Category Archives: Medicaid and Medi-Cal

California Well Positioned for Excellence Act (CCBHC) Certification, Management and PPS

December 20, 2015

On Monday, December 7th, I participated in the National Council for Behavioral Health’s second all day training for state associations to support state planning to develop proposal under the Excellence in Mental Health Act Certified Community Behavioral Health Centers program which will significantly increase funding and significantly reduce documentation requirements for outpatient behavioral healthcare. See my paper documenting that the value of this is about $1 Billion statewide in the first year and growing.

A centerpiece of that training was the review of a new and expanded “Integrated CCBHC Certification Criteria Feasibility and Readiness Tool (I-CCFRT)”.
In studying that tool and discussions with other state association representatives I learned that the structure of county mental health in California (not yet the case for substance use disorders- but should eventually be with the implementation of the Organized Delivery System) is well aligned with the requirements for CCBHC certification, management and establishment of a prospective payment system.

Continue reading California Well Positioned for Excellence Act (CCBHC) Certification, Management and PPS

Department of Finance provides MHSA estimates for next four years

Department of Finance provides MHSA estimates for next four years – modest continued growth forecast to bring total to nearly $2 Billion

Last month I reported that two newspaper stories indicated that counties had hundreds of millions of dollars in unspent MHSA funds above their prudent reserve for the inevitable eventual economic downturn.

CBHDA had responded by indicating that counties considered this to be one time funding created by a spike in MHSA revenues which would not be sustained. This suggested that counties believed that MHSA revenues would go down in the next years and so I asked the state department of finance if they could take their multi year estimates of state income tax revenues and do similar estimates for MHSA revenues. Continue reading Department of Finance provides MHSA estimates for next four years

Early Psychosis Programs – taking it to scale

Early psychosis programs began about 20 years ago in Melbourne Australia led by a psychiatrist who observed data showing that there was an incredibly greater recovery rate among those people with schizophrenia who were first seen within a few months after the onset of psychosis.

Their program demonstrated that for that population they were able to achieve a success rate of 80% being discharged from the intensive treatment program to medication only after 18 months and full time employment or education as compared to a success rate of only about 20% for people for whom treatment is delayed for more than a year after the initial experience of psychosis.

This success has generally been replicated in other programs. Until recently, nearly all such programs were small “pilot” programs including about a dozen funded by the MHSA in California.

Continue reading Early Psychosis Programs – taking it to scale

June 2015 Blog – Excellence in Mental Health Act – Certified Community Behavioral Health Centers

Excellence in Mental Health Act – Certified Community Behavioral Health Centers

State Preparation for Planning Grant- to compete for increased federal funds

The biggest federal investment in community behavioral health is  buried in a little-known provision in a federal law known as the Protecting Access to Medicare Act of 2014. This law authorizes SAMHSA (the federal Substance Abuse and Mental Health Services Administration) to designate eight states to receive a 15% increase in their federal share of costs for outpatient behavioral health care for two years through designation of certified community behavioral health centers (CCBHCs). The law is also known as the Excellence in Mental Health Act which is the term still preferred by its sponsoring members of Congress (including California’s Doris Matsui) and lead advocacy organization the National Council for Behavioral Health. Continue reading June 2015 Blog – Excellence in Mental Health Act – Certified Community Behavioral Health Centers

March 2015 Blog – Steinberg Institute and CBHDA response to Little Hoover Commission Report

Steinberg Institute and CBHDA response to Little Hoover Commission Report

What we can show now and what still needs to be done

Early this year the state’s Little Hoover Commission released a report that included a press release stating that there was a lack of data to determine if Proposition 63 is achieving its goals.CCCMHA_63_logo

On March 11th Darrell Steinberg led a press conference, joined by several county mental health leaders, to present data that shows that the Full Service Partnership program representing 40% of Proposition 63 funds is accomplishing its goals of reducing homelessness by 50% , incarcerations by 80%, emergency room use by 80% and psychiatric hospitalizations by 40%. Continue reading March 2015 Blog – Steinberg Institute and CBHDA response to Little Hoover Commission Report

February 2015 Blog – In many states, behavioral health Medicaid carve outs are in jeopardy, but not in California. Why is that so?

ICCCMHA_63_logon many states, behavioral health Medicaid carve outs are in jeopardy, but not in California. Why is that so?

It is difficult to go to a health policy forum and not hear people talk about ending the behavioral health carveout in MediCal. Health plans, federally qualified health centers, health policy “experts” all seem to advocate for such an action and not surprisingly many in the mental health community fear that this will happen and worry about the state not seeking renewal of the Section 1915 (b) Freedom of Choice Waiver which has been in place since 1995 creating counties as the single managed care entity for mental health. That waiver is up for renewal in June of 2015. Many in the mental health community appear worried that the state will not seek its renewal or that the federal government will not approve it. They further worry that if that happened the so called carve out by which these services are provided through counties instead of managed care plans would come to an end.

However, those worries appear to be misplaced. Moreover, even if the waiver did not continue, the county system would not go away without a vote of the people to overturn two voter approved ballot measures.

Continue reading February 2015 Blog – In many states, behavioral health Medicaid carve outs are in jeopardy, but not in California. Why is that so?

January 2015 Blog – Steinberg Institute: Advancing Mental Health Policy

Steinberg Institute:
Advancing Mental Health Policy

A unique and powerful new ally from our best friend ever

California’s mental health community has enjoyed an incredible run of legislative support over the past 16 years led by Darrell Steinberg, who is probably the first person elected to declare from the outset that his highest priority was to provide funding to support community mental health – especially for people who were homeless or at risk of homelessness due to their severe mental illness. His legislation in the Assembly laid the foundation for Proposition 63 which he co-authored with me. In the Senate he rose to the most powerful position in the legislature as Senate President Pro Tem. In the first few years, during a devastating state recession and budget deficits, all he could do was to minimize the losses. Finally in his last two years in office he was able to successfully get mental health front and center in the fight for very limited state budget funds for expansion of programs.

Continue reading January 2015 Blog – Steinberg Institute: Advancing Mental Health Policy