November 16, 2015
- Opportunities and challenges for counties and providers
- New Alcohol and Drug Organized Delivery System
- CCBHC/Excellence in Mental Health Act Certification and PPS
- Whole Person Healthcare Integration Pilots under Section 1115 Waiver
All of these issues have to be addressed in the coming year by counties and providers.
When I speak with community behavioral health agencies, the biggest issue for most seems to be the lack of contract expansion and the frustration that counties don’t seem to make that a very high priority and claim that they don’t have the significant growth in revenues that all of the state revenue charts indicate they have received or soon will receive.
CCCBHA continues to work to acquire information about how much money each county is receiving each year from each revenue source. In addition we participated in a meeting last Friday with representatives of local associations of providers to see how we can work together to develop strategies and information that can produce positive results.
While we seek to gain funding increases under the current structure we should also be focusing on the significant additional funding opportunities from the major restructuring of systems and the funding opportunities that they create.
The initial restructuring is the development of the new Organized Delivery System for alcohol and drug services. (In small rural counties this change will be done on a regional basis and not as quickly as in most of the larger counties.)
There is no understating the significance of the new Organized Delivery System and the opportunities it creates in facilitating not only better substance use disorder services but aligning and integrating those services with community mental health services.
That new system has to be developed but as big a change as that is the Excellence Act and the Section 1115 Waiver Whole Person Health care Pilots represent even bigger opportunities.
Last week I was told by state officials that I was the only person telling them that the excellence act could be worth $1 Billion per year to California if we are selected to implement it statewide. At their request I prepared a simple analysis which National Council experts confirmed was an accurate assessment of its potential. Nonetheless, our membership seems way ahead of county and state officials in focusing on this opportunity and the payment and system reform opportunities it represents.
I have met with the key consultants that they state will be working with and we expect to have a steering committee that includes our membership to work with state and county officials and their consultants to make sure that we take full advantage of this incredible opportunity.
I also confirmed that it is very complimentary to both the new alcohol and drug organized delivery system and the Section 1115 Waiver’s Whole Person Healthcare county level pilots.
The state just received the formal notice that these pilots will be part of the new Physical Health Care system Federal Waiver which will be approved before December 31st this year.
The whole person pilots represent a $1.5 Billion opportunity for counties. (it is not yet clear who the lead entity will be but it will have to include the MediCal managed care plans and county behavioral health as the details won’t be known until the new federal waiver becomes official and state officials provide guidelines but the premise is that the state and federal government will save money from better integration of physical and behavioral health- meaning more people getting the behavioral health they need and people with severe mental illnesses getting quality consistent physical health care will create better overall health and less use of hospitals and other high cost care. The state will be offering counties $1.5 Billion of incentive funding over the next five years to develop these systems. This will be optional for counties but every major county should seek to participate
This type of integration is also a central feature of the Excellence Act so the planning for the two can be combined and the organized delivery system for substance use disorders will be a necessary building block for both. Like the Excellence Act there does not yet seem to be great attention to this issue among county officials. Hopefully that will change soon. In order to be successful in the competition for excellence act funds we need counties fully engaged. All member agencies should be in discussions with county directors to make sure they are dedicating the necessary high level staff for these opportunities that are comparable in scale to the mental health services act but probably even bigger in the magnitude of structural change that they will bring. They also provide a context in which counties can think about the best strategies to serve the large numbers of people who are not getting the behavioral health care that they need – which in turn will bring them back to the issue of service expansion and how to use all available funds in the best way possible.
November 16, 2015