1. Mental Health Programs in the 1115 Waiver Process June 5, 2013 Crossroads Conference 2013 Lubbock, Texas Cathy Pope Chief Executive Officer

2. 1115: WHY BACK STORY 2012 roll-out of Medicaid Managed Care in Texas had unintended consequences upon the Upper Payment Limit (UPL) Program for Hospitals

3. 1115: WHY Directed by Senate Bill 7 (82 nd Session,) The Texas Health and Human Services Commission (HHSC) Submitted an 1115 Demonstration Waiver application to The Centers for Medicare and Medicaid (CMS)

4. 1115: The Basics 1115 is a LOCAL initiative Regional Health Partnerships and designated regional Anchors serve to coordinate the development and implementation of regional health plans Regional plans are reflective of LOCAL solutions designed to reduce Cost and improve Outcomes

5. 1115: Top 5 Community Center Projects Integrate Physical and Behavioral Health Care30 Crisis Stabilization Services23 Evidence-based Interventions for a Target Population22 Expand Community-based Behavioral Health Services in Underserved Areas12 Whole Health Peer Support for Persons with Mental Health/Substance Use Disorder9

6. 1115 IDD Crisis Services LYNN RUTLAND EXECUTIVE DIRECTOR MHMR SERVICES FOR THE CONCHO VALLEY

7. Larry Carroll Executive Director

8. Extended Observation Unit (EOU) Kristen Daugherty Executive Director

9. 1115: Projects for People with IDD 20 Centers have identified projects that focus on serving people with Intellectual and/or Developmental Disabilities

10. 1115 IDD Crisis Services LYNN RUTLAND MHMR SERVICES FOR THE CONCHO VALLEY

11. 1115 IDD Projects 28 Specific 1115 Projects Across Texas 44 Additional Mental Health 1115 Projects that are not specific, but include IDD IDD Projects within the West Texas Region: Betty Hardwick, Concho Valley, Emergence Health Network, Helen Farabee, StarCare Specialty Health, Texas Panhandle, West Texas Centers

12. Specific 1115 IDD Projects Crisis Response Team Crisis Stabilization Respite Dual Diagnosis Clinic Drop in Skills Training Program Behavior Day Treatment Program Health & Wellness Program Autism Day Treatment & Behavior Support Outreach Therapeutic Intervention for Infants & Toddlers at Risk

13. 1115 IDD Crisis Projects The primary focus for 1115 IDD funding is projects to address the growing need for Crisis Support Services for individuals with a dual diagnosis of Intellectual & Developmental Disabilities (IDD) / Autism Spectrum Disorders (ASD) and Mental Illness who may experience a psychiatric/behavioral crisis or significant life transition that presents a risk for institutional placement or a loss of their current home in the community. The objective of these services would be to prevent inappropriate use of Emergency Rooms, Jails, or Psychiatric Hospitals, when the need for service can be effectively met in a more natural, less restrictive, and less costly setting.

14. New Model of Service This new model of care will provide wrap-around services for the individual that includes Psychiatric Services, On-Call Crisis Response Teams and a Crisis Respite Facility. Recipients would have access to a team of professionals: Psychiatrist, Psychiatric Nurse Practitioner, RN, LPC/LPA, Behavioral Specialists, and Skills Trainers to assess needs, identify resources, link to a network of resources within the team and through contracted providers, and assure services are provided that will appropriately de-escalate the crisis in the community when possible.

15. New Model of Service The team will develop strategies to build skills of individuals and competency of their support network to address the individual’s future needs more adequately, targeting crisis prevention. While this model of care is not designed to replace natural support systems or formal residential care systems, it is specifically targeted to insert a new support for individuals in between these systems and institutional care or loss of current home environment.

16. Larry Carroll Executive Director

17.  Crisis Services in community, hospitals, jails  Psychiatric Evaluations  Medication Services  Intensive Community Rehabilitative Services  Counseling  Mental Health Deputies  Mental Health First Aid training

18.  Bi-Polar Disorder, Major Depression, or Schizophrenia ◦ 34% are Medicaid Eligible ◦ 44% are indigent Over half do not have a primary care physician

19.  People with Severe Mental Illness (SMI) have a life expectancy of 25 years less than people without SMI.  A significant number of those with SMI do not receive adequate primary treatment for medical conditions.  They instead consume costly emergency department services for medical conditions that could have been managed by primary care outpatient physicians. Severe Mental Illness

20.  PBCC will start providing primary care services in our outpatient clinics next year as a part of a new Medicaid waiver program  We see approximately 1200 people in our Midland and Odessa clinics

21.  20.3% of Long-Term Diabetes  44.4% of Chronic Obstructive Pulmonary Disease (COPD)

22.  High rates of chronic disease  High costs associated with preventable admissions  Shortage of health care professionals

23.  Recruiting and training licensed providers  Overall shortage of Primary Care Physicians in the Permian Basin  Data gathering and analysis  Proving up Economic Evaluations

24.  Cost Effective Analysis ◦ 480 persons served x $18,852 = $9,048,960 annually ◦ or $36,195,840 over 4 years  Cost Utility Analysis ◦ Quality Adjusted Life Years = $32,160,000 over 4 years

25. Extended Observation Unit (EOU) Kristen Daugherty Executive Director

26. Community Need Target Population Regional Goal Project Goals Implementation

27. Care delivery gaps Wait times for bio-psychosocial services Inpatient bed shortage

28. Total population = 4,380 Predominantly Hispanic (82%) Bio-psychosocial needs

29. Paso Del Norte Health Foundation o 2012 Regional Strategic Health Framework Report Priority Area 2 o Mental Health and Behavioral Health/Wellness Regional Goal o Enhance and expand access to behavioral health services and alternatives

30. 1. Access to behavioral health services 2.  inappropriate systems of care 3.  hospital ER use for psychiatric care

31. 2012-16 Time-line Phase IPhase IIPhase III Milestone activities July 2012 Jan 2013 Sept 2013 April 2014 March 2015 Feb 2016 1. Convene stakeholder meetings 2. Conduct mapping and gap analysis (plan) 3. EOU site, design and construction 4. Services planning and implementation 5. Crisis alternative utilization 6. Utilization best practices and solutions

32. QUESTIONS? June 5, 2013 Crossroads Conference 2013 Lubbock, Texas Cathy Pope Chief Executive Officer