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Substance Abuse Mental Health

Substance Abuse Mental Health

Services Administration Adolescent

Services Administration Adolescent

Substance Abuse Treatment

Substance Abuse Treatment

Coordination Grant

Coordination Grant

William H. Janes

William H. Janes

Project Director Project Director Director, Florida Office of Drug Control Director, Florida Office of Drug Control Assistant Secretary, Florida Department of Assistant Secretary, Florida Department of Children and Families Children and Families Substance Abuse and Mental Health Substance Abuse and Mental Health Program Program

(2)

What Were the Funding Challenges?

What Were the Funding Challenges?

z

z

System not well

System not well

-

-

coordinated

coordinated

z

z

Funding fragmented

Funding fragmented

z

z

Mental health and substance abuse

Mental health and substance abuse

stove

stove

pipes

pipes

z

z

High use of high

High use of high

-

-

end services

end services

z

z

High use of juvenile justice system for services

High use of juvenile justice system for services

z

z

Managed care system difficult to

Managed care system difficult to

understand/access

understand/access

z

(3)

Challenges

Challenges

-

-

Continued

Continued

z

z

Low incentive to bill for Medicaid

Low incentive to bill for Medicaid

z

z

Conflicting regulatory requirements

Conflicting regulatory requirements

z

z

Mental health Medicaid in a managed

Mental health Medicaid in a managed

care/medical model system

care/medical model system

z

z

Substance abuse/direct billing/recovery model

Substance abuse/direct billing/recovery model

z

z

Recruiting and retaining credentialed staff

Recruiting and retaining credentialed staff

z

z

Inflexible funding streams

Inflexible funding streams

z

z

High administrative costs from multi

High administrative costs from multi

-

-

layered and

layered and

disjointed system

disjointed system

z

(4)

Adolescent Substance Abuse Treatment Funding

Adolescent Substance Abuse Treatment Funding

in Florida 2006

in Florida 2006

(Source: Florida Alcohol and Drug Abuse Association) (Source: Florida Alcohol and Drug Abuse Association)

County Contributions

4%

Medicaid 6%

Dept of Children and Families-Mental Health 3% Other (Grants, Insurance, Local Sources) 9% Dept of Juvenile Justice 31% Dept of Children Families -Substance Abuse 47%

Dept of Children Fam -Sub Abuse

Dept of Juvenile Justice

Medicaid

Dept of Children and Fam - Mental Health County Contributions

Other (Grants, Insurance, Local Sources)

(5)

Florida Medicaid

Florida Medicaid

A Snapshot

A Snapshot

z

z $15 billion Medicaid reimbursements 2006$15 billion Medicaid reimbursements 2006--20072007

z

z $92.4 million reimbursed for child and adolescent $92.4 million reimbursed for child and adolescent

mental health services 2006

mental health services 2006--20072007

z

z $1,8 million reimbursed for adolescent substance $1,8 million reimbursed for adolescent substance

abuse 2006

abuse 2006--20072007

z

z 2.1 million Florida citizens eligible for Medicaid2.1 million Florida citizens eligible for Medicaid

z

z 44thth largest Medicaid population in the nationlargest Medicaid population in the nation

z

z 11% of Florida11% of Floridas total Medicaid allocation spent on s total Medicaid allocation spent on

medications

medications

z

z 80,000 fee80,000 fee--forfor--service Medicaid providers (includes service Medicaid providers (includes

mental health and substance abuse)

mental health and substance abuse)

z

z 18 separate Medicaid managed care plans 18 separate Medicaid managed care plans

z

z Mental Health based on medical modelMental Health based on medical model

z

(6)

Florida Department of Children and Families

Florida Department of Children and Families

Service Utilization 2006

Service Utilization 2006--2007 2007

Source: Florida Department of Children and Families 2008 Source: Florida Department of Children and Families 2008

z DCF intended to be payer of last resort

TANF - Mental Health $1,100,969 TANF - Substance Abuse $2,211,237 Adolescent Substance Abuse $57,602,038 C&A Mental Health, $30,327,692

C&A Mental Health Adolescent Substance Abuse

TANF - Mental Health TANF - Substance Abuse

(7)

Florida Healthy Kids Behavioral Health Benefits Utilization 2006-2007

Source: Florida Healthy Kids 2008 Source: Florida Healthy Kids 2008

53,666 15,184 1,451 7,815 13,147 32,584 79,615 223 0 13 62 10 1 174

Total Enrolled # Utilizing Behavioral Health Benefits

AmeriGroup Blue Cross/Blue Sheild Blue Options Blue Cross/Blue Shield Health Options Florida Health Care Plans United Healthcare Vista Health Plan

(8)

What Have We Done to Address

What Have We Done to Address

Adolescent Substance Abuse and

Adolescent Substance Abuse and

Mental Health Funding?

Mental Health Funding?

z

z Office of Drug Control secured early cooperation of Office of Drug Control secured early cooperation of

stakeholders

stakeholders

z

z Participants who were involved were in a position to Participants who were involved were in a position to

influence organizational change

influence organizational change

z

z Collaboration and shared vision evidenced by:Collaboration and shared vision evidenced by:

1. Adolescent Treatment Grant participation

1. Adolescent Treatment Grant participation

2. Juvenile Justice Blueprint Commission

2. Juvenile Justice Blueprint Commission

3. Leifman Report

(9)

Advisory Board and Workgroup

Advisory Board and Workgroup

Participants

Participants

z

z Florida Office of Drug ControlFlorida Office of Drug Control

z

z Department of Children and FamiliesDepartment of Children and Families

z

z Department of Juvenile JusticeDepartment of Juvenile Justice

z

z Department of HealthDepartment of Health

z

z Department of EducationDepartment of Education

z

z Substance Abuse Mental Health CorporationSubstance Abuse Mental Health Corporation

z

z Agency for Health Care AdministrationAgency for Health Care Administration

z

z Florida Alcohol and Drug Abuse AssociationFlorida Alcohol and Drug Abuse Association

z

z Florida Certification BoardFlorida Certification Board

z

(10)

Advisory Board and Workgroup Participants

Advisory Board and Workgroup Participants - -Continued

Continued

z

z Southern Coast Addiction Technology Transfer Southern Coast Addiction Technology Transfer

Center

Center

z

z Florida Council for Community Mental HealthFlorida Council for Community Mental Health

z

z Florida Network for Family and YouthFlorida Network for Family and Youth

z

z University of MiamiUniversity of Miami

z

z 44thth Circuit Court of AppealsCircuit Court of Appeals

z

(11)

What Have We Done to Address Adolescent

What Have We Done to Address Adolescent

Funding

Funding - - ContinuedContinued

z

z More cost effective and accessible service system More cost effective and accessible service system

promoted through Comprehensive Continuous

promoted through Comprehensive Continuous

Integrated Systems of Care initiative

Integrated Systems of Care initiative

z

z EvidenceEvidence--based treatment will lead to improved based treatment will lead to improved

treatment outcomes that will support budget requests

treatment outcomes that will support budget requests

z

z Improved data systems will help articulate budget Improved data systems will help articulate budget

requests

requests

z

z National Outcome Measures (NOMS) will improved National Outcome Measures (NOMS) will improved

competitiveness for federal funding

competitiveness for federal funding

z

z Third party reimbursement sources identified through Third party reimbursement sources identified through

grant expected to reduce demand on public funding

(12)

Co

Co

-

-

Occurring Disorders System Integration

Occurring Disorders System Integration

z

z StateState--wide Comprehensive Continuous wide Comprehensive Continuous

Integrated System of Care effort formalized in 2008

Integrated System of Care effort formalized in 2008

z

z Funding for coFunding for co--occurring integration efforts shared occurring integration efforts shared

across disabilities

across disabilities

z

z Match contributions enabled adolescent coMatch contributions enabled adolescent co-

-occurring training at minimal cost to the grant

occurring training at minimal cost to the grant

z

z Training and promotion has led to increased Training and promotion has led to increased

provider buy

provider buy--inin

z

z Integrated service system will be more cost Integrated service system will be more cost

effective; will increase access and utilization; and

effective; will increase access and utilization; and

will improve treatment outcomes

(13)

Identification of Underutilized

Identification of Underutilized

Resources

Resources

z

z Healthy KidsHealthy Kids

1. Promoted evidence

1. Promoted evidence--based assessment and treatmentbased assessment and treatment 2. Promoted behavioral health benefits among enrollees

2. Promoted behavioral health benefits among enrollees

z

z Medicaid County Match ProgramMedicaid County Match Program

1. Promoted provider participation

1. Promoted provider participation

2. Identified new substance billing codes

2. Identified new substance billing codes

z

z Behavioral Health Network (BBehavioral Health Network (B--Net)Net)

1. Mandated co

1. Mandated co--occurring training participationoccurring training participation 2. Mandated Memorandums of Agreement for

2. Mandated Memorandums of Agreement for

for substance abuse treatment

for substance abuse treatment

3. Mandated adoption of evidence

3. Mandated adoption of evidence--basedbased assessment instruments

(14)

Healthy Kids

Healthy Kids

z

z Identified mechanism to increase quality of careIdentified mechanism to increase quality of care

z

z Recommendations adopted by Policy BoardRecommendations adopted by Policy Board

z

z New Contracts based on utilization of accredited New Contracts based on utilization of accredited

and licensed providers

and licensed providers

z

z Insurers required to promote behavioral health Insurers required to promote behavioral health

benefits

benefits

z

z Training provided to substance abuse providersTraining provided to substance abuse providers

z

z Providers increasing education of consumers on Providers increasing education of consumers on

Healthy Kids benefits

(15)

Medicaid County Match Program

Medicaid County Match Program

z

z

Launched in 2008

Launched in 2008

z

z

New Medicaid codes for

New Medicaid codes for

--

Intervention

Intervention

--

Community Support

Community Support

--

Aftercare

Aftercare

z

z

19 counties currently enrolled

19 counties currently enrolled

z

z

56% federal drawdown for verified local match

56% federal drawdown for verified local match

z

z

Promotes partnership between county

Promotes partnership between county

governments and providers

governments and providers

(16)

Behavioral Health Network (B

Behavioral Health Network (B

-

-

Net)

Net)

Utilization 2006

Utilization 2006

-

-

2007

2007

z

z Underutilized resource for substance abuseUnderutilized resource for substance abuse

z

z Provides services for severe casesProvides services for severe cases

z

z 1000+ served in 20061000+ served in 2006--20072007

z

z $5,664,000 appropriated in 2006$5,664,000 appropriated in 2006--20072007

z

z $2,049,447 total reimbursed in 2006$2,049,447 total reimbursed in 2006--20072007

z

z $83,610 reimbursed for substance abuse in 2006$83,610 reimbursed for substance abuse in 2006-

-2007

2007

z

z $7,737,000 appropriated for 2008$7,737,000 appropriated for 2008--20092009

z

z Training provided to providers on Comprehensive Training provided to providers on Comprehensive

Continuous Integrated Systems of Care

(17)

Why Did It Take the Adolescent Treatment

Why Did It Take the Adolescent Treatment

Grant to Accomplish These Changes?

Grant to Accomplish These Changes?

z

z FloridaFloridas large population s large population -- 44thth most populous statemost populous state

z

z Geography Geography -- 53,927 square miles (522 miles from 53,927 square miles (522 miles from

Pensacola to Key West)

Pensacola to Key West)

z

z Dissimilar philosophies and interests among many Dissimilar philosophies and interests among many

stakeholders

stakeholders

Sweeping system changes could not have Sweeping system changes could not have occurred without the leadership and support of occurred without the leadership and support of

the Governor

the Governor’’s Office, Office of Drug Control, s Office, Office of Drug Control, and Department of Children and Families

(18)

Contact Information

Contact Information

William H. Janes, M.A., M.A., M.M.A.S. William H. Janes, M.A., M.A., M.M.A.S.

Assistant Secretary, Mental Health and Substance Abuse Program Assistant Secretary, Mental Health and Substance Abuse Program Florida Department of Children and Families

Florida Department of Children and Families 1317 Winewood Blvd., Building 1, Room 312 1317 Winewood Blvd., Building 1, Room 312 Tallahassee, FL 32399 Tallahassee, FL 32399--07000700 Phone: (850) 414 Phone: (850) 414--90649064 Fax: (850) 922 Fax: (850) 922--49964996 E

E--Mail: Mail: bill_janes@dcf.state.fl.usbill_janes@dcf.state.fl.us Larry J. Kearley, LCSW, CAPP Larry J. Kearley, LCSW, CAPP

Adolescent Treatment Grant Coordinator Adolescent Treatment Grant Coordinator Department of Children and Families Department of Children and Families Substance Abuse Program Office Substance Abuse Program Office

1317 Winewood Blvd., Building 6, Room 312 1317 Winewood Blvd., Building 6, Room 312 Tallahassee, Florida 32399 Tallahassee, Florida 32399--07000700 Phone: (850) 488 Phone: (850) 488--92109210 Fax: (850) 414 Fax: (850) 414--74747474 E

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