The significance of the changes in the BH service delivery system which will be driven by the “redesign” were not as evident during the past conversations as they are with an actual written manual; and Section 3.2 is a perfect illustration of the dramatic shift toward significant reduction in services available for both adults and youth.   Implementation of the requirements for “referral to standalone EBPs” will be unsustainable when you consider both the cost and the administrative burden of:

• having the requisite knowledge of the clinical appropriateness of a service that perhaps you do not provide,
• performing the required referral tasks,
• educating the individual and the families about the mandated process, and
• demonstrating successfully to one of six MCOs that you have complied with the requirement (including documentation of an assessment and denial by another entity)    

This requirement alone will result in significant disruption – perhaps that is the intent, but the cost in both dollars and human terms will be long lasting.