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4/7/2016 12:00 AM

Observing that mental health is one of the biggest public health issues currently facing their communities, Minnesota hospital and health system officials have embarked on a campaign to engage the public in a statewide conversation about mental health and work with community partners to spread the message.

Observing that mental health is one of the biggest public health issues currently facing their communities, Minnesota hospital and health system officials have embarked on a campaign to engage the public in a statewide conversation about mental health and work with community partners to spread the message.

The Minnesota Hospital Association on March 31 launched its “Strengthening Healthy Communities” campaign using the hashtag #HealthyMinds. The campaign aims to feature stories about the impact of mental health issues from the perspective of the patient, families, law enforcement, schools, health care providers and other community members, officials announced in a press release.

“With this public initiative we intend to turn up the volume on the needs and create additional focus on the biggest health issue facing our state,” Wendy Burt, spokesperson for the Minnesota Hospital Association, told MHW. “We’ve been hearing from our hospitals’ 140 members throughout metropolitan and rural areas who feel the state cannot meet the demand for mental health services.”

Burt added, “We conducted a poll in late October that found that 85 percent of respondents say mental health is a serious problem in the community. That’s a big number.” One in four respondents said they knew someone who missed work due to depression or anxiety, she added. “It’s touching virtually everyone in the state,” said Burt.

The initiative will help to increase public education about mental health and reduce stigma, noted Burt. Currently, the National Alliance on Mental Illness (NAMI), one of the hospital system’s community partners, is pushing forward its #makeitokay campaign, a public service announcement to also reduce mental health stigma.

The NAMI campaign and the Minnesota Hospital Association’s health partner are making much headway in getting people comfortable in talking about mental health, Burt said.

Multiyear effort

The multiyear effort is grounded in five core principles that hospital and health system officials said are essential in reforming the complex mental health system in Minnesota:

  1. Share experiences — Building greater awareness of mental health challenges and improving care starts with community members sharing their experiences and learnings.
  2. Engage early and often — Treat mental health by recognizing conditions early and ensuring Minnesotans have access to appropriate levels of care.
  3. Foster stronger community partnerships — A communitywide approach is required to develop safe, effective and culturally competent solutions to identify and treat mental health conditions among all Minnesotans regardless of geography, income, ethnicity, gender or age.
  4. Use good data to make informed decisions — Consistent reliable data will inform well-founded solutions to mental health.
  5. Expand education, innovation and technology — Minnesota can identify and treat mental health conditions by using the latest technology and innovations, and ensuring communities have access to qualified, trained mental health specialists.

“We also are working with groups that represent community-based clinics,” Burt said. “There are a lot of local efforts going on.”

One such effort is a partnership between Park Nicollet Methodist Hospital and St. Louis Park Middle School called NOW (No Obstacles to Well-being) to provide telemental health services to the students via videoconferencing. In a Facebook video, officials have noted only one child psychologist in the state per 17,000 students. “We will be running Facebook posts and Facebook ads as well to turn up the volume on this issue,” said Burt.

A priority issue

The hospital has identified mental health as a priority moving forward, said Shannah Mulvihill, executive director of Mental Health Minnesota. “They’re acknowledging that mental health plays a key role in our community,” Mulvihill told MHW. “We will likely jump in playing a role at some point, helping share stories about what experiences [consumers] are having and how to improve the system to serve them better.”

The state is making other efforts to improve its mental health system, said Mulvihill. Minnesota is one of the 24 states selected to participate in the first round of federal demonstration programs to help states establish certified community behavioral health clinics. The U.S. Department of Health and Human Services awarded Minnesota $982,373 in planning grants to support the state’s efforts to improve the behavioral health of their consumers by providing community-based mental health and substance use disorder treatment.

“Our state legislature is putting the pieces in place to move that forward,” Mulvihill said of the bills (Senate File 2549, House File 2609). “The legislation will help us do what we need to do and make us competitive," she said. “The care will be a very integrated model of care. Clients will be addressing more of the whole person. Support will include housing and physical health care. You can’t isolate one condition." Meanwhile, this fall, eight states will be selected to participate in the two-year pilot program, Mulvihill noted.

4/7/2016 12:00 AM

A new rule by the Maine Department of Health and Human Services to address service eligibility for adults and children with mental illness who receive Medicaid along with a review of provider rate adjustments has sounded the alarm for the entire mental health community who fear business closures and subsequent loss of services.

A new rule by the Maine Department of Health and Human Services (DHHS) to address service eligibility for adults and children with mental illness who receive Medicaid along with a review of provider rate adjustments has sounded the alarm for the entire mental health community who fear business closures and subsequent loss of services.

Hundreds of Maine consumers turned out March 25 during a public hearing to oppose Gov. Paul LePage’s administration’s eligibility changes to Section 17 of the MaineCare rules. The plan limits automatic eligibility to Mainers with schizophrenia or schizoaffective disorder, potentially leaving behind Mainers with post-traumatic stress disorder, major anxiety disorder and other diagnoses, according to a press release from Rep. Drew Gattine’s (D-Westbrook) office.

Maine lawmakers on April 6 voted to keep services in place to help Maine consumers with mental illness stay in their homes and avoid costly hospitalization and residential services. The committee’s bill provides at least a 120-day transition period for each individual affected by the DHHS’s plan, and if alternative services are not available, a 90-day extension through June 30, 2017.

The new rule regarding Section 17 took effect April 8. Meanwhile, the legislative proposal will need to be presented before the full legislature.

David Sorensen, an aide in Gov. LePage’s office, in a March 31 editorial to The Portland Press Herald, wrote that of the 17,000 people currently served by Section 17, the department estimates that about 8,000 have these less-severe diagnoses. Meanwhile, there are 350 people on waitlists for these services, many of them requiring the higher level of care that Section 17 was originally intended to provide, Sorensen wrote.

Provider rate adjustments

Proposed provider rate adjustments have also raised concern in the provider community. Samantha Edwards, DHHS spokesperson, said there are no “proposed cuts” but rather draft rate models prepared by Arizona-based Burns & Associates and the DHHS for provider review and comment, she said.

The rates are for services provided under various sections, including Section 17, of the MaineCare policy. “Before proposing new final rates, the department will review provider comments and respond to each in writing — either agreeing and adjusting rate models accordingly or disagreeing and explaining why — as has been the practice for each of the prior four rate studies that the department has conducted with Burns & Associates,” she noted.

Edwards added that the DHHS is committed to ensuring that MaineCare rates adequately support delivery of services authorized under the program. As noted earlier, the current rate study is the fifth the department has conducted over the past two years with Burns & Associates. We have found their work to be exceptional, and the rate studies they have produced have been well-received.

The DHHS is at the midpoint of the rate review process, and the department extended the comment period to May 16, giving providers and stakeholders two months to provide feedback on the draft models, Edwards said.

Once the comment period closes, the DHHS and Burns & Associates will review each submission and respond in writing, either accepting the comment and incorporating its recommended changes into the rate model(s) or explaining their disagreement with the comment, said Edwards. “Herein, our goals are transparency in our reasoning, granularity in our analysis and thorough engagement with providers and stakeholders,” she said.

Legislative action

As the DHHS prepares to move consumers from one Medicaid program to another, the legislative proposal is expected to move to the full legislature, said Rep. Gattine, co-chair of the legislature’s Health and Human Services Committee. “We’re telling the department to provide for a longer transition period,” Gattine told MHW.

“There are concerns that people aren’t ready to make the transition because behavioral health homes are a relatively new service in the state,” he said. There are capacity issues in geographic parts of the state, Gattine noted.

The department’s plans regarding provider reimbursement rates are technically a separate issue but are very much related, noted Gattine. The provider rate proposal reduction would range anywhere from about 25 to 50 percent, he said.

“Providers are telling us that if the department moves forward there would be thousands of adults and children [without services],” he said. The problem is the department proposed a rate cut last year during its budget session, which was rejected by legislators, he said.

The DHHS had until January of this year to release another proposal regarding the provider reimbursement rates; however, they never did, he said. It wasn’t until March when they presented the rate proposal, he said. “Providers will be in a very compromised position with the rate cuts,” said Gattine. At MHW press time, a meeting had been scheduled to address the proposed rate adjustments.

Gattine said he is hoping the department will delay its proposal until the legislative session resumes January 2017. The current session is expected to end April 20, he said. “We’re now at the end of the session and the department is proposing these cuts,” Gattine said. “We’re not in a budget crisis. We’re not trying to fill a budget hole.”

Gattine added, “This is a very hot topic and a topic of great concern to the people.” For the past 30 years, Maine has been pretty much operating under a consent decree, he said.  The consent decree plays a huge factor in how mental health services can be provided in the state, he said.

“The consent decree has a lot of bearing on how services can be developed for people in the community,” he said. “It’s been a real struggle for us to create a quality mental health system. We can’t afford to take a step backward. We’re looking very hard at building a mental health system we can be proud of.”

Advocacy, peer concerns

Aashley Malsbury, policy associate at the National Alliance on Mental Illness Maine, said the DHHS’s proposal would have a devastating impact, not just on consumers receiving MaineCare, but on the state’s entire mental health system as well. “Providers can’t keep their doors open with the suggested proposal,” she told MHW.

The proposed rule would impact about 8,000 consumers with mental health needs who aren’t currently receiving services under MaineCare, said Malsbury. New eligibility criteria would apply to individuals diagnosed with bipolar disorder or schizophrenia, and who might be at risk of homelessness, criminal justice involvement or hospitalization, she said.

NAMI Maine submitted written testimony highlighting their concerns and its impact on peers utilizing services, and the unnecessary anxiety caused by the notices consumers received, she said. The notices about the changes to Section 17 were sent to consumers before being sent to providers, Malsbury said. NAMI Maine raised concerns because the service eligibility under the new rule should be more specific to the need for that type of service, rather than the diagnosis, she said.

Under the rule, a person with schizophrenia would receive case management services. One-third of people diagnosed with schizophrenia would experience only one episode of psychosis in their lifetime, she said. They would automatically be eligible to receive those services. It would not be based on need, Malsbury said.

According to the Burns & Associates rate study, the reimbursement rate cut for providers of adult case management services would be reduced by 28.7 percent. The rate for a physician or nurse practitioner for medical management services would be reduced by 47.8 percent, she said. “The proposed rate cuts would have a devastating impact on the mental health system as a whole — not just on those receiving services through MaineCare. Providers can’t keep their doors open with the suggested proposal,” she said.

Although pleased with the momentary reprieve from lawmakers courtesy of legislation to extend the transition to services, peers are concerned that the department’s proposal could mean potentially closing four of the state’s 12 recovery centers, said Marge Grant, coordinator of Friends Together Peer Support and Recovery Center in Livermore Falls.

“We could lose our contract,” Grant told MHW. “They want to close four of the 12 recovery centers in the state of Maine,” said Grant. The recovery center receives the bulk of its funding from the DHHS, she added.

The center, in operation for 20 years, provides social, leisure, educational and recreational services to promote recovery among its members, along with nutritional and wellness support, Grant said.

Representatives from the Maine Association of Peer Support and Recovery Center participated in the state hearing on March 25 to air their concerns, she noted.

The legislative proposal introduced April 6 is a step in the right direction, said Grant. “Unfortunately, it’s not going to happen overnight,” she said. “We’re now waiting to see [what more] the legislature is doing going forward. We’re trying to get this all figured out.”

Bottom Line…

The DHHS plan that includes provider rate adjustments is still being addressed by lawmakers.

4/7/2016 12:00 AM

MaineCare members who currently receive Section 17 services will not lose support altogether, Samantha Edwards, DHHS spokesperson, told MHW in an emailed interview. “Those with less serious mental illness such as PTSD [post-traumatic stress disorder], anxiety and depression will be re-evaluated to receive services under Section 65 or 92,” she said.

MaineCare members who currently receive Section 17 services will not lose support altogether, Samantha Edwards, DHHS spokesperson, told MHW in an emailed interview. “Those with less serious mental illness such as PTSD [post-traumatic stress disorder], anxiety and depression will be re-evaluated to receive services under Section 65 or 92,” she said.

“This does not diminish the importance of treating depression, anxiety or PTSD, but rather acknowledges that a member with these conditions should not receive the same level of treatment as a schizophrenic,” said Edwards. The National Institute of Mental Health lists the appropriate treatment for each of these diagnoses, she said. It is clearly stated that PTSD, depression, and bipolar and anxiety disorder are best treated with medication and psychotherapy. These treatments are available under Section 65, she noted.

“DHHS is focused on ensuring that MaineCare members receive appropriate care and treatment under program policy,” said Edwards. “But treating members with an overly aggressive complement of services than their respective diagnoses warrant is inefficient and may prove detrimental to their well-being.”

“Even so — DHHS has established safeguards to ensure members will receive the appropriate level of service and exceptions are in place for individuals to remain under Section 17 if their clinician can provide documentation that it is necessary,” said Edwards.

“Services will not just stop after April 8th,” she noted. “Members will continue to receive services under their current 90-day continued stay review authorization. After April 8th, there will be a 90-day transitionary period so the Department can work with providers and case managers for those members that no longer meet the clinical criteria to access Section 17 services.”

In Case You Haven’t Heard
4/7/2016 12:00 AM

The debate over the name of the 51FIFTY energy drink and whether it’s offensive to people with mental health issues has taken an unusual twist, The Fresno Bee reported April 5. The Livingston, California–based energy drink landed in the spotlight two weeks ago when Save Mart said it was pulling the drink from its shelves in response to pressure from mental health advocates, several of them from Fresno. The advocates said the drink’s name and the “Live The Madness” slogan printed on the can contribute to the stigma faced by people dealing with mental illness. Police and first responders use the term “5150” in situations when a person “as a result of a mental health disorder is a danger to others, or to himself or herself, or gravely disabled.” Carlos Vieira, 51FIFTY CEO, refuses to change the name. According to the drink’s website, the name represents “a person who never quits, meets all challenges head on, doesn’t feel fear, pushes the limit and is crazy enough to chase his or her dream.”

From the Field
9/26/2013 12:00 AM

Editor’s note: Mental Health America (MHA) on Aug. 23 announced the resignation of its president and CEO, Wayne W. Lindstrom, Ph.D., effective Sept. 19. MHA is currently conducting a national search for a replacement.

I find myself frequently framing today’s realities in mental health within the context of Charles Dickens’ first line in A Tale of Two Cities: “It was the best of times, it was the worst of times.” While many of us are familiar with this beginning quote, we are less familiar with the remainder of his opening line, which next goes on to say “it was the age of wisdom, it was the age of foolishness.” Today I am increasingly astonished by evidence of the age of wisdom. We are learning almost daily of new discoveries in neuroscience, genetics and technology that offer us leaps forward in effective prevention, early intervention, treatment and recovery. Simultaneously I find myself stunned at hearing of another impact of sequester cuts on government-funded research that has been propelling these leaps forward.

Dickens goes on to say “it was the epoch of belief, it was the epoch of incredulity.” With the passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) and the requirement under the Affordable Care Act (ACA) that mental health services be fully integrated within the rest of healthcare, I had come to believe that mental health services would no longer be delivered within a separate and inferior care system. But now I find myself incredulous over the almost $5 billion that has been lost to the publicly funded mental health service system over the last five years due to state budget cuts, and over the machinations by elements of the Republican Party to dismantle the very vehicle I had come to believe in, “ObamaCare.”

The validity of Dickens’ commentary applied to our field and in our time does not end there for me. He goes on to further say “it was the season of Light, it was the season of Darkness.” When I look at how far consumer and family empowerment and recovery have come, I am convinced we are all embraced by a “season of Light.” But when I hear voices calling for more involuntary commitment options and for more inpatient psychiatric beds, rather than intensive and comprehensive community-based treatment capacity, I feel a “season of Darkness” is upon us.

As we begin to more fully understand neurophysiological brain development during the first five years of life and we begin to implement evidence-based services and supports that make for resilient children, who can withstand the stressors of life and be launched on a healthy life trajectory, it is indeed “the spring of hope.” But for me, when we fail to treat gun violence as a public health problem and prohibit, by law, the Centers for Disease Control and Prevention (CDC) to even study it, and when we permit our children to be gunned down not only in Newtown, but also on the streets of Chicago, then “the spring” for me, turns to a “winter of despair.”

As in Dickens’ writing, we have “everything before us.” We are becoming a global community that is experiencing rapid technological and social change. I look around and see us beginning to grow our own food again, becoming not only increasingly health- and wellness-conscious, but also mindful and respectful, while holding ourselves, others and the Earth in reverence. With this new consciousness, the elimination of health inequities and discrimination against those with mental health or emotional conditions, and others who are thought to be different, is indeed possible. But rapid change creates anxiety and a sense that events are beyond one’s control. The associated fear-based reactions are an attempt to restore the old order, to return to fundamental beliefs, systems and institutions. We witness this desperation playing itself out even within the halls of the U.S. Congress and around the world. Should fear dominate our choices, then we have “nothing before us.”

We need to stand firm against fear-based reactions but not become fearful and angry reactionaries in response to those who express them. To do so will result in us “going direct the other way” rather than “going direct to Heaven,” as Dickens said as he drew his opening to A Tale of Two Cities to a close. For me, Gandhi ultimately said it best for all of us: “Be the change you want to see in the world.”

 

Wayne W. Lindstrom, Ph.D., is a 42-year veteran of the behavioral health field. His last position was as president and CEO of Mental Health America.

FromtheField
8/7/2013 12:00 AM

The National Quality Forum (NQF), a nonprofit membership organization created to develop and implement a national strategy for healthcare quality measurement and reporting, and build consensus on national priorities for performance improvement, reported in July preliminary quality measures to the Centers for Medicare & Medicaid Services (CMS) for the CMS-state demonstrations for persons dually eligible for Medicare and Medicaid. Officials and advocates are considering the application of these measures for Medicaid managed long-term services and supports (MLSS) programs.

It is estimated that there are now 10.5 million persons dually eligible for Medicare and Medicaid. Previous data (based on nearly 9 million eligible people) included 5.5 million low-income seniors and 3.4 million people with disabilities under the age of 65. Sixty-six percent of the beneficiaries have three or more chronic conditions, and 86 percent of these persons have incomes below 150 percent of poverty.

The July NQF report to the CMS estimated that 58 percent of dual-eligible beneficiaries have a serious mental illness (SMI) or other type of mental impairment. Within that group, 20 percent have more than one mental illness or impairment. An estimated 20 percent of disabled dual beneficiaries younger than 65 have substance use problems. Nearly 7 percent of dual-eligible beneficiaries between the ages of 18 and 64 have an intellectual and/or developmental disability (ID/DD).

Identification of quality measurement gaps

To be endorsed by the NQF, a measure must be national in scope and have a data steward (to manage, collect and report data). Most existing measures being examined are traditional medical treatment–focused — delivered in medical treatment settings by medical professionals. Some of the measures specifically exclude persons with disabilities, including persons with mental illness. The NQF identifies gaps in quality measures — outcomes we want to measure but currently aren’t systematically capable of, given the steward and related requirements.

In spring 2012, the Consortium for Citizens with Disabilities (CCD) Task Force on Long Term Services and Supports identified six gaps in existing quality standards as they directly relate to persons with disabilities, with a focus on home- and community-based services and settings, to be pursued within the NQF (see MHW, Jan. 28, 2013; Sept. 17, 2012).

In the July 2013 NQF to CMS preliminary findings, seven high-priority measure gaps are identified:

  1. Goal-directed, person-centered care planning and implementation;
  2. Shared decision-making;
  3. Systems to coordinate healthcare with nonmedical community resources and service providers;
  4. Beneficiary sense of control/autonomy/self-determination;
  5. Psychosocial needs;
  6. Community integration/inclusion and participation; and
  7. Optimal functioning (e.g., improving when possible, maintaining, managing decline).

“Starter set” measures

The July 2013 NQF preliminary findings to the CMS endorsed 45 measures. Most of these are chronic illness condition–specific and are traditional medical treatment–focused — delivered in medical treatment settings by medical professionals. There are a few exceptions.

The report identifies a “starter set” of 15 measures for “immediate implementation”:

  1. Initiation and engagement of alcohol and other drug dependence treatment;
  2. CAHPS® 4.0 adult questionnaire (Consumer Assessment of Healthcare Providers and Systems);
  3. Experience of Care and Health Outcomes (ECHO) survey;
  4. Controlling high blood pressure;
  5. Use of high-risk medications in the elderly;
  6. Preventive tobacco use: screening and cessation intervention;
  7. Falls: screening, risk assessment and plan of care to prevent future falls;
  8. Transition from certain healthcare settings;
  9. Preventive depression screening and follow-up treatment plan;
  10. Documentation of current medications in the medical record;
  11. Prevention — Body Mass Index (BMI) screening and follow-up;
  12. Adoption of medication e-prescribing;
  13. Follow-up after hospitalization for mental illness;
  14. Planning for all-cause hospital readmissions; and
  15. “Medical Home” system survey.

The NQF will continue its work over the next two years. The complete report is available at www.qualityforum.org/Setting_Priorities/Partnership/Duals_Workgroup/Dual_Eligible_Beneficiaries_Workgroup_Meetings.aspx.

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  • Meet the Editor

    Valarie Canady
    Managing Editor

    Valerie Canady, managing editor of Mental Health Weekly, knows the mental health field inside and out. She uncovers the essential stories and gets the scoop directly from leaders and advocates in the field.
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