Project BRAVO (originally called Behavioral Health Redesign and then Behavioral Health Enhancement), was launched in 2018 under the leadership of DMAS and DBHDS with strong stakeholder engagement.

The VACBP strongly supports the goals of Project BRAVO -- to implement well integrated behavioral health services that provide a full continuum of care to Medicaid members.

As we continue to support enhancement of Virginia's full continuum of Medicaid community-based services, we will maintain a focus on the following priorities:

	Ensuring that Project BRAVO results in a comprehensive continuum of care for community-based services that is trauma-informed and evidence-based where possible, and enables individuals to easily move from service to service without gaps in coverage so that the most appropriate care can be accessed.
	Early intervention and prevention services, including outpatient supports, should be built into the continuum. Early intervention services can not only help reduce the state’s Medicaid costs, but also provide cost avoidance, recognizing the resources that are needed when individuals who don’t receive the care become more sick, are incarcerated, homeless or otherwise unable to care for themselves.
	The chronic nature of behavioral health challenges must be recognized. Serious mental illness is no different than other chronic conditions that require ongoing care, like diabetes or heart disease. Incorporating tiered services with lower cost/lesser intensity services that can be provided over an extended period of time can be critical to helping patients manage their conditions and maintain healthy living. This can lead to better health outcomes and longer-term stability for the patient, decreased need for crisis services, and lower overall healthcare costs.
	It is important to have greater clarity and consistency in service definitions, diagnostic and clinical necessity criteria, level of care descriptions and service requirements. Regulators, payers and providers must have a shared and consistent understanding of services throughout the continuum of care. This will increase consistency in authorization decisions within and between the MCOs, better care coordination by payers and providers, and a more efficient and effective delivery system.
	Reimbursement rates must more appropriately reflect the true costs to provide services. This should include, but not be limited to: • Costs associated with the use of evidence-based practices • Administrative costs to navigate MCO processes, including an increase in    the number of authorization requests that must be submitted • Increasing staff qualification and supervision requirements • Use of technology (i.e., EHR systems, data collection, telehealth) • Costs associated with national accreditation attainment (i.e., CARF or COA) • Professional liability insurance costs • Ongoing training and professional development for staff • Increases in the overall cost to do business (i.e., wages, benefits, rent)
	The expertise and capacity or private-sector, community-based providers must be more fully leveraged all components of the service continuum. Private-sector behavioral health agencies currently provide more than 80% of all community-based behavioral health services funded by Medicaid. It's critical that the role private providers play in meeting the needs of Virginia's most vulnerable residents be recognized and supported to ensure Virginia’s Medicaid recipients are able to access an appropriate and cost-effective level of care in a timely, efficient and patient-centered manner.

The enhancement of our system is absolutely critical to meet the needs of vulnerable Virginians and will significantly impact every provider in Virginia. Join us to ensure your voice is heard.

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