The Department of Administration made a decision about the Regional Behavioral Health Contract for Maricopa County this week. Deputy Director Cory Nelson explains more about the decision and its impact on the current behavioral health service in his blog.
Posts Tagged ‘RBHA’
The formal protest process regarding our award of the Regional Behavioral Health Authority contract in Maricopa County is finally winding down. The proceedings at the Office of Administrative Hearings (OAH) were completed a few weeks ago, and the Administrative Law Judge (ALJ) issued her recommendation on Monday, concluding that: “Based on the foregoing, it is recommended that ADHS’s award of the 2013 RBHA contract to MMIC shall be affirmed and that Magellan’s appeal shall be dismissed.”
The Recommendation (at the end) says: “In the event of certification of the Administrative Law Judge Decision by the Director of the Office of Administrative Hearings, the effective date of the Order will be five days from the date of that certification”… which suggests that the ALJ’s recommendation still needs to be certified by the OAH Director- and that the effective date of the recommendation would be 5 days after that. At that point the certified recommendation would go to the Arizona Department of Administration for a final determination.
The formal protest process regarding our award of the Regional Behavioral Health Authority contract in Maricopa County is finally winding down. The oral part of the hearing in front of the Administrative Law Judge was completed a couple of weeks ago. The final legal filings are due next week and the responses to those filings are due October 29. At that point, the judge will have everything. After 10/29 the hearing will be completely in the hands of the judge and she’ll determine what her recommendation will be to the AZ Department of Administration.
We expect the recommendation to go to the ADOA sometime in November, but that remains at the discretion of the judge based on all the filings that are received. Once the recommendation from the judge is issued, the ADOA will examine the result (and the evidence) and make a determination about whether the procurement decision stands or not.
Earlier this week the Arizona Department of Administration issued a “Stay Order” for transition related activities connected with the transfer of our Maricopa County Behavioral Health Authority from Magellan to Mercy Maricopa Integrated Care. This isn’t uncommon during protests, and the Stay wasn’t issued on the merits of the award protest. It’s more of a procedural decision that allows ADOA to review all the material submitted by Magellan, ADHS and Mercy Maricopa Integrated Care.
The Stay shouldn’t impact most of our daily business in managing our current contracts. Areas like the Office of Health Care Development and the Office of Individual and Family Affairs will need to restrict their activity related to the transition until the Stay Order is lifted. Our legal staff will also be providing advice on daily work in those areas as it relates to preparation for integrated care versus actual transition of services. More to come…
We’re happy to announce that we’re officially adopting four evidence-based practice models endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA) including Assertive Community Treatment (ACT); Supported Employment; Permanent Supportive Housing; and Consumer-Operated Services. We’re adopting these evidence-based best practice models because they resonate with our core commitment to a system of care rooted in hope and an unwavering belief in recovery. Each of the links above offers additional detail for each model, including (a) building the program, (b) training program staff, and (c) evaluating fidelity to the program.
These four SAMHSA evidence-based practice models will be incorporated into our future Maricopa County RBHA contract… and formal monitoring of fidelity will begin in 2014. We still have a few years left on our contracts in the other regions, but we’ll be encouraging all of our RBHAs and providers that elect to offer the above services and to conduct self-assessments using the fidelity tools in order to establish baseline scores and to drive ongoing improvement in our system of care.
Our point people for the standards are: 1) Assertive Community Treatment: Don Erickson & Nitika Singh; 2) Supported Employment: Adam Robson; 3) Permanent Supportive Housing: Adam Robson; and 4) Consumer-Operated Services: Kathy Bashor & ChazLongwell.
Posted in Behavioral Health
Tags: ACT Adam Robson Assertive Community Treatment Chaz Longwell Consumer Operated Services Don Erickson evidence based practice Kathy Bashor Maricopa County Nitika Singh Permanent Supportive Housing RBHA SAMHSA Substance Abuse and Mental Health Services Administration Supported Employment
Thanks for your patience as we developed our continuity plan for leadership in our Division of Behavioral Health. I know you’re all anxious to hear the transition plan for after Dr. Nelson leaves on August 24. Fortunately, we are very lucky to have so many strong leaders here at the agency, including a really great team of DBHS Branch Chiefs and Bureau Chiefs. Many of you will be key in helping to make this time period a success, and we’ll be looking to you to keep our great momentum going!
We’ve already posted the Deputy Director position and have had interviews underway for the Assistant Director position. I think we’ll move smoothly with filling both of these positions permanently in the near future. In the interim, I’ve asked Cory Nelson, AZ State Hospital CEO to serve as the Acting Deputy Director- and he’s agreed to help out. Cory will spend the next three weeks working closely with Dr. Nelson and the rest of the team and should have no problem getting up to speed- as he’s a quick study. This plan will offer a great opportunity to further strengthen our important link between the Hospital and the community-based behavioral health system. It’ll also bring in additional people-power to DBHS during this incredibly busy time. Cory has a great team at the Hospital as well and they’re up to the task of picking up some of Cory’s day-to-day work there. Donna Noriega will be leading the team at the hospital as Acting CEO and will be working closely with the rest of the leadership team to make sure the great things happening there keep moving forward.
Some may ask why Bob Sorce, our fearless Assistant Director, has not been asked to serve as Acting Deputy Director. While Bob is very capable and no doubt would do a good job in that role, his current assignment in managing the Maricopa County RBHA RFP project is at a critical stage with the expected release of the RFP next month. Given the importance of this project, I am not willing to disrupt the positive momentum that has been building over the last several months by reassigning him to a different position. Bob, along with the rest of the RFP Core Team must continue to spearhead this important work as well as prepare for the monumental changes to health care that are expected on January 1, 2014 when federal healthcare reform is set to kick in. Bob will also serve as back-up to Cory and assist whenever needed. As I have previously said, we’ll continue with our mission as a team and I feel good about the team we have in place.
It’s nice to know that we have a strong team in place throughout the Agency- which gives me comfort that we’ll make it through this transition effectively.
Behavioral Health Services for folks that don’t Qualify for Medicaid
The budget that was just signed includes about $39M in new funding for services for folks with a serious mental illness that don’t qualify for Medicaid. With it, we’ll be able to provide some services like supported employment and housing, peer and family support, living skills training, and health promotion to help folks along their Recovery journey. We’ll also be expanding the list of medications for the folks with a serious mental illness so it matches the list for folks that qualify for Medicaid. Our behavioral health team has already begun working closely with the RBHAs, providers, and members/families to plan for the most effective use of this funding.
Our newborn screening program has been running in the red for the last couple of years- despite the fact that we’ve squeezed just about every efficiency out of the program and are collecting more than 95% of our service fees. The current screening fee is $30 for the 1st (hospital) screen and $40 for the 2nd (which happens in the pediatric office a couple of weeks after birth). These fees haven’t been raised in several years- meanwhile the instruments and reagents we use have become increasingly expensive. We’ve been supplementing the program with Title V funds that really should be used for other more effective purposes. The budget that was just signed allows us to set new fees for the 2nd screen in Rule… and we’ll be starting that process shortly.
County Contribution toward Hospital Patients and Residents
The “Budget Reconciliation Bill” or BRBs included specific instructions regarding how much counties are obligated to pay (50%) for the patients and residents at the Hospital and ACPTC (the sexually violent person’s unit).
Hospital Operating Fund
Despite all our efforts to reduce overtime, cut shift overlap, streamline services and other efficiency measures- our hospital operating fund was headed for big trouble next fiscal year- partly because the Hospital Fund (which had provided funds to operate the Hospital) went dry. The state budget that was just signed rescued us from needing to cut our staffing ratio’s to below Licensing standards (which would have put us in jeopardy of losing Medicare and Medicaid funds). Whew.
Tags: ACPTC ASH Forensic Hospital Behavioral Health Services birth budget Budget Reconciliation Bill employment family support funding Governor health promotion Hospital operating fund housing living skills medicaid medication newborn screening pediatric pediatric office visit peer support pregnancy providers public health RBHA recovery seriously mentally ill service fees sexually violent persons unit SMI state budget Title V Funds
It’s time to step up to the plate if you’re interested in providing clear and concise information about how best to integrate primary and acute healthcare with behavioral health care for folks with serious mental illnesses in Arizona. One of our top priorities in behavioral health over the coming years will be to better integrate physical health and mental health/substance abuse services in Arizona. Why is this a priority you ask? It’s because folks with the most serious mental illnesses die at least 25-30 years earlier than the average Arizonan. Physical and mental illnesses are often linked- and when left untreated, folks can experience lost productivity, unsuccessful relationships, significant distress and dysfunction; it can also affect how well they care for their kids. You can check out several recent blog posts on this topic for more information about where we’ve been and where we’re going.
One of the ideas that our interagency integration steering committee has been exploring over the last several weeks is shifting to a service model that includes contracting with managed care organization(s) to serve as a Specialty Regional Behavioral Health Authority that would also include a health home for folks with serious mental illness. The initial idea includes the potential for moving ahead with this new model as we implement the next major behavioral health contract in Maricopa County beginning October 1, 2013.
The team is inviting interested folks and organizations to provide concise input over the next few weeks by replying to our newly released Request for Information. In addition, our team has put together a nifty integration website that provides a cornucopia of data and information about integrating primary and acute healthcare with behavioral health care. On the main page, you can click on the icon for the Specialty RBHA and follow along as work continues on the health home planning grant and the research into a Specialty RBHA. Additional Stakeholder input will be getting underway in the coming weeks and months as well.
You’ll remember that ADHS and AHCCCS jointly applied for and received a $750K Planning Grant to explore integrating primary health care and behavioral health care- especially for folks with serious mental illnesses. Our teams have been very busy over the last couple of weeks getting the initiative underway. One of the concepts we’re exploring is a specialty Regional Behavioral Health Authority (RBHA) containing a Serious Mental Illness (SMI) Health Home.
Our Interagency Steering Committee is exploring the feasibility of contracting with managed care organization(s) to serve as a Specialty RBHA with SMI Health Homes in Maricopa County beginning October 1, 2013. The team has been working hard on a Request for Information (RFI) that we expect to release in the very near future to help us with our planning. Meanwhile, our IT web design folks have been putting together a new website that should be ready to roll out next week. Additional Stakeholder input will be getting underway in the coming weeks and months as well. Stay tuned!
We recently extended our contract with the Regional Behavioral Health Authority in Maricopa County through September 30, 2013. We authorized the contract extension (which will be the 6th year of the contract) so that we can better serve our members and families while we hammer out the details of several new initiatives designed to improve the quality of the services that we provide in the behavioral health system. Several large-scale initiatives are just getting underway and we have important details to iron out before we put out the next contract Request For Proposal (technically called the Maricopa County RFP).
For example, you’ve heard me talking about our commitment to improve health and wellness for folks with serious mental illnesses by better integrating psychiatric and physical healthcare. To move forward, we’ve (ADHS and AHCCCS) applied for and received a Health Homes Planning Grant to plan for implementation of health homes for adults with serious mental illness. There’ll undoubtedly need to be significant changes to the RFP based on the outcomes of this work, and this extra year will give us an opportunity to include results of the planning grant in that next RFP.
In addition, because of the current (and continuing) budget crisis, the parties in Arnold v. Sarn agreed to stay the court orders until June 30, 2012. During the stay, we all agreed to negotiate revised court orders. Over the past several months, we’ve been conducting dozens of focus groups with adults with serious mental illness to help inform and set priorities for the new court orders. Our negotiations will take place this summer and they’ll most likely continue into 2012. The framework for the new court orders will also help shape the language in the new RFP. Lastly, there are some significant Medicaid reforms proposed (or already being implemented) for Arizona, as outlined in the Fiscal Year 12 budget that will potentially have an impact for the next RFP.
The bottom line is that this extension will allow us to issue a thorough, well-researched and comprehensive RFP so we can achieve our ultimate performance objectives of integrating care and incorporating new court orders while maintaining continuity of care and preventing a disruption in services. The agreement we signed outlines other initiatives impacting this decision to extend the current contract and indicates that we’ll be carefully evaluating the progress on the Health Homes Planning Grant.