DPW: OMHSAS

1
DPW OMHSAS

• Unified Systems Update
• January 15, 2005
• Pennsylvania AMI

2
OMHSAS Background

• County Government legislatively grounded and
  uniquely positioned to manage local systems of
  care primary objective to integrate program and
  fiscal accountability.
• 46 County MH/MR Programs
• 1966 MH/MR Act
• 9 State Mental Hospitals 1 Long Term Nursing
  Care Restoration Center
• Closed or Consolidated 5 (five) state hospitals
• Eliminated State Hospital capacity for children
  adolescents
• Discharged 2,236 individuals through Community
  Hospital Integration Projects Program (CHIPP)
  with funding of 167M through 44 county programs
• 49 Single County Authorities
• DOH State Plan for Drug Alcohol establishes
  Local Single County Authority (SCA)
• DOH Bureau of Drug and Alcohol Programs is Single
  State Agency for purposes of Federal Block Grant
  Funding
• 25 HealthChoices Counties
• 24 of 25 counties accepted HealthChoices contract
• Variety of models including full risk county
  contracts subcontracts with Administrative
  Services Organizations and full risk
  subcontracts.

3
Unified Systems Strategy

• Background
• Community Hospital Integration Projects Program
  (CHIPPS Dollars follow person into Community)
  (1991)
• Develop County Based Medicaid state plan services
  utilizing county base funding for state match
  (1990-91)
• Streamline appropriation (Community/Hospital
  Appropriation) (1993-94)
• ACT 152 dollars administered by OMHSAS (1996-97)
• BHSI funds established and administered by OMHSAS
  (1997)
• HealthChoices Behavioral Health Program
  Administered by OMHSAS (1997)
• HealthChoices County Right of First Opportunity
  (1997)
• OMH changes name to OMHSAS (1998)
• HealthChoices Expansion to Southwest (1999)
  Lehigh/Capital (2001)
• Area Planning Initiatives County Planning
  Initiatives re-energize unified systems
  approach/strategy (2003-04)
• Childrens Integrated Planning (2004-05)
• HealthCare Reform Behavioral Health Initiative (
  2004-05)

4
Major Objectives
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OMHSAS Objectives 2005/2006
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OMHSAS Objectives 2005-2006
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OMHSAS Objectives 2005-2006
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OMHSAS Objectives 2005-2006
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OMHSAS Objectives 2005-2006
10
HSH Closure Why Now?

• First and Foremost- moving people from
  institutional settings to more integrated
  settings is the RIGHT thing to do
• Consumer/Family Support
• Presidents Commission
• National Perspective California, Ohio
• Olmstead/State Litigation
• Builds Community Infrastructure for long term
  impact
• Dollars redirected to County Government
• Services developed through HC allow for FFP
• Unified Systems Strategy braiding multiple
  funding streams to support people/programs
• Provide experienced staff resources to the
  community
• Promotes Statewide Solution
• Proposal supports state as well as area planning
  efforts for downsizing and refinancing community
  systems across the state
• Promotes regionalization/consolidation efforts
  across hospitals and systems

11
Community/State Hospital Systems Reform
12
Community/State Hospital Systems Reform
State hospital per diem costs are calculated
annually (April) by the DPW Office of Budget,
based on Cost Apportionment Reports, Statements
of Financial Status and Medicare Cost Reports.
Total allowable costs are divided by total
patient days to yield a per diem cost for each
hospital. Separate per diems are calculated for
each level of care, General Psychiatric, Long
Term Care (South Mt.) and Forensic (Norristown,
Mayview and Warren). The graph above shows the
average per diem for General Psychiatric Care in
the nine state hospitals.
13
Community/State Hospital Systems Reform Where to
Start ?

• Closure of Harrisburg State Hospital Campus
• Environmental Scan
• Clinical and Environmental Impact assessment
  performed
• 50 of individuals served LOS under 2 years
• County experience with CHIPPS
• Minimal economic impact on community
• Alternative state employment for the affected
  staff at Harrisburg State Hospital
• Options for extended-acute care and treatment
  services in community hospitals to serve
  individuals who are now being treated at
  Harrisburg State Hospital ability to increase
  capacity at alternative state hospitals within 1
  hour radius
• Campus infra-structure and potential opportunity
  for alternative governmental and non-governmental
  uses
• Majority of counties in HealthChoices
• Mold abatement issues at HSH
• Target Closure for completion in December 30,
  2005

14
Community/State Hospital Systems Reform

• Closure of Harrisburg State Hospital Campus
• Current Budget 41,487,951
• Current Individuals Treated at Hospital 260
• Current Staff Complement 559 ( as of 6/30/05)
• Counties Served Dauphin, Cumberland, Perry,
  York, Adams, Franklin, Fulton All except
  Franklin/Fulton in HealthChoices
• Discharge Plan
• FY 04/05 CHIPP
• 15 individuals discharged through current CHIPP
  initiative
• FY 05/06 Budget Request to facilitate closure
• Transfer 50 individuals to Danville State
  Hospital
• Includes a 20 person CHIPP
• Transfer 60 individuals to Wernersville State
  Hospital
• Includes a 30 person CHIPP
• Discharge 135 individuals to Community

15
Community/State Hospital Systems Reform

• Financial Strategy
• Support Community Infrastructure through
  community base, state hospital funds,
  HealthChoices, FFS Medicaid and reinvestment
• Extended Acute Community Treatment Teams, and
  other treatment and rehabilitation services
  supported through MA
• Community Housing, Specialized Personal Care
  Services, Supportive Living Options, Vocational
  Supports, Peer to Peer, Warm Line, Club House and
  Drop- In Center. In Haverford Closing,
  approximately 90 of closure dollars used to
  support these services approximately 4,000 per
  person MA expenditures

16
Performance Based Initiative

• Quality Management structure established
  including performance benchmarks. Financial
  Incentive pool attached to performance measures
  and POMS
• Current Measures
• Access
• Example of individuals with SMI ( which would
  incorporate our CHIPP recipient) receiving mental
  health services substance abuse services and
  co-occurring
• Quality of Process
• Example Older adults with psychiatric inpatient
  readmission rates within 30 days of discharge
• Quality of Outcomes
• Example Changes in independence of Living (
  community tenure)

17
Community/State Hospital Systems Reform

• Implementation Plan ( current activity)
• Project Manager and Internal implementation Team
  Established
• County Meeting Held Meeting Outcomes
• Primary Point of Contact Established
• Review of Draft Implementation Plan
• Issues Identification
• Establishment of Advisory Structure
• PMHCA, NAMI-PA, PPA, MHA will identify local
  reps
• County representation
• Aging, DA, rep
• Other
• Assessment Teams
• CSAT to assist in co-ordination of consumer teams
• CSAT to work with HSH staff and counties to
  establish training, protocol for assessments
• Assessments to begin late January/early February

18
Community/State Hospital Systems Reform

• Implementation Plan ( current activity)
• Public Hearings
• Dauphin County Hearing 1/12
• State Hearing 1/27
• Service Area Plan Update
• State/County Review of Service Area Plan requests
• Assessment of Regional Service Development
• Establish extended acute capability
• DOH workgroup
• Contact with local hospitals
• Quality Management/Monitoring
• Data Base of individuals currently at HSH
• CHIPP monitoring
• Service Area Plan Objectives
• Staff Update ( office of administration lead)
• Meetings Held with all staff
• Unions Notified

19
County Plans

• OMHSAS Advisory Committees

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County Plan Process

• A project to revise the County Planning Process
  began in 2002
• Stakeholder feedback included
• Plans need to be meaningful
• Plans need to be based on data, not wish lists
• Plans need to be tied to funding
• Consumers, families need to be involved in every
  step of process
• State needs to provide feedback

21
County Plan Process

• New Planning Process includes
• New timelines to coincide with state budget cycle
• Consolidates plans (service area and county and
  Chipps) into one document
• Includes a formal review instrument on the plan,
  face-to-face meetings with each county and
  feedback process for ongoing improvements at the
  local and state level

22
County Plan Summary

• OMHSAS is drafting the 1st annual report on
  county mental health plans
• Timeline for issuing the report is Nov/Dec,04
• The annual report will summarize four attachments
  to the county plans and list trends noted during
  the County Plan reviews.

23
Plan Review Trends

• Counties participated in the onsite visit with
  OMHSAS and most had both consumers and family
  members present at the meetings.
• All counties support the recovery philosophy and
  were interested in receiving any
  information/training available to assist in
  moving the local system in that direction.
• Concerns were raised in both HealthChoices and
  non HealthChoices counties in regard to the
  ability to financially support recovery oriented
  programs that may not fit into the current
  Medicaid medical model within Pennsylvania.
• Housing issues were common among most counties as
  well as transportation and meaningful employment
  for consumers.
• Continued emphasis on stakeholder involvement is
  needed.
• There was very little focus on Redesigned Funding
  and Reinvestment in the plans.
• Quality Management needs strengthening.

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Plan Review Trends

• Cultural Competency needs strengthening
• There continues to be confusion regarding the CSP
  Indicators Checklist and requests for a revised
  checklist.
• The Counties and the regional staff should
  participate in Recovery Training within the next
  year to become versed in components of developing
  and building a recovery system.

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Summaries to be Included In Report

• Attachment H TOP FIVE SYSTEMS CHANGES
• Change to a Recovery Oriented system (20
  counties)
• Forensic initiatives (12 counties)
• Changes/additions to case management (9 counties)
• Additions to psychiatric services (9 counties)

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Summaries to be Included In Report

• Attachment K - TOP FIVE NEW SERVICES THAT REQUIRE
  NEW STATE FUNDS
• Residential/housing services (39 counties)
• Psychiatric/outpatient services (16 counties)
• Psychiatric Rehab (14 counties)

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Summaries to be Included In Report

• Attachment L - COUNTY DEVELOPMENT OF SYSTEMS THAT
  SUPPORT RECOVERY/RESILIENCY
• Many counties have or are moving forward in
  developing a recovery/resiliency supporting
  system by developing respite, additional CFST
  capacity, drop-in centers, advocacy, student
  assistance programs, and outreach to older
  adults.

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Summaries to be Included In Report

• Attachment M - QUALITY MANAGEMENT ACTIVITIES
• CFST development/enhancement (28 counties)
• Monitoring of providers (19)
• QM meetings/reports/action plans (19 counties)

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OMHSAS Updates

• Upcoming Activities ( just to name a few)
• Service Area Plan Written Feedback
• Revised County Plan Guidelines
• Managed Care Discussion Paper
• Integrated Childrens Planning MA realignment
• BH Childrens Workgroup
• Outpatient regulation Workgroup