Proposed Budget Amendments Would Benefit Mental Health Services

On October 25 at 5:30 in room 354 of the City/County Building, Supervisor Heidi Wegleitner will present budget amendments to benefit human services at the Health and Human Needs Committee.  Here are the items.

HHN-O-09 (Wegleitner)
Increase operating expenditures by $780,000 to fund supportive services for affordable housing admissions and continued occupancy for persons on the Homeless Services Consortium of Dane County’s Priority List, including homeless veterans (42), chronically homeless (268), and homeless youth (71).

Other related amendments
HHN-O-01 (Levin)
Increase expenditures by $30,000 to expand HUD coordinated entry to areas outside the City of Madison.

HHN-O-07 (Wegleitner)
Increase operating expenditures by $300,000 to provide one buss passes for some of the 22,227 SNAP case units.

HHN-O-08 (Wegleitner)
At the end of fiscal year 2018, any surplus of deficit of general purpose revenue in the Human Services Fund, net of any deficit or surplus in the Badger Prairie Fund, shall be retained in the Human Services Fund. Any surplus will be applied in fiscal year 2019 to support programs of the Human Services Department. Only by a 2/3 vote of the County Board may surplus funds from the Human Services Reserve Fund be appropriated for other purposes.

HHN-C-01 (Wegleitner)
Increase expenditures and borrowing proceeds by $8,000,000 for planning and development of one or more 24/7 community-based crisis, assessment, and resource centers focused on supporting persons in the community, and diverting persons with mental health, substance abuse, or developmental disability issues who have contact with law enforcement from being arrested and/or admitted to
the County jail.

NOTE: Annually, approximately $6 million is transferred from the Human Services Fund to other areas of the Dane County budget.  The sheriff’s department often is the recipient.  The proposed budget amendment would keep any surplus in the Human Services Reserve Fund unless 2/3 of the county board approve a transfer.

UPDATE:  The amendment for planning and development of community-based crisis, assessment and resource centers failed.   An amendment for $40,000 for bus passes passed.

 

Walker Raises Medicaid Reimbursement Rates for Mental Health and Substance Abuse Services

Wisconsin’s rates have long been among the lowest in the country.  The result is that mental health services are curtailed because of lack of availability of those who can afford to provide the services.  See “Voices from the Front Lines: NAMI’s Lindsay Wallace” for a discussion of how the low rates affect people with mental illness in Dane County.

Gov. Walker has just announced that rates will be raised next year.  According to him, they will be competitive with those in neighboring states.  Click here to read the press release.  Here are excerpts.

“This morning, at the 13th Annual Mental Health and Substance Use Recovery Training Conference in Wisconsin Dells, Department of Health Services Secretary Linda Seemeyer announced an investment of about $17 million, including $7 million in state funding, to raise rates for professionals providing outpatient mental health and substance use disorder services.”

“Effective January 1, 2018, Wisconsin Medicaid will increase reimbursement for outpatient mental health and substance use disorder treatment. This policy change will increase the maximum allowable fee for each covered outpatient service, and simplify the current rate structure, moving from five different fees per service to two fees per service. The new rates are competitive with border-state Medicaid programs and Medicare reimbursement, supporting growth of the Wisconsin provider workforce.”

Click here to read a story in the Milwaukee Journal Sentinel that describes reactions by advocates to the increase.

UPDATE:  Wisconsin Health News provided this report about the state’s AG’s reaction to the opioid crisis.

“Attorney General Brad Schimel called for increased attention to prevention and higher reimbursement rates for addiction treatment at a Medical College of Wisconsin forum on the opioid epidemic.

‘We’re making great progress but I kind of liken this to a sinking rowboat,’ he said. ‘Law enforcement is bailing it out by arresting drug dealers. Treatment providers are bailing it out by helping people get treatment. But there’s a big hole in the bottom of the boat. And I think this is the most important piece of our efforts, it has to be the prevention side. We’ve got to get this message out to the public and to the medical community.’

Schimel also said that ‘we’re going to commit to dramatically raising the rates at which we reimburse people to provide mental health services’ and addiction treatment services to attract more workers to the field.

He and other attorneys general are putting pressure on insurers to make those changes, he said.”

UPDATE:  Wisconsin Health News (11/29) reported on problems identified by the Wisconsin Hospital Association.  Here is an excerpt from WHN‘s report.

“In comments submitted to DHS in mid-November, the association praised the increase. But they urged the department to add codes for psychiatrists, advanced practice psychiatric nurses and psychiatric physician assistants.

WHA general counsel Matthew Stanford wrote that the lack of codes for those professions is a “significant omission if the goal is to provide a comprehensive outpatient behavioral health reimbursement increase to address access difficulties – particularly Wisconsin’s acute shortage of psychiatrists.”

 

 

New Funding for Jail Diversion and Violence Reduction Stimulates Creative Responses

Nearly a year ago, Madison’s City Council approved $400,000 to fund the first steps of a violence reduction plan developed by the Focused Interruption Coalition.   Three agencies responded to the RFPs issued by the city with proposals that offer both new and  time-tested approaches to reducing recidivism, violence, and the trauma associated with it.

Below are the highlights of the proposals as reported by Abigail Becker in Cap Times. Click here to read “Three Agencies in the Running for Madison’s Long-term Peer Support Program.”

According to the proposal from Nehemiah Community Development Corporation , “Participants would receive peer counseling and case management in addition to help with housing, transportation, access to AODA and mental health services and priority entry into job skills training and placement programs.”

“The program would operate a 24/7 hotline with two dispatchers on call to respond to situations. Each peer support specialist would maintain a caseload of 10 to 15 participants, and services would be provided for no less than six months.”

Madison Urban Ministry (MUM)  would provide participants ” access to community engagement opportunities, peer support and mentoring, employment and housing opportunities and mental health and AODA support.”

MUM’s proposal is particularly strong in terms of job training and opportunities.  An  “innovative element to MUM’s proposal is the urban agriculture employment and vocational training program through the FAIR Initiative. The program would train up to five program participants in literacy and cultural competency skills and local food systems in addition to urban agriculture and entrepreneurial training. Participants would earn $13.01 per hour for the training.

Other employment learning opportunities could be available through FoodShare Employment Training, the Employment and Training Association and MUM’s Just Bakery vocational training program.”   In addition, MUM has a long and successful history offering programs that reduce recidivism.

“Zion City International Church Ministries proposed a program called Renewal After Prison, which is meant to teach skills to make the transition from incarceration successful and to stabilize an individual’s life through support services.”

“Under the program, participants would meet in one of four groups, three time per week for one year and will meet with a case manager until stable. The four groups serve as phases and include the initial transition, integration, family reunification and implementation. After a year, participants who are interested can become a peer support specialist.Under the program, participants would meet in one of four groups, three time per week for one year and will meet with a case manager until stable. The four groups serve as phases and include the initial transition, integration, family reunification and implementation. After a year, participants who are interested can become a peer support specialist.”

UPDATE:  Four city council members are proposing a cut of $250,000 in the $400,000 allocated for this effort.  Click here to read the story.

UPDATE: Nehemiah Community Development Corporation and Madison Urban Ministry were recommended by Madison’s Finance Committee to receive funding.  Click here to read the article.  (The cut of $250,000 was not approved.)

UPDATE:  Dane County DA’s office shows a poor response to the opportunities for diversion through restorative justice.  Click here to read an article in Cap Times.

Parisi Responds to Pressure from Jail Diversion Advocates: Sheriff’s Department Benefits

MOSES and other organizations have fought persistently for the right of people with mental illness to be treated in the community instead of being incarcerated.

County Executive Parisi seems to have heard the words.  He includes a focus on jail alternatives and re-entry services in his most recent budget proposals concerning the Dane County Jail.   But, the meaning remains elusive.  Most of the new funding would go to the criminal justice system.

Here are some of the highlights from Parisi’s proposal, as reported in the Wisconsin State Journal (10/1).   Click here to read the article.

His budget proposal would reduce the total number of beds by 91 which, according to him, “illustrates our commitment to alternatives and services to avoid re-incarceration.”

The new jail would have 64 mental health beds.  It currently has none, resulting in solitary confinement for inmates with mental health problems.  According to Sheriff Mahoney, the proposed space “will allow us to virtually eliminate solitary confinement.”

The budget includes $110,000 for re-entry case management services that would provide peer support counselors to help inmates transition back into the community and offer  help finding housing, mental health or substance abuse treatment services.

The budget also contains $68,000 to hire someone to  coordinate the Dane County Re-Entry Team, which is made up of staff from the Sheriff’s Office and Dane County Human Services.

Sheriff Mahoney’s budget includes $1.1 million for re-entry and diversion staff and programming. That staff would work with the team in the community (budgeted at $110,000) to provide a “seamless handoff” as inmates leave jail.

The budget also provides: $100,000 for a comprehensive review of local mental health resources to identify gaps in services and barriers to access; $100,000 to keep  Safe Haven open, and $15,000 to NAMI-Dane to expand its crisis intervention training course for police, public safety and medical personnel.

The math does not compute for anyone who wants more community treatment and less jail time for people with mental illness.  Sheriff Mahoney gains more than $1 million for diversion and programming.  An unspecified community team is budgeted at about 1/10 that amount for re-entry case management services.  That team is responsible for assisting inmates find mental health services and other help.  Those services receive a zero increase.

ANOTHER LOOK AT THE BUDGET: Here is hopeful language from Parisi’s budget statement concerning the crisis restoration center.

” Recently, there’s been discussion about the feasibility of a Mental Health Crisis Restoration Facility to further our community’s response to mental illness. Done in the context of a more thorough examination of available mental health resources in our community, this concept is worth exploring. A comprehensive review of existing mental health services and potential gaps in services would identify how such a facility could be operated in partnership with health care providers and community organizations. It could also shed appropriate focus on the need for all entities – including our health care providers – to reexamine how current mental health services are accessed and administered. There is room to do better. My budget includes $100,000 for a comprehensive review of existing mental health services in our community. This work will both identify potential gaps while evaluating how a potential Crisis Restoration Center or similar community run facility could help improve care and outcomes.”

 

 

 

 

More Medicaid Reimbursement Woes

Providers of services for children with autism are the latest group to describe the harm caused by the state’s low Medicaid reimbursement rate.

Wisconsin Health News (9/22) includes an interview with Jackie Vick and Mike Miller, the president and treasurer of the newly formed Wisconsin Autism Providers Association.  One of the five goals of the WAPA is to “Increase reimbursement rates for Medicaid treatment.  Low reimbursement rates are the primary cause of client demand exceeding the supply of providers…”

Miller and Vick conducted a survey to see if other providers shared the problem of “putting families in a holding pattern” because of an inability to take more Medicaid clients.  The answer was “yes across the board for all of those providers.”

Miller estimated that over 500 children in the state are waiting for treatment under Medicaid funding.  The lists are growing by 15 to 20 children a week and could total 1,000 by the end of the year.

Vick said that providers have responded to the challenges of the reimbursement rate in different ways.  Some limited the number of Medicaid clients in order to maintain fiscal stability.  A related problem, she said, is the difficulty of hiring therapists and technicians because of the low rate of pay.

She pointed out that access to treatment for young children pays off for them and for  taxpayers.  Vick said, “…the research shows that they make great gains and the lifetime costs of care for a child on the autism spectrum go down.”

The low Medicaid rate affects children with other behavioral health problems.  Here is an excerpt from the Kids in Crisis/Legislative Action Tracker article that was part of a series by USA Today-Wisconsin (June 2016)

There is evidence that Wisconsin’s Medicaid reimbursement rates – among the lowest in the country – are shutting children out of accessing outpatient behavioral health care and leading to higher costs associated with emergency psychiatric care.

A report by Milwaukee’s Public Policy Forum found that in Milwaukee County, low reimbursement rates were stopping mental health providers from accepting Medicaid patients. A 2014 survey by the Wisconsin Statewide Medical Home Initiative found that only 20 percent of Wisconsin pediatricians said they could find therapists when needed for their patients on Medicaid, and just 5 percent could find psychiatrists for patients on Medicaid.

Check out “Voices from the Front Lines: NAMI’s Lindsay Wallace” on this blog for a report on how people with mental illness in Dane County are affected by the rate.

Click here to read a study by Pew Trusts that reports experiences of states that supplemented Medicaid rates for primary care doctors.

 

 

 

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Look for the Tiny Rays of Sunshine in Walker’s Budget

Wisconsin Health News (9/22) offered comments by advocacy organizations about small steps forward in this year’s budget.  Here are excerpts.  WHN is a subscription service.

“The Survival Coalition of Disability Organizations said the budget would help eliminate long-term care wait lists for 2,200 children with physical, developmental or emotional disabilities. And they called a 2 percent increase in Medicaid personal care rates “an important first step in addressing the workforce crisis.”

“Wisconsin Health Care Association and Wisconsin Center for Assisted Living Executive Director John Vander Meer lauded the budget for including a 2 percent increase for skilled nursing facilities and a $60 million increase for Family Care over the biennium.”

“Linda Hall, executive director of the Wisconsin Association of Family and Children’s Agencies, said the budget makes a “significant investment” in student mental health by providing $3.25 million in new grants along with Medicaid-funded consultation services.”

On the other hand, WHN also reported that Walker vetoed a resolution passed by the Joint Finance Committee stipulating that the state’s requested Medicaid waiver could not be implemented without its approval.  The requested waiver is the most Draconian in the country.

Voices from the Front Lines: NAMI’s Lindsay Wallace

Lindsay Wallace, executive director of NAMI-Dane County, published a blog post that offers a good explanation of how Medicaid reimbursement rates can limit access to care for many people.  She titled her article, “The Quiet Crisis in Dane County Mental Health Services.”   Here it is.

“Recently, we’ve received a high volume of calls on our support line from people on Medicaid who were finding it increasingly difficult to get care. It’s not hard to imagine the frustration and sense of helplessness these individuals felt when every provider they reached out to told them they were no longer accepting Medicaid patients.

As a result of the high volume of calls we were receiving, I’ve spent the last few months meeting with community mental health providers and private practitioners to get a better understanding of why people in need of treatment and on medical assistance (MA) were being turned away.

It became evident that the issue affected individuals on straight MA, or fee-for-service, and not those served through BadgerCare HMO contracts or SSI Managed Care contracts. Under fee-for-service, qualified Medicaid providers are paid for each covered service such as a psychiatric evaluation, outpatient therapy, or targeted case management according to rates set by the state. Currently, the fee-for-service rate paid by Medicaid is, on average, about 50 cents on the dollar.

Over the years, there has been little increase in the reimbursement rate even though the cost for delivering mental health care services continues to rise. With this in mind, providers like Journey Mental Health Center (JMHC), who offers services to many MA clients, have faced significant financial losses.

Lynn Brady, CEO of JMHC, said, “In the past, we used some of the general purpose revenue (GPR) we received from the county to supplement the fee-for-service rate. However, the county has to control their costs also, and no longer allows us to do this. They are focusing county dollars on the uninsured.”

Given the toll the financial losses were taking on JMHC’s budget, they made the decision to no longer admit straight MA (fee-for-service) clients into services from their Central Intake Unit. However, this does not mean that Journey is not seeing straight MA (fee-for-service) consumers. In fact, they are seeing high numbers of them.

Lynn explained, “The difference is that now, straight MA consumers get into service here because they had a crisis and were seen in our Emergency Services Unit.”

The result of the above change? Unfortunately, rates that are not reflective of the full costs to provide services mean straight MA clients must deteriorate to a point of crisis in order to get timely access to care. We know that early intervention leads to the best outcomes but stagnant fee-for-service rates guarantee poorer access to care and sicker adults and children. This is unacceptable.

Though the county and community providers like JMHC have advocated for change, as well as many other human service providers across Wisconsin, there has been no movement in bringing about the needed changes. It appears that this is largely due to the lack of awareness on the part of policymakers about the severity of the issue. This lack of awareness may, in part, be due to the fact that unlike a sudden crisis, poorer access to care has been progressive in nature, happening slowly over time. As a result, there is little to no media coverage of the “quiet crisis”, which often serves as the catalyst for change.

So, where do we go from here?

It’s no surprise the solution is adequate mental health funding to cover the costs of delivering care; however, accomplishing that goal rests with the state. NAMI Dane County and community mental health partners and providers, and other key stakeholders can educate policymakers about the negative consequences poor reimbursement rates have on the people they believe they are covering.

Our greatest asset and most powerful tool for accomplishing this goal is to use our voices by contacting legislators and leveraging relationships with various media outlets. Power in numbers exists when policymakers hear from a large number of their constituents advocating for the policies that ensure those affected by mental illness have access to quality mental health care support and services.”

To stay up to date on this issue, sign up for action alerts at : https://www.namidanecounty.org/policy-issues/.    The website for NAMI-Dane at http://www.namidanecounty.org has information about its advocacy committee and other events.

Check out the post “Low Reimbursement Rates for Medicaid Limit Access to Care” on this blog for more information.