Financing to Support the Behavioral Health System of Care for Justice Involved Youth June 28, 2016

Overview Incremental Change Defining the Attainable Care System Coordinating Funding to Meet Your Needs SAMHSA Funding Sources Other Funding Sources

Fundamental Laws of Community Systems and Financing You cannot divert to or coordinate with services that do not exist. Services cost money.

Components of a Coordinated Behavioral Health Care System Information sharing Quality assurance Support for system coordination Evaluation Workforce development and training Prevention services Evidence Based Practice Development

Creating State and Local Frameworks to Match Dollars to Desired Services State Level Planning Councils - You have the players here at the table. Your role is to define the best attainable service array, potential funding streams, and to develop the financing framework to enable community service system development. Medicaid maximization Using flexible or specialized funding streams for hard to pay for services Creative use of contracting Care Management Entities - a centralized vehicle for coordinating the full array of needs for children and adolescents with complex behavioral health issues (often at the local or regional level). Public agencies Nonprofit organizations Health Maintenance Organization (HMOS)

Care Management Entity Roles High-quality wraparound implementation Development and management of provider networks, including natural supports Screening, assessment, and clinical oversight Utilization management and quality improvement Intensive care coordination Outcomes management Information management, including real-time data Training for CME staff, providers, families, and referring entities Access to family and youth supports and advocacy Care monitoring and review Access to crisis supports

Mental Health/ Substance Abuse Block Grants Flexible state level funds The Mental Health Block Grant must support community-based services for children or youth with serious emotional disturbances or adults with serious mental illness. The Substance Abuse Block Grant must support the prevention and treatment of substance abuse. Can be used for supports and infrastructure that are not covered by Medicaid. MHBG: $1,051,067 SABG: $6,041,710 MHBG: $19,839,321 SABG: $67,645,777 MHBG: $33,793,628 SABG: $111,379,297 MHBG: $8,532,072 SABG: $34,079,985

Takeaways Define Attainable Service Array Identify/ Develop State Funding Sources Support development of coordinating entities at the state and local levels Repeat

Resources: Intensive Care Coordination Using High-Quality Wraparound for Children with Serious Behavioral Health Needs: State and Community Profiles http://www.chcs.org/resource/intensive-care-coordination-using-high-quality-wraparound-children-serious-behavioral-health-needs-state-community-profiles/ Center for Health Care Strategies (2011) Care management entities: A primer. Washington, DC: Center for Health Care Strategies. Available at: http://www.chcs.org/usr_doc/CHIPRACMEPrimer.pdf Center for Health Care Strategies (2012) Using care management entities for behavioral health home providers: Sample language for state plan amendment development. Washington, DC: Center for Health Care Strategies. Available at: http://www.chcs.org/usr_doc/CMEs_as_Behavioral_Health_Homes_-_SPA_Development.pdf The Maryland Child and Adolescent Innovations Institute and Mental Health Institute. University of Maryland (2008). The Maryland care management model: Care coordination using high-fidelity wraparound to support the strengths and needs of youth with complex needs and their families. Baltimore, MD. Summary of Key Considerations in the Use of the Health Home & 1915(i) State Plan Amendments for Children & Youth with Intensive Behavioral Health Needs SAMHSA’s Medicaid Handbook: Interface with Behavioral Health Services http://store.samhsa.gov/product/Medicaid-Handbook-Interface-with-Behavioral-Health-Services/SMA13-4773

Contact Information David de Voursney Chief, Policy Analysis Branch Division of Policy Innovation Office of Policy, Planning, and Innovation Phone: (240) 276-2332 Fax: (240) 276-1024 1 Choke Cherry Rd. Rockville, MD 20857 david.devoursney@samhsa.hhs.gov