SERVICES AND FUNDING OVERVIEW PREPARED BY THE FISCAL ANALYSIS - PowerPoint PPT Presentation

STATE PROVIDED BEHAVIORAL HEALTH CARE SERVICES AND FUNDING OVERVIEW PREPARED BY THE FISCAL ANALYSIS DIVISION OF THE LEGISLATIVE COUNSEL BUREAU JANUARY 30, 2019

STATE PROVIDED BEHAVIORAL HEALTH SERVICES CHANGES OVER THE LAST FIVE YEARS 2

STATEWIDE MONTHLY CLIENTS BY FACILITY TYPE 270 Statewide Forensic Clients (Lake's Crossing & Stein Hospital) 220 214 Statewide Civil Psychiatric Clients (Rawson-Neal & Dini-Townsend) 213 220 204 Average Monthly Clients 162 170 152 145 142 136 140 134 138 137 137 137 134 137 134 133 132 126 125 123 114 113 115 114 113 110 120 93 83 83 80 76 74 70 20 3

MEDICATION CLINIC AND PHARMACY SERVICES SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES Prior to the ACA Evaluation & ongoing Evaluation & ongoing treatment treatment Prescribing medicine Prescribing medicine Injectable medicines Injectable medicines Dispensing of Dispensing of mediation mediation (limited) Full-time clinics in East Part-time clinics in East At Present Las Vegas & Henderson Las Vegas & Henderson 4

OTHER OUTPATIENT SERVICES SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES Prior to the ACA Outpatient Outpatient Counseling Counseling Drop-in centers Drop-in centers Service Service coordination coordination Consumer Consumer At Present assistance programs assistance programs 5

INTENSIVE SERVICES SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES Prior to the ACA Multiple levels of Residential Housing community-based living arrangements and Mental Health residential supports Court Mental Health Court Mobile Crisis Justice Involved Diversion Programs At Present Mobile Crisis Mobile Outreach T eams 6

INPATIENT PSYCHIATRIC CARE SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES Prior to the ACA Rawson-Neal Rawson-Neal operating 211 civil operating 88 civil beds beds Forensic services Stein Hospital only offered in operating up to 67 At Present Sparks at Lake’s forensic beds in Las Crossing Vegas 7

BARRIERS TO CARE REMAIN Workforce Shortages Access to Care Quality of Care / Sufficient Follow Up Care Supportive Housing Services Intensive Service Demand 8 Note: Additional information, including statistics and backup documentation, on barriers to care are discussed in LCB’s Regionalizi ng the Mental Health System in Nevada: Consideration and Options report (Bulletin No. 17-6).

INDIVIDUALS SERVED BY PROGRAM SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES 900 Residential Housing & Support 780 781 781 770 800 755 757 751 747 734 700 627 602 600 Outpatient Assessment 465 500 445 431 397 405 400 336 327 315 343 303 298 Justice Involved Diversion 297 286 300 241 238 235 234 229 228 227 325 241 262 200 259 234 225 218 Mobile Crisis 181 178 100 122 134 0 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 9

INDIVIDUALS SERVED BY MEDICATION CLINICS SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 0 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Medication Clinic Waitlist 10 Note: Waitlist information is unavailable for the months of May 2018 to December 2018.

STATEWIDE MEDICAID BEHAVIORAL HEALTH SPEND STATE AND MATCHING FEDERAL SHARE $298.9 M $350 M $273.9 M $246.5 M $300 M $250 M $200 M $247.3 M $225.2 M $150 M $199.7 M $100 M $50 M $51.6 M $48.7 M $46.8 M $ M FY 2016 FY 2017 FY 2018 State Share Federal Share 11

REVENUE SOURCES FY 2018 SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES Medicaid, $4.8 M, 6% General Fund, Medicare, $2.1 M, 2% $77.3 M, 89% Federal Grants, $1.8 M, 2% Other, $0.8 M, 1% 12 Note: Chart excludes state General Fund appropriations of $5.9 million which were reverted back to the state in FY 2018.

HISTORIC FUNDING LEVELS (FY 2013 – FY 2018) SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES $100M $90M $6.4M $6.7M $4.4M $4.6M $8.5M $5M $80M $5M $8M $1M $5M $10M $14M $70M $60M $50M $40M $77M $75M $72M $72M $69M $66M $30M $20M $10M $11M $6M $10M $4M $0.0M $0.3M $M 2013 2014 2015 2016 2017 2018 General Fund Medicaid Medicare Federal Grants Other Reversion 13

EXPENDITURE TYPES FY 2018 SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES Operating, $7.1 M, 9% Staffing, $58.9 M, 74% Food & Medicine, $3.8 M, 5% Housing Assistance, $7.5 M, 10% Diversion Programs, $1.9 M, 2% 14 Note: Staffing includes costs associated with state FTEs and contractors.

HISTORIC SPENDING LEVELS (FY 2013 – FY 2018) SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES $100. M $90. M $3.9M $610K $80. M $715K $750K $1.2M $12M $9M $8M $1.0M $7M $70. M $7M $4M $4M $7M $8M $5M $13M $2M $7M $7M $60. M $6M $7M $6M $6M $50. M $40. M $30. M $59M $59M $55M $55M $54M $50M $20. M $10. M $. M 2013 2014 2015 2016 2017 2018 Personnel Operating Food & Medicine Housing Assistance Diversion Programs Other 15

MEDICATION EXPENSES (FY 2009 – FY 2018) SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES $14M $12.7M $12.3M $12.2M $12M $10M $8M $7.1M $6M $3.6M $4M $2.5M $2.5M $2M $0.4M $0.7M $0.8M $M 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 16

CRIMINAL JUSTICE DIVERSION PROGRAMS SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES $3M $2.1M $2.M $2.M $1.9M $1.9M $2M $2M $1.2M $1.2M $1.1M $1.1M $1M $0.6M $1M $M 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 17 Note: May include housing expenditures.

PSYCHIATRIC RESIDENCY PROGRAM SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES $800,000 $701,866 $700,000 $643,850 $600,000 $478,537 $478,440 $500,000 $450,666 $400,000 $365,462 $351,739 $316,642 $285,660 $300,000 $200,000 $100,000 $- 2010 2011 2012 2013 2014 2015 2016 2017 2018 18

COMMUNITY TRIAGE SERVICES (FY 2009 – FY 2018) SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES $1,000,000 $919,400 $892,560 $900,000 $800,000 $750,000 $750,000 $750,000 $750,000 $700,000 $655,056 $650,000 $620,685 $609,874 $600,000 $500,000 $400,000 $300,000 $200,000 $100,000 $- 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 19

STATEWIDE RECOMMENDED ENHANCEMENTS FOR THE 2019-21 BIENNIAL BUDGET Behavioral Health Clinics Caseload Increases Mobile Crisis Expansion Salary Increase • $1.0 million to add 5 • $300,000 to expand • $1.0 million to fund a 2- • $40.4 million over the Psychiatric Nurses to operating hours for the 2019-21 biennium to grade pay increase for Rawson-Neal Hospital for Mobile Outreach Safety continue the enhanced 88 Forensic Specialists civil psychiatric services T eam (MOST) to operate reimbursement rates for in the SNAMHS budget 24 hours a day in Clark Certified Community • $1.9 million to add 6 County Behavioral Health Clinics • $720,042 to fund a 2- Psychiatric Nurses and 6 $346,349 for an at 3 existing clinics, and to • grade pay increase for Mental Health T echnicians Emergency Physician at expand services to 7 new 57 Forensic Specialists to Dini-T ownsend SNAMHS to assist with clinics for a total of 10 in the Lake’s Crossing Hospital commitments clinics budget • $310,824 to expand $418,548 to add 2 operating hours for • Psychiatric Nurses to the MOST to 24 hours a day NNAMHS Medication in Washoe County 20 Clinic