Mental Health
Services for
Transitional Age
Youth
2012 Maryland Transition
Conference Transition
Outcomes: From High School
to Life Long Learning
Saturday, November 17, 2012
Steve Reeder
Mental Hygiene Administration, Adult Services
Division
1
The Good and Bad News:
MHA is not DDA
 Mental
health services are not
accessed in the same manner that
DDA or DORS services are accessed.
 The
Public Mental Health System
functions differently – cannot
compare systems.
2
Maryland’s current
Public Mental Health System (PMHS)

1115 MA managed care waiver which combines
state general funds and Medicaid under a single
payor system.

Mental health is carved out from substance
abuse and somatic care services under the
auspices of an Administrative Services
Organization (ASO).

Services are provided through a fee-for-service
system by approved providers.
3
Maryland’s PMHS:
Roles and Responsibilities

Mental Hygiene Administration (MHA) is the
state mental health authority responsible for the
design and delivery of public mental health
services.

Core Service Agencies (CSAs), local mental
health authorities, have the authority and
responsibility to develop and manage a
coordinated network of Maryland’s public mental
health services in a defined local service area.
4
Core Service Agencies (CSAs)
Wicomico
and
Somerset
Regional
CSA
19 CSAs
covering all 24
jurisdictions
http://www.dhmh.state.md.us/mha/Miscellan
eous/csa/MACSA%20Directory.pdf
5
CSAs (continued)
 Core
Service Agencies provide
services and resources to consumers
and families that are not otherwise
available through the fee-for service
Public Mental Health System (PMHS)




training and education;
peer support and advocacy;
family support and advocacy;
specialized services for Transitional Age Youth
(TAY) (in 12 jurisdictions)
6
Administrative Services Organization
(ASO)




Under contract with MHA, the ASO authorizes
services and provides utilization management,
management information, claims processing, and
evaluation services.
http://maryland.valueoptions.com
You may contact ValueOptions® Maryland at the
following toll-free numbers:
Call: 800-888-1965
TTY: 866-835-2755
7
Organizational Chart
Medicaid
Maryland DHMH
MHA
ASO
DDA
CSAs
OHCQ
ADAA
ADAA=Alcohol & Drug Abuse
Administration
DHMH=Department of Health &
Mental Hygiene
DDA =Developmental Disabilities
Administration
OHCQ=Office of Health Care Quality
8
PMHS Eligibility


The adult Medicaid population is eligible for all
services within the ‘benefits package’ if they
meet medical necessity criteria for that level of
service.
The Medicaid-ineligible individuals are eligible for
all services, except inpatient, partial
hospitalization, and emergency room services, if
funding is available, the individual meets medical
necessity criteria for that level of service, and the
individual meets any specific eligibility
requirements such as:
9
Eligibility Requirements for
the MA-Ineligible Individual
The consumer requires treatment for a
DSM IV TR mental health diagnosis(es)
covered by the PMHS, AND
 The consumer has a verifiable Social
Security #, AND
 The consumer has applied for Medical
Assistance (MA), Social Security Insurance
(SSI), or Social Security Disability
Insurance (SSDI). AND…

10
Eligibility Requirements for the MAIneligible Individual (continued)
One of the following:
 The consumer meets the financial
criteria [200% of the Federal Poverty
Level (FPL).]; OR
 has received services in the PMHS
within the past two years; OR
 has SSDI due to a psychiatric
impairment; OR
11
Eligibility Requirements for the MAIneligible Individual (continued)
 Is
on conditional release from a
Maryland state hospital; OR
 Recently released from a Maryland
psychiatric hospital, jail, or prison
within the last three months.
12
Public Mental Health Service
Benefits package includes:
Psychiatric inpatient care
 Psychiatric day treatment (partial
hospitalization)
 Residential Treatment Respite
 Outpatient mental health clinic
 Individual mental health practitioner
services
 Psychiatric Rehabilitation (PRP)
 Residential Rehabilitation (RRP)
 Mobile Treatment Services
 Supported Living Services
 Supported Employment (SE)
 Case Management Services
 Residential Crisis Services
 Mental Health related laboratory
services

13
Service Pre-Authorization

ValueOptions® of Maryland or the local Core Service
Agency (CSA) can help you find a provider.

The provider selected will request authorization for
services on behalf of the consumer.

ValueOptions® of Maryland staff confirms that the
request is based on the consumer’s goals and needs.
and that the consumer was involved in the decision. We
ValueOptions® also ensures that the services
requested meet established medical necessity attendant
to the level of service.
14
Service Pre-Authorization

In most cases, ValueOptions® of Maryland
authorizes the services to be provided. The
CSA authorizes SE.

If services are not authorized, ValueOptions® of
Maryland will work with the consumer and the
provider to find a service that best meets the
consumer’s goals and needs.
15
Service Pre-Authorization

The consumer and/or the provider can ask
questions or complain. In addition, the
consumer and/or provider can also file an
appeal if the consumer’s needs are not met.
16
Policy Application to Youth and Young
Adults with Mental Health Conditions
 SE
is available and accessible to
youth at age 16 or two years before
graduation.
 Best
predictor of post-school success
is paid competitive employment prior
to graduation from high school
(mitigates against drop-out)
Evidence Based Practice (EBP)
Supported Employment (SE)

Maryland was one of three
states to implement SE as
part of the National
Implementing Evidence
Based Practices Project,
sponsored by the New
Hampshire-Dartmouth
Psychiatric Research Center
and the Substance Abuse
and Mental Health Services
Administration (SAMHSA).
18
Evidence Based Practice (EBP)
Supported Employment (SE)
 Joint
MHA/DORS
application for
funding to Johnson &
Johnson Foundation
for Dartmouth
Community Mental
Health Program in
SE. in 2002.
19
EBP SE Access and Availability
20
Evidence-Based Supported
Employment Outcomes
 Consistent
rates of 50%-70%
competitive employment for
consumers in supported employment
programs which achieve high fidelity.
 DORS closure rates average 65%
(two to one advantage of EBP versus
non-EBP, though gap improving due
to overall increase in service quality
and system improvements.)
21
Contact Information
Steven A. Reeder, M.Ed., CPRP, CRC
Chief, Evidence-Based Practice Services and Program
Evaluation
Maryland Department of Health and Mental Hygiene
Mental Hygiene Administration
Spring Grove Hospital Center, Mitchell Building
55 Wade Avenue, Catonsville, MD 21228
Phone: 410-402-8476 Fax: 410-402-8304
E-mail: [email protected]
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Successful Transitioning for Youth with Mental Health Disabilities