Medicaid Mental Health Benefits Overview of Coverage, Service Delivery and Utilization Mental Health and Substance Abuse Interim Committee Meeting August 14, 2006

Range of Service Coverage for Mental Health & Substance Abuse Inpatient hospital Inpatient hospital Outpatient hospital Outpatient hospital Federally Qualified Health Centers & Rural Health Clinics Federally Qualified Health Centers & Rural Health Clinics Physician Services Physician Services Clinic Services Clinic Services Inpatient Psychiatric Services for participants <21 Inpatient Psychiatric Services for participants <21 Rehabilitative Services Rehabilitative Services School-based Services School-based Services Targeted Service Coordination Targeted Service Coordination

Community-based MH Services Mental Health Clinic services Mental Health Clinic services  medical model, provided in a facility with physician oversight Psycho-Social Rehabilitative services Psycho-Social Rehabilitative services  social model, provided in home & community Targeted Service Coordination Targeted Service Coordination  social model, provided in home & community

Population Data 2006 State of Idaho Population: 1.4 million Medicaid Caseload: 170,585 (12.0) National Prevalence Rates: Adults with SMI (5.4%) Adults with SPMI (2.6%) Children with SED (5%) Medicaid Children using MH services: 14,622 (0.01) Medicaid Adults using MH services: 8,984 (0.006) In 2000, just under 5,200 children and just under 5,000 adults were receiving services paid by Medicaid

1/ "State Spending on Substance Abuse Treatment", National Conference of State Legislatures, Policy Matters, Critical Issues in Health Care Access, A. Scanlon 2/ "Mental Health and Substance Abuse Services in Medicaid, 1995", J. Buck & K. Miller, HHS/SAMHSA

Regional Population Vs. Medicaid Enrollment Regions RegionalPopulation201,570100,465227,825389,228170,617159,534179,857 May 2006 Enrolled22,70011,38038,21331,64722,03922,28223,261 % of Region11.26%11.33%16.77%8.13%12.92%13.97%12.93%

Regional Enrollees Using MH Services Regions % Medicaid enrollees using MH services % Regional Pop. On Medicaid 14.1%11.3%10.6%11.3%11.0%16.7%19.5%8.1%11.2%12.9%14.9%13.97%22.9%12.9% Per MH user cost$4,107$3,476$2,116$1,978$3,884$4,309$5,913

Outcomes: ER ER Claims Costs ER Visits # Clients AverageVisits/Yr. CBMH services provided <30days before ER CBMH services provided <30 days after ER Children $43, %13.0% $174, %14.0% Adults $179,8631, %17.0% $537,3782,5721, %10.7%

Outcomes: MH Inpatient Admits Inpatient Claims Costs Inpatient Admits # Clients # Admits per Client Re- Admissi on Rates CBMH provided <30 days prior to admit CBMH provided <30 days after admit Children $6,448, %7.41%46.3% $8,500,0331, %8.16%67.9% Adults $5,421,6361, %9.11%56.3% $7,040,0171,4471, %10.99%57.9%

Management Initiatives to Address Quality/appropriate Utilization Rules (service definitions & expectations) Rules (service definitions & expectations) Limits on excessive utilization of partial care Limits on excessive utilization of partial care MH pharmacy initiative MH pharmacy initiative Legislative direction Legislative direction On-site clinic reviews On-site clinic reviews New MH provider agreements & enrollment New MH provider agreements & enrollment Freeze on new provider applications Freeze on new provider applications Roll-out provider credentialing system Roll-out provider credentialing system

Medicaid Reform HB 776: defines benefits according to health needs of different populations HB 776: defines benefits according to health needs of different populations HCR 48: provides further benefit parameters for Medicaid participants who are of average health HCR 48: provides further benefit parameters for Medicaid participants who are of average health Federal authorization of three state plans: Federal authorization of three state plans: Basic benefits for those of average health Basic benefits for those of average health Enhanced benefits for those with disabilities/special needs, and Enhanced benefits for those with disabilities/special needs, and A coordinated plan for dual eligible A coordinated plan for dual eligible

Basic Benefit Plan Standard package of medical services available to all Medicaid enrollees. Standard package of medical services available to all Medicaid enrollees. Prevention & wellness benefits are expanded. Prevention & wellness benefits are expanded. Mental health services. Mental health services. Allows for 26 MH clinic services/annually with physician and FQHC exempted from limit. Allows for 26 MH clinic services/annually with physician and FQHC exempted from limit. Eliminates coverage of partial care, psycho-social rehabilitation, and service coordination which are preserved for individuals in the enhanced plan. Eliminates coverage of partial care, psycho-social rehabilitation, and service coordination which are preserved for individuals in the enhanced plan.

Enhanced Plan Includes all service coverage in the Basic Plan Includes all service coverage in the Basic Plan Plus LTC coverage in institutions & community Plus LTC coverage in institutions & community Plus developmental disability coverage Plus developmental disability coverage Plus enhanced mental health coverage, including partial care, psycho-social rehabilitation, service coordination, and expanded mental health clinic services Plus enhanced mental health coverage, including partial care, psycho-social rehabilitation, service coordination, and expanded mental health clinic services

Reform Implementation Planning New Medicaid applicants begin enrolling in new benefit plans (July 2006) New Medicaid applicants begin enrolling in new benefit plans (July 2006) Expedited medical home enrollment (July 2006) Expedited medical home enrollment (July 2006) Health risk assessment (July 2006) Health risk assessment (July 2006) Rules publish (August) Rules publish (August) Public Hearings (August) Public Hearings (August) Healthy school grants (September 2006) Healthy school grants (September 2006) Existing Medicaid enrollees move into new benefit plans at re-determination (over the next year) Existing Medicaid enrollees move into new benefit plans at re-determination (over the next year)

Horizon Explore improvements to assessment process Explore improvements to assessment process Examine results of reform Examine results of reform Coordinate management oversight with new Behavioral Health Division Coordinate management oversight with new Behavioral Health Division Participate on MH Transformation work group and steering committee Participate on MH Transformation work group and steering committee Support initiatives that provide for best practice, quality, and evidenced-based coverage Support initiatives that provide for best practice, quality, and evidenced-based coverage