1 / 33

A Call to Excellence Update on the Excellence in Mental Health Act

A Call to Excellence Update on the Excellence in Mental Health Act. Chuck Ingoglia National Council for Behavioral Health June 12, 2014. A Call to Excellence. Healthcare change is rampant… States are experimenting with payment and delivery models…

ailish
Download Presentation

A Call to Excellence Update on the Excellence in Mental Health Act

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A Call to ExcellenceUpdate on the Excellence in Mental Health Act Chuck Ingoglia National Council for Behavioral Health June 12, 2014

  2. A Call to Excellence Healthcare change is rampant… States are experimenting with payment and delivery models… Community providers struggling to move from special silo status to equality… From incremental improvement to fast paced change

  3. Q: What do vegetables and community health centers have in common?

  4. A: A definition in US Code

  5. What is a…?

  6. How Many Are There? What services do they provide? • Clearly delineated in federal law Nursing homes: 15,531 Hospitals: 5,010 FQHCs: 1,048 Rural Health Centers: 3,755 All data available on www.statehealthfacts.org

  7. What is… • A substance use treatment organization? • No definition • A mental health treatment organization? • No definition • A psychiatric rehabilitation facility? • No definition • A community mental health center? [§1913(c)(1)] • Definition is limited to participation in Medicare Partial Hospitalization Program

  8. How many are there? What services do they provide?

  9. Why does this create problems? …but substance use & mental health services were optional in traditional Medicaid. Medicaid makes up a major share of public spending on behavioral healthcare…

  10. Why does this create problems? …while behavioral health centers cobble together patchwork funding for their services. FQHCs and other safety net providers get paid for their actual costs of providing services…

  11. Why does this create problems? • ARRA • FQHC Construction: $1.5 billion • FQHC Expansion: $500 million • Affordable Care Act • FQHC Construction: $1.5 billion • FQHC Expansion: $9.5 billion • National Health Service Corps: $1.5 billion • HITECH Act: $19 billion …but without a definition, behavioral health organizations were less easily included. Major spending legislation often includes funding for established safety net providers…

  12. The basics Creates criteria for “Certified Community Behavioral Health Clinics” (CCBHCs) Funds state planning grants Allows 8 states to be selected for a 2-year demo Provides 90% FMAP for the demo Requires participating states to develop a Prospective Payment System

  13. implementation Implementation timeline Guidance released on CCBHC certification and Prospective Payment System Participating states selected State planning grants awarded

  14. implementation Questions When will the RFP for state planning grants be released? How much flexibility will states be given in implementing certification and payment criteria?

  15. certification criteria Who can become a CCBHC? Nonprofit organizations or local government centers… …that meet the CCBHC criteria

  16. certification criteria Scope of services • Crisis mental health services • Including 24-hour mobile crisis teams • Screening, assessment & diagnosis • Person-centered treatment planning • Outpatient mental health AND substance use services

  17. certification criteria Scope of services (cont.) Primary care screening and monitoring of key health indicators Targeted case management Psychiatric rehabilitation Peer support and family support Services for members of the military and veterans

  18. certification criteria Care coordination partnerships Federally Qualified Health Centers Rural health clinics Inpatient psychiatric facilities and substance use detox and residential programs Other community services (e.g. schools, child welfare, housing agencies, etc.) Dept. of Veterans Affairs medical centers/clinics Inpatient acute care hospitals

  19. certification criteria Staffing requirements Diverse disciplinary backgrounds State-required licensure and accreditation Culturally and linguistically competent

  20. certification criteria Availability & accessibility of services Services provided regardless of patient’s ability to pay Use of sliding scale for payment Crisis management services available 24-hours

  21. certification criteria Quality reporting requirements Sylvia Mathews Burwell, HHS Secretary nominee “Such as the Secretary requires…”

  22. certification criteria Opportunities • Ability to provide more comprehensive and accessible services… • That are responsive to consumer and family need • Provide critical support for local law enforcement • Build or enhance community partnerships • Provide avenue for additional federal investments

  23. certification criteria Questions Will it be possible to establish all of the necessary relationships? How easy will it be to provide all of the required services? What will the start up costs be? Others?

  24. September 1, 2015, the Secretary shall issue guidance for the establishment of a Prospective Payment System. No payments for inpatient care, residential treatment, room and board, or other non-ambulatory services No payments to satellite facilities of CCMHCs if facilities established after April 1, 2014 State PPS rates will be developed during planning process, prior to application to be a demonstration state prospective payment system Requirements

  25. prospective payment system Questions Will PPS be the same for new clinics as it is for FQHCs? What data will drive rate-setting for the first year? Will there be a “wrap around” payment for managed care? What support do providers need to complete cost reports?

  26. state planning grants Requirements • No later than January 1, 2016, HHS must award planning grants to states for the purpose of developing proposals to participate in the demonstration program. • Only states with planning grants will be eligible to participate in the demonstration program • States must: • Solicit input from patients, providers, and other stakeholders; • Certify clinics as CCBHBs; and • Establish a PPS for mental health services furnished by a CCBHC participating in the demonstration program.

  27. state planning grants Questions What parameters will HHS set for states to get planning grants? How detailed must a state’s PPS and certification criteria be described in their planning grant applications?

  28. What can you do today? Examine your current scope of services against requirements in the statute. Begin talking to your state agencies about benefits of CCBHC status/participation in the demonstration. Build community and political support.

  29. elements of excellence Easy Access World Class Customer Service Built on a Culture of Engagement and Wellness Comprehensive Care Excellent Outcomes Excellent Value

  30. element 1: easy access Walk-in, same day, or rapid access intake models • Results include: elimination of no-shows, increased staff productivity, and higher client satisfaction Important factor in getting referrals and handling increased caseloads • “Be there when I need you.”

  31. element 3: comprehensive care Single care plans to move towards whole health Multidisciplinary care teams Care management connects the dots and creates whole picture “Provide or help me get the health care and services I need.”

  32. FQHCs: 5 Decades of Unfolding First Step in a Process

  33. Questions? Chuck Ingoglia, MSWSr. Vice President Public Policy and Practice Improvement Chucki@thenationalcouncil.org202-684-7457 ext. 249

More Related