DMHAS Stakeholder Meeting

1. DMHASStakeholder Meeting September 22, 2011

2. Agenda Items Mission, Vision and Values Merger Involuntary Outpatient Commitment Requests for Proposals Office of Inspector General - Audit Regulations State Plan Amendments Hagedorn Psychiatric Hospital Update Medicaid Comprehensive Waiver Application

3. DMHAS Mission, Vision and Values Mission: DMHAS, in partnership with consumers, family members, providers and other stakeholders, promotes wellness and recovery for individuals managing a mental illness, substance use disorder or co-occurring disorder through a continuum of prevention, early intervention, treatment and recovery services delivered by a culturally competent and well trained workforce.

4. Mission, Vision and Values, cont… Vision: DMHAS envisions an integrated mental health and substance abuse service system that provides a continuum of prevention, treatment and recovery supports to residents of New Jersey who have, or are at risk of, mental health, addictions or co-occurring disorders. At any point of entry the service system will provide prompt and easy access to appropriate and effective person-centered, culturally-competent services delivered by a welcoming and well trained work force. Consumers will be given the tools to achieve wellness and recovery, a sense of personal responsibility and a meaningful role in the community.

5. Mission, Vision and Values, cont… • Values: • DMHAS’ work is driven by its values. • Staff with the Division and its partner agencies value: • consumers’ dignity and believe that services should be person-centered and person-directed • the strength of consumers, their families and friends because it serves as a foundation for recovery. • the commitment of its partner agencies to professionalism, diversity, hope and positive outcomes. • evidence-based practices that show consumer-informed and peer-led services improve and enhance the prevention and treatment continuum. • the public trust and believe that it is essential to provide effective and efficient services.

6. Merger Update First draft of the Table of Organization is being developed to begin combining functions and duties. Units will then begin to be co-located. Reports from Consumer Forums and Stakeholder Survey are posted on the website and can be found at: http://www.state.nj.us/humanservices/divisions/dmhas/merger.html A Block Grant Combined Behavioral Health Assessment and Plan application was submitted and is available on the website at: http://www.state.nj.us/humanservices/divisions/dmhas/Final%202012-2013%20Joint%20Block%20Grant%20Application.pdf Mental Health Acute Care system and Substance Abuse integration meeting was held for state staff on September 14 and 15 Regional meetings to include STCF, Screening Centers and Community providers to be scheduled

7. Involuntary Outpatient Commitment In April 2011 DMHAS convened an IOC Advisory Committee. This committee was comprised of representatives from consumer and family organizations, providers, the court system and DMHAS staff. Members of the IOC Advisory Committee also participated in 2 subcommittees that were convened. The Screening Subcommittee The Court Procedures Subcommittee The IOC Advisory Committee and the 2 subcommittees concluded its deliberations in July 2011. Currently DMHAS is in the process of drafting an RFP for the implementation of IOC In up to 7 counties using the $2 million that was appropriated in the FY12 budget RFP to be published in the Fall, with programs awarded and operational early in CY12. Ultimately, the number (up to 7) and location of the awarded IOC programs during this first RFP initiative will be contingent upon the applicant pool. The IOC Advisory Committee will reconvene after the RFP is published.

8. RFP Update An RFP for Geriatric Mobile Outreach (RFP to Develop a Clinical Intervention and Treatment Program for Older Adults at Risk of Psychiatric Hospitalization) was posted on 6/30 and the proposals were due to DMHAS on 8/12. A preliminary award was given to Trinitas. DMHAS will be issuing an RFP in FY12 for Supportive Housing Services for individuals who are transitioning to the community from the state hospitals (CEPP). We plan to develop 95 CEPP beds in FY’12. DMHAS will be issuing an RFP in FY12 for 3 additional Early Intervention and Support Service (EISS) programs. Currently there are EISS programs in Morris, Atlantic, Middlesex, Camden and Ocean Counties. DMHAS will be issuing an RFP in FY12 to rebid Screening services in 3 counties. The counties that will be rebid have yet to be determined. These rebids are being done in accordance with the revised Screening regulations that require that a Screening service be rebid every 7 years. DMHAS will be issuing an RFP in FY12 for Outpatient and Intensive Outpatient Treatment and Support Services (IOTSS) in Sussex County. DMHAS will be issuing an RFP in FY12 for Supportive Housing Services for 50 individuals who are At Risk of Hospitalization and Homelessness.  This RFP will be posted on website 9/26/11. An RFP for Training, Technical Assistance and Evaluation Support for Regional Prevention Coalitions due to DMHAS on 9/26/11 and to be awarded on or before 10/31/11. A RFP for Regional Coalitions to Utilize Environmental Strategies to Achieve Population-Level Change due to DMHAS on 9/26/11 and to be awarded on or before 10/31/11.

9. OIG AUDIT

10. Regulations Licensure of Residential Substance Use Disorders Treatment Facilities regulations have been proposed as published in the NJ Register on September 6, 2011. http://www.state.nj.us/humanservices/providers/ruleprop/Res%20Rule%20Proposal%20N.J.A.C.%2010_161A.pdf Written comments due by November 5, 2011 to Lisa Ciaston, 50 E State St. PO Box 727 Trenton NJ 08625-0362 Amendments were proposed to DMHAS’s Partial Care regulations (NJAC10:F) as published in the NJ Register on August 15, 2011. http://www.state.nj.us/humanservices/dmhs/info/notices/Rule_proposal_PC_aug_15_2011.pdf Written Comments are due by October 14, 2011 to Lisa Ciaston, 50 E State St. PO Box 727 Trenton, NJ 08625-0362

11. State Plan Amendments The DMHAS had four FY 12 budget reduction initiatives involving developing State plan Amendments or Waivers to draw down additional federal financial participating (FFP) for MH services funded primarily with State funds 1) Community Support Services Approved by CMS to be effective 10/1/11 Division will operationalize prospectively upon adoption of regulations approximately 7/1/12 2) Crisis Services SPA under development primarily to secure FFP in the cost of screening and emergency services currently funded by Division via State resources Anticipate sharing with CMS in draft in next month or two Earliest possible operationalization date Summer FY 12 3) Intensive Outpatient Treatment and Support Services   In light of the Medicaid comprehensive waiver the decision was made not to advance this initiative at this time 4) PACT and Residential services for GA Recipients This was included in the GA waiver and was effective 4/1/11 Providers are billing but not getting paid as system changes at Molina are not complete No reductions to contracts has or will occur until Medicaid payments are properly being made Additional communication regarding relationship with contract funding will be forthcoming

12. Hagedorn Closure Timeline September 6, 2011 – HPH closed admissions to younger adult population October 3, 2011 - HPH will close admissions to older adult population June 30, 2012 – HPH will close

13. Closure Process – Diversion of New Hospital Admissions All consumers from HPH Catchment area will be served by GPPH October 3, 2011 – Geriatric patients from Ocean County will go to APH October 3, 2011 – Burlington residents of all ages will return to APH’s catchment area. Legal patients with serious criminal charges from all catchment areas will continue to be admitted to AKFC Patients with lesser charges will continue to be admitted to TPH or APH depending on catchment area.

14. Closure Process, cont… Geriatric consumers to GPPH based on: Current Census numbers and projections indicate that GPPH would best accommodate the older adult transfers and future admissions Ability to create fully enclosed living and treatment space in two shared GPPH units with properly trained staff

15. Closure Process - Assessment All hospitalized consumers have continuing clinical assessments of their discharge readiness and service needs. Assessments include the Individual Needs for Discharge Assessment (INDA) and the Housing Preference Interview (HPI) Families are included in the assessment and planning whenever possible Division Level Reviewis in place to further evaluate the appropriateness of clinical assessments and discharge plan Hagedorn will usethe regulated appeal process for any consumer who refuses or challenges a transfer or community placement

16. Closure Process – Discharges & Transfers to Other State Hospitals Discharging consumers into the least restrictive, clinically appropriate setting remains the priority. Each Hagedorn consumer will have a Discharge/Transfer Plan completed before leaving Hagedorn. The plan will outline the consumers preferences and needs as identified by the consumer, guardian or family member. The plan will follow the consumer to the receiving facility and/or services  to make the transition as smooth and therapeutic as possible. For consumer assessments which indicate a need for hospitalization after 6/30/12, consumers will be transferred to the appropriate hospital Transfers will be conducted in a planned manner with involvement from the consumer and family during planning process.DMHAS has begun transfers on a limited basis.

17. Community Capacity Development SFY 2011 Opportunities for consumers currently hospitalized 171 Supportive Housing beds Opportunities for consumers to be diverted from hospitalization 82 Supportive Housing Beds Development of three new Early Intervention Support Services programs (diversion from emergency screening)

18. Community Capacity Development Projections for SFY 2012 Opportunities for consumers currently hospitalized 110 Supportive Housing Beds Emphasis on serving individuals with: legal challenges including sexually problematic behaviors, co-morbid medical challenges, and developmental disabilities.

19. Community Capacity Development Projections for SFY 2012 Opportunities for consumers to be diverted from hospitalization 50 beds for individuals at risk of hospitalization Geriatric Statewide Consultation Service 3 Early Intervention Support Service Programs Monmouth Mercer Essex

20. Hospital Readiness Hagedorn treatment team, inclusive of families, consumers, community providers, and Olmstead staff are working together in discharge planning efforts. Hagedorn treatment teams are working with the treatment teams, inclusive of families and consumers, from the receiving hospitalsin preparation for transfer of consumers who will not be discharged before the hospital’s closure Hospitals have submitted their preliminary plans for accepting Hagedorn transfers The reorganizationplans address staffing, space planning and special needs of Hagedorn consumers Plans will be coordinated with central office and with Hagedorn. 

21. Comprehensive Waiver Behavioral Health Overview What is the Vision? Improved access Improved quality Greater value Sustainability

22. Proposed Behavioral Health System Vision The design of the State’s Medicaid program to manage Behavioral Health (BH) is grounded in the following vision: To improve access to appropriate physical and BH care services for individuals with mental illness or substance use disorders To better manage medical costs for individuals with co-occurring BH-PH conditions To improve health outcomes and consumer satisfaction

23. Why? The DMHAS merger: Integration of mental health and addictions Integration of behavioral health and primary care Preparation for Health Care Reform under ACA (January 2014) To sustain the Medicaid program through reform initiatives

24. Integration of Mental Health and Addictions The merger of DMHS and DAS into DMHAS lays the foundation to build a combined system that provides best practice treatments for individuals with co-occurring mental illness and substance use disorders

25. Integration of Behavioral Health and Primary Care (PC) Currently, BH care for adult consumers and children’s services under Medicaid fee-for-service (FFS) is fragmented and largely unmanaged, with an over-reliance on institutional rather than community-based care These same individuals receive their medical care through one of four Managed Care Organizations (MCOs), with very limited or no formal protocols for coordination between the medical and BH delivery systems For Medicaid’s highest cost adult beneficiaries - approximately two-thirds have a mental illness and one-fifth have both a mental illness and substance use disorder - the opportunity for improved clinical outcomes through improved BH-PH coordination is welcome

26. What is the Plan? Systems Managed Behavioral Health Organization (MBHO) MCO/MBHO coordination Braided funding Opportunities for rate rebalancing Evolution from no risk model, to risk model Children, SAI and consumers with developmental disabilities

27. What is the Clinical Service Model? Clinical eligibility Uniform screening and assessment The SAMHSA 4-quadrant model ASO/MBHO clinical role Behavioral health homes Accountable care organizations New Medicaid covered services Additional special initiatives

28. In Sum-What is the Good News? Integrated Care SA/MH and BH/PH Opportunities for rate rebalancing Increased FFP Medicaid service expansion for SA services Potential reinvestment of savings Potential for Medicaid reimbursement under the risk arrangement to support first 30 days of residential community-based services in lieu of acute care Better access, enhanced quality, and improved outcomes

29. What are the Greatest Challenges? Communication Consumer involvement to ensure ease of access IT infrastructure Moving from non-risk to risk over time Managing eligibility and enrollment Coordination between MBHO and HMO Defining outcome measures to gauge performance

30. Roll Out Timeline Stakeholder involvement Communication strategy

31. Timeline Stakeholder presentations; workgroups formed Workgroup recommendations delivered to DMHAS Adolescent SA services transitioned to DCBH Treasury RFP for MBHO published MBHO selected Readiness review of the MBHO conducted January 1, 2013 - MBHO implemented for adults expanding community-based mental health and addictions services

32. Stakeholder Involvement Consumers Providers Counties Other State partners Primary care partners Federal partners