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Using Medicaid To Transform Public Mental Health Services

Using Medicaid To Transform Public Mental Health Services. Glenn A. Stanton, M.A. State Mental Health Olmstead Coordinator’s Training Institute Georgetown, September 23, 2003. Importance of Language. “Using” Medicaid

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Using Medicaid To Transform Public Mental Health Services

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  1. Using Medicaid To Transform Public Mental Health Services Glenn A. Stanton, M.A. State Mental Health Olmstead Coordinator’s Training Institute Georgetown, September 23, 2003

  2. Importance of Language • “Using” Medicaid • Utilizing Medicaid as ONE resource to assist in the transformation of public mental health services • While MA is the single largest public payer, State GF/GP, SAMHSA, Private Pay are all needed to meet the demand

  3. Importance of Dialog • New Freedom Commission on Mental Health - Communication between MH Authorities and Single State Medicaid Agencies • This meeting and the inclusion of CMS staff (Peggy, Shawn, Alissa, Kate, Linda) • Future CMS/SAMHSA facilitation between MHA and SMD

  4. Culture of Responsiveness • Initiative by Secretary Thompson and Administrator Tom Scully to be responsive to the needs of CMS Stakeholders, including its State partners • This requires CMS to spend more time listening, finding solutions, and taking more timely action (even if it means saying no) • Examples include: • National Account Representatives • National Open Door Forums

  5. President Bush’s New Freedom Initiative • February 1, 2001 • Swift Implementation of ADA/Olmstead • Executive Order 13217 – Alternatives to Community Living • Presidential Commission on Mental Health

  6. Executive Order - 13217 • Alternatives for Community Living • 10 Federal Agencies to identify barriers • Public Testimony • Report to President March 2002 • TA to States re: MA funds for persons with MI and Co-Occurring Disorders • Residential Alternatives for Children with SED

  7. Executive Order - 13217 • Independence Plus • Facilitate states development of self-directed services • 1915c and 1115 Options • Individual budgets with options in “own homes”

  8. New Freedom Commission on Mental Health • CMS as an Ex-officio Member • One of Two Members Representing Payers of Mental Health Systems • Medicaid Sub-committee

  9. New Freedom Commission on Mental Health Recommendations • Medicaid/Medicare Reform • Demonstrations • President’s ’04 Budget Proposals • New Demonstrations • Self-directed services • IMD Alternatives • Technical Assistance – Evidenced-Based Practices • Facilitation of Medicaid Buy-In Options

  10. Self-Direction • Choice & Control • Menu Options & Personal Relationships • Collective voice and Individual Control • Medical Care vs. Rehabilitation/supports • Complications of court ordered treatment and medical liability, but not unsolvable

  11. CMS Actions • Dialog • Technical Assistance • Resources • Grants • Federal Financial Participation for Medical Assistance

  12. Emerging Roles for CMS Within Mental Health • Dialog • New Freedom Commission on Mental Health • NASMHPD Medicaid Summit • Open Door Forum – August 27, 2003 • Olmstead Coordinator’s Training Institute • “Paired” MHA/SMD Meetings • SAMHSA/CMS Mental Health Conference

  13. Emerging Roles for CMS Within Mental Health • Technical Assistance • Participation with SAMHSA – Policy Papers & ACT Guidance/Budget Model • Participation with ASPE – Medicaid Handbook for Mental Health (HSRI) • Evidenced-Based Practices Guidance • Self-Direction for Persons with Mental Illness

  14. Emerging Roles for CMS Within Mental Health • Resources - System Change Grants • $80 Million in FY ’01 & ‘02 • NF Transition • C-PASS • Real Choice Systems Change

  15. ’03 Budget - Systems Change Grants • Feasibility Studies/Development Grants • Respite Adults/Children • RTF Alternatives • Research and Demonstration Grants • QA/I HCBS • Independence Plus • Money Follows the Person • Community Integrated Personal Assistance Services

  16. ’04 President Budget Proposal • Money Follows the Person - $1.75 Billion • Respite for Adults • Respite for Children • Alternatives for Children’s RTFs • Systems Change Grants - $40 Million

  17. Evidenced-Based Practices • New Freedom Commission on Mental Health call for transformation of a fragmented system • “Pay for What Works” – Dennis Smith, Director Center for Medicaid & State Operations • Federal Law Requires that the State’s Medicaid Plan is administered in a method which assures the “proper and efficient operation of the plan”

  18. Evidenced-Based Practices • Medicaid can play a major role in supporting the health care/medical components of EBPs • Tools: • State Plan Options (Rehabilitation, Clinic Services, Prescribed Drugs, Case Management) • Managed Care Savings (1915b) • Research Demonstrations (1115)

  19. State Plan Services • Offered State-wide • Sufficient in amount, scope and duration to reasonably achieve their purpose • Comparable among eligibility groups

  20. Required Elements in SPA • Medical/Rehabilitative Services (which can be described in coverage policy, not simply principles) • Provided directly to, or for the exclusive benefit of, Medicaid-eligible beneficiaries • Qualified Providers • Reimbursement Methodology to assure payments are consistent with economy, efficiency and quality of care • Non-duplicative with other federal agency responsibilities

  21. EBPs Identified by SAMHSA • Family Psycho-education • Illness Management & Recovery • Medication Management Approaches in Psychiatry • Supported Employment • Co-Occurring Disorders: Integrated Treatment • ACT

  22. EBP will Medicaid Pay? • Emphatic – MAYBE • ACT - Well established model that more than 30 states fund using MA in part • Illness Management and Recovery – (psycho-ed with beneficiary, management of meds, relapse prevention, coping skills training) could be covered with a focus on the provider and their qualifications

  23. EBP will Medicaid Pay? • Medication Management – Practice description that includes monitoring activities by non-physician members. Consistent with state practice acts? • Family Psycho-social Education – who is the recipient and the beneficiary of the service. When does the intervention become treatment for a non-Medicaid eligible individual?

  24. EBP will Medicaid Pay? • Supported Employment – Vocational training is statutorily excluded as a Medicaid benefit, and may not replace other federal funds directed to this purpose. However, the surrounding supports described in SE could well be covered. (e.g., psycho-social clubhouse services) • Integrated Treatment – Matching Practice to Coverage policy is difficult

  25. EBP will Medicaid Pay? • For State Plan Option services, the focus is on the State’s description of the service, the provider (and their qualifications), and the rate setting methodology • For Managed Care programs, the focus is on what is allowed in the state plan prior to managed care and what is funded through savings.

  26. Conclusion • CMS is committed to a culture of responsiveness and the President’s New Freedom Initiative • CMS strives to improve access to quality health care services for aged and disabled Medicaid recipients through Dialog, TA and Financial Resources • “CMS Assistance” will no longer be an Oxymoron

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