Medicaid Mental Health Benefits Overview of Coverage_ Service

Medicaid+Mental+Health+Benefits%0d%0aOverview+of+Coverage%2c+Service+Delivery+and+Utilization%0d%0aMental+Health+and+Substance+Abuse+Interim+Committee+Meeting+August+14%2c+2006%0d%0a%0d%0a%0cRange+of+Service+Coverage+for+Mental+Health+%26+Substance+Abuse%0d%0a%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae%0d%0a%0d%0aInpatient+hospital+Outpatient+hospital+Federally+Qualified+Health+Centers+%26+Rural+Health+Clinics+Physician+Services+Clinic+Services+Inpatient+Psychiatric+Services+for+participants+%3c21+Rehabilitative+Services+School-based+Services+Targeted+Service+Coordination%0d%0a%0d%0a%0cCommunity-based+MH+Services%0d%0a%ef%81%ae%0d%0a%ef%83%98%0d%0a%0d%0aMental+Health+Clinic+services%0d%0amedical+model%2c+provided+in+a+facility+with+physician+oversight%0d%0a%0d%0a%ef%81%ae%0d%0a%ef%83%98%0d%0a%0d%0aPsycho-Social+Rehabilitative+services%0d%0asocial+model%2c+provided+in+home+%26+community%0d%0a%0d%0a%ef%81%ae%0d%0a%ef%83%98%0d%0a%0d%0aTargeted+Service+Coordination%0d%0asocial+model%2c+provided+in+home+%26+community%0d%0a%0d%0a%0cPopulation+Data%0d%0a2006+State+of+Idaho+Population%3a+Medicaid+Caseload%3a%0d%0aNational+Prevalence+Rates%3a+Adults+with+SMI+(5.4%25)+Adults+with+SPMI+(2.6%25)+Children+with+SED+(5%25)%0d%0a%0d%0a1.4+million+170%2c585+(12.0)%0d%0a%0d%0aMedicaid+Children+using+MH+services%3a+14%2c622+(0.01)+Medicaid+Adults+using+MH+services%3a+8%2c984+(0.006)%0d%0aIn+2000%2c+just+under+5%2c200+children+and+just+under+5%2c000+adults+were+receiving+services+paid+by+Medicaid%0d%0a%0d%0a%0cMH%2fSA+Estimate+of+Spending+by+Idaho+Medicaid+(Based+on+11.5%25+of+Total+Expenditures+2%2f)%0d%0a%24140%2c000%2c000+%24120%2c000%2c000+%24100%2c000%2c000+%2480%2c000%2c000+%2460%2c000%2c000+%2440%2c000%2c000+%2420%2c000%2c000+%24Substance+Abuse+(14%25)+1%2f+Mental+Health+(86%25)+1%2f%0d%0a%0d%0aFY1999+%248%2c052%2c513+%2449%2c465%2c437%0d%0a%0d%0aFY2000+%249%2c056%2c564+%2455%2c633%2c179%0d%0a%0d%0aFY2001+%2411%2c341%2c334+%2469%2c668%2c196%0d%0a%0d%0aFY2002+%2412%2c503%2c093+%2476%2c804%2c711%0d%0a%0d%0aFY2003+%2414%2c001%2c012+%2486%2c006%2c216%0d%0a%0d%0aFY2004+%2415%2c605%2c846+%2495%2c864%2c484%0d%0a%0d%0aFY2005+%2417%2c258%2c176+%24106%2c014%2c510%0d%0a%0d%0aFY2006+%2417%2c967%2c760+%24110%2c373%2c380%0d%0a%0d%0a1%2f+%22State+Spending+on+Substance+Abuse+Treatment%22%2c+National+Conference+of+State+Legislatures%2c+Policy+Matters%2c+Critical+Issues+in+Health+Care+Access%2c+A.+Scanlon+2%2f+%22Mental+Health+and+Substance+Abuse+Services+in+Medicaid%2c+1995%22%2c+J.+Buck+%26+K.+Miller%2c+HHS%2fSAMHSA%0d%0a%0d%0a%0c%25+Growth+of+Overall+Medicaid+Expenditures+Versus+Community+Based+Mental+Health+(CBMH)%0d%0a50.0%25%0d%0a37.3%25%0d%0a%0d%0a45.0%25%0d%0aYear-to-Year+Growth+Rate%0d%0a%0d%0a40.0%25+35.0%25%0d%0a25.2%25%0d%0a%0d%0a30.0%25+25.0%25+20.0%25+15.0%25+10.0%25+5.0%25+0.0%25%0d%0a%0d%0a23.4%25%0d%0a%0d%0a20.2%25%0d%0a%0d%0a26.0%25%0d%0a%0d%0aMedicaid+CBMH%0d%0a10.9%25%0d%0a%0d%0a12.0%25%0d%0a%0d%0a13.1%25%0d%0a%0d%0a11.5%25%0d%0a%0d%0a10.2%25%0d%0a%0d%0a10.6%25%0d%0a%0d%0aSFY00+to+01%0d%0a%0d%0aSFY01+to+02%0d%0a%0d%0aSFY02+to+03%0d%0a%0d%0aSFY03+to+04%0d%0a%0d%0aSFY04+to+05%0d%0a%0d%0aSFY05+to+06%0d%0a%0d%0a4.1%25%0d%0a%0d%0a%0cCommunity+Based+Mental+Health+Expenditures%0d%0a%24100%2c000%2c000+%2490%2c000%2c000%0d%0aAnnual+Expenditures%0d%0a%0d%0a%2480%2c000%2c000+%2470%2c000%2c000+%2460%2c000%2c000+%2450%2c000%2c000+%2440%2c000%2c000+%2430%2c000%2c000+%2420%2c000%2c000+%2410%2c000%2c000+%24Adult+(21%2b)+Child+(0-20)+Total+CBMH+SFY2000+%2416%2c074%2c185+%2411%2c864%2c109+%2427%2c938%2c294+SFY2001+%2419%2c015%2c382+%2415%2c461%2c513+%2434%2c476%2c895+SFY2002+%2421%2c987%2c480+%2419%2c470%2c705+%2441%2c458%2c185+SFY2003+%2423%2c631%2c963+%2423%2c267%2c161+%2446%2c899%2c124+SFY2004+%2428%2c697%2c777+%2435%2c679%2c423+%2464%2c377%2c200+SFY2005+%2433%2c635%2c009+%2447%2c227%2c811+%2480%2c862%2c820+SFY2006+%2438%2c412%2c806+%2455%2c485%2c314+%2493%2c898%2c120%0d%0a%0d%0a%0cUnduplicated+Provider+Numbers+Billing+for+Services%0d%0aBy+Provider+Specialty+Number%0d%0a%0d%0a350+300+250+200+150+100+50+SFY2000+SFY2001+SFY2002+SFY2003+SFY2004+SFY2005+SFY2006+013+Community+MH+Clinics+140+153+170+200+252+258+304+131+Rehab+Mental+Health+Services+119+136+164+211+255+320+285+176+Mental+Health+-+Case+Management+46+50+70+78+91+94+94%0d%0a%0d%0a%0cRegional+Population+Vs.+Medicaid+Enrollment%0d%0aRegions%0d%0a%0d%0a1%0d%0a%0d%0a2%0d%0a%0d%0a3%0d%0a%0d%0a4%0d%0a%0d%0a5%0d%0a%0d%0a6%0d%0a%0d%0a7%0d%0a%0d%0a201%2c570+100%2c465+227%2c825+389%2c228+170%2c617+159%2c534+179%2c857+Regional+Population%0d%0a%0d%0aMay+2006+Enrolled+%25+of+Region%0d%0a%0d%0a22%2c700%0d%0a%0d%0a11%2c380%0d%0a%0d%0a38%2c213%0d%0a%0d%0a31%2c647%0d%0a%0d%0a22%2c039%0d%0a%0d%0a22%2c282%0d%0a%0d%0a23%2c261%0d%0a%0d%0a11.26%25+11.33%25+16.77%25%0d%0a%0d%0a8.13%25%0d%0a%0d%0a12.92%25+13.97%25+12.93%25%0d%0a%0d%0a%0cRegional+Enrollees+Using+MH+Services%0d%0aRegions+1+2+10.6%25+3+11.0%25+4+19.5%25+5+11.2%25+6+14.9%25+7+22.9%25+%25+Medicaid+14.1%25+enrollees+using+MH+services+%25+Regional+Pop.+On+Medicaid+11.3%25%0d%0a%0d%0a11.3%25%0d%0a%0d%0a16.7%25%0d%0a%0d%0a8.1%25%0d%0a%0d%0a12.9%25%0d%0a%0d%0a13.97%25%0d%0a%0d%0a12.9%25%0d%0a%0d%0aPer+MH+user+cost%0d%0a%0d%0a%244%2c107%0d%0a%0d%0a%243%2c476%0d%0a%0d%0a%242%2c116%0d%0a%0d%0a%241%2c978%0d%0a%0d%0a%243%2c884%0d%0a%0d%0a%244%2c309%0d%0a%0d%0a%245%2c913%0d%0a%0d%0a%0cCBMH+Regional+Expenditure+Comparison%0d%0a%24100%2c000%2c000+%2490%2c000%2c000+%2480%2c000%2c000+%2470%2c000%2c000+%2460%2c000%2c000+%2450%2c000%2c000+%2440%2c000%2c000+%2430%2c000%2c000+%2420%2c000%2c000+%2410%2c000%2c000+%24Region+7+Region+6+Region+5+Region+4+Region+3+Region+2+Region+1+SFY2000+%249%2c024%2c480+%245%2c213%2c701+%242%2c484%2c316+%244%2c746%2c774+%242%2c188%2c205+%242%2c205%2c258+%242%2c054%2c218+SFY2001+%2410%2c476%2c870+%245%2c125%2c910+%244%2c945%2c794+%246%2c202%2c250+%242%2c236%2c703+%242%2c203%2c189+%243%2c280%2c868+SFY2002+%2412%2c403%2c439+%245%2c798%2c746+%246%2c495%2c314+%247%2c088%2c626+%242%2c493%2c345+%242%2c685%2c726+%244%2c487%2c531+SFY2003+%2414%2c785%2c740+%245%2c520%2c781+%246%2c590%2c790+%247%2c465%2c254+%243%2c352%2c192+%243%2c099%2c387+%246%2c050%2c340+SFY2004+%2421%2c829%2c148+%247%2c815%2c289+%246%2c974%2c656+%249%2c290%2c503+%245%2c296%2c614+%244%2c161%2c816+%248%2c987%2c375+SFY2005+%2428%2c054%2c591+%2410%2c711%2c815+%248%2c335%2c196+%2411%2c040%2c453+%247%2c393%2c472+%243%2c910%2c677+%2411%2c394%2c102+SFY2006+%2431%2c465%2c146+%2414%2c352%2c104+%249%2c586%2c081+%2412%2c189%2c485+%248%2c909%2c893+%244%2c271%2c888+%2413%2c118%2c066%0d%0a%0d%0aRegion+7+Region+6+Region+5+Region+4+Region+3+Region+2+Region+1%0d%0a%0d%0a%0cOutcomes%3a+ER%0d%0aER+Claims+ER+Visits+Costs+%23+Clients+Average+Visits%2fYr.+CBMH+services+provided+%3c30days+before+ER+18.1%25+22.4%25+CBMH+services+provided+%3c30+days+after+ER+13.0%25+14.0%25%0d%0a%0d%0aChildren+2000+2005+Adults+%2443%2c870+%24174%2c202+315+737+287+650+1.10+1.13%0d%0a%0d%0a2000+2005%0d%0a%0d%0a%24179%2c863+%24537%2c378%0d%0a%0d%0a1%2c044+2%2c572%0d%0a%0d%0a793+1%2c842%0d%0a%0d%0a1.32+1.40%0d%0a%0d%0a43.0%25+40.6%25%0d%0a%0d%0a17.0%25+10.7%25%0d%0a%0d%0a%0cOutcomes%3a+MH+Inpatient+Admits%0d%0aInpatient+Claims+Costs+Inpatient+%23+%23+Admits+Clients+Admits+per+Client+ReCBMH+Admissi+provided+on+Rates+%3c30+days+prior+to+admit+13.7%25+7.41%25+CBMH+provided+%3c30+days+after+admit+46.3%25%0d%0a%0d%0aChildren+2000+%246%2c448%2c688+904+648+1.40%0d%0a%0d%0a2005%0d%0aAdults+2000+2005%0d%0a%0d%0a%248%2c500%2c033+1%2c189%0d%0a%0d%0a865%0d%0a%0d%0a1.37%0d%0a%0d%0a12.0%25%0d%0a%0d%0a8.16%25%0d%0a%0d%0a67.9%25%0d%0a%0d%0a%245%2c421%2c636+1%2c230+%247%2c040%2c017+1%2c447%0d%0a%0d%0a823+1%2c203%0d%0a%0d%0a1.49+1.41%0d%0a%0d%0a15.7%25+13.0%25%0d%0a%0d%0a9.11%25+10.99%25%0d%0a%0d%0a56.3%25+57.9%25%0d%0a%0d%0a%0cManagement+Initiatives+to+Address+Quality%2fappropriate+Utilization%0d%0a%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%ef%81%ae+%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aRules+(service+definitions+%26+expectations)+Limits+on+excessive+utilization+of+partial+care+MH+pharmacy+initiative+Legislative+direction+On-site+clinic+reviews+New+MH+provider+agreements+%26+enrollment+Freeze+on+new+provider+applications+Roll-out+provider+credentialing+system%0d%0a%0d%0a%0cMedicaid+Reform%0d%0a%ef%81%ae+%ef%81%ae+%ef%81%ae%0d%0a%0d%0aHB+776%3a+defines+benefits+according+to+health+needs+of+different+populations+HCR+48%3a+provides+further+benefit+parameters+for+Medicaid+participants+who+are+of+average+health+Federal+authorization+of+three+state+plans%3a%0d%0aBasic+benefits+for+those+of+average+health+%ef%81%ae+Enhanced+benefits+for+those+with+disabilities%2fspecial+needs%2c+and+%ef%81%ae+A+coordinated+plan+for+dual+eligible%0d%0a%ef%81%ae%0d%0a%0d%0a%0cBasic+Benefit+Plan%0d%0a%ef%81%ae+%ef%81%ae+%ef%81%ae%0d%0a%0d%0aStandard+package+of+medical+services+available+to+all+Medicaid+enrollees.+Prevention+%26+wellness+benefits+are+expanded.+Mental+health+services.%0d%0aAllows+for+26+MH+clinic+services%2fannually+with+physician+and+FQHC+exempted+from+limit.+%ef%81%ae+Eliminates+coverage+of+partial+care%2c+psycho-social+rehabilitation%2c+and+service+coordination+which+are+preserved+for+individuals+in+the+enhanced+plan.%0d%0a%ef%81%ae%0d%0a%0d%0a%0cEnhanced+Plan%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%ef%81%ae+%ef%81%ae%0d%0a%0d%0aIncludes+all+service+coverage+in+the+Basic+Plan+Plus+LTC+coverage+in+institutions+%26+community+Plus+developmental+disability+coverage+Plus+enhanced+mental+health+coverage%2c+including+partial+care%2c+psycho-social+rehabilitation%2c+service+coordination%2c+and+expanded+mental+health+clinic+services%0d%0a%0d%0a%0cReform+Implementation+Planning%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae%0d%0a%0d%0aNew+Medicaid+applicants+begin+enrolling+in+new+benefit+plans+(July+2006)+Expedited+medical+home+enrollment+(July+2006)+Health+risk+assessment+(July+2006)+Rules+publish+(August)+Public+Hearings+(August)+Healt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