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Texas Initiative for Program Success & Sustainability Leadership Summit January 10, 2011 David Lakey, M.D. Commissioner Texas Department of State Health Services. Outline. Review of recent substance abuse data Recent accomplishments related to substance abuse efforts The session

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Outline

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  1. Texas Initiative for Program Success & Sustainability Leadership SummitJanuary 10, 2011David Lakey, M.D.CommissionerTexas Department of State Health Services

  2. Outline • Review of recent substance abuse data • Recent accomplishments related to substance abuse efforts • The session • DDRAC recommendations • The budget

  3. Leading Causes of Death Texas 2005 and 2001 3 DSHS Center for Health Statistics

  4. Actual Causes of DeathShaped by Behavior Chronic Disease in Texas 2007, DSHS 4

  5. The Costs of Substance Abuse in Texas • In 2009, ~24,500 Texans died as a result of smoking • Of the 2,865 newly reported AIDS cases in 2008, 15.5% were drug related • ~ 75% of Texas prisoners are involved with alcohol or drugs • 47% of Texas motor vehicle fatalities (2009) were alcohol-related • 23% of fatally injured drivers tested in Texas were found positive for drugs (2009) • The cost related to alcohol and drug abuse to Texans (2007) was ~ $33 billion • This includes health care, lost productivity, motor vehicle accidents and crime • Annual per capita cost for Texas residents: $2,800

  6. PAST-MONTH CIGARETTE USE AMONG ADULTS IN TEXAS AND THE UNITED STATES, NSDUH, 2002-2007

  7. PAST-MONTH CIGARETTE USE AMONG YOUTH IN TEXAS AND THE UNITED STATES, 2000-2008

  8. PREVALENCE OF CURRENT CIGARETTE SMOKERS IN TEXAS AND THE UNITED STATES (AGE-ADJUSTED), BRFSS, 2000-2009

  9. PERCENTAGE OF TEXAS MUNICIPALITIES WITH SMOKE-FREE ORDINANCES, BY NUMBER OF SMOKE-FREE SETTINGS, 2000-2009

  10. Past-Month Binge Drinking among Adults, 2002-2007 Source: National Survey on Drug Use and Health – State Estimates, Office of Applied Studies, Substance Abuse and Mental Health Services Administration.

  11. Alcohol Use in the Past Month among Youth (Grade 7 to 12) by Sex, Texas School Survey, 2000-2008 Sources: Texas School Survey of Substance Use Among Students: Grades 7-12, Texas Department of State Health Services.

  12. Binge Drinking in the Past Month among Youth (Grade 7 to 12) by Sex, Texas School Survey, 2006 and 2008

  13. Past-Year Illicit Drug Use among Adults in Texas, Ages 18 to 25, NSDUH 2002-2007 Source: National Survey on Drug Use and Health – State Estimates, Office of Applied Studies, Substance Abuse and Mental Health Services Administration.

  14. Past-Year Illicit Drug Use among Adults in Texas, Age 26 and Older, NSDUH, 2002-2007 Source: National Survey on Drug Use and Health, Office of Applied Studies, Substance Abuse and Mental Health Services Administration.

  15. Recent Accomplishments of the Texas’ SA Programs • The number of youth served • Over the past four years has increased from 1 to 1.5 million • Decrease in smoking rates • 17.9% for adults and 12.5% for youths grades 7-12 (2009) • Clinical Management of Behavior Health Systems • Rollout began to substance abuse providers December 2009: full deployment was reached in September 2010 • Roll out of the Medicaid Substance abuse Benefit

  16. Medicaid Substance Use Disorder (SUD) Benefits • The 2010-11 General Appropriations Act (Article IX, Section 17.15 of S.B. 1) directs HHSC to: • provide Comprehensive Substance Abuse Services in Medicaid to adults with substance abuse disorders; and • analyze and provide data to the Legislative Budget Board (LBB) on the provisions of substance abuse services and discontinue the benefit if services increase overall Medicaid expenditures.

  17. Service Delivery System and Eligible Persons • Applies to all Medicaid recipients • Applies to all of Medicaid: managed care and fee for service (FFS)/primary care case management (PCCM), and STARHealth • Some benefits may not be clinically appropriate for certain age groups

  18. The Benefits • The new benefits were implemented in 2 phases • Phase I Benefits began on September 1, 2010, and included: • Assessment • Ambulatory Detoxification (in STAR and STAR+PLUS managed care only) • Outpatient Counseling • Medication assisted therapy (MAT)

  19. The Benefits (cont.) • Phase II Benefits began on January 1, 2011, and included: • Ambulatory detoxification (Traditional Medicaid and Primary Case Care Management [PCCM]) • Residential Detoxification • Residential Treatment Services

  20. Medicaid Substance Use Disorder Challenges • This is a complicated and unfamiliar process • There are multiple administrative entities involved: DSHS, HHSC, CMS, CSAT, Texas Medicaid Healthcare Partnership (TMHP), Medicaid Managed Care Plans, Providers, other stakeholders • Challenges can be overcome with continued commitment and effort by state staff, Medicaid payers and provider community

  21. Opportunities • This is an opportunity to • expand clinically effective, cost efficient services to a needed population • expand services • demonstrate the value of treatment, the impact that it has on people and society, and elevate the stature of the profession • Provides opportunities for providers to broaden their payor mix and expand their revenue streams

  22. Drug Demand Reduction Advisory Committee (DDRAC) The 77th Texas Legislature (2001) passed Senate Bill 558 establishing the DDRAC with a mandate to develop comprehensive statewide strategy and legislative recommendations that will reduce drug demand in Texas 16 state agencies must participate in this effort, as well as 5 at-large members from different geographical areas within the state

  23. DDRAC Recommendations • Border • Recruitment and Retention of Service Professionals • Uniform Individual Accident and Sickness Policy Provisional Law (UPPL) • Texas Prescription Drug Monitoring Program • Statewide Indoor Smoking Ben • Higher Education Alcohol and Other Drug Enforcement

  24. DDRAC Border Recommendation • Strengthen the prevention and treatment infrastructure along the border. • Provide increased security and threat assessment training for unarmed individuals in high-risk employment fields. • Target border counties for Workforce Reinvestment Act (WIA) funds to incentivize chemical dependency field. • Provide additional funding in support of the Rural Border Initiative (RBI) and other programs that focus on services to border populations.

  25. DDRAC Recruitment and Retention of Service Professionals Recommendation • Support recruitment and retention of quality service professionals in the field of substance abuse prevention and treatment by reducing or eliminating barriers to entering the workforce and maintaining high standards of professional development

  26. DDRAC Recruitment and Retention of Service Professionals Recommendation • Require that local workforce boards be informed and educated about the substance abuse profession as a high-demand occupation. • Establish and disseminate reciprocity guides for each state and all branches of the military. • Create an effective strategy to promote the licensed chemical dependency counselor (LCDC) profession by increasing public awareness through state interagency efforts of information dissemination. • Promote access to a peer assistance program to support counselors and aid in career retention.

  27. DDRAC Uniform Policy Provision Law Recommendation • Remove the exclusion clause for medical expenses from the Uniform Individual Accident and Sickness Policy Provision Law (UPPL).

  28. DDRAC Smoking Ban Recommendation • Passage of a statewide smoking ban to eliminate smoking in all workplaces and public places nationwide.

  29. DDRAC Prescription Drug Recommendation • Expand the Texas Prescription Drug Program to allow proactive prevention of prescription drug abuse through web-based real-time access to data and automatic email alerts of potential fraud for physicians, pharmacists and law enforcement • Work across agencies to inform parents of prescription drug abuse through a public awareness campaign

  30. DDRAC Higher Education Recommendation • Mandate comprehensive alcohol and other drug reduction strategies targeting college students that include: • Enforcing the campus alcohol and other drug policy violations through • Alcohol screening and brief motivational enhancement interviews • Notifying parents of student violators under age 21 • Appointing campus-wide task forces to address the substance abuse problems and solutions for their campus

  31. State Agency Budget Reductions • In January 2010, the Governor's Office of Budget, Planning and Policy requested state agencies to identify potential savings totaling 5% of GR for the FY 2010-11 budgets • Agencies were urged to identify prudent reductions that would minimize the impact on direct services • Substance abuse items were not included by DSHS/ HHSC • An additional10% in budget reduction options for 2011-13 was requested in May • December, 2010 letter directed state agencies to identify an additional 2.5% budget reduction in current year • Substance abuse items were not included by DSHS/ HHSC

  32. Ten Percent Reduction Options (By Strategy)

  33. FY 2010-11 Appropriations(By Goal)

  34. Total 10% Reduction Schedule

  35. Approach to Exceptional Items • Maintain current level of services • Federal and state regulation • Moving health forward in Texas

  36. Exceptional Item Request

  37. Hospital/Jail Diversion Projects • The proposed jail diversion programs will provide behavioral health treatment and screen for infectious diseases • Adult Mental Health – ACT, Supported Housing • Children’s Mental Health – WRAP around • Substance Abuse - ATR

  38. Expansion for Border Services • In response to high levels of drug trafficking and violence along Texas’ borders, DSHS also proposes increasing access to prevention and treatment services in key border communities • Increased access to Prevention services • Increased access to Substance Abuse Treatment services • Expansion of Rural Border Intervention Activities

  39. Enhancement of CMBHS • DSHS seeks to expand the capacity of CMBHS to support these projects • Additional functionality and certifications • Support for jail diversion activities and voucher management system • Physician support functionality, E-Prescriptions Interface and other required functionality to implement the exceptional item projects

  40. Summary • Substance abuse continues to be a driver of • poor health in Texas • high societal costs • Progress has been made in some areas, especially in to tobacco • Significant challenges still in alcohol and illicit drugs in Texas • New opportunities related to Medicaid Substance Abuse Benefit • The session • DDRAC recommendations • The budget

  41. Thank You!

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