MARIN BEHAVIORAL HEALTH AND RECOVERY SERVICES D E P A R T M E N T U P D A T E GRANT COLFAX, MD H E A L T H A N D HUMAN SERVICES DIRECTOR SUZANNE TAVANO, PHD B E H A V I O R AL H E A L T H A N D RECOVERY SERVICES DIRECTOR Pht Credit: Jeff Wng Health and Human Services 20 Nrth San Pedr Rad, Ste 2028 San Rafael, CA 94903 415 473 3696 T / 415 473 3344 F marinhhs.rg
Seeking Bard Guidance Cnsider Tw Year AB 1421 pilt prgram starting FY 17-18 Pending adptin f AB 1421 as part f the FY17-18 budget Scale prgram fr up t 5 clients t cmplete curt prcess Revisit census if demand is greater Explre priritizing enrllment t Medicaid ppulatin Cntinue t explre establishing a Transitinal Residential Prgram Prgress Fundatin as lead cntractr Cntinue cmmunity utreach and engagement prcess Explre establishing Psychiatric Health Facility (PHF) Snma/Marin partnership Expand Medicatin Assisted Treatment Enhance services t individuals with alchl and piate abuse disrders Explre expansin f Behaviral Health Services in jail Expand behaviral health treatment in jail Enhance re-entry planning fcusing n linkage t behaviral health care Slide 2
Repeal/Replace f Affrdable Care Act G O P P R O P O S E D A M E R I C A N H E A L T H C A R E A C T Repeals Medicaid expansin ptin (cvering adults belw 138% federal pverty level ) and enhanced federal match dllars Repeals essential health benefits requirement fr Medicaid t prvide the same as cmmercial plans Repeals access t Medicaid fr thse withut prf f citizenship r lawful presence Transitin t a per capita alltment Impses per enrllee limits n federal payments t states Uses state s FY2016 spending as base year t set targeted spending Any state with spending higher than specified targeted aggregate amunt wuld receive reductins t Medicaid funding fr the fllwing year Slide 3
AB 1421 Overview K E Y E L I G I B I L I T Y C R I T E R I A Histry Aged 18+ 2+ Psychiatric hspitalizatins/ past 36 mnths - r - 1+ serius acts f vilence/past 48 mnths Clinical Determinatin Serius Mental Illness Cnditin Substantially deterirating Declines vluntary treatment Unlikely t survive in cmmunity withut supervisin AOT wuld be least restrictive setting Will likely benefit frm AOT AOT Services Intensive client care prvided by multidisciplinary team Curt rder fr treatment, but cannt cmpel cmpliance Husing assistance Medicatin cannt be prvided invluntarily Slide 4
AB 1421 Experience Nevada 7 years 67 referrals 30 AOT curt rders 5 adversarial hearings Orange 12 mnths 389 referrals 126 accepted vluntary services 16 petitins 3 curt rders San Francisc 5 mnths 59 referrals 12 accepted vluntary services 1 petitin 0 curt rders San Dieg 5 mnths 376 referrals (includes IHOT) 20 vluntary AOT clients 0 curt rders Placer 6 mnths 10 referrals 8 accepted vluntary services 2 petitins 1 curt rder refused treatment despite curt rder Slide 5
Cmmunity Crisis Respnse Teams T 1,311 MCR O&E Transitins: Shrt term case management t help avid r reslve a psychiatric crisis Mbile Crisis: Mbile respnse t acute crises in the cmmunity in crdinatin with law enfrcement. 80% f the Mbile Crisis Respnse Team cntacts initiated by cmmunity members Outreach and Engagement: Outreach and supprt t individuals nt willing t engage in treatment, and t their families Individuals Served 5,290 Services Prvided Slide 6
Expanding Residential Care 75 mre beds needed IMD/Skilled Nursing Facility Acute Hspital State Hspital Crisis Residential Transitinal Residential Independent Living Supprted Husing Licensed Bard & Care 12 Persn Transitinal Residential Facility Structured therapeutic setting Supprts persns returning t the cmmunity Slide 7
Crisis Stabilizatin Unit Admissins I N C R E A S I N G A D M I S S I O N S / C L I E N T S 1800 Admissins 1600 1529 1400 1200 1154 1260 1000 800 Admissins 600 400 200 0 CY2014 CY2015 CY2016 Slide 8
Imprving Crisis Care C R I S I S S T A B I L I Z A T I O N A N D C R I S I S R E S I D E N T I A L Expanding n-site weekend physician cverage Cntract t stabilize and expand MD cverage Imprving the care envirnment: Crisis Stabilizatin Unit remdel Dubles bed capacity frm five t ten Imprves client and staff safety Supprting legislatin t allw flexibility in duratin f Crisis Stabilizatin Unit stays AB 1372 spnsred by Assemblypersn Levine Imprving care transitins Evening/weekend admissins t next level f residential care Imprving access t acute inpatient psychiatric care Marin-Snma Cunty cllabrative t explre a facility fr Medi-Cal Beneficiaries Access n Demand Walk In Access 3 days/week Increase f 66% ver last tw years Slide 9
Strengthening Services in Cunty Jail A Crss-Department Cllabratin Expedited treatment t restre cmpetency Evaluatin and treatment f persns with misdemeanr charges fund incmpetent t stand trial Expedited access t acute behaviral health care Created and implemented a prtcl t btain cnditinal release f jail inmates in need f psychiatric hspitalizatin Jined Stepping Up Initiative Natinal initiative fr imprved treatment f persns in the justice system Imprved access t intensive treatment fr inmates Cntracted fr psychiatric treatment in a secure frensic unit Slide 10
Expanding Substance Use Services D R U G M E D I - C A L W A I V E R Expanding access t/ federal reimbursement fr substance use services nt currently cvered by Medi-Cal Enhanced Cntinuum f Services includes: Outpatient Treatment (General and Intensive) Case Management Medicatin Assisted Treatment Recvery Services Withdrawal management (at least ne level) Residential Treatment (any size) Physician Cnsultatin Expanded services begin Mnday, April 3, 2017 Slide 11
Integrated Mental Health and Substance Use Care Rad t Recvery Clinic Outpatient Treatment fr adults with cmplex c-ccurring substance use disrders and Serius Mental Illness Services include individual and grup cunseling, case management, and care crdinatin with mental health, primary care and ther ancillary service prviders Opened: Nvember, 2016 47 clients t date Slide 12
Addictin Medicine E X P A N D I N G M E D I C A T I O N A S S I S T E D T R E A T M E N T Hired Chief f Addictin Services Specializes in substance use disrder treatment Opiate addictin: Created mdel fr efficient referrals and management f individuals with piid addictin Supprting prviders t btain certificatin t prescribe Subxne Prviding training fr law enfrcement t administer inhalant Narcan Prviding Narcan fr individuals at high risk fr verdse upn release frm jail custdy Alchl Addictin: Initiating Vivitrl use in Marin Cunty Jail Supprting Vivitrl treatment implementatin at cmmunity clinics HHS lead in cunty-wide stakehlder prcess t determine best practices t treat chrnic inebriates Slide 13
Seeking Bard Guidance Cnsider Tw Year AB 1421 pilt prgram starting FY 17-18 Pending adptin f AB 1421 as part f the FY17-18 budget Scale prgram fr up t 5 clients t cmplete curt prcess Revisit census if demand is greater Explre priritizing enrllment t Medicaid ppulatin Cntinue t explre establishing a Transitinal Residential Prgram Prgress Fundatin as lead cntractr Cntinue cmmunity utreach and engagement prcess Explre establishing Psychiatric Health Facility (PHF) Snma/Marin partnership Expand Medicatin Assisted Treatment Enhance services t individuals with alchl and piate abuse disrders Explre expansin f Behaviral Health Services in jail Expand behaviral health treatment in jail Enhance re-entry planning fcusing n linkage t behaviral health care Slide 14
Thank Yu THANK YOU Pht Credit: Jeff Wng Health and Human Services 20 Nrth San Pedr Rad, Ste 2028 San Rafael, CA 94903 415 473 3696 T / 415 473 3344 F marinhhs.rg