Ron Manderscheid PhD Exec Dir NACBHDD and NARMH amp Adj Prof BSPH JHU NACBHDD Time for a Thrilling Ride Report of President Obamas Task Force on Parity for Mental Health and Substance Abuse ID: 674468
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Slide1
Changes and Constants in Behavioral Health
Ron Manderscheid, PhD
Exec Dir, NACBHDD and NARMH
&
Adj
Prof, BSPH, JHU
© NACBHDD Slide2
Time for a
Thrilling
Ride!Slide3
Report of President Obama’s
Task Force on Parity for Mental Health and Substance Abuse
Report:
https://www.hhs.gov/sites/default/files/mental-health-substance-use-disorder-parity-task-force-final-report.pdf
Observations:More training and technical assistanceFocus on consumer reporting of violationsRecommendation of penalties
Very Recent Developments - 1Slide4
21
st
Century Cures Act (an authorization bill)
Includes the
Mental Health Reform Act of 2016Increased grant funding for services integrationSome funding for human resources, particularly in the National Health Service CorpsIncludes the Mental Health and Corrections Collaboration Act
DOJ will be permitted to spend re-entry funds on appropriate services
Grants will be available to build re-entry infrastructure between corrections and mental health
Very Recent Developments - 2Slide5
21st
Century Cures Act (Continued)
$1 billion authorization for the Comprehensive Addiction and Recovery Act (CARA)
$500 million
has been appropriated in the current Continuing ResolutionWe now are working to get the other $500 million appropriated as part of the next Continuing Resolution or 2017 Funding Bill
Very Recent Developments - 3Slide6
Medicaid Managed Care Regulation
(Spring 2016)
Permits the use of federal Medicaid IMD funds for restricted inpatient and residential treatment care (up to 15 days in a month)
CMS Letter to the State Medicaid Directors
(Spring 2016)Federal Medicaid funds can be used for persons in the correction system if the person is not actually in a cell Very Recent Developments - 4Slide7
New
1115 Medicaid Waivers
CA Systems of Care for Substance Use Clients: The length of residential services range from 1 to 90 days with a
90-day maximum for adults and a 30 day maximum for adolescents;
unless medical necessity authorizes a one-time extension of up to 30 days annually.Very Recent Developments - 5Slide8
TRENTON
-
Gov. Chris Christie boasted
the success of expanding the Medicaid program in the state, arguing the "naysayers" have been "proven wrong" and that
566,000 additional New Jerseyans have insurance coverage. ""We made a deal with the federal government. If they keep their deal, we'll keep our part of the deal," he said. "I am for Medicaid expansion ... but I am not for Medicaid expansion at any price
."
NJ and Medicaid ExpansionSlide9
The Factors Have Become
More ComplexSlide10
POLICY:
Affordable Care Act
implementation is in question.RESEARCH
: Early intervention with
first episode psychosis.PRACTICE: Trauma as a causative factor in most mental illness.
Key Game ChangersSlide11
From “deficit” to
“strength-based”
approaches e.g., NAM panel. From “separate” to
“integrated”
services.From “clinical only” to “clinical and community” together.
Key Underlying TrendsSlide12
APHA
has a major 5 year initiative on altering the negative
social determinants of health. Goal: Health for all society!
The
UN has set personal and community “well-being” as a world-wide 15 year objective for 2030.Major US corporations are beginning to embrace a
“culture of well-being”
in the work place, e.g., Carter Center Summit.
Key ResponsesSlide13
Let’s Begin Our AdventureSlide14
Old Model:
Disease
is a personal characteristic
Role is to treat disease
Goal is to restore functioningFocus:Clinical interventionCare system managementCare policy
Our Model is Changing-1Slide15
New Model
Disease
is a principally a community
characteristic
Role is to change communitiesGoal is to improve community functioningFocus:Community interventionCommunity managementCommunity policy
Our Model is Changing-2Slide16
Our current task is to blend the
old
and new
models to achieve the Triple Aim:
Better population healthBetter quality careReduced care costs Our Model is Changing-3Slide17
Population Health Management
Integrated Care Systems
that incorporate Disease Prevention and Health Promotion Strategies
How?Slide18
Our DilemmaSlide19
VERY
HEALTHY
l
I
NO DISEASE -----|
-----
SEVERE DISEASE l
l
l
VERY UNHEALTHY
Health and Well-being --1981Slide20
VERY
HEALTHY
Pop 1 l Pop 2 I
NO DISEASE
-----| -----SEVERE DISEASE
l
P
op 3
l
Pop 4
l
VERY UNHEALTHY
Viewed as Population HealthSlide21
Tomorrow’s Well-Being ModelSlide22
Public Health Reports - 1978Slide23
Integrating Care and Well-being Slide24
Your Tasks as a Manager:Manage
old
and new
systems across these chasms
Effectively manage blended models Train and lead a new generation in a new way of thinking and working
Our Model is Changing-4Slide25
Let’s Go!Slide26
Move to
Integrated Care
ServicesDeveloping better linkages with
social services
Incarceration of persons with mental and substance use conditionsLinkage with public healthPervasive
National Concerns
in Behavioral HealthSlide27
Integrated Care ServicesSlide28
Importance of
Social ServicesSlide29
The
Incarceration CrisisSlide30
About
730,000 persons in these jails
:182,500 (25%) persons with a mental illness
365,000
(50%) persons with a substance use disorderMajor co-morbidity between the two groupsThe two groups (547,500) actually approximate the total number in state mental hospitals in 1955 just before deinstitutionalization started (559,000).
Tonight: City and County JailsSlide31
Juvenile Justice Facilities: About 70,800 (more than
500,000 in one year
)NCSL
:
“As many as 70 percent of youth in the system
are affected with a mental
disorder.”
Tonight – Juvenile Justice FacilitiesSlide32
The actual incarceration rate in the US is about
1 person in 100
.The actual rate of involvement in the criminal justice system, including probation and parole, is about
4 in 100
. US is generally thought to have the highest rates in the world! Some ObservationsSlide33
Slide34
Goal: To reduce the number of persons with MH, SUD, and ID/DD conditions who arrive at the jail.
Major foci:
Intercept “0”: Improving county behavioral health crisis response capacity
Direct TA
to small and medium size countiesInitiation of a small pilot with corporate sponsors
NACBHDD
Decarceration InitiativeSlide35
NACBHDD is partnering with NACo on its Stepping Up Initiative
NACBHDD and NACoSlide36
Linkage with Public Health: 1,943 County Public Health Departments Slide37
Change is in the AirSlide38
Repeal and Replacement of the Affordable Care Act (New Bill:
American Health Care Act
)Block-granting of Medicaid
Privatization of Medicare
Thoughts on the FutureSlide39
Concerns:
Health insurance coverage (good benefits) and access to care (good care for all).
Concerns: Medicaid Expansion? Persons covered through the Marketplace with subsidies?
Understand:
repeal, rename, replace.Avoid: Trap about labels, such as “ACA” or “Obamacare”
Repeal and Replacement of ACASlide40
Would repeal the Medicaid Expansion at the end of 2019.
Would change Medicaid to a per capita block grant at the end of 2018.
Would reduce subsidies paid to persons insured under the State Marketplaces at the end of 2018.
Would end the “individual mandate”, and would promote Health Savings Accounts.
Would increase insurance costs for all, especially those who are older.BOTTOM LINE: A bad bill for mental health and substance use care.BILL: American Health Care ActSlide41
Concerns:
Financial implications for the states and coverage for those insured by Medicaid.
Understand: Fixed amount per state?; Per person in population? Per person covered? With what baseline: Now? 2013? Other?
Avoid:
Discussions about the federal and state rolesBlock-granting of MedicaidSlide42
Concerns:
health
insurance coverage (good benefits) and access to care (good care for all).
Understand:
Benefit variability from plan to plan? Fixed payment plans? Health savings accounts for premiums? Coverage of other age groups?Avoid: Change nothing vs. Change everything.Privatization of MedicareSlide43
So, which will it be?Slide44
Comments?
Slide45
Ron Manderscheid, PhD
Executive Director
NACBHDD – The National Assn of County Behavioral Health and Developmental Disability DirectorsNARMH – The National Assn for Rural Mental Health
660 North Capitol Street, NW, Suite 400
Washington, DC 20001(V) 202 942 4296 (M) 202 553 1827The Only Voice of County and Local Authorities in the Nation’s Capital! Contact Information