ACNL/CHA Webinar: AB 1300 May 10, 2016

Transcription

1 ACNL\CHA Webinar AB 1300: An Opportunity to Improve Care for 5150 Patients in California EDs - 12:30 1:30 p.m. Call-In: Conference ID: # Welcome and Introductions Brenda Brozek MAOL, RN ACNL Consultant Patricia McFarland MS, RN, FAAN ACNL CEO Our Presenter Sheree Lowe, MPA is Vice President, Behavioral Health at the California Hospital Association, serving as primary legislative advocate for hospitals serving individuals with mental health and substance use disorders. She monitors federal and state regulatory, legislative, and policy activities that impact general acute care hospitals and psychiatric hospitals, including inpatient and outpatient services. 1

2 California s Hospitals Approximately 440 in California ~340 with emergency departments (EDs not required) 115 provide inpatient psychiatric care Cost to build $2 million for med/surg bed $1 million for psych bed If you ve seen one county/city/hospital, you ve seen one county/city/hospital. ED Utilization Stratasan Data million ED visits annually 1+ million with behavioral health diagnosis 40% of ED encounters have alcohol on board Stratasan Report (handout) ED volume increased 14% statewide Behavioral health diagnosis increased 47% EDs only 24/7 provider EMTALA trumps CA state law on involuntary care No funding/billing mechanism for County Mental Health Plans Broken out by county Data is pre-aca 1 in 3 Californians covered by Medi-Cal Current Affairs - Handout Inpatient Psychiatric Bed Data (handout) 2013 OSHPD Data beds for 38 million people 2400 beds in 27 Acute Psychiatric Hospitals (APH) no EDs and no physical health medical services All IMD excluded 3850 beds in 88 dedicated psych units in General Acute Care Hospitals (GACH) 400 beds in 23 Psychiatric Health Facilities (PHF) no physical health medical services (Medicaid only) Does not include approximately 2000 beds in State Hospitals 2

3 Psychiatric Bed Change in CA Loss Between 1995 and 2013: Decrease of 23.8% in facilities (43) Decrease of 28.6% in beds (2673) Increase of 20.8% in population (6.6m) Growth Between 2011 and 2013: Increase of more than 300 beds Projection Between 2014 and 2017: Increase of 600 more beds County Breakdown 58 County Breakdown 25 Counties have 0 Adult beds (45% of state) 46 Counties have 0 Child/Adolescent beds (79%) 56 Counties have 0 Gero-Psych beds (97%) 53 Counties have 0 Psych Intensive Care beds (91%) 49 Counties have 0 Chemical Dependency beds (84%) 25 Counties have NO inpatient psych services (45% of state) 3

4 Bed Type Breakdown Adult Beds 133 facilities 5670 beds 25 counties without beds Bed Type Breakdown Child/Adolescent Beds 655 beds statewide 47 specifically for children under 12 Bed Type Breakdown Chemical Dependency Beds 25 facilities 851 beds 49 counties without beds 4

5 New or Newer Opportunities Behavioral health now considered an essential health benefit (EHB) Covered CA (1 in 3 in CA on Medicaid) State and Federal Parity rules HMO and PPO network adequacy access regulations Department of Mental Health (DMH) and Department of Alcohol and Drug abolished duties assumed by Department of Health Care Services New or Newer Opportunities SBIRT (alcohol screening) now a covered benefit in primary care settings New voluntary inpatient detox as a covered benefit for Medicaid Efficacy of the community-based social rehabilitation model is being questioned and scrutinized New partners emerging police, sheriff, highway patrol, EMS transport entities, schools, judges/courts, veteran services Challenges Patients are sicker and have multiple co-morbid conditions, including tri-morbid: substance use disorder, psychiatric disorder, physical health issue Increasing numbers being served with no social support system More entities in the delivery system, learning as they go Most risk assessment tools lack in appropriate psychosocial areas 5

6 Challenges Patients ready for discharge o Determining who s responsible hospital, health plan, county, conservator/guardian, regional center system o Is the necessary level of care even available in/out of county? o Crossing county lines to obtain services (seen one county/seen one county) o Social determinants for success need to be identified ED Boarding/Overcrowding/Throughput Current Activities Federal Government Involvement Issue Paper (handout) PES White Paper (handout) SB 82 Mental Health Wellness Grants 2013 (handout) AB 2743 Psychiatric Patient Bed Registry Oppose Letter (handout) AB 1300 Mental Health Involuntary Commitment Flow Chart (handout) Issue Paper (handout) Video (link provided) Why AB 1300 LPS Act Established 1967 Designated LPS Facilities typically provide inpatient psychiatric care Less than 1/3 of hospitals are designated Re-cast Welfare & Institutions Code Sections 5150 Detain/Transport Hold 5151 Evaluation of Validity of Hold 5152 Assessment for Inpatient Admission 6

7 AB 1300 Status Introduced February pages Significant Opposition County Behavioral Health Directors Association NAMI California Amended 6 times Now 15 pages Out of Assembly with 0 No Votes In Senate Health Committee Hearing June 2016 AB 1300 Details Authority/liability protections for ED doctors to write/release holds in non-designated hospitals Hospitals to report 5150s to County Mental Health Plans (MHPs) Communication between law enforcement, EMS, hospitals, and County MHPs Copy vs. original 5150 form AB 1300 Support Medical Community California American College of Emergency Physicians California Psychiatric Association California Emergency Nurses Association California Hospital Association 7

8 AB 1300 Next Steps Help educate locally Write support letters Partner with local NAMI affiliates - Special consideration for unique patient population Questions? THANK YOU! Sheree Lowe Vice President, Behavioral Health California Hospital Association (916) slowe@calhospital.org Wrap Up of Today s Webinar Final Questions Evaluation Access to webinar recording Thank You for Participating! 8