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BEHAVIORAL HEALTH ADMINISTRATION Annual Conference Presentation
Barbara J. Bazron, Ph.D., Deputy Secretary Behavioral HealthDate: May 3, 2017
VISION
Improved health, wellness, and quality of life for individuals across the life
span through a seamless and integrated behavioral health system of care.
MISSION
The BHA will, through publicly-funded services and support, promote recovery,
resiliency, health and wellness for individuals who have or are at risk of
emotional, substance related, addictive and/or psychiatric disorders to improve
their ability to function effectively in their communities.
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Note: Based on claims data through 01/31/2017. Total Individuals is an unduplicated count of individuals receiving mental health or substance use disorder services in the PBHS.Dually Diagnosed are those individuals receiving services in the PBHS with MH and SUD diagnoses during the year.Claims can be submitted up to 12 months from the service date and therefore data regarding FY 2016 and FY 2017 are incomplete now.
Total Number of Individuals Served in Public Behavioral Health System FY 16 and FY 17
198,196
67,832
52,656
0
50,000
100,000
150,000
200,000
250,000
300,000
FY 2016 FY 2017
241,602TOTAL INDIVIDUALS
TOTAL INDIVIDUALSTOTAL
DUALLY DIAGNOSED INDIVIDUALS
DUALLY DIAGNOSED INDIVIDUALS
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Individuals Receiving Mental Health Services in Maryland’s Public Behavioral Health System
0
50,000
100,000
150,000
200,000
250,000
FY 2015 FY 2016
188,315203,546
Note: Based on claims data through 01/31/2017. Claims can be submitted up to 12 months from the service date and therefore data regarding FY 2016 and FY 2017 are incomplete now.
• 8.09% increase from FY 2015 to FY 2016
5
Individuals Receiving Substance Use Disorder Services in Maryland’s Public Behavioral Health System
Note: Based on claims data through 01/31/2017. FY 2015 data for substance use disorder services is for only six months January through June 2015. Claims can be submitted up to 12 months from the service date and therefore data regarding FY 2016 is incomplete now.
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
FY 2015 FY 2016
51,832
75,766
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1. Moving towards an integrated system of care.
2. Improving access and quality of care throughout the
continuum of care.
3. Build the infrastructure to support capacity to collect,
analyze and track data to improve service outcomes.
4. Develop and implement population-based efforts to
promote wellness, improve overall health and ensure safety
of people in care, their families and communities.
5. Review the array of services provided to individuals
requiring in-patient care to develop specific strategies to
address hospital capacity.
FY 2016 -2017 Goals
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Goal 1:Moving towards an integrated system of care
Service Integration is a significant systems change
process….
“With every act of creationthere is an act of destruction to make room for the new order of things.”
Pablo Picasso
1. Seamless system oversight.
2. Policy that supports best practices through the provision of resources, including funding.
3. Service delivery system provides:
• Co-occurring competent and enhanced services
• Assertive outreach and engagement
• Person-centered goals for active treatment
• Skill development and support to manage one’s illness
• Recovery services and supports.
4. Data-driven decision-making to determine what works, what does not work and why to identify/fill gaps in service.
Key Elements to Service Integration
10
Service Integration Accomplishments to Date…
1. Restructured BHA
2. Expanded the role of the Forensic Services Department
3. Reduced Wait List for State Hospitals
4. Began restructuring jurisdiction-level systems management
5. Provided funding and geo-maps to support local capacity building
6. Moved ambulatory SUD services to FFS
7. Developed residential SUD rates and established phased transfer of services
8. Provided technical assistance, support and funding for accreditation
9. 2% rate increase obtained for all providers
10.SUD Roll-over funds made available for the first time
11.Allocated $369,422,508 in funds (Federal and State) to address SUD
12.Maryland received 1115 Waiver to support reimbursement for SUD services and presumptive eligibility. Implementation process developed
13.Developed credentialing requirement for Recovery Residences
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Goal 2:Increasing Access and Quality of Care
• Person-centered approach
• Expanding the Provider Network
• Expanding Services:
8-507 placements;
increasing bed capacity in hospitals;
1115 waiver to support residential care;
presumptive eligibility; tele-health applications Tele-health consultation for pediatricians serving children,
youth and OB/GYNs serving women at-risk or with SUD issues
Enhancing quality within the system of care
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Enhancing quality within the system of care
• Bringing Evidence-based practices to scale
Assertive Community Reinforcement Approach (ACRA)
SBIRT (screening brief intervention and referral to treatment) is being adopted as a routine part of primary care and used in emergency rooms
SBIRT is an Integrated Early Intervention Strategy used for the purpose of identifying, reducing and preventing the misuse, abuse, and dependency on alcohol and illegal drugs.
The primary goals are to improve the health status of Marylanders through the integration of behavioral health and somatic health care services, reduce overdose deaths and promote health equality through the provision of universal behavioral health prevention and early intervention approaches, and to demonstrate increased capacity to treat SUD in underserved regions of Maryland.
SBIRT services are using a Peer Coach model in hospitals
Fatality Review Committees
Prescription Drug Monitoring Program (PDMP)
Goal: reduce Rx drug misuse & diversion
Integrated with CRISP, the state-designated health information exchange
Secure, electronic database with information on the prescribing and dispensing of Rx controlled substances
Data is reported by drug dispensers, including pharmacies and dispensing practitioners
Access granted to healthcare practitioners, licensing boards, law enforcement & specific DHMH agencies
In January 2017, clinical users generated over 189,000 queries in portal and integrationsType of User # of Registered
Users (Feb 2017)
# of Active Users
(% of Registered)
% of Licensees who
are PDMP Registered
Prescriber 22,670 17,569 (77.50%) 67.06%*
Pharmacist 4,149 3,114 (75.05%) 36.73%**
Delegates 3,607 2,117 (58.69%) N/A
Total 30,426 22,800 (74.94%) 67.46%
Enhancing quality within the system of care
Enhancing Access to Care: Expansion of Residential Placements Under 8-507
$4
$5
$6
$7
$8
$9
$10
$11F
Y10
FY
11
FY
12
FY
13
FY
14
FY
15
FY
16
(pro
jecte
d)
FY
17
(bu
dg
ete
d)
Budget Expenditures
in m
illio
ns
In FY 16, Governor Hogan provided an additional $3M to the Justice Reinvestment Act to support residential placements. FY 17 a total of $10.5M was available to support this service.
• Existing Capacity: BHA Contracts with 3 programs for 245 available residential treatment slots
❑ Gaudenzia - 135
❑ Jude House - 45
❑ New Horizons -65
Residential Treatment Program Capacity
Funded Treatment Slots
FY 2015 FY 2016 FY 2017
120
($6M from base budget)
180
($3M from JRA –
July 2016)
240
($1.5M from
Governor’s Budget
– January 2017)
Expanding Recovery Support through Recovery Residences
HB 1411 Requirements:
Department of Health and Mental Hygiene (DHMH) shall approve credentialing entity to develop and administer a certification process for Recovery Residences.
– Establishing processes to administer the application, certification, and recertification process
– Establishing processes to monitor and inspect recovery residences
– Issue certificate of compliance valid for one year
– Submit a list of credentialed entities by October 1, 2017
– Post list of residences on BHA website by November 1, 2017
HB 1411 - Limitations
Not all residences where individuals in recovery for a substance use disorder reside are required to become
certified. A residence must be certified if it:
– Receive funding from the Department; or
– Advertises, represents, or implies to the public that it is a recovery residence.
Implementation Plan for HB 1411 Requirements
• The Behavioral Health Administration (BHA) will be the Credentialing Entity
• Grandfathering process will be available for currently credentialed providers in good standing
• Field Assessors (BHA Consultants) will conduct housing inspections
• Consultation from Florida Association of Recovery Residences (John Lehman) used to develop the credentialing process
• Maryland Association of Recovery Residences will provide - Training & Education and Outreach
Expanding Recovery Supports - Provision of Recovery Residences in Compliance with HB1411
Credentialing
Process
Established
February 2017
Technical Assistance and
Training for Providers
• Service and environmental standards
established based upon the National
Association of Recovery Residence
(NARR) Standards
Technical Assistance
and Training to Providers
March 2017July 1, 2017 November 1, 2017
Establishing credentialing, monitoring and inspection process for
Recovery Residences (N=136 houses with a capacity of 1,271 beds)
Application
Posted on
Website and
Distributed
Applications
Due
Certification
Due for all
Recovery
Residence
Providers
List of
Credentialed
Recovery
Residences
Published
October 1, 2017
• Providers Currently
Holding
Certificates/MSARR
Membership will be
“grandfathered”
Residential Substance Use Reimbursement Process
Medicaid will pay for two 30-day stays in
a rolling calendar year.
An individual can move to another level of
care within a stay as long as there is not
more than a 48 hour break in service.
Only clinical services will be Medicaid
reimbursable.
• ASAM Level 3.3 - $189.44
• ASAM Level 3.5 - $189.44
• ASAM Level 3.7 - $291.65
• ASAM Level 3.7WM - $354.67
BHA will pay for all days over 30 days
within a stay and room and board
($45.84/day).
Transition to Fee-for-Service
Rate
Established
March 2017
Technical Assistance to
grant-funded providers
• Regulations developed and approved
• Reconfiguration of Beacon System
• Build required workflows in Beacon
System
Technical Assistance to
remaining providers
July 2017
• Transition of grant-
funded residential SUD
services.
• Levels 3.3, 3.5,
3.7/3.7D
January 2018
• Transition of grant-
funded residential SUD
services for:
• Pregnant women &
children
• Child welfare
• Drug exposed
newborns
• 8-507
Transition of Residential Substance Use Disorder Services
to Fee-for-Services
January 2019
• Transition of
grant-funded
residential SUD
services.
• Level 3.1
Moving Toward an Integrated System of CareAccreditation and Licensure
Programs will be required to be accredited by January 1, 2018 in order to be licensed.Therefore, License applications must be submitted before January 1, 2018 in order to receive a License before April 1, 2018.
Accreditation
Licensure
• Joint Commission
• CARF
• ACHC
• COA (in process)
• Fire/building codes
• Policy requirements
• Environment of care
• Quality of Care
• DHMH
Goal 3:Building the infrastructure to support system capacity to
collect, analyze and track data to improve service outcomes
Framework for Data-Driven Decision-making
R Reporting
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Data Analysis
Moving towards a Date-Driven Decision-making
Framework
1. Expansion of Outcomes Management System to include SUD
2. Data Briefs developed and distributed
3. Template for county-specific data reports on opioid drug use
and consequences developed
4. Created MD-specific overdose predictive risk model
5. Collected and analyzed non-fatal overdose data
6. Established the Applied Research and Evaluation Unit
CRISP – DATA DASHBOARD
• BHA is working with CRISP to develop data dashboards for overdose-related hospital encounters (HSCRC data) and controlled substance prescribing, dispensing and use.
• The dashboards will include dynamic maps and charts. Users will be able to filter results based on drug classes, geographic levels (state, jurisdiction, zip code) and patient demographics.
• Estimated completion of first versions in June with roll out to DHMH and LHD users soon afterward.
Goal 4:Develop and implement population based efforts to
promote wellness, improve overall health and ensure the safety of people in care, their families and communities
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Opioid Operational Command Center (OOCC)Goal: Reduce the number of deaths related to opioid use
Position Lead Agency NameOOCC Director Governor’s Office Clay Stamp
Admin Support MEMA Lydia Simonaire
Legislative Affairs Governor’s Legislative Office Chris Shank
Lead Public Information Officer Governor’s Communications Team Erin Montgomery
Joint Information Center (JIC) Manager MEMA Charissa Cooper
Legal DHMH Linda Bethman
Position Lead Agency Name
Planning Section Chief DHMH Jessica Goodell
Current Planning Unit DHMH Genevieve Polk
Situational Awareness Group - Data Unit GOCCP Angelina Guarino
Situational Awareness Group – Data Unit DHMH Michael Baier
Situational Awareness Group – Progress Reporting Unit DHMH Smita Sarkar
Future Planning Unit MEMA Kyle Overly
GIS Unit MEMA MEMA GIS Unit
Position Lead Agency Name
Finance/Admin Section Chief DBM Nick Napolitano
Center Costs & Logistics Unit MEMA DonaldLumpkins
Crisis Costs Unit DBM Nick Napolitano
Position Role Agency Name
Operations Section Chief MEMA Elizabeth Jones
Social Services Branch Lead DHR Bethany Brown
Health and Medical BranchLead DHMH Sara Barra
Support MIEMSS Randy Linthicum
Support MIA Joy Hatchette
Public Safety BranchLead MSP Michael Parker
Support DPSCS Zola Rowlette and/or Latawyna Stallworth
Support DJS Terrence Proctor
Education BranchLead MSDE Reginald Burke
Support MHEC Emily Dow
Local Liaison BranchLead MEMA Brian Bauer
Support Baltimore Regional IMT John Scholz
Position Lead Agency Name
Resources Section Chief GOCCP
Opioid Operations Command Center Updates
• The OOCC continues the mobilization phase (0 - 120 days) to engage partners at the state and local level working on heroin and opioid-related initiatives
• OOCC Director continues to have direct dialogue with local efforts and persons-impacted across the state to identify best practices for sharing of lessons learned and coordination of efforts for future support.
• All 24 local jurisdictions have established Opioid Intervention Teams as defined by their local partnerships and need
• Evaluate streamlining the hiring process for Peer Recovery Support Specialists by local health departments, including assessment of the DBM classification and job descriptions
• BHA helped design and contributed to the content on the OOCC website, due to launch in mid May.
• BHA also was the lead on the April 27, 2017 a twitter event sponsored by the OOCC promoting national Drug Take Back Day. The Twitter event produced more than 1.1 million impressions.
Overdose Prevention Initiatives
• Improve epidemiology & strategic planning at state & local levels– Overdose surveillance & data dissemination
– Local Overdose Fatality Review Teams
– Opioid Misuse Prevention Program
• Naloxone training & distribution (Overdose Response Program)
• Reduce Rx opioid misuse & inappropriate prescribing– Prescription Drug Monitoring Program
– Medicaid “lock-in” standardization across MCOs
– Prescriber education
• Targeted outreach to high-risk individuals for treatment & recovery support services– Overdose Survivors Outreach Program
– Medication-assisted treatment and recovery support grant
– Overdose Awareness Campaign
Outreach and Engagement
Public Education – Awareness Campaign
Collaboration with MPT on documentary on recovery from opioid addiction. (Aired February 11, 2017)
Public Service Announcements for TV and movie theaters on:
– Naloxone
– Good Samaritan
– Anti-stigma
Billboards and bus ads on naloxone
Fentanyl alert cards for high risk population
PDMP awareness outreach
Digital Stories covering treatment and recovery, fentanyl, use of naloxone, peers, medication assisted treatment
34
35
• Estimated statewide treatment gap for opioid use disorders is for 29,909 citizens
• Key strategies:
–Support Federal expansion of the pool of prescribers to include Nurse Practitioners and Physician Assistants in addition to physicians
–Expand use of buprenorphine in Opioid Treatment Programs and Outpatient Mental Health Clinics
–Emergency Department(ED) initiative: prescribe buprenorphine in ED and use peers to link to community based providers (N=4 hospitals; Bon Secours, Harbor, Mercy and Franklin Square)
–Buprenorphine induction in SUD crisis beds to be funded by CURE Grant
–Creating statewide consultation service to support prescribers to be funded by Cure Grant
Treat Opioid Dependence - Buprenorphine Expansion
• Created to develop recommendations for managing potential impacts of programs in a community setting and quality of care standards for OTPs. Workgroup membership includes representation from BHA, the Local Addictions Authorities (LAA), Medical Care Programs (MA), Opioid Treatment Programs (OTPs), Community Representatives, and Consumer Advocates.
• Outcomes:
• Needs Assessment Report (2016), which is an analysis of treatment needs and capacity required to meet the need in each jurisdiction of the state .
• LAAs provided data to identify areas in which additional OTPs are needed. This information is shared with potential providers who are required to notify LAAs prior to submission of licensure applications.
• Compiled best practices in managing potential the impact of programs on a community.
• Obtained agreement from the Board of Professional Counselors to require specific CEUs to increase counselor competence in Medication Assisted Treatment.
• LAAs required to participate in audits, complaint investigations, and monitoring quality of care as a Condition of Grant Awards.
• Created quality of care standards in areas of staffing, training, use of the PDMP, medical coverage and treatment of individuals with co-occurring disorders.
Treat Opioid Dependence – Established the OTP Quality of Care Workgroup
Expanding Recovery Support Services
Maryland Recovery Net
State Care Coordination
Continuing Care
Recovery Community Centers
Care Coordination for Pregnant/Postpartum Women with SUD
Detoxification
Supportive Recovery Housing for Women with Children
Expand Recovery Supports
Continuum of Care Program:
Projects for Assistance in Transition from Homelessness (PATH)
Assertive Community Treatment (ACT):
Supported Employment
SOAR
Wellness and Recovery Action Plan
Peer Recovery Support Services
✓accompanying individuals to appointments/12-step meetings and leisure activities
✓providing assistance with completing paperwork for social services and other support services
✓providing assistance/preparation for employment such as shopping for work related clothing coaching to prepare for an interview
Certified Peers (N=108) perform activities aligned with four domains:
✓Advocacy
✓Recovery & Wellness
✓Mentoring & Education
✓Ethical Responsibility
Conducted Peer Listening Sessions
Expand Peer Recovery Supports
• Use of Peers throughout
system: Homeless shelters
Hospitals (N=10)
Peer Hotlines/Warm lines
First Responder/Overdose Calls
Office of Problem Solving Courts
Treatment Centers
Individual Recovery
Medicated Assisted Therapy
Physiological Therapy
Telephone Based Support
Jails/Reentry Programs
Community Outreach
Wellness Programs
Outreach and Engagement
• Assertive engagement by providers
• Community-based case management
Goal 5:Review of the array of services provided to individuals
requiring in-patient care to develop specific strategies to address hospital capacity
1. Improvements in bed capacity realized
2. Developing an implementation strategy to address the recommendations of the Forensic Services Work Group:
– Increase bed capacity
– Increase availability of community crisis services
– Expand capacity of the Office of Forensic Services
– Increase outpatient provider capacity to meet the needs of forensic patients
– Centralize DHMH forensic processes
– Increase education to reduce stigma in both the general public and the mental health treatment community
3. Forensic Services Advisory Council (FAC) established
4. Opened Segue, step-down unit, on Springfield Hospital campus
5. SETT transferred from Perkins Hospital to Springfield Hospital
6. Perkins new unit opened, which established another step-down unit
7. Enhancing service array for individuals who are forensically involved
Addressing capacity Issues in BHA hospitals
44
Actions Taken by DHMH to Address the Hospital Capacity Issue
Activity January February March April May June July August
1. DHMH hires new Behavioral Health Executive Director; CEO at Perkins and
Spring Grove Hospital Center X X X
2. BHA began tracking data weekly to monitor admissions and dischargesX
3. BHA begins an intensive discharge planning process for 98 patients “ready
to discharge.” To date, 69 have been discharged. X
4. Letter sent from Secretary Mitchell informing the judiciary of the issue
related to State hospital bed capacity X
5. DHMH staff in court to defend against finding of contempt X X X X
6. BHA implements a standardized Admissions Policy in all State facilities and
identified “intensive discharge process” for those ready to be discharged
(ongoing monitoring)X
7. Forensic Services Workgroup was convened to develop strategies to
address the capacity issue X
8. The Segue Program, operated by Way Station, opened on Springfield
Hospital campus creating 16 step-down beds X
9. Renovations began to relocate the SETT Unit from Perkins to create 16 in-
patient beds X
10. Forensic Services Work Group report submitted to the SecretaryX
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Activity Sept Oct Nov Dec Jan Feb Mar Apr May June July
1. Recommendations by
Forensic Workgroup Report
reviewed & implementation
strategies identified
X
2. Continued to communicate
with Court Officials and
respond to Court Orders
X X X X X X X X X
3. A Forensic Advisory Board
Convened to monitor
progress and advise
Executive Director
X X
4. Moved SETT unit from
Perkins to Springfield
Hospital campus
X
5. Perkins renovation started)X
6. Closely monitoring
admissions-discharge
process
X X X X X
7. Opened Perkins UnitX
8. Draft central admissions
policy developedX
Actions Taken by DHMH to Address the Hospital Capacity Issue (continued)
46
Addressing Hospital Safety
In response to a FY 17 Joint Chairman’s Report, findings of a Security Needs Assessment were addressed.
• Needs Assessment completed in 2016
• Chief of Police was hired February 2016
• Assures that all security personnel are trained and credentialed to ensure compliance with policy and with Public Safety Article.
• Works with each hospital CEO to assess security needs, assists with recruitment and provides ongoing trainings.
• Salaries of security personnel continues to be a barrier in recruitment and retention.
Moving Forward…Developing FY17-18
Strategic Goals
Mission
Customers
Major goals for this perspective:
• Goal 1
• Goal 2
• Goal 3
Finance
Major goals for this perspective:
• Goal 1
• Goal 2
• Goal 3
Internal Business Processes
Major goals for this perspective:
• Goal 1
• Goal 2
• Goal 3
Learning and Innovation
Major goals for this perspective:
• Goal 1
• Goal 2
• Goal 3
Areas of Focus
Moving Forward……
1. Integrated System of Care Development
Work with jurisdictions to integrate systems management
functions
Continue Transfer of Funds process for residential services
Implement accreditation and licensure
2. Improving Access and Quality of Services
Develop state-wide crisis service system
Establish a recovery-oriented system of care (ROSC)
Develop co-occurring capable and competent service delivery
capacity
Build provider capacity
Expand peer services
Continue efforts to address the opioid crisis
49
Moving forward….
3. Data-collection, Analysis and Tracking• Track impact of Transfer of Funds and accreditation on provide
capacity• Establish dashboards to track progress and identify gaps in services• Determine what is working, what’s not and redirect funding to support
successful efforts• Move towards value-based contracting• Acquire/develop EHR and data-tracking systems
4. Promoting Wellness, Health and Safety• Develop/implement mental health and SUD prevention activities• Continue public education and awareness activities• Continue opioid prevention, intervention efforts
5. Hospital Access• Implement recommendations from the FAC• Centralize Forensic Services
Thank you, and Enjoy your day!