2013 Legislative Issues:
The Medicaid Managed Care System for Behavioral Health Services to be Implemented on July 1, 2013. Implemented and adequately funded, Medicaid Managed Care could provide a broad range of effective mental health services and still control costs. NAMI and NAMI Idaho support the expansion of Medicaid under the Affordable Care Act. With Medicaid expansion, 96% of individuals living with mental illness will be serviced through Medicaid.
A. Data Collection and Reporting under Medicaid Managed Care:
Neither the Legislature nor the citizens of Idaho will be able to adequately assess the effectiveness of Medicaid managed care in improving the quality of life for individuals living with mental illness in our state without an adequate data collection and reporting system.
The contract to be entered into with the managed care organization (MCO) must be specific and definitive with respect to the state-wide data that the MCO is required to provide to Idaho Medicaid, the legislature and the taxpayers. Data must be collected in a standard format and published in a useful and readable format at least quarterly. Such data must include:
1) 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
2) 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, and voluntary termination of treatment while in an unstable or unknown condition.
3) Administrative Performance – consumer satisfaction surveys, service appeals, service denials, complaints/grievances, call pick-up, claims payment rate, network turnover, timeliness of data reporting
B. Transition Between Mental Health Providers:
The move towards managed care for mental health services raises some particular issues for those living with mental illness. A change of mental health providers for a person living with mental illness can be a traumatic and dangerous event. It often takes a long time to create a trusted relationship with a mental health provider. It can take years for a mental health service provider to properly understand a particular individual’s illness and determine the right mix of medications and therapy. Every effort should be made to minimize mental health provider changes, such as during the transitions into and between managed care plans. Consideration must be given to continuity of care.
It is imperative that the all transitions between plans and/or mental health providers be closely monitored and coordinated by Idaho Medicaid. A person living with mental illness may not have the capacity to independently transition to a new provider without the direct and personal assistance of an Idaho Medicaid follow-up service. This service is essential to prevent individuals living with mental illness from ‘falling through the cracks’ with severe behavioral, social and irreversible health consequences. In light of all the confusing health care changes already being required by the Affordable Care Act, this vulnerable population will need special transition assistance.
C. Initial One-Time Funding:
Sufficient one-time funding must be provided to Idaho Medicaid to:
1) Ensure the establishment of the information systems to collect, analyze, and report the data described above.
2) Effective transition of all individuals living with mental illness to new providers, if necessitated by the implementation of Medicaid managed care, so mental health services are not disrupted.
Legislation Creating Regional Behavioral Health Boards. (Title 39, Chapter 31: Regional Behavioral Health Services). This legislation could improve the delivery of community behavioral health services if the Division of Behavioral Health and the Regional Behavioral Health Boards are adequately funded.
A. Funding of Regional Behavioral Health Boards:
Through an amendment to Title 39, Chapter 31, legislation is being proposed to create regional behavioral health boards under the supervision of the state behavioral health authority - the department of health and welfare (DHW). These regional behavioral health boards will be authorized to provide community recovery support services in their region when they are deemed ready to do so for those living with mental illness and/or substance use disorder. The proposed amendment establishes the mechanism for creating the criteria and determining readiness, in terms of organizational, professional and financial competence. These competences cannot be achieved without appropriate support in terms of funding and technical resources.
DHW, as the state behavioral health authority, is required to provide oversight and is responsible for the spectrum and quality of services if and when they are provided by the regional behavioral health boards. DHW must obtain sufficient funding to establish, organize, staff, and maintain the regional behavioral health boards. Acquisition of funding should include seeking adequate appropriations from the legislature combined with the pass-through of federal block and other grants sources.
B. Provision of Services:
The proposed legislation establishing the regional behavioral health boards also defines the services to be provided for individuals living with mental illness and/or substance use disorders by the regional behavioral health centers operated by the Behavioral Health Division of DHW (BH). Other than crisis service and court-ordered services, BH is currently serving only those without Medicaid or Medicare and without individual or employer-provided insurance. It is vitally important for the legislature to understand that, because of resource restraints, the services currently provided by BH have been reduced to basic medication management only. BH has ceased providing most prevention and support recovery services.
Limitation of prevention and support recovery services ultimately leads to increased taxpayer burden by shifting cost to emergency rooms, inpatient hospitalization, law enforcement, prisons and jails. The increased use of these alternatives and their related costs are being experienced throughout the state. These resource-based limitations also lead to increased suicides, homelessness and reduced opportunity for recovery for individuals living with mental illness and/or substance abuse disorders.
The long-term most cost-effective behavioral health systems devote adequate resources to fund a broad spectrum of services that include early diagnosis, treatment, and rehabilitative support services to facilitate recovery. Idaho must provide sufficient resources to eliminate the current restriction limiting available services to medication management.
2013 Mental Health Facts (PDF File)
2013 Introduction to NAMI (PDF File)