Mental health advocates say there are other options
May 12, 2011--County mental health administrators are relieved that the newest version of the healthcare transformation bill (House Bill 3650) requires written agreements between counties and coordinated care organizations (CCOs) that will stipulate how the two entities will coordinate mental health services and funding for Medicaid and non-Medicaid clients.
The new language is verbatim language as suggested by Claudia Black, Multnomah County’s lobbyist and Cindy Becker, with Clackamas County, and reflects what other proponents of county mental health systems wanted to see.
“They clearly wanted this exact language,” said Rep. Tim Freeman (R-Roseburg). “We spent a ton of time on this section.”
“We think we have it right,” said Rep. Mitch Greenlick (D-Portland), the committee’s co-chair.
“We’re really pleased with how it turned out,” Becker said. “It brings the counties into being an active participant with the CCOs around mental health and addictions.”
The written agreement between the counties and the coordinated care organizations—which would be responsible for integrating physical, oral and mental healthcare for OHP members and the dually eligible (those receiving both Medicaid and Medicare services)—would outline mutually agreed upon outcomes and funding to “maintain the mental health safety net system.”
The language specifically mentions a number of services provided by the counties, which are local mental health authorities, that need to be funded in order for there to be “effective management” of those services.
They include managing services related to people transitioning to or from the Oregon State Hospital to residential treatment facilities, residential care and related supports, crisis services and supportive services.
“It’s our vision that those written agreements will help the CCOs and the counties coordinate those services,” said Mark Nystrom, policy director with the Association of Oregon Counties.
The bill now makes it possible for coordinated care organizations to contract with counties and receive Medicaid funding. Previously, as The Lund Report reported
, county mental health administrators were extremely worried that taking those dollars away from the counties would destroy the community mental health system.
“There was going to be a lack of coordination between Medicaid and non-Medicaid clients,” Nystrom said.
But mental health advocates are critical of allowing counties to continue being the local mental health authority, and said there are other options that should be considered by the Transformation Committee..
Chris Bouneff, the executive director of Oregon’s chapter of the National Alliance of Mental Illness
(NAMI), said that counties have not necessarily proven themselves capable of providing adequate mental healthcare, and that the current transformation legislation may result in the perpetuation of a broken system.
“People aren’t getting good, quality care,” he said. “The care is uneven. It’s not as if counties are doing a ton of services, and frankly, they’re not meeting all the needs of the [non-Medicaid] population right now.”
One month ago, the City Club of Portland released a scathingly critical report
on Multnomah County’s mental health system, calling for the system to be “completely restructured.”
NAMI is continuing to work with legislators on a proposal that would create a "brokerage" type system allowing counties to purchase services, using their general fund dollars, from the CCO. Those services would involve crisis and safety net services.
However, Greenlick announced last week that it's no longer possible for organizations to submit amendments to the Transformation Committee. Any amendments must come from a legislator. The committee intends to take a vote on the transformation bill on May 19.
Bouneff said if the current version of the transformation bill goes through, the written agreements need to clearly spell out a county’s responsibilities and the outcomes they are expected to deliver.
“Those counties that do a good job should continue to receive preference in contracting," he said. "[But] if outcomes aren't being met, then CCOs should be responsible for finding service providers that can meet the needs of Oregonians living with mental illness."
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