1. Overview – Behavioral Health Care in Utah
Patrick Fleming, MPA, LSUDC
USIM Consultant
Jeremy Christensen, LCSW
Associate Director, Utah Division of Substance Abuse and Mental Health
Tim Whalen, LCSW
Director, SLCo Division of Behavioral Health Services

2. Private Pay vs. Public Pay (Substance Abuse Treatment)
1986
2006

3. States Where Counties Deliver or Have a Role in the Delivery of Mental Health Services

5. Utah State Division of Substance Abuse and Mental Health
Utah Overview
Jeremy Christensen
Assistant Director
Utah State Division of Substance Abuse and Mental Health

7. Local Mental Health Authorities
Centers are required by statue to provide at a minimum the following services:
inpatient care;
residential care;
outpatient care;
24 hour crisis care;
psychotropic medication management;
psychosocial rehabilitation, including vocational training and skills development;
case management;
community supports, including in-home services, housing, family support services, and respite services;
consultation and education services, including case consultation, collaboration with other county service agencies, public education, and public information; and
services to person incarcerated in a county jail or other county correctional facility.

8. Thirteen (13) Local Substance Abuse Authorities
Thirteen (13) Local Mental Health Authorities
They are the same Authority in all but two areas (Utah County and Bear River-Rich, Cache and Box Elder Counties)

9. 4 Models of service delivery in Local Authority system
Employee provider model
(County employees provide services)
Special Service District
(District employees provide services)
Private non-profit under contract to county
(Non-profit employees provide services)
County contracts with managed care organization/providers to deliver services
(County employees oversee contracts)

10. Co-morbidities in the Adult Population
Source: Druss & Walker. “Mental disorders and medical comorbidity.” The Robert Wood Johnson Foundation Synthesis Project, February 2011.

11. Different policies for levels of Severity
In Treatment ~ 2,300,000
Addiction ~ 25,000,000
(Focus on Treatment)
“Harmful Use” – 68,000,000
(Focus on Early Intervention)
Little or No Use
(Focus on Prevention) 11

14. SUD Clients – Household Income

15. MH Clients – Household Income

16. Medicaid
Medicaid program is administered by the Utah Department of Health.
Utah Department of Health contracts with Counties (Local Authorities).
Counties use State General Fund appropriated by Legislature to DSAMH and County Funds to pay Match.
Counties “at risk.”
DSAMH conducts Qualitative Review for UDOH.

17. Medicaid Primary payor for mental health
Not the primary payor for substance use disorder (SUD) treatment (YET)
12 of 13 MH authorities capitated MH (Wasatch County Fee For Service)
Mental Health and Substance Use Disorder Services are Capitated
Safety Net

18. Thoughts About Integration
Tim Whalen
Director
Salt Lake County Behavioral Health Services

26. Some Critical BH Compenents of Integrated Care:
Supported Living
Targeted Case Management 
Respite Care
Transportation
Crisis Services 
Social Detox
Residential Care (IMD, waiver)
Vocational Rehab
Evidence Based Criminal Justice Services
Housing, Housing, Housing. 

27. HB 437S03 Health Care Revisions
$30M State dollars & $70M Federal
($13.6M Hospital Assessments & $17.5M SF)
$11,770/yr
$1,177/yr
CHIP
Currently Eligible
Medicare
Those Eligible For
Tax Credits
FPL’s and numbers served are not provided in the bill, and will likely be determined by the DOH based on available funding. 
70/30 Match Rate
Integrated BH/PH Benefit in Counties that “Opt-In”
Requests for waivers or amendments to existing waivers to be submitted by July 1, 2016
~63,000 individuals, not currently eligible for Medicaid, fall under the 100%FPL in FY17
Medicaid Benefit
~12,500 Individuals
Priorities:
Chronically Homeless (~500) or those living in supported housing for the chronically homeless (~1,000)
If funding available, those on probation/parole or court ordered into treatment with BH conditions
If funding available, individuals with BH conditions
12 month eligibility period
Medicaid Benefit
~3,800 Individuals
40-55% FPL?
40-55% FPL
FPL?
FPL?
Expedited enrollment for incarcerated individuals eligible or enrolled prior to incarceration
Slide Modified by SL Co

28. Questions