IOWA COALITION ON MENTAL HEALTH AND AGING

1. IOWA COALITION ON MENTAL HEALTH AND AGING Policy and Administration Workgroup

2. PRIMARY GOALS • Make mental wellness a priority issue for policy makers • Make mental wellness a priority among program administrators

3. OBJECTIVES • Establish the business case for aging and mental health issues • Support policies & programs that advance education & training • Support policies & programs that advance outreach & clinical services

4. The Business Case • Demographic imperative • Quality of life • Funding Issues

5. Demographics

6. The Demographic Imperative

7. Iowa Nursing Home Population Avg. % per Facility National Avg.

8. Quality of Life or provide flexible options for community-based mental health care substantiated by evidenced-based treatment. Warehousing older adults with mental health issues . . .

9. Funding Issues Medicare Expenditures • Total Health Expenditures: $211.4 Billion • Total Mental Health Expenditures: $1.2 Billion (0.57%) • Outpatient Mental Health: $ 718 Million (0.34%)CMS, 2001

10. Funding Issues Medicare Expenditures

11. Outreach & Clinical Services WorkgroupPRIMARY GOALS • Increase public awareness about aging and mental health issues • Expand the supply of qualified mental health service providers

12. Education & Training WorkgroupOBJECTIVES • Facilitate provider training • Conduct public education campaign

13. Support policies & programs that advance education & training • Training conferences – Public Health Conference, June 2006 – Family Practice Association August in 2006 – Mental Health Issues in Long Term Care, November 2006 – Iowa Community Mental Health Centers, March 2007 – Iowa Psychological Association, April 2007 • Online training administration – Iowa Geriatric Education Center – University of Iowa – John A. Hartford Center of Geriatric Nursing Excellence – University of Iowa • Online training participation– Facilitate use of web-based training programs in mental health and aging

14. Support policies & programs that advance education & training • Continuing Education Requirements – Administer continuing education opportunities for licensed providers across the state – Support graduate training in medicine, nursing, psychology, social work and pharmacology that focus on mental health and aging.

15. Education & Training Workgroup Public Education • Fact Sheets • Conference Displays • Annual Mental Health Conference, October 2006 • Long Term Care Conference, November 2006 • Gerontology Society of Iowa, April 2007 • Iowa Psychological Association, April 2007 • Governor’s Conference on Aging, May 2007 • Media • Website Resources – www.ICMHA.org

17. Education & Training Workgroup Primary Objectives • Promote mental wellness among older Iowans • Increase the number of mental health providers who are qualified to treat older Iowans • Integrate qualified mental health service providers into usual places of care delivery

18. Support policies & programs that advance outreach & clinical services • Increase payments to non-physician mental health providers (Medicare, Medicaid, and supplemental insurance) • Support inclusion of older adults in Iowa Peer Support Training Academy

19. Support policies & programs that advance outreach & clinical services • Screening efforts integrated into other preventive servicesOpportunities: Mental health screenings at County Fairs, Meal Sites, Senior Centers, Long-Term Care Institutions, and Home and Community-Based Care Centers (e.g. Case Management for Frail Elders Program)

20. Support policies & programs that advance outreach & clinical services • Screening efforts integrated into other preventive servicesAdvantages: • Reduce ER Admissions • Monitor compliance locally • Reduce costs and stabilize population • Opportunity to serve greater numbers, more effectively at lower costs (e.g. co-location of care)

21. Support policies & programs that advance outreach & clinical services • Increase payments to non-physician mental health providers (Medicare and Medicaid) in long-term care institutions and community-based settings. • Promote and monitor use of tele-health in long-term care settings– IFMC’s Nursing Home Quality Initiative

22. Nursing Homes Nursing Home Quality Initiative IFMC, Iowa’s Medicare Quality Improvement Organization (QIO) offers assistance at no cost to nursing homes by providing education, identifying improvement opportunities and sharing valuable resources and best practices. The focus of IFMC’s Nursing Home Quality Initiative is to assist nursing homes in providing the best possible care for their residents. These services include improving care processes and setting improvement targets for pressure ulcers, restraints, depression and chronic pain.

23. Nursing Homes Nursing Home Quality Initiative (continued) Additionally, IFMC is working with nursing homes to increase resident and staff satisfaction through work on organizational culture change and implementing person-centered care. Our Nursing Home Quality Initiative combines this assistance to improve quality of care with information for consumers about the quality of care provided by nursing homes available at www.medicare.gov.

24. Ask the ExpertI am a psychologist who services the geriatric population. Can you direct me to resources which are related to the use of psychotherapy with mildly demented patients? Would like Screening questions to be used on an acute care hospital nurse admission history to screen for suicide. Would appreciate an evidenced based tool that is quick and easy to use. I am working with a client who is exhibiting symptoms of depression; what is the age range criteria to get an adequate score with the Geriatric Depression Scale? I am a licensed Psychologist who works in nursing homes and long term care facilities with geriatric patients. What short screening tests might you use to measure anxiety with this population?

25. Support policies & programs that advance outreach & clinical services • Establish primary care – mental health care collaborative models • Collaborate with primary care, aging services, residential care facilities, and home and community-based services • Encourage continuity of care between inpatient and community-based services/preventive services

26. Support policies & programs that advance outreach & clinical services • Replicate Employee Assistance Programs which offer mental health screenings and community-based treatments that have demonstrated patient success in treatment at significantly lower costs per patient over inpatient care.

27. Support policies & programs that advance outreach & clinical services • Document successful behavioral interventions-evidence-based for the reimbursement stream • Develop health networks linking mental health providers and rural populations to primary care, public health, substance abuse programs, and nursing care

28. Iowa Coalition on Mental Health & Aging2008 Policy Agenda National InitiativesH.R. 3162 – Children’s Health and Medicare Protection Act of 2007, Introduced by Rep. John Dingell on 7/24/07, Passed by U.S. House 8/1/07 Highlights: • Gradually provides parity between Medicare mental health services and services for physical conditions; • 5% increase for Medicare Part B payments to social workers and psychologists; • 0.5% increase in current physician payment system, impacting mental health providers;

29. Iowa Coalition on Mental Health & Aging2008 Policy Agenda Highlights (H.R. 3162 continued): • Medicare reimbursement to services provided by marriage and family therapists; • Authorizes new benefits for preventive items and services, including mental health services; • Include benzodiazepines in required coverage under Medicare Part D prescription drug program; • Reduce over-payments to private Medicare Advantage (MA) plans, charges limited to costs under original Medicare plan;

30. Iowa Coalition on Mental Health & Aging2008 Policy Agenda Highlights (H.R. 3162 continued): • Discounted premiums via the Extra Help program for low income participants (Medicare Savings Plan and Part D); • Access to improved drug formularies for name brand and generics; • Prevention of marketing fraud by Medicare Advantage plans Attention is focused in the U.S. Senate which does not have this legislation.

31. Iowa Coalition on Mental Health & Aging2008 Policy Agenda National InitiativesH.R. 1663 – Medicare Mental Health Modernization Act, introduced by Rep. Pete Stark, Chair Health Subcommittee of House Ways and Means with Co-sponsors Rep. Patrick Kennedy and Rep. Jim Ramstad Highlights: • Reduce Medicare’s 50% co-payment for mental health care to the 20% level charged for most other Part B medical services; • Eliminate the 190 day lifetime cap for inpatient services; • Add intensive residential mental health services to Medicare, including crisis services, psychiatric rehabilitation, substance abuse intervention, and other non-institutional mental health care

32. Iowa Coalition on Mental Health & Aging2008 Policy Agenda Highlights (H.R. 1663 continued): • Cover intensive outpatient services, including psychiatric rehabilitation; assertive community treatment; intensive case management; day treatment for individuals under 21 years of age; and ambulatory detoxification; • Expand the types of mental health professionals eligible to provide services through Medicare; • Correct a legislative oversight to permit direct payment under the Medicare program for clinical social worker services provided to residents of skilled nursing facilities;

33. Iowa Coalition on Mental Health & Aging2008 Policy Agenda Highlights (H.R. 1663 continued): • Require the Secretary of the Department of Health and Human Services to conduct a study to examine whether the Medicare criteria to cover therapeutic services to beneficiaries with Alzheimer’s Disease and related cognitive disorders discriminates by being overly restrictive.

34. Iowa Coalition on Mental Health & Aging2008 Policy Agenda National Initiatives H.R. 1669 – Positive Aging Act of 2007, introduced by Rep. Patrick Kennedy, to amend the Public Health Service Act. (Also S. 982, Introduced by Senator Clinton, 4/23/07) Highlights: • Provide grants to states to integrate mental health services in primary care settings; • Fund community-based mental health treatment outreach teams; • Designate a Deputy Director for Older Adult Mental Health Services within the Center for Mental Health Services; • Targeted funds for substance abuse in older adults, homeless, and rural older adults.

35. Iowa Coalition on Mental Health & Aging2008 Policy Agenda National Initiatives Older Americans Act as Reauthorized September 30, 2006Highlights: • Title IV – Activities for Health, Independence, and Longevity, grants to states for rural caregivers, especially for Alzheimer’s patients, creating awareness of organic brain syndromes, depression, and the need for mental health care for older adults; • Funding for mental health screening, prevention, treatment services, planning for Boomers, and multidisciplinary centers for mental health screening;

36. Iowa Coalition on Mental Health & Aging2008 Policy Agenda Older Americans Act as Reauthorized September 30, 2006Highlights (continued): • Title III – Grants for State and Community Programs on Aging, funding for mental health outreach/screening, health education, counseling, preventive assessments and health screenings; • Priority for persons caring for MR, DD and persons with Alzheimer’s Disease. Congress has not passed the 2008 budget bill funding amounts pending

37. Iowa Coalition on Mental Health & Aging2008 Policy Agenda National Initiatives American Association for Geriatric Psychiatry and the Substance Abuse and Mental Health Services Administration (SAMHSA) within HHS, working on a national behavioral health workforce development strategy through a public-private partnership with the Annapolis Coalition on Behavioral Health Workforce Education. These partners are working to build new competencies among providers and educators, among health care organizations and academic institutions. Federal and State agencies, accrediting bodies, health care insurers, and professional organizations

38. Iowa Coalition on Mental Health & Aging2008 Policy Agenda National Initiatives Institute of Medicine has suggested the following to be included in the Fiscal Year 2008 Labor/HHS Appropriations bill: The Committee provides $1 Million for a study by the Institute of Medicine of the National Academy of Sciences to determine the multi-disciplinary mental health workforce needed to serve older adults. The initiation of this study should be not later than 60 days after the date of enactment of this Act, whereby the Secretary of HHS shall enter into a contact with the Institute of Medicine to conduct a thorough analysis of the forces that shape the mental health care workforce for older adults, including education, training, modes of practice, and reimbursement. This matter is pending the approval of the Federal Budget for FY 2008.

39. Iowa Coalition on Mental Health & Aging2008 Policy Agenda State Initiatives • Iowa Coalition on Mental Health and Aging Legislative Breakfast, January 31, 2007 – Over 20 legislators attended and received information on the Coalition and the mental health needs of older Iowans • H.F. 909 (passed) Health and Human Services Appropriations bill, includes $60,000 for Dementia-specific education for Direct Care Workers • S.F. 128 – Tobacco Tax bill, created a Health Care Trust Fund

40. Iowa Coalition on Mental Health & Aging2008 Policy Agenda State Initiatives (continued) • State’s Mental Health Systems Improvement Bill, establishes 6 workgroups including Community Mental Health Center Planning • Proposal to conduct a series of regional meetings on the issue of mental health and aging in cooperation with Area Agencies on Aging • Potential funding via the Older Americans Act mental health and aging initiatives via the aging network and collaborations with community-based providers

41. Iowa Coalition on Mental Health & Aging2008 Policy Agenda State Initiatives (continued) • Continue letter writing in support of Federal initiatives, attending caucus meetings, and planning for the 2008 Iowa Legislative Session • Iowa Coalition on Mental Health and Aging Legislative Breakfast, to be held January 31, 2008, 7:00-9:00 am, Legislative Dining Room 15