NASMHPD Research Institute (NRI)

Transcription

1 NASMHPD Research Institute (NRI) NASMHPD Annual Meeting June 16, 2013 TECHNICAL PROPOSAL RFP No

2 Panel Tim Knettler, NRI Executive Director Ted Lutterman, Senior Director of Government & Commercial Research Scot Adams, Director, State of Nebraska, Division of Behavioral Health Questions and Answers 2

3 NRI Origins (1980s) NIMH expressed concern about funding an advocacy organization (NASMHPD) for some of the research and data efforts and encouraged NASMHPD to explore setting up a separate organization to conduct policy neutral analyses and data collection about state systems NASMHPD Convened a group of SMHA Commissioners that discussed roles and functions of a separate organization to do State MH related research and data 3

4 NRI Origins 1987 NASMHPD Commissioners incorporated NRI as a separate 501-c-3 not-for-profit organization to conduct research and data collection focused on SMHA systems 4

5 NRI Corporate Profile Separate 501c3 non-profit Providing Objective Data & Analysis Extensive database of state profiles, revenues, expenditures, performance benchmarks, etc. Services to States Research Projects & Programs 5

6 NRI Board of Directors (Officers) President, Lorrie Rickman Jones, Illinois Vice President, Nancy Rollins**, New Hampshire Treasurer, Brian Hepburn, Maryland Secretary, Stephen Baron, District of Columbia ** NASMHPD Board Member 6

7 Board of Directors (Members At Large) Scot Adams**, Nebraska Jane Beyer,* Washington Kevin Anne Huckshorn,* ** Delaware Michael Lardiere, NCCBH Ron Manderscheid, NACBHDD * New Board Member 2013 ** NASMHPD Board Member 7

8 Board of Directors (continued) Matt Salo, Nat l Assoc. of Medicaid Directors David Shern, Consultant James W. Stewart, III,* Virginia Lynda Zeller,* ** Michigan Tim R. Knettler, NRI Exec. Director (non-voting) * New Board Member 2013 ** NASMHPD Board Member 8

9 NRI Strategic Planning Jim Paglia, Ins & Outs, Facilitator Brand Hierarchy Blue Ocean Strategy 9

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11 It isn t enough to want the truth, you must know where to look for it and the truth is elusive because it knows where to hide. Mary Alice from Desperate Housewives

12 Thank you for your Leadership! 12

13 Profiles of State Mental Health and State Substance Abuse Agencies: 2013 NASMHPD Commissioners Meeting June 16, 2013

14 2013 State Mental Health Agency and State Substance Abuse Agency Profiles 2013 State Profiles are the first of a new collaboration with NASADAD to develop Profiles of both SMHAs and SSAs Funded as subcontract w/ SAMHSA s Center for Financing Reform and Innovation (CFRI) by Truven Health 4 Option Years ( ): Full Profiles developed every 2 years Focused Topical Profile Reports in alternate years 14

15 State Mental Health Agency Profiles Have been compiled every 2-3 years since 1996) Information about how SMHAs are Organized, Major Policies, Services, Financing including revenues and expenditures to provide services, Workforce, and HIT including EHRs Guided by Advisory Group of SMHA Commissioners and SMHA Senior Staff Makes use of other existing information/data whenever possible

16 Profiles of State Mental Health and Substance Abuse Authorities Goal: To Provide timely information about public Mental Health and Substance Abuse Systems Meet the needs of SMHA and SSA Directors and other State Staff, SAMHSA and Other Federal Policy Makers, and Mental Health and Substance Abuse System Advocates for reliable information on the organization, policies, services, and clients of SMHAs and SSAs. 16

17 Users of the SMHA Profiles SAMHSA and other Federal Agencies: to identify and understand state systems and issues facing States State Mental Health Agencies (SMHAs) and State Substance Abuse Agencies (SSAs): to identify other states with policies, services, or structures of interest NRI, NASADAD, and NASMHPD: to prepare reports and analyses for States and SAMHSA Consumers/Families/and other Advocates: to understand and advocate for state systems Researchers: Profiles data are being used in several research studies to understand similarities and difference in state systems 17

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19 Profiles Planning Group Includes representatives of SAMHSA, SMHAs, SSAs, National MH and SA advocacy groups Provides guidance to the development of State Mental Health and Substance Abuse Profiles Initial Focus (Spring 2013): guidance on critical areas to include as content of 2013 Profiles Later Focus (Summer 2013): guidance on development of products making Profiles results accessible to stakeholders in the mental health and substance abuse communities

20 Topics Identified by Policy Group to Address in Profiles SMHA and SSA Roles in Health Care Reform and ACA implementation SSA and SMHA efforts to integrate mental health, substance abuse, and primary care health services Organization of SSA and SMHAs within state governments Policies (e.g., are state psychiatric hospitals used for acute or longterm care, forensics, children s mental health, substance abuse detoxification, etc.). Financing of mental illness and substance use disorders within States including their revenues and expenditures and Use of Managed Care to deliver services Involuntary Mental Health Treatment Implementation and use of EHRs by SSA and SMHA systems.

21 2013 SMHA Profiles Components Organization/ Structure SMHA Policy/ Statutes SMHA and SSA Healthcare Reform Activities Information Management and EHRs State Mental Health & Substance Abuse Agency Profiling System Financial (includes SMHA Rev/Exp) Managed Care/ Medicaid Waivers Health and Mental Health Integration Involuntary Treatment New special component 21

22 Status of Compiling 2013 Profiles from SMHAs Forms were sent to SMHAs in April & May MH Profiles are in 8 components organized to facilitate review and responses by appropriate SMHA staff Almost all SMHAs have designated a state contact person to work with NRI on Profiles 22

23 2013 Profiles Schedule April 2013: Revenues/Expenditures and Profiles forms sent to SMHAs April-June: NRI and NASADAD work with States and Existing Information sources to compile, clean, and edit information for Profiles Develop Outline for Draft Profiles Report July 2013: NRI develops draft state summary reports for review by SMHAs Planning Group Call to discuss Profiles Report Outline August 2013: Prepare Draft Profiles Report for review by States, Planning Group, and SAMHSA September 2013: Submission of Draft Profiles Publication: Funding and Characteristics of State Substance Abuse and State Mental Health Agencies: 2013

24 2013 Profiles and SMHA Revenues & Expenditures Compilation Progress As of June 19, 2013: FY 11 and FY 12 SMHA Controlled Revenues and expenditures information has been received from 25 SMHAs 2013 State Profiles Components have been received from 33 SMHAs (65% of SMHAs) 228 Profiles Component have been received 24

25 Status of 2013 SMHA Profiles Forms 25

26 Status of Revenues and Expenditures Information (FY 2011 and 2012) 26

27 Making Profiles Results Available to States and Others Profiles Results are available to SMHAs in multiple formats: SAMHSA Publications PowerPoint Slides and special reports from NRI Special requests of NRI Web-based database SMHAs can query Online system lets users search by: 1. Keyword (such as Health Homes, Assertive Community Treatment, NRGI Patients, Accredited Hospitals) 2. By State: to see a short summary of an SMHA s MH System 3. By Which States are Alike searching for similar states based on organizational, financing, or other criteria 27

28 2013 Profiles Products Report on Funding and Characteristics of State Mental Health and State Substance Abuse Authorities: 80 to 100 page publication that discusses state organization, financing, and major policies in the Profiles For each state there will be a 2 page appendix that describes how the SMHA and SSA is organized within state government, its Service System, financing, with a focus on activities around implementation of ACA. 2 page report for each SSA 2 page report for each SMHA

29 Development of SAMHSA Publications about State MH Systems NRI combines information from State MH Profiles, SMHA Revenues/Expenditures, and URS/CLD to produce publications for SAMHSA summarizing the Organization, Structure, Policies, Services, and Financing of SMHAs. Reports for 2007, 2009, 2010, and Report is at SAMHSA for publication clearance New for 2013: The State Report will be produced jointly with NASADAD and will cover both SMHAs and SSAs

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31 Sample 2012 State MH Agency Profiles Results 31

32 Disability Responsibilities of SMHAs: 2012 MH and ID in Same Agency (1) MH and SA in Same Agency (24) MH Only Agency (15) MH, SA, and ID in Same Agency (11) 32

33 States with Mental Health and Substance Abuse Responsibilities in One Agency: 1970 to 2012 States * 2012 includes proposed mergers in California and Ohio

34 SMHA Roles in Working to Establish Health Homes for Behavioral Health: 2012 Health Homes Yes No Is your SMHA working with Medicaid and/or health providers in your state to establish Health Homes that include behavioral health services and supports? 32 8 Is your SMHA working with Medicaid Health Homes State Plan Amendment (Section 2703)? Are Health Homes being developed with funds other than Medicaid? Is your SMHA providing any financial supports to help establish Health Homes that include behavioral health services? 8 25 Is your SMHA providing technical assistance and training to mental health providers to help them partner with primary care providers? Are any of the SMHA's Community Mental Health Centers (CMHCs) in your state partnering with health providers to become part of a Health Home? Have any Community Mental Health Centers (CMHCs) partnered with

35 State Psychiatric Hospital Residents per 100,000 Population: 2011

36 Number of State Psychiatric Hospitals and Resident Patients at End of Year: 1950 to Hospitals 600,000 Number of State Psychiatric Hospitals Residents , , , , ,000 Number of Residents in State Psychiatric Hospitals Sources: CMHS Additions and Resident Patients at End of Year, State and County Mental Hospitals, by Age and Diagnosis, by State, United States, 2002, and NRI 2012 State MH Agency Profiles System

37 Sample FY 2010 State MH Agency Revenues and Expenditures Results 40

38 SMHA Revenues/Expenditure Study Compiled from SMHAs using standardized methodology since FY 1981 Documents historic shifts from State Hospitals to Community-based care Increase in Forensic/Sex Offender Expenditures within state hospitals From predominately using State General Funds to Medicaid becoming the major funder Currently Compiling FY 2011 & 2012 data 41

39 SMHA-Controlled Mental Health Expenditures SMHA-Controlled Mental Health Expenditures are those expenditures that the State Mental Health Agency either directly funds, or requires local mental health providers to expend as part of their funding allocations SMHA-Controlled Expenditures should match the expenditures with the clients and programs reported in a state s MH Block Grant Application and in its URS reporting of clients and services

40 SMHA Expenditures for Mental Health: FY 1981 to 2010 in Current and Constant 1981 Inflation Adjusted Dollars $40 $37.5 $35 SMHA-Controlled Expenditures (In Billions of Dollars) $30 $25 $20 $15 $10 $5 Constant Dollars Current Dollars $8.06 $-

41 State Mental Health Agency Controlled Expenditures for State Psychiatric Hospital Inpatient and Community-Based Services as a Percent of Total Expenditures: FY'81 to FY 10 80% Community Mental Health 70% 60% 63% 60% 60% 58% 54% 66% 67% 69% 70% 70% 70% 71% 72% 72% 73% 50% 48% 58% 40% 30% 33% 36% 36% 38% 43% 49% 39% 32% 30% 29% 28% 28% 28% 26% 27% 26% 25% 20% 10% State Mental Hospital- Inpatient 0%

42 Total FY'2010 SMHA-Controlled Per Capita Mental Health Expenditures $75 or Less (13) $75 to $105 (12) $105 to $160 (13) > $160 (13)

43 SMHA-Controlled Forensic and Sex Offender Mental Health Expenditures As a Percentage of State Psychiatric Hospital Expenditures, FY'83 to FY'10 40% 35% 30% 25% 20% 15% Sex Offenders Forensics 10% 5% 0%

44 Funding Sources for SMHA Services: 2010 $40 $35 SMHA-Controlled Funding in Billions $30 $25 $20 $15 $10 $5 $- State General Funds

45 SMHA Expenditures of the Mental Health Block Grant as a Percentage of Total SMHA-Controlled Mental Health Expenditures and Community-based Mental Health Expenditures: FY 1983 to FY % 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% 11% MHBG as percent of SMHA-controlled Community MH Expenditures 7.9% 7.1% 5.6% 3.9% 3.2% 2.9% 2.7% 2.4% 1.9% MHBG as percent of Total SMHA-controlled MH Expenditures 2.6% 2.4% 2.2% 2.2% 2.1% 1.9% 1.8% 1.7% 1.5% 1.5% 1.5% 1.5% 1.6% 1.5% 1.5% 1.5% 1.4% 1.3% 1.2% 1.1% 1.1% 1.1% 48

46 Next Steps for SMHAs June: Please make sure your SMHA s Information (Profiles and Revenues/Expenditures) gets submitted July/August: Review the Draft 2-page Summaries of your SMHA s information is reviewed for completeness and reflects how you want your SMHA to be seen by the public August/September: Review Draft Final Report to assure ensure it reflects your SMHA properly 51

47 A State Mental Health Agency Commissioners Perspective on State Profiles Scot L. Adams, Ph.D. Director, Division of Behavioral Health Nebraska 52

48 How States can use Profiles Profiles can provide information useful to SMHAs in budget preparation and hearing Puts your state s spending for MH in context of similar or neighboring States Identify other States with a Policy or Service of interest Learn from other states and avoid reinventing the wheel Strategic Planning putting state in context of regional or national trends 53

49 How Advocates use Profiles NAMI, MH America, and Consumer Groups use Profiles to assess SMHA systems SMHA Expenditure Consumers Served Provision of EBP Services Hospital beds and Policies 54

50 How Others use Profiles State Legislators and Governor s Budget Offices often ask about SMHA Expenditures and other information from State Profiles News Media local and national newspapers, radio, and television news find and use Profiles information about Expenditures and Services 55

51 Next Steps for Commissioners Because Profiles information get used by so many others, it is important for SMHA Commissioners to ensure that: Their information is complete and accurate Their information reflects their public Mental Health System the way the Commissioner wants it depicted 56

52 When Draft Profiles Reports are sent back this summer for review Make sure that they or a senior deputy takes the time to review and make sure it reflects their system the way they want depicted 3 Products to Review this Summer 1. Their State s 2-page summary 2. Their State s Revenues and Expenditures Summary 3. The Draft 2013 Funding and Characteristics of State Mental Health and Substance Abuse Agencies 57

53 Sample page 1 of the 2 Page State Summary

54 Use the Profiles Data Access Profiles via the NRI website or call or e- mail NRI to get and use Profiles Data to assist your SMHA. They will help you understand and use the data. 59

55 Contact Information for Profiles Ted Lutterman Senior Director, Government & Commercial Research NASMHPD Research Institute, Inc Fairview Park Dr., Suite 650 Falls Church, VA

56 CMS Psychiatric Hospital Reporting Requirements

57 CMS Requirement FY 2013 Reporting IPFQR inpatient psychiatric facilities quality reporting program. This is the new program specific to psychiatric hospitals and psychiatric units in general hospitals. IPFQR is part of the Affordable Care Act Authorized to deduct 2% from annual payment rate to hospitals that fail to report Becomes effective for the FFY2014 payment Performance measure aggregate data will be posted for the public on the CMS website Hospital Compare 62

58 FY 2013 Reporting, continued HBIPS measures 2 7 (restraint, seclusion, antipsychotic medication use, continuing care plan) October 2012 thru March 2013 patient discharges and events Transmission occurs July 1 Aug 15, 2013 NRI will transmit data for our hospitals 63

59 Proposed Rule: FY 2015 reporting January December 2014 data collection HBIPS 2-7 Three new measures: SUB1, SUB4, FUH Patient Experience of Care July August 2015 data transmission to CMS FY2016 Payment Update 64

60 FY2015 reporting, continued SUB 1: Alcohol Use Screening: The number of patients age 18 years or older who were screened for alcohol use using a validated screening questionnaire for unhealthy alcohol use. SUB- 4: Alcohol and Drug Use: Assessing Status After Discharge: The number of discharged patients who are contacted between 7 and 30 days following discharge and follow-up information is collected regarding alcohol or drug use status. This measure pertains to discharged patients age 18 or older who screened positively for unhealthy alcohol use or who received a diagnosis of alcohol or drug use disorder during their hospital stay. Sampling IS permitted. Will include specialty Alcohol and Drug Treatment Only units. Measure developer: The Joint Commission 65

61 FY2015 reporting, continued FUH: Follow-Up After Hospitalization for Mental Illness: This measure assesses the percentage of discharged patients age 6 years or older who had an outpatient visit, an intensive outpatient encounter, or a partial hospitalization with a mental health practitioner. Two rates are reported for this measure: (1) The percentage of patients receiving outpatient follow-up within 30 days of discharge (2) The percentage of patients receiving outpatient follow-up within 7 days of discharge. Sampling IS NOT permitted. Measure Developer: NCQA 66

62 Proposed Rule: Patient Experience IPFs are requested to provide information on whether or not they measure patient experience of care, and if so, what survey they use Provision of this information has no payment implication CMS intends to make this provision mandatory in the future and will use this information to pursue the adoption of a standardized measure of patient experience of care for the IPFQR Program 67

63 Proposed Rule: Recommendations for future measures CMS is looking for recommendations in the following areas: 1. Treatment and quality of care of geriatric patients and other adults, adolescents, and children 2. Quality of prescribing for antipsychotics and antidepressants 3. Readmissions 4. Access to care 5. Screening for suicide and violence 6. Screening and treatment for non-psychiatric comorbid conditions 68

64 Proposed Rule: Commenting NRI s summary statement: NRI does not support adding three new measures to the required quality reporting for FY2015 (FY2016 payment update). Our major concerns with the proposed measures to be added for FY2015 reporting are the following: 1) high burden for data collection, 2) incompatibility with existing quality measures used by psychiatric hospitals, and 3) measures outside the scope of inpatient provider responsibility. Copy of the comment was sent to facilities last week Contact Lucille.Schacht@nri-inc.org for a copy 69

65 Proposed Rule: Commenting Comment period closes on June 25, We encourage you to submit your comments to CMS by June 25, 2013 at ( CMS ) 70