1. Sonja Gaines, Associate Commissioner
Office of Mental Health Coordination
Health and Human Services Commission
October 15, 2015
Texas Mental Health Moving
in the Right Direction: A
Year in Review
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2. Office of Mental Health Coordination
Office of Mental Health Coordination (MHC) created by the 83rd Regular
Session:
• Provides broad oversight-public mental health policy in Texas
• Coordinating the policy and delivery of mental health services
throughout the State of Texas.
• The office of MHC shall consult and coordinate with other state
agencies, local governments and other entities to ensure a strategic,
statewide approach to mental health.
Vision: To ensure that Texas has a unified approach to the delivery of
behavioral health services that allows all Texans to have access to care
at the right time and place.
Texas Mental Health
Moving in the Right Direction
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3. A Year in Review: MH Coordination3
Cross Agency Mental Health Liaison Workgroups
Representation across all state agencies that impact mental health- meet
monthly to improve cross agency coordination, collaboration, reduce duplication
and improve efficiency and replicate best practices.
Texas Education Agency: Established a cross agency workgroup to address the
Behavioral Health needs of school aged children. Outcomes are Mental Health
First Aid training by TEA, expansion of the anti-stigma community conversations to
several regional education centers across Texas.
MH First Aid Training Initiative: 2000 staff trained across Commission, 28 new
trainers trained cross agency to expand MHFA statewide. Currently developing a
reporting structure for all HHS System agencies to quantify outcomes as well as a
timeline for 2016 trainings.
Immigration and Refugee Affairs - to address current barriers to identifying and
addressing the mental health needs of refugees in Texas. Current activities involve
strengthening community collaborations and developing a brief, uniform MH
screening to be used at intake.
4. Continued A Year in Review
SB58 Carve-in: Moved TCM and MH Rehabilitation to Managed Care
model focused on integrated care
DSRIP Projects through the 1115 Waiver -Approximately 400 projects focus
on behavioral health across Texas; focus on rapid access to care, Peer
services ,telemedicine, concentrated efforts to support unique populations
such as IDD, enhanced integrated health projects, SUD and MH
MH Awareness Campaign-Provided consultation and recommended
direction related to the Mental Health Awareness Campaign, instrumental
in solicitation of stakeholder feedback and the utilization of Texas 2-1-1 as
the identified call center for the initiative, facilitated expansion across
agencies.
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5. Agency Focused BH Initiatives:
• DFPS: CANS Assessment, staffing, improved agency collaboration
• DARS: MHFA-more than 1000 trained, awareness and relations
• DADS: Crisis Services Implementation
• DSHS: MH Campaign, MHFA, 84th Session - $200 Million, NorthSTAR transition, Performance
Measures; New Co-occurring MH/Substance Abuse Planning federal grant; new early
childhood grant focused on social-emotional development strategies
• Medicaid: MDCD Medical Policy,SB58,MH Excellence Grant, Re-Enrollment, Peer Services
• Social Services: Refugee Program , 211 Support and enhancements, CRCG- MH training
• TEA: USAC Group, MHFA, MH Campaign
• TJJD: Data Project, MHFA, troubleshoot, webinars, training
• Texas Veterans Commission: Staff Training, Veteran Grant
• University of Texas - The Institute for Excellence in Mental Health: System of Care
Framework implementation for children’s mental health
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6. 6
SG Coordination Matrix (SGCM)
Populations
Juvenile
Justice
Veteran
Foster
Child
Legally
Blind
Refugee Homeless
Goal Re-Entry Community
Integration
Permanency
Independent
Living
Obtain
Employment
Safe and
Affordable
Housing
Barriers Untreated
MH/SUD
Singular
Focused
Programs
Lack of cross
agency
coordination
Staff lack
training, tools &
expectations
Challenged
Business
Relations
Drivers Funding
Performance
Expectations
Contract
Agreements
Available
Resources
Service
Connections
Additional
Complexities
English Prophecy/
Culture
Physical Disability Economics Transportation Geography
Uncoordinated
Care
Inpatient,
Criminal Justice,
Suspension
Economic Impact Long waitlists Co-Morbidity Confusing
7. What Does Effective Coordinated
Care Look Like?
Coordinated care is the fusing and linking of key aspects
of care and support systems to address a common and
compelling need.
• Should be seamless to individual
• Use of technologies, peers and stakeholders
• Leveraging of funding and resources
• Culturally and Linguistically responsive
• It is intentional and well thought out
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Texas Mental Health
Moving in the Right Direction
2015 HHS Cross Systems Summit
9. 9
http://mentalhealthtx.org/
Mental Health Texas
Website: Offer a one-stop
web based resource point
for Texas residents in need
of immediate mental
health information and
resources to find basic
mental health information
and direction.
11. Texas Veterans Phone App
• March 2014, HHSC launched a free mobile application designed to be
used by veterans, active duty personnel, military families, and service
providers for quick portable access to crisis lines, online resources,
personal connections with local/regional veterans, and assistance with
services.
• Offers access to: Veterans Crisis Line, Hotline for Women Veterans,
Connect with Texas Veterans, Texas Veterans Hotline, and the Texas
Veterans Portal.
Texas Veterans Portal (TVP)
• A resource for veterans, their families, and survivors: the Texas Veterans
Commission (TVC) manages the website, which includes helpful
information from many government agencies regarding assistance,
services, and benefits.
• HHSC coordinates with TVC to ensure that all state agency websites
include the portal.
• HHSC is working with county governments to include the portal in their
websites.
HHS Veterans Services and Initiatives:
Connecting Veterans to Resources11
12. 84th Legislative BH Impact: Update on HHS
SB 200: HHSC Consolidation Bill
• Mental health & substance abuse services consolidated into HHSC by 9/1/16
• State Hospitals consolidated into HHSC by 9/1/17
• ECI moves to TWC-9/1/16
• DSHS will retain public health functions
BH Advisory Committees Transformation
• SB 200 directed the Executive Commissioner to establish in rule, advisory
committees to consider issues and solicit public input
o Across major areas of HHS System
o Including behavioral health
• DSHS Sunset Commission report directed HHS to establish an
Enterprise-wide behavioral health advisory committee
• SB 200 and SB 277 abolished in statute certain advisory
committees
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13. Approved Statewide Behavioral Health
• HB 1, Art. 9, Section 10.04, 84th Legislative Regular Session created the
Statewide Behavioral Health Strategic Plan and Coordinated Expenditures
with the purpose of a detailed plan to coordinate these programs and
services to eliminate redundancy, utilize best practices in contracting
standards, perpetuate identified, successful models for mental health and
substance abuse treatment, ensure optimal service delivery, and identify
and collect comparable data on results and effectiveness.
Texas Veterans Initiative, SB 55
• The 84th Texas Legislature passed Senate Bill 55, by Senator Nelson, to
establish a pilot program and a grant program at HHSC, to support
veterans and their family’s mental health through grant projects around
Texas.
• Appropriated $20 million for 2016-17 to HHSC to enhance community
mental health services and treatment to veterans and their families.
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14. • MH Excellence Grant – selection of sites
• 1115 Waiver renewal
• YES Waiver Expansion - including the use of wraparound as an
intensive care coordination approach
• Medicaid Re-enrollment requirements
Touching on Managed Care :
• SB58-Medicaid Medical Policy Changes
• Review/changes in performance measures - Sunset language14
Community Center Impacts
15. • The strategic planning process will result in better
coordination and collaboration across state agencies
• Increase in BH focused policy changes across state agencies
• Improved data that outlines the need to focus on enhanced BH
services across systems
• Improved coordination across agencies and stakeholders to
address BH needs-distribution of resources and ID gaps
• Focus on Integrated Health across disciplines
• Changes in leadership at the state level
• The Vision starting to become a reality!
• Moving towards a unified approach to BH services across
state agencies that allows all Texans to gain access to care
at the right time and place.
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Future Predictions
Editor's Notes
Reality-People with unmet and uncoordinated mental health needs are seen throughout multiple Texas systems. Of the persons served in state funded agencies, 20-70% have a mental health condition. In addition to impacting the individual, their families and communities; these unmet needs impede success in services, drive up cost and place a higher demand on state systems and resources.-Cris Cole
Texas Lawmakers are taking notice of the need for improved services throughout Texas-83rd and 84th session-significant increases in funding
Locally driven collaborative and initiatives appear to yield the best results by meeting the unique needs of communities, minimizing duplication of efforts, and leveraging funding and community investments.
Medicaid Reenrollment:
New Federal regulations stipulate that all Medicaid providers must to re-enroll in the Medicaid program every three to five years. This means any Medicaid provider enrolled before January 1, 2013, must be fully re-enrolled by March 24, 2016. To be considered fully re-enrolled, providers must submit a completed re-enrollment application and receive notification from TMHP that their application has been approved. Application processing times will vary based on accuracy and complexity of the application. To allow sufficient time for application processing and to avoid a lapse in enrollment status, providers are encouraged to begin this process immediately.
Assist with the execution of LMHA contracts
Mental Health Excellence – HHSC/DSHS submitted an application to CMS for the Excellence in Mental Health planning grant. HHSC will use the grant to pursue a framework for certifying community behavioral health centers and to develop a prospective payment system (PPS) for behavioral health services provided to Medicaid clients, with the goal of a more integrated healthcare delivery system.
Mental Health Excellence:
HHSC, in collaboration with DSHS, has submitted an application to the Centers for Medicare and Medicaid Services (CMS) in pursuit of the Excellence in Mental Health planning grant. The planning phase of the grant will allow HHSC to pursue a framework for certifying community behavioral health centers and to develop a prospective payment system (PPS) for behavioral health services provided to Medicaid clients by these certified clinics, with the ultimate goal of developing a system which will support and encourage a more integrated healthcare delivery system. If awarded, the planning phase of the grant would begin on October 1, 2015
Medicaid Reenrollment - New Federal regulations stipulate that all Medicaid providers must to re-enroll in the Medicaid program every three to five years.
Enterprise-wide Behavioral Health Advisory Committee
• Members to be appointed by Executive Committee November 2015
• Meetings to begin soon after that
• Will incorporate certain functions of abolished committees
• Looking for diversity in background, experience, and geographic location
Behavioral Health Advisory Committee Membership
• Adult and youth consumers, family representatives, and peer providers
• Texas Council of Community Centers
• Association of Substance Abuse Programs
• Interagency Coordinating Group for faith and community-based orgs
• Behavioral health advocate/advocacy organization
• Managed care organization
• Local government
• Others with interest in/knowledge of behavioral health
Statewide behavioral health coordinating council goal: develop a five year statewide behavioral health strategic plan and a coordinated statewide expenditure proposal for FY 2017 for each agency in the council.
Veterans Grants-The grant will allow for the development of innovative and best practice services across Texas to address unique needs and gaps in care for veterans and their family members.
Mental Health 1915(c) Youth Empowerment Services (YES) Waiver Expansion
Continues to authorize YES services to provide comprehensive community based mental health services to children at risk of parental relinquishment due to a need for services to treat serious emotional disturbance
Participants must be between the ages of 3-18 and meet specific eligibility criteria based on diagnosis and level of need
Children enrolled in YES are eligible for all Medicaid behavioral health services as well as those that are specific to the YES service array
Requires expansion of the YES Medicaid waiver statewide, contingent on approval by CMS
We will see more BH focused policy changes across state agencies
The strategic planning process will result in better coordination and collaboration across state agencies
Improved data that outlines the need to focus on enhanced BH services across systems
More focus on Integrated Health across disciplines
Changes in leadership at the state level
The Vision starting to become a reality!
Moving towards a unified approach to BH services across state agencies that allows all Texans to gain access to care at the right time and place.
