This document discusses mental health care access in rural Colorado. It provides background on policies that have aimed to improve access, including House Bill 92-1036 in 1992 and House Bill 15-1029 in 2015, which requires insurance coverage of telehealth services. While telehealth improves access for rural communities, weaknesses of the current policy include a lack of provisions around licensing, security, and prescribing medications via telehealth. The document examines research on the benefits and limitations of telehealth and implications for at-risk populations, social work practices, and ways the policy could be strengthened.
Linda Rosenberg, President and CEO of the National Council for Community Behavioral Healthcare, discusses the increased demand community mental health centers will face under healthcare reform and the Affordable Care Act. An estimated 1.5 million new patients will enter treatment, increasing caseloads by over 20%. However, cuts to public mental health services have also occurred. She asks Congress to support the Community Mental Health and Addiction Safety Net Equity Act to provide reimbursement parity for community behavioral health centers. She also asks Congress to ensure people with mental illness can benefit from provisions in the Affordable Care Act, including its Health Home State Option, and receive equal access to health information technology.
Clinician’s Research Digest, An APA Journal – Supplemental Bulletin 39, “Improving Access to Behavioral Healthcare Services: The Georgia Crisis & Access Line,” part of a series on research-informed day-to-day clinical practice.
2011 technology and telemedicine plus nacbhdd newsletter for november 2011Gilbert Gonzales
This document summarizes an article from the November 2011 newsletter of the National Association of County Behavioral Health and Developmental Disability Directors. The article discusses the history and increasing use of telemedicine and how it can improve access to healthcare, quality of care, reduce costs and isolation of professionals. Key benefits mentioned are improved access to underserved areas, improved quality through collaboration, reduced costs from less travel, and reduced isolation for professionals. The document also announces an opportunity for counties to apply for grants through HHS's Health Care Innovation Challenge to fund innovative healthcare projects using telemedicine and targeting mental health and substance abuse disorders.
The document discusses the history and rationale for eliminating extra billing and user fees in Canada's health care system. It describes how extra billing proliferated in the 1980s due to funding cuts, undermining the principles of accessibility and universality. Several reports from this time recommended banning extra billing, leading to the Canadian Health Act of 1984 which eliminated the practices nationwide. The document argues that extra billing and user fees should continue to be banned, as they pose economic and ethical issues that could erode the social values underlying Canada's universal health care system. Allowing their re-introduction could risk accessibility for those unable to pay and higher overall costs.
The document summarizes key findings from a report on America's nonprofit community clinics, free clinics, and community health centers from 2006 to 2009. It finds that the total number of patients receiving services continues to rise, with a larger increase from 2008 to 2009 than previous years. The number of uninsured patients also continues to rise. While the proportion of uninsured patients decreased slightly, the proportion of Medicaid patients increased. Rates of chronic diseases like diabetes, hypertension, and asthma are increasing among patients at these safety net facilities.
Nonprofit community health centers and clinics that provide preventive and primary healthcare services for 24 million people – or one in 13 persons in the U.S. – report that the first year of the Affordable Care Act’s implementation had uneven effects, particularly between facilities in Medicaid expansion and non-expansion states.
The findings were released today by Direct Relief in The State of the Safety Net 2014, an annual report that examines issues and trends within the extensive network of nonprofit, community-based health centers and clinics, which are the principal point of access to healthcare and the medical home for persons with low incomes, without health insurance, and among the country’s most vulnerable. Such facilities include Federally Qualified Health Centers (FQHCs), nonprofit community-based health clinics, and free and charitable clinics.
Presentation made by Dr. Carolyn A. (Cindy) Watts on the 5th of November, 2012 during the live webinar hosted by VCU Department of Gerontology (discussion moderated by Dr E. Ayn Welleford) - review recording of webinar at http://www.alzpossible.org/wordpress-3.1.4/wordpress/alliedhealth/
Linda Rosenberg, President and CEO of the National Council for Community Behavioral Healthcare, discusses the increased demand community mental health centers will face under healthcare reform and the Affordable Care Act. An estimated 1.5 million new patients will enter treatment, increasing caseloads by over 20%. However, cuts to public mental health services have also occurred. She asks Congress to support the Community Mental Health and Addiction Safety Net Equity Act to provide reimbursement parity for community behavioral health centers. She also asks Congress to ensure people with mental illness can benefit from provisions in the Affordable Care Act, including its Health Home State Option, and receive equal access to health information technology.
Clinician’s Research Digest, An APA Journal – Supplemental Bulletin 39, “Improving Access to Behavioral Healthcare Services: The Georgia Crisis & Access Line,” part of a series on research-informed day-to-day clinical practice.
2011 technology and telemedicine plus nacbhdd newsletter for november 2011Gilbert Gonzales
This document summarizes an article from the November 2011 newsletter of the National Association of County Behavioral Health and Developmental Disability Directors. The article discusses the history and increasing use of telemedicine and how it can improve access to healthcare, quality of care, reduce costs and isolation of professionals. Key benefits mentioned are improved access to underserved areas, improved quality through collaboration, reduced costs from less travel, and reduced isolation for professionals. The document also announces an opportunity for counties to apply for grants through HHS's Health Care Innovation Challenge to fund innovative healthcare projects using telemedicine and targeting mental health and substance abuse disorders.
The document discusses the history and rationale for eliminating extra billing and user fees in Canada's health care system. It describes how extra billing proliferated in the 1980s due to funding cuts, undermining the principles of accessibility and universality. Several reports from this time recommended banning extra billing, leading to the Canadian Health Act of 1984 which eliminated the practices nationwide. The document argues that extra billing and user fees should continue to be banned, as they pose economic and ethical issues that could erode the social values underlying Canada's universal health care system. Allowing their re-introduction could risk accessibility for those unable to pay and higher overall costs.
The document summarizes key findings from a report on America's nonprofit community clinics, free clinics, and community health centers from 2006 to 2009. It finds that the total number of patients receiving services continues to rise, with a larger increase from 2008 to 2009 than previous years. The number of uninsured patients also continues to rise. While the proportion of uninsured patients decreased slightly, the proportion of Medicaid patients increased. Rates of chronic diseases like diabetes, hypertension, and asthma are increasing among patients at these safety net facilities.
Nonprofit community health centers and clinics that provide preventive and primary healthcare services for 24 million people – or one in 13 persons in the U.S. – report that the first year of the Affordable Care Act’s implementation had uneven effects, particularly between facilities in Medicaid expansion and non-expansion states.
The findings were released today by Direct Relief in The State of the Safety Net 2014, an annual report that examines issues and trends within the extensive network of nonprofit, community-based health centers and clinics, which are the principal point of access to healthcare and the medical home for persons with low incomes, without health insurance, and among the country’s most vulnerable. Such facilities include Federally Qualified Health Centers (FQHCs), nonprofit community-based health clinics, and free and charitable clinics.
Presentation made by Dr. Carolyn A. (Cindy) Watts on the 5th of November, 2012 during the live webinar hosted by VCU Department of Gerontology (discussion moderated by Dr E. Ayn Welleford) - review recording of webinar at http://www.alzpossible.org/wordpress-3.1.4/wordpress/alliedhealth/
The document discusses homelessness and health care in Multnomah County, Oregon. It notes that homelessness remains a major public health challenge, leaving those without housing vulnerable to disease and health issues. The expansion of Medicaid under the Affordable Care Act in 2014 has the potential to significantly improve access to health care for the homeless population in Multnomah County. The document analyzes data on homelessness in the county, health outcomes for the homeless, the health care system prior to reform, implementation of the ACA, and initial outreach efforts to the homeless. It concludes with recommendations for maximizing health benefits for the homeless under health care reform.
This document summarizes a research paper that explores the direct and indirect financial burden of utilizing health care services in Canada. The paper examines how limited public insurance and the cost of supplemental private insurance affect health care utilization among low-income households. It hypothesizes that low-income households face a "double disadvantage" in that they are directly burdened by costs of uninsured services and indirectly burdened by the cost of supplemental insurance needed to reduce costs. The research aims to provide evidence that low-income Canadians utilize fewer health services due to the direct and indirect financial barriers. It will analyze whether higher-income households use more services and are more likely to have supplemental insurance that induces greater utilization.
This document provides information and instructions for applying for National Legal Assistance and Elder Rights Projects grants from the U.S. Administration on Aging (AoA). The grants aim to enhance and coordinate elder rights legal assistance through activities like training, technical assistance, publishing materials, and case consultations. Eligible applicants are national non-profit organizations with experience providing nationwide support to elder rights programs. AoA plans to fund approximately 5 new projects at $150,000 per year for 3 years. Applications are due by July 8, 2005 and must meet requirements around planning, implementation, management, and reporting.
1) Community-based mental healthcare services are more effective than institutional care by allowing for greater family involvement, being less restrictive, and producing better outcomes at a lower cost.
2) Integrating community-based services helps with early detection and treatment of mental health issues while reducing hospitalization needs and helping patients live successfully in their communities.
3) Studies show that average monthly spending per person for home and community-based services is much lower than for institutional care like nursing homes.
Learn Valuable Information for Getting Paid to Take Care of Your Family Membe...BestHomeCare
The need for home care is constantly growing and, as a result, providing care for a family member or friend has become much more common than it was just a few years ago. Most family caregivers are unaware of the opportunity they have to get paid for taking care of a family member or friend. The state of Minnesota and Federal Government sponsor programs designed to compensate caregivers for their services. This paper outlines these programs to help friend and family caregivers find the appropriate method for getting paid to take care of a loved one.
The document discusses improving mental health and criminal justice outcomes through community-based solutions. It notes that the current mental health system is fragmented and fails to address the needs of those with severe mental illness, leading to unnecessary costs. The Bexar County, Texas model created a county-wide jail diversion program through collaboration between law enforcement, courts, treatment providers, and other stakeholders. Key outcomes included reduced incarceration and revocation rates, lower healthcare costs, and over 800 empty jail beds.
The document discusses several topics related to guardianship, nursing home complaints, and rights of nursing home residents in Virginia. It proposes strategies to incorporate person-centered language and practices into public guardianship programs. It also discusses proposed bills aimed at strengthening the nursing home complaint investigation process and ensuring the right of readmission to nursing homes after hospitalization. Additionally, it talks about the importance of the Behavioral Risk Factor Surveillance System for collecting data on Alzheimer's disease and dementia.
This document summarizes New Mexico's behavioral healthcare crisis and proposes reforms. Key points:
- New Mexico faces high rates of substance abuse and mental illness that burden the state financially and socially.
- Previous reforms failed to create an effective, coordinated system, and a 2013 scandal further divided stakeholders.
- The summary argues that simply increasing funding will not solve problems and that New Mexico must reform its system through more effective policies rather than looking to the dysfunctional US federal system for guidance or funds.
Hearing loss is common among aging populations and can be caused by many factors. Treatment options are limited and can be very expensive without insurance coverage. The Affordable Care Act improved preventive care coverage through Medicare, including annual wellness visits. However, hearing aids and other hearing services are still not adequately covered. Improving access to affordable hearing healthcare could help catch hearing loss earlier and improve quality of life for many older adults.
The document summarizes recent federal legislative activity related to autism and disability services. It discusses funding amounts for autism research and services through the Combating Autism Act. It also provides updates on health care reform legislation and bills addressing issues like insurance coverage of autism treatment, long term services and supports, reducing restraint and seclusion in schools, and reauthorizing acts related to education, workforce development, and developmental disabilities.
This document provides information about disability resources available from the City of New Haven and the State of Connecticut Department of Social Services (DSS). It describes services offered by the City of New Haven's Department of Services for Persons with Disabilities, including information and referrals, advocacy, and assistance. It then summarizes several Medicaid, income assistance, housing assistance, prescription drug coverage, child care, food stamp, and social services programs administered by DSS to support people with disabilities. These programs provide services like medical coverage, personal care assistance, rent subsidies, food assistance, and help preventing evictions. Contact information is provided for each agency.
This document provides answers to 20 questions raised about the one-year old Affordable Care Act. It discusses provisions of the law such as the constitutionality of the individual mandate, options for obtaining affordable health insurance, elimination of pre-existing condition exclusions, and expansion of Medicaid eligibility. The document is intended to help readers better understand the structure and benefits of the landmark health reform law.
- A survey was conducted of 107 family law practitioners in New Zealand to understand the impact of fixed fees on legal aid providers, practices, and clients.
- The majority of long-term providers (over 10 years experience) were considering stopping legal aid work due to factors like fees not covering costs.
- Under fixed fees, 44% of practitioners said they were undertaking less family legal aid work compared to before fixed fees, and 9% had stopped work altogether or planned to soon.
- Communication with clients was reduced for some due to financial considerations under fixed fees.
The document discusses the pros and cons of implementing a universal healthcare system in the United States. It provides background on universal healthcare and what it would entail. While universal healthcare could provide healthcare access to all citizens and reduce costs, there are also concerns that it may stifle medical innovation, lead to increased wait times, and be vulnerable to government mismanagement. The document weighs different perspectives on universal healthcare but does not take a definitive position.
The document discusses the impending long-term care crisis in the US as the population ages. By 2030, 70 million US citizens will be over 65 and 5.2 million will be over 85 with disabilities requiring long-term care. However, most will not be able to afford the high costs of care. The goals are to raise awareness of long-term care options like insurance plans. Additionally, the healthcare workforce will be unable to support the increase in those needing long-term care services. Solutions proposed include educating individuals to plan ahead financially and consider expanding Medicare coverage.
States recognize that supportive housing directed at the right population can improve health outcomes and reduce
Medicaid spending. They also recognize that supportive housing services need to be financed in a way that is more
sustainable than short term government and philanthropic grants that have been the historical funding sources. Therefore,
states, localities and health services payers such as managed care organizations are experimenting with ways to more
comprehensively finance outreach and engagement, tenancy supports and other tenancy sustaining services.
Hipa Health Insurance Portability And Accountability ActAmy Williams
The Health Insurance Portability and Accountability Act (HIPAA) aims to protect patient privacy and secure medical records. It includes the Privacy Rule, which protects protected health information and gives patients rights over that information. It also includes the Security Rule, which requires covered entities to implement security protocols and safeguards for electronic protected health information. In Stevens vs Hickman Community Hospital, the plaintiff's medical malpractice lawsuit was dismissed because they failed to comply with both Tennessee's medical malpractice laws and HIPAA by not providing a properly formatted HIPAA-compliant medical authorization form.
The Canada Health Act established conditions for publicly funded universal healthcare across Canada, requiring that provinces receive federal funding only if they comply with provisions like public administration, comprehensiveness, universality, portability, and accessibility. This legislation aimed to protect Canadians' physical and mental well-being by facilitating reasonable access to health services without financial barriers. The Act and related reforms sought to establish a nationwide system of universal public healthcare coverage in Canada.
The document discusses homelessness and health care in Multnomah County, Oregon. It notes that homelessness remains a major public health challenge, leaving those without housing vulnerable to disease and health issues. The expansion of Medicaid under the Affordable Care Act in 2014 has the potential to significantly improve access to health care for the homeless population in Multnomah County. The document analyzes data on homelessness in the county, health outcomes for the homeless, the health care system prior to reform, implementation of the ACA, and initial outreach efforts to the homeless. It concludes with recommendations for maximizing health benefits for the homeless under health care reform.
This document summarizes a research paper that explores the direct and indirect financial burden of utilizing health care services in Canada. The paper examines how limited public insurance and the cost of supplemental private insurance affect health care utilization among low-income households. It hypothesizes that low-income households face a "double disadvantage" in that they are directly burdened by costs of uninsured services and indirectly burdened by the cost of supplemental insurance needed to reduce costs. The research aims to provide evidence that low-income Canadians utilize fewer health services due to the direct and indirect financial barriers. It will analyze whether higher-income households use more services and are more likely to have supplemental insurance that induces greater utilization.
This document provides information and instructions for applying for National Legal Assistance and Elder Rights Projects grants from the U.S. Administration on Aging (AoA). The grants aim to enhance and coordinate elder rights legal assistance through activities like training, technical assistance, publishing materials, and case consultations. Eligible applicants are national non-profit organizations with experience providing nationwide support to elder rights programs. AoA plans to fund approximately 5 new projects at $150,000 per year for 3 years. Applications are due by July 8, 2005 and must meet requirements around planning, implementation, management, and reporting.
1) Community-based mental healthcare services are more effective than institutional care by allowing for greater family involvement, being less restrictive, and producing better outcomes at a lower cost.
2) Integrating community-based services helps with early detection and treatment of mental health issues while reducing hospitalization needs and helping patients live successfully in their communities.
3) Studies show that average monthly spending per person for home and community-based services is much lower than for institutional care like nursing homes.
Learn Valuable Information for Getting Paid to Take Care of Your Family Membe...BestHomeCare
The need for home care is constantly growing and, as a result, providing care for a family member or friend has become much more common than it was just a few years ago. Most family caregivers are unaware of the opportunity they have to get paid for taking care of a family member or friend. The state of Minnesota and Federal Government sponsor programs designed to compensate caregivers for their services. This paper outlines these programs to help friend and family caregivers find the appropriate method for getting paid to take care of a loved one.
The document discusses improving mental health and criminal justice outcomes through community-based solutions. It notes that the current mental health system is fragmented and fails to address the needs of those with severe mental illness, leading to unnecessary costs. The Bexar County, Texas model created a county-wide jail diversion program through collaboration between law enforcement, courts, treatment providers, and other stakeholders. Key outcomes included reduced incarceration and revocation rates, lower healthcare costs, and over 800 empty jail beds.
The document discusses several topics related to guardianship, nursing home complaints, and rights of nursing home residents in Virginia. It proposes strategies to incorporate person-centered language and practices into public guardianship programs. It also discusses proposed bills aimed at strengthening the nursing home complaint investigation process and ensuring the right of readmission to nursing homes after hospitalization. Additionally, it talks about the importance of the Behavioral Risk Factor Surveillance System for collecting data on Alzheimer's disease and dementia.
This document summarizes New Mexico's behavioral healthcare crisis and proposes reforms. Key points:
- New Mexico faces high rates of substance abuse and mental illness that burden the state financially and socially.
- Previous reforms failed to create an effective, coordinated system, and a 2013 scandal further divided stakeholders.
- The summary argues that simply increasing funding will not solve problems and that New Mexico must reform its system through more effective policies rather than looking to the dysfunctional US federal system for guidance or funds.
Hearing loss is common among aging populations and can be caused by many factors. Treatment options are limited and can be very expensive without insurance coverage. The Affordable Care Act improved preventive care coverage through Medicare, including annual wellness visits. However, hearing aids and other hearing services are still not adequately covered. Improving access to affordable hearing healthcare could help catch hearing loss earlier and improve quality of life for many older adults.
The document summarizes recent federal legislative activity related to autism and disability services. It discusses funding amounts for autism research and services through the Combating Autism Act. It also provides updates on health care reform legislation and bills addressing issues like insurance coverage of autism treatment, long term services and supports, reducing restraint and seclusion in schools, and reauthorizing acts related to education, workforce development, and developmental disabilities.
This document provides information about disability resources available from the City of New Haven and the State of Connecticut Department of Social Services (DSS). It describes services offered by the City of New Haven's Department of Services for Persons with Disabilities, including information and referrals, advocacy, and assistance. It then summarizes several Medicaid, income assistance, housing assistance, prescription drug coverage, child care, food stamp, and social services programs administered by DSS to support people with disabilities. These programs provide services like medical coverage, personal care assistance, rent subsidies, food assistance, and help preventing evictions. Contact information is provided for each agency.
This document provides answers to 20 questions raised about the one-year old Affordable Care Act. It discusses provisions of the law such as the constitutionality of the individual mandate, options for obtaining affordable health insurance, elimination of pre-existing condition exclusions, and expansion of Medicaid eligibility. The document is intended to help readers better understand the structure and benefits of the landmark health reform law.
- A survey was conducted of 107 family law practitioners in New Zealand to understand the impact of fixed fees on legal aid providers, practices, and clients.
- The majority of long-term providers (over 10 years experience) were considering stopping legal aid work due to factors like fees not covering costs.
- Under fixed fees, 44% of practitioners said they were undertaking less family legal aid work compared to before fixed fees, and 9% had stopped work altogether or planned to soon.
- Communication with clients was reduced for some due to financial considerations under fixed fees.
The document discusses the pros and cons of implementing a universal healthcare system in the United States. It provides background on universal healthcare and what it would entail. While universal healthcare could provide healthcare access to all citizens and reduce costs, there are also concerns that it may stifle medical innovation, lead to increased wait times, and be vulnerable to government mismanagement. The document weighs different perspectives on universal healthcare but does not take a definitive position.
The document discusses the impending long-term care crisis in the US as the population ages. By 2030, 70 million US citizens will be over 65 and 5.2 million will be over 85 with disabilities requiring long-term care. However, most will not be able to afford the high costs of care. The goals are to raise awareness of long-term care options like insurance plans. Additionally, the healthcare workforce will be unable to support the increase in those needing long-term care services. Solutions proposed include educating individuals to plan ahead financially and consider expanding Medicare coverage.
States recognize that supportive housing directed at the right population can improve health outcomes and reduce
Medicaid spending. They also recognize that supportive housing services need to be financed in a way that is more
sustainable than short term government and philanthropic grants that have been the historical funding sources. Therefore,
states, localities and health services payers such as managed care organizations are experimenting with ways to more
comprehensively finance outreach and engagement, tenancy supports and other tenancy sustaining services.
Hipa Health Insurance Portability And Accountability ActAmy Williams
The Health Insurance Portability and Accountability Act (HIPAA) aims to protect patient privacy and secure medical records. It includes the Privacy Rule, which protects protected health information and gives patients rights over that information. It also includes the Security Rule, which requires covered entities to implement security protocols and safeguards for electronic protected health information. In Stevens vs Hickman Community Hospital, the plaintiff's medical malpractice lawsuit was dismissed because they failed to comply with both Tennessee's medical malpractice laws and HIPAA by not providing a properly formatted HIPAA-compliant medical authorization form.
The Canada Health Act established conditions for publicly funded universal healthcare across Canada, requiring that provinces receive federal funding only if they comply with provisions like public administration, comprehensiveness, universality, portability, and accessibility. This legislation aimed to protect Canadians' physical and mental well-being by facilitating reasonable access to health services without financial barriers. The Act and related reforms sought to establish a nationwide system of universal public healthcare coverage in Canada.
The document is a letter from the National Council for Community Behavioral Healthcare responding to CMS's proposed rule on the Electronic Health Record Incentive Program. It discusses challenges community behavioral health organizations face in adopting electronic health records, including a significant digital divide compared to primary care. It recommends that CMS simplify requirements around reassigning EHR incentive payments from eligible professionals to their employing organizations to help more community behavioral health providers participate. The letter emphasizes the importance of behavioral health in overall healthcare and urges CMS to ensure the proposed rule does not further isolate behavioral health providers.
The document discusses the Affordable Care Act (ACA) and its impact on socioeconomic inequality from an interdisciplinary perspective. It analyzes the ACA through the lenses of economics, political science, and communication. While the ACA aims to expand access to healthcare, it has also increased costs and reduced access for some. There are also issues with unclear communication about the ACA and lack of cooperation from some state governments in implementing aspects of the law. The document argues that an interdisciplinary approach is needed to fully understand and address the complex problems posed by the ACA.
The document discusses improving connectivity and coordination in Canada's mental healthcare system. It notes that while diagnostic tools and treatments have improved, mental health outcomes have remained largely unchanged, with high costs to individuals and the economy. A new platform called FeelingBetterNow aims to address this by providing a patient-centered, technology-enabled system that offers personalized care options based on evidence, and coordinates existing resources to streamline referrals and support self-care. The goal is to empower individuals to access help anywhere, and better integrate care to improve adherence and outcomes.
HIPAA is a federal law that protects patients' medical information and sets rules for who can access it. It requires health plans, providers, and clearinghouses to protect oral, written and electronic protected health information. It gives patients rights over their information, such as access and request for amendments. Violations can result in civil penalties up to $1.5 million and criminal penalties including prison time, depending on the severity and intent of the violation. Healthcare workers must carefully protect patient privacy and only share information with those directly involved in their care.
HIPAA is a federal law that protects patients' medical information and sets rules for who can access it. It requires health plans, providers, and clearinghouses to protect oral, written and electronic protected health information. It gives patients rights over their information, such as access and request for amendments. Violations can result in civil penalties up to $1.5 million and criminal penalties including prison time, depending on the severity and intent of the violation. Healthcare workers must carefully protect patient privacy and only share information with those directly involved in their care.
Lesson 6: Mental Healthcare Financing
Readings:
Frank, R, Glied, S. (2006). Changes in mental health financing since 1971: Implications for policymakers and patients. Health Affairs 25(3): 601-613.
Garland, R.I., Lave, J.R. & Donohue, J.M. (2010). Health reform and the scope of benefits for mental health and substance use disorder services. Psychiatric Services 61(11): 1081 – 1086.
Druss, B (2006). Rising mental health costs: What are we getting for our money? Health Affairs 25(3): 614-622.
Scheffler, RM, Eisenberg, D (2004). How money makes its way through the mental health system. Family Therapy Magazine March/April 2004: 12-19.
Insurance Market Reforms in the Patient Protection & Affordable Care Act and the Health Care & Education Reconciliation Act, Bazelon Mental Health Law Center http://www.bazelon.org/LinkClick.aspx?fileticket=rLF-G4_8dbw%3d&tabid=137.
Scan:
Barry, C.L., Huskamp, H.A. & Goldman, H.H. (2010). A Political History of Federal Mental Health and Addiction Insurance Parity. Milbank Quarterly 88(3): pp. 404-433.
Readings also of interest:
Honberg, R., Diehl, S., Kimball A., Gruttadaro, D., & Fitzpatrick, M. (2011). State mental health cuts: A national crisis. NAMI. http://www.nami.org/ContentManagement/ContentDisplay.cfm?ContentFileID=126233
Kliff, S. (December 17, 2012). Seven facts about America’s mental healthcare system. Washington Post. Retrieve at: http://www.washingtonpost.com/blogs/wonkblog/wp/2012/12/17/seven-facts-about-americas-mental-health-care-system/
Introduction
There are many sources of financing for mental health care in both the private and public sectors. Private sector financing includes private insurance, out-of-pocket payment and a modest amount of charitable and philanthropic sources (Garfield, 2011). In addition, the Patient Protection and Affordable Care Act (ACA) passed in 2010, which was discussed last week, will have a substantial impact on behavioral health financing.
The amount of funding for behavioral health care is substantial. Including those for the Affordable Care Act, private and public expenditures for mental health and substance abuse treatment are expected to be around $280.5 billion by 2020, an increase in spending from $171.7 billion in 2009. Growth in expenditures, however, will trail behind that of health care in general. This lesson will briefly discuss financing of the public mental health system.
Public sector financing includes Medicaid, Medicare and other sources of funding support at the federal, state and local level. The largest amount of funding from other public sources is primarily from the federal level, the Community Mental Health Services Block Grant. On the substance abuse side, the Substance Abuse Prevention and Treatment Block Grant is also a large source of financing.
Why examine the public mental health system? Garfield (2011) notes that there are differences in financing between general health and behavioral health in that “public s ...
1. Running Head: RURAL COLORADO 1
Mental Health Care in Rural Colorado
SOWK 520
Robert Cope
December 9, 2015
School of Social work, Colorado State University
Introduction
2. RURAL COLORADO 2
The topic of mental health care is especially important and prevalent in the news right
now. People are pointing fingers at the failing system after the wake of mass shootings in the
public arena. Some people have misconceptions about what people suffer from concerning their
mental health and what policies there are to protect the public. However important the aspect of
protecting people is, another issue concerning policies around mental health are the rights to
receive services in rural parts of Colorado. Our amazing state has many things going for it, but
quality mental health care is concentrated largely in densely populated parts of our state.
Policy history
As early as 1992, Colorado recognized that there was an issue in serving all of its
community members who suffered from mental health issues. In May of that same year, the
state passed House bill 92-1036 which was aimed at ensuring that Medicaid recipients had access
to mental health care within the communities that they lived in. Bloom et al., (1998) described
one of the bills central goals “to improve the public mental health system in Colorado by
expanding community mental health services, particularly those services that can assist
consumers to remain in their communities rather than require services in an inpatient
hospital”(p.4). While this seems like a straightforward solution, it may not be as easy to solve as
they originally thought.
Even before the advent of HB 92-1036, there was largely a serious lack of facilities to
provide care for mental health related illness. Catalano, Libby, Snowden, & Cuellar, (2000)
conveyed “ Colorado’s mental health system consisted of 17 mental health centers, 4 specialty
clinics, and 2 state hospitals”(p.1862). After the passage of HB 92-1036, 14 of these 17,
restructured into 7 new centers called “mental health assessment and service agencies” (Catalano
et al., 2000, p.1862). The 3 lingering centers remained as community mental health centers and
3. RURAL COLORADO 3
resided to survive as a pay-as-you-go centers otherwise considered Non-profit mental health
centers.
These remaining centers served low-income, Medicaid and Medicare recipients who
received everything from mental health services, case management, and psychiatric assistance.
One of the centers was Larimer county mental health, which is today known as Summit stone,
located in Fort Collins. The core ones are, Community Reach Center in Thornton, Mental Health
Colorado, Denver (MHCD), and North Range Behavioral Health. A further portion of the seven
are Arapahoe Douglas mental health, Aurora community mental health, and Centennial Peaks in
Littleton, Colorado.
Considering the mental health deficiency, Fort Collins, Loveland and Greeley are lucky
in that they are served by Summit Stone and North Range Behavioral Health. However, if you
reside in Craig, Colorado, you may be required to drive for two hours or more to obtain mental
health services at the nearest center. There are some smaller mental health centers in the
community such as Mind Springs Health, which has a location in Craig, and consists of four
therapists, psychiatrists and nurse practitioners. Their website states that they mainly do
substance abuse in seven locations across Northwestern, Colorado. They also appear to do
individual and family therapy, but the services to this extent are not mentioned specifically
(“Mental Health, Psychiatrist, Counseling, Therapy, Psychologist,” 2015). If this center does not
provide a specific client service, Google maps shows that to the nearest center, is over a 4 hour
drive to Summit Stone in Fort Collins or a two hour drive to the nearest Mind Springs center in
Eagle, Colorado (“Google Maps,” 2015).
Background
4. RURAL COLORADO 4
The central theme is that on the eastern and western plains of Colorado the support for
mental health services, people have a lack of options for care. Over a course of time, a legislative
bill has been passed and was put in action. It was Colorado, House Bill 15-1029, which allowed
people living in communities with less than 150,000 people to see mental health professionals
over the internet and more commonly referred to as Tele-health services (“House Bill 15-1029,”
2015). Whereas there were mental health centers to serve the population, the new bill was voted
almost unanimously into action starting from the time it was introduced in January and signed
into action in March 2015 (http://www.leg.state.co.us).
In comparison, to the prior issues with HB 92-1036 that medical insurance paid for
services; were only to take place when the patient saw a clinical professional in a face-to-face
setting, the new bill changed that. HB 15-1029 required that medical plans pay for services in a
Tele-Health setting where the client can visit with the clinician over a secure internet connection
for example; Skype or Facetime. However the new bill did require the visit to be done over
internet, secure visual interaction, it does not cover visits that are done in other ways such as by
phone, email, or fax communication. This bill also does not allow insurance companies to
placement on limits of the number of services or monetary limits, that insurance companies may
impart of other types of services, for example limits on care for cancer patients (“ HB1029 |
2015 | Regular Session,” 2015).
Discussion
Numerous studies have been done explaining the benefits and drawbacks to telemedicine.
One of these such studies by Handley et al., (2013) specifically examines how viable
telemedicine could be. His study focused primarily on the mental health side of care, considering
the need for mental health and medical health, this study provides valuable insight into just how
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feasible it is. The study utilized twelve hundred participants living in rural Australia, who were
over the age of 50 and had internet access with some vague understanding of online use.
Researchers found that individuals who were more familiar with internet use were more
comfortable and that if educated, the other participants would be just as likely to use internet
health services.
Whereas the older generation may be shunning the new technology, with education, they
be more susceptible to using the technology. Handley et al., (2013) proclaimed “feasibility was
significantly higher among people with recent mental health problems…indicating a greater
willingness to access internet-delivered treatments among those who are most likely to benefit
from them”(p.278). A large weakness that was pointed out by the researchers is that while the
preponderance of the participants agreed to use the internet-derived treatment, those that did had
recent mental health issues. As explained by the researchers, they found that those who were
likely to shun the service, had a lack of mental health disparities over the last few months and did
not feel a benefit or need to use the service.
With regard to the expansion of telemedicine in Colorado, there are considerations to
make with regard to potential weaknesses. Such as people who decline to use the internet service
due to a lack of desire or failure to feel their mental health issues need to be resolved. A further
thought that could be another potential weakness is that there may be rules, and regulations that
need to be abided by. These may go beyond the scope of HB 15-1029 as well. Kramer, Kinn, &
Mishkind, (2015) explain that the greatest benefit of telemedicine is its ability to reach people in
the farthest reaches of the rural community and ensure that they receive care. Unless a mental
health facility is willing to undertake the financial responsibility to cover program design,
technology protections and compensation for nurses to travel to do minimal and routine medical
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care (blood pressure, weight, and medication management); the center may need to be contracted
with larger medical providers.
As such, Kramer et al., (2015) justified “ compliance with appropriate laws regarding
health care licensure is one of the most immediate concerns raised prior to engaging in TMH
(telemedical health)practice” (p.259). Specifically looking at corporations that are outside
Colorado, contracting with them could cause the local nonprofit to undertake costs of licensure
for out of state practitioners, psychologists, and psychiatrists. This would be different if the
provider is local and licensed by state regulators, but if they are out of state, they may not have
state-to-state license reciprocity.
Largely a weakness of HB 15-1029 is that it only mandates coverage by medical health
insurance and payments to providers and leaves out licensing and costs associated with it. If this
is to fall on the small non-profit, it could cause budgeting issues. A strength of the policy is that
more people will have access to care and it will be paid for if they use tele-medical care. One
large positive to the law is that by using telemedicine, a patient can avoid a stigmatizing
experience by going into a facility and possibly being seen in a small town where neighbors may
notice. By using telemedicine, they can seek much needed care with a reduction in feeling
stigmatizing effects (Burfeind, Seymour, Sillau, Zittleman, & Westfall, 2014).
In large support of HB 15-1029 is Ben Price, who is the Executive Director of the
Colorado Association of Health Plans. He feels that it is an opportunity to explore modern
technology and reach out to populations that need it most. However, Mr. Price also feels that a
shortcoming of the bill is the question of how prescriptions and therapeutic exercise will be
implemented and that further legislation will be needed to address the issue. Also there is the
issue that the initial intake of the client is still needed on a face-to face bases before telemedicine
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can be started (Murphy, 2015). The face-to-face problem might be resolved if only the initial
intake and monthly check-ins are required while clinical services are done via tele-med
connection.
Impact on the social problem and at-risk populations
Support of tele-medicine, video conferencing is quite extensive, from websites such as
“The American Telemedicine association” and research has shown that this new form of
therapeutic service is very valuable. Shealy, Davidson, Jones, Lopez, & de Arellano, (2015)
explained how mental health illness may be higher in rural settings and the opportunity to access
quality care is less than people in urban environments. Shealy et al., (2015) asserts that a relative
amount of research has been done that shows the benefit to telemedical mental health support
and that it is just as valuable as in-person care. This assertion is valuable evidence to the point
that despite being in separate locations, the clinician is still able to gain the view of patient
physical changes that the office environment would have provided.
Initial impact on the social problem of access to care and how it can aid the rural
population. Shealy et al., (2015) delivered a case study where the researchers supplied
therapeutic care to a 13-year-old patient who had been through a traumatic event. The initial
intake was completed in the office, but the consistent weekly care was completed via tele-
medical videoconference. Since the care providers used a network that allowed for workbook
exercises to be downloaded and completed by the patient, the full therapy experience was able to
be provided to this case study. The researchers found that the client made huge improvements
over 10 sessions, and the only issue was with consistent internet connection.
Due to driving time and distance Shealy et al., (2015) were able to provide care to an
individual that would not have had 3 plus hours to dedicate to driving to the clinic once a week.
8. RURAL COLORADO 8
The use of tele-medicine allowed the clinicians to keep up to date and do continuous weekly
treatment meetings, and allow the client an access to care that they may not have accessed
otherwise. One issue that could impact attainment of services through telemedicine is having the
care covered by insurance. Luckily HB 15-1029 requires that medical insurance plans cover
these services for people living in areas where the population is less than 150,000. However
Shealy et al., (2015) stated “the federal government does not require Medicaid to reimburse for
telemedicine, hence each state determines if it will provide Medicaid reimbursement for
telemedicine services’(p.341). HB 15-1029 has already addressed the issue and appears to
require that all medical plans cover tele-medicine, and it is assumed that Medicaid is covered in
this requirement, the bill does not make a statement about this as such.
Impact on social work
As social workers we have the unique declaration to work toward social welfare for all
people. In the context of HB 15-1029, this bill allows people in rural communities the ability to
use tele-health to access care that may be far away and out of reach, and now those services are
required to be covered by medical insurance. Social workers have the ability to provide social
welfare through education of people rights and the policies that protect them. While providing
the connections to accessible tele-health providers and services.
Frueh, (2015) provides insight into the positives of tele-medicine but also states that the
largest obstacle that we as social workers face is ensuring that our clients receive evidence-based
treatment. By way of educating consumers to ask questions about treatment and safeguarding
that the treatment prescribed has been tested across a variety of situations. While also having
adequate clinical backing to the community it is being prescribed. HB 15-1029 allows services
in rural communities, which clients may not have knowledge of what the services are and which
9. RURAL COLORADO 9
ones are appropriate for their condition. The profession of social work, should make education
about common mental health disparities accessible to the populace and make sure people know
its ok to change providers if they do not feel like they connect with the provider on a personal
level. One of the hardest is issues is feeling comfortable with the person providing mental health
care, whether its online or in person. If people are educated on appropriate relationships they are
more likely to continue care.
Shealy et al., (2015) stipulated “ some studies comparing telemedicine to treatment
provided in person have reported that telemedicine may in fact be a superior route of treatment
administration for children and adolescents noting novelty of the therapeutic interaction via
technology”(p.333). Their assertion provides fodder for the thought that if the younger
generation grasps utilizing technology, social workers can employ this to help educate parents
and other care providers. If youth are provided pamphlets and access to websites, they can be an
alternative to outreaching parents about HB 15-1029’s benefits and what is available to the
parents. As well as allowing for tabs on the website that lead to providers of tele-medicine
services that can be accessed from the potential patients home.
Suggestions to improve the policy
Though HB 15-1029 has evolved from HB 92-1036, one major issue remains that was
pointed out previously by Ben Price is the need for pharmaceutical legislation added to the bill.
Murphy, (2015) quoted Mr. Price as stating that he see medication treatment as being left on the
table and the need to be included on future revision of the bill. This mainly covers psychiatrists
and practitioners that prescribe and less so those who do mental health care. If a client sees a
physician, they may be likely to have a prescription, which could be required to be mailed or
electronically sent to a participating pharmacy. However, if the pharmacy does not recognize the
10. RURAL COLORADO 10
physician’s credentials or questions the prescription there may be a drop in communication as the
physician is outreached. This could cause the patient to be denied medication for a time being
that they desperately need the medication.
A further concern that was noticed is the assertion that the medical and mental health
being provided over the Internet is fully functional and secure. Some parts of the country still are
not fully wired for internet, for example Wellington, Colorado still has spotty internet service
that could cause drops in service. If the service is consistent, the bill does not provide a provision
for security. With the large business hacking issues in the news recently, it leaves one to wonder
how secure the individual’s appointment would be. HIPAA rules cover confidentiality of health
information, but the rules do not specifically state that internet services are covered (“HHS.gov,”
2015). This could allow hackers to do whatever they choose should they hack into a tele-
medical appointment. Also, allowing the hacker to circumvent papers and release forms that are
transferred via Internet. A future provision of HB 15-1029 would probably need to ensure that
security and confidentiality is enforced and applicable to all parts of Colorado tele-medicine.
Conclusion
In HB 15-1029, there has been an advancement in the access to care for people in rural
Colorado. The bill allows people to also see care providers in the privacy of their home,
preventing undo costs and also preventing stigma in small towns. While the bill has its pluses
and has evolved over the last twenty plus years from the inception of HB 92-1036, it is not
without its oversights. One is internet security, and the other is prescription access over internet.
However large the oversights are, HB 15-1029 provides care to a segment of the population that
would be otherwise left without access to care. Rural health has traditionally been left off the
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table, HB 15-1029 brings rural health to the table and gives voice to people providing food to the
nation.
References
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