State Perspectives on Behavioral Health Sonja Gaines Associate

State Perspectives on Behavioral Health Sonja Gaines Associate Commissioner Texas Health and Human Services October 28, 2016

HHS Transformation Organization Chart Effective Sept. 1, 2016 Veterans’ Services Aging Services e-Health Mental Health Coordination Executive Commissioner Chief Deputy Exec. Comm. Medical & Social Services (MSS) Division Community Services Access & Eligibility Services • Community Access • Eligibility Ops • Disability Determination • Community Care Eligibility Behavioral Health & Intellectual and Developmental Disability Services • Behavioral Health Services • IDD Services Health, Developmental & Independent Services • Rehab & Social Services • Health & Developmental Services Medicaid & CHIP Services • Program Enrollment • Operations • Policy & Program • Quality • Health Plan Monitoring 2

Behavioral Health-IDD Services Functions Community Services includes the Behavioral Health. IDD Services Department • Behavioral Health Services: Oversees and contracts for community-based mental health and substance use disorder services for children and adults provided by Local Mental Health Authorities and community-based providers and organizations. – • Services such as crisis, out-patient, local inpatient, residential, prevention, intervention, veterans mental health, jail diversion, and peer support. Intellectual and Developmental Disability (IDD) Services: Oversees IDD services by Local Intellectual and Developmental Disability Authorities. 3

Mental Health Coordination Functions Office of Mental Health Coordination (MHC) created by S. B. 1 -83 R (Article II, HHSC Rider 82). The Office has authority to: • Provide broad oversight on public mental health policy. • Coordinate the policy and delivery of mental health services throughout the State of Texas. • Consult and coordinate with other state agencies, local governments, and other entities to ensure a strategic, statewide approach to mental health. 4

Statewide Behavioral Health Strategic Plan & Coordinated Expenditure Proposal H. B. 1 -84 R (Article IX, Section 10. 04) created the Statewide Behavioral Health Coordinating Council comprised of 18 state agencies charged with developing a: • Five-Year Statewide Behavioral Health Strategic Plan • Coordinated Expenditure Proposal for Fiscal Year 2017 5

Statewide Behavioral Health Coordinating Council Members The Council, includes the Texas Education Agency as a voluntary member, as well as representation from the following agencies: • • • • The Office of the Governor Texas Veterans Commission Health and Human Services Commission Department of Aging and Disability Services Department of Family and Protective Services Department of State Health Services Texas Civil Commitment Office The University of Texas Health Science Center at Houston The University of Texas Health Science Center at Tyler Department of Criminal Justice Texas Juvenile Justice Department Texas Military Department Health Professions Council has one seat representing the Texas Medical Board, Texas Board of Pharmacy, Texas Board of Dental Examiners, Texas Board of Nursing, Texas Optometry Board, and Texas Board of Veterinary Medical Examiners 6

Statewide Behavioral Health Strategic Plan & Coordinated Expenditure Proposal Expected Outcomes • Significant improvements in behavioral health coordination across state agencies • Maximize use of existing resources and services • Address behavioral health gaps identified through strategic approach • More efficient and effective state government • Ensure utilization of successful best, promising, and evidencebased behavioral health services and service delivery • Ensure prompt access to quality behavioral health services 7

Statewide Behavioral Health Strategic Plan 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. Mission: To develop a coordinated statewide approach to providing appropriate and cost-effective behavioral health services to Texans. 8

Behavioral Health Prevalence in Texas by Condition, Fiscal Year 2014 SUD (Adults) SMI SED SPMI Legend: • SUD – Substance Use Disorder • SMI – Severe Mental Illness • SED – Severe Emotional Disturbance • SPMI – Serious & Persistent Mental Illness SUD (Youth) 9

Behavioral Health Funding in Texas for Fiscal Years 2016 -17 by Program Notes: • Medicaid expenditures include all claims with a primary diagnosis code that represents a behavioral health condition. • Estimates for Medicaid do not include Delivery System Reform Incentive Payment (DSRIP). • Estimated fiscal years 2016 and 2017 Medicaid expenditures are proportioned from prior year's mental health costs to total costs, and applied to forecasted costs. North. STAR costs are included with DSHS in fiscal year 2016 and four months of fiscal year 2017 as appropriated. 10

Behavioral Health Population Served by Council Agencies in Fiscal Year 2016 Agency Office of the Governor TVC HHSC DADS DFPS DSHS TCCO UTHSC–Houston UTHSC–Tyler TDCJ TJJD TMD Health Professions Council* TEA Youth ● ● ● Adults ● ● ● ● ● Veterans ● ● ● ● Criminal & Juvenile Justice ● ● ● ● ● IDD ● ● ● ● * The Health Professions Council represents the Texas Board of Dental Examiners, Texas Board of Pharmacy, Texas State Board of Veterinary Examiners, Texas Optometry Board, Texas Peer Assistance Program for Nurses, and Texas Medical Board. 11

Behavioral Health Investment in Texas • Large investment and stewardship of the Governor and the Legislature to improve Texas’ behavioral health service delivery system have made positive change • • – Increased treatment alternatives to incarceration – Enhances local community collaboration – Coordinating funding efforts However, gaps in services still remain – Council member agencies and community stakeholder groups provided valuable insight to identify gaps and challenges related to coordination, access, and service provision – Council members also identified specific populations that are underserved in the current behavioral health system Identified gaps provide opportunities to strengthen the system as the strategic plan is implemented 12

Strength, Weaknesses, Opportunities, & Threats Survey Feedback 745 individuals responded to a survey of current Strengths, Weaknesses, Opportunities, and Threats related to Texas behavioral health services conducted in February 2016 • Geographic Location of Respondents: – 69% from large urban areas (population greater than 50, 000) – 24% from small urban areas (population between 2, 500 and 50, 000) – 7% from rural areas (population less than 2, 500) 13

Strength, Weaknesses, Opportunities, & Threats Survey Feedback Top Three Responses for Each Survey Category Strength Weaknesses 1. Availability of Peer Services 2. Diverse array of available services; increased services available 3. Availability of crisis response teams 1. Limited available services 2. Shortage of psychiatrists, clinical staff, behavioral health providers and lack of substance use treatment 3. Low coordination between providers; lack of follow-through, organization, and attention to effective outcomes Opportunities Threats 1. Expand telemedicine/telehealth 2. Increase stakeholder involvement and front line staff input 3. Expand existing services 1. Lack of appropriate and adequate funding; funding cuts 2. Sustainability of innovative and grantfunded programs 3. High cost of services; lack of insurance; claims and reimbursement issues 14

Statewide Behavioral Health Strategic Plan Goal 2: Program and Service Delivery Goal 1: Program and Service Coordination Goal 3: Prevention and Early Intervention Services Goal 4: Financial Alignment Goal 5: Statewide Data Collaboration 15

Behavioral Health Strategic Plan Implementation Two Phases: • Phase I: Immediate implementation of short-term opportunities which are low- or no-cost • Phase 2: Planning and implementation of long-term strategies – Statewide Behavioral Health Advisory Council will seek direction from the Legislature and the Office of the Governor 16

Behavioral Health Gaps in Services • • • • Gap 1: Access to Appropriate Behavioral Health Services Gap 2: Behavioral Health Needs of Public School Students Gap 3: Coordination across State Agencies Gap 4: Veteran and Military Service Members Supports Gap 5: Continuity of Care for Individuals Exiting County and Local Jails Gap 6: Access to Timely Treatment Services Gap 7: Implementation of Evidence-based Practices Gap 8: Use of Peer Services Gap 9: Behavioral Health Services for Individuals with Intellectual Disabilities Gap 10: Consumer Transportation and Access to Treatment Gap 11: Prevention and Early Intervention Services Gap 12: Access to Housing Gap 13: Behavioral Health Workforce Shortage Gap 14: Services for Special Populations Gap 15: Shared and Usable Data 17

1115 Waiver • The Delivery System Reform Incentive Payment (DSRIP) pool provides incentive payments for 3 - and 4 -year projects to improve health care access, innovate care delivery, and improve outcomes under the 1115 Waiver. Ø Supports coordinated care and quality improvement through 20 Regional Healthcare Partnerships Ø Targets Medicaid recipients and low-income uninsured individuals. • Currently have 1, 451 DSRIP projects of which more than onequarter (461) have a behavioral health focus: peer services, integrated health, telehealth, homeless services, veteran services Ø 342 performed by community mental health centers Ø 119 performed by hospitals and other providers 18

Notable Behavioral Health 1115 Waiver Projects • Bluebonnet Trails Community Center: Peer-led Transitional Housing project targets “super utilizers” and provides peer services, housing, other psychosocial supports • MHMR of Tarrant County: Systemic, Therapeutic, Assessment, Respite and Treatment (SMART) model provides behavioral health crisis prevention and intervention services for individuals with IDD and/or Autism Spectrum Disorder with co-occurring behavioral and medical problems • Austin-Travis County Integral Care: evidence-based health promotion programming for adults with severe mental illness in chronic disease management 19

Texas Veterans + Family Alliance S. B. 55 (84 R) requires HHSC to establish a grant program to support community mental health programs providing services and treatment to veterans and their families. • Total Grant Program Funding is $21 million • Mission: Improve the quality of life of Texas veterans and their families by supporting local Texas communities to expand the availability of, increase access to, and enhance the delivery of mental health treatment and services. • Expected Outcomes: Ø Local communities will increase access to mental health care that is safe, appropriate and timely, of high quality, and respectful of military culture for Texas veterans and their families. Ø Barriers to accessing care, including community stigma, will be reduced. Ø Community partnerships will be supported as they develop projects and integrate services to strengthen their collaborative planning capacity. 20

Pilot Program: Texas Veterans + Family Alliance • Phase I: $1 Million Pilot Program: HHSC identified $1 million to support a pilot program to be matched with $1. 1 million by grantees Ø Emergence Health Network – El Paso Ø Texas Panhandle Centers – 30 northern-most counties in the Texas Panhandle Ø Tropical Texas Behavioral Health – Cameron County Ø University of Texas at Dallas – Center for Brain. Health Ø United Way of Denton County • Expected to serve approximately 1, 500 veterans and family members through August 31, 2017 21

Full Program: Texas Veterans + Family Alliance Phase II: $20 Million Full Program: Article II, HHSC Rider 68 appropriated $20 million for full program to be matched dollarfor-dollar by grantees which will be implemented in two phases: A and B • Phase II-A Ø 14 applicants selected in October 2016 Ø Anticipated start period November 1, 2016 • Phase II-B Ø Request for Award issued soon Ø Anticipated start period March 1, 2017 Visit https: //hhs. texas. gov/services/health/mental-health-substanceabuse/texas-veterans-family-alliance-grant-program for more information 22

Questions? Sonja Gaines, Associate Commissioner for Behavioral Health & IDD Services Sonja. Gaines@hhsc. state. tx. us www. Mental. Health. TX. org 23