wisconsin department of health services children’s mental health overview kevin moore deputy...

Wisconsin Department of Health Services

Children’s Mental Health Overview

Kevin Moore

Deputy Secretary

July 17, 2013

Protecting and promoting the health and safety of the people of Wisconsin 2

Division of Mental Health and Substance Abuse Services (DMHSAS)– Division Administrator: Linda Harris– Deputy Administrator: Patrick Cork

Mental Health Organization Within DHS

Key Areas of DMHSAS


CommunityPrograms

• Bureau of Prevention, Treatment & Recovery

• Community Forensics

• Client Rights Office

PsychiatricHospitals

• MendotaMental Health Institute

• WinnebagoMental Health Institute

Secure TreatmentFacilities

• WisconsinResource Center

• Sand RidgeSecure Treatment Center

• MendotaJuvenile Treatment Center

DMHSAS Budget (SFY 12)


DMHSAS Budget$ in millions

GPR, $212.5

Other, $100.4

Total Budget = $312.9 million

DMHSAS Position Authority (SFY 12)


DMHSAS PositionsFTEs

Facilities, 2,395

Central Office, 55

Total Positions = 2,450 FTE

Department’s Potential Clientele

Total Wisconsin Residents: 5.7 million Adults: 4.3 million Children: 1.4 million

Residents w/ Any Mental Health Needs: 1,140,000 (20%) Residents w/ Serious Mental Health Needs: 328,900 (5.8%) Adults w/ Serious Mental Health Needs: 233,700 (5.4% of adults) Children w/ Serious Mental Health Needs: 95,200 (6.8% of children) Residents Aged 12+ w/ Substance Abuse Issues: 505,000 (8.9%)


State Psychiatric Hospitals

Department of Health Services


Mendota Mental Health Institute

Location: Madison Mission: Court-ordered mental health

treatment for persons committed under civil and forensic laws.

Budget (FY12): $66.8 m AF, $45.2 m GPR Positions: 687.93 FTE Rate: $999/day (adult) Population: 226 (29 civil, 197 forensic

as of July 1, 2011)



Winnebago Mental Health Institute

Location: Oshkosh Mission: Court-ordered mental health

treatment for persons committed under civil and forensic laws.

Budget (FY12): $53.1 m AF, $30.6 m GPR Positions: 604.86 FTE Rate: $999/day (adult) Population: 167 (49 civil, 118 forensic

as of July 1, 2011)



Populations Served in the Institutes

Civil Patients (WI Stats Chapter 51)

– Courts commit mentally ill persons found to be a danger to self or others to the care of the county.

– Counties can choose to admit persons to a state Institute for treatment; counties control discharge and approve aftercare placements in the community.

– Local law enforcement can also initiate “emergency detentions”, with approval and fiscal authorization of the county (can last no more than 72 hours without court review).

– Institute treatment costs for civil patients paid for by the counties through daily rates charged by the DHS Institutes. Medicaid and other third-party payers are also billed by DHS when appropriate, and revenues obtained offset county costs.


State Psychiatric HospitalsPopulations Served in the Institutes

Forensic Patients (WI Stats Chapter 971)– Circuit courts commit persons accused of crimes to the care and

custody of DHS, as follows: Competency Evaluation [s.971.14(2)]

– Court commits defendant to DHS for 14 days for evaluation of competency to stand trial. Placement may be inpatient or outpatient as determined by DHS.

Restoration to Competency Treatment [s.971.14(5)]– Court commits defendant to DHS for up to 12 months. Placement may be

inpatient or outpatient as determined by DHS.– Reports to court at 3, 6, 9-month intervals re: competency

Not Guilty by Reason of Mental Disease or Defect (NGI) [s. 971.17]– Court commits defendant to DHS; placement for treatment by court may

be inpatient at MHIs or community-based in Conditional Release Program.– Commitment can sometimes be for life.

– Institute treatment costs for forensic patients paid for with state GPR funds.


Secure Treatment Facilities



Mendota Juvenile Treatment Center (MJTC)

Location: Madison Mission: Secure mental health

treatment of juvenile offenders. Budget (FY12): $5.0 million PR Positions: 0.5 FTE Cost per day: $400 Population: 29 (as of July 1,

2011) Also provides enhanced aftercare

services.


MJTC


Population Served at MJTC

Adolescent males who have been adjudicated delinquent and are in need of intensive treatment services.

Referrals made by the DOC Division of Juvenile Corrections.


MJTC

Community Programs


Community ProgramsBureau of Prevention, Treatment and Recovery

Budget (FY12): $68.9 m AF, $21.3 m GPR Positions: 39.32 FTE Major Functions:

• Federally Designated State Mental Health and Substance Abuse Authorities• Grants Management and Contract Administration for Federal Block Grants and

Discretionary Grants • Contract Administration for Community Mental Health & Substance Abuse Grants &

Services (e.g., Intoxicated Driver Program, Crisis/Hospital Diversion Programs, Institute for Mental Disease (IMD) funding, Preadmission Screening & Resident Review, Women’s and TANF Recipient’s Substance Abuse Treatment Programs)

• Development and Technical Assistance for the Mental Health & Substance Abuse Administrative Rules and State Statutes

• Staff Support to the State Councils (Alcohol & Other Drug Abuse Council & Wisconsin Council on Mental Health)

• Planning, Development and Provision of Technical Assistance for the Public Mental Health/Substance Abuse Services System


Medicaid Reform and the Affordable Care Act


Medicaid and the Affordable Care Act

Proposed Eligibility Modifications

AdultsParents and Caretakers – 100% FPL Childless Adults – 100% FPL Adults above these levels will have access to affordable health insurance through the federal health insurance exchange

ChildrenNo eligibility changes for children up to 300% FPLChildren in families above 300% FPL will no longer be able to buy into BC Plus, but can seek coverage in exchange

No change in coverage levels for elderly or disabled individuals



Net Impact of Governor’s Reforms

Through Medicaid and the Federal Health Insurance Exchange 224,580 more individuals will have access to affordable health coverage.

Percentage of uninsured non-elderly adults drops from 14% to 7%.

Overall enrollment in Medicaid for adults drops 5,400.

Projected 30,000-40,000 new children will be covered under Medicaid from the “Woodwork” effect.



ACA & Essential Health Benefits

The Affordable Care Act and its implementing regulations, building on the Mental Health Parity and Addiction Equity Act, will expand coverage of mental health and substance abuse disorder benefits and federal parity protections in three distinct ways:

Including mental health and substance use disorder benefits in the Essential Health Benefits;

Applying federal parity protections to mental health and substance use disorder benefits in the individual and small group markets;

Providing more Americans with access to quality health care that includes coverage for mental health and substance use disorder services.

Source: ASPE Source, Affordable Care Act Will Expand Mental Health and Substance Use Disorder Benefits and Parity Protections for 62 Million Americans ; http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.pdf


Governor Walker’s Mental Health Reform Package



Governor’s proposal was developed with input from individuals and groups throughout Wisconsin:– Mental health providers and physicians– Consumers– K-12 social workers and psychologists– Law Enforcement Officials– Community-based service providers

10/24/08Protecting and promoting the health and safety of the people of Wisconsin 22


Coordinated Service Teams (CST)

Background:

Coordinated Service Teams are evidence-based practice wraparound models of care for kids with behavioral health issues.

CST is targeted to children and families involved in two or more systems of care (such as mental health, long-term care, juvenile justice, child welfare, substance abuse or special education) who have complex needs.

Counties or tribes may operate CSTs.

Currently there are 44 programs that receive some state funding support (including Milwaukee and Dane counties) in 2011.



Coordinated Service Teams (CST)

Governor Walker’s Proposal:– The Governor’s budget expands the use of

Coordinate Service Teams (CST) statewide.– Investment:

FY 2014 GPR: $1,250,000 FY 2015 GPR: $1,250,000 Total GPR: $2,500,000

Signed into law as part of 2013 Act 20.



Office of Children’s Mental Health

The Office of Children’s Mental Health will assure the coordination and integration of services across state agencies:

– The office will facilitate communication with all state agencies serving children, coordinate initiatives, and monitor program performance focused on children’s mental health.

– The office will support administrative efficiencies to allow for a reduction in duplication of efforts among state organizations devoted to children’s programming.

– The office will improve access to appropriate services to children.

– The office will be staffed by a Director appointed by the Governor, and three liaison staff. It will report directly to the Governor’s office.



Office of Children’s Mental Health

Investment: FY 2014 GPR: $185,200 FY 2015 GPR: $350,200 2013-2015 GPR: $535,400

Staffing:– 1 Office Director– 3 Liaison Staff

Signed into law as part of 2013 Act 20. Protecting and promoting the health and safety of the people of Wisconsin 26


In-Home Counseling for Children

Background:

In-home counseling within Medicaid is typically targeted to children in need of family therapy, or children involved in the child welfare system.

Currently, in-home counseling is only available to children diagnosed with a severe emotional disturbance. This policy excludes children in need of service who have less serious psychiatric histories.



In-Home Counseling for Children

Governor Walker’s Proposal:– The Governor’s budget would allow the home to be a service delivery location for

Medicaid eligible children in need of mental health services.

– This model of service delivery is used extensively across the country, and is used to promote family therapy approaches between family members.

– Investment:

FY 2014 GPR: $262,000 FED: $393,000 AF: $655,000 FY 2015 GPR: $262,000 FED: $393,000 AF: $655,000 2013-15 GPR: $524,000 FED: $786,000 AF: $1,310,000*

*In home counseling for children is a Medicaid benefit. State funding is matched at the state’s current Medicaid matching rate




Comprehensive Community Services (CCS)

Comprehensive Community Services (CCS) is a publicly operated program for adults and children with mental illness and/or substance abuse issues.

Many services are provided in home and/or in the community as opposed to a clinician’s office.

– CCS service plans typically include a mix of access to and maintenance of psychiatric medication, counseling and supportive education, mental health psychotherapy, and case management service.

– CCS also allows for residential services and other evidence-based mental health and substance abuse treatment.

CCS is unique in that that each community bases its behavioral services on local resources and need.

In 2011, 1,469 Wisconsin residents were served by Comprehensive Community Services.




Governor Walker’s Proposal:– The Governor’s plan expands the use of Comprehensive

Community Services statewide.

– In addition, the budget will provide state funding for current programs, saving counties with CCS programs over $6 million. Roll out of CCS is budgeted to begin in the second year of the biennium.

– Investment:

FY 2015GPR: $10,202,000 FED: $6,499,900 AF: $16,701,900**CCS is considered a psychosocial rehabilitation service and is reimbursable via Medicaid.




Signed into law as part of 2013 Act 20 with the following modifications:

Require DHS to submit a report to the Joint Committee on Finance no later than March 1, 2014, that addresses the following issues relating to the proposal: –a description of the criteria DHS will apply in its CCS regionalization model; –a description of how the regions will be established and the degree of county participation in that process; –an updated list of the counties which, by that date, have indicated they will offer CCS on a regional basis according to DHS-established criteria; and –an evaluation of the long-term costs of the proposed regional model.




In addition, transfer the GPR funding in the bill for the Governor's CCS proposal ($10,202,000 in 2014-15) to the Joint Committee on Finance supplemental appropriation and require DHS to submit a request for the release of these funds under a 14-day passive review process after DHS submits the report to the Committee.

Department is working with stakeholders, advocates and providers and intends to submit its report and request the release of the funding for the 2014-15 fiscal year.



Peer-Run Respite Centers

Peer Respite Centers are an innovative service designed to improve quality of life and reduce emergency room visits.

The services are delivered by people who themselves have been successful in the recovery process (certified peer counselors).

The services are community-based, residential settings that offer a small number of beds to people before or during a crisis situation, or to those having difficulty coping with mental illness.

Because services are peer-run and community-based, Peer Respite Centers show promise in the continuum of crisis programming.



Peer-Run Respite Centers

Governor Walker’s Proposal:– The Governor’s budget invests in the

development of Peer Respite Centers.– Investment:

FY 2014 GPR: $64,600 FY 2015 GPR: $1,282,700 Total: GPR: $1,347,300



Opportunities…

Corrections:– Is there more we can do to help children earlier so they remain

part of the community and out of the correctional system?

Education:– Are we maximizing resources across programs so the focus is on

positive outcomes for children and their families?

Social Services:– Are state and local agencies working in collaboration to find

solutions that address the mental health and behavioral needs of children and their parents?


The Future…

This budget, combined with the direction of the Department, establishes children’s mental health as a priority:– Significant investment in services for children.– Continued development of Trauma-Informed care

services inside and outside of Medicaid: Foster Care “Medical Home” First Lady’s Fostering Futures Initiative



Questions and Comments


Wisconsin Department of Health Services


Kevin Moore

Deputy Secretary

July 17, 2013

wisconsin department of health services children’s mental health overview kevin moore deputy...

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