Page 1 MHSA Vision and Mission VISION Hope, Resilience, and Recovery for Everyone MISSION To improve health and well-being in Texas and by providing leadership and services that promote hope, build resilience, and foster recovery

Page 2 MHSA Goals Promote resilience-based and culturally competent substance abuse prevention and mental health promotion across the life span Implement a statewide behavioral health recovery model Maximize service delivery through accountable and sustainable partnerships Ensure quality, cost-effective service delivery Utilize data to improve service delivery outcomes Implement effective administration strategies to empower staff to achieve the division’s mission Create and maintain effective internal and external communications

Page 3 Block Grant Changes – General Concepts SAMSHA wants states to start planning for 2014 when Health Care Reform is implemented. Block Grant will be directed toward: persons not insured; services not covered by any type of insurance; primary prevention; collecting performance and outcome data Conduct an assessment of current services/populations using a four step process given the direction above: address the strengths/needs of the services system to address the specific populations identify the unmet service needs and critical gaps in the current system prioritize state planning activates develop objectives, strategies, and performance indicators

Page 4 Block Grant Changes – Specific Changes MH and SA plan will be submitted together and it will be bi-annual. Plan will be due 9/1/2011 for 21 months. Next plan would not be due until 4/13. Changing planning year to July 1-June 30. Implementation reports for MH and SA will be submitted 12/1 of each year. In the past, S.A. report was due 9/1. These reports will remain separate. We will respond to 14 areas designed to move states toward healthcare reform (i.e. state dashboards (possible incentives), data and information technology, self directed care). Plan will assess additional populations encouraged by SAMSHA including homeless; persons in criminal justice system; persons in rural areas; underserved racial and ethnic minorities including GLBTQ populations. Plan will coordinate directly with Tribes. There are three federally recognized tribes in Texas. Plan will develop a Behavioral Health Planning Advisory Committee (expanding MHPAC to SA). Plan will concentrate more on recovery supports/services. This follows the direction of SAMHSA and our on internal vision and mission.

Page 5 Block Grant – Current Activities Collecting comments on plan. Due before June 9 th to Federal Register. Discussing changes in the plan with SAMHSA. Reviewing all resource materials in plan. Beginning assessment of current services/populations. Attending a combined MH and SA Block Grant Conference in June.

Page 6 Recovery Dialog Meeting Meeting goal: to conduct a facilitated meeting of recovery-oriented systems of care for substance abuse and mental health. Meeting charge: To compare and contrast mental health and substance abuse recovery issues in Texas To articulate/clarify commonalities and differences between the two Develop action steps to advance a mental health and substance use recovery partnership Clarify the role of MH/SA in the state’s future health care delivery system that will inform state and local level policy and practice initiatives Meeting outcome: A document or brief of the meeting results and action steps that can be shared for broader input and consensus at the BHI meeting this summer. Attendees: Dr. Thomas Kirk, former Commissioner of Mental Health and Substance Abuse from Connecticut, key staff from MH/SA, UT School of Social Work Research and thought leaders from the MH/SA field.

Page 7 MHSA FY12-13 Exceptional Items – House and Senate Actions to Date FTEs for Funding below = ALL FUNDSSenate Priorities for ConsiderationGR + GR-DAll Funds each yr HOUSE Actions SENATE Actions FTEs added 1. Restore Critical Base Bill Reductions$169,477,672$237,687, $185,208, d.d. Community MH Services$74,968,074$136,795, d.1. MH Services - Adults $45,819,742$84,810,953 d.2. MH Services - Children $7,684,390$22,481,006 d.3. Community MH Crisis Services $9,085,236 d.4. NorthSTAR $12,378,706$20,418,378 e.e. Substance Abuse Intervention Services$4,000,000$10,382,073 f.f. Tobacco Prevention and Cessation$20,943, $10,943,000

Page 8 MHSA FY12-13 Exceptional Items – House and Senate Actions to Date FTEs for Funding below = ALL FUNDSSenate Priorities for ConsiderationGR + GR-DAll Funds each yr HOUSE Actions SENATE Actions FTEs added g.g. State and Community MH Hospitals$39,711, $24,811,938 - g.1. MH State Hospitals$30,711, $15,811,938 g.2. MH Community Hospitals$9,000, Maintain Hospital Operations$58,224, $50,804,718 a.a.Maintain Capacity$15,804,718 b.b. Annualization of New Capacity$32,500, $30,000,000 b.1. MH State Hospitals$2,500, Priority 2 b.2. MH Community Hospitals$30,000,000 c.c. Psychiatrist Salaries$9,919,321 $5,000,000

Page 9 MHSA FY12-13 Exceptional Items – House and Senate Actions to Date FTEs for Funding below = ALL FUNDSSenate Priorities for ConsiderationGR + GR-DAll Funds each yr HOUSE Actions SENATE Actions FTEs added 4.Hospital Capacity$10,361,106 a.a. Hospitality House$433,106 b.b. Forensic patient capacity in Harris County$9,928, Hospital Equipment/Repair and Renovation $10,329,176$62,329,176 $0 a.a. Bonds for Aging Facilities$0$52,000,000 b.b. Critical Information Technology Items$1,660,000 Priority 2 & Cap authority c.c. Emergency Preparedness$356,310 Priority 2

Page 10 MHSA FY12-13 Exceptional Items – House and Senate Actions to Date FTEs for Funding below = ALL FUNDSSenate Priorities for ConsiderationGR + GR-DAll Funds each yr HOUSE Actions SENATE Actions FTEs added d.d. Critical Equipment for Hospitals$6,635,262 Priority 2 & Cap authority e.e. Consolidated Laundry Operations$77,604 Priority 2 & Cap authority f.f. Vehicles Supporting Patient Care$1,600,000 Priority 2

Page 11 Update on Medicaid Substance Abuse Benefit Expansion Benefit expansion included an expansion of the current outpatient benefit for clients less than 21 years old to include the services listed below for all age groups in Medicaid. The adult benefit will be measured by the LBB for overall cost effectiveness to Medicaid for approximately a 2 year period. Report on cost effectiveness to be completed in Benefits: Assessment Individual and Group Counseling Medication Assisted Treatment Ambulatory and Residential Detoxification Residential 9/1/10: Implemented outpatient benefits 1/1/11: Implemented residential benefits

Page 12 Summary of Utilization Data (9/1/10 - January-February, 2011) TMHP Approximately $896,000 in claims paid by TMHP (includes DSHS funded and non DSHS funded providers) $508,000 in claims for clients <21 years old $388,000 in claims for clients >=21 years old 1,206 unique clients served across all levels of care, across all age groups Claims paid broken out by service category: Assessment and Outpatient Counseling$564,000 Medication Assisted Treatment$174,000 Residential$158,000

Page 13 Summary of Utilization Data (9/1/10 - January-February, 2011) HMO Approximately $292,0000 in claims paid by STAR and STARPlus HMOs (includes DSHS funded and non DSHS funded providers) $131,000 in claims for clients <21 years old $161,000 in claims for clients >=21 years old 404 unique clients served across all levels of care, across all age groups Claims Paid Broken out by service category: Assessment and Outpatient Counseling$141,000 Medication Assisted Treatment$142,000 Residential$9,000

Page 14 Medicaid Substance Abuse Benefit Expansion Positives: Medicaid claiming by providers is increasing on a monthly basis Some providers have relatively robust Medicaid billing Issues brought forth by providers seem to be decreasing DSHS and HHSC are responsive to issues as they arise Areas of Needed Improvement: Medicaid claiming is still lower than expected, particularly in HMO models. Some of this may be attributable to lag in provider claiming and data collection by state. There are still lingering issues related to operationalization of benefit, communication gaps between TMHP and providers, HMOs and providers Many of the DSHS funded providers have extremely low or no Medicaid billing. Many are providers with large awards. Based on the low Medicaid billing thus far, the SAPT block grant appears to be the primary payor for many Medicaid covered services to Medicaid clients Some high utilization patterns have been observed in the data

Page 15 Medicaid Substance Abuse Benefit Expansion Ongoing Activities: Medicaid utilization data will continued to be reviewed and shared on an ongoing basis throughout rollout to monitor for under and overutilization. This data will be at the client, service, provider and payor levels. Consultations/technical assistance will continue to occur on an as needed basis Data matches between CMBHS and Medicaid data will also occur to ensure appropriate payor order