August 2005 NACBHDD Newsletter
The monthly newsletter for the National Association of County Behavioral Health and Developmental Disabilities Directors
In this Issue...
The 2005 NACBHDD Newsletter series is brought to you by:
NACBHD Moves Forward with Action Plan Focused on National Priorities
NACBHD continues to move forward with a focus on priorities and a new state association committee. The NACBHD Board met on July 8 and 9 to discuss the organization's priorities, the creation of a new state association directors committee to better facilitate work on state issues, and the NACBHD member survey, or member profiling system. An agenda was developed for the organization's public policy advocacy priorities. In addition to the necessary day to day operations, NACBHD staff will focus their efforts in DC on following public policy issues: (1) Medicaid, (2) Medicare, (3) Transformation, (4) Methamphetamine, (5)Criminal Justice, and (6) Accountability/Outcomes. Staff work for the remainder of 2005 will also be dedicated to the completion of NACBHD's member survey. As reported earlier, implementation of the survey and analysis of the findings are deliverables of NACBHD's SAMHSA grant. Given that this is NACBHD's first SAMHSA grant awarded, it is critical that the survey is completed and that meaningful findings are reported. NACBHD is most appreciative in the member support of this effort.
NACBHD Member Survey: Mechanism for Giving Congress a Complete Picture of the role of County/city Governments and other Local Authorities in Behavioral Health and Developmental Disability Services
Goes Out September 1
NACBHD member survey to be sent out September 1. Melissa Staats showcased a draft of the NACBHD member survey at the July Board meeting. As noted, the survey is intended to provide NACBHD with information about its membership and-more broadly-a "snap shot" of the role of county/city government and other local authorities in the behavioral health and developmental disabilities services systems. The Board is committed to completing this project quickly, and reviewed and approved it for distribution September 1. In order to gain a complete picture of county and county-based behavioral health care, the member survey will be sent to the entire NACBHD membership and county-based behavioral health authorities who are eligible to be members of NACBHD but have not yet joined. NACBHD will need the new state association committee to help with the survey, which will enable NACBHD to give Congress important information about the specific communities served by members. The survey also may help in gaining new members.
The survey will help develop a comprehensive picture of the role of county/city government and other local authorities in behavioral health and developmental disabilities services system. NACBHD received a SAMHSA grant at the beginning of 2005, intended to develop a more complete picture of county government and county-sponsored behavioral health and developmental disabilities, and to identify evidence based practices and models for outcome and quality improvement. The survey is a required part of the SAMHSA grant.
It is critical that members contribute to this important information source on local behavioral health. Not only is the survey a requirement of the SAMHSA grant, it will provide crucial information regarding local behavioral health needs and issues, and, ultimately, will allow NACBHD to move forward as we deal with issues important to the membership in the national arena.
Access to Membership Privileges
Members who have not paid their dues will no longer have membership privileges as of October 1. If you have questions or would like to make arrangements on your membership dues, please contact Melissa Staats at mstaats@nacbhd.org or Maeghan Gilmore at mgilmore@nacbhd.org, or at (202) 661-8816.
NACBHD Annual Meeting: "Transformation, Recovery, & Self-Determination" Mark Your Calendars for October 20-22
The NACBHD Annual Meeting will take place October 20-22 in Portland, Oregon. The theme for this year's conference is "County/City Government and County/City-Sponsored Authorities Leading Transformation, Recovery, & Self-Determination." Consumers, county/city/local authorities, and staff from national advocacy organizations will lead discussions on issues critical to transformation to a recovery-based system. Please take a moment to mark this important event on your calendar, and check the website for more information and to register online. (Click here.) Please note that the last day to register for the hotel is September 29.
And, NACBHD is pleased to announce that officials from the Centers for Medicare and Medicaid Services (CMS) have already agreed to present the most up-to-date information on the MMA implementation at the Annual Conference. This is especially timely as beneficiary enrollment begins November 15, and official implementation is January 1. (See the article on Medicare for more details on implementation of the MMA.)
Campaign for Mental Health Reform Releases Roadmap to Congress; Executive Director Interviewed on C-SPAN; Budget Reconciliation and Medicaid Is Current Focus
Release of the Roadmap for Federal Action on America's Mental Health Crisis
On July 27, the Campaign for Mental Health Reform released to Congress and the Administration the Roadmap for Federal Action
on America's Mental Health Crisis. Chair of the President's Commission on Mental Health Mike Hogan delivered remarks.
Governors and the media were invited to the event, and NACBHD staff was present at the event.
The Roadmap for Federal Action on America's Mental Health Crisis, contains 28 actions items and is now available at www.mhreform.org/emergency.
The following information is from the July 27 press release about the presentation of the Roadmap:
Today at the U.S. Capitol, the Campaign for Mental Health Reform released "Emergency Response: A Roadmap for Federal Action on America's Mental Health Crisis." The coalition of 16 national organizations proposed 28 action steps as a "roadmap" for Congress and the Administration to transform the country's ailing mental health care system.
Speaking at the press conference in support of the Campaign's efforts were Members of Congress from both political parties and both chambers: Senators Mike DeWine (R-OH) and Edward Kennedy (D-MA), and Representatives Sue Myrick (R-NC), Patrick Kennedy (D-RI), Jim Ramstad (R-MN), Grace Napolitano (D-CA), and Ted Strickland (D-OH).
The Campaign, representing millions of Americans, came together after President Bush's New Freedom Commission on Mental Health released its groundbreaking report in July 2003, "Achieving the Promise: Transforming Mental Health Care in America." In that report, the 22 Commissioners found the U.S. mental health system "fragmented and in disarray, lead[ing] to unnecessary and costly disability, homelessness, school failure and incarceration." The Commission called for a "fundamental transformation of the Nation's approach to mental health care."
"Yet, since the release of the Commission's report," said Michael Faenza, President and CEO of the National Mental Health Association, "63,000 Americans have died by suicide; more than 200,000 Americans with mental illnesses have been incarcerated; more than 25,000 families have given up custody of their children in order to get mental health services; juvenile detention centers have spent $200 million 'warehousing' youth in juvenile justice facilities instead of providing treatment; and the American economy has lost more than $150 billion in productivity due to unaddressed mental health needs."
In all, there are an estimated 20 million adults and 6 million children and teenagers in the U.S. with serious mental illness. The Campaign for Mental Health Reform seeks to make mental health a national priority and to make early access, recovery and quality in mental health services the hallmarks of our nation's mental health system.
"Our model for action is the bipartisan commitment to combating the public health crisis of youth suicide embodied in the Garrett Lee Smith Memorial Act, which Congress swiftly enacted and funded last year," said Campaign Director Charles S. Konigsberg.
Named for Senator Gordon Smith's son who died by suicide, the law provides Federal funds for youth suicide prevention initiatives. "By identifying people at risk of suicide and getting mental health services to them in a timely way, this law will prevent suicides; it will save lives," said Jerry Reed, Executive Director of the Suicide Prevention Action Network USA (SPAN USA).
Commenting on the broad scope of the Campaign, Konigsberg said: "War veterans and 9/11 first-responders with traumatic stress; children suffering with disorders that, untreated, can lead to school failure; people with severe depression that can lead to suicide; homeless adults suffering hallucinations and hunger; people suffering in silence due to stigma or lack of accessible treatment-all deserve the hope, dignity and promise of productive lives."
"The Campaign's report provides a detailed action plan for the Federal government to more effectively coordinate and align Federal, state, and local resources to get the right services to the right people at the right time," said Michael Fitzpatrick, Executive Director of NAMI, the National Alliance for the Mentally Ill. "The time is now to make the promise of the New Freedom Commission a reality."
Among the 28 action items included in the Roadmap report are proposals by the Campaign to:
Executive Director Interviewed on C-SPAN
Campaign Executive Director Chuck Konigsberg appeared on C-SPAN as a follow up to the release of the Roadmap.
Members can view the interview at www.cspan.com, click on "Washington Journal," the July 30, 2005 show.
Copies of the release of the Roadmap to Congress event can be ordered from C-SPAN.
Medicaid and the Budget Resolution
The Campaign is now focusing on trying to gather intelligence on the most likely proposals around Medicaid reform and
their impact on mental health, according to Konigsberg. Congressional staffers are currently reviewing the various proposals,
and action is expected in Congress in September.
SAMHSA Releases Federal Mental Health Action Agenda: An Interview with SAMHSA Administrator Charles Curie
On July 22, SAMHSA released the Federal Mental Health Action Agenda. In developing the document, six cabinet level departments, Education, Health and Human Services, Housing and Urban Development, Justice, Labor, Veterans Affairs, and the Social Security Administration outlined 70 specific steps in an effort to alter the mental health system over a period of several years. The creation of a Federal Executive Steering Committee to guide the work of mental health system transformation was announced at the same time. For the full press release on the Action Agenda, see the July newsletter. The entire report can be accessed at www.samhsa.gov. Click on "mental health transformation."
NACBHD recently spoke with Charles Curie, SAMHSA Administrator, regarding the Federal Mental Health Action Agenda and questions and concerns of specific interest to NACBHD members.
Data collection at the community level
Many of the action items involve data collection at the community level (related to evidence-based practices,
demonstration projects for children, and unemployment initiatives). NACBHD asked how SAMHSA would collect such data,
and Curie responded that the Action Agenda urges data collection at many levels, with the ultimate goal to collect
transparent data at many levels. This does not always involve SAMHSA. The recovery model is consistent with the
National Outcomes Measures Model, which is the primary driver of the approach. There are 10 domains, with real
results in people's lives, such as employment, education, stabilized housing, and no involvement with the criminal
justice system. He does not see any additional data collection burden on communities. This involves aligning all
data collection under NOMS. SAMSHA is already working with CMS on data regarding mental health services.
How do the Medicaid demonstration action items (principle C and references to coordination and improved access) align with proposed Medicaid reductions and cuts to SAMHSA's budget? SAMHSA has identified many actions planned in partnership with federal agencies and states. Has SAMSA costed out the financial support to get "there" from "here"?
The President's Executive Order establishing the New Freedom Commission and the Commission's final report pointed to a fragmented system as a barrier to access, says Curie. The resources have to be aligned to improve mental health services delivery, and fragmentation is solved through alignment, not more resources. The Action Agenda, he adds, presents an opportunity for alignment and to strengthen the position that budgets be put forward. Most of the financial support will come from the budgets in collaborating agencies, and that collaboration will be a key point of working together on budget development.
Principle B focuses on community-level models and effective coordination, with specific mention that mental health be included in community center assessments, and that community health centers will refer and coordinate follow up treatment with community mental health and other providers. How will this be implemented?
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The interagency workgroup with SAMHSA, HRSA, and the CDC is looking at states, counties, and providers,
and looking to CMS at the process of aligning financing, says Curie.
The agenda mentions that SAMHSA has been convening directors of state mental health, state Medicaid, and state regional Medicare. Is it possible to include county and city government in those discussions and meetings?
Curie says SAMHSA would welcome county and city government in meetings. He notes that over 25 states are
county-based, and that Pennsylvania counties actually manage the Medicaid dollars. He mentioned perhaps joining
with the National Governors Association to plan regional meetings. Curie would welcome sitting down with NACBHD
to discuss how counties can best position themselves. The Action Agenda has states as the center of gravity,
and SAMHSA hopes to work with NACBHD and NASMHPD together to ensure counties can be poised in a strong way and
to ensure the NOMS data collection.
NACBHD, which is composed of county and city authorities with legal status for managing public mental health, substance abuse, and developmental disability services, can help in promoting the Action Agenda. Can you suggest ways in which NACBHD might help?
Curie says that broad-based effort and collaboration across stakeholders is critical to success, and that
it is critical that counties be involved in the planning process. He says there are examples of counties
that are already involved in transformation. The federal government is trying to model collaboration among
federal agencies, and hopefully this will be a model for the states. NACBHD can help with promoting these
models of alignment; he would welcome the opportunity to engage NACBHD in promoting alignment and transformation.
Counties need to lend clarity regarding what data needs to be collected and regarding infrastructure. Counties are
critical for transformation, says Curie.
SAMSHA must report to Congress regularly on the Action Agenda, which Curie says, fortunately, puts mental health at the forefront of the Congressional agenda. SAMHSA is committed to ensuring that progress around the 70 steps is fulfilled.
CMHS's Transformation Trends: An Interview with CMHS Director Kathryn Power
NACBHD recently spoke with Kathryn Power, M.Ed., Director of SAMHSA's Center for Mental Health Services about Transformation Trends, the new CMHS newsletter dedicated to activities and issues in the transformation process. The newsletter is published every two months, and is available online at www.samhsa.gov. Transformation Trends is available under "Latest News."Newsletter highlights transformation in states and federal partners
The publication focuses on transformation activities in the states and with the federal partners,
and it also identifies what is happening in general areas of transformation, such as leadership,
which is one of the areas cited by the President's Commission in its Final Report. States are asked
to specifically highlight local examples of transformation. When NACBHD spoke with Power, the July/August
issue, which concentrates on recovery, almost was ready for distribution. Power says that the next cycle
of newsletters will focus on national associations like NACBHD. The goal is to produce the newsletter
for at least a year.
Power noted that there is a "Resource Corner" in the each issue, and that it would be helpful to know what information counties think might be helpful in that area.
Transformation State Incentive Grants
Transformation Trends will be used to talk about the Transformation State Incentive Grants, or TSIGs.
They have received 33 applications in the first round, and the grant review office is currently
tabulating the scores and those with the highest scores will be awarded in October. A total of $18 million
will be split among five to six awardees. Power says it is a great program and that they are very excited about it.
They hope to gather information about how to change the infrastructure in states to achieve transformation.
On the other hand, she emphasizes that transformation is going on in many places, and she characterizes
transformation as "movement."
While Power was not in on the review process and therefore could not comment on any "themes" that emerged from the initial phase of the grant process, she did note that applicants were required to articulate of vision of transformation and the six goals of the President's Commission.
SAMHSA continues to encourage and expect that in TSIG states and non-TSIG states, local mental health providers and county-based systems will be at the table in developing the planning process. In fact, Power says that if local authorities are not at the table, then it is not transformation. She says that county, state, regional, and local entities are all part of the concept of a consumer-driven system, and she says she "absolutely stands behind NACBHD" and the concept that it should be at the table in the planning process. In the TSIG application process, applicants had to show evidence that they will involve local authorities n the process. Power says it will be interesting to see how many TSIGs are awarded to county-based states.
The SAMHSA Action Agenda
Power says that a progress report on the Action Agenda may appear in Transformation Trends in a few months.
While the Action Agenda was released in July, it "has been worked," says Power, since last October. And she says,
Congress expects a stand-alone report on the Action Agenda.
Medicaid Update: Advocates Gather Intelligence on Reforms for September Congressional Action
NACBHD is involved in ongoing advocacy meetings about Medicaid and the federal budget. As noted above in the article on the Campaign for Mental Health Reform, the Campaign is now focusing on gathering intelligence on the likely proposals around Medicaid reform. NACBHD staff is attending Campaign meetings about Medicaid and the budget resolution. (The Senate Finance and House Energy & Commerce Committees are charged with developing legislation for the $10 billion in savings over the next five years mandated in late April in the FY 2006 budget resolution and congressional staffers are reviewing the various proposals. Action is likely in September.)
The National Governors Association has presented their proposals to Congress, and the Medicaid Reform Commission's recommendations regarding the $10 billion in cuts is due to Secretary Leavitt September 1, with a second report on long-term sustainability of the program due on December 31, 2006.
For background information on Medicaid and the various reform proposals, see the July newsletter and the most recent Washington Updates.
NACBHD white paper on Medicaid. The Medicaid Committee is preparing a white paper on Medicaid. This paper will identify the Medicaid Reform proposals that are gaining traction in DC. It will also specify NACBHD's position on such reforms. Lastly, NACBHD's Medicaid Reform White Paper will identify alternatives that continue quality services to the most vulnerable in the most cost effective and effectives ways. It is hoped that this paper and other NACBHD writings will be useful to members as they conduct advocacy in their communities.
Medicare Update: More Resources for the MMA Transition
NACBHD is pleased to announce that officials from the Centers for Medicare and Medicaid Services (CMS) have already agreed to present the most up-to-date information on the MMA implementation at the Annual Conference. This is especially timely as beneficiary enrollment begins November 15, and official implementation is January 1.Background
In fall 2005, CMS will auto-enroll approximately 6 million dually eligible beneficiaries
(those receiving both Medicare and Medicaid) into Medicare prescription drug plans. These new Medicare
drug plans will replace Medicaid as it is currently used by the dually eligible (and others) to support t
their access to medications. Starting November 15, 2005, beneficiaries may select another or different plan
from the one in which they are auto-enrolled. The new prescription coverage begins on January 1, 2006.
An ongoing inventory of resources for implementation of the MMA
NACBHD is working with CMS and other advocacy partners to provide the best information about MMA
implementation so that members can be fully informed and ready for the transition period this fall
and the implementation January 1, 2006. Given the oversight and planning responsibilities of county
governments and county based authorities, communities will rely on the NACBHD membership as points of
dissemination of information.
NACBHD's Developmental Disability (DD) Committee has taken the lead in supporting the cataloging of resources to help the NACBHD membership as implementation of the MMA proceeds, and to aid the membership in better understanding and planning for such activities as beneficiary plan selection, eligibility determination, formularies selection, and provider training. Maeghan Gilmore is compiling an inventory of outreach and education resources, which will be available on the NACBHD website soon. Beneficiaries, guardians, providers, physicians, pharmacists and case managers are those stakeholders who will likely have a direct role in implementation and will benefit from the inventory. In addition, NACBHD is routinely updating members on outreach and education efforts in the newsletter. SAMHSA has forwarded the following resource information to NACBHD:
Formulary Guidance from CMS - Categories of Special Interest
Transition Guidance for Dually Eligible Beneficiaries
To learn more about the provisions that CMS has made regarding the transition from Medicaid to Medicare for prescription coverage, visit http://www.cms.hhs.gov/pdps/transition_process.pdf.
State Medicaid Director's Letter
On June 3, 2005, CMS issued a letter that explains the requirements in Federal law for coverage of
these excluded drugs and asks state Medicaid programs that cover these excluded drugs to consider
continuing this coverage for all Medicaid recipients, including full benefit dual eligibles, after the
transition of dual eligibles to the Medicare drug benefit. Go to http://www.cms.hhs.gov/states/letters/smd060305.pdf
to access the letter.
Kaiser Commission on Medicaid and the Uninsured Releases New Report: Dual Eligibles: Medicaid's Role for Low-Income Medicare Beneficiaries
Kaiser's new fact sheet describes the over 7.5 million dual eligibles enrolled in both Medicare and Medicaid, why this population needs Medicaid, what services they receive from Medicaid, and the current policy challenges related to dual eligibles, including the new Medicare prescription drug benefits.
NACo Forms Meth Action Group; NACBHD Makes Meth a Priority
The National Association of Counties (NACo), of which NACBHD is an affiliate, recently announced the formulation of a Meth Action Group to address the methamphetamine epidemic in communities. Twenty-three county officials will address issues related to the problem in an effort to promote communication among federal, state, and local officials and the private sector. For more information, see www.naco.org.
In addition, NACBHD has made the methamphetamine epidemic a priority in its work plan for the coming year. Look for an article on the methamphetamine crisis in the September newsletter, as NACBHD begins to address the crisis and formulate a policy.
Dental Resources for the DD Population
Mike Chambers, former chair of the Developmental Disabilities Committee and Executive Director, MH/MR Program Admin. of Pennsylvania, provided the following resources regarding dentistry in the DD population:
http://www.eparent.com/resources/associations/aadmd.htm
http://www.jdentaled.org/cgi/content/abstract/67/12/1337
2005 Recovery in Action Summit Seeks Scholarships
Faces and Voices of Recovery, the national addiction recovery movement, is hosting the 2005 Recovery in Action Summit, September 6-8 in Washington, DC. Pat Taylor, from Faces and Voices, briefly spoke about this at NACBHD's March legislative conference, and the issue was covered in the April newsletter as well. Faces and Voices asks NACBHD members (if possible) to provide a scholarship to someone in their county or locality so that they may attend the summit.
The summit will bring together recovery efforts from across the country so that individuals may learn how to communicate the goals of the recovery movement in an attempt to gain national exposure and reduce stigma.
Please visit http://www.facesandvoicesofrecovery.org/summit2005/index.php to learn about the summit. Also, please complete a scholarship form if your county or organization is able to provide assistance. Click here for the scholarship form.
SAMHSA Announcements
From a July 27 SAMHSA press release:
Clinical Support System Available to Assist Physicians Who Treat Patients Dependent on Opiates
SAMHSA has announced the availability of the Physician Clinical Support System (PCSS) to assist
physicians who prescribe or dispense buprenorphine to their patients dependent on heroin or
prescription drugs containing opiates.
SAMHSA, in collaboration with the American Society of Addiction Medicine (ASAM) and other specialty addiction medicine, psychiatric, pain and general medicine societies, created the support system to assist physicians in the appropriate use of buprenorphine, and to promote improved patient care, research and education.
The PCSS supports primary care physicians, pain specialists, psychiatrists and other non addiction medical practitioners, and is designed to significantly increase access to buprenorphine treatment among the millions of untreated opioid dependent patients. It will offer support on patient selection; induction; dosing and patient monitoring; and treatment of polysubstance dependence or co-occurring conditions. The PCSS is designed to significantly increase access to buprenorphine treatment among the millions of untreated opioid dependent patients.
The PCSS is a national network of 45 trained physician mentors with expertise in addiction treatment and skilled in clinical education, who are supported by a PCSS Medical Director, and by 5 physicians who are national experts in the use of buprenorphine. The physicians within the network provide services via telephone, email, and/or at the place of clinical practice, thereby allowing others to observe them providing office-based treatment with buprenorphine.
The PCSS is a free service. To find a PCSS clinician in your locale or region, to become a PCSS mentor, or for more information about the project, contact the PCSS staff at PCSSproject@asam.org, at 877-630-8812, or fax: 301-656-3815, and website: http://www.PCSSmentor.org.
CMS Announcements
CMS has announced the release of a Quality Improvement Roadmap. This document was created by the CMS Quality Council, in an effort to delineate and advance a vision for improving of medical care. It provides a summary of CMS's many quality-related initiatives. The goal of the quality roadmap is to ensure the right care for every person every time and to do this by making care safe, effective, efficient, patient-centered, timely and equitable.
The Quality Council believes that this vision is realistic and substantially achievable and that recent developments create unprecedented opportunities and need for that achievement. To that end, the Quality Improvement Roadmap describes how CMS will take a national leadership position to transform the healthcare system in the United States. Additionally, CMS will conduct a set of focused "breakthrough" projects to demonstrate the feasibility of major improvement through coordinated CMS activities.
As we strive to make improvements to the health care system, CMS will do its part, by strengthening our partnerships and using them to identify, support, and improve high-quality, personalized care. This is essential for the sustainability of Medicare, Medicaid, and our health care system, since increasingly, high-quality care is the only kind of care we can afford. There is bipartisan interest in many quality issues related to Medicare and Medicaid and CMS looks forward to working with all of its partners, including Congress, to improve quality and avoid unnecessary costs.
A copy of the Quality Improvement Roadmap is available on the CMS website at http://www.cms.hhs.gov/quality/quality%20roadmap.pdf.
SPAN USA Announces 10th Annual Awareness Event: Focus on Full Funding of Garret Lee Smith Act and Mental Health Parity
From an August 1 email to advocates:The Suicide Prevention Action Network (SPAN USA) will conduct is 10th Annual National Awareness Event
September 8-10, 2005 in Washington, DC. On the 8th we will visit legislators on the Hill calling for
full funding for the Garrett Lee Smith Memorial Act and passage of mental health parity. On the 9th we
will have a day of training (advocacy skills, engaging the media skills and other topics). Finally,
on the 10th (World Suicide Prevention Day) we will hold a National Awareness Event on the mall where
the "Faces of Suicide Quilts" will be on display and numerous speakers will address those in attendance
on the importance of addressing suicide prevention as a national priority. We will also "Hike to Hill"
to deliver petitions to members of Congress. An on-line petition is available at
http://capwiz.com/spanusa/mail/oneclick_compose/?alertid=7814716. More information is available at
www.spanusa.org. The tentative agenda may be found at http://www.spanusa.org/A_find-events1.html
and a registration form can be found at http://www.spanusa.org/pdf/2005%20Registration%20Form.pdf.
