The Office of Mental Health and Substance Abuse Services (OMHSAS) held its fiscal year 2005-2006 budget briefing March 10. Highlights include:
General
- Deputy Secretary Joan Erney emphasized the difficult budget year and the goal of preserving and reforming the safety net for vulnerable Pennsylvanians.
- OMHSAS proposed budget totals $2,864,018,378.
- OMHSAS intends to restructure children’s services and assume fiscal responsibility for behavioral health services. Also under consideration is development of an Office of Disabilities.
- A cost-of-living-adjustment (COLA) is included for direct care workers at 2 percent ($5.8 million) and the COLA that was provided last year is annualized in an effort to address salary disparities between state and community employees in behavioral health services.
- Pharmacy benefits for Medical Assistance recipients are limited to six prescriptions per month and only three per month for General Assistance recipients. Behavioral health medications are included, as are multiple prescriptions issued to identify the appropriate medication to be used. Exceptions will be permitted. OMHSAS and the Office of Medical Assistance Programs (OMAP) are considering an exclusion list for certain medications so that, for example, an individual will not have to choose between a behavioral health medication and insulin.
- A preferred drug list (PDL) is planned. Prior authorization will be required for medications that are not on the PDL. A process to influence change in prescribing practices is also being planned.
- OMHSAS and the Department of Aging (PDA) are working together to identify meaningful data on behavioral health needs and services for older adults.
- OMHSAS and PDA are implementing a case review project for older adults to identify gaps in service provision between behavioral health, aging, and physical health services, and to improve coordination and quality of service.
- The Department of Public Welfare wil;l sustain significant administrative cuts.
Mental Health
- Fee-for-service
benefit limitations for adults are included.
- Behavioral health inpatient hospitalization is limited to 30 days annually.
- Partial hospitalization is reduced from 720 hours to 540 hours annually.
- Psychiatric outpatient services are reduced from seven to five hours per month. Medication checks, psychiatric evaluations, and laboratory tests are not included.
- An exception process will be implemented. Exceptions will be granted if the individual would otherwise require a higher level of care, i.e. hospitalization.
- Deputy Secretary Erney stated that she would meet with the affected providers of partial hospitalization services to strategize on reorganization of programs.
- $17.3 million is allocated for Harrisburg State Hospital closure and service area planning. This includes bridge funding to prepare for 135 persons to be discharged; Community Hospital Integration Projects Program (CHIPP) discharges (15 from Harrisburg and 50 from Danville and Wernersville State Hospitals); and funding to support provider performance incentives.
- The physical health inpatient hospital limitation of of admissions per year will not include psychiatric admissions unless they are under a Diagnosis Related Group (DRG) related to a physical health admission.
Drug and Alcohol
- The 2% COLA will be on the Department of Health state dollars line item and will be allocated through the Bureau of Drug and Alcohol Programs.
- OMHSAS is working to streamline requirements for co-occurring disorders programs.
Children’s Services
- Fee-for-service regions will require prior authorization for behavioral health rehabilitation services and residential treatment facility (RTF) admission, which will be done using an Appendix T tool. Children with an autism diagnosis and children in substitute care are not affected.
- Premium payments will be required for "loophole" children. Families with incomes of $40,000+ will be required to make payments. A sliding scale has been drafted with a current maximum of $875 per month. Families object to the rapidity of increase at the $100,000 - $200,000 income level. OMHSAS is working on possible adjustments.
Managed Care - HealthChoices
- Behavioral health managed care is to expand statewide over the next two years, although expansion is not accommodated in the proposed budget. A concept paper will be distributed.
- HealthChoices behavioral health rates will increase as contracts are negotiated. No set amount for increase has been determined.
- Behavioral health services will continue for dual eligibles through HealthChoices.
- Co-pays with accompanying rate decrease are not applicable to behavioral health managed care.
Copies of the OMHSAS budget brief and OMHSAS talking points are available from the links below.
OMHSAS
2005/06 Budget Talking Points
OMHSAS
2005/06 Budget Brief
