Behavioral Health is top-of-mind for many people today. I currently lead a collaborative of community mental health providers in Wayne County, Michigan, and another group of Substance Use Disorder Providers also in Wayne County. I prepared this memo for them outlining the mental health and SUD priorities for the Michigan Department of Health & Human Services (MDHHS) and for President-Elect Biden, hoping we can be a part of the conversation. The information was found on the President-elect’s transition website and from conversations with people at the MDHHS.
MDHHS
01.
Drive improved outcomes and more funding to the front lines through streamlined oversight PIHP/CMHP accountability reforms.
Ensure providers have enough funding for evidence-based practices is critical for the client, family, and provider.
• Ensure parity in each county in how funding is distributed.
• Parity for SUD funding with MH funding
• Standardization for codes for all regions + funding for SUD services.
• SED/DD -- Payment amounts are different with DD being lower when it is more difficult and challenging to do it -- perhaps leftover from legacy system that has not yet been fixed
• Accountability for PHIPS for approving services
02. Integrate physical and behavioral health care at the point of service with a person-centered approach and inclusion of social determinants of health.
• Providers are integrating care in different ways. Concerns over how funding/codes will be implemented.
03. Ensure all Michiganders have access to behavioral health, mental health, and substance use prevention, treatment, services, and follow-up services for the best quality of life.
• Timelines and guidelines to get services timely
• Access is a concern -- Create a better way to educate consumers.
• People should be able to call providers directly to access services
• SUD Providers take on more risk, arduous re-authorization process and providers lose a lot of people in the process.
• Hospital discharge concerns.
04. Provide people with outreach, service delivery, and access to behavioral health services at their preferred locations and mechanisms. Consider telehealth and telephone services utilized during COVID-19.
Need to have the flexibility for treatment without the need to obtain authorizations in treatment plans.
Need to break down county barriers. Requests by families to use a certain service provider should be honored, regardless of where people live or where providers are located.
Concern that PHIPs will not add providers to a list of providers.
Even within Wayne County, Well Place will assign someone to a specific location even after the family identified someplace else. (Person-Centered- Planning)
Other issues with no shows and or the ability to access records due to issues with CRSP.
Access has been enhanced via telehealth especially to those with transportation barriers. Also, from a cost-effectiveness perspective telehealth has been helpful.
Concerns over telehealth becoming primary means to provide treatment given the amount kids are spending time on screens.
Provider Participation - Providers have asked repeatedly to have a seat at the table to advise policies impact, front-line providers. Perhaps include contract language that includes providers in clinical and other discussions setting policy. Require PHIPs to have provider advisory groups.
05. Provide quality and time-efficient patient care flow from the community to residential treatment or institution (hospital, juvenile detention centers, jail) to the community with individualized clinical treatment.
Do No Justice perspective -- Lack of access to beds and then get cycled back? Kids may also not be connected to community-based care or families may not be familiar with the system of care.
Need to think of children at the beginning of every process and how we can work through prevention, so we do not need to transition children to adult care
06 Other issues
The ability of PHIP to generate reserves and invest at the inability to support providers -- Need to create a system of fair play, transparency, and oversight as to the distribution of funds -- Monitoring of PHIPs.
Standardize PHIPs across the state
Impact as to how providers are contracted with -- PHIPs have managed care contracts but in Wayne County, we are on Fee for Services agreements complete with restrictions and barriers to providing care -- There is a strong need to change the type of contracts offered to local providers, which influences how services are provided and need to offer value-based contracts.
Behavioral Health Priorities of The Biden Administration
Expand the definition of Medically Underserved Population (MUP) to include people with disabilities, which will drive investments through the Health Resources and Services Administration for expanding access to primary health service providers.
Enforce parity laws. Biden will set clear standards raising the bar for mental health coverage, including habilitative services and other forms of behavioral health care.
Integrate mental health and substance use disorder treatment into primary care and expand community-based programs. Biden will expand community-based programs that incorporate the full spectrum of services that are necessary for successful treatment, including supported employment and housing. He will support efforts to expand the successful Certified Community Behavioral Health Clinics (“CCBHC”) Demonstration program to expand access to high-quality, evidence-based behavioral health services at the community level.
Increase the number of mental health professionals and paraprofessionals. Biden will increase funding for the National Health Service Corps and develop high school-community college-health center partnerships to inspire young people, including diverse young people with disabilities, to pursue jobs in health care. He will build on the work done through the 21st Century Cures Act, which included resources designed to increase the number of mental health and substance use disorder professionals and paraprofessionals. Biden will also double the number of psychologists, counselors, nurses, social workers, and other health professionals in our schools.
Provide greater access to home and community-based services and long-term services and supports in the most integrated setting appropriate to each person’s needs, by Affirming the right of people with disabilities to self-direct services. Biden will encourage more states to allow older Americans and people with disabilities to receive long-term services and supports under Medicaid the option of self-directing their own home and community-based services, including the right to hire family members as support workers. He will direct the Administration for Community Living to identify best practices in self-direction and make them available to people who need them.
Invest in the direct care workforce. Biden will ensure that people with disabilities receive support from direct care professionals who earn a living wage, have access to affordable health care, and do not have to get a second job to pay household bills. To support and increase the direct care workforce, Biden will: Increase the minimum wage to $15 per hour and provide federally funded paid leave. Every worker deserves to earn enough to live a middle-class lifestyle, provide for their family, save for retirement, and send their kids to college. The Obama-Biden Administration extended long overdue overtime and minimum wage protections to nearly 2 million home care workers. As President, Biden will codify these protections into law and build on them. Biden will support indexing the minimum wage to the median hourly wage so that low-wage workers’ wages keep up with those of middle-income workers. He will also ensure that Medicaid reimbursement levels reflect fair wages while increasing access to HCBS—alleviating the tension between access to services and paying people a fair wage.
Biden will fund initiatives to partner mental health, disability, and substance use disorder experts and social workers with police departments and first responders. These service providers will train police officers and other frontline responders to better de-escalate interactions with people in severe emotional distress and to interact with individuals respectfully and appropriately with disabilities.
