Supportive Housing Association of NJ January 4, 2012 Overview of the Division of Mental Health and Addiction Services I

1. Supportive Housing Association of NJ January 4, 2012 Overview of the Division of Mental Health and Addiction Services Initiatives

2. 2 AGENDA Mission, Vision and Values Merger Housing Related Updates Involuntary Outpatient Commitment Requests for Proposals Hagedorn Psychiatric Hospital Update Medicaid Comprehensive Waiver Application Informational Forums

3. 3 MISSION Our Mission - Wellness Recovery Prevention DMHAS, in partnership with consumers, family members, providers and other stakeholders, promotes wellness and recovery for individuals managing a mental illness, substance use disorder or co-occurring disorder through a continuum of prevention, early intervention, treatment and recovery services delivered by a culturally competent and well trained workforce.

4. 4 VISION Our Vision – Laying the Foundation for Healthy Communities, Together DMHAS envisions an integrated mental health and substance abuse service system that provides a continuum of prevention, treatment and recovery supports to residents of New Jersey who have, or are at risk of, mental health, addictions or co-occurring disorders. At any point of entry the service system will provide prompt and easy access to appropriate and effective person-centered, culturally-competent services delivered by a welcoming and well trained work force. Consumers will be given the tools to achieve wellness and recovery, a sense of personal responsibility and a meaningful role in the community.

5. 5 VALUES Our Values – We are driven by our values We value consumer’s dignity and believe that services should be person-centered and person-directed We value the strength of consumers, their families and friends because we believe it serves as a foundation for recovery We value our partner agencies and believe in their commitment to professionalism, diversity, hope and positive outcomes We value evidence-based practices and believe that consumer-informed and peer-led services improve and enhance the prevention and treatment continuum We value the public trust and believe that it is essential to provide effective and efficient services

6. 6 Table of Organization is developed and posted on the website Units will begin to be co-located Reports from Consumer Forums and Stakeholder Survey are posted on the website and can be found at: http://www.state.nj.us/humanservices/divisions/dmhas/merger.html

7. Office of the Assistant Commissioner – Lynn Kovich Disaster and Terrorism Branch - Adrianne Fessler-Belli Governor’s Council on Stigma – Vacant Office of the Deputy Director – Raquel Mazon Jeffers Office of Fiscal and Management Operations –Steve Adams Office of Human Resources – Valerie Bayless Office of Information Technology – Roy Roldan Office of Legal and Regulatory Affairs – Lisa Ciaston Office of the Medical Director – Dr. Robert Eilers Office of Quality Assurance – Rosita Cornejo Office of State Hospital Management – John Whitenack

8. Office of the Deputy Director – Raquel Mazon Jeffers Office of Care Management - Mollie Greene Office of Prevention, Early Intervention and Community Support – Roger Borichewski Office of Research, Planning and Evaluation - Vacant Office of Treatment and Recovery Supports – Valerie Larosiliere

9. Non Elderly Disabled Voucher Program DHS was given 100 vouchers, and about 120 referrals have been made. DMHAS was given 34 vouchers, and has made 40 referrals. No further referrals will be made unless the original NED vouchers become available for re-distribution in the future.

10. Regulation The regulations for “Supportive Housing and Supervised Residential Services for Adults with Mental Illness” are currently being drafted to include the provisions of the State Plan Amendment under Title XIX (Medicaid) for Mental Health Community Support Services. There was one informal public meeting to discuss themes in the regulations. The official public hearing will be held after the regulations are published. The draft is expected to be completed by the end of April, 2012.

11. Every type of housing for adults with mental illness regulated by this chapter shall be operated in accordance with supportive housing principles, to the extent practical. Supervised residential services are those which have been known as Level A+ and A housing and family care homes. Housing previously known as Level B and C shall be converted to supportive housing. REGULATIONS Rates MAY come up. We set rates by credential/rate band, per 15 contiguous minute units of FTF.  What WILL come up is the concern, (completely valid in some cases, not others) regarding additional resources that may be necessary to implement CSS. . As inquiries have been coming to our attention for some time now, we developed and contract administrators are using the language below (nothing more / nothing less) to allay some of the fears and anxiety regarding this worthy initiative.  Pull what you want or just copy and paste for Lynn’s use. The impact of the CSS regulations is expected to be budget-neutral for providers.  That is, any contractually agreed upon increases in costs necessary to implement the regulations and billing activities are expected to be off-set by Medicaid billing.  Providers will be tasked with identifying any additional costs that they expect to incur as a result of data collection, quality assurance, billing and follow-up activity.  There may be more or less impact on providers depending on the level of staff currently delivering services.  DMHAS intends to fully evaluate any requests for additional resources required to bring programs into compliance with the regulations published.  We are preparing a communication to providers impacted by these regulatory changes requesting information about the anticipated budgetary implications.  Rates MAY come up. We set rates by credential/rate band, per 15 contiguous minute units of FTF.  What WILL come up is the concern, (completely valid in some cases, not others) regarding additional resources that may be necessary to implement CSS. . As inquiries have been coming to our attention for some time now, we developed and contract administrators are using the language below (nothing more / nothing less) to allay some of the fears and anxiety regarding this worthy initiative.  Pull what you want or just copy and paste for Lynn’s use. The impact of the CSS regulations is expected to be budget-neutral for providers.  That is, any contractually agreed upon increases in costs necessary to implement the regulations and billing activities are expected to be off-set by Medicaid billing.  Providers will be tasked with identifying any additional costs that they expect to incur as a result of data collection, quality assurance, billing and follow-up activity.  There may be more or less impact on providers depending on the level of staff currently delivering services.  DMHAS intends to fully evaluate any requests for additional resources required to bring programs into compliance with the regulations published.  We are preparing a communication to providers impacted by these regulatory changes requesting information about the anticipated budgetary implications. 

12. 12 In April 2011 DMHAS convened an IOC Advisory Committee comprised of representatives from consumer and family organizations, providers, the court system and DMHAS staff Members of the IOC Advisory Committee also participated in 2 subcommittees that were convened The Screening Subcommittee The Court Procedures Subcommittee The IOC Advisory Committee and the 2 subcommittees concluded its deliberations in July 2011 The Screening subcommittee reviewed various clinical models that could be used by an IOC provider. The subcommittee also considered core requirements that were viewed as important to the successful implementation of IOC programs. The Court Procedures subcommittee addressed aspects of the court system that will be impacted by the implementation of IOC. The subcommittee also reviewed topics such as expert testimony at the hearings and the process for addressing IOC non-adherence. The Screening subcommittee reviewed various clinical models that could be used by an IOC provider. The subcommittee also considered core requirements that were viewed as important to the successful implementation of IOC programs. The Court Procedures subcommittee addressed aspects of the court system that will be impacted by the implementation of IOC. The subcommittee also reviewed topics such as expert testimony at the hearings and the process for addressing IOC non-adherence.

13. 13 The IOC RFP is completed and going through the internal approval process We hope to post the RFP in early January DMHAS intends to select programs that give wide representation to diverse areas of the state, both demographically and geographically, keeping in mind the availability of needed ancillary resources in each area The IOC Advisory Committee will reconvene after the RFP is published

14. RFP Update Preliminary awards have gone out for the Supportive Housing proposals for the “At Risk” population. Final awards will be made on 1/12/12. Preliminary awards for the RIST/PACT expansion are scheduled to be mailed out 1/10/12. Final award notifications are expected by 1/24/12. Atlantic County RIST proposals are due on 1/11/12. Preliminary awards are due 2/22/12, and final notifications are due out by 3/7/12.

15. The DMHAS is preparing a joint RFP for Supportive Housing to serve the CEPP dually diagnosed SMI/DDD population. We expect to serve approximately 20 individuals in this initiative. The DMHAS is also preparing an RFP for Supportive Housing services for CEPP consumers with legal issues. The target population will be those in Ancora and TPH and involves 25 consumers. DMHAS also intends to develop a Supportive Housing RFP to target 25 Hagedorn consumers on CEPP. RFP UPDATE

16. 16 RFP UPDATE, cont. DMHAS issued an RFP for start up funds to support the provision of integrated mental health and addictions treatment for Drug Court clients who present with co-occurring disorders Proposals were due on November 30, 2011 and announcement of awardees is expected in early 2012 DMHAS has issued an RFP for Cultural Competence Training Centers Proposals were due December 5 and preliminary awards will be announced January 19, 2012

17. 17 September 6, 2011 – HPH closed admissions to younger adult population October 3, 2011 - HPH closed admissions to older adult population June 30, 2012 – HPH will close

18. 18 All consumers from HPH Catchment area will be served by GPPH October 3, 2011 – Geriatric patients from Ocean County will go to APH October 3, 2011 – Burlington residents of all ages will return to APH’s catchment area. Legal patients with serious criminal charges from all catchment areas will continue to be admitted to AKFC Patients with lesser charges will continue to be admitted to TPH or APH depending on catchment area.

19. 19 Closure Process, cont… Geriatric consumers to GPPH based on: Current Census numbers and projections indicate that GPPH would best accommodate the older adult transfers and future admissions Ability to create fully enclosed living and treatment space in two shared GPPH units with properly trained staff

20. 20 HAGEDORN CLOSURE December Census Total census for all hospitals on 12/1/11 =1761 Total final census for all hospitals on 12/31/11 =1767 Total census for Hagedorn on 12/1/11 = 177 Total census Hagedorn on 12/31/11=167 Total discharges for Hagedorn from 12/1/11–12/31/11 =10  Total transfers from Hagedorn 12/31/11 = 0 FYI – Where they went 1 to Alternative Housing 2 to Assisted Living 1 to a group home 1 to Hospice Two to Nursing Homes One to out of state family 1 to a RIST Apt.FYI – Where they went 1 to Alternative Housing 2 to Assisted Living 1 to a group home 1 to Hospice Two to Nursing Homes One to out of state family 1 to a RIST Apt.

21. 21 Census as of 12/31/11 at Hagedorn = 167

22. 22 New Jersey Medicaid Comprehensive Waiver submitted to Medicaid on September 9, 2011 The BH design is linked with the vision: To improve access to appropriate physical and BH care services for individuals with mental illness or substance use disorders To better manage total medical costs for individuals with co-occurring BH-PH conditions To improve health outcomes and consumer satisfaction

23. 23 The BH goal of the Waiver is to integrate mental health and addictions, integrate behavioral health and primary care, prepare for Health Care Reform under ACA (January 2014), and to sustain the Medicaid program through savings initiatives The merger of DMHS and DAS into DMHAS lays the foundation to build a combined system that provides best practice treatments for individuals with co-occurring mental illness and substance use disorders

24. 24 Development of an ASO Behavioral Health Homes MCO/MBHO coordination Braided funding Opportunities for rate rebalancing No risk transitioning to risk Children, SAI and consumers with developmental disabilities Integrated Care SA/MH and BH/PH Increased FFP Medicaid service expansion for SA services Potential reinvestment of savings Potential for Medicaid reimbursement under the risk arrangement to support first 30 days of residential community-based services in lieu of acute care

25. Understanding Medicaid Benefit Changes for Mental Health Medications To Be Announced Three Forums in January 2012 MEDICAID INFORMATIONAL FORUMS

26. Questions and Comments??? THANK YOU