News and Notes

NASMHPD issue brief on HIT’s role in integrated care: Integration of behavioral health and primary care depends to a large extent on providers’ ability to share information via health information technology (HIT), including electronic health records (EHRs) and health information exchanges (HIEs). However, federal incentives promoting use of HIT have failed to include behavioral health care providers among the physician groups targeted, as described in an issue brief from the National Association of State Mental Health Program Directors (NASMHPD). The document is both a warning and a call to action: unless state agencies develop HIT systems that can accept electronic data from mental health providers while meeting all HIPAA privacy requirements, they will not realize the promises of integrated care: improved patient outcomes and substantial cost savings. The report includes recommendations in three specific areas of care delivery in which HIT will be critically important to integration: care coordination, patient engagement, and medication management. For example, to improve care coordination, federal agencies should encourage EHR vendors to include clinical decision support for behavioral health screening. To better engage patients, HIEs should allow information sharing with members of a patient’s recovery team who are not a part of the medical establishment, such as peer support workers. A key section—“Case Studies in Integration: What’s Working? What Are the HIE Challenges?”—details ways in which programs in four states have made innovative use of HIT to overcome barriers to information sharing. The report concludes with a list of four actions to help state behavioral health agencies lay a foundation for progress: convene key stakeholders in groups to develop a roadmap for full integration of behavioral health in the state’s HIE; charge these groups with identifying cases that would benefit from additional automation or standardization and with prioritizing steps to promote system efficiencies, clinical decision support, and use of evidence-based guidelines; use purchasing power to ensure that behavioral health information is integrated into HIEs in provider networks and in contracts for Medicaid managed care and state employee benefit programs; and educate providers and consumers about the value of including behavioral health information in the HIE and to improve their understanding of laws affecting information sharing. The 20-page report, Crossing the Behavioral Health Digital Divide: The Role of Health Information Technology in Improving Care for People with Serious Mental Illness in State Mental Health Systems, is available at www.nasmhpd.org.

Bazelon report on strategies to maximize enrollment: The expansion of Medicaid and the creation of health insurance marketplaces under the Affordable Care Act (ACA) have enabled states to offer an array of health care options that will greatly improve the lives of people with serious mental illnesses. To comply with ACA provisions and with the Americans with Disabilities Act, states must make reasonable modifications to their enrollment processes to ensure that people with disabilities have an equal opportunity to participate in health care programs. A new report from the Bazelon Center for Mental Health Law explores outreach and enrollment strategies that have proven useful in connecting people with serious mental illness to vital benefits. Under the ACA, people with serious mental illnesses are in the group classified as “medically frail,” the report notes. This designation allows them to opt out of “alternative benefit plans” and instead receive traditional Medicaid coverage, which provides access to more services, including assertive community treatment, supported employment, and peer support services. However, to receive this classification, people with serious mental illness may need help understanding and answering “the disability question” that is part of the new streamlined application for Medicaid and marketplace health plans, as explained in the report. The report describes specialized case manager training and other strategies used in the SOAR program (SSI/SSDI Outreach, Access and Recovery) that have led to notably high success rates for applications. In general, successful enrollment strategies for people with serious mental illness require active outreach efforts that are sustained over time; one-on-one assistance throughout the application, enrollment, and renewal processes; and targeted efforts for incarcerated individuals. The 29-page report, Making the Connection: Meeting Requirements to Enroll People With Mental Illnesses in Healthcare Coverage, is available on the Bazelon Center Web site at www.bazelon.org.

Kaiser Foundation issue brief on Medicaid’s role in the juvenile justice system: Many girls and boys in the juvenile justice system have complex unmet needs for general medical, reproductive, and behavioral health services—not only while they are in juvenile justice residential facilities but also on release. Because many are from low-income families, Medicaid and the Children’s Health Insurance Program (CHIP) can play an important role in financing these services, as described in an issue brief recently released by the Kaiser Family Foundation. The brief cites data indicating that as of September 2010, about 70,800 youth were in the nation’s approximately 2,500 juvenile justice residential settings that hold youths under age 21. These settings vary widely—from short-term detention centers to long-term secure facilities—as do the health care services available in them. The brief also cites data indicating that although one in three American children (37%) is covered by Medicaid and CHIP, more than seven million children remain uninsured and that most (5.2 million) are eligible for but not enrolled in Medicaid or CHIP. Uninsured children in juvenile justice facilities present a special case because the “inmate exclusion” in federal law prohibits most from having their services paid for by Medicaid or CHIP—and although the ACA strengthens Medicaid and CHIP coverage for children, it does not make any changes to the inmate exclusion. The brief concludes with a summary of key issues: national standards are needed for assessment and treatment of youths in juvenile justice facilities; to promote continuity of coverage on release, states should adopt policies that suspend rather than terminate Medicaid coverage (the inmate exclusion) for youths who enter detention facilities; jurisdictions should ensure that youths are immediately connected to primary care providers and medical homes once they leave detention; and states should adopt policies that promote better collection of data on the characteristics of youths in the juvenile justice system, including their needs for coverage and care. The 15-page brief, Health Coverage and Care for Youth in the Juvenile Justice System: The Role of Medicaid and CHIP, is available on the Kaiser Foundation site at kff.org.

CSG call for applicants for Collaboration Learning Sites Program: In partnership with the U.S. Department of Justice’s Bureau of Justice Assistance, the Council of State Governments (CSG) Justice Center is seeking applicants for the Criminal Justice/Mental Health Collaboration Learning Sites Program. The program is designed to highlight agencies that have developed successful collaborations between the criminal justice and mental health systems in the areas of pretrial, community corrections, and court-based programs (for example, mental health courts) that are willing to share their expertise with the field. Selected jurisdictions will be designated as learning sites and will work closely with the CSG Justice Center to provide peer learning opportunities to programs nationwide as well as to fellow learning sites, stay abreast of current research and best practices, and improve their own programs. Interested jurisdictions must submit a letter of interest and application by July 11, 2014. The application and more information are available on the CSG site at csgjusticecenter.org/wp-content/uploads/2014/06/Learning-Sites-Solicitation-2014.pdf.

PCPCC interactive map shows growth of patient-centered homes: The Patient-Centered Primary Care Collaborative (PCPCC) has created an online U.S. map that identifies active programs and initiatives built on the principles of patient-centered medical homes (PCMHs), including payment reform and quality improvement. Clicking on each state brings up a brief description of PCMH activity across the state, including a checklist of potential options that states can use to expand PCMH activity (for example, legislation, regulations, and grant-funded demonstration programs); a list of PCMH programs grouped by payer type; evaluation data; population health data and statistics, and state-specific news. The map allows users to identify where medical homes are becoming a standard of care in commercial and public-sector health plans, which is useful for state and federal policy makers, researchers and educators, health professionals, and other stakeholders. The map is available on the PCPCC site at www.pcpcc.org/initiatives.

Fact sheets on ACA’s and MHPAEA’s effects on smoking cessation services: Two new fact sheets from the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) detail the main provisions in the ACA and in the Mental Health Parity and Addiction Equity Act (MHPAEA) that address tobacco use and control, including insurance coverage for tobacco cessation treatment. Under the ACA, tobacco users can be charged up to 50% more than those who do not use tobacco for health insurance premiums in the marketplace for individual or small group plans. For purposes of the premium surcharge, use is defined as use of any tobacco product (e-cigarettes are not currently included) other than for religious or ceremonial use, average use of four or more times per week, and use within the past six months. Although the ACA stipulates that “tobacco cessation services” (not further defined) must be provided at no cost under most types of insurance, the scope of coverage (for example, counseling, prescription medications, and over-the-counter nicotine replacement therapies) is likely to vary by state, type of insurance, and insurance provider. In employer-sponsored insurance plans, ACA rules allow employers to reward or penalize employees by up to 50% of the cost of health care coverage on the basis of tobacco use. Tobacco users may be able to avoid the penalty by participating in tobacco cessation services in a wellness program offered by their workplace. Under both the ACA and the MHPAEA, tobacco cessation can be included under treatment for substance use disorders. The MHPAEA requires coverage of substance use disorder benefits to be similar to that for medical-surgical benefits. However, it does not require a plan to offer substance use disorder benefits, nor is a plan obligated to offer benefits for any particular substance use disorder, such as nicotine addiction, even if the plan offers benefits for other such disorders. The two fact sheets are available on the CIHS site at www.integration.samhsa.gov.

AHRQ tool kit to help rural primary care practices manage obesity: Research shows that primary care physicians are not doing well in getting patients to lose weight. Although evidence suggests that linking primary care practices with community resources is a critical step in addressing the chronic illness of obesity, creating such linkages may be especially challenging in rural areas. Integrating Primary Care Practices and Community-Based Resources to Manage Obesity: A Bridge-building Toolkit for Rural Primary Care Practices, developed by the Oregon Rural Practice-Based Research Network and the Agency for Healthcare Research and Quality (AHRQ), provides tools and concepts informed by the experiences of six primary care practices in three rural Oregon communities. The 45-page tool kit is available at www.ahrq.gov.