May 2002 NACBHDD Newsletter
The Newsletter of the National Association of County Behavioral Health and Developmental Disability Directors
In this Issue...
NACBHD Survey Identifies Medicaid Concerns;
Now the Challenge is to Address Them Given a State/Federal Split
NACBHD Medicaid Committee Chairman David Wiebe chuckles when he talks about the difficulties of getting at problems with Medicaid, noting that some of Medicaid is governed at the Federal level and some at the state level: "Frequently when you go to Centers for Medicare and Medicaid Services (CMS) and talk about an issue, they say that's not really us that's the states," says Wiebe. "You go talk to the state Medicaid authority and they say the federal regulations really require that we do this."
Wiebe notes the dilemma because the concerns expressed by 25 NACBHD members from 14 states in a survey conducted last November fall into the categories of cost/payment issues, which are the result of state Medicaid policy, and structure/management issues that are federally mandated. For those reasons Wiebe notes in his survey report NACBHD's proposed four-pronged Medicaid strategy reaches out to both federal and state organizations "for the purpose of achieving a common frame of reference and agreement on how Medicaid can most effectively support county government's behavioral health safety net mission." The strategy includes:
NACBHD President Jim Stewart (see story below) has made Medicaid a NACBHD priority. It is the largest single source of funding for behavioral health programs and services provided by county government behavioral health authorities. Nationwide, it represents approximately 50% of all public spending for community based behavioral health services. The rules and policies governing the Medicaid program has great impact on the structure and function of local government sponsored programs, and their ability to effectively serve consumers affected by mental illness and other behavioral health disorders.
NACBHD conducted the survey to determine member views on current issues pertaining to the policies, rules, structure, and financing of Medicaid behavioral health services. Responses fell into the categories of cost and structure with an addendum being added to reflect concerns about the new HIFA waivers. Results are as follows:
Cost and Payment for Services
Low Reimbursement Rates
- Rates that do not cover the full cost of providing behavioral health services. Inadequate rates cause local authorities to divert non-Medicaid funds to supplement the cost of services to Medicaid recipients. Fewer resources are then available to serve indigent non-Medicaid recipients.
- Low reimbursement, or non-coverage, for other primary health care services. Behavioral health consumers are further disadvantaged by not receiving necessary health care due to non coverage for certain services, or because primary care physicians refuse to accept Medicaid recipients. Inadequate primary health care for consumers remains a major challenge for local authorities and providers.
Cost Shifting
- Prevalence of restrictive medical necessity criteria, or denial of service, by managed care entities with Medicaid contracts. When medical necessity criteria become too restrictive, local providers are forced to either use non-Medicaid funds to treat Medicaid consumers, or forgo the provision of needed services.
- Requirements by states that counties use local funds to pay the non-Federal portion of Medicaid payments. When counties are required to use their own funds for Medicaid match, fewer local dollars are available to serve non-Medicaid, indigent consumers.
- "Best Practices" (e.g. case management, attendant care, atypical anti-psychotic medications) frequently not covered under Medicaid state plans. When state plans do not recognize current best practices, it forces the use of substandard models of care, or the use of non-Medicaid funds to provide uncovered services.
Structure and Management of Medicaid Programs
Competitive Bidding
- Requirement that contracts for Medicaid services be competitively bid when states implement Medicaid Managed Care. Competitive bid requirements threaten the stability of local government sponsored behavioral health safety net systems, which are supported by multiple funding streams. This may, in turn, split local systems of care, creating fragmentation of services for consumers.
Choice of Plan
- Requirement that Medicaid recipients have a "choice of plan" when states implement Medicaid Managed Care. Choices of Plan requirements also threaten the stability of local government safety net systems, and create fragmentation of services.
Health Insurance Flexibility and Accountability (HIFA) Demonstration Initiative
In the fall NACBHD will have a chance to express some of these concerns at an invitation-only Medicaid/mental health conference organized by SAMHSA's Center for Mental Health Services. Wiebe is hoping to get one person from each of the NACBHD-member states, members of the Medicaid committee and NACBHD officers to make a big showing at the 200-person conference.
Wiebe believes it is vital for county mental health authorities to speak up in defense of systems of care that provide, coordinate and support "not only traditional mental health treatment, but an array of accompanying social services, such as case management, housing services, supported employment, attendant care, mobile crisis services, and 24-hour emergency access." Because they are difficult to maintain and expensive, Wiebe says it is critical, that Medicaid policies and rules be constructed to support these local government operated systems of care. "CMS," he says ruefully, "looks at it from the more restricted point of view of a health insurer purchasing health care services."
NACBHD Moves Ahead on Medicaid, Criminal Justice, Legislative Fronts
By NACBHD President Jim Stewart
Our Association's work in the area of Medicaid continues. A survey of all members was conducted last fall to better understand the most pressing Medicaid concerns within each of our member states. At its winter retreat in San Antonio, the NACBHD Board of Directors considered the preliminary results of this survey to begin work on strategies that will be pursued by the Association to address the Medicaid issues that have been identified. At the NACBHD Legislative Conference that was held in Washington, D.C in February, David Wiebe and representatives of the Medicaid Committee presented the survey findings to those in attendance. With representatives of CMS and SAMHSA who were present for our conference we began a dialogue about our Medicaid concerns. Both of these federal agencies have expressed a real interest in working with NACBHD to explore our concerns. The preceding newsletter article provides an excellent summary of the Medicaid survey and the strategies that are being pursued.
In order to increase NACBHD's capacity to support the membership, the Board of Directors recently made the decision to create two additional committees. (1) Corrections and Behavioral Health Committee: Because of the increasing emphasis at federal and state levels on the mental health and substance abuse needs of those who are involved in the correctional system, this committee has been established to focus on both funding and service issues. Jeff Davis from Marion Co., OR will serve as chair. (2) Legislative Committee: Historically, NACBHD has focused its legislative effort on assuring that the concerns of the membership are addressed in the annual legislative package of the National Association of Counties (NACo). With the formation of this committee that will be chaired by Sandy Naylor-Goodwin from CA, we will be able to pursue federal legislative and policy issues throughout the year.
Finally, I would like to welcome several new members to the NACBHD Board of Directors: Chuck Benjamin, WA; Carol Duncan-Clayton, NC; Paul Fleissner, MN, Marge Hanna, PA; Steven Katkowsky, GA; Barbara Martley, IA; Douglas Morton, MI; Raymond Ratke, VA; Patricia Ryan, CA; John Tanner, UT; Robin Travers, MD.
States Cut Back on Medicaid Benefits; Reimbursement Rates
"Medicaid is the big issue," says Health Policy Tracking Service (HPTS) Director Lee, summing up his organization's 2002 State Health Priorities Survey. Because of the economy, revenue shortfalls and the rising cost of healthcare states have Medicaid on their minds. All 50 states responded to the survey, 42 of them had to address budget shortfalls, and 26 were planning to enact cuts of up to six percent. Medicaid is about 20 percent of total state expenditures and is the largest state expense except for education. Congressional Budget office projections show Medicaid costs continuing to increase at an average annual rate of 8.6 percent through 2011.
While deadline for the newsletter was too early to say where most states will come out on their Medicaid thinking in 2002 legislative sessions, Dixon says that his survey shows they are considering cutting back on optional services. Twenty-six states said they might trim benefits. An even greater number, 30 states, said they would consider rolling back reimbursement rates and 37 states said they would be looking into Medicaid waivers.
So far, says Dixon, states are not cutting back on eligibility. "They're talking about it but nobody's taken that action yet," he says, adding that, if anything, they're trying not to enroll as aggressively as they did before."
Part of the National Conference of State Legislatures, HPTS has surveyed state health priorities every year since 1997. During that time Dixon has seen the rise and fall of managed care as a priority. By now, he says, most states have dealt with patients' rights issues, internal and external appeals, access, provider reimbursements, and timely reimbursement of providers. "They've done just about everything that needs to be done," says Dixon. "While congress is still considering a patient rights bill, they have moved on."
By HPTS' count 26 states have passed mental health parity laws. Parity, as defined by HPTS, not only mandates equal coverage for mental health but also mental health coverage. In the survey 23 states said they would either enact new parity laws or amend current ones. Nineteen states said they would do the same for substance abuse parity. Currently at least ten states offer parity coverage for substance abuse. They are CT, DE, MD, MN, VT, VA and RI. IN, NC and SC offer substance abuse parity to state employees only.
An argument that has not been widely made, says Dixon, is the importance of parity to the Medicaid system. "If people don't have access to mental health services they then go to public system," he says, in which case the public system is subsidizing- private insurance.
Children's mental health services are a big priority for many states. Twenty-eight said they would give it precedence this year. Although this priority would seem to be at odds with budget cutting necessities, HPTS says media stories about the lack of services for children has given them a high profile.
An equal number of states highlighted the need to provide drug treatment in lieu of incarceration. HPTS says that while a number of states have already established drug courts or diversion programs, lawmakers want to expand or enhance these services.
Following is a list of responses to the survey made by NACBHD member states:
AL: Survey respondents identified no high priorities. Low priorities include mental health parity, and drug courts and treatment in lieu of incarceration.
AZ: High priority items include mental health parity; children's mental health, specifically psychotropic medications and coordinating systems of care; and out patient civil commitment of the mentally ill. Low priorities include mandated benefits
AR: Because of a biennial legislative schedule, AR will not hold a 2002 legislative session. However the state is facing a budget shortfall that may result in cuts of $50 million to the Medicaid program proposed by Governor Mike Huckabee. The Medicaid cuts have been challenged in court. One time savings and unspent appropriations are expected to keep AR Medicaid solvent through the end of June. A high priority for next year will be drug courts and treatment in lieu of incarceration.
CA: Unresolved issues from 2001 to be addressed in 2002 include assertive mental health treatment. The government will have to cut 15% across all government programs to male up a $2.2 billion dollar shortfall in 2002 and anywhere from $12.3 to $17.5 billion dollar shortfall in 2003. Executive Director of the California Institute for Mental Health Sandra Naylor Goodwin says there will be mental health cuts but not major ones since mental health is recognized to be under funded. High priorities are mental health parity; children's mental health, specifically psychotropic medications and coordinating systems of care; outpatient civil commitment of the mentally ill; drug courts and treatment in lieu of incarceration; TANF, women and substance abuse treatment; substance abuse parity; and methamphetamine abuse. Low priorities are restraints and seclusion, and mandated benefits.
CO: Different estimates place the budget shortfall in CO at $500 million to one billion dollars. Drug courts and treatment in lieu of incarceration is a high priority.
DE: In December Governor Ruth Ann Miner ordered all state agencies to cut two percent from their 2002 budgets. The only exempted agency was the Department of Children, Youth and Families because of increased child mental health costs, among others. The governor also restored one million dollars in funding cut from prison drug treatment. For 2003 the governor is proposing a small 2.2 percent budget increase. Unresolved issues from 2001 to be addressed in 2002 include involuntary commitment for drug addiction and mental health parity. Among high priorities are mental health parity; mandated benefits; outpatient civil commitment of the mentally ill; drug courts and treatment in lieu of incarceration; substance abuse parity and TANF, women; and substance abuse treatment.
FL: Governor Jeb Bush has asked the legislature for $437 million for health and human services programs including substance abuse treatment and reducing the list of 9,000 developmentally disabled people waiting for housing. However, the governor also proposed to cut all non-pregnant adults from the medically needy program July first. Health care priorities identified by state leaders include issues related to the developmentally disabled and mentally ill. High priority are drug courts and treatment in lieu of incarceration; and TANF, women and substance abuse treatment. Low priority items include mental health parity, mandated benefits and outpatient commitment of the mentally ill.
GA: In early March Governor Roy Barnes ordered $80 million cut from the state budget for 2002 in addition to a 2.5 percent cut previously made. Health care priority issues identified by state leaders include mental health and substance abuse wait list for services. Low priority issues include mental health parity; children's mental health pertaining to psychotic medications; mandated benefits; drug courts and treatment in lieu of incarceration; substance abuse parity; and TANF, women and substance abuse treatment.
IL: IL is facing a $500 million shortfall in revenue. A budget proposed by Governor George Ryan included closure of mental health facilities in Peoria, Rockford and Elgin. Among unresolved issues from 2001 are mental health services for children and for the juvenile and adult jail systems. State leaders identify developmental disabilities as a high priority. Survey high priorities include mental health parity; children's mental health; mandated benefits; drug courts and treatment in lieu of incarceration; substance abuse parity; TANF, women and substance abuse treatment; and methamphetamine abuse. Restraints and seclusion, and outpatient civil commitment of the mentally ill are low priorities.
IA: IA lawmakers just resolved a 2002 budget shortfall by making a 5.3 percent budget cut and now must face a $132.5 million shortfall in 2003. Unresolved issues from 2001 that were to be addressed in 2002 included restoration of substance abuse funding for treatment and prevention programs versus treatment programs, as well as mental health and substance abuse issues. Restructuring the department of health will be considered. State leaders have opposing views concerning the importance of mental health parity. On the high priority list is mental health parity; children's mental health relating to coordinating systems of care; mandated benefits; outpatient civil commitment of the mentally ill, drug courts and treatment in lieu of incarceration; and substance abuse parity.
KN: So far legislators have resisted raising taxes to cover a $680 million budget shortfall but some lawmakers think the issue may be revisited when cuts, including cuts in health care, are considered. No high priorities identified. Low priorities include children's mental health pertaining to coordinating systems of care, drug courts and treatment in lieu of incarceration; TANF, women and substance abuse treatment; and methamphetamine abuse.
MD: In spite of increases proposed by Governor Parris Glendenning the state Mental Hygiene Administration may end the year with $40 million deficit that may require cuts in services during the last five months of the fiscal year. MD has changed the way it pays for community services. It now reimburses on a fee for service basis, rather than grant basis taking away the ability of community programs to move funds between budget line items. Some programs are strapped for cash. MD's budget deficit my reach $300 million. Among proposed cuts is $20 million from the Department of Health and Mental Hygiene that would result in up to 16,000 people losing their health care coverage. High priorities include children's mental health pertaining to psychotropic medications and coordinating systems of care; mandated benefits; drug courts and treatment in lieu of incarceration; substance abuse parity; and TANF, women and substance abuse treatment.
MA: In February acting Governor Jane Swift cut $10 million from the 2002 budget and froze $90 in spending. The cuts affected the mental health program. The 2003 deficit is projected at two billion dollars. High priorities are drug courts and treatment in lieu of incarceration; substance abuse parity; TANF, women and substance abuse treatment; coordinating systems of care and substance abuse parity.
MI: MI faces a $900 million deficit in 2003. Governor John Engler would tap various reserve funds to address the bulk of the deficit including $247 million from the Medicaid trust fund. His budget also includes $308 million in state spending reductions including $112 that was to go to local governments. On the plus side his budget contains $50 million for community mental health. Low priorities are children's mental health pertaining to psychotropic medications and outpatient commitment of the mentally ill.
MN: MN faces an over two billion dollar deficit over the next 18 months. The legislature plans to take $1.3 billion from various reserve accounts and is requiring Governor Jesse Ventura to make $374 million in permanent program cuts. The remaining deficit may be made up from tobacco settlement funds and cutting welfare and health insurance benefits to people receiving general assistance by $55 million. A leftover issue from 2001 that was to be considered in 2002 was a vulnerable adults act. Children's mental health pertaining to coordinating systems of care and custody relinquishment of children is a high priority. Low priorities are mental health parity and mandated benefits.
MO: In March Governor Holden declared a state of emergency in order to use $135 million from MO's rainy day fund to pay for services to the mentally ill, disabled and elderly. Included was $56 million for community mental health services and $16 million for alcohol and drug abuse treatment. Unresolved issues from 2001 to be revisited in 2002 include mental health advanced directives and Olmsted decision compliance. High priorities are mental health parity; children's mental health; drug courts and treatment in lieu of incarceration; and methamphetamine abuse. Low priorities include restraints and seclusion, and outpatient commitment of the mentally ill.
NE: The budget shortfall in NE is growing and is estimated around $200 million. One legislative plan calls for three percent cuts from most agencies. A high priority is drug courts and treatment in lieu of incarceration. Low priorities are children's mental health; TANF, women and substance abuse treatment; and methamphetamine abuse.
NY: High priorities are mental health parity; drug courts and treatment in lieu of incarceration; substance abuse parity; and TANF, women and substance abuse treatment. Low priorities include restraints and seclusion; coordinate systems of care for children's mental health, custody relinquishment of children; and outpatient commitment of the mentally ill.
NC: A current year deficit could go to $900 million by June 30th. The biggest contributing factor is the number of people on Medicaid, growing from 882,520 in 2000 to 962,901 in 2001. Earlier this year Governor Mike Easley took $37.5 million out of a $48 million mental health trust fund to ease the deficit. Due to the budget shortfall in NC and a short 2002 session only issues that have a positive impact on the budget are likely to be considered. Leftover from the 2001 session are mental health reform and mental health parity. Lawmakers cite mental health facilities and the availability of community-based services as priorities. Low priority issues are mental health parity and substance abuse parity.
OH: Tobacco settlement money will probably be used to cover deficits that include $22 million for health care programs, including drug abuse prevention. Unresolved issues to be revisited in 2002 include Medicaid waivers and mental retardation/developmental disability services. A high priority is mental health parity. Low priorities include mandated benefits; outpatient civil commitment of the mentally ill; drug courts and treatment in lieu of incarceration; and substance abuse parity.
OR: Because of a biennial schedule Oregon will not hold a 2002 session. However, the legislature met in special session to address a budget shortfall of over $800 million. A combination of budget reserve funding and cuts was agreed on including cutting $131 million in Medicaid funds and $25.7 from human services. An unresolved issue for 2003 and one identified by lawmakers as a priority is Medicaid waivers. Also high priority are mental health parity, children's mental health, drug courts and treatment in lieu of incarceration, and methamphetamine abuse. Low priority are restraints and seclusion, mandated benefits and outpatient civil commitment of the mentally ill.
PA: High priorities are mental health parity; coordinating systems of care for children's mental health, psychotropic medications and custody relinquishment of children, mandated benefits, outpatient civil commitment of the mentally ill, drug courts and treatment in lieu of incarceration; substance abuse parity; and TANF, women and substance abuse treatment and methamphetamine use.
TX: Unresolved issues from 2001 to be covered in a 2003 biennial session include Medicaid costs and access. High priority issues are mental health parity, restraints and seclusion, coordinating systems of care for children's mental health and TANF, women and substance abuse treatment. Low priority are mandated benefits, outpatient commitment of the mentally ill, drug courts and treatment in lieu of incarceration, and substance abuse parity.
UT: Cuts to ease a $203 million shortfall include $11 million in human services and $10.4 million in health. UT was planning to re-visit 2001 issues that include 1115 waivers and mental health insurance mandates. Lawmakers cite the uninsured, drug courts, mental health and people with disabilities as priorities. High priorities are mandated benefits, drug courts and treatment in lieu of incarceration and methamphetamine use. Low priorities include mental health parity, children's mental health, outpatient civil commitment of mentally ill, substance abuse parity; and TANF, women and substance abuse treatment.
VA: Among budget reduction measures is program cuts amounting to three percent in 2002, seven percent in 2003 and eight percent in 2004. An unresolved issue from 2001 is Medicaid funding. High priorities are mental health parity, coordinating systems of care for children's mental health, drug courts and treatment in lieu of incarceration; TANF, women and substance abuse treatment; and methamphetamine use.
WA: WA legislators closed a $1.6 billion deficit with reserve money and tobacco settlement revenues and $600 million in cuts including $180 million from the Department of Social and Human Services. Unresolved issues from 2001 to be revisited in 2002 included mental health and cost-saving strategies for public health plans. High priorities are mental health parity, coordinating systems of care for children's mental health; outpatient civil commitment of mentally ill; drug courts and treatment in lieu of incarceration; and methamphetamine use. Mandated benefits; and TANF, women and substance abuse treatment are low priorities.
WI: Tobacco settlement revenue was to be used to bridge a $1.3 billion funding gap. Unresolved issues from 2001 include mental health parity. High priorities are mental health parity, mandated benefits and substance abuse parity.
NAMI: Concerned about Medicaid in 2003, New HIFA Waivers
"It rained this year," says Michael Fitzpatrick, the director of the new NAMI Policy Research Institute (NPRI), speaking about state budgets. What Fitzpatrick has observed is that many states are using rainy day funds and tobacco settlement money to make up for budget shortfalls. Fitzpatrick worries that "while the economy is coming back, gradually, these states are still going to face the same challenges in January 2003." Only then, he points out, the rainy day fund and tobacco money will have been used up. Medicaid will not have been fixed unless Congress acts to increase federal funding, which doesn't seem likely to him. "So that puts us in the same situation we are right now in 40 to 45 states but only worse," he predicts, adding that in 2003 many states will be establishing biennial budgets.
NPRI is NAMI's bid to drive the national debate on state and local levels, says Fitzpatrick, "recognizing that in many states the most powerful shaper of the mental health system is really county government." Fitzpatrick, who was previously NAMI's state policy director and served in the ME House of Representatives, adds, "We want at all levels to talk about best practices and make strong recommendations about how the system should be funded and what services should be funded."
For starters NPRI has identified 13 key areas, including financing of the mental health system for further discussion. In each area an eight to 10 person task force will be formed, joining grass roots advocates and national experts to forge consensus opinions that can then that can then be folded into advocacy strategies. NAMI is also sponsoring five national training session that will bring in state leaders from five different geographic areas and provide them with training on the Medicaid issue and the budget picture for 2003. "Medicaid funds anywhere from 30 to 50% of services in given states," says Fitzpatrick, "It's a huge issue."
HIFA is a particular concern. "We're concerned that an already fragile program could be at risk," says Fitzpatrick. Because the new waivers "give states the ability to throw the Medicaid program up in the air, particularly for optional beneficiaries, and re configure" Fitzpatrick worries that "an already fragile system could be at risk." While the advantage to the HIFA waivers is that they allow people who aren't covered to be brought into the system, Fitzpatrick is afraid it may be to the detriment of people "who fall into the medically needy program, a number of whom have mental health or substance abuse issues." Specifically he is afraid that the size of Medicaid packets and/or the use of co-pays will make some services not available or less available.
HIFA waivers have already been approved for UT and AR. WA is in the process of applying for one.
NACBHD's Legislative Conference
By Lauren Wolfe, MS, NACBHD Deputy Executive Director
NACBHD's 2002 Legislative Conference was a great success. We were pleased to have with us an especially broad range of influential policy makers this year. The conference kicked off with a heartfelt presentation by Congressman Patrick J. Kennedy (D-R.I.) who spoke compassionately about his commitment to mental health concerns and the importance of mental health parity. He discussed his bill and told us what we can do to ensure its passage. Cong. Kennedy was generous with his time to respond to questions and enthusiasm for his causes. We know that we have a strong advocate in him for the issues are most important to us.
Charles Curie, the new SAMHSA Administrator spoke to us with all of the agency directors attending: Dr. Bernard Arons, CMS, Dr. Westley Clark, CSAT and Dr. Ruth Sanchez-Way, CSAP. Mr. Curie ensured his commitment to county behavioral health authorities and invited us to meet with him periodically to share information, concerns and perspectives from the local level. He emphasized his experience with county authorities in Pennsylvania and spoke of his sensitivity to local behavioral health concerns. He values the work that county authority directors do and understands the current challenges.
Each agency director reviewed his/her priorities for direction for this year, highlighting special programs and grant opportunities. The Federal Update is usually a well-received session; this was particularly meaningful. We are optimistic that Mr. Curie and his directors will be more responsive to and receptive of county/local issues, providing greater opportunity for meaningful dialogue.
This year's conference introduced the first children's behavioral health congressional update. Policy directors from the Child Welfare League, the National Assn. of Psychiatric Treatment Centers for Children and The Federation of Families for Children's Mental Health updated participants on their policy agenda this year. The consensus was clear that including this presentation was very beneficial to us and laid the foundation for future collaborations and stronger policy-oriented partnerships. We welcomed, once again, our traditional partners: NAMI, the NMHA, The ARC of the US, The National Assn. of State Directors of Developmental Disability Services, the National Council of Community Behavioral Healthcare, and the National Assn. of State Mental Health Program Directors.
In our effort to include more substance abuse-related policy, we heard from NASADAD (as in past years) and a new partner, the National Assn. of Alcohol and Drug Abuse Counselors. Participants came away with a deep, broad understanding of the critical concerns that these organizations are facing.
Gary Weiskopf, Director, The New York State Conference of Mental Hygiene Directors moderated a most informative and timely panel on emergency services and disaster relief. We heard from SAMHSA on its emergency services branch, New York Office of Mental Health on their Project Liberty and John Russotto, Mental Health Director of Arlington County, VA on his first-hand experience organizing relief efforts at the Pentagon. Participants shared their support for these efforts and provided good feedback on how these systems can be improved and strengthened.
The Centers for Medicare and Medicaid Services (CMS-formerly HCFA) have always welcomed the opportunity to participate in this conference. This year was no exception. Mr. Glenn Stanton, Deputy Director, Disabled and Elderly Health Programs, provided his perspectives on the internal changes effecting Medicaid waivers, the Olmsted decision and the New Freedom Initiative. He spoke of closer cooperation between his department and county authorities, inviting dialogue and closer communication with county behavioral health directors.
This conference has certainly achieved its goal to provide timely, relevant, accurate policy information to county authority directors. We are attracting top federal officials, key federal policy makers and have cultivated an influential, vocal group of policy partners with which we work continually to make your concerns heard in Washington. I would like to take this time to thank NACBHD's Conference Program Committee chaired by Kathy Eilers and including Barbara Droher, George Braunstein, Gary Weiskopf, Steve Ashby, Gale Bataille, Karen Scherra, and Debbie Donaldson. Your efforts resulted in a truly outstanding conference this year.
We greatly appreciate the support we receive from our conference participants and urge all of you to mark you calendars for next year's Legislative Conference, February 26 - 28th at the Jury's Doyle Hotel (we are back at Dupont Circle!).
Final Managed Care Regulations Due Out at the End of May
Ever since the proposed rule governing Medicaid/managed care plans was published last August, CMS has been evaluating and responding to comments. Submitted by a large array of interests, including county behavioral health authority directors, the comments are not comparatively great in number, amounting to just over 300. A CMS official, who requested anonymity, promises that each comment will be thoroughly addressed, although he has declined to talk about specific comments prior to publication of the regulations. Nor would he talk about possible changes to the rule, beyond saying that usually comments do result in some alterations.
The rule spells out in detail what a Medicaid HMO or managed care organization is. To date, says the CMS official, these organizations have been operating under a less restrictive set of rules than private health plans. The new rules will change that by requiring "a little more accountability that everyone's going to see", says the official, adding, "hopefully that's a good news story for both the plans and the enrollees."
One of the proposed new requirements is an external quality review (section D 438.240 in the August proposal). It would mandate states to conduct an annual external quality review into some particular aspect of a behavioral health care plan. The official insists that since the state Medicaid agency will be charged with contracting the review, it won't be a cost burden for the plans. "The regulations will not drive anybody out of business," says the CMS official, "we're hoping we'll have more business and do better business."
Although the final regulations are scheduled to be published May 24th, the official doesn't rule out a delay. "Thorny issues have to be weighed and assessed," he says of the questions raised in the comments, "I think what we're trying to do in this proposal is hit a balance between beneficiary protection and what's workable and doable."
Are your behavioral health services reaching the people who need them? Analyze your own access to care gap with the following report:
Access Gap Analysis: A Key Part To Strategic Planning
By Niels Eskelsen, MBA, CPA
Welcome to the Newest NACBHD Members
We are delighted to welcome the following county behavioral health directors as new NACBHD members this year.
California:
Iowa:
Illinois:
Maryland:
Michigan:
Minnesota:
New York:
North Carolina:
Oregon:
Pennsylvania:
South Carolina:
Texas:
Utah:
Virginia:
Wisconsin:
NACBHD 2002 Annual Conference
Behavioral Health and Disability Systems: Leadership for a Complex Environment
July 25 - 27th
Clarion Bay View Hotel
San Diego, CA
Keynote Speaker - Monica Oss, President, Open Minds
Conference Announcements
October 28-30, 2002. Hotel Nikko, San Francisco, CA
The GAINS Center's 2002 National Conference, "Expanding Access to Community-Based Mental Health and Substance Abuse
Services for People with Co-Occurring Disorders in Contact with the Justice System". This three-day conference will highlight
diversion and community re-integration models developed for adults and juveniles with co-occurring disorders in contact with
the justice system, and strategies for expanding access to community-based services. Registration will open June 17, 2002.
For more information about the conference check www.gainsctr.com
or contact Ashley Lounsbury of the GAINS Center at 1-800-311-4246 ext. 269.
July 10-14, 2002. Washington, D.C.
Training Institutes Developing Local Systems of Care for Children and Adolescents with Emotional Disturbances and their
Families: Family Involvement and Cultural Competence. In-depth, practical information on how to develop, organize, and operate
coordinated, community-based, family-focused, culturally competent systems of care for children and their families and how to
provide high quality, effective clinical interventions and supports within them. Special emphases on family involvement and
cultural competence. For more information, contact the National Technical Assistance Center for Children's Mental Health at
Georgetown University, 3307 M Street, NW, Suite 401, Washington, DC 20007, (202) 687-5000, or
institutes2002@mindspring.com
NACBHD 2002 Membership Campaign
There is still time to join and be a part of the only national organization representing the interests and concerns of county and local behavioral health authorities. You can join on our web site at www.nacbhd.org/join_us.html or be contacting the NACBHD office for an application form at (202) 234-7543. Ensure your investment today!
