Mental Health Mental Health Services for Services for

Transitional Age Transitional Age YouthYouth

Steve ReederSteve ReederMental Hygiene Administration, Adult Services Mental Hygiene Administration, Adult Services DivisionDivision

2012 Maryland Transition Conference Transition Outcomes: From High School to Life Long Learning

Saturday, November 17, 2012

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The Good and Bad News: The Good and Bad News: MHA is not DDAMHA is not DDA

Mental health services are not Mental health services are not accessed in the same manner that accessed in the same manner that DDA or DORS services are accessed. DDA or DORS services are accessed.

The Public Mental Health System The Public Mental Health System functions differently – cannot functions differently – cannot compare systems.compare systems.

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Maryland’s current Maryland’s current Public Mental Health System (PMHS)Public Mental Health System (PMHS) 1115 MA managed care waiver which combines 1115 MA managed care waiver which combines

state general funds and Medicaid under a single state general funds and Medicaid under a single payor system.payor system.

Mental health is carved out from substance abuse Mental health is carved out from substance abuse and somatic care services under the auspices of and somatic care services under the auspices of an Administrative Services Organization (ASO).an Administrative Services Organization (ASO).

Services are provided through a fee-for-service Services are provided through a fee-for-service system by approved providers.system by approved providers.

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Maryland’s PMHS: Maryland’s PMHS: Roles and ResponsibilitiesRoles and Responsibilities

Mental Hygiene Administration (MHA) is the state Mental Hygiene Administration (MHA) is the state mental health authority responsible for the design mental health authority responsible for the design and delivery of public mental health services.and delivery of public mental health services.

Core Service Agencies (CSAs), local mental Core Service Agencies (CSAs), local mental health authorities,health authorities, have the authority and have the authority and responsibility to develop and manage a responsibility to develop and manage a coordinated network of Maryland’s public mental coordinated network of Maryland’s public mental health services in a defined local service area. health services in a defined local service area.

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Core Service Agencies (CSAs)Core Service Agencies (CSAs)

19 CSAs covering all 24 jurisdictions

19 CSAs covering all 24 jurisdictions

Wicomico and Somerset Regional CSA

Wicomico and Somerset Regional CSA

http://www.dhmh.state.md.us/mha/Miscellaneous/csa/MACSA%20Directory.pdf

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CSAs (continued)CSAs (continued) Core Service Agencies provide Core Service Agencies provide

services and resources to consumers services and resources to consumers and families that are not otherwise and families that are not otherwise available through the fee-for service available through the fee-for service Public Mental Health System (PMHS)Public Mental Health System (PMHS)

training and education;training and education; peer support and advocacy; peer support and advocacy; family support and advocacy; family support and advocacy; specialized services for Transitional Age Youth specialized services for Transitional Age Youth

(TAY) (in 12 jurisdictions)(TAY) (in 12 jurisdictions)

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Administrative Services Organization Administrative Services Organization (ASO)(ASO)

Under contract with MHA, the ASO authorizes Under contract with MHA, the ASO authorizes services and provides utilization management, services and provides utilization management, management information, claims processing, and management information, claims processing, and evaluation services.evaluation services.

http://maryland.valueoptions.comhttp://maryland.valueoptions.com

You may contact ValueOptionsYou may contact ValueOptions®® Maryland at the Maryland at the following toll-free numbers:following toll-free numbers:

Call: 800-888-1965Call: 800-888-1965TTY: 866-835-2755TTY: 866-835-2755

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Maryland DHMH

MHA DDA ADAA

OHCQMedicaid

ASO CSAs

ADAA=Alcohol & Drug Abuse Administration DHMH=Department of Health &

Mental HygieneDDA =Developmental Disabilities

AdministrationOHCQ=Office of Health Care Quality

Organizational Chart

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PMHS Eligibility PMHS Eligibility

The adult Medicaid population is eligible for all The adult Medicaid population is eligible for all services within the ‘benefits package’ if they services within the ‘benefits package’ if they meet medical necessity criteria for that level of meet medical necessity criteria for that level of service. service.

The Medicaid-ineligible individuals are eligible for The Medicaid-ineligible individuals are eligible for all services, except inpatient, partial all services, except inpatient, partial hospitalization, and emergency room services, if hospitalization, and emergency room services, if funding is available, the individual meets medical funding is available, the individual meets medical necessity criteria for that level of service, and the necessity criteria for that level of service, and the individual meets any specific eligibility individual meets any specific eligibility requirements such as:requirements such as:

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Eligibility Requirements for Eligibility Requirements for the MA-Ineligible Individualthe MA-Ineligible Individual

The consumer requires treatment for a The consumer requires treatment for a DSM IV TR DSM IV TR mental health diagnosis(es) mental health diagnosis(es) covered by the PMHS, ANDcovered by the PMHS, AND

The consumer has a verifiable Social The consumer has a verifiable Social Security #, AND Security #, AND

The consumer has applied for Medical The consumer has applied for Medical Assistance (MA), Social Security Insurance Assistance (MA), Social Security Insurance (SSI), or Social Security Disability (SSI), or Social Security Disability Insurance (SSDI). AND…Insurance (SSDI). AND…

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Eligibility Requirements for the MA-Eligibility Requirements for the MA-Ineligible Individual (continued)Ineligible Individual (continued)

One of the following: One of the following: The consumer meets the financial The consumer meets the financial

criteria [200% of the Federal Poverty criteria [200% of the Federal Poverty Level (FPL).]; ORLevel (FPL).]; OR

has received services in the PMHS has received services in the PMHS within the past two years; ORwithin the past two years; OR

has SSDI due to a psychiatric has SSDI due to a psychiatric impairment; ORimpairment; OR

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Eligibility Requirements for the MA-Eligibility Requirements for the MA-Ineligible Individual (continued)Ineligible Individual (continued)

Is on conditional release from a Is on conditional release from a Maryland state hospital; ORMaryland state hospital; OR

Recently released from a Maryland Recently released from a Maryland psychiatric hospital, jail, or prison psychiatric hospital, jail, or prison within the last three months. within the last three months.

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Public Mental Health ServicePublic Mental Health ServiceBenefits package includes:Benefits package includes:

Psychiatric inpatient carePsychiatric inpatient care

Psychiatric day treatment (partial Psychiatric day treatment (partial hospitalization)hospitalization)

Residential Treatment RespiteResidential Treatment Respite Outpatient mental health clinicOutpatient mental health clinic

Individual mental health practitioner Individual mental health practitioner servicesservices

Psychiatric Rehabilitation (PRP)Psychiatric Rehabilitation (PRP) Residential Rehabilitation (RRP)Residential Rehabilitation (RRP)

Mobile Treatment ServicesMobile Treatment Services Supported Living ServicesSupported Living Services

Supported Employment (SE)Supported Employment (SE) Case Management ServicesCase Management Services Residential Crisis ServicesResidential Crisis Services

Mental Health related laboratory Mental Health related laboratory servicesservices

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Service Pre-AuthorizationService Pre-Authorization ValueOptionsValueOptions®® of Maryland or the local Core Service of Maryland or the local Core Service

Agency (CSA) can help you find a provider.Agency (CSA) can help you find a provider.

The provider selected will request authorization for The provider selected will request authorization for services on behalf of the consumer.services on behalf of the consumer.

ValueOptionsValueOptions®® of Maryland staff confirms that the of Maryland staff confirms that the request is based on the consumer’s goals and needs. request is based on the consumer’s goals and needs. and that the consumer was involved in the decision. We and that the consumer was involved in the decision. We ValueOptionsValueOptions® ® also ensures that the services also ensures that the services requested meet established medical necessity attendant requested meet established medical necessity attendant to the level of service. to the level of service.

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Service Pre-AuthorizationService Pre-Authorization

In most cases, ValueOptionsIn most cases, ValueOptions®® of Maryland of Maryland authorizes the services to be provided.  The authorizes the services to be provided.  The CSA authorizes SE. CSA authorizes SE.

If services are not authorized, ValueOptionsIf services are not authorized, ValueOptions® ® of of Maryland will work with the consumer and the Maryland will work with the consumer and the provider to find a service that best meets the provider to find a service that best meets the consumer’s goals and needs. consumer’s goals and needs. 

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Service Pre-AuthorizationService Pre-Authorization

The consumer and/or the provider can ask The consumer and/or the provider can ask questions or complain. In addition, the questions or complain. In addition, the consumer and/or provider can also file an consumer and/or provider can also file an appeal if the consumer’s needs are not met. appeal if the consumer’s needs are not met.

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SE is available and accessible to SE is available and accessible to youth at age 16 or two years before youth at age 16 or two years before graduation.graduation.

Best predictor of post-school success Best predictor of post-school success is paid competitive employment prior is paid competitive employment prior to graduation from high school to graduation from high school (mitigates against drop-out)(mitigates against drop-out)

Policy Application to Youth and Young Policy Application to Youth and Young Adults with Mental Health ConditionsAdults with Mental Health Conditions

Maryland was one of three states to implement SE as part of the National Implementing Evidence Based Practices Project, sponsored by the New Hampshire-Dartmouth Psychiatric Research Center and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Evidence Based Practice (EBP) Supported Employment (SE)

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Joint MHA/DORS Joint MHA/DORS application for funding application for funding to Johnson & Johnson to Johnson & Johnson Foundation for Foundation for Dartmouth Community Dartmouth Community Mental Health Program Mental Health Program in SE. in 2002.in SE. in 2002.

Evidence Based Practice (EBP) Supported Employment (SE)

1919

EBP SE Access and AvailabilityEBP SE Access and Availability

2020

Evidence-Based Supported Evidence-Based Supported Employment OutcomesEmployment Outcomes

Consistent rates of 50%-70% Consistent rates of 50%-70% competitive employment for competitive employment for consumers in supported employment consumers in supported employment programs which achieve high fidelity.programs which achieve high fidelity.

DORS closure rates average 65% DORS closure rates average 65% (two to one advantage of EBP versus (two to one advantage of EBP versus non-EBP, though gap improving due non-EBP, though gap improving due to overall increase in service quality to overall increase in service quality and system improvements.) and system improvements.)

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Contact InformationContact Information

Steven A. Reeder, M.Ed., CPRP, CRCSteven A. Reeder, M.Ed., CPRP, CRC

Chief, Evidence-Based Practice Services and Program Chief, Evidence-Based Practice Services and Program EvaluationEvaluation

Maryland Department of Health and Mental HygieneMaryland Department of Health and Mental Hygiene

Mental Hygiene AdministrationMental Hygiene Administration

Spring Grove Hospital Center, Mitchell BuildingSpring Grove Hospital Center, Mitchell Building

55 Wade Avenue, Catonsville, MD 2122855 Wade Avenue, Catonsville, MD 21228

Phone: 410-402-8476 Fax: 410-402-8304Phone: 410-402-8476 Fax: 410-402-8304

E-mail: E-mail: sreeder@dhmh.state.md.us

  

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