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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 IDD Crisis Services

LYNN RUTLANDEXECUTIVE DIRECTOR

MHMR SERVICES FOR THE CONCHO VALLEY

Larry CarrollExecutive Director

Extended Observation Unit (EOU)

Kristen DaughertyExecutive Director

1115: Projects for People with IDD

20 Centers have identified projects that focus on serving people with Intellectual and/or Developmental Disabilities

1115 IDD Crisis Services

LYNN RUTLANDMHMR SERVICES FOR THE CONCHO

VALLEY

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.

Larry CarrollExecutive Director

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

20.3% of Long-Term Diabetes

44.4% of Chronic Obstructive Pulmonary Disease (COPD)

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

Extended Observation Unit (EOU)

Kristen DaughertyExecutive Director

•Community Need

•Target Population

•Regional Goal

•Project Goals

•Implementation

• Care delivery gaps

• Wait times for bio-psychosocial services

• Inpatient bed shortage

Total population = 4,380

Predominantly Hispanic (82%)

Bio-psychosocial needs

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            

           

QUESTIONS?

June 5, 2013Crossroads Conference 2013

Lubbock, Texas

Cathy PopeChief Executive Officer


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