FY 07-08 Budget Presentation

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Office of Mental Health and Substance Abuse
Services
FY 07-08 Budget Presentation Stakeholder
Briefing March 1, 2007
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The Rendell Administrations Major Budget
Initiatives

• Increase in total state education funding for
  PreK12 by 6
• Accelerate property tax relief
• Address the transportation funding crisis for
  Pennsylvanias roads, bridges, and public transit
  systems
• Continue investments to make appropriate options
  available for long-term living
• Propose the Energy Independence Initiative to
  invest in alternative energy production in
  Pennsylvania
• Jonas Salk Legacy Fund (500 M for bioscience
  research, commercialization, and early-stage
  capital investments)
• Additional funding to address the continuing
  offender population growth and new resources to
  reduce the rate of prison re-entry

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Prescription for Pennsylvania

• Increases access to affordable health care
  coverage for all Pennsylvanians, improves the
  quality of care delivered throughout the
  Commonwealth, and helps bring health care costs
  under control for employers and employees. FY
  07-08 budget recommends a total of 255.3 million
  in state and federal funds to implement this
  initiative.
• The Prescription for Pennsylvania initiatives are
  being paid for by levying a tax on other tobacco
  products. Every other state except Pennsylvania
  already taxes these products.
• Expands access in underserved rural areas (5.4 M
  investment)
• Increases the number of health professionals
  equipped to address the needs of racial and
  ethnic minorities (1 M)
• Includes a Behavioral Health Services component

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Pennsylvanias FY 2007-2008 General Fund
Expenditures
Spending on Education, Medical Assistance, other
Public Welfare Programs, Corrections, and Debt
Service comprises 86 of total General Fund
expenditures.
27.3 Billion
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National Medicaid Spending Growth MA Spending
Growth is Down from 2002 Peak but Costs are Still
Rising 1996 2007
Economic Downturn, Enrollment Cost Growth, 2000
- 2003
Health Care Cost Growth, 1998 - 2000
Strong Economy, Welfare Reform, Enrollment
Declines, Managed Care 1995 - 1998
Start of Economic Recovery, Slower Enrollment
Growth 2004 - 2006
Note Estimates in State Fiscal Year.
Preliminary estimate for 2007. SOURCE Kaiser
Commission on Medicaid and the Uninsured.
Results from a 50-State Medicaid Budget Survey,
State Fiscal Years 2006 and 2007 October 2006.
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MA Eligibles Expected to Increase by 64,000
3.4
3.9
4.9
7.8
4.9
-0.2
4.8
4.3
-3.6
7.0
4.5
-8.2
2.8
10.5
-2.9
1.4
-1.7
Projected
Average Monthly Enrollment
Source DPW Budget Office
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A common misconception

• The claim that Pennsylvania has 1.9 million
  welfare recipients is
• wrong and confuses health care and cash assistance

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Elderly Disabled Are Driving Eligibility
Increase
Eligibility Category Dec-05 Dec-06 Change
Chronically Ill Adults 99,831 99,897 0.07
Elderly/Healthy Horizons 243,403 257,063 5.6
Disabled 376,428 383,769 2.0
Adults/Parents 281,532 265,497 (5.7)
Children 821,528 865,338 5.3
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Department of Public Welfare

• Provides for a 56.154 M increase for County
  Child Welfare needs-based budgets as mandated by
  Act 30 of 1991. BH transition fund for ICSI
  (Integrated Childrens System Integration)
  maintained at 8M
• Deputy Secretary for Early Childhood dual
  reporting structure to Education and Department
  of Public Welfare expansion of day care mental
  health consultation
• Office of Developmental Programs
• Office of Mental Retardation is now the Office of
  Developmental Programs
• 28.902 M increase to expand community mental
  retardation and autism services
• Will work to coordinate both autism services and
  community mental retardation services

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Office of Medical Assistance Programs FY 07/08
Budget Initiatives

• MCO Pay for Performance (P4P)
• MCO Capitation Payment Change (PH Only)
• Pharmacy Carve-Out
• Transition Clients from Voluntary to ACCESS Plus
• Hospital Pay for Performance

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Other Departments and Funds

• PA Dept of Corrections was provided an increase
  of 792,000 for reintegration programs to enhance
  skills and treatment for inmates to reduce
  recidivism rates
• Board of Probation and Parole was provided 3.167
  M to provide additional resources to enhance
  community re-entry preparation and offender
  management
• Department of Health was provided a 3 COLA
  (1.229 M) for drug and alcohol abuse prevention
  and treatment services

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DPW OMHSAS Administered Behavioral Health
Funding

• Community Mental Health Services
• Base Funds
• CHIPPS
• BHSI- Mental Health
• MH Block Grant/SSBG/Other Federal
• Other Categoricals
• State Mental Hospitals
• DPW Administered Drug and Alcohol
• Act 152
• BHSI- Drug Alcohol
• Medicaid
• BH FFS
• HealthChoices Behavioral Health

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OMHSAS Administered Behavioral Health

• County government legislatively grounded and
  uniquely positioned to manage local systems of
  care primary objective to integrate program and
  fiscal accountability
• 48 County MH/MR Programs
• 1966 MH/MR Act
• 49 Single County Authorities
• DOH Bureau of Drug Alcohol Programs as Single
  State Agency
• DOH Primary Licensing entity for DA
• 8 State Mental Hospitals 1 Long Term Nursing
  Care Restoration Center
• Closed or Consolidated 5 (five) state hospitals
  since 1994-1995
• Eliminated State Hospital capacity for children
  adolescents
• Discharged 2,539 individuals through the
  Community Hospital Integration Projects Program
  (CHIPP)

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• 67 HealthChoices Counties
• 28 counties accepted right of first opportunity
• 1 direct state contract with BH-MCO (Greene
  County)
• Direct state contract with 23 counties
• 15 counties accepted right of first opportunity
  for 7/01/07 implementation
• Incorporates broad behavioral mandates
• Variety of models including full risk county
  contracts, subcontracts with Administrative
  Services Organization and full risk subcontracts

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OMHSAS Unified Systems Strategy

• County Based Medicaid state plan services
  utilizing county base funding for state match
  1990-91
• CHIPP dollars follow person from State Hospital
  to community 1991
• Streamline appropriation Community/Hospital
  Appropriation 1993-94
• Act 152 Dollars administered by OMHSAS 1996-97
• BHSI funds mental health and drug and alcohol
  established and administered by OMHSAS 1997
• HealthChoices Behavioral Health Program
  Administered by OMHSAS
• 1997(Southeast)
• OMH changes name to OMHSAS 1998
• HealthChoices expansion to Southwest 1999
  Lehigh/Capital 2001
• Service Area Planning Initiatives County
  Planning (2003-04)
• Childrens Integrated Planning Initiative (ICSI)
  (2004-05)
• Expansion of Health Choices Northeast Counties
  (2005-06)
• BH FFS Transfer (2006-07)
• Health Choices Expansion23 counties (2006-07)
• HealthChoices Expansion to all 67 counties by
  7/01/07

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Movement of Funding from State Administration to
County Administration
Dollars Under County Admin. 2,906,576,139
Percentage of OMHSAS Funding Under County Admin.
Dollars Under County Admin. 354,355,067
Dollars Under State Admin. 626,228,510
Dollars Under State Admin. 914,662,672
Percentage of OMHSAS Funding Under State Admin.
1994-1995
2007-2008
Note State Mental Hospital and Medicaid
Fee-For-Service Funding are under State
Administration.
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OMHSAS Guiding Principles

• The Mental Health and Substance Abuse Service
  system will provide quality services that
• Facilitate recovery and resiliency for adults and
  children
• Are responsive to individuals unique strengths
  and needs throughout their lives
• Focus on prevention and early intervention
• Recognize, respect, and accommodate differences
  as they relate to culture/ethnicity/race,
  religion, gender identity and sexual orientation
• Ensure individual human rights and eliminate
  discrimination and stigma
• Are provided in a comprehensive array by unifying
  programs and funding building on natural and
  community supports unique to each individual and
  family
• Are developed, monitored and evaluated in
  partnership with consumers, families and
  advocates
• Represent true collaboration with other agencies
  service systems

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OMHSAS Objectives

• Policy implementation of a Call for Change to
  recovery and resiliency
• Transform the Childrens Behavioral Health System
  to a system that is family driven and youth
  guided
• Assure that behavioral health services and
  supports recognize and accommodate the unique
  needs of older adults

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Fiscal Year 2004-2005 Unified Mental Health and
Substance Abuse Services System

• County Allocations
• Persons Served 200,004
• Expenditures 401,610,444
• Ave. Expend. 2,008
• MA FFS (03/04)
• Persons Served 88,141
• Expenditures 377,941,134
• Ave. Expend. 4,288
• HealthChoices
• Persons Served 227,087
• Expenditures 1,111,910,124
• Ave. Expend. 4,896
• incomplete county data

BHSI (DA) Persons Served
39,325 Expenditures 40,408,520 Ave.
Expend. 1,028 Act 152
(DA) Persons Served
5,690 Expenditures 18,431,321 Ave.
Expend. 3,239 State Mental
Hospital Persons Served
3,582 Expenditures
404,429,485 Ave. Expend. 112,906










































































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OMHSAS FY 2007-2008 BUDGET SUMMARY
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OMHSAS FY 2007-2008 Budget Unified System
Strategy

• Community MH Services
• 991.24M total state and federal funds, net
  increase of 10.359M State funds increase
  30.097
• 15.977 M provided for three (3) percent cost of
  living adjustment, including Base, CHIPPS and
  BHSI
• CHIPP funding of 18.9M included for the
  discharge of 200 individuals from the State
  Hospitals
• 500,000 to support respite care services for
  2,000 families
• Transfer of 12.7M for Behavioral Health
  HealthChoices Expansion
• Transfer of 8.7M matching funds for Structured
  Treatment Services
• Elimination of funding for Psychiatric Services
  in Eastern PA

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OMHSAS FY 2007-2008 Budget Unified System
Strategy

• Presidents Proposed Budget Federal Funding Update
• Reflects a slight decrease in the Community
  Mental Health Services Block Grant
• Reflects a 4.442 M decrease in the Social
  Services Block Grant FY 2006-07 funding restored
  to prior year funding level of 14.808 M
• Changes to the Medicaid Rehabilitative Services
  Option are projected to yield a federal savings
  of over 2.3 billion over the next 5 years

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OMHSAS FY 2007-2008 Budget Unified System
Strategy

• Drug and Alcohol Services
• 1.238 M in Act 152 funding transferred to MA
  Capitation as a result of HealthChoices
  expansion FY 2007-08 Act 152 budget is 16.2 M
• BHSI IGT funding of 12.107 million
• BHSI funding is 45.300 million (MH 20.130,
  DA 25.170), which includes a 3 COLA
• Sexual Responsibility and Treatment Program (Act
  21)
• Implemented in April 2004 on the grounds of
  Torrance State Hospital
• Ten men are now being served
• SRTP program operation was transferred to the
  Commonwealth and operated by Torrance State
  Hospital (July 1, 2006)
• 3 million in additional funding was provided in
  FY 06-07 additional funding will not be
  available in FY 07-08

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OMHSAS HealthChoices

• As of January 1, 2007, there are 1.375 M people
  enrolled in HealthChoices. Projected enrollment
  for SFY 2007-08 is 1.74 M.
• Funding for Fiscal Year 2007-08 is projected to
  be 2.3 Billion in the Southeast, Southwest,
  Lehigh/Capital, Northeast Zone, 23 county
  expansion zone and 15 county expansion zone
• Southeast Zone total 939.7 million
• Southwest Zone total 435.4 million
• Lehigh/Capital Zone total 408.4 million
• Northeast Zone total 119.5 million
• 23 county expansion zone 186.4 million
• 15 county expansion zone 244.5 million
• Mental Health portion 2,051.0
  billion
• Substance Abuse portion 283.1 million
• (includes admin.)

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• Currently OMHSAS has 8 state hospitals and 1 long
  term nursing care facility
• Since FY 1994-95 there has been a reduction of
  60 in the census of the individuals being served
  in our state hospitals through June 30, 2008
• During the same period, staff complement will
  have decreased by 48
• Through the CHIPP funding opportunity, 2,539
  individuals will have been discharged and 12,387
  individuals will have received diversionary
  services as a result of these discharges through
  June 30, 2007, and supported in the community
  with funding of 190,337,062
• Service area planning work will continue through
  Fiscal Year 2007-2008

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OMHSAS State Mental Health Facilities and Service
Areas

• ERIE

SUSQUEHANNA
WARREN
McKEAN
BRADFORD
TIOGA
POTTER
Warren
WAYNE
CRAWFORD
Clarks Summit
FOREST
WYOMING
LACKAWANNA
SULLIVAN
ELK
CAMERON
VENANGO
MERCER
LYCOMING
PIKE
CLINTON
LUZERNE
CLARION
COLUMBIA
JEFFERSON
MONROE
Danville
LAWRENCE
CLEARFIELD
MONTOUR
UNION
BUTLER
CARBON
CENTRE
ARMSTRONG
SNYDER
NORTHAMPTON
NORTHUMBERLAND
SCHUYLKILL
Allentown
BEAVER
INDIANA
LEHIGH
MIFFLIN
CAMBRIA
BLAIR
JUNIATA
DAUPHIN
BERKS
ALLEGHENY
PERRY
LEBANON
Mayview
Torrance
BUCKS
Wernersville
WESTMORELAND
HUNTINGDON
MONTGOMERY
Norristown
CUMBERLAND
WASHINGTON
LANCASTER
SOMERSET
BEDFORD
PHILADELPHIA
CHESTER
ADAMS
FRANKLIN
YORK
FULTON
DELAWARE
FAYETTE
GREENE
South Mountain
Warren Staff 494 Patients 180
Torrance Staff 477
Patients 237
Clarks Summit Staff 513
Patients 219
Wernersville Staff 461 Patients
219
South Mountain serving all counties Staff
311 Patients 130

Mayview Staff 677 Patients
303
Danville Staff 405 Patients
182
Allentown Staff 377
Patients 170
Norristown Staff 793 Patients 403
As of February 09, 2007
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CHIPP FUNDING HISTORY (CUMULATIVE)
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MENTAL HEALTH AND DRUG AND ALCOHOL SERVICE SYSTEM
FY 2007-2008
Total Funding 3,532,804,649
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Program Updates

• OMHSAS Fee-For-Service Transfer
• Transfer of 41 staff from OMAP to OMHSAS on
  8/15/06
• BH FFS Staff provide prior authorization for the
  following services
• Inpatient Psychiatric Services
• Inpatient Drug and Alcohol Services
• Residential Treatment for Children
• Behavioral Health Rehabilitation Services (BHRS)
  for Children
• Working to replace outdated HUP manual for
  initial authorizations
• Reviewing cases individually to determine cases
  incorrectly identified as FFS which should be
  HealthChoices
• Refined process for automated site to correct
  errors in eligibility
• Streamlined process to resolve eligibility issues
  through Field Office contact with BHMCOs

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Program Updates

• HealthChoices
• CMS approved waiver for the HC BH Expansion
• Implementation began on January 1, 2007
• County Human Services Staff including MH/MR/SCAs
  will co-monitor state contract
• HC County Option 15 counties
• Technical and Cost Proposals finalized
• Recommendations made to the Secretary of Welfare
  to support all of the proposals
• Final Rates have been issued all but three
  counties have accepted rates
• Readiness Review Spring, 2007
• Implementation will begin on July 1, 2007

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Program Updates

• Objectives
• State Plan Services approved by CMS
• Certified Peer Specialists
• Mobile Mental Health Treatment
• HC Expansion
• Older Adult Priorities and Supporting Projects
• MFP resubmission
• Regional Forums
• Adult Priorities and Supporting Projects
• Housing TA identified
• Integrated Treatment Standards Completed
• Childrens Priorities and Supporting Projects
• Response to the BH Taskforce Report
• School Based Intensive and Partial Hospital
  Bulletins/Subcomm

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