Mental Health Programs in the 1115 Waiver Process
June 5, 2013Crossroads Conference 2013
Lubbock, Texas
Cathy PopeChief Executive Officer
1115: WHY
BACK STORY
2012 roll-out of Medicaid Managed Care in Texas
had unintended consequences upon the
Upper Payment Limit (UPL) Program for Hospitals
1115: WHY
Directed by Senate Bill 7 (82nd Session,)
The Texas Health and Human Services Commission (HHSC)
Submitted an 1115 Demonstration Waiver application to
The Centers for Medicare and Medicaid (CMS)
1115: The Basics
1115 is a LOCAL initiative
Regional Health Partnerships and designated regional Anchors serve to coordinate the development and implementation of regional health plans
Regional plans are reflective ofLOCAL solutions designed to reduce Cost and improve Outcomes
1115: Top 5 Community Center Projects
Integrate Physical and Behavioral Health Care 30
Crisis Stabilization Services 23
Evidence-based Interventions for a TargetPopulation 22
Expand Community-based Behavioral HealthServices in Underserved Areas 12
Whole Health Peer Support for Persons withMental Health/Substance Use Disorder 9
1115: Projects for People with IDD
20 Centers have identified projects that focus on serving people with Intellectual and/or Developmental Disabilities
1115 IDD Projects
• 28 Specific 1115 Projects Across Texas
• 44 Additional Mental Health 1115 Projects that are not specific, but include IDD
• IDD Projects within the West Texas Region:
Betty Hardwick, Concho Valley, Emergence Health Network, Helen Farabee, StarCare Specialty Health, Texas Panhandle, West Texas Centers
Specific 1115 IDD Projects• Crisis Response Team
• Crisis Stabilization Respite
• Dual Diagnosis Clinic
• Drop in Skills Training Program
• Behavior Day Treatment Program
• Health & Wellness Program
• Autism Day Treatment & Behavior Support Outreach
• Therapeutic Intervention for Infants & Toddlers at Risk
1115 IDD Crisis Projects• The primary focus for 1115 IDD funding is
projects to address the growing need for Crisis Support Services for individuals with a dual diagnosis of Intellectual & Developmental Disabilities (IDD) / Autism Spectrum Disorders (ASD) and Mental Illness who may experience a psychiatric/behavioral crisis or significant life transition that presents a risk for institutional placement or a loss of their current home in the community.
• The objective of these services would be to prevent inappropriate use of Emergency Rooms, Jails, or Psychiatric Hospitals, when the need for service can be effectively met in a more natural, less restrictive, and less costly setting.
New Model of Service• This new model of care will provide wrap-around
services for the individual that includes Psychiatric Services, On-Call Crisis Response Teams and a Crisis Respite Facility.
• Recipients would have access to a team of professionals: Psychiatrist, Psychiatric Nurse Practitioner, RN, LPC/LPA, Behavioral Specialists, and Skills Trainers to assess needs, identify resources, link to a network of resources within the team and through contracted providers, and assure services are provided that will appropriately de-escalate the crisis in the community when possible.
New Model of Service
• The team will develop strategies to build skills of individuals and competency of their support network to address the individual’s future needs more adequately, targeting crisis prevention.
• While this model of care is not designed to replace natural support systems or formal residential care systems, it is specifically targeted to insert a new support for individuals in between these systems and institutional care or loss of current home environment.
Crisis Services in community, hospitals, jails Psychiatric Evaluations Medication Services Intensive Community Rehabilitative
Services Counseling Mental Health Deputies Mental Health First Aid training
Bi-Polar Disorder, Major Depression, or Schizophrenia◦34% are Medicaid Eligible◦44% are indigent
Over half do not have a primary care physician
People with Severe Mental Illness (SMI) have a life expectancy of 25 years less than people without SMI.
A significant number of those with SMI do not receive adequate primary treatment for medical conditions.
They instead consume costly emergency department services for medical conditions that could have been managed by primary care outpatient physicians.
Severe Mental IllnessSevere Mental Illness
PBCC will start providing primary care services in our outpatient clinics next year as a part of a new Medicaid waiver program
We see approximately 1200 people in our Midland and Odessa clinics
High rates of chronic disease
High costs associated with preventable admissions
Shortage of health care professionals
Recruiting and training licensed providers
Overall shortage of Primary Care Physicians in the Permian Basin
Data gathering and analysis
Proving up Economic Evaluations
Cost Effective Analysis◦480 persons served x $18,852 =
$9,048,960 annually◦or $36,195,840 over 4 years
Cost Utility Analysis◦Quality Adjusted Life Years =
$32,160,000 over 4 years
Paso Del Norte Health Foundationo 2012 Regional Strategic Health Framework Report
Priority Area 2 o Mental Health and Behavioral Health/Wellness
Regional Goalo Enhance and expand access to behavioral health services and
alternatives
1. Access to behavioral health services
22 2 inappropriate systems of care
22 2 hospital ER use for psychiatric care
2012-16 Time-line
Phase I Phase II Phase III
Milestone activitiesJuly 2012
Jan2013
Sept 2013
April2014
March 2015
Feb 2016
1. Convene stakeholder meetings
2. Conduct mapping and gap analysis (plan)
3. EOU site, design and construction
4. Services planning and implementation
5. Crisis alternative utilization
6. Utilization best practices and solutions