still further detail and would be designed for other agencies and provider staff who are directly responsible for accessing screenings, assessments and services for children in their care. To assist the Defendants to perform these tasks, the Defendants are currently seeking funding from the Legislature for a Rosie D. Communications Coordinator who will have primary responsibility for developing these materials. c. Developing and implementing c. The Defendants currently are training programs for line staff at seeking funding from the the Legislature for, among other things: Departments of Mental Health, > staff to serve as liaisons Social Services, Youth Services, between MassHealth and the Mental Retardation, Transitional Departments of Mental Assistance, and the Office for Health, Social Services and Refugees and Immigrants on how to Youth Services; access MassHealth services for > a Communications children with SED. Coordinator. Part of the role of these staff will be to work with the agencies to develop and implement staff trainings with the above-mentioned state agencies, as well as the Departments of Mental Retardation, Transitional Assistance and the Office for Refugees and Immigrants, regarding how to 18 Judgment Text of Judgment^ Steps Taken by Defendants to f number Implement Judgment f access MassHealth services, including Rosie D. remedy services. d. Distributing outreach materials in d. The Defendants anticipate primary care settings, community meeting with the associations for health centers, and community these provider types, and working mental health centers and posting with them to place ‘Fact Sheet 1’ electronic materials on the EOHHS (described above) at the appropriate Virtual Gateway that are designed to provider sites. Regarding the provide information to MassHealth Virtual Gateway, please see the Members and to public and private comments above for Paragraph 6.i. agencies that come in contact with or serve children with SED or their families. e. Working with the Department of e. As described above in sub- Early Education and Care to educate paragraph c., the Defendants will preschools, childcare centers and start planning with the Department Head Start Programs on how to of Early Education and Care how to access MassHealth services for effectively disseminate ‘Fact Sheet children with SED. 2’ to preschools, childcare centers, and Head Start programs. f. Working with the Department of f. Similarly, the Defendants will Education, the Department of Public work with the Department of Health and Public School Districts Education, the Department of to educate school nurses and other Public Health, and the Public school personnel on how to access School Districts to disseminate MassHealth services for children ‘Fact Sheet 2.’ with SED. Title 2. Screening for Behavioral Health 8 The Defendants will require primary The Defendants have drafted care providers who perform periodic language for inclusion in and medically necessary inter- MassHealth regulations governing periodic screenings pursuant to 42 the EPSDT program (130 CMR U.S.C. §1395d(r)(1) to select from a 450.140-150) to require primary menu of standardized behavioral care providers who perform 19 Judgment f number Text of Judgment^ Steps Taken by Defendants to Implement Judgment f health screening tools. The menu of standardized tools will include, but not be limited to, the Pediatric Symptom Checklist (PSC) and the Parents’ Evaluation of Developmental Status (PEDS). Where additional screening tools may be needed, for instance to screen for autistic conditions, depression or substance abuse, primary care providers will use their best clinical judgment to determine which of the approved tools are appropriate for use. periodic and medically necessary inter-periodic screenings pursuant to 42 USC 1395d(r)(1) to select from a menu of standardized behavioral health screening tools. MassHealth will promulgate these regulations, incorporating the opportunity for public comment, in a timeframe that allows for necessary operational changes to be in place to support this regulatory requirement, but in no event will this be later than December 31, 2007. The Defendants have proposed a menu of screening tools, which includes the Pediatric Symptom Checklist (PSC) and the Parents’ Evaluation of Developmental Status (PEDS), as well as other tools to screen for autistic conditions, depression or substance abuse, and plans to request review of the menu from stakeholders, including the Massachusetts Chapter of the American Academy of Pediatrics and the Massachusetts Medical Society. 9 The Defendants will amend pertinent MassHealth provider regulations to clarify that all primary care providers, whether they are paid through the managed-care or the fee-for-service system, are required to provide periodic and inter-periodic screens. The Defendants have drafted language for inclusion in MassHealth regulations governing the EPSDT program (130 CMR 450.140-150) to clarify that all primary care providers are required to provide periodic and medically necessary inter-periodic screens. MassHealth will promulgate these regulations, incorporating the opportunity for public comment, in a timeframe that allows for necessary operational changes to be in place to support this regulatory requirement, but in no event will 20 Judgment f number Text of Judgment^ Steps Taken by Defendants to Implement Judgment f this be later than December 31, 2007. 10 There will be a renewed emphasis on screening, combined with ongoing training opportunities for providers and quality improvement initiatives directed at informing primary care providers about the most effective use of approved screening tools, how to evaluate behavioral health information gathered in the screening, and most particularly how and where to make referrals for follow-up behavioral health clinical assessment. Additional quality improvement initiatives will include improved tracking of delivered screenings and of utilization of services delivered by pediatricians or other medical providers or behavioral health providers following a screening and use of data collected to help improve delivery of EPSDT screening, including assuring that providers offer behavioral health screenings according to the State’s periodicity schedule and more often as requested (described in Section I.E.2). The Defendants plan to develop a set of quality improvement initiatives that they will begin to implement between the date of this Report and December 31, 2007, and that will inform primary care providers about the most effective use of the approved screening tools, educate them how to evaluate behavioral health information gathered during the screening, and will provide information on how and where they can refer members needing further behavioral health clinical assessment. Also, the Defendants have drafted language to be included in the contracts with the MCOs to require them to develop and implement such quality improvement activities for providers in their networks. The Defendants expect these contract amendments to be effective August 15, 2007 or soon thereafter. Finally, the Defendants are developing a plan for updating existing, or developing new, systems and methods to allow the Defendants to track the number of delivered screenings and the utilization of services following a screening. The Defendants plan to monitor the data gathered from such systems, and use the data to help improve delivery of EPSDT screening, including assuring that providers offer behavioral health screenings according to the State’s periodicity schedule 21 Judgment f number Text of Judgment^ Steps Taken by Defendants to Implement Judgment f Title 3. Identification of Behavioral Health Needs – The Role of Other EOHHS Agencies, and other Public and Private Agencies 11 MassHealth will continue its practice of not requiring a primary care visit or EPSDT screening as a prerequisite for an eligible child to receive MassHealth behavioral health services. MassHealth-eligible children and eligible family members can be referred or can self-refer for Medicaid services at any time by other, including other EOHHS agencies, state agencies, public schools, community health centers, hospitals and community mental health providers. The Defendants do not plan to change its policy that all MassHealth members, regardless of their managed care enrollment status, may access behavioral health services without the need for a referral as a prerequisite for receiving services. MassHealth-eligible children and eligible family members can continue to be referred or to self-refer for Medicaid services at any time by other, including other EOHHS agencies, state agencies, public schools, community health centers, hospitals and community mental health providers. 12 The Defendants will provide information, outreach and training activities, focused on such other agencies and providers. In addition, the Defendants will develop and distribute written guidance that establishes protocols for referrals for behavioral health EPSDT screenings, assessments, and services, including the home-based services described in Section I.D., and will work with EOHHS agencies and other providers to enhance the capacity of their staff to connect children with SED and their families to behavioral health EPSDT screenings, assessments, and medically necessary services. As described in the comments for Paragraph 7, the plan to develop and distribute written guidance that establishes protocols for referrals for screenings, assessments and services, including home-based services, and to work closely with the child-serving state and private agencies to enhance the capacity of staff to connect children with SED and their families to these screenings, assessments and services. 22 Judgment Text of Judgment^ Steps Taken by Defendants to f number Implement Judgment f 36 Project 1: Behavioral Health Screening, Informing, and Noticing Improvements a. Project Purpose: Implementation a. This section is a purpose of improvements to behavioral statement, and requires no response. health screening and clear communication of new requirements about the use of standardized screening tools. b. Tasks performed will include: b. i) Developing and announcing a i. See report in Paragraphs 6 and standardized list of behavioral 8 health screening tools. ii) Drafting managed-care or ii. See report in Paragraphs 4, 5 provider contract amendments (b), 6 (d), (g), and (h). and regulatory changes to conform to the new requirements. iii) Improving EPSDT Member iii. See report in Paragraph 3 notices concerning the availability of behavioral health and other EPSDT screening, and the availability of behavioral health services. c. Timelines for implementation: c. The submission of this report is i) Defendants will submit to the intended to fulfill the requirement Court a written report on the set forth in this Title. implementation of Project 1 no later than June 30, 2007. ii) Completion of this project will be by December 31, 2007. 23 Respectfully submitted, MARTHA COAKLEY Attorney General /s/ Deirdre Roney . Deirdre Roney (BBO No. 652886) Office of the Attorney General Commonwealth of Massachusetts One Ashburton Place Boston, MA 02108 (617) 727-2200 ext. 2075 June 27, 2007 Certificate of Service I hereby certify that this document was filed through the Electronic Case Filing (ECF) system and thus copies will be sent electronically to the registered participants as identified on the Notice of Electronic Filing (NEF); paper copies will be sent to those indicated on the NEF as non registered participants on or before June 28, 2007. /s/ Deirdre Roney . 24