1. Succeeding not seceding: The work of the Texas legislative workgroup on integrated healthcare Mary Lehman Held, L.C.S.W. Lynda E. Frost, J.D., Ph.D. Katherine Sanchez, L.C.S.W., Ph.D. Collaborative Family Healthcare Association 14 th Annual Conference October 4-6, 2012 Austin, Texas U.S.A. Session # A6b October 6, 2012

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. Objectives 1. Describe the efforts in Texas to establish a legislative workgroup and issue recommendations for the implementation of integrated health care. 2. Identify integrated health care opportunities within the Patient Protection and Affordable Care Act of 2010. 3. Identify opportunities for similar legislative action in your home states.

4. Establishing the Workgroup  House Bill 2196: The executive commissioner of the Health and Human Services Commission shall establish a workgroup to recommend best practices in policy, training, and service delivery to promote the integration of health and behavioral health services in this state.

5. The Integration of Health and Behavioral Health Services Workgroup  Members and Agency Representatives  Subcommittees  Format of Meetings  Final Report  Best Practices  Barriers  Possible Solutions  Recommendations

6. The Report  Best Practices  Barriers  Clinical  Consumer  Organizational  Policy  Financial

7. Recommendations 1. Create a State Healthcare Integration Leadership Council 2. Create and support a focus on healthcare integration in Texas 3. Support local healthcare integration planning 4. Address systemic barriers to healthcare integration 5. Encourage adoption of confidential health information technology and information sharing

8. Recommendations continued 6. Develop systems for meaningful and functional outcome measurement and tracking 7. Support routine health and behavioral health screening during patient assessments 8. Develop policies to address training, continuing education and workforce needs 9. Implement integration efforts as part of federal health reform requirements http://www.hhsc.state.tx.us/about_hhsc/AdvisoryCommittees/Behavior alHlth/BehavioralHealth.shtml

9. Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008  Purpose: to eliminate differences in coverage of mental health and substance abuse treatment benefits versus general medical care in health insurance plans for employers with more than 50 employees.  Requires a health plan that does provide MH/SA benefits to apply the same financial requirements and treatment limits as they do to medical and surgical benefits.  Financial requirements include deductibles, copayments, coinsurance and out-of-pocket expenses.  The treatment limits cannot be more restrictive with regard to frequency, number of visits or days of coverage, than the limitations applied to medical and surgical conditions.

10. Health Information Technology for Economic and Clinical Health (HITECH) Act  Enacted as part of the American Recovery and Reinvestment Act of 2009.  Promotes the adoption and meaningful use of health information technology (HIT) and provides funding to strengthen the HIT infrastructure nationwide through grants to states.  Provides HIT implementation assistance to health care providers to adopt, implement and effectively use electronic health record (EHR) technology through regional extension centers designed to provide technical assistance and disseminate best practices.  Intended to assist health care providers in developing meaningful and functional outcome measurement and tracking.

11. Patient Protection and Affordable Care Act (PPACA) of 2010  Prevention and Public Health Fund provided HRSA with Mental Health Training grants to train and recruit providers in behavioral health professions, including social work and psychology.  The fund provided additional grants to establish specific models that integrate physical and mental health services through the co-location of primary and specialty care services in community-based mental and behavioral health settings  Mandates a public health workforce loan repayment program to promote training in preventive medicine, a diverse workforce and cultural competence.  National Health Care Workforce Commission that will develop a workforce strategy with a strong emphasis on training positions in primary care.  Patient Centered Medical Home

12. Unanticipated consequences  New Healthcare Transformation and Quality Improvement Program 1115 Demonstration Waiver in Texas  Created 20 Regional Health Partnerships  Includes “Integrate Primary and Behavioral Healthcare Services” as a project area  New relationships have increased significance  Best practice guidelines can help shape programs

13. Additional roles for former Workgroup members  Continue to meet to share info and identify opportunities  Formed advisory committee to plan CFHA policy summit  Serve as resource to RHPs doing integration projects  Identify and pursue opportunities to improve regulatory framework

14. What difference did legislation make?  It was a formal expression of support for integration  It got a broad range of organizations to the table  It laid the groundwork for more specific regulatory requests  It compiled information about current programs in Texas and encouraged information sharing  It focused attention on best practices

15. Questions?  Mary Lehman Held, L.C.S.W. mlheld@utexas.edu  Lynda E. Frost, J.D., Ph.D. lynda.frost@austin.utexas.edu lynda.frost@austin.utexas.edu  Katherine Sanchez, L.C.S.W., Ph.D. ksanchez@uta.edu

16. Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!