Cultural Competence Standards in Managed Care Mental Health Services For Native American Populations

Benefit Design

 

Standard

The Health Plan should ensure equitable access and comparability of benefits across populations and age groups. Coverage should provide for access to a full continuum of care, from most to least restrictive in ways which are comparable, though not identical, acknowledging that culturally competent practice provides for variance in individualized care.

 

Implementation Guidelines

1. Urban/Suburban:

The health plan benefit level should be based on the principles of quality care management and utilization review mechanisms. Utilization review should be performed by culturally and linguistically competent staff.

Rural/Reservation:

The health plan benefit level should be based on the principles of quality care management and utilization review mechanisms. There should be a formal review by the tribal sovereign nation(s) to identify needs specific to that tribal nation (an example: uranium exposure).

2. Urban/Suburban and Rural/Reservation:

Coverage should incorporate and integrate innovative treatment modalities, including alternative and traditional healers, in order to enhance the acceptability and cost-effectiveness of care.

3. Urban/Suburban and Rural/Reservation:

Coverage should incorporate services delivered by qualified Native American Mental Health Specialists when available or culturally competent mental health specialists.

4. Urban/Suburban and Rural/Reservation:

Coverage should incorporate the coordination of services across service agencies and systems serving the consumer.

5. Urban/Suburban and Rural/Reservation:

The Health Plan should provide information, community education and written and oral materials to consumers and families regarding covered services and procedures for accessing and utilizing services in their primary language(s). Such information should be made available through partnerships with community organizations in addition to conventional means of dissemination.

6. Urban/Suburban:

Written correspondence or audio presentation regarding eligibility should be in consumers’ and families’ primary language(s) with alternative methods of communication also documented.

Rural/Reservation:

Special efforts should be made to make eligibility clear to consumers and families via written correspondence, documented translation or other means whereby consumer and family have access to information in their primary language.

7. Urban/Suburban and Rural/Reservation:

The Health Plan should provide for consumer choice of provider.

8. Urban/Suburban:

The managed care contract health plan should provide for the needs of both sponsored and unsponsored Native populations.

Rural/Reservation:

The managed care contract health plan should provide for and should have clear agreements about the needs of both sponsored and unsponsored Native populations which include input from tribal sovereign nations, federal and state agencies. On reservations there should be a risk pool where there are agreements about what unsponsorship means.

9. Urban/Suburban and Rural/Reservation:

The Health Plan should make provisions in the benefit design for people who leave the Health Plan, including service planning and a transition process to new plans.

10. Urban/Suburban:

The Health Plan should ensure coordination with private plans to plan for those instances when a sponsored participant becomes unsponsored and is considered for services under the Health Plan.

Rural/Reservation:

The Health Plan should ensure coordination with tribal sovereign nations, federal, and multiple state plans, in addition to private plans to plan for those instances when a sponsored participant becomes unsponsored and is considered for services under the Health Plan.

 

Recommended Performance Indicators

  1. Culturally competent eligibility and level of care criteria are formally established.
  2. Eligibility determinations and service planning are performed by, or under the supervision of, Native American Mental Health Specialists.
  3. Native American consumers receive direct services provided by Native American Mental Health Specialists, or from personnel supervised by Native American Mental Health Specialists.
  4. Consumers receive bilingual materials on Health Plan benefits whenever feasible.
  5. Percent of consumers receiving services by cultural healers.
  6. Treatment plans incorporate services from multiple agencies.

 

Recommended Outcomes

  1. Benefit distribution and service provision for Native American consumers
    Benchmark: Comparable to overall service population
  2. Percent of Native American covered consumers who know benefits and how to access them
    Benchmark: 100%, as measured by consumer survey
  3. Consumer and family satisfaction with services
    Benchmark: 90% satisfaction
  4. Proportionality of Native American consumer access to full range of benefits
    Benchmark: Comparable to overall service population