2017 Behavioral Health Public Policy Agenda
Addressing the Needs of the Uninsured and Underinsured.
One option to ensure that persons who currently are uninsured or underinsured receive the critical behavioral health services they need is the block grant funding provided by the Kansas Mental Health Reform Act of 1990. This was intended to allow the CMHCs to serve the uninsured and underinsured who do not qualify for Medicaid and do not have resources to pay for their mental health treatment. This funding is intended to ensure every Kansan has access to mental health treatment. The CMHCs are required to serve every person who walks through their doors, regardless of their ability to pay, much like community hospitals. Since FY 2008, this funding stream has been reduced significantly, though the demand for services from the uninsured and underinsured continues to increase. If those in need of services do not receive timely treatment, they may have to be served in emergency rooms, state hospitals or jails, all of which are much more expensive than community-based services.
Support Increase of the Residency Program at the University of Kansas Department of Psychiatry.
CMHCs and the State psychiatric hospitals are facing an alarming shortage of licensed psychiatrists who specialize in the treatment of persons with mental illness. Kansas has lost a significant number of psychiatrists over the last decade due to a reduction in training programs and retirements. A significant step in enhancing the treatment for persons with mental health issues could be achieved by doubling the number of residents at KU to begin the process of replenishing this shortage and helping Kansas to be a national leader in mental health treatment. The Association fully supports this initiative with the inclusion that the additional residents be required to work two years at a State psychiatric hospital or three years at a CMHC in order to complete the conditions of the residency appointment.
Address Critical Needs in Psychiatric Inpatient Resources.
Reductions in State psychiatric inpatient budgets, coupled with funding reductions in Mental Health Reform dollars, have resulted in our system reaching a crisis. The State hospitals are the inpatient safety net for individuals with severe mental illness in Kansas. Seventy (70) percent of those admitted to State hospitals do not have Medicaid as a payor source. We support Osawatomie State Hospital (OSH) returning to 206 beds. OSH is a vital part of the mental health treatment system in Kansas and the State cannot afford to lose any more inpatient beds.
Funding to establish local public/private partnerships for psychiatric inpatient hospital beds across Kansas to alleviate demand on our State hospital beds and the creation of regional Crisis Stabilization Units will help provide treatment for those individuals who need less acute care for shorter lengths of stay than the use of State psychiatric hospitals. Savings from the admissions to the State psychiatric hospitals should be reinvested into the CMHC System. Rainbow Services in Wyandotte County has been a center for innovation and has been providing care for individuals in crisis for over two years. The collaboration in Wichita with COMCARE of Sedgwick County and other providers has experienced similar successes. We support ongoing resources for Rainbow, the COMCARE Crisis Center and similar programs across the State. It is vital that the State continue its investment into this more localized shorter term, inpatient options.
Restore Four Percent Reduction to Medicaid Rate Reimbursement for FY 2018.
As a result of the State’s budget crisis, a rate reimbursement reduction of four percent was made to the Kansas Medicaid Program for FY 2017. This has resulted in a loss of over ten million dollars in revenue to CMHCs that has caused job loss and a reduction in access to treatment and services. We believe it is essential to restore this reduction in funding.
Restore Medicaid Mental Health Inpatient Assessments.
In October, the Kansas Department for Aging and Disability Services, at the recommendation of the Federal Centers for Medicare and Medicaid Services (CMS), eliminated the long utilized process for screening persons in need of inpatient behavioral health treatment in hospitals and Psychiatric Residential Treatment Facilities (PRTFs) for youth. Subsequently, the funding for this service disappeared as well. The previous process for screening individuals had resulted in the diversion of thousands of patients from the more costly, less necessary inpatient hospital admissions. The screening process allowed for a continuity of care with outpatient community based services which resulted in lower hospital and PRTF utilization rates and moreover the admission of those who needed inpatient resources most. Abandoning the previous policy has resulted in an escalation of admissions to the point that hospitals in other states are now seeing Kansas as a business opportunity in that we have an even greater shortage of inpatient behavioral hospital beds. Our Association requests restoration of the previous process and associated funding.
Medicaid Expansion (SB 38 and HB 2064).
Another option that is available to help reimburse CMHCs for treatment and care of persons who are uninsured or underinsured includes a significant expansion of Medicaid that will enhance funding for services to Kansans with mental illness. More than half of those who present for treatment at CMHCs have no insurance. Expansion of Medicaid will provide coverage for those who have a mental illness so they can access needed mental health treatment in their communities. Our Association strongly feels that it is important with any expansion conversations to include the requirement that the benefit package for mental health treatment be equal to or greater than the current benefit package for Medicaid benefit recipients and that mental health parity requirements be enforced.
Oversight of KanCare (SB 69).
Given the fact that more than 300,000 Kansans are eligible for and served by Medicaid and that $3 billion is spent annually on Medicaid in Kansas, it is critical that the Kansas Legislature continue to exercise oversight of this program to ensure that savings from implementing KanCare are in fact a result of improving overall health outcomes and care coordination, and not from restricting access to care. Some of the issues that should be addressed are as follows:
- Implement more timely credentialing processes;
- Standardizeprior authorization requirements and timely response to prior authorization requests through an electronic format;
- Mandate consistent interpretation ofstate payment policies;
- Make data available that is necessary toverify and track expenditures at the request of the provider; and
- Make available data reports that reflect both the aggregate state per member per month cost for each cohort of beneficiaries, as well as the actual expenditures by the MCOs for those beneficiaries.
Support Policy Change to Suspend rather than Terminate Medicaid Eligibility upon Incarceration.
Support the government’s primary responsibility for the provision of health and mental health care to the State’s most vulnerable citizens—those with disabilities, both physical and psychological. This includes suspension of, NOT termination of, Medicaid eligibility when an individual is incarcerated in a county facility or state prison. Upon release, the ex-offenders’ eligibility should immediately be reinstated to ensure those individuals with mental illness or substance abuse are able to immediately access care, treatment and needed medications upon release. At this time, Kansas law does not allow for suspension of Medicaid eligibility to be reinstated upon release from prison.
Support Use of Problem Gambling and Addictions Fund (PGAF) As Provided in Statute.
Senate Bill 66, the Expanded Lottery Act, established the Problem Gambling and Addiction Fund to treat pathological gambling and other addictions. Two percent of state gaming revenues are supposed to go to establish prevention and treatment programs to mitigate problem gambling related harms as well as long-standing funding gaps in the prevention and treatment of substance use disorders. We support the long-range plan to expend funds according to the KDADS Strategic Plan including problem gambling treatment and expansion of substance use disorder treatment services.
Amend the Medical Student and Resident Loan Assistance Act to Include Psychiatry for Medical Student Loan Repayment (SB 32 and HB 2124).
This would assist our state in recruiting and retaining psychiatrists, of which there is a continual and ever growing shortage. This would be helpful especially in rural areas of the state for mental health providers including CMHCs and the State Mental Health Hospitals (SMHHs) in Osawatomie and Larned.
November 28, 2016
For further information:
Contact: Kyle Kessler
(785) 234-4773 or
Community Mental Health Centers Announces Mental Health 2020 Proposal
Citing strong concerns about funding cuts to the community mental health system and the need for other system enhancements, the Association of Community Mental Health Centers of Kansas is proposing to state policy makers an initiative that will be known as Mental Health 2020.
Kansas has long depended on the Community Mental Health Center (CMHC) system to treat patients with the severest mental illnesses. Locally operated and administered CMHCs covering all 105 counties provide an array of community-based mental health services. The State once supported the mental health safety net at a much higher level that has eroded significantly over the last decade.
The collaboration of CMHCs with other systems of care is crucial to the health and welfare of Kansans. CMHCs are at the intersection of community hospitals, physicians’ clinics, and other health and human services providers but also work with local law enforcement, community corrections, and schools. Whether responding to natural disasters such as tornadoes or workplace violence, CMHCs are integral to community care and treatment.
The Association of Community Mental Health Centers is proposing The Mental Health 2020 Initiative. The initiative will restore funding balance to the CMHC System as well as a workforce development program to increase the number of psychiatrists who will be trained and incentivized to stay in Kansas. Lastly, the Association requests funding for the Kansas Department of Aging and Disability Services (KDADS) to invest in community-based crisis stabilization and treatment services similar to the successful programs commenced in Kansas City with Rainbow Services, Inc. and in Wichita with the Community Crisis Center.
“Our system of care has been neglected for far too long and we are looking for our state leaders to have implemented great vision by 2020,” said David Elsbury, President of the Association of Community Mental Health Centers and CEO of KANZA Mental Health and Guidance, Inc.
The Association proposes a total of $20 million, with $11 million in FY 2018 and an additional $9 million in FY 2019, to restore the safety net grants program back to the FY 2007 level. Mental Health Reform funding that was implemented in coordination with the closure of hundreds of state mental health hospital beds has eroded significantly over time. When the State originally cut funding, it was in combination with an increase in Medicaid services. The State cuts have gradually reduced services to the point CMHCs lost the flexibility to serve other patients adequately. As a result, the restoration of the State’s original commitment to Mental Health Reform is essential.
“Mental health is about brain health and emotional health, as a part of overall individual and population health. Our work helps to sustain families, the Kansas workforce, and Kansas communities” said Jessie Kaye, President and CEO of Prairie View, Inc.
The Association proposes funding for enhancing the psychiatric residency training program in the Department of Psychiatry in the School of Medicine at the University of Kansas Medical Center. The addition of new psychiatrists each year by 2020 would place an emphasis on rotations at state mental health hospitals and CMHCs. Kansas will gain a head start in retaining these vital treatment providers in our state. In the first year, $550,000 in funding for an additional four residents for FY 2018 will gradually increase to the proposed resident and funding levels by FY 2020.
Lastly, the Association proposes funding for FY 2018 to sustain the current crisis stabilization programs in the Kansas City Metro and Wichita areas and also establish other regional community-based programs. The current programs have been successful in creating a “port of calm” for persons who have had an interaction with law enforcement as a result of mental illness and substance or alcohol abuse. As a result, hospital admissions have been reduced and referral to appropriate community-based services have occurred.
Kyle Kessler, Executive Director for the Association of Community Mental Health Centers of Kansas, said, “At a time when the need for mental health treatment is increasing, the system in Kansas must keep pace with funding for services, the psychiatry workforce, and the newly formed Kansas solution of creating crisis stabilization centers for intermediate inpatient care to supplement the work done at state mental health hospitals.”
The Association believes that the CMHCs’ commitment to indefinite sustainability needs to be met by its partners in state government. The recognition that CMHCs are the safety net for persons with mental health needs is underscored by preventing unnecessary emergency room visits and admissions to higher cost inpatient settings such as community hospitals and state mental health hospitals as well as other high cost alternatives including incarceration and engagement with the child welfare system.
“Mental Health 2020 is a health and human services initiative that will improve the lives of families and the quality of the Kansas work force. Our goal is to have the best mental health treatment system in the United States and that goal is unwavering,” said Elsbury.