David Evans, Integral Care chief executive officer and Dr. Matt Snapp, Integral Care board chair provided a brief welcome before the panel presentations began.

Affordable Care Act in Texas

Anne Dunkelberg, Center for Public Policy and Priorities associate director

Highlights (PPT)

-80% of 6.2 million uninsured have incomes above 400% of federal poverty level

-89% of 6.2 million uninsured in Texas have incomes

-Early gains include:

• The Pre-existing Condition Insurance Plan
• Young adults can stay on their parent’s policy until their 26th birthday
• Texas’ largest employers got over $425 million to cut early retiree health costs.
• Insurers cannot deny coverage to a child based on the child’s pre-existing condition.
• The Consumer Health Assistance Program has helped thousands
• Small Employer tax credits up to 35% cost of coverage

1115 Medicaid Waiver and Community Centers

Melissa Rowan, Texas Council of Community Centers healthcare policy director

Highlights

- Waivers are intended to test new or existing ways to deliver and pay for Medicaid and CHIP health care services

-Quality-based payment reform new opportunity for mental health

-Texas Health and Human Services Commission wants more transparency with funds, health homes, incentivizing innovation to utilize community resources.

-The Delivery System Reform Incentive Payment Pool (DSRIP) is intended to reduce inappropriate use of ERs, inpatient admissions, potentially preventable readmissions through:

• Infrastructure Development
• Program Innovation and Redesign
• Quality Improvements
• Population Focused Improvements

-Unique role of community centers:

• Public Entity status and mental health authority role
• State and local government funding
• Can submit DSRIP funds as community partner to meet regional goals

1115 Medicaid Waiver and Local Efforts Underway

John Stephens, Central Health chief financial officer

Highlights

• Includes legislatively mandated pharmacy carve-in and dental managed care.
• Preserves upper payment limit hospital funding under a new methodology.
• Regional Health Plan is being developed by local anchoring agency, Central Health.
• Can potentially return $175M more/year for a total of $310M/year in DSRIP efforts
• Requires a local match or IGT (intergovernmental transfer) to draw down federal funds.

Local Network Development

Louise Lynch, Integral Care director of network development

Highlights

House Bill 2439 (2007): Calls for a system of service in which consumers have choice from multiple providers; Requires all Local Mental Health Authorities to assemble a network of service providers by providing management and oversight, ensuring mental health services are provided in their local area, serving as a provider of last resort, and considering public input, cost-benefit and consumer issues

• 2010-2012 Plan Contract Results: Crisis Residential, Crisis Respite, RFAs for Licensed prof's (17), non-traditional (54)

Preliminary results of survey given in 2012: total of 60 respondents

• Most respondents = local providers
• 57% unaware of State law requirements for network provider expansion
• Importance of religious diversity/cultural competency very important to consumers
• Majority ranked availability of additional providers as “Very Important”
• Timely Access ranked as most important factor to consider when choosing provider; mental health services most important service to be provided.
• 65% of respondents said they need services not currently offered at Integral Care

Next steps for local plan:

• Draft plan on website for comment (14 days)
• Consider, respond and make appropriate revisions based on feedback
• Plan feedback requirements:

• Description of stakeholder participation
• Summary of public comments received
• Response to public comments

Q&A

Moderated by David Evans

Question: How does the criminal justice system become involved in access to services?

Answer (David Evans): Integral Care has processes in place where we respond to individuals leaving jails within seven days if we're notified of a mental health diagnosis. Additionally, we are able to now provide services in the jail. Supplementary planning work is being done with the Bureau of Justice grant to do mental health/jail diversion planning as well.

Audience comment: A huge area at the County is with probationers who live with co-occurring disorders- need to improve access for services.

Audience Question: Requests for Spanish counselors – does Integral Care have responsibility to provide diversity language for population?

Answer (Louise Lynch): Yes, absolutely. It is part of Integral Care’s strategic planning efforts (as a strategic imperative) to look at cultural competency, and we are actively working as an organization to utilize best practices in order to effectively serve several population groups. Within our agency, we have a stipend for bilingual employees, among other efforts, which are critical to meeting our goal. We are responsible to have competency in languages across the spectrum – and we are using tools available and looking at targeting recruitment efforts to better meet the demographics of our community.

Audience Question: What would it look like to have wellness as a community center?

Answer (David Evans) – This is an area that we are rapidly expanding at Integral Care. As a community center, it means are involved in disaster preparedness efforts, where we work collaboratively with other critical community agencies to offer our strength sin times of need. Part of an overall community response plan. Additionally, we are leading the efforts for social networking for crisis services, including an online Crisis Chat service. We implemented tobacco cessation policies within the organization in collaboration with the City of Austin and continue to introduce these important new ideas as part of overall wellness for our staff and consumers. The City of Austin health plan will be looking at this area and prioritizing these efforts as part of an assessment.

Audience Question: Where does prevention fit in with everything?

Answer (David Evans) – There are several pilot programs that offer insight in to this arena. There is a new frontier for prevention and wellness initiatives under the Affordable Care Act. At Integral Care, we have expanded our prevention and wellness initiatives to incorporate more holistic approaches to health.

Audience Question: Thinking about children and trauma, what kinds of interventions would be there early on for school-based mental health?

Answer (David Evans):  Understanding that good public information on the nature of illnesses to help families access services early is key. We are very fortunate that our board chair, Dr. Matt Snapp, is a trained school psychologist, who has information that can assist us in these efforts.

Audience Question: Are there some initiatives/challenges in funding services for Intellectual and Developmental Disabilities (IDD)?

Answer (David Evans/Maya Vega, director of IDD): Much of the work we have done has involved working with an array of private providers in our intellectual and developmental disabilities division – more than 80% of services are delivered in partnership with great community organizations. In the IDD division, we had had less than ten individuals a year going to state schools or state institutions, a major accomplishment for our community. Person-centered planning and service coordination is our focus, making it habilitative, not rehabilitative. Medicaid funds almost 85% of IDD services in Texas, and we continue to make strides in meeting the needs of our consumers and families.

Audience Comment: The stigma of mental illness supersedes everything in our community. I think each of us has a badge of honor to wear for being here and learning more.  It’s great to be here to expand awareness.

Audience Question: I’m a private citizen with a child in the YES Medicaid waiver program – I’m trying to tie it all together. How does one transition after services?

Answer David Evans: What we have learned in special education is not to wait until their last year of services to begin planning. Start early in planning for adult services. The wait lists can be long, but if you begin the process early, it can make the transition process that much easier.

Feedback Form: ATCIC survey showed 65% and 62% of problems in system. This mirrors employee unhappiness. How can both dissatisfactions be addressed?

Answer: We are currently working to address these issues through our employee satisfaction workgroup, and continue to make advancements to meet the needs of both consumers and staff.

Feedback Form: What can I do as a private citizen with special needs in mental health issues? Son on the YES waiver, what do we do for Medicaid when he is no longer eligible?

Answer: There are several ways to get involved. Connect with advocacy groups, such as NAMI Austin – they have several resources for family members to address these critical issues. You can learn more by clicking here.

 Feedback Form: Re: ATCIC local network development

-Crisis services must be expanded – long waits at PES not appropriate for clients experiencing psychotic episodes.

-Community outreach must be expanded (MCOT, ACCESS), with in-field medication mgmt.

Feedback Form: 65% of clients think Integral Care do not (sic) have/provide services which they would like. What is Integral Care doing on that?

Answer: Integral Care is engaged in several planning efforts to expand access and integrated services.

Feedback Form: Can you add services/increase capacity to house homeless persons with mental illness? Why did two contracts not have applicants?

Answer: We are actively involved in several housing initiatives, including work with ECHO and the City of Austin, to address this very important, community issue.

Feedback Form: How does one become part of a regional healthcare plan? We are doing alternative healing, yoga, massage, and acupuncture for the benefit of low-income and mental health.

Answer: These details have not been worked out yet. However, you can visit the Central Health website for more information as the planning processes are developed. Find the waiver here.