The Office of Mental Health and Substance Abuse Services (OMHSAS) held a budget briefing March 9 highlighting key issues for fiscal year (FY) 2006/07. Details of the budget are available in the Governor’s Executive Budget for Fiscal Year 2006-2007 – Department of Public Welfare (the bluebook) on the Department of Public Welfare (DPW) web site (www.dpw.state.pa.us, keyword bluebook). Information relating to mental health services can be found in several sections: Mental Health Services (p. 76), Medical Assistance – Outpatient (p. 123), Medical Assistance – Capitation (p. 160), Medical Assistance – Inpatient (p. 146), Special Pharmaceutical Service (Mental Health) (p. 200), Behavioral Health Services (p. 271), Program Revision Request – Increasing the Efficiency and Integrity of the Medical Assistance Program (p. 173), and Community Mental Health Block Grant (p. 411). The OMHSAS budget briefing handout is also available on the web site (www.dpw.state.pa.us/General/FormsPub/MentalHealthPublications/003672619.htm).
Mental health issues highlighted by OMHSAS Deputy Secretary Joan Erney at the OMHSAS budget briefing and by DPW Secretary Estelle Richman during the House and Senate DPW Appropriations Hearings were as follows.
Medicare/Medical Assistance
- The increasing aging and disabled populations of Pennsylvania will cause higher demand for DPW services.
- DPW will pay $348 million to the Centers for Medicare and Medicaid Services (CMS) for Medicare Part D implementation. DPW is considering joining litigation that questions the authority of the federal government in requiring states to pay for a federal program.
- OMHSAS is very concerned that behavioral health provider networks for most plans are insufficient to meet need, although Medicare Advantage Plans are required to have adequate network capacity to serve enrollees. Medical Assistance is the payer of last resort and Medicare should pay for Medicare covered services, but it can be difficult to access behavioral health services paid by Medicare.
- Providers who serve a dual eligible clientele will be required to become certified as Medicare providers.
Managed Care
- It is unlikely that CMS will approve DPW’s request for a preferred drug list (PDL) for HealthChoices managed care organizations. Therefore, DPW is considering carving out the pharmacy benefit from HealthChoices. If the PDL is not approved a $40 million shortfall to the budget is projected.
- A four percent capitation increase is in the proposed budget for HealthChoices.
- DPW will roll a payment cycle for managed care, both behavioral and physical health, into the following fiscal year. Instead of being paid mid-June payment would be received mid-July.
- HealthChoices
for behavioral health will expand statewide. All counties are offered the
right of first opportunity.
- Counties accepting the right of first opportunity are Blair, Cambria, Erie, Bedford-Somerset, Crawford-Mercer-Venango, Carbon-Monroe-Pike, Lycoming-Clinton, and Northumberland. The planned implementation date is July 2007.
- Counties in the single state-administered zone are Bradford, Sullivan, Cameron, Elk, Center, Clarion, Clearfield, Jefferson, Columbia, Montour, Snyder, Union, Forest, Warren, Huntingdon, Mifflin, Juniata, McKean, Potter, Schuylkill, Tioga and Wayne.
- The Franklin/Fulton joinder is in question and had not yet indicated a preference by March 9, the date of the OMHSAS budget briefing.
- There are 158,000 individuals covered in the state contract if Franklin/Fulton is included. The request for proposals for the state contract will be issued March 15 with implementation projected for January 1, 2007.
Cost-of-Living Adjustment (COLA)
- A two percent COLA for mental health includes a COLA for the Community Hospital Integration Plan Program (CHIPP).
- The 2005/06 COLA for direct care workers was annualized at $5.8 million.
State Hospital/Community Integration
- 2005/06 CHIPP is annualized at $17.2 million for 193 persons.
- State hospitals are to discharge 10 persons from Wernersville and 10 from Danville. An additional 60 discharges are anticipated statewide. Consolidation in administrative functions will occur between the state hospitals.
- Spending on Act 21 was set at $2.5 million to serve seven individuals.
Other
- DPW will focus on fraud and abuse and third party liability to husband resources.
- Structured treatment services – room and board will be retained in county base funds. Services will be moved to Medical Assistance with federal match. This should free $2.5 million for use on services other than Long Term Structured Residences.
- OMHSAS will find administrative savings through staff attrition and unfilled vacancies.
- The Behavioral Health Services Initiative (BHSI) is funded at $12 million, but 2006/07 is the last year for the intragovernmental transfer funds.
- The Drexel University contract for education and training programs continues.
- Psychiatric rehabilitation is not included in a state plan amendment, but there are currently 22 psychiatric rehabilitation programs in Pennsylvania. When HealthChoices expands statewide, psychiatric rehabilitation is seen as a cost effective alternative to partial hospitalization programs.
- Incident Management is moving forward for July implementation. There is no money available for information technology upgrades. Instead, existing HCSIS resources will be used.
- Listservs are being considered as a means for communication about OMHSAS issues. The DPW web site is difficult to use.
- The Network of Care system is available for counties to share information and may be a viable option for tracking advance directives.
- The “loophole” waiver has not been approved by CMS, but the proposed budget does assume that there will be an impact.
- OMHSAS is pursuing inclusion of buprenorphine on the preferred drug list and the health plan formularies.
- OMHSAS has indicated that CMS is questioning whether to continue its support for peer support waivers.
- The OMHSAS Housing Task Force will discuss housing and supports as separate issues.
- Some issues that OMHSAS is investigating are: Medical Assistance transportation in rural areas, telepsychiatry, including transportation in rates, and transportation for employment.
For additional information contact Betty Simmonds at PCPA.
