Department of Health and Mental Hygiene Behavioral Health Services 2013 and Beyond Integrating Mental Health and Addiction Treatment in Maryland Tuerk Conference April 9, 2013

Behavioral Health Services  Mental Hygiene Administration  Developmental Disabilities Administration  Alcohol and Drug Abuse Administration  Forensic Services  Residents Grievance System

Mental Hygiene Administration today  5 regional facilities (one with an adolescent unit)  2 child and adolescent residential facilities  130,000 + served; Budget: over $1 billion  Funds the Specialty Mental Health Service System for Medicaid and the uninsured o Fee for service reimbursement o Authorization for services based on medical necessity  Funds the Specialty Mental Health Service System for Medicaid and the uninsured  Core Service Agencies function as the local mental health authority

Mental Hygiene Administration  Program-specific regulations include: appeals process, due process, provider requirements o Various levels of oversight-MHA, OHCQ, MHA, Medicaid  Coordination of care through case managers, ASO, CSAs  Value Options Maryland-Administrative Service Organization (ASO) o manages utilization, authorization, auditing, data collection and reporting o coordinates with providers and manage care organizations o facilitates collaboration with other state serving agencies  MHA audits appropriateness of clinical decision making and compliance with contract

Alcohol and Drug Abuse Administration  49,762 persons served in FY2012  Budget of approximately $150,000,000  Grant funds for ambulatory (uninsured only), residential and recovery services.  Grant funds awarded to jurisdictions for allocations based on service needs.  MCOs receive funding for ambulatory substance abuse services  Levels of care determinations based on ASAM II criteria  Public health initiative –Maryland Center of Excellence on Problem Gambling –Overdose Prevention Initiative –Smoking Reduction Initiative

Alcohol and Drug Abuse Administration Today  ADAA funds specialized programs –Buprenorphine Initiative –Methadone clinics  Regulations –OHCQ –Medicaid –ADAA –Federal government  MCO-specific Administrative and clinical management –Each MCO determines authorization for services  SMART program – collects data, has EHR

DHMH-Behavioral Health Services Beyond 2013 Mission:  To develop and manage an outcome guided behavioral health service delivery system:  Integrating prevention, health disparities, recovery principles evidence based practices and cost effectiveness

Integration-Why now? Leading causes of death Co-morbidity of somatic and behavioral health conditions Expansion of health care access Need for consumer specific outcome measures and population specific outcome measure Performance measures to effectiveness of treatment services

Integration-Why now?  Improve communication between providers and consumers and health care managers  Engage consumers in managing illness and recovery  Continuity of care  Reduce fragmentation in the service delivery system  Outcome driven process for administrative and clinical decision making  Reduce disparities in health care  Reduce morbidity and overall cost of care  Expand role to include public health initiatives

Status of Integration- Financing Model FINANCIAL MODEL –Recommendation – Behavioral Health Administrative Service Organization that manages carved out funding for substance abuse and mental health treatment integrating evidence based practices and performance risk –Next steps: Collaboration between DHMH agencies Draft next ASO request for proposal Obtain stakeholder input

Status of the Integration of the Regulations  Objective: Maintain quality of care –Maintain access to clinically appropriate services –Remain consumer sensitive and welcoming –Address both mental health and substance abuse service delivery systems  Strategy: Accreditation –Consistent with current medical practice –Sets minimum standards –Reduces redundancy –Simplification of the regulations with some degree of flexibility –Integrates evidence based practice  Regulations to address services not covered by accreditation

Merger of the Administrations GOALS: Maintain the strengths of both agencies – MHA & ADAA Align the Behavior Health Administration more closely with a public health oriented agency. Engage administrative representatives and stakeholders Establish new guidelines that reflect the changing role of the local authorities Provide for ongoing cross-training and agency collaboration

Status of the Integration of the ADAA and MHA Update organizational chart to reflect expansion of the public health mission and restructured oversight –Overdose Initiative, Suicide Commission, Drug Monitoring, Smoking Reduction, Primary care consultation, Problem Gambling, Early Intervention Monitor attrition, gaps in staffing, changes in the administration, liaisons with other departments, Propose statutory/regulatory language for the consolidation of the agencies Continue with cross-training of DHMH, MHA and ADAA staff

Proposed Organizational Chart

Next Steps Jurisdictional needs assessment Jurisdictional diversity: –Integrated administrative systems –Access to services within the jurisdictions –Population specific needs –Data collection and reporting Continue with merger process, cross training, agency collaborations Identify programming needs, operational needs Develop a provider “toolkit” Engage stakeholders in the process to identify provider and consumer transitional needs and outcome measures Establish communication process and formal timeline

Acknowledgements Consumers, Providers, Elected Officials, Local Health Departments and staff Brian Hepburn, M.D., Executive Director of the Mental Hygiene Administration Charles Milligan, JD, MPH, Deputy Secretary for Health Care Financing Kathleen Rebbert-Franklin, LCSW-C, Acting Director of ADAA