So .. YOURE NE W T O BE HAVIORAL HE AL T H F INANCE ? - PDF document

So… .. YOU’RE NE W T O BE HAVIORAL HE AL T H F INANCE ? CBHAA Whe re to F ind Re so urc e s to Assist in Unde rsta nding F unding So urc e s Be ha viora l He a lth F unding History CBHAA � Co unty He a lth F unding L e a ding to 1991 Re a lig nme nt � Re a lig nme nt – Wha t I t I s � 1991 Re a lig nme nt � E PSDT / Me di-Ca l Spe c ia lty Me nta l He a lth Co nso lida tio n � Me nta l He a lth Se rvic e s Ac t (MHSA) � 2011 Re a lig nme nt � Othe r F unding So urc e s

County He a lth F unding Prior to 1991 CBHAA � 1933 – W&I Se c tio n 17000 � 1966 – Adve nt o f Me dic a id/ Me dic a re � 1971 – Cre a tio n o f Sta te Only MI A Me di-Ca l Ca te g o ry County He a lth F unding Prior to 1991 CBHAA (c ont.) � 1978/ 79 – Afte rma th o f Pro po sitio n 13 � 1982/ 83 – T ra nsfe r o f MI A’ s to Co untie s � 1988/ 1989 – Pro po sitio n 99

Re a lig nme nt – Wha t It Is CBHAA � Conc e pt � Re a lig nme nt – to a djust two o r mo re c o mpo ne nts o f re spo nsib ility � T ra nsfe rs o r “re a lig ns” funding re spo nsib ility b y shifting a g re a te r sha re o f c o st to the c o untie s � 1991/ 92 Re a lig nme nt 1991 Re a lig ne d Prog ra ms CBHAA AB 8 County He a lth Se rvic e s L oc a l He a lth Se rvic e s Ca lifornia Childre n’s Se rvic e s Indig e nt He a lth Ca lWORKs E mployme nt Se rvic e s County Se rvic e s Bloc k Gra nt In- Home Supportive Se rvic e s F oste r Ca re CWS Adoptions County Sta biliza tion Subve ntions County Juve nile Justic e Subve ntions (AB 90) Me nta l He a lth

1994- 95 E a rly a nd Pe riodic Sc re e ning , CBHAA Dia g nosis a nd T re a tme nt (E PSDT ) � E PSDT ha s b e e n a re q uire me nt o f the Me dic a id Pro g ra m sinc e its inc e ptio n in 1966 � T he fe de ra l Omnib us Budg e t Re c o nc ilia tio n Ac t o f 1989 (OBRA ‘ 89) e xpa nde d the b e ne fit to inc lude d dia g no stic a nd tre a tme nt se rvic e s ne e de d to “c o rre c t o r a me lio ra te de fe c ts, physic a l a nd me nta l illne ss a nd c o nditio ns disc o ve re d b y sc re e ning se rvic e s, whe the r o r no t suc h se rvic e s we re c o ve re d unde r the Me dic a id Sta te Pla n.” � A 1993 la wsuit a g a inst the sta te De pa rtme nt o f He a lth Se rvic e s fo r no t suffic ie ntly c o mplying with fe de ra l la w re sulte d inc re a se d a va ila b ility o f Sta te Ge ne ra l F unds to fina nc e Me di-Ca l spe c ia lty me nta l he a lth se rvic e s to c hildre n a nd a do le sc e nts. � Co unty me nta l he a lth pla ns pa id a 50% ma tc h, pursua nt to 1991 Re a lig nme nt, until it re a c he d its a djuste d fisc a l ye a r 1994-95 b a se line o f e xpe nditure s fo r spe c ia lty me nta l he a lth se rvic e s. � I n 2002, in a n e ffo rt to e nsure tha t c o untie s ha d a n “inc e ntive ” to c o ntro l c o sts, a n a dditio na l 10% c o unty sha re o f c o st o n g ro wth in the E PSDT pro g ra m wa s impo se d. 1995- 98 Me di- Ca l Spe c ia lty Me nta l CBHAA He a lth Consolida tion � F ro m 1995 thro ug h 1998 the sta te c o nso lida te d F e e -F o r-Se rvic e (F F S) a nd Sho rt-Do le pro g ra ms into o ne “c a rve o ut” spe c ia lty me nta l he a lth ma na g e d c a re pro g ra m unde r a Me dic a id 1915(b ) “F re e do m o f Cho ic e ” wa ive r. � Unde r the c o nso lida tio n, a ll Me di-Ca l b e ne fic ia rie s we re re q uire d to a c c e ss the ir spe c ia lty me nta l he a lth se rvic e s thro ug h the c o unty Me nta l He a lth Pla n (MHP). � Upo n c o nso lida tio n the sta te De pa rtme nt o f He a lth Ca re Se rvic e s tra nsfe rre d the funds it ha d b e e n spe nding unde r the F F S syste m fo r impa tie nt psyc hia tric a nd o utpa tie nt physic ia n a nd psyc ho lo g ist se rvic e s to c o unty MHPs. � Additio na l c o sts fo r inc re a se s in Me di-Ca l b e ne fic ia ry c a se lo a ds a nd COL As b e yo nd the b a se a llo c a tio n fo r c o nso lida tio n, we re to b e pa id fo r with c o unty 1991 Re a lig nme nt.

2004 Me nta l He a lth Se rvic e s Ac t CBHAA (MHSA) � Re ve nue s a re vo la tile a nd funding is no t g ua ra nte e d � Ca sh flo w va rie s sig nific a ntly during e a c h fisc a l ye a r � E xpe nditure s must b e c o nsiste nt with a n a ppro ve d pla n � F unds must b e spe nt within a spe c ifie d time fra me (g e ne ra lly, thre e (3) ye a rs) � F unds distrib ute d o n a mo nthly b a sis (W&I Co de Se c tio n 5892(j)(5)) � Co untie s a re re spo nsib le fo r e nsuring c o mplia nc e with W&I Co de Se c tio n 5892(a ) � 20% fo r Pre ve ntio n & E a rly I nte rve ntio n pro g ra ms � Ba la nc e fo r Co mmunity Se rvic e s & Suppo rts (Syste m o f Ca re ) � 5% o f to ta l funding utilize d fo r I nno va tive pro g ra ms Me nta l He a lth Se rvic e s Ac t (MHSA) CBHAA � F unds must b e de po site d in a fund whic h inte re st e a rne d re ma ins in the fund to b e use d fo r MHSA e xpe nditure s � Be g inning in F Y 2008/ 09, c o untie s c a n a nnua lly de dic a te up to 20% o f the a ve ra g e o f the ir 5-ye a r to ta l o f MHSA funds to the Prude nt Re se rve , Ca p/ T e c h o r WE T pro g ra ms/ pro je c ts � Ma y use up to 5% o f to ta l a nnua l MHSA re ve nue s fo r pla nning a nd suppo rting Co nsume rs, fa mily me mb e rs, sta ke ho lde rs a nd c o ntra c to rs in the lo c a l pla nning pro c e ss

2011 Re a lig ne d Prog ra ms CBHAA F oste r Ca re CWS Adoptions Adult Prote c tive Se rvic e s Child Abuse Pre ve ntion, Inte rve ntion & T re a tme nt (CAPIT ) Wome n a nd Childre n’s Re side ntia l T re a tme nt Drug Me di- Ca l Non- Drug Me di- Ca l Drug Court Me nta l He a lth E PSDT Ma na g e d Ca re L a w E nforc e me nt • T ria l Court Se c urity • Distric t Attorne y & Public De fe nde r • Juve nile Justic e • Community Corre c tions • L oc a l Public Sa fe ty Subve ntions Inte rse c tion of Re a lig nme nt Prog ra ms CBHAA 1991 Re a lig nme nt 2011 Re a lig nme nt Adult Prote c tive Se rvic e s Child Abuse Pre ve ntion, Inte rve ntion AB 8 County He a lth Se rvic e s SHARE D & T re a tme nt (CAPIT ) L oc a l He a lth Se rvic e s Wome n a nd Childre n’s Re side ntia l Ca lifornia Childre n’s Se rvic e s T re a tme nt Indig e nt He a lth F oste r Ca re Drug Me di- Ca l Ca lWORKs CWS Non- Drug Me di- Ca l E mployme nt Se rvic e s Adoptions Drug Court County Se rvic e s Bloc k Gra nt Me nta l He a lth E PSDT In- Home Supportive Se rvic e s Ma na g e d Ca re County Sta biliza tion Subve ntions L a w E nforc e me nt County Juve nile Justic e Subve ntions • T ria l Court Se c urity (AB 90) • Distric t Attorne y & Public De fe nde r • Juve nile Justic e • Community Corre c tions • L oc a l Public Sa fe ty Subve ntions

Gra nts CBHAA � Community Me nta l he a lth Se rvic e s Bloc k Gra nt (MHBG) � Pro vide s g ra nt funds to e sta b lish o r e xpa nd a n o rg a nize d c o mmunity-b a se d syste m o f c a re fo r pro viding no n-T itle XIX me nta l he a lth se rvic e s to c hildre n with se rio us e mo tio na l disturb a nc e s (SE D) a nd a dults with se rio us me nta l illne ss (SMI). � Pr oje c ts for Assista nc e in T r a nsition from Home le ssne ss (PAT H) � F unds c o mmunity b a se d o utre a c h, me nta l he a lth a nd sub sta nc e a b use re fe rra l/ tre a tme nt, c a se ma na g e me nt a nd o the r suppo rt se rvic e s, a s we ll a s a limite d se t o f ho using se rvic e s fo r the ho me le ss me nta lly ill. � Substa nc e Abuse Pre ve ntion & T r e a tme nt (SAPT ) Bloc k Gr a nt � F unds to pre ve nt a nd tre a t sub sta nc e a b use ta rg e ting po pula tio n a nd se rvic e a re a s inc luding pre g na nt wo me n a nd wo me n with de pe nde nt c hildre n, intra ve no us drug use rs, tub e rc ulo sis se rvic e s, e a rly inte rve ntio n se rvic e s fo r HIV/ AI Ds a nd prima ry pre ve ntio n se rvic e s. � Othe r Gra nts � T ria g e , No Pla c e L ike Ho me , e tc ….. Othe r F unding Sourc e s CBHAA � Drug Me di-Ca l Org a nize d De live ry Syste m (ODS) Wa ive r � Sta te Ge ne ra l F unds � Co ntra c ts � Ca lWORK s � Co urt F e e s & Co sts (SUDS) � E sta te F e e s – Pub lic Administra to r/ Gua rdia n � Priva te I nsura nc e � Me dic a re � Clie nt F e e s (UMDAP & SUDS Sliding F e e )

De live ring Se rvic e s T hroug h Multiple CBHAA F unding Sourc e s � Know the re quire me nts a nd limita tion of your funding sourc e � Re a d the c o ntra c t � Whe n in do ub t c o nta c t yo ur lia iso n fo r the spe c ific funding so urc e � F unding Hie ra rc hy � Priva te (I nsura nc e ) � L o c a l (F e e s, Ge ne ra l F und) � Sta te Ge ne ra l F und � Sta te (Re a lig nme nt) � F e de ra l (F e de ra l Gra nts, Me di-Ca l) Informa tion to Support F ina nc ia l CBHAA De c ision Ma king � Me a ning ful Da ta � Go o d da ta is ne c e ssa ry fo r so und de c isio n ma king � Community Ne e d � Wha t a re the ne e ds o f the c o mmunity � Histor y � In b o th te rms o f re ve nue a nd se rvic e de live ry � Antic ipa te d Outc ome s � Will the a ntic ipa te d o utc o me b e wo rth the inve stme nt � Susta ina bility � Will the d e c isio n b e susta ina b le into the future in te rms o f re ve nue , pro g ra m a nd sta ffing .