Home 2012 Legislative Issues

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2012 Legislative Issues:

“By using the lack of resources as a reason to make no change, the existing situation will get predictably worse; higher cost crisis services will become the stop gap for escalating issues avoided by the availability of early intervention and prevention services.”*

     *2011 Behavioral Health Transformation Work Group Report to the Governor.

Issue:  Budget

• Additional funding should be provided for Idaho’s mental health services for children and adults.  NAMI Idaho will oppose any cuts to mental health services.
• Idaho’s level of support for mental health services is deplorable.
  • On a percentage basis, Idaho was in the top ten states (#8) in the nation in making mental health care budget cuts between FY 2009 and 2012.**
  • Only one state budgeted less than Idaho for mental health services in FY2012.**
  • Only four states spent less than Idaho on a per capita basis.**
  • Idaho spent $44.00 per capita – less than 36% of the national average of $122.90.**

        **State Mental Health Cuts:  The Continuing Crisis © 2011 NAMI, the National Alliance on Mental Illness, www.nami.org/budgetcuts

• Limiting Idaho’s mental health services to cover only crisis interventions ultimately leads to increased taxpayer burden by shifting cost to emergency rooms, inpatient hospitalizations, law  enforcement, prisons and jails.  The increased use of these alternative services and their related costs is being experienced throughout the state.  Such limitation also leads to increased   suicides, homelessness, and a reduced chance of recovery for those living with mental illness.
• The most cost-efficient mental health systems emphasize early treatment, support services and recovery.

 Issue:  The Proposed Medicaid Managed Care System for Mental Health Services

• The primary focus of the proposed Medicaid managed care system for mental health services should be on improved access to quality mental health care throughout all    of Idaho, insuring the quality of services and providing measurable accountability.  Implemented properly Medicaid managed care can help manage the cost of providing mental health services.
• Creating an efficient and effective Medicaid managed care system is extremely complex and sufficient time should be spent designing the program to avoid the negative experience of a number of states.
• The program will be most cost-effective if the focus is on recovery-oriented and community-based activities such as supported employment, Assertive Community Treatment teams (ACT), and supportive housing.
• The standards for access to care should provide for a choice of providers with reasonable geographic access.   
• The Managed Care Entity (MCE) should have specific requirements for supporting consumer and family involvement such as the utilization of peer specialists, the creation of consumer advisory councils, and involvement in quality improvement initiatives.
• The MCE should be directed to invest in evidence-based and promising practices.
• The MCE should specifically address how mental health services will be integrated with substance use disorder treatment.
• DHW may need additional one-time resources during the transition to the Medicaid managed system from the current system.
  • Persons living with mental illness must be individually informed and tracked so there are not any breaks in the delivery of mental health services. 
  • DHW also needs to create systems to process the data described below.   
• Data in a standard format should be collected throughout the state through the MCE at least quarterly and published in a timely fashion to the legislature and the public in a useful format. It must include:
  • System Performance – availability of services, utilization levels, rate of critical incidents, time between inpatient discharge and first outpatient appointment, consumer involvement in the program planning, and use of evidence-based and promising practices.
  • Clinical Performance – symptom improvement, hospital diversion rates, identification of medication gaps, quality of life improvement (housing, employment, relationships), re-hospitalization level, and involvement with the criminal or juvenile justice systems.
  • Administrative Performance – consumer satisfaction surveys, service appeals, service denials, complaints/grievances, call pick-up, claims payment rate, network turnover, timeliness of data reporting.

Issue:  Suicide Prevention Hotline

• Establish and fund a state-wide suicide prevention hotline.
  • Idaho is the only state in the country without a nationally certified suicide prevention hotline.  In a study of hotlines around the country, 12 percent of callers interviewed spontaneously said the initial calls had saved their lives.
  • Idaho is consistently among the states with the highest suicide rates.  In 2008 (the most recent year available) Idaho had the 6th highest suicide rate, 40% higher than the national average.
  • In the past five years through 2010, 1,286 Idahoans have died by suicide.
  • The tragedy of these deaths is that these lives lost to suicide may have been saved through increased awareness, education, prevention and intervention strategies.

Issue:  Idaho’s Mental Health System

• NAMI Idaho supports the integration of primary care with mental health and substance abuse systems.
  • The average person living with a serious mental illness has a life expectancy that is 25 years shorter than the average American.  Most of the differential is preventable with integrated primary care, mental health and substance abuse systems.
• Idaho should restore funding to community supports such as assertive community treatment (ACT), mobile crisis teams, psycho-social rehabilitation (PSR), job training, and housing which focus on recovery and re-integration of those living with mental illness into the community. 
• NAMI Idaho supports the continued development of a data collection system for its mental health system that ensures transparency and accountability in the collection and publication of meaningful performance, process and outcome measures that will allow for informed policy decisions and will promote quality improvement.

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