Transcript Title

Department of Health and
Mental Hygiene
Behavioral Health Services
2013 and Beyond
Integrating Mental Health and Addiction
Treatment in Maryland
Tuerk Conference
April 9, 2013
Behavioral Health Services
Mental Hygiene Administration
Developmental Disabilities Administration
Alcohol and Drug Abuse Administration
Forensic Services
Residents Grievance System
Mental Hygiene Administration
today
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5 regional facilities (one with an adolescent unit)
2 child and adolescent residential facilities
130,000 + served; Budget: over $1 billion
Funds the Specialty Mental Health Service System for Medicaid
and the uninsured
o Fee for service reimbursement
o Authorization for services based on medical necessity
 Funds the Specialty Mental Health Service System for Medicaid
and the uninsured
 Core Service Agencies function as the local mental health
authority
Mental Hygiene Administration
 Program-specific regulations include: appeals process, due process,
provider requirements
o Various levels of oversight-MHA, OHCQ, MHA, Medicaid
 Coordination of care through case managers, ASO, CSAs
 Value Options Maryland-Administrative Service Organization (ASO)
o manages utilization, authorization, auditing, data collection and
reporting
o coordinates with providers and manage care organizations
o facilitates collaboration with other state serving agencies
 MHA audits appropriateness of clinical decision making and
compliance with contract
Alcohol and Drug Abuse
Administration
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49,762 persons served in FY2012
Budget of approximately $150,000,000
Grant funds for ambulatory (uninsured only), residential and recovery
services.
Grant funds awarded to jurisdictions for allocations based on service needs.
MCOs receive funding for ambulatory substance abuse services
Levels of care determinations based on ASAM II criteria
Public health initiative
– Maryland Center of Excellence on Problem Gambling
– Overdose Prevention Initiative
– Smoking Reduction Initiative
Alcohol and Drug Abuse
Administration Today
 ADAA funds specialized programs
– Buprenorphine Initiative
– Methadone clinics
 Regulations
– OHCQ
– Medicaid
– ADAA
– Federal government
 MCO-specific Administrative and clinical management
– Each MCO determines authorization for services
 SMART program – collects data, has EHR
DHMH-Behavioral Health
Services Beyond 2013
Mission:
 To develop and manage an outcome guided
behavioral health service delivery system:
 Integrating prevention, health disparities,
recovery principles evidence based practices and
cost effectiveness
Integration-Why now?
• Leading causes of death
• Co-morbidity of somatic and behavioral health
conditions
• Expansion of health care access
• Need for consumer specific outcome measures
and population specific outcome measure
• Performance measures to effectiveness of
treatment services
Integration-Why now?
 Improve communication between providers and
consumers and health care managers
 Engage consumers in managing illness and recovery
 Continuity of care
 Reduce fragmentation in the service delivery system
 Outcome driven process for administrative and clinical
decision making
 Reduce disparities in health care
 Reduce morbidity and overall cost of care
 Expand role to include public health initiatives
Status of IntegrationFinancing Model
FINANCIAL MODEL
– Recommendation – Behavioral Health Administrative Service
Organization that manages carved out funding for substance
abuse and mental health treatment integrating evidence based
practices and performance risk
– Next steps:
• Collaboration between DHMH agencies
• Draft next ASO request for proposal
• Obtain stakeholder input
Status of the Integration of the
Regulations
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Objective: Maintain quality of care
– Maintain access to clinically appropriate services
– Remain consumer sensitive and welcoming
– Address both mental health and substance abuse service delivery systems
 Strategy: Accreditation
– Consistent with current medical practice
– Sets minimum standards
– Reduces redundancy
– Simplification of the regulations with some degree of flexibility
– Integrates evidence based practice
 Regulations to address services not covered by accreditation
Merger of the Administrations
GOALS:
• Maintain the strengths of both agencies – MHA & ADAA
• Align the Behavior Health Administration more closely
with a public health oriented agency.
• Engage administrative representatives and stakeholders
• Establish new guidelines that reflect the changing role of
the local authorities
• Provide for ongoing cross-training and agency
collaboration
Status of the Integration of the
ADAA and MHA
• Update organizational chart to reflect expansion of the public
health mission and restructured oversight
– Overdose Initiative, Suicide Commission, Drug Monitoring,
Smoking Reduction, Primary care consultation, Problem
Gambling, Early Intervention
• Monitor attrition, gaps in staffing, changes in the
administration, liaisons with other departments,
• Propose statutory/regulatory language for the consolidation of
the agencies
• Continue with cross-training of DHMH, MHA and ADAA staff
Proposed Organizational Chart
Next Steps
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Jurisdictional needs assessment
Jurisdictional diversity:
– Integrated administrative systems
– Access to services within the jurisdictions
– Population specific needs
– Data collection and reporting
Continue with merger process, cross training, agency collaborations
Identify programming needs, operational needs
Develop a provider “toolkit”
Engage stakeholders in the process to identify provider and consumer
transitional needs and outcome measures
Establish communication process and formal timeline
Acknowledgements
• Consumers, Providers, Elected Officials, Local
Health Departments and staff
• Brian Hepburn, M.D., Executive Director of the
Mental Hygiene Administration
• Charles Milligan, JD, MPH, Deputy Secretary for
Health Care Financing
• Kathleen Rebbert-Franklin, LCSW-C, Acting
Director of ADAA