Transcript Leadership Briefing Outline - The Association of Substance Abuse

Report from DSHS
Mimi Martinez McKay
Chief of Staff/Legislative Liaison
DSHS/MHSA
TIPSS Conference
DSHS Report
 FQHC’s in Texas/Health Care Reform
 Drug Demand Reduction Advisory Committee
(DDRAC)



2009 recommendations
UPPL
Workforce
 Substance Abuse Medicaid Benefit

Current Status
Federally Qualified
Health Centers
Opportunities for Behavioral
Health Integration
FQHC Partnerships –Key
Things to Know
 What is a FQHC?
 Scope of service
 Cost-based reimbursement
 BH Expansion Grants for FQHCs
 Provisions in healthcare reform
What are Federally Qualified
Health Centers?
 A federally qualified health center (FQHC) is
a type of provider defined by the Medicare
and Medicaid statutes. FQHCs include all
organizations receiving grants under Section
330 of the Public Health Service Act, certain
tribal organizations, and FQHC Look-alikes.
 A FQHC Look-Alike is an organization that
meets all of the eligibility requirements of an
organization that receives a PHS Section 330
grant, but does not receive grant funding.
Scope of Service
 Provides medical, mental health and dental care to all
regardless on their ability to pay – uninsured or
underinsured
 Provides enabling services such as pharmacy,
transportation, prenatal and family care services,
case management and other basic needs, referrals to
other agencies
 Provides services through all the life cycles-prenatal,
pediatric, adult and geriatrics.
Cost-Based Reimbursement
 Per provider fee for each encounter
regardless of amount of time
 Determined based on costs, prospective
payment
 Potential for increased revenue for psychiatric
visits
 Federal Tort Claims Act liability coverage
 Increased payment for BH staff under this
model too
BH Expansion Grants
 Funding available, often each year, to expand
BH services in FQHC settings
 Most recent application February, 2009
 All New Starts must have behavioral health
services


Direct Hires
Contract with Community Mental Health
Centers (CMHCs)
FQHC Related Provisions in
Healthcare Reform Legislation
Prevention and Wellness Programs:
Based on integration, which includes substance abuse services:
 Establishes a Prevention and Public Health Fund and
appropriates $7 billion in funding for fiscal years 2010 through
2015 and $2 billion for each fiscal year after 2015 for prevention,
wellness, and public health activities, including prevention
research and health screenings, the Education and Outreach
Campaign for preventive benefits, and immunization programs.
 Provides grants for up to five years to small employers that
establish wellness programs.
FQHC Related Provisions in
Healthcare Reform Legislation
 Establishes a demonstration program for health centers to
receive funding for drafting individualized patient wellness plans.
 Directs the President to establish the “National Prevention,
Health Promotion and Public Health Council” composed of the
heads of Federal departments and agencies (including HHS,
DHS, Agriculture, Transportation, FTC, FCC, etc.), dedicated to
promoting “healthy policies” at the federal level, as proposed in
the HELP Committee bill.
 Formally establishes and charges the Community Preventive
Services Task Force to review effectiveness of clinical and
community-based preventive services and make
recommendations.
FQHCs in Texas
 Texas currently has 70 Federally Qualified
Health Centers. For more information on
FQHCs access the directory at:
http://www.dshs.state.tx.us/chpr/FQHCmain.shtm
 The Texas Association of Community Health
Centers can be found at:
http://www.tachc.org/
Professional
Personnel
FTEs
FTEs
%
Group
FTEs
%
Total
Encounters
Encounters
% Group
Encounters
% Total
Patients
Psychiatrists
11.29
13.2
0.2
19,288
26.4
0.6
Licensed clinical
psychologists
2.70
6.6
0.1
14,638
20
0.5
Licensed
Clinical Social
Workers
32.53
37.9
0.6
14,497
19.8
0.5
Other licensed
MH providers
24.30
28.3
0.4
23,452
32.1
0.8
Other MH staff
11.97
14
0.2
1,190
1.6
0.0
Mental Health
Total
85.79
100
1.5
73,065
100
2.4
22,470
Substance
Abuse Total
11.42
100
0.2
44,813
100
1.5
2,330
Financial Costs
Clinical
Service
Accrued
Cost
MH
SA
% of
Category
% of
Total
Allocation
of Facility
and Admin
Total Cost
after
Allocation of
Facility and
Admin
Loaded
Cost,
Including
Overhead
$7,002,350 9.2
1.6
$3,474,737
$10,477,087
2.4
$726,169
0.2
$376,476
$1,102,645
0.3
1.0
Latest BH funding to FQHC’s
Contractor Name:
HSR
FY 10
Approved
Funding
Amount
Community Health Clinics of Northeast Texas
Partner: Andrews Ctr.
2/3
$28,199
Community Health Centers of South Central Texas,
Inc. Partner: Blue Bonnet Trails MHMR
8
$34,398
Tejas Health Care Partner: Blue Bonnet Trails
MHMR
7
$39,266
Community Action Corporation of South Texas
Partner Coastal Plains Community MHMR
11
$31,200
Chambers County Public Hospital District #1
Partner: Spidletop MHMR Services
6/5S
$20,216
East Texas Border Health Clinic Partner:
HealthCore
4/5N
$25,598
Totals:
$178,877
Resources
The Partners in Health Primary Care/County
Mental Health Collaboration Toolkit offers
an overview on the types of affiliation
agreements that FQHCs can pursue for
behavioral health care services, and can be
found at:
http://www.thenationalcouncil.org/cs/tools_tips
DDRAC
Drug Demand Reduction
Advisory Committee
2009 DDRAC
Recommendations
•
Remove the exclusion clause for medical expenses from the Uniform
Individual Accident and Sickness Policy Provision Law (UPPL).
•
Expand the Texas Prescription Program to allow the proactive
prevention of prescription drug abuse.
•
Mandate comprehensive alcohol and other drug reduction strategies,
targeting college students, that includes enforcement of campus policy
violations.
•
Pass a statewide public smoking ban eliminating smoking in all
workplaces and public places statewide.
•
Support the recruitment and retention of quality service professionals in
the field of substance abuse prevention and treatment by increasing
funds to support wage.
Uniform Individual Accident
and Sickness Policy
Provision Law (UPPL)
Recommendation and Rational for
Repeal
Uniform Individual Accident and
Sickness Policy Provision Law (UPPL)
UPPL allows insurance companies to
exclude medical coverage for injuries if
patients are under the influence of
alcohol or unprescribed drugs, thus
creating a major barrier to screening
and intervention.
DDRAC Recommendation:
Remove the exclusion clause for medical
expenses from the UPPL.
UPPL
Rationale:
 UPPL allows insurance companies to exclude medical coverage
for injuries if patients are under the influence of alcohol or
unprescribed drugs.
 The Texas UPPL exclusion has an adverse financial impact on
patients, hospitals, and healthcare providers.
 Financial concerns cause healthcare providers to avoid
screening for alcohol and drug abuse, jeopardizing trauma
center certification and hindering the identification and treatment
of substance abusers.
 Failure to conduct these screenings interferes with the
prosecution of injured drunk drivers.
Efforts to Repeal UPPL
Texas update:

HB 634 (Eiland), prohibiting the exclusion of coverage described above, was filed on
1/17/07 and left pending by House Committee on Insurance on 4/17/07.

Screening and brief intervention for emergency room patients through the Texas InSight
Project in the Harris County Hospital District reduced costs to the Hospital District by more
than $4 million.
Other information:

In December 2009, Ohio became the most recent state to repeal the UPPL by a vote of 32-0
in their Senate and 93-1 in their House of Representatives.

California addressed concerns that the repeal would constitute an insurance mandate by
clarifying the statutory nature of the UPPL. By only removing the statutory permission, CA
insurance companies must now negotiate the exclusion upfront if they choose to do so.

As of 2010, eight states do not have health/sickness exclusion laws, and 13 states prohibit
the denial of benefits
2010 Workforce Proposed
Recommendations
ASAP/TAAP/DDRAC
ASAP/TAAP/DDRAC
Workforce Recommendations
•
Allow persons with a bachelor’s or more
advanced degree in a “non related” field to enter
the field as a Counselor Intern (CI) upon
completing 270 classroom hours of accredited
chemical dependency education.
Rational:
Studies indicate that the chemical dependency
counseling field is highly representative of persons
in secondary careers. A bachelor’s or higher degree
demonstrates educational accomplishment and the
required 270 classroom hours of education provide
the necessary subject matter expertise.
Workforce Recommendations
• Clarify current interpretation and/or change the
statute to eliminate the prohibition that
individuals with criminal records cannot begin
their CI status until they have met required
sanctions.
Rational:
It is prohibitive for many people to wait 5-7 years to
begin their CI status. By the time they qualify, most
have found other employment and their passion for
working in the field is abated.
Workforce Recommendations
•
Establish reciprocity guides for each state and all branches
of the military.
Rational:
Legislation to update Texas licensure law to reflect current
IC&RC standards was introduced during the 81st legislative
session but was not passed in the final days of the session
•
Change current 448.607 (d) to allow former clients to work
at a facility one year after documented discharge from
active services.
Rational:
Reducing the waiting time to one year both provides the
necessary distance from a treatment experience as well as one
year in recovery to appropriately be employed in non-direct care
positions with limited client contact.
Workforce Recommendations
• To support counselors and aid in career
retention, require enrollment in a peer assistance
program rather than the current stipulation to
show “documented access to” these programs
Rational:
Enrollment in peer assistance programs is a
requirement for most professions and will lend
additional credibility and professionalism to the field.
Workforce
Recommendations
• Provide displaced workers in Texas with
information and awareness about the chemical
dependency counseling field
Rational:
Requesting the Texas Workforce Commission
(TWC) to designate LCDCs as an in demand
occupation will allow access to federal dollars
through programs such as the Workforce
Investment Act (WIA) be used for re-training
displaced workers as chemical dependency
counselors.
Workforce Recommendations
• Encourage state leadership to assist in working
with the Texas State Board of Social Worker
Examiners to allow LMSW’s to continue as a
Qualified Credentialed Counselor (QCC) in
chemical dependency treatment facility without
the supervision of an LCSW.
Rational:
Many facilities employ LMSW’s as QCCs and are
faced with the decision to let them go because they
cannot afford to keep them on staff without a QCC
designation or afford to find and hire a LCSW.
• Promote the chemical dependency counseling
career through all appropriate avenues and
methods of dissemination
SUD Medicaid Benefit
 Outpatient Services (9/1/2010)




Clinical assessment.
Ambulatory Detoxification.
Outpatient individual and group chemical
dependency counseling.
Medication assisted treatment.
 Residential Services (1/1/2011)

Residential detoxification.

Residential treatment.
How will clients be able to access the
new SUD treatment benefits?
 A Medicaid client can self-refer or be referred
to receive an assessment. No referral from a
primary care physician is needed.
 An assessment must be made before
services can begin. No prior authorization is
needed for an assessment.
Who is the primary payer or payer
of last resort?
 Clients eligible for Substance Abuse block
grant services:

Medicaid pays first if the benefit is covered by
both the block grant and Medicaid
 Medicaid clients with private insurance:


Private insurance pays first.
Medicaid pays for Medicaid-covered benefits
not covered by the client’s private insurance.
How are providers reimbursed?
 Generally, SUD treatment providers will be
reimbursed by:

STAR, STAR+PLUS - through the Medicaid
managed care health plans.

STAR+PLUS clients receiving Supplemental
Security Income (SSI)-through the Medicaid
managed care health plans.
 PCCM and FFS - through TMHP.
 NorthSTAR – through the BHO, Value
Options.
How long does it take?
 The state requires that health plans pay
providers within 30 days of receiving a “clean”
claim, or a claim that has all required
elements. The HMO is contractually
obligated to meet this requirement. Likewise,
TMHP has 30 days to process a clean claim
for PCCM and FFS.
For more information . . .
 About the Texas SUD treatment benefits for
adults in Medicaid, contact HHSC
[email protected]
 By phone: 512/491.1162
 HHSC plans to offer training to providers via
an interactive desk-top webinar and in select
locations around the state later this summer.
Contact information
[email protected]
512/206.5804