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Role of Local Governmental Units in Health Care Reform

Role of Local Governmental Units in Health Care Reform. Kathleen C. Plum, Ph.D., RN, NPP Monroe County DCS. NYS Mental Hygiene Law. Creates a local governmental unit (LGU) for the 57 counties & NYC, headed up by a Director of Community Services (DCS)

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Role of Local Governmental Units in Health Care Reform

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  1. Role of Local Governmental Units in Health Care Reform Kathleen C. Plum, Ph.D., RN, NPP Monroe County DCS

  2. NYS Mental Hygiene Law • Creates a local governmental unit (LGU) for the 57 counties & NYC, headed up by a Director of Community Services (DCS) • The DCS is charged with ensuring the effective direction & administration of a local comprehensive service system for persons in the county who need mental health, alcohol & substance abuse, & developmental disabilities services

  3. Conference of Local Mental Hygiene Directors (CLMHD) • The Conference is established in compliance with Section 41.10 of the NY Mental Hygiene Law and is comprised of DCS’s in all of the 57 counties and the City of New York. • The Conference advances state and local policies, practices, laws, regulations and funding for the purpose of promoting a comprehensive system of care for persons • The NYS CLMHD is an affiliate of NYSAC

  4. LGU Responsibilities • Comprehensive planning for mental health, alcoholism & substance abuse, and & developmental disabilities • Supervision & monitoring of local services/facilities in the county • Contracting for the delivery of mental health, alcoholism & substance abuse, and & developmental disabilities services • And, in some counties, direct operation of MH &/or ASA clinics

  5. Forensic Mandates • Allow for the provision of mental health services to the population of persons in the county jail • Initiate mandated transport orders through section 9.45 and/or 9.37 of the NY MHL • Approve designees • Provide for competency evaluations ordered by state courts • Pay for forensic services related to state hospitalizations per NY MHL section 43.03

  6. Forensic Mandates, cont’d • Oversee local implementation of Kendra’s Law and transition management of persons from emergency hospital and prison settings • Oversee local Implementation of NY SAFE Act • Reports accepted for persons aged 11 and up • Approve/disapprove reports • Approve designees

  7. LGU Fiscal Authority • The LGU is the local identifiable entity which is a requirement to allow the county to receive most of the state aid for mental hygiene services • Most of the state aid for local mental hygiene services is distributed by the State to the LGU from: • The NYS Office of Mental Health • The NYS Office of Alcoholism and Substance Abuse Services • The NYS Office for People With Developmental Disabilities

  8. Current Regional Efforts • NYCCP, Inc. • 7 counties at time of incorporation in 2011 • 19 county RBHO contract for WNY in partnership with Beacon and CCSI • Approved Health Home in 22 counties under 4 provider lead agencies in partnership with Beacon and CCSI • NYS Success • Monroe County as lead agency for SAMHSA stae expansion grant • Create cross systems teams within all 55 counties of Upstate NY

  9. CLMHD White Paper • Focus on 4 areas: • Proposed MCO criteria to manage full behavioral Health care benefit • The LGU role in the managed care environment • Equitable and transparent distribution of reinvestment dollars driven by regional needs • Protect the safety net for the uninsured

  10. Recommendation #1 • To be approved to manage the full behavioral health benefit under phase 2, MCO’s must • Embrace recovery focused, person-centered, evidence-based philosophy • Have ability to implement a robust care coordination system for behavioral health, physical health, LTC and all relevant social service needs of individuals with high needs in collaboration with Health Homes • Ensure a meaningful role for peers and family members throughout the program implementation to ensure the voice of peers and family members informs policymaking

  11. #1, cont’d • Endorse an appropriate standard which recognizes the critical role of community-based and wraparound services which are not medical in nature and therefore may not meet traditional “medical necessity” criteria . • Provide adequate payment for Out of Network providers to avoid disrupting existing therapeutic relationships between clients, therapists, family members etc., and for specialized behavioral health treatment. • Include non-medical supports and providers. Support and wraparound services to develop and maintain individualized “natural supports” are important components of recovery and access must be available.

  12. #1, in addition…. • The LGU should continue to provide formal comment on PAR/CON applications for OMH/OASAS licensed services. • The LGU should also have an opportunity to formally comment on MCO/BHO provider networks to provide an opinion on access and capacity of the overall provider network. • MCO/BHO must work with the LGU on AOT cases, recognizing the LGU’s authority under the Mental Hygiene Law as the lead entity on AOT cases

  13. Recommendation #2 • The LGU brings a unique, cross-system expertise that comes from being embedded in the community and working partnerships with DSS, CJ/JJ, State operated psychiatric centers, and ATCs and others. • Statutory authority under Article 41 MHL and role in programmatic oversight of the local impact – positive or negative - of managed care and health homes on clients and families, access, cost and quality. • Role in the allocation and fiscal oversight of federal dollars (including administration of the Medicaid program), state aid and local tax levy funding

  14. #2, cont’d • The need for a regional, multi-county approach, with: oversight of the mental hygiene system, local planning with the MCO/BHO and Health Homes, and collaboration to solve issues specific a region. • The process for allocation of the Medicaid savings to be reinvested in the community must be driven by unique regional needs which meet the overarching state objectives. • The safety net for the uninsured must be maintained.

  15. #2, in addition… • Recommend formation of Regional Planning Consortiums comprised of each LGU in the region, and representatives of mental health and substance abuse service providers, peers, families and health home leads. • The RPC would work closely with the MCO/BHO and State agencies to guide policy and problem solve. • An “advisory committee” falls short of the intention for the Plan to work in collaboration with the community.

  16. #2, addition, cont’d • For a BHO structure outside of New York City, the State large geographic areas will be needed to configure the number of covered lives needed for BHO fiscal viability. • The current BHOs regions under Phase 1 are too large and unwieldy for the State alone to effectively oversee and monitor the impact of managed care on the community. • The Conference endorses using the 11 proposed Regional Health Improvement Collaboratives (RHIC) put forward by the DOH Public Health and Planning Council in its Certificate of Need (CON) Redesign

  17. Recommendation #3 • The allocation of resources and projects funded by reinvestment be locally-driven through a transparent and inclusive process to ensure the unique needs and priorities of the regions are given strong consideration so long as the proposals meet the State’s objectives for the triple aim and care coordination for all.

  18. Recommendation #4 • The discussion over the past two years has focused on the Medicaid population. • However, even after the implementation of the Insurance Exchange and the Medicaid expansion in 2014, it is estimated that over 1 million New Yorkers will remain uninsured, including undocumented immigrants. • And, State OMH, OASAS and the LGUs are responsible for ensuring access to mental health and substance abuse treatment services for the uninsured.

  19. #4, cont’d • The Conference remains hopeful that CMS will approve New York’s 1115 Waiver Reinvestment Plan which would allow the state to use reinvestment funding to support care for the uninsured. The safety net funding through State Aid to the LGUs must continue to support the cost of treatment and services to uninsured people with behavioral health needs who the state and LGU are responsible for serving.

  20. County SPOA going forward? • Care management • Is there a county role separate from or under an RPC? • Must include provisions for uninsured • Housing, residential services • Need for County and PACC? PACC under the RPC? • Potential areas for flexibility: use empty Community Residence, RTC and RTF beds for respite; improve transitions across levels of care; increase in-home services; flex net deficit or state grant funding to allow programs to carry some reserves if program goals are met

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