Mental Health Redesign Senate File 2315

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Mental Health RedesignSenate File 2315

• A Provider Perspective
• on Core Services

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Core Services Eligibility

• Persons in Need of Mental Health or Intellectual
  Disability Services Only
• Persons Age 18 or Older
• Resident of the State of Iowa
• Income Equal To Or Less Than 150 Federal Poverty
  Level
• Person has no other form of funding, such as
  Medicaid or private insurance (must apply if
  eligible)

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Definitions

• Intellectual Disability
• Having a significant sub-average intellectual
  functioning (I.Q of 70 or below)
• Onset prior to age 18
• Accompanied by significant limitations in
  adaptive functioning in at least 2 areas
• SF 4427 Replaced the term Mental Retardation with
  Intellectual Disability

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Definitions, Continued

• Mental Illness
• Includes persons with psychosis, persons who are
  severely depressed, and persons with any type of
  mental disease or mental disorder, except that
  mental illness does not refer to intellectual
  disability, or to insanity, diminished
  responsibility, or mental incompetency as defined
  and used in the Iowa Criminal code or in the rule
  of criminal procedure

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Core Services Defined

• A Core service is a service that must be
  available in each REGION, not each COUNTY
• Current plan is for Counties to begin paying for
  Core services July, 1, 2013
• Regions only have to fund the services IF FUNDING
  IS AVAILABLE
• Regions can choose to fund other persons and
  other services if funding is available

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Providers of Core Services

• Must show competency in
• Serving persons with co-occurring conditions
• Providing evidenced-based services
• Providing Trauma Informed Care that recognizes
  trauma symptoms

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Core Services Defined

• At this time, there are no specific definitions
  for each Core Service
• Strict or narrow definitions might exclude more
  flexible, individualized approaches to service
  provision
• - Lack of definitions makes it difficult for
  providers to develop new services in a timely
  manner, or to know what currently exists in their
  region

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Core Service Domains (including, but not
limited to..)

• Treatment design to ameliorate a persons
  condition
• Assessment and Evaluation
• Mental Health outpatient therapy
• Medication prescribing and management
• Mental health inpatient treatment

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Core Service Domains Cont.

• Basic Crisis Response Provisions
• Twenty-four hour access to crisis response
• Evaluation
• Personal emergency response system

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Core Service Domains Cont..

• Support For Community Living
• Home Health Aide
• Home and Vehicle Modifications
• Respite
• Supportive Community Living

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Core Service Domains Cont..

• Support for Employment
• Day Habilitation
• Job Development
• Supported Employment
• Prevocational Services

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Core Service Domains Cont

• Recovery Services
• Family Support
• Peer Support

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Core Service Domains Cont

• Service Coordination
• Case Management
• Health Homes
• This includes coordinating physical
• health and primary care

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Core Plus Possibilities

• IF funding is available, potential additional
  services may include
• Crisis services, such as mobile crisis, 24
  hour hotlines, 23 hour observation and holding,
  crisis residential services, crisis
  stabilization, sub acute services in facilities
  and community. Jail diversion, crisis training,
  commitment prescreening, peer drop in centers,
  ACT, positive behavior supports, etc.

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Areas To Address in this Legislative Session

• Funding Funding Funding
• Transportation to Regional Services
• Time to Develop Programs, train staff
• Rate Setting for New Services
• Staff Shortages
• No procedure for what provider will provide what
  service in which county and when
• Disagreements related to current Core list

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Areas to Address in this Legislative Session
Cont.

• No mention of Residential Care Facilities as a
  Core or Core Plus service
• No mention of psychiatric provider shortages
• No mention of psychiatric bed shortages
• No mention of below cost rates for some current
  core services, such as employment services
• Variations within region related to what services
  each County has funded

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Opportunities

• New services to areas of the State that truly
  need them
• End of legal settlement may decrease the
  pre-services paperwork time, allowing providers
  to streamline intake
• Rare that this much attention paid to mental
  health needs in Iowa
• Still time to advocate! Get Involved!