April 2004 NACBHDD Newsletter
The monthly newsletter for the National Association of County Behavioral Health and Developmental Disabilities Directors
In this Issue...
A Message from the Executive Director
Melissa Staats, NACBHD’s first full-time Executive Director, has been on the job for a little over a month. She reports on her work so far and plans for the immediate future.
NACBHD Moves Forward on the National Front
NACBHD continues to move forward in the national policy arena in all three disability areas in which our members are active. Since I arrived in Washington
in late February, I’ve been fortunate to represent NACBHD’s interests, as well as to continue to foster relationships already established by Bob Egnew, with
national advocacy organizations such as the National Alliance for the Mentally Ill (NAMI), the National Mental Health Association (NMHA), the Campaign for
Mental Health Reform (see following article), and the Mental Health Liaison Group. In addition, I’m looking forward to meetings with the American Academy
of Child and Adolescent Psychiatry (AACAP), the American Network of Community Options and Resources (ANCOR), the National Association of State Alcohol and
Drug Abuse Directors (NASADAD), and Faces and Voices of Recovery (FAVOR). (See descriptions of ANCOR and FAVOR under Resources.) Establishing a dialogue
and relationship with these, and other, policy and advocacy organizations is key to making our interests highly visible on the national front.
Enhancing Membership Benefits
At the same time, we are looking inward. As you know from the last newsletter, the NACBHD headquarters is located in the National Association of
Counties (NACo) headquarters on Washington’s Capitol Hill. While we are settling in, we are assessing what needs to be done administratively and in
terms of supporting the organization. A key element of this transition is to create the optimal infrastructure so that the organization can run
smoothly. One of my first tasks in that area has been to ensure that you receive timely information. Hopefully, you are already receiving and
benefiting from these email communications.
Beyond that, there is much more both the Board and I hope to do to enhance your membership and to help you as you lead your county in these changing and challenging times. A brief look at our plans for the immediate future.
Enhance and Strengthen Communication
- Email updates – Important News from NACBHD
Hopefully, you are receiving these timely updates about important legislative issues, national advocacy activities, educational materials, and general membership services. Please let us know if there is additional information you would find helpful – your ideas are welcome!
- Member-to-Member Communication
We plan to use the membership database to establish a venue for communication among members, including a bulletin board to share information, experiences, and concerns. In addition to helping us communicate common concerns and “best ideas,” this type of communication will also help us establish our overall organizational priorities. We are pleased to say that we are already using email to schedule committee meetings. (See below.)
- Online Conference Registration
Beginning with this year’s annual conference, members will be able to register for NACBHD conferences online at the NACBHD website, as well as process conference payments through the website.
Reinvigorate Committee Activity
I’ll be depending on the committees for guidance on important issues and on direction in terms of where I should focus my energies. I am pleased that enhanced communication has already allowed us to conveniently schedule and hold a Legislative Committee meeting via conference call, just in the past month. Since the work of NACBHD’s committees is critical to developing a “NACBHD message” for the Hill, fostering committee work and communication in the easiest and most efficient way for all is crucial. I look forward to more committee meetings in the very near future.
Building a Relationship with the National Association of Counties
From my short time at the headquarters, it has become clear that both NACo and NACBHD will benefit from the close proximity to one another. NACo’s legislative staff has been helpful in supporting NACBHD operations and in providing important insights into the political process in Washington, DC. NACBHD has been able to give back by articulating important components of the behavioral health platform.
Help Us Help You
- Updating the Membership Database
While we are working hard to enhance your benefits and strengthen the infrastructure, there is one thing that you can do to help in this effort. Please watch for a request to update your membership and contact information, so that we can have the most up-to-date membership database possible. We apologize for any previous “snafus” with returned mail or other confusion. As we continue to move forward, we’ll be checking with you to make sure your information is correct and current.
- New Medicaid/State Budget Impact Column
We have recently featured interviews with NACBHD members about the impact of state Medicaid and budget crises on local behavioral health services. In an effort to share this information about this nationally prominent issue and its effect locally, we are going to continue this column in each newsletter. In June, we will feature an interview with Tod Citron, Executive Director, Cobb/Douglas, Georgia, Community Services Board. Please share your experience with this important issue with the membership. Contact Sandra Naylor-Goodwin, Managing Editor, at sgoodwin@cimh.org or Nancy Sydnor-Greenberg, newsletter writer, at nesydnor@erols.com.
A Chance to Get Together: Mark Your Calendars for July 15-17, 2004
I’m especially looking forward to a chance to meet with NACBHD members (some of you again, some for the first time) in July for the Annual Conference in Phoenix, Arizona. We are thrilled that this year’s conference, Developing New Leaders for the Future, focuses on building leadership skills and current developments and changes in Medicaid funding that directly impact you in your job, the nature of services delivered, and the individuals you serve. Please see the following article about the conference, and plan to join us in this important learning and networking opportunity.
As always, your thoughts, ideas, comments, and questions are welcome. Please don’t hesitate to contact me at (202) 661-8816 or at mstaats@nacbhd.org.
Mark Your Calendar: Developing New Leaders for the Future Annual Conference
Planning is underway for the 9th Annual Membership Conference to be held July 15-17, 2004 at the Ritz Carlton Hotel in Phoenix, Arizona. Developing New Leaders for the Future presents an opportunity for participants to gain knowledge and tools for effective leadership in a changing environment, with a special focus on Medicaid, its impact on county governments, behavioral health, and the individuals served. The overall goal of the conference is for attendees to gain knowledge about critical issues like the role of Medicaid in their communities, its impact on those with behavioral health needs, and subsequently, new leadership opportunities. Participants will also obtain information regarding implementation of best practices at the community level and opportunities for collaboration across disability areas. And, the NACBHD conference overlaps with the National Association of Counties (NACo) Annual Conference, also in Phoenix, scheduled for July 16-20. A tentative workshop agenda of nationally prominent issues is as follows:
Look for information and instructions regarding registration on the website soon.
Highlights from the Legislative Conference
NACBHD held its 9th Annual Legislative Conference in Washington DC on February 26-28, 2004. A number of critical issues were raised during the Conference (e.g. Medicaid reform, strengthening relationships with agency/advocacy partners). These issues and others will be included in NACBHD’s 2004-05 legislative and general association agendas.
A New Member’s Perspective on the Legislative Conference
New NACBHD and new Board member Jan Bolin brings her perspective as the community developmental disability organization for her area (in Kansas this is
the local developmental disability authority) and as a provider of developmental disabilities services to both NACBHD and to the Legislative Conference
as a first-time attendee. Bolin is President and CEO of CLASS, Ltd., which covers four counties in the mostly rural southeastern part of Kansas with
administrative offices in Columbus, Kansas, and serves people of all ages with developmental disabilities, those dually diagnosed with mental illness
and developmental disabilities, and those with developmental disabilities and substance abuse issues. CLASS, as a community provider, provides case
management, helps individuals find work, and deals with various aspects of living arrangements.
Bolin found the conference very informative and describes it as a “great opportunity to hear from a number of national people and their perspectives on human services,” including different perspectives on what has been accomplished. And she believes that hearing first-hand these various points of view helped her formulate her thinking about the current state of affairs. Presentations from local authorities about their work were equally valuable -- she cites the Wrap-Around Milwaukee presentation as particularly helpful and relevant to a population CLASS is working hard to provide services for. “Being able to hear state-of-the-art [information] is great.”
Wrap Around Milwaukee materials will be forthcoming.
Health Economics and Medicaid Implications
Presenters:
Kaiser Commission and Georgetown University representatives presented a paper, Medicaid and the State Fiscal Crisis. The paper provides a general overview of expenditures and services associated with Medicaid for persons with disabilities (including long term care). The paper also provides statistics regarding state reaction to the costs of Medicaid (e.g. cost containment strategies). Lastly, the presentation raised issues for which NACBHD, as well as others, must pay close attention. Such issues include Administrative and Congressional proposals to create waiver programs that can be used to cap funding, the expiration of increased FMAP legislation (without reauthorization) and the restrictions on intergovernmental transfers (IGTs).
Presentation materials forthcoming.
The Federal Level Perspective on Developmental Disability Issues
Presenters:
Debbie Powell used this opportunity to provide attendees with a summary of the evolution of federal funding for community services to the developmentally disabled population. As part of this evolution discussion, the presenter explained the specific grant programs funded by the ADD and the positive outcomes such investments have made in communities to date. Ms. Powell also discussed the need and desire of ADD to reach out to all partners at all levels of government to ensure that individuals with developmental disabilities can achieve life goals in communities.
Presentation materials forthcoming.
Federal Agency Updates
Presenters:
Kathryn Power began the SAMHSA session with a presentation intended to motivate participants about their opportunity to implement the vision of the President’s Commission Report. CMHS espoused that NACBHD and others can be change agents—this is necessary for the transformation identified in the Commission Report. Ms. Power then proceeded to describe each of the Commission’s established transformation goals. This segment of this session was concluded with a brief overview of the President’s proposed 2005 budget.
Robert L. Stephenson, II, MPH, Acting Deputy Director, Center for Substance Abuse Prevention, described the vision of SAMHSA and CSAP’s role in implementation. This included a description of a prevention framework and a relationship to best practices. Lastly, this presentation includes a description of resources and grant programs.
Download SAMHSA: Substance Abuse Treatment Capacity (PPT) by Westley Clark, MD, Director, Center for Substance Abuse Treatment
Advocacy Training
Presenters:
This session was intended to provide NACBHD members (and others) with strategies that can be used to advocate effectively in Washington DC. Overall, the presenter conveyed the importance of knowing both sides of an issue, timing, and the critical role of Congressional staffers. Mr. Joseph has been advocating for county governments for more than 15 years. He shares his expertise and “tips” in the materials enclosed below.
Presentation materials forthcoming.
President's Commission Report-Children and Behavioral Health Policy
Presenters:
Larke N Huang, Ph.D., provided a thorough and detailed analysis of the President’s Commission Report in regard to its vision and potential impact on children’s behavioral health policy and services. Dr. Huang stated that recommendations related to behavioral health services for children can be identified in most of the report, although not separately highlighted in an individual section. This is indicative of the fact that reform and implementation of a “system of care” for children cuts across a wide range of partners (in communities and throughout government sectors). A report, Children and Families Issue Paper (further detail of the Commission’s recommendations), will be available in the near future.
Bruce Kamradt presented the principles and actual operations of Wrap Around Milwaukee—a successful system of care model. This presentation illustrated how the ideals and vision expressed in the President’s Commission can be implemented. Wrap Around Milwaukee has been improving the lives of children and families since the 1990s.
Download Evidence Based Practices and Supports for Children with Serious Emotional Disturbance (PPT) by Bruce Kamradt, Director, Child and Adolescent Services for the Milwaukee County Mental Health Division, Wrap Around Milwaukee Managed Care System
Discussion with Consumers and Families
Presenters:
Because of the election year and the short legislative session, and a possible omnibus budget bill, very few single pieces of legislation are anticipated to leave Congress. However, parity is still alive, and still under negotiation. Senator Domenici is still very committed to parity. Andrew Sperling discussed the status of legislation, SAMHSA reauthorization, and the recommendations of the New Freedom Commission, none of which may see much action this year. Paul Marchand discussed the potential negative impact on developmental disabilities services – more restrictive housing, a more narrowly defined special education bill, and the threat to Medicaid. Susan Rogers talked about what is important to consumers and consumer involvement in provision of services and treatment, both in terms of decision making and consumer run services.
Congressional Update: Public Sector Policy Partners
Presenters:
In a presentation moderated by Robert Egnew, Robert Morrison discussed NASADAD’s perspective on Access to Recovery, and providing input in terms of policies and procedures involved in the granting process. Andy Hyman gave an overview of the Campaign for Mental Health Reform, and said that mental health constituency groups are coming together to formulate legislative opportunities, and that it is imperative for there to be unanimity among the groups. Daniel Berland talked about major concerns of state directors regarding changes in state Medicaid programs and the impact on developmental disabilities services, and the impact of state budget cuts on developmental disabilities services.
Centers for Medicaid and Medicare Services Reports (CMS)
Presenter:
New managed care requirements for states in which county sponsored behavioral health authorities have been designated the managed care providers – in which regulations may be considered difficult to implement, expensive, and duplicative of other state effort – Peggy Clark did not see that these requirements were likely to change unless by statutory requirement. The Secretary is theoretically able to waive the requirement, but Peggy Clark does not see any indication that the administration is willing to do that. CMS, along with SAMHSA, is sponsoring a meeting of six state Medicaid directors and six state mental health directors to discuss better utilization of how best to use Medicaid in public mental health services. Their goal is to help states become more knowledgeable of Medicaid’s application to state mental health services and appropriately maximize Medicaid dollars.
Thomas M. Wernert Award for Innovation in Community Behavioral Healthcare
From the Technical Assistance Collaborative (TAC):
TAC announces the availability of the Thomas M. Wernert Award that will give $10,000 to a state, county, or community-based non-profit organization providing exemplary behavioral health (mental health and/or substance abuse) services. TAC and The David and Lura Lovell Foundation, in collaboration with the National Association of County Behavioral Health Directors (NACBHD), join to present the fifth annual Thomas M. Wernert Award for Innovation in Community Behavioral Healthcare. These organizations are committed to supporting and honoring innovation in community behavioral health. The annual award program seeks to identify and give national recognition to a program that demonstrates innovation and creativity while ensuring community and consumer participation.
TAC is a Boston-based, non-profit organization providing consultation and technical assistance to governments and community organizations in the health, human services, and supported housing fields.
This award is given in memory of Thomas M. Wernert, former Executive Director of the Lucas County Mental Health Board in Toledo, Ohio. The winning program will embody the ideas and ideals Mr. Wernert exercised in his leadership in public behavioral healthcare.
Eligible programs are state, county, or community-based private or non-profit agencies providing behavioral healthcare services that have been in operation for at least 12 months.
For a more information or a complete application, contact Aggie Douglas at (617) 266-5657 or visit www.tacinc.org/index/viewPage.cfm?pageId=122.
From the Hill
Melissa Staats will be providing updates on information related to the legislative activities in which various advocacy organizations are involved. This is provided for information and is not a request for action. We will notify members separately from the newsletter if there is a request for action.
2005 Budget Activity
On March 29, 2004, a Joint Budget Conference Committee was established to reconcile differences between the House and the Senate. (Note: The House bill
contains instructions to the Energy and Commerce Committee to cut spending by $2.2 billion —Medicaid is the most likely target.) The official goal
of the Committee is to, “set forth the congressional budget for the United States Government for fiscal year 2005 and including the appropriate budgetary
levels for fiscal years 2006 through 2009 (S. Con. Res. 95).”
Most advocates on the Hill are reporting that it is unlikely that the Committee will reach agreement by the congressionally imposed April 15 deadline -- given the House recess. Advocates did push for an agreement that the House instructions be eliminated. However, that effort failed and the House instructions remain. Advocates also report that it is unlikely that a budget resolution will be in place by September 30. Congress must then pass a continuing resolution. Spending will then be “pay as you go” – meaning that any expenditure must be off set by revenue. This rule will not apply to the President’s tax cuts.
Although Congress has not reached agreement, appropriation committees are busy trying to determine availability of resources for 2005. The behavioral health community is most supportive of the President’s proposal that includes a $44 million dollar increase to CMHS. (This $44 million increase is dedicated to the State Incentive Grants for Mental Health System Transformation – see following article – interview with Kathryn Power.)
A Congressional Budget is not required by law, however, “it represents an agreement between the House and Senate that establishes budget priorities, and defines the parameters for all subsequent budgetary actions. The spending, revenue, and public debt laws necessary to implement decisions agreed to in the budget resolution are subsequently enacted separately.” [See for CRS (Congressional Record Service) Report for Congress on the NACBHD website, which describes the federal budget process.]
Joint Budget Conference Committee Members:
The following individuals serve on the Joint Budget Conference Committee:
House: Jim Nussle (R-Iowa, Chair House Budget Committee), Rob Portman (R-Ohio), John Spratt (D-South Carolina)
Senate: Don Nickles (R-Oklahoma, Chair Senate Budget Committee), Pete Domenici (R-New Mexico), Charles Grassley (R-Iowa, Chair Finance Committee), Judd Gregg (R-New Hampshire), Kent Conrad (D-North Dakota), Ernest Hollings (D-South Carolina), Paul Sarbanes (D-Maryland).
Campaign for Mental Health Reform
See the following article for an interview with the Campaign’s project director, Bill Emmet, and an update on Campaign activities. NACBHD is an affiliate
member of the Campaign, and as such, is involved in formulating overall plans for implementing the recommendations of the President’s Commission on Mental
Health.
Other Legislative Discussions/Activities
TANF
In late March 2004, the Senate began discussions on HR 4 (TANF reauthorization legislation) and passed an amendment adding $6 billion for child care. The Senate proposed many other amendments in an effort to maintain work participation rates and increase the minimum wage. These amendments were not successful. Advocates are reporting that TANF reauthorization is unlikely this year. The original legislation expired on September 30, 2002. Congress has passed five extensions. Both houses just passed an extension that expires in June 2004.
Advocates agree that the best opportunities to influence TANF reauthorization will be through the conference committee process.
The Child Healthcare Crisis Relief Act
As highlighted at the Surgeon General’s Conference on Children’s Mental Health (January 2001) and as cited in the Surgeon General’s Report on Mental Health (1999), There is a dearth of child psychiatrists…Furthermore, barriers remain that prevent children, teenagers, ad their parents from seeking help from the small number of specially trained professionals who are available…This places a burden on pediatricians, family physicians, and other gatekeepers to identify children for referral and treatment decisions.
In response to this, the American Academy of Child and Adolescent Psychiatrists (AACAP) secured introduction of The Child Healthcare Crisis Relief Act in both houses of Congress (H.R. 1359 and S.1223). AACAP and NACBHD have met and will continue to meet as action on these bills is taken. AACAP will also present at the NACBHD annual conference scheduled for July 2004, to strategize about how to increase access to child services in the current environment, while at the same time identifying necessary reforms.
Parity
Parity is still stuck in the House as Speaker Dennis Hastert continues to oppose the legislation. However, advocates believe that increased media attention and phone calls may elevate this issue forcing the Speaker to take action.
Update on the Campaign for Mental Health Reform
In an effort to routinely update members about the activities of the Campaign for Mental Health Reform, whose partners, including NACBHD, are working to advance the goals and recommendations of the President’s Commission on Mental Health, NACBHD spoke with Bill Emmet, project director at the National Association of State Mental Health Program Directors, and project director for the Campaign.
The Campaign was recently awarded a grant from the MacArthur Foundation to support infrastructure work related to information dissemination, communication, and opinion research. While the Campaign is examining what can reasonably be accomplished this year and laying the groundwork for success for the next two to three years, Campaign partners continue to meet periodically to develop policy, and work continues on several fronts:
For additional information on the Campaign for Mental Health Reform, see www.mhreform.org.
Kathryn Power, Director, CMHS, Discusses SAMHSA’s Role in Transformation
One month after she began her job as Director of SAMHSA’s Center for Mental Health Services (CMHS) in August, Kathryn Power was “asked to take [the Final Report of the President’s Commission on Mental Health] and make it real.” She calls the six goals and 19 recommendations delineated in the Final Report “drivers” for her work. To that end, her first task was to gather together federal partners to begin work on the Action Agenda. For the last seven months she has met with federal partners – all agencies inside HHS, as well the departments of Labor, Justice, Housing and Urban Development, Social Security, and the Veterans Administration, to follow a process in developing the action agenda.
A “Center of Gravity for Transformation”
Power says, “The center for gravity for transformation is consumers and the center for making that happen is in the state,” with an emphasis on
individualized plans that focus on recovery. In addition, Power says, “All players need to be at the table,” including entities from behavioral
health, consumer representatives, Medicaid, vocational rehabilitation, and local authorities. She notes that there are already 15 states doing
transformation work, embedding such principles as evidence-based practice, local agencies tracking outcomes, and a focus on recovery. In addition,
she cites instances in which some of the recommendations are already being met, such as the national suicide strategy. However, Power says there
is “a long way to go to get services and supports at a level where consumers believe they should be.” Tremendous work needs to be done. For example,
she cited a need for fundamental conversations about the larger impacts of the goals, such as: How many people really believe Goal 1 (Americans
understand that mental health is essential to overall health) – that we should no longer bifurcate between mental and physical health? And, what
can we do together to move that goal farther – how is that goal made practical at a local level?
What Happens Next with the Action Agenda?
Currently, the Action Agenda is in Health and Human Services Secretary Thompson’s office to receive clearance. While there is no exact time projected
for its publication, when the agenda comes back to CMHS and is released, it becomes a public document and a set of activities for action. And Power
says, the agenda is very specific and discrete; there will probably be iterative agenda over the next few years.
Other Specific Activities Related to the Goals and Recommendations of the President’s Commission
Owning Transformation
“Transformation has to be owned by the participants,” says Power. She says NACBHD needs to be at the table with officials from other entities such
as state mental health agencies and Medicaid when comprehensive mental health plans are discussed, and that this is SAMHSA’s expectation for NACBHD.
She encourages any disconnect to be repaired, and notes that thinking through what works for a region is important.
Also, Power reports that consumers “are fully at the center of the conversation.” She recently hosted a two-day consumer determination summit at which there was discussion about how these issues will be communicated to all relevant stakeholders. And, in competing for State Incentive Grants for Mental Health System Transformation, applicants will have to demonstrate that consumers are at the heart and center of the process.
Access to Recovery: Program Details and Highlights from SAMHSA Administrator Charles Curie
Access to Recovery (ATR), the voucher system that will provide people seeking drug and alcohol treatment with vouchers to pay for a range of appropriate community-based services, has been funded at $100 million for 2004, with RFAs due by June 4, and there is an additional $100 million proposed for the ’05 budget. SAMHSA Administrator Charles Curie characterizes Access to Recovery as the “third avenue” of funding in addition to the historic major federal/state funding streams for substance abuse, the Substance Abuse Prevention and Treatment Block Grant, and the Targeted Capacity Expansion grants for emerging needs, such as club drugs. The program is part of President Bush’s substance abuse treatment initiative announced in his 2003 State of the Union address. Applications must be made through governor’s offices, with states and federally recognized Indian tribes eligible to apply. For program background and details, a fact sheet, information on how the program will work, frequently asked questions, and to download the RFA, see www.samhsa.gov/atr/main/html.
NACBHD spoke with Substance Abuse Committee Chair Karen Scherra, about county questions and concerns about ATR, which include issues related to informed consumer choice and consumer education, housing and other concerns related to substance abuse, administrative burden and measuring outcomes, using ATR as an opportunity to explore newer treatments in populations where traditional modalities might not be working, and sustainability. NACBHD also spoke with Administrator Curie about the details of the program, and the questions posed by Scherra.
Opening Up to Recovery and a Greater Range of Providers
“This third avenue of funding operationalizes us to open up recovery in a real way,” says Curie. One emphasis of ATR is to bring a greater range of
providers to the table; as Curie says, “Two hundred people in a room will have 200 different ways of how they got to recovery.” And, “If I were a
provider, I would see ATR as another potential revenue source to me so that I’m on a list of providers clients could see when they make a choice.”
Informed Consumer Choice
Curie says there will be an educational element to the infrastructure. States will be asked to demonstrate how consumers will be informed and educated.
In addition, consumers will have to be provided a list of choices for eligible providers. Providers will need to be licensed if they fit under a
traditional licensing category; however, faith-based providers may not have a traditional clinical or medical overlay, but they may have a good record of
recovery; thus, it may make sense for them to receive a voucher.
Measuring Outcomes
What Curie refers to as the “Seven Domains of Recovery,” may fit into what states are already doing in terms of measuring outcomes. SAMHSA is looking
to use these domains of measurement across all programs. The seven domains are:
Housing and Other Issues Related to Substance Abuse
While housing is not funded under the vouchers, it is one of the measured domains of recovery. And, ATR may be connected to other efforts around
recovery. For example, some states are evaluating whether to do ATR in conjunction with drug courts. SAMHSA views this as supporting the overall
goal of obtaining a life in the community.
Exploring New Things
One of the premises in ATR is that states and tribes will be given latitude in determining their needs, says Curie. And, ATR is “absolutely an opportunity
to try new things.” If applicants want to set up vouchers around an adolescent population, for example, they will need to demonstrate how they have to
access to adolescents and how they will assess adolescents.
Technical Assistance
Technical assistance is ongoing outside of the funded $100 million, including two sessions of regional technical assistance have already taken place
in Washington, DC, and Atlanta. Sessions in Phoenix and Seattle are scheduled next.
Sustainability
While an additional $100 million is proposed for the 2005 budget, Curies says that as ATR proves itself over the years, it will hopefully become part
of the overall budget in conjunction with the ongoing Substance Abuse Prevention and Treatment Block Grant and the Targeted Capacity Expansion grants.
A single grant cannot exceed $15 million; SAMHSA expects 15-20 states to be funded the first year.
NACBHD’s Substance Committee will follow the ATR program and report to the membership as the details become available.
NACo Resolution for Inmates in County Jails to Retain Medicare and Medicaid Medical Benefits
Resolution to Extend Benefits Until Conviction
A resolution that would allow eligible juvenile and adult inmates in county jail facilities to retain their Medicare and Medicaid benefits until they
have been convicted and become a ward of the state or county was passed by the National Association of Counties (NACo) Board of Directors on March 1.
Currently, Medicare or Medicaid eligible individuals lose these benefits when they are charged with a crime and incarcerated while awaiting trial.
The cost of medical care, which is significant, including behavioral health care, falls to the county when the individual is arrested and detained.
As the resolution notes, many individuals awaiting trial are later acquitted and released. In addition, many people awaiting trial are released on
bond, their own recognizance, or under house arrest or other alternative detention means; and these individuals continue to be eligible for Medicare
and Medicaid benefits while awaiting trial.
According to NACo policy, the resolution, which was introduced by the Montana state association of counties, will be readopted at the NACo Annual Conference in July, and then will be lobbied for by NACo staff on Capitol Hill. NACo Associate Legislative Director and NACBHD’s liaison within NACo, Jennifer Myers, will be lobbying for the policy in the House of Representatives with the Energy and Commerce Committee, the Judiciary Committee, and the Ways and Means Committee, and with the Judiciary, Finance, and Health, Education, Labor, and Pensions (HELP) Committees in the Senate.
NACBHD members interested in the policy should feel free to contact Myers at (202) 942-4230 or jmyers@naco.org. In addition, those wishing to support the policy should contact their county commissioners.
Other Work Related to the Mentally Ill in Jail
In addition to the resolution, NACo has been partnering with other organizations, such as the Council of State Governments, the National Alliance for
the Mentally Ill (NAMI), and the Bazelon Center for Mental Health Law, among others, regarding the mentally ill in jails and the loss of benefits upon
incarceration for any individual.
A Resource for Those Who Have Been Incarcerated
The Bazelon Center has recently released a publication to help people with disabilities who have been arrested understand what happens to their benefits,
including health coverage (Medicare and Medicaid), disability checks, and veterans’ benefits among others. (According to Bazelon’s press release, more
than 16% of adults in U.S. jails have a mental illness; and many relied on federal benefits before incarceration and do not regain benefits for weeks or
months after release.) The booklet "Arrested? What Happens to Your Benefits If You Go to Jail or Prison?" is available online at
www.bazelon.org/newsroom.
NACo Liaison, Jennifer Myers
In addition to her work on the resolution, Myers works with NACBHD, as well as other affiliates such as NACCHO – County and City Health Officials and NACHFA – Health Facility Administrators, on issues of common interest, and as she describes it, NACo will be looking to NACBHD and the other affiliates for guidance on specific details in which the affiliates have expertise. “We are excited here at NACo. It will help us to build a stronger relationship [with NACBHD] to be housed in the same building. We are looking forward to building a stronger relationship between the two organizations.” Myers staffs the Health Steering Committee, and its Subcommittees on Behavioral Health, Public Hospitals, Public Health and the Environment, Long Term Care, and Medicaid and Indigent Care. (The Subcommittees have no formal membership – any Health Steering Committee member may attend any subcommittee meeting. NACBHD members Deborah Donaldson, David Wiebe, and William Harper are members of the Health Steering Committee.) She also contributes to weekly Legislative Bulletins. A six year veteran of Capitol Hill, Myers worked for Congressman Ray LaHood of Peoria, Illinois and Congressman Doc Hastings from Washington before moving to NACo a year ago. She has worked on many legislative issues, but is most interested in health care. Jennifer may be contacted at (202) 942-4230 or jmyers@naco.org.
Cultural Challenges: A Georgia Community Service Board Addresses Latinos’ Mental Health Needs
Tod Citron, Executive Director of the Cobb/Douglas Community Services Board in Marietta, Georgia, knows first hand some of the challenges faced in addressing the mental health needs of the country’s growing Latino population. The Board is coping with these challenges in a geographic area that is experiencing extremely rapid growth, and in an environment which is encountering the financial and workforce challenges common to public behavioral health across the country. The suburban area north of Atlanta has grown 45% since 1990, with the clients served by the Cobb/Douglas Community Service Board doubling in the past eight years to 12,800, while funding has decreased per client served by about 5%. The Latino population is a significant contributor to the growth of the area – they comprise about 10% of the total population of the area. The Board served 400 Latinos last year, or about 3% of the total clients served.
Tailored Services
Citron feels that his staff has done a good job of serving this population in light of the rapid increase in clients in general and the decrease in
funds. As he points out, there are more people to serve each year with fewer dollars. In addition, there are significant ongoing funding and stigma
issues. (Citron cites continuing NIMBY attitudes which have affected housing, a $750,000 loss in the adult mental health program last year because
of underfunding, and closing of a satellite clinic (which now happens to the area with the largest Latino population) five years ago because of lack
of funding. Also, in addition to the 12,800 the Board serves, they also serve 2,400 inmates. More on the budget issues in the next newsletter.)
There is no “niche programming” for the population, but there are some specific services. Citron says, “It boils down to what we can make available
with the staff we have.” He notes that his survey of other agencies in the Mental Health Corporation of America, of which the Board is a member,
revealed other agencies are providing similar services. Services include:
Issues Specific to the Latino Population
Citron cites some issues specific to helping the population:
Citron says his staff does receive cultural competence and diversity training (a requirement for accreditation), which is helpful. He feels that a lot of what they do is driven by the lack of trained, educated bilingual personnel and the difficulty in hiring these people. While addressing cultural issues that “lie below the surface” will have to wait for an increase in educated bilingual staff, Citron feels that “Overall we do a good job given a difficult situation.” The workforce theme continues to be an overriding concern --his optimal wish to best serve the population would be a better trained workforce -- specifically better access to trained and educated bilingual staff.
State Budget and Medicaid Crises and the Impact on Counties
In the February 2004 newsletter, NACBHD talked with local authorities about their current Medicaid concerns, particularly as they relate to budget difficulties they are experiencing in their state, as well as representatives from disability advocacy organizations to gauge the direction Medicaid may take in the coming year. (See “Which Way Medicaid? Current Conditions and the Forecast,” February newsletter.) While we will continue to provide timely information about national Medicaid developments via the newsletter and NACBHD emails, we would like to share member’s experiences about the impact of state budget and Medicaid problems in the newsletter on a routine basis. Contact Sandra Naylor-Goodwin, Managing Editor, at sgoodwin@cimh.org or Nancy Sydnor-Greenberg, newsletter writer, at nesydnor@erols.com, if you would like to share your experience with this important issue.
California
In February, Cathy Geary, NACBHD member, and Chair of the Medi-Cal Policy Committee for the California Mental Health Directors Association, as well
as Mental Health Director of the Sonoma County Mental Health Division, reported on the Medicaid crisis in California. Governor Schwarzenegger has
mandated that the restructuring of the California Medicaid program is the number one priority for the year, with restructuring to happen no later
than the Spring. Counties are both managers and providers of Medicaid to mental health beneficiaries, and many provide both mental health and drug
and alcohol abuse services, depending on county structure.
Geary reports that the Governor is due to issue his revised proposed budget in mid-May, and that California should be ready to unveil plans for a reform of the Medicaid program at around the same time. More on these developments and their impact on behavioral health in the June issue of the newsletter, as well as an interview with Cathy Geary and with Patricia Ryan, Executive Director, California Mental Health Directors Association.
Look for Results of the Developmental Disabilities Survey in the June Newsletter
Recently, the Developmental Disabilities Chair Lynn Ferrell, Executive Director, Polk County, Iowa, Health Services, surveyed the NACBHD Board on important issues related to developmental disabilities services in counties, including funding and organizational structure and key federal issues to be addressed by the Developmental Disabilities Committee. Watch for an article on the survey results and an interview with Lynn Ferrell in the June newsletter.
Announcements
Housing Alert: Look for HUD SuperNOFA Announcement Soon
The Department of Housing and Urban Development (HUD) SuperNOFA (Notice of Funding Availability) announcement for people who are homeless and disabled
comes out yearly in the Spring. While there is no exact date projected for the announcement, those interested should check the HUD website weekly at
www.hud.gov/offices/adm/gramts/fundavail. or subscribe the Technical
Assistance Collaborative (TAC) listserve, or other housing listserves. For a list of housing resources, see the February newsletter, “Housing Alert:
HUD SuperNOFA Information and Resources.”
NAMI’s Campaign for the Mind of America and NAMI Walks for the Mind of America
NACBHD recently spoke with Katrina Gay, Chief of Field Operations, and Joel Miller, Senior Policy Analyst, at the National Alliance for the Mentally
Ill, about two important activities NAMI is currently engaged in focusing on recovery and access to treatment. They submitted the following information:
NAMI WALKS for the Mind of America
Every journey begins with that first step. In May 2004, thousands of concerned citizens in more than 35 communities across the country will join the Campaign for the Mind of America and walk together to raise money and awareness about our country’s need for access to treatment and services for people with mental illness.
This is the second year of NAMI WALKS, representing an expansion on last year’s 19 sites, which raised over $1M for the local, state and national NAMI organization.
NAMI depends on generous volunteers to raise funds and awareness at each walk site. Participation in a corporate, family, or organization team is one way NACBHD members can participate in supporting the event. Teams are forming NOW, so find out if there is a WALK in your community and contact a local coordinator soon to get involved. Visit the NAMI Website for site and contact information, www.nami.org.
Campaign for the Mind of America
NAMI’s Campaign for the Mind of America is a national, state, and local partnership aimed to imprint a message of recovery and underscore the unintended consequences of lack of access to treatment and services for people living with mental illness. The Campaign is being waged on two fronts representing two distinct but connected elements currently in the final stages of pilot process.
The state effort focuses on the execution of a strategic grassroots political campaign aimed at protecting and enhancing policies that secure access to treatment and services by underscoring the unintended consequences of inadequate access and the impact of untreated mental illness to the community. Community partners representing diverse leaders in areas of law enforcement, education, healthcare, and local government will join in the campaign to echo the call to action.
The national effort reinforces the “investment” side of things and will promote messages that mental illnesses are very treatable, that recovery is possible, and that recognizing and embracing recovery is beneficial to the entire community. Building on community partnerships and engaging NAMI’s grassroots leaders, the Campaign will expand its message of recovery to citizens and the public.
State pilot launches in West Virginia, Florida, Maine, Kentucky, and Massachusetts are complete. The Campaign will be expanding its scope rapidly in the coming months.
Find out more about the Campaign by visiting the NAMI website at www.nami.org.
SAMHSA Grant Information
SAMHSA has recently posted the following press releases:
New Grant Announcement Process
SAMHSA has a new approach to announcing grant opportunities. Rather than publishing an individual detailed grant announcement (usually known as a Request for Application or Program Announcement) for each funding opportunity, SAMHSA will instead publish a brief Notice of Funding Availability (NOFA) linked to a standard grant announcement.
The NOFA will detail the total funding available to address a specific issue or target population, and will provide information about the expected size and number of grant awards for a particular funding opportunity, the application deadline, and any special programmatic requirements.
Each NOFA will refer to one of four new standard grant announcements that provide basic program design and application instructions for: Services Grants; Infrastructure Grants; Best Practices Planning and Implementation Grants; and Service-to-Science Grants. These standard announcements will allow potential applicants to more effectively anticipate program requirements for SAMHSA grants, and will allow applicants to better plan their grant applications.
In general, service grants will fund substance abuse and mental health services. Infrastructure grants will fund identification and implementation of new systems, but are not designed to fund services. Best practices planning and implementation grants will help communities and providers identify effective practices to meet local needs, develop strategic plans for implementing or adapting those practices, and pilot-test practices prior to full-scale implementation. Service-to-science grants will document and evaluate innovative practices that address critical substance abuse and mental health service gaps, but have not yet been evaluated.
SAMHSA’s goal is to have all applications qualify for review. Applicants are urged to adhere to all requirements listed in both the NOFA and the appropriate standard grant announcement. The entire funding announcement should be read before preparing an application.
SAMHSA will continue to fund some programs that do not fit within the four standard grant announcements, and will continue to publish some Requests for Application (RFAs) and Program Announcements (PAs), as it has done in the past.
SAMHSA’s web site has complete documents of the standard program announcements (www.samhsa.gov/grants/2004/useful_Info.asp) as well as funding information from NOFAs and RFAs (www.samhsa.gov/grants/2004/funding_opps.asp). For more information, please contact Cathy Friedman at (301) 443-4111 or cfriedman@samhsa.gov.
Manual for Competitive Grant Applications Available
“Developing Competitive SAMHSA Grant Applications” can be accessed electronically through www.samhsa.gov; or for free copies of the document, call the National Clearinghouse for Alcohol and Drug Information at (800) 729-6686. Email questions regarding the manual to TAManual@samhsa.gov. For a table of contents, see www.samhsa.gov/grants/tamanual/toc.htm.
SAMHSA Assistance Center for Co-Occurring Disorders
SAMHSA recently announced the creation of a help line and technical assistance center to assist state efforts in effective treatment for individuals
with co-occurring mental and substance abuse disorders. The Co-Occurring Center for Excellence (COCE) will assist in identifying best practices for
treating co-occurring disorders, and will support those best practices through technical assistance, a website, and resource materials.
The technical assistance center will operate under a one-year, $2.6 million grant that is renewable for five years. The CDM Group in Chevy Chase, Maryland, will work with the National Development and Research Institutes, Inc., the Center for Behavioral Health, Justice & Public Policy at the University of Maryland, and the National Opinion Research Center at the University of Chicago.
Entities to which assistance will be available include: all states, substance abuse, mental health, criminal justice, education and other social and public health systems who want to improve their ability to serve people with co-occurring disorders. The program will identify best practices using criteria from SAMHSA’s National Registry of Effective Programs.
Requests for technical assistance should be made in writing to: The Co-Occurring Center for Excellence, Jill Hensley, Project Director, 5530 Wisconsin Ave., Suite 1600, Chevy Chase, MD 20815, or by email to: samhsacoco@cdmgroup.com. Questions can be addressed to the COCE team at (301) 951-3369.
Resources
Developmental Disabilities and Substance Abuse Advocacy Resources
Descriptions and contact information for important new advocacy resources is outlined below. As noted previously in this issue of the newsletter (see “Message from the Executive Director”), NACBHD hopes to develop partnering relationships with these organizations. Thanks to the NACBHD members who have suggested these organizations as valuable partners.
ANCOR (Action Network of Community Options and Resources
Described on its website as “providers offering supports to people with disabilities,” This member organization advocates with other disability
organizations on issues of national importance such as full participation, Medicaid, residential care facilities and group homes, SSI benefits,
and more. Information on legislation, conferences, other current events, a national advocacy campaign site, and action alerts for urgent advocacy
issues. See www.ancor.org.
Families USA
A national nonprofit, non-partisan organization dedicated to the achievement of high-quality, affordable health care for all Americans, Families USA
has been working for over 20 years at the national, state, and community levels. Issues covered include Medicaid, Medicaid and children’s health,
Medicare, including current legislation, the uninsured, and communities of color; and resources include publications, an action center, and state
information. You may have already noted information from Families USA coming to you in the “Important News from NACBHD” member email updates. The
organization works to:
For more information or to subscribe to the Health Action Network, see www.familiesusa.org.
FAVOR (Faces and Voices of Recovery)
Faces and Voices of Recovery “is working to mobilize, organize, and rally the families, friends and allies of the millions of Americans in recovery
from addiction in a campaign to: end discrimination, broaden social understanding, and achieve a just response to addiction as a public health crisis.”
Resources include: a “Take Action!” alert on timely addiction treatment and recovery issues (see the website for a current issue in the House), a
directory of local recovery advocates, events and conferences, “Recovery in the News,” and a spotlight on “Faces of Recovery.” See
www.facesandvoicesofrecovery.org.
Kaiser Releases New Reports on Medicaid and Medicare
From recent press releases from the Kaiser Family Foundation:
The Kaiser Commission on Medicaid and the Uninsured has released two reports on the financing and fiscal management of the Medicaid program. “Financing the Medicaid Program: The Many Roles of State and Federal Matching Funds” examines Medicaid’s state-federal matching mechanism, which has been part of financing health and long-term care coverage for millions of low-income Americans since the program’s creation in 1965. Issues examined include the financing structure, its implications for states, and the federal government and health coverage for the low-income population. Available online at www.kff.org/medicaid/7000.cfm.
“Medicaid’s Federal-State Partnership: Alternatives for Improving Financial Integrity” addresses the current financial management of the Medicaid program and offers way to improve fiscal integrity. Written by a former CMS official, the paper uses models from the private sector and the government to identify alternatives to improve financial management within Medicaid’s existing structure. Such alternatives would reduce exposure to questionable practices, help control federal costs, and make financial management of the program like that of the private sector. Available online at www.kff.org/medicaid/7027.cfm.
Medicare Fact Sheets
Kaiser has released the following Medicare fact sheets:
- Medicare at a Glance is an overview of the Medicare program, including financing, eligibility, and benefits. It also describes supplemental health insurance, benefits under the new drug law, and data on Medicare expenditures and financing.
- Medicare Prescription Drug Law covers the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the new drug benefit, and additional changes to the Medicare program.
- Medicare Advantage is an overview of the Medicare Advantage program (formerly know as Medicare+Choice) and includes current data on plan participation, beneficiary enrollment, benefits and premiums, and changes made by the 2003 law regarding Medicare payments to participating plans. To access the Medicare fact sheets, go to www.kff.org/medicare/factsheets.cfm.
