FY Budget Presentation

(1)

Edward G. Rendell, Governor ▪ Joan L. Erney, Deputy Secretary DPW OMHSAS www.dpw.state.pa.us

2010-2011 Executive Budget

Office of Mental Health and Substance Abuse Services

FY 10-11 Budget Presentation

(2)

2010-2011 Executive Budget

Health Care Budget Overview

• Budget responds to the current economic challenge by

permanently reducing costs

• Allows for a $346

million expansion in health care across

all commonwealth agencies ($329 million for DPW)

• Increases the number of children receiving health care

through CHIP by 10,300

• Maintains adultBasic

enrollment at 2008 levels

• Builds on progress to rebalance the long term living

system

• Supports DPW safety net programs and investments in

(3)

2010-2011 Executive Budget

The FY10-11 DPW budget prepares PA

to meet rising demand

–

MA enrollment is expected to grow 3%

–

In child welfare, the number of children needing

out-of-home placement will continue to decline, allowing

more children to be served in their homes

–

150 new individuals will be able to access MR

community services to avoid institutionalization

–

More children will be able to participate in early

learning programs, and more individuals will be able

to access needed mental health and substance abuse

services

(4)

2010-2011 Executive Budget

Risks to the Budget

1. The Economy –

if the recovery is slower than

expected, revenues will be below target

2. MCO Pharmacy Rebates –

if Congress fails

to act, we will have less pharmacy savings

3. Enhanced FMAP –

if Congress fails to

extend the enhanced match for Medical

Assistance, the budget will not balance

(5)

2010-2011 Executive Budget

Office of Mental Health and

Substance Abuse Services

(6)

2010-2011 Executive Budget

OMHSAS: Guiding Principles

• The Mental Health and Substance Abuse Service system will provide quality

services that:

–

Facilitate recovery and resiliency for adults and children

–

Are responsive to individuals’ unique strengths and needs throughout

their lives

–

Focus on prevention and early intervention

–

Recognize, respect, and accommodate differences as they relate to

culture/ethnicity/race, religion, gender identity and sexual orientation

–

Ensure individual human rights and eliminate discrimination and stigma

–

Are provided in a comprehensive array by unifying programs and funding

building on natural and community supports unique to each individual

and family

–

Are developed, monitored and evaluated in partnership with consumers,

families and advocates

(7)

2010-2011 Executive Budget

DPW: OMHSAS-Administered

Behavioral Health Funding

• Community Mental Health Services

–

Base Funds

–

CHIPPs/SIPPs

–

BHSI- Mental Health

–

MH Block Grant/SSBG/Other Federal

–

Other Categoricals

–

State Mental Hospitals

• DPW Administered Drug and Alcohol

–

Act 152

–

BHSI- Drug & Alcohol

• Medicaid

–

BH FFS

–

HealthChoices Behavioral Health

(8)

2010-2011 Executive Budget

OMHSAS: Unified Systems Strategy

1990-91

County-based Medicaid state plan services utilizing county base funding for state match

1991

CHIPP dollars follow person from State Hospital to community

1993-94

Streamline appropriation Community/Hospital Appropriation

1996-97

Act 152 Dollars administered by OMHSAS

1997

BHSI funds for MH and D&A established and administered by OMHSAS

HealthChoices BH program administered by OMHSAS (Southeast)

1998

OMH changes name to OMHSAS

1999

HealthChoices expansion to Southwest

2001

HealthChoices expansion to Lehigh/Capital

2003-04

Service Area Planning Initiatives; County Planning

2004-05

Children’s Integrated Services Initiative (ICSI)

2005-06

HealthChoices expansion to Northeast Counties

2006-07

BH FFS Transfer

HealthChoices Expansion to 23 counties

2007-08

HealthChoices Expansion to all 67 counties

Assume responsibility for SPBP program

2008-10

Enhanced cross system initiatives; maximization financial supports

Funding transfer to ODP to support persons with Intellectual Disabilities/MH

Funding transfer to PCCD to support Forensic Initiatives, including Center of Exec.

Braided Funding pilot for persons with Traumatic Brain Injury

Joint Funding with OCDEL for Early Childhood Mental Health Initiative

Joint Funding of Evidence Based Practices ( PCCD, OCYF)

(9)

2010-2011 Executive Budget

Movement of Funding from

State Administration to County Administration

14% Community Grant 28% Community Grant 71% HealthChoices 15% State 72% State

Community Grant Program HealthChoices

Dollars Under County Admin. $354,355,067 Dollars Under State Admin. $914,662,672 Dollars Under County Admin. $3,429,592,084 Dollars Under State Admin. $582,530,796

Percentage of OMHSAS Funding Under County Admin.

1994-1995

Percentage of OMHSAS Funding Under County Admin.

2010-2011

(10)

2010-2011 Executive Budget

HealthChoices, $2,838,974,084 70% MH/D&A MA FFS, $107,018,689 3% SM Hospitals, $403,954,000 10%

Comm Based Grants, $590,618,000

15%

BHSI/Act 152, $71,558,107 2%

Mental Health and Drug and Alcohol Service System

Total Funding

$4,012,122,880

(11)

2010-2011 Executive Budget

OMHSAS FY 2010-11 Budget Summary

Fiscal Year

2008-2009

2009-2010

2010-2011

APPROPRIATION

SOURCE

Actual

Available

MH Services

State

$707,890,000

$728,730,000

$710,354,000

Federal

264,158,000

270,847,000

273,769,000

Other

11,995,000

10,449,000

TOTAL

$984,043,000

$1,010,026,000

$994,572,000

BHSI/Act 152

BHSI (State)

$43,739,000

$55,331,000

IGT (Other)

12,107,000

0

0 MAOP/Act 152 (State)

16,205,094

15,674,107

16,227,107

TOTAL

$72,051,094

$71,005,107

$71,558,107

(12)

2010-2011 Executive Budget

OMHSAS FY 2010-11 Budget Summary

Fiscal Year

2008-2009

2009-2010

2010-2011

APPROPRIATION

SOURCE

Actual

Available

MH/D&A MA Capitation

State

$1,250,078,683

$1,002,197,020

$1,104,686,007

Federal

1,321,554,705

1,557,728,860

1,734,288,077

TOTAL

$2,571,633,388

$2,559,925,880

$2,838,974,084

MH/D&A MA Fee-For-

State

$54,867,643

$45,310,078

$47,672,488

Service

Federal

42,418,180

54,521,637

59,346,201

(13)

2010-2011 Executive Budget

OMHSAS FY 2010-11 Budget Summary

2008-2009

2009-2010

2010-2011

APPROPRIATION

SOURCE

Actual

Available

Grand Total

State

$2,072,780,420

$1,847,242,205

$1,934,270,602

Federal

1,628,130,885

1,883,097,497

2,067,403,278

Other

24,102,000

10,449,000

TOTAL

$3,725,013,305

$3,740,788,702

$4,012,122,880

(14)

2010-2011 Executive Budget

OMHSAS: FY 2010-11 Budget Unified System Strategy

• Mental Health Services

–

$994.6 B total state, federal and other funds

• FY 09/10 freeze restored

• One time cost containment, $20M

–

Provides sufficient funds to support the closure of Allentown State Hospital

• $14.335 M for 155 CHIPPs

–

110 Discharges from Allentown State Hospital

–

30 Discharges from Norristown State Hospital

–

15 Discharges from Wernersville State Hospital

»

Transfer of $1.820 M to ODP for 13 individuals from the state hospitals to the

waiver program

»

Funding targeted for up to an additional 17 persons with Intellectual Disabilities/

Mental Illness (Funding transfer in subsequent year)

–

$5 M savings achieved through reimbursement from counties for the first 90 days that pre-trial

(15)

2010-2011 Executive Budget

OMHSAS: FY 2010-11 Budget Unified System Strategy

• BHSI Funding for MH and D&A

-

$55.331 M

• $22,132,400 MH

• $33,198,600 D&A

• Act 152 funding is maintained at $16,227,107 for FY 2010-11

• Expedited Plus enrollment-19 counties submitted; 1 county fiscal impact in HC

• Sexual Responsibility and Treatment Program (Act 21)

–

Implemented in April 2004 on the grounds of Torrance State Hospital

–

28 men are now being served; no one has been discharged since first admission of

program, planning for up to 2 releases

–

SRTP program operation was transferred to the Commonwealth and operated by

Torrance State Hospital (July 1, 2006)

• Special Pharmaceutical Benefit Program (SPBP)

(16)

2010-2011 Executive Budget

Behavioral Health HealthChoices

• 67 HealthChoices Counties

–

43 counties accepted right of first opportunity

–

1 direct state contract with BH-MCO (Greene County)

–

Direct state contract with 23 counties – operates in partnership

with BHARP (county oversight entity)

–

Incorporates broad behavioral health mandates

–

Variety of models including full risk county contracts,

subcontracts with Administrative Services Organization and full

risk subcontracts

(17)

2010-2011 Executive Budget

OMHSAS: HealthChoices

• As of January 1, 2010, there are 1.78 M people enrolled in HealthChoices,

2.1M projected in MA overall for FY 2010-11.

• Projected enrollment for SFY 2010-11 is $1.88 M

• FY 2010-11 funding projected to be $2.839 Bin the Southeast, Southwest,

Lehigh/Capital, Northeast Zone, 23 county expansion zone and 15 county

expansion zone:

–

Legacy Zones ( SE, SW, L/C)

$2.163B

–

Expansion Zones (NE, SO, CO)

$ 676M

–

Mental Health portion*

$2.507B

–

Substance Abuse portion*

$ 332M

• Reinvestment (savings) generated since 1997: $446M; 3.1%

(18)

2010-2011 Executive Budget

Our work in the coming year

• General

–

Monitor implementation of MH /SA Parity

regulations

• Children

–

Implement and monitor implementation of act 62

autism legislation ($30M estimated total savings)

• Adults

(19)

2010-2011 Executive Budget

Statewide Gross Receipts Tax on

MA Managed Care Revenues

• Statewide MCO Assessment ended 9/30/09

• Effective 10/01/09, PA enacted a gross

receipts tax of 5.9% on MA MCO revenue

received from DPW by MA MCOs

• $354 M revenue in FY 10/11

(20)

2010-2011 Executive Budget

HealthChoices

Cost Containment

• Proposal:

1) Seek return of uncommitted funds and unspent

reinvestment funds from counties in HealthChoices

behavioral health program.

2) Modify cap for risk and contingency funds.

3) Continue Shared Savings cap on reinvestment up to 3%

(Legacy Zones) and 5% (Expansion Zones).

• FY 10/11 $3M state savings

(21)

2010-2011 Executive Budget

Clinton Armstrong Indiana Washington Greene Fayette Allegheny Beaver Westmoreland Bedford Somerset _Franklin Fulton Cambria Huntingdon Blair Forest Venango Mercer Lawrence_Butler Clarion Crawford Erie Warren Jefferson Clearfield Centre McKean Elk Cameron Potter Northampton Lebanon Cumberland York Adams Lancaster Perry Juniata Mifflin Dauphin Schuylkill Montgomery Chester DelawarePhiladelphia Berks Bucks Lehigh Columbia Montour Snyder Union Northumberland Lycoming Tioga Sullivan Bradford Pike Carbon Luzerne Monroe Susquehanna Wyoming Wayne

HEALTHCHOICES ZONES

SOUTHEAST Implemented Feb. 1997 SOUTHWEST LEHIGH/CAPITAL Implemented Oct. 2001 Implemented Jan. 1999 BH Implementation July 1, 2007 January 1, 2007 NORTH/CENTRAL

STATE OPTION NORTH CENTRAL COUNTY OPTION BH Implementation

NORTHEAST BH Implementation July 1, 2006

(22)

2010-2011 Executive Budget

State Hospitals/CHIPPs

• OMHSAS has 7 state hospitals and 1 long term nursing care facility *

• Since FY 1994-95:

–

69% reduction in the state hospital census (through June 30, 2011)

–

55% decrease in staff complement

• Through the CHIPP funding:

–

2,909 individuals will have been discharged

–

14,305 individuals will have received diversionary services as a result of these

discharges through June 30, 2010

–

$249,030,560 in funding for community programs and supports

*

South Mountain recognized as top state nursing home in the country- US News &

World Report

(23)

2010-2011 Executive Budget

State Hospital Closure Updates

• Harrisburg State Hospital closed on January 27, 2006

–

132 individuals were discharged to the community

–

Cumberland county 4 years later!

• Mayview State Hospital closed on December 29,

2008

–

235 individuals were discharged to the community

–

One year report!

• Announcement of the closure of Allentown State

Hospital occurred on January 21, 2010

(24)

2010-2011 Executive Budget

CHIPP Funding History (Cumulative)

Fiscal Year

Funding Level

Beds

Persons Served

94-95

$

52,903,014

769 2,626

95-96

$

60,627,725

867 3,733

96-97

$

66,702,352

1,072

4,246

97-98

$

83,801,837

1,432

5,105

98-99

$

100,608,283

1,523

6,173

99-00

$

117,221,000

1,721

6,875

00-01

$

135,619,558

1,931

8,435

01-02

$

155,651,196

2,170

9,990

02-03

$

164,409,141

2,203

10,883

03-04

$

166,997,141

2,236

11,048

04-05

$

172,508,492

2,269

11,213

05-06

$

194,690,118

2,462

11,538

06-07

$

197,781,292

2,541

12,389

07-08*

$

229,584,081

2,738

12,902

08-09

$

247,102,665

2,849

13,801

09-10**

$

249,030,560

2,909

14,305

**5.5 million in Reserve for Allegheny County

Persons served include persons receiving CHIPP funds and others receiving diversionary services.

*Transferred $4.037 M to support federal match for structured treatment services Funding level includes carryover

(25)

2010-2011 Executive Budget

ERIE CRAWFORD WARREN FOREST McKEAN POTTER CAMERON ELK VENANGO MERCER BEDFORD BLAIR SOMERSET CAMBRIA INDIANA JEFFERSON CLINTON LYCOMING SULLIVAN TIOGA BRADFORD WAYNE WYOMING PIKE LUZERNE SCHUYLKILL CARBON LEHIGH COLUMBIA BUCKS BERKS CHESTER LANCASTER MONTGOMERY YORK LEBANON PERRY CUMBERLAND DAUPHIN JUNIA TA MIFF LIN UNION SNYDER CENTRE ADAMS FRANKLIN FULTON HUNTINGDON CLEARFIELD CLARION LACKAWANNA MONTOUR NORTHU MBERLA ND PHILADELPHIA DELAWARE SUSQUEHANNA LAWRENCE BUTLER ARMSTRONG FAYETTE WESTMORELAND ALLEGHENY BEAVER WASHINGTON Warren Staff 448 Patients 183 GREENE

Warren

NORTHAMPTON MONROE

Torrance

Danville

South Mountain

Wernersville

Norristown

Allentown

Clarks Summit

Torrance Staff 602 Patients 290 Danville Staff 373 Patients 175 Clarks Summit Staff 473 Patients 220 Allentown Staff 379 Patients 175 Wernersville Staff 469 Patients 217 Norristown Staff 743 Patients 369 South Mountain

serving all counties Staff 283

Patients 134

As of February 05, 2010

(26)

2010-2011 Executive Budget

Fiscal Year 2007-2008

Unified Mental Health and Substance Abuse Services System

• Community Mental Health

–

Persons Served: 218,827*

–

Expenditures: $538,672,180

–

Ave. Expend. $2,462

• BHSI (MH)

–

Persons Served:

31,978

–

Expenditures

$23,967,751

–

Ave. Expend:

$749

• MA FFS

–

Persons Served: 91,156

–

Expenditures: $103,004,712

–

Ave. Expend.

$1,130

• HealthChoices

–

Persons Served: 330,606

–

Expenditures: $1,959,682,174

–

Ave. Expend.

$5,928

* not all counties submitted data

• BHSI (D&A)

–

Persons Served: 46,617

–

Expenditures:

$33,426,597

–

Ave. Expend.

$717

• Act 152 (D&A)

–

Persons Served: 6,223

–

Expenditures:

$18,275,378

–

Ave. Expend.

$2,937

• State Mental Hospital

–

Persons Served: 3,539

–

Expenditures:

$387,997,439

(27)

2010-2011 Executive Budget

Program Initiatives

Progress on Our

(28)

2010-2011 Executive Budget

Approximately how many consumers

are employed as peer specialists in your state?

21 of the 22 states answered this question. The range was from 9 to 500.

(29)

2010-2011 Executive Budget

Certified Peer Specialists

• General update:

–

Number of trained CPS:

1160

–

Number of trained CPSS:

720 –

Number of programs enrolled:

67

• Consumer Leadership Group identified additional goals

• OMHSAS with The Main Link, developed curriculum for

specialized training centered on Forensic Peer Specialists;

Second training next week!

• OMHSAS also supported older adult peer

development

(30)

2010-2011 Executive Budget

Impact of Certified Peer Specialists

• Service Area Planning Response

–

Participation and Leadership in Community Support Planning for

individuals leaving State Hospitals

(Allegheny County, Beaver, Lehigh, Northampton, CMP)

–

Transition Support and Linkages (All Service Areas)

• Certified Peer Specialists Report

–

Compelling Stories of Recovery (Statewide)

–

Opportunities for Employment, Recognition, Income (Statewide)

• Traditional Agency Response

–

Impact of CPS on traditional agency, change of culture

(Montgomery)

(31)

2010-2011 Executive Budget

Impact of Certified Peer Specialists

• County Response

–

Systems Change Agent ( Montgomery,

Cumberland, Dauphin, Westmoreland, Erie,

Philadelphia, and on and on…..)

–

County Plan

–

Recognition of value to all Human Services

(Bradford Co)

• State Response

–

Employees at OMHSAS, DPW

(32)

2010-2011 Executive Budget

Justice Related Services

• PCCD/OMHSAS Partnership

• Forensic Peer Support Training Grant/Funding

Announcement

• Funding Announcement contacts

–

Ms. Jacqueline Weaknecht (PCCD)

• (717) 265-8498

–

Ms. Jessica Reichenbach (OMHSAS)

• (717) 772-7415

–

http://www.portal.state.pa.us/portal/server.pt/community/f

unding/5424/more_page17/551664

(33)

2010-2011 Executive Budget

Justice Related Services

Mental Health and Justice Advisory Committee

Mental Health & Justice Center of Excellence

http://www.pacenterofexcellence.pitt.edu

Jointly fund grants to counties for mental health

courts and jail diversion programs ($6.5M

(34)

2010-2011 Executive Budget

OMHSAS: Housing Reinvestment Expenditures 2005-2010

• Bridge $8,657,661

• Master Leasing

7,783,353

• Capital 15,209,429

• PBOA

10,072,753

• Management Clearing House

2,557,288

• Housing Support

4,453,310

• Housing Contingency

1,712,480

• Fairweather

82,000

• Other 1,650,198

• Total

$ 52,133,472

• **

Provides overview of type of use of one time funds

• Partners include OMHSAS, County MH, County Development Offices, Local Housing

Agencies, Pennsylvania Housing Finance Agency and Technical Assistance

(35)

2010-2011 Executive Budget

Projected Supportive Housing Initiative Summary

Type of Project

# of Counties

Projected # of Units

• Bridge Subsidies

11

750

• Master Leasing

11

250

• Capital Financing (units)

13

200

• Project Based

6

400 Operating Subsidies

• Total Number of

(36)

2010-2011 Executive Budget

Quality Management:

How are We Doing….

What difference are we

(37)

2010-2011 Executive Budget

How we are doing:

Service Area Planning

–

During FY 07/08, 719 people were discharged from the civil

hospitals (excluding Mayview).

• 37 people were readmitted

–

CSP’s were developed for 123 (17%) of the people discharged.

–

Overall readmission rate for 710 people discharged was

5.1%.

Readmission rate for people discharged with a CSP during this

same period was

0.4%.

This has held true for individuals

discharged from Mayview State Hospital.

This difference between the two readmission rates reinforces

the value and importance of a CSP in sustaining a person’s

discharge and ultimately their recovery.

Far fewer incidents when individuals have a Community

Support Plan that includes Consumer and Family input!

(38)

2010-2011 Executive Budget

Service Area Plan Updates: Goal 1

Consumers served in State Hospital System 6/03-6/09

Length of Stay for Consumers

886

913 ₈₂₆

608 1115

₁₀₀₆

924 ₇₈₂

₈₄₃

₆₉₆

₈₄₂

926 ₇₇₅

1060

0

500 1000

1500

2003 2004 2005 2006 2007 2008 2009

Years

Nu

m

b

er

o

f

Co

n

su

m

er

s

Under 2

Years

over 2

Years

(39)

2010-2011 Executive Budget

Service Area Plan Updates

• Percentage of Individuals with a Length of

Residence < 2 Years and > 2 Years

Percentage of Individuals with a Length of Residence Less Than 2 Years and

Greater Than or Equal to 2 Years

56 ₅₄

₅₂

₅₃

55

56

47

46

44

48

47

45 ₄₄

0

20

40

60

200

3

200

4

200

5

200

6

200

7

20

08

200

9 Year

Pe

rc

e

n

ta

g

e

2 + Years

Under 2 Years

(40)

2010-2011 Executive Budget

Service Area Plan Updates

Despite a decrease in the absolute number of

individuals who have been in state hospitals

for 2+ years- particularly with the closure of

Harrisburg and Mayview State Hospitals-

the percentage remains relatively constant.

We must remain committed to Goal 1 –

closing hospitals is the most effective method

for achieving that goal…

(41)

2010-2011 Executive Budget

Quality Management Updates:

HealthChoices Behavioral Health Performance Report 2009

Positive trends in OMHSAS Priority Areas

Adult Mental Health Services

• The rate of eligible adults (ages 18-64) receiving MH services

increased from 25% in 2007 to 26% in 2008. The Southwest

region has consistently shown the highest utilization rates,

with 29.8% of eligible adults receiving MH services in

calendar year 2008.

• There was also an increase in the 2008 rate of adults with

Serious Mental Illness receiving MH services, with 7% of this

population receiving community based care. This was

significantly higher than the estimated national average of

approximately 3.1%.

(42)

2010-2011 Executive Budget

Quality Management Updates:

HealthChoices Behavioral Health Performance Report 2009

Drug and Alcohol:

• Adults (ages 18-64) receiving drug and alcohol services

remained unchanged at 7% of eligible members in 2007 and

2008. The estimated national need is 4.8%.

• Those adults with Serious Mental Illness and a co-occurring

substance disorder who received services remained constant at

2% of eligible members from 2004 to 2007. This was below

the national estimated need of 3.1%.

(43)

2010-2011 Executive Budget

Quality Management Updates:

HealthChoices Behavioral Health Performance Report 2009

Minority Service Utilization

Mental Health:

• Utilization of MH services by African-American adults (ages 18-64)

increased from 18% of eligible members in 2004 to 22% statewide in 2008.

• With the exception of the North/Central State Option (which dropped by 1%),

every region reporting multiple years of data showed increased use of MH

services by African-American adults in 2008 (the last year data are available).

Drug and Alcohol:

• African-American adults (ages 18-64) receiving drug and alcohol services

increased from 7% of eligible members in 2004 to 8% in 2008.

• The minority population for some counties was so small it was not included in

this indicator.

(44)

2010-2011 Executive Budget

Quality Management Updates:

HealthChoices Behavioral Health Performance Report 2009

Psychiatric Inpatient Readmission Rates

• Older adults (ages 65 and over) who were readmitted to community

inpatient psychiatric hospitals within 30 days of discharge decreased

statewide from 10% in 2007 to 8% in 2008.

• The adult (ages 21-64) readmission rate to community inpatient psychiatric

hospitals within 30 days of discharge dropped slightly from 21% of

discharges in 2007 to 20% in Calendar Year 2008.

• Children (ages 0-20) who were readmitted to community inpatient

psychiatric hospitals within 30 days of discharge in 2008 decreased

from16% in 2007 to a statewide average of 15% in 2008.

NOTES: To adjust for County size, weighted averages were used. Unlike many other performance

indicators, the readmission measure is an inverted rate, in that lower rates are preferable

.

(45)

2010-2011 Executive Budget

Quality Management Updates:

HealthChoices Behavioral Health Performance Report 2009

Services following Inpatient Discharge

• The rate of adults (ages 21-64) receiving community

behavioral health services within seven days of discharge from

inpatient psychiatric care increased from 30% in 2004 to 39%

in 2008. The Northeast Region reported the highest 2008 rate

at 60.4%.

• The 7-day follow-up rate for children (< 21 years) discharged

from inpatient psychiatric care increased to 56% in 2008 (from

48% in CY 2004).

• The national norm for this measure is 42.5%.

OMHSAS has

established a Gold Standard of 90% community follow-up care

within seven days of hospital discharge.

NOTES: To adjust for County size, weighted averages were used. The data reflect the fact that additional allowable procedure codes were added between 2004 and 2008 to these HEDIS (Health Effectiveness Data and Information Set) measures.

(46)

2010-2011 Executive Budget

Quality Management Updates:

HealthChoices Behavioral Health Performance Report 2009

Children’s Service Utilization

Mental Health

• Children (< 21 years) who were admitted to residential treatment facilities

remained steady with 4% of eligible children receiving services in CY 2007

and 2008.

• The rate of children who remained in residential treatment facilities more than

120 days decreased in 2008 when compared to the prior calendar year, with 2%

of these children having extended stays in 2008.

Drug and Alcohol

• Adolescents (ages 13-17) receiving drug and alcohol services remained steady

over time, with 1% of eligible members receiving services in 2004 and in 2008.

(47)

2010-2011 Executive Budget

Other OMHSAS Quality Improvement Initiatives

• Quality improvement is an ongoing, collaborative process with all

stakeholders. Several 2010 efforts of note:

• Convening Consumer and Family Satisfaction Survey Methodologies

Workgroup to:

–

Revise language within Appendix L of the HC BH contract to reflect current

and projected survey activities.

–

Expand use of the ROSI consumer survey statewide, for a targeted population

of adults.

–

Review existing 3 statewide survey questions and develop age-appropriate

companion sets of 5-10 survey items.

• Develop a toolkit and implementation strategy for all C/FSTs, Counties, BH-MCOs

and OMHSAS.

• Year 2 of Root Cause Analysis and Action Plan processes with BH-MCOs

and Counties on select performance indicators.

• Development of an OMHSAS Dashboard, which will enhance management

(48)

2010-2011 Executive Budget

Perspectives of Care: MHSIP

• The

ultimate measure of services is how individuals are doing in their lives.

An integral measurement strategy involves asking consumers and family

members about their perceptions of care.

• Adults

• OMHSAS conducts an annual mailed MHSIP (Mental Health Statistics

Improvement Program) survey with adult recipients of behavioral health

services.

• The survey items are categorized into 7 national “Domains”, which are

reported to the federal government in our mental health block grant.

• The 2009 findings showed that adults surveyed feel most positively about

participation in their own treatment.

• Outcomes of Care commonly receives the lowest ratings of the domains.

This performance indicator is one of nine National Outcome Measures.

(49)

2010-2011 Executive Budget

Perspectives of Care: MHSIP

Pennsylvania Consumer Perception of Care 2009:

Adult Survey Respondents Reporting Posivtively on MHSIP Domains

84.67% 82.75% 64.15% 85.59% 83.60% 70.51% 63.37% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Access Quality and Appropriateness Outcomes Participation in Treatment Planning General Satisfaction Social Connectedness Functioning

(50)

2010-2011 Executive Budget

Perspectives of Care: MHSIP

Families

• Annually, OMHSAS also conducts a mailed MHSIP survey with family

members of children and adolescent behavioral health service recipients.

• Social Connectedness and Functioning are the two domains most recently

added to the structure of the MHSIP surveys.

• The 2009 findings showed that families surveyed feel most positively about

two key items regarding their child’s care: Cultural Sensitivity of the staff

and Participation in their child’s treatment planning.

• 62.4% of families surveyed believed that their child’s outcomes were

improved as a direct result of services received.

(51)

2010-2011 Executive Budget

Perspectives of Care: MHSIP

• .

Pennsylvania Consumer Perception of Care 2009:

Family Member Survey Respondents Reporting Positively on MHSIP Domains

83.89% 77.21% 62.41% 89.26% 92.31% 79.97% 62.26% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Access General Satisfaction Outcomes Participation in Treatment Planning for their Children Cultural Sensitivity of Staff Social Connectedness Functioning

(52)

2010-2011 Executive Budget

OMHSAS use of the Recovery Oriented System Indicators Measure (ROSI) in 2009

• Consumer Survey

–

Contracted with the Consumer Satisfaction Team Alliance

of PA & 21 local satisfaction teams in a pilot program

–

576 adults with SMI surveyed face-to-face in 24 counties.

• Administrative Data Profile

–

Counties reported their providers’ survey responses.

–

The areas surveyed were: Peer/Consumer programs, Jail

diversion, Affirmative action hiring policies by providers,

Recovery-oriented mission statement & Consumers serving

on provider governing boards

(53)

2010-2011 Executive Budget

The "Top Ten" ROSI questions by percentage

answered by participants in 2009

91.6

88.6

88.4

87.3

86.3

83.9

83.7

81.9

96

81.5

Staff listens carefully to what I say

Physical health is not ignored

Dr. worked w/ me to get meds that were most

Staff have not interferred w/ personal relationships Residence feels like comfortable home

Services have not caused me emotional or physical harm Staff do not use pressure, threats or force

Respected as a whole person Respect for cultural background At least one person who believes in me

(54)

2010-2011 Executive Budget

Administrative ROSI: What percent of funds are allocated for peer/consumer delivered services?

What we learned by asking….

No association between size of county and %

What further question we had….

Was the data accurate in the higher %s reported?

8 12 10 7 11 0 - 1% > 1% - 2.5% > 2.5% - 5% > 5% - 7% > 7% - 25%

The Number of Counties reporting their allocated %s for Peer/Consumer Programming in 2009

8

12

10

7

11 0 - 1%

> 1% - 2.5%

> 2.5% - 5%

> 5% - 7%

> 7% - 25%

The Number of Counties reporting their allocated

percentages for Peer/Consumer Programming in 2009

(55)

2010-2011 Executive Budget

When we placed all of the counties together we could see the comparative

differences in their allocated percentages reported

0 1 2 3 4 5 Bucks Chester Delaware Montgomery Philadelphia Allegheny Arm/Ind Beaver Butler Cam-Elk Clarion Clear/Jeffe Crawford Erie Fayette For/Warr Greene Lawrence McKean Mercer Potter Venango Washington Westmoreland Bed/Som Blair Cambria Centre CMSU Cumb/Perry Dauphin Frank/Fult HMJ Lancaster Lebanon Lyc/Clint Northumberland York/ Adams Berks Brad/Sull CMP Lack/Susq Lehigh Luz/Wyom Northampton Schuylkill Tioga Wayne ↑ number means higher spending by percentage in Counties for Consumer/Peer Programs

(56)

2010-2011 Executive Budget

Transition to New Administration

• Identifying leadership team for transition to

new administration

• Preparing briefing book for new Governor

• Developing public ‘legacy’ document

summarizing current initiatives and

accomplishments

• Prioritizing initiatives to finish before the new

(57)

2010-2011 Executive Budget

(58)

2010-2011 Executive Budget

You Are The Evidence !!!!!!

I’

m The Evidence

For how belief inspires

How hope transforms and

How giving heals the soul

I’m

T

he Evidence

For what can be achieved

How feeling connected can ground and

How there is invaluable worth in an act of faith

I’m The

E

vidence

For how an example can lead

How far encouragement can take you and

How one step begins a journey towards endless possibilities

(59)

2010-2011 Executive Budget

Office of Mental Health and

Substance Abuse 2007-2010

Objectives

(60)

2010-2011 Executive Budget

OMHSAS Objectives

• Transform the children’s behavioral health system to

a system that is family driven and youth guided

• Implementation of services and policies to support

recovery and resiliency in the Adult Behavioral

Health System

• Assure that behavioral health services and supports

recognize and accommodate the unique needs of

older adults

(61)

2010-2011 Executive Budget

Children’s Objectives

Transform the children’s behavioral health

system to a system that is

(62)

2010-2011 Executive Budget

Some Guiding Principles

• Trauma informed culture should serve as the

background for all services to children and

adolescents

• CASSP principles are assumed to be part of the

children’s Objective and Supporting Projects

• Youth and Family Teams will lead to a

transformation of the children’s behavioral health

system

(63)

2010-2011 Executive Budget

Children’s Supporting Projects

and Actions

• Establishment of Child-Family Teams to

support Transformation

–

Establish an Institute to provide training, support

and monitoring of Youth and Family Teams -

Complete

–

Develop mechanism for Medicaid payment of

Youth and Family Team process -

Complete

(64)

2010-2011 Executive Budget

Children’s Supporting Projects

and Actions

• Create Home and Community Based Alternatives to

Residential Treatment

–

Develop a “White Paper” addressing current environment,

needs and recommendations for creating alternatives to the

current residential treatment system -

Complete

–

Change existing rules to permit small group homes and

therapeutic housing –

Under consideration

–

Enroll Multi Dimensional Treatment Foster Care as a

Medicaid funded service –

Nearly complete

(65)

2010-2011 Executive Budget

Children’s Supporting Projects

and Actions

• Partner with Education to support the development of effective

school based supports and interventions

–

Have OMHSAS Children’s Advisory develop “White Paper” on school

based behavioral health services -

Complete

–

Engage youth to get their perspective on school based behavioral health

services -

Complete

–

Review and update the existing Memorandum of Understanding with

DOE, DOH, and DPW to detail responsibilities for SBBH –

Different

approach being taken

–

Continue to build the relationship with DOE and collaborate on

projects such as SBBH Demonstration Grants, Positive Behavioral

Interventions and Supports, etc. -

Ongoing

–

Reduce admission to segregated programs -

Ongoing

–

Identify efforts underway with BHMCOs on collaborative efforts with

schools -

Ongoing

–

Enhance letters of agreement between Counties, BHMCOs and Schools

(66)

2010-2011 Executive Budget

Children’s Supporting Projects

and Actions

• Create Behavioral Health competency to honor the strengths

and address the unique individualized needs of children and

adolescents: -

All ongoing

• In the child welfare system

–

In, or at risk of entering, the Juvenile Justice system

–

In the drug and alcohol system

–

With Fetal Alcohol Syndrome Disorder

–

That are Deaf or Hard of Hearing

–

With Traumatic Brain Injury

–

With Autism Spectrum disorder or other Pervasive Developmental

Disorder

–

With Physical Disabilities

(67)

2010-2011 Executive Budget

Children’s Supporting Projects

and Actions

• Develop a process for identifying and implementing evidence

based practices, promising practices and culturally relevant

practices

–

Utilize the SAMHSA National Registry of Evidence Based Practice,

the NASMHPD Research Institute, the National Blue Print initiative

and other sources to identify evidence based and promising practices

–

In process

–

Document the expansion of Multi Systemic Therapy, Functional

Family Therapy and other evidence based practices in current practice

-

Ongoing

–

Develop the Youth and Family Team process as the practice model for

children’s behavioral health to support evidence based practice

-

(68)

2010-2011 Executive Budget

Children’s Supporting Projects

and Actions

• Develop strategies to address the needs of

Transitional Youth

–

Support Youth involvement in the OMHSAS Advisory

Council

-

Ongoing

–

Obtain Youth input in identifying needs, developing plans,

implementing and monitoring service development for

Transition Youth

-

Ongoing

–

Summarize OMHSAS Transition Pilot projects -

C

omplete

–

Identify existing initiatives in other agencies

-

Ongoing

(69)

2010-2011 Executive Budget

System of Care Priority

• The System of Care Partnership will build on and

enhance cross system efforts that have been

underway for several years to integrate and more

effectively provide services to youth.

• The System of Care Partnership will transform the

current categorical and fragmented service delivery

approach into a comprehensive community-oriented

delivery system.

(70)

2010-2011 Executive Budget

High Fidelity Wraparound Priority

• High Fidelity Wraparound has proven to be

cost-effective for youth with complex, multi-

system involvement.

• This approach has been implemented in 4

counties, 2 additional counties are now in

training, and 2 more will begin in the near

future.

• We want to expand to all counties in the

(71)

2010-2011 Executive Budget

Evidence Based Practice Priority

• We have successfully expanded the availability of

FFT, MST, and MTFC – which treat similar

populations.

• Evidence-based programs that treat young children,

youth with serious mental illness, traumatized youth,

and youth with internalizing disorders (e.g.,

depression, anxiety) need to be identified and a

strategy for making these additional EBPs available

to Pennsylvania youth must be developed.

(72)

2010-2011 Executive Budget

Early Child Mental Health Priority

• Expand ECMH consultation

• Provide Medicaid reimbursement for evaluation and

services based on DSM-IV V-Codes

• Expand collaboration between physical and

behavioral health; e.g., expand screening for social

and emotional developmental delays and referrals to

qualified behavioral health practitioners

• Support professional development options to increase

the number of practitioners and providers with

(73)

2010-2011 Executive Budget

RTF Priority

• Publish RTF Regulations as proposed

• Continue to work with bringing Sanctuary model to RTFs

• Implement actions to support the Continuum of Care goal of

reducing the number of youth in RTF’s, providing services in-

state for youth currently placed out-of-state, and ensuring that

appropriate services in the least restrictive environment are

available to youth.

• Work cooperatively to divert youth with predominant mental

health issues away from juvenile justice placements and into

community based programs that can meet their MH needs.

(74)

2010-2011 Executive Budget

Transition Youth Priority

• Implement a training curriculum for peer specialist

working specifically with transition age youth.

• Develop ways to address the housing needs of

transition age youth and young adults.

• Create a developmentally sensitive system of

behavioral health services for transition age youth

and young adults in every county.

(75)

2010-2011 Executive Budget

Call for Change Priority

• OMHSAS is developing a “Call for Change,”

a strategic plan to implement the goal of

transforming the children’s behavioral health

system to be youth guided and family driven.

• The plan will focus on improving access and

streamlining the process for quality, effective

behavioral health services for children and

(76)

2010-2011 Executive Budget

Adult Objective

Implementation of services and policy

to support recovery and resiliency in

(77)

2010-2011 Executive Budget

Adult Supporting Projects and Actions

• Define and expand the range of and financial commitment to

consumer-run services, supports and trainers

–

New Freedom Initiative Project

-

Complete

–

Gain baseline understanding of existing consumer- run

services, supports and trainers statewide –

Ongoing

• Develop

Centers of Innovation

around Evidence- based and

Promising Practices-

Complete for Forensic

–

Review national models and define the Pennsylvania model

(78)

2010-2011 Executive Budget

Adult Supporting Projects and Actions

• Support community re-integration of

individuals who have been in state hospitals

over 2 years

–

Close at least 2 state hospitals by 2010 by

• Development and implementation of individual

community support plans –

Complete for individuals

discharged from Mayview, Plan for Allentown Closure

by December 2010