[NYAPRS Enews] MHW: Field Releases Policy Report To Address BH Needs In Health Care Reform

[Harvey Rosenthal]

Field Releases Policy Report To Address BH Needs In Health Care Reform

Mental Health Weekly  September 7, 2010

 

Faced with the prospect of a realignment of the nation's health care
system courtesy of health care reform, more than 60 leaders of the
mental health and substance abuse field worked together to sharpen their
message to the federal government about the need to address the mental
health and chronic physical needs of consumers with serious mental
illness (SMI).

Mental health providers, policy experts, commissioners, advocates and
consumers convened last November in Washington, D.C., to develop an
agenda for reform for consumers with SMI. The result was a new report,
"Recommendations to Foster System Reform for Adults with Serious Mental
Illness," that summarizes those discussions. The report promotes changes
in policy, funding and program design, increased cost savings, and
greater efficiency in health care.

 

The report outlines five key recommendations to inform the federal
government about what must be developed for improved outcomes in mental
health service delivery and to ensure high quality services. Each
recommendation addresses challenges at hand; opportunities for
improvement, actions that will address the challenges; and anticipated
outcomes/benefits.

The recommendations include:

1. Development of performance measures.

2. Designating consumers with SMI as a health disparities group.

3. The support of health information technology (HIT) for community
behavioral health care systems.

4. Removing obstacles to integrated mental health and general health
care.

5. Development of a national definition of "medical necessity." (See
below for more details.)

 

"Health care reform cannot succeed in its goal of improving access to
care unless the federal government addresses the health care policy
issues specific to consumers with serious mental illness outlined in the
report," Joseph Parks, M.D., president of the National Association of
State Mental Health Program Directors (NASMHPD), told MHW.

The report is not a comprehensive road map for delivering mental health
services, said Parks, who is also the medical director of psychiatric
services for the Missouri Department of Mental Health. "It addresses
five key obstacles that can interfere with people getting the care they
need," he said. "It's not an attempt to paint a picture of the whole
mental health system."

Consumers with SMI have chronic physical health care needs as well, said
Parks. "Health care reform is about taking care of people with multiple
chronic conditions," he said. "It's about treating the whole person."
Conditions such as high blood pressure, diabetes and asthma also affect
consumers with SMI, he said. "You can't fix the chronic illness without
taking care

of their mental illness."

 

'Medical Necessity' Definition

Parks said the report identifies the need for a national definition for
"medical necessity." A national definition would "make things
administratively simple and fair across plans," he said.

 

According to the report, the addition to Michigan's definition of
"medical necessity," for example, states: "Mental health, developmental
disabilities and substance abuse services are supports, services, and
treatment [which are] designed to assist the consumer to attain or
maintain a sufficient level of functioning in order to achieve his/her
goals of community inclusion and participation, independence, recovery,
or productivity."

Michigan's definition includes rehabilitation services that will help
promote people getting work and living independently - the types of
services often not included, Parks said. "I've seen several dozen
definitions of medically necessity, he said. "It's kind of absurd. It
should be a function of what the individual's condition is, and not a
function of what the individual plan thinks."

 

Parks said the workgroup made up of conference participants is just
beginning to disseminate the report. Additionally, they are attempting
to publish the report and its recommendations in a peer review journal.
Meanwhile, they're encouraging mental health commissioners to have
regular dialogue with their respective state politicians about these
five key issues. Consumers, advocates and others in the field are
encouraged to talk with their state legislators and representatives,
added Parks.

 

A 'Consensus Document'

The real significance of this new report is that it is a consensus
document, supported by a cross-section of individuals around the SMI
population, said Arthur Evans, Ph.D., director of Philadelphia's
Department of Behavioral Health and Mental Retardation Services and a
contributor to the report.

"The issues of behavioral health, mental health and substance use
disorders can easily be forgotten as people think about health care
reform," Evans told MHW. "We want to make sure behavioral health is an
integral part of the health care reform efforts. People with SMI have
particularly significant challenges; we want to make sure their issues
are addressed."

The new report takes an existing vision of recovery-oriented care and
identifies the top five priorities to help the field achieve that
vision, said Evans. "If the vision is that people with SMI have an
opportunity to recover to the [fullest] extent possible, here are five
things really critical for that to happen," he said. Evans noted that
when the group met last November, health care reform had not passed;
however, they anticipated that it would.

 

One of the critical issues to be addressed in the health care reform
legislation and in the new report was health information technology
(HIT) and the subsequent legislation to support community mental health
providers, said Evans. The Health Information Technology Extension for
Behavioral Health Services Act of 2010 (HR 5040) would extend the use of
incentives

established through the American Recovery and Reinvestment Act (ARRA) to
mental health and substance use providers and facilities excluded from
the law, including community mental health centers, clinical
psychologists and psychiatric hospitals.

The field is pleased that the legislation was crafted and by the level
of support it has generated, Evans said. "The  infrastructure of
behavioral health is already underfunded," he said. "If we don't have
the resources at [this] critical juncture, we're going to be further
behind and put at risk the SMI population."

 

Evans added, "It's really critical that we come together as a field and
identify some critical issues that are very important for the
populations we serve." * For a copy of the report, "Recommendations to
Foster System Reform for Adults with Serious Mental Illness," visit the
National Association of County Behavioral Health and Developmental
Disability Directors at www.nacbhdd.org. 

 

Five Policy Priorities For SMI Population

A new report, "Recommendations to Foster System Reform for Adults with
Mental Illness," was developed following a national meeting in November
2009 of mental health professionals, commissioners, advocates, providers
and consumers, as an opportunity to reform mental health care delivery
in a new healthcare environment (see story, page 1).

 

The report outlined five recommendations:

 

1. The U.S. Department of Health and Human Services (DHHS) must design
and implement a robust set of performance measures, including consumer
outcomes, with risk-adjusted financial incentives to facilitate a system
that financially supports the best patient outcomes.

Actions: DHHS should assist stakeholders, including researchers,
practitioners, and payers, in developing a set of standard service
definitions that are consistent across states and incorporated into
licensing and professional practice standards.

Outcomes/benefits: Investments in building a performance outcome
infrastructure will more than pay for themselves in offsetting
healthcare, criminal justice, and housing costs.

 

2. The U.S. Congress and relevant DHHS agencies should designate people
with serious mental illness (SMI) as a health disparities group in order
to close the 25-year gap in life expectancy.

Actions: The Secretary of DHHS should charge SAMHSA's Center for Mental
Health Services (CMHS) with reviewing disparities data collected by the
Agency for Healthcare Research and Quality (AHRQ) with the goal of
developing an operational definition of SMI that can be used across all
federal agencies involving health care policies and public health.

Outcomes/benefits: This designation would facilitate tracking and
measuring of health disparities experienced by persons with SMI, thereby
providing the opportunity to focus resources on addressing those
disparities.

 

3. Congress and DHHS entities should support health information
technology (HIT) for community behavioral health care systems and
organizations as well as for mental health and substance use services.
All federal HIT initiatives, including Health Information Technology for
Economic and Clinical Health (HITECH) should be required to have
substantial involvement from

behavioral health stakeholders. Any technology systems developed in the
future must be capable of supporting behavioral health content and
operational needs.

Actions: Congress should add Community Behavioral Healthcare
Organizations and mental health and substance use services as eligible
groups for HIT implementation assistance under the HITECH Act and
support inclusion of these groups in subsequent initiatives and
legislation related to HIT.

Outcome/benefits: Ensuring full inclusion of all behavioral healthcare
providers along with general healthcare providers in HIT

implementation will improve efficiency and outcomes across the
healthcare spectrum, including persons with SMI and those with any
health condition displaying behavioral health symptoms.

 

4. Remove obstacles to the integration of mental health and general
medical care by: 

1) Ensuring that all Person Centered Medical homes (PCMH)/Healthcare
Homes (PCHH) include ready access to behavioral health services as a
core element; 

2) Allowing Behavioral Health Centers (BHCs) to be designated as a
PCMH/PCHH; and 

3) Allowing BHCs to qualify as a Federally Qualified BHC (FQBHC).

Actions: Person Centered Medical Homes (PCMH/Healthcare Homes (PCHH)
created or supported under federal programs must include mental health
and substance abuse treatment expertise and capabilities. The federal
government should support the creation of FQBHC to complement the safety
net care already provided in conjunction with treatment for many
physical conditions

Outcome/benefits: These actions would increase access to and capacity
for behavioral health treatment services and would make possible
coordination/integration of primary care and behavioral health care,
resulting in less fragmentation, duplication of services, and improved
outcomes for the individuals served by PCMHs/PCHHs and FQBHCs.

 

5. DHHS, in particular, the Centers for Medicare and Medicaid Services
(CMS), should develop a national definition of "medical necessity' to
include the full range of services needed by persons with SMI.

Actions: CMS, the principal payer for public mental health services,
must provide guidance in the form of a definition of "medical necessity"
that incorporates an accepted scientific understanding of SMI that can
be applied across jurisdictions and treatment settings.

Outcomes/benefits: Improved access to the range of needed services for
individuals with SMI resulting in improved outcomes.

The definition set by CMS will provide a standard for other payers to
follow in paying for a scope of services that meets the needs of
individuals with mental illness, providers, and services, but also the
needs of the payers themselves.

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