iowa coalition on mental health and aging policy and administration workgroup

IOWA COALITION ON IOWA COALITION ON MENTAL HEALTH AND MENTAL HEALTH AND

AGINGAGING

Policy and Policy and AdministrationAdministration

Workgroup Workgroup

PRIMARY GOALSPRIMARY GOALS

Make mental wellness a Make mental wellness a priority issue for policy makers priority issue for policy makers

Make mental wellness a Make mental wellness a priority among program priority among program administrators administrators

OBJECTIVES OBJECTIVES Establish the business case for aging Establish the business case for aging

and mental health issuesand mental health issues

Support policies & programs that Support policies & programs that advance education & trainingadvance education & training

Support policies & programs that Support policies & programs that advance outreach & clinical services advance outreach & clinical services

The Business CaseThe Business Case

Demographic imperative Demographic imperative

Quality of lifeQuality of life

Funding Issues Funding Issues

Iowa's Older Adult PopulationN = 436,000

64 65 66 68

81

104

582

452

384370367361

0

100

200

300

400

500

600

700

800

1990 1995 2000 2005 2015 2025

Year

Number of People (in thousands)

Population 85+

Population 65-84

US Census of the Population, 2000

DemographicsDemographics

The Demographic The Demographic ImperativeImperative

Residents with Mental Illness

60.658.8

0

10

20

30

40

50

60

70

80

US

Colorad

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Illinois

India

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wa

Main

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Mich

igan

Minn

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Avg

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UCSF, 2002

Iowa Nursing Home Iowa Nursing Home PopulationPopulation

Avg. %

per

Faci

lity

Natio

nal

Avg.

Quality of LifeQuality of Life

Warehousing older adults with Warehousing older adults with mental health issues . . .mental health issues . . .

oror provide flexible provide flexible options for community-options for community-based mental health based mental health care substantiated by care substantiated by evidenced-based evidenced-based treatment.treatment.

Funding Issues Funding Issues Medicare ExpendituresMedicare Expenditures

Total Health Expenditures:Total Health Expenditures: $211.4 Billion $211.4 Billion

Total Mental Health Expenditures: Total Mental Health Expenditures: $1.2 Billion (0.57%) $1.2 Billion (0.57%)

Outpatient Mental Health:Outpatient Mental Health: $ 718 Million (0.34%) $ 718 Million (0.34%)

CMS, 2001CMS, 2001

Funding Issues Funding Issues

Medicare MH Expenditures 1998

99%0%

1%All Other Expenditures

Inpatient Psychiatric

Outpatient Mental Health

Medicare Medicare ExpendituresExpenditures

Outreach & Clinical Services Outreach & Clinical Services WorkgroupWorkgroup

PRIMARY GOALSPRIMARY GOALS Increase public awareness Increase public awareness

about aging and mental health about aging and mental health issues issues

Expand the supply of qualified Expand the supply of qualified mental health service providers mental health service providers

Education & Training WorkgroupEducation & Training Workgroup

OBJECTIVESOBJECTIVES

Facilitate provider training Facilitate provider training

Conduct public education Conduct public education campaign campaign

Support policies & programs Support policies & programs that advance education & that advance education &

trainingtraining Training conferences Training conferences

– – Public Health Conference, June 2006Public Health Conference, June 2006 – – Family Practice Association August in 2006Family Practice Association August in 2006 – – Mental Health Issues in Long Term Care, November 2006Mental Health Issues in Long Term Care, November 2006 – – Iowa Community Mental Health Centers, March 2007Iowa Community Mental Health Centers, March 2007 – – Iowa Psychological Association, April 2007Iowa Psychological Association, April 2007 Online training administrationOnline training administration

– – Iowa Geriatric Education Center – University of IowaIowa Geriatric Education Center – University of Iowa – – John A. Hartford Center of Geriatric Nursing Excellence – John A. Hartford Center of Geriatric Nursing Excellence – University of IowaUniversity of Iowa

Online training participationOnline training participation – – Facilitate use of web-based training programs in mental Facilitate use of web-based training programs in mental health and aginghealth and aging

Support policies & programs Support policies & programs that advance education & that advance education &

trainingtraining Continuing Education Continuing Education

Requirements Requirements – – Administer continuing education Administer continuing education opportunities for opportunities for licensed providers across the licensed providers across the statestate

– – Support graduate training in medicine, Support graduate training in medicine, nursing, nursing, psychology, social work and psychology, social work and pharmacology that pharmacology that focus on mental health and focus on mental health and aging.aging.

Education & Training WorkgroupEducation & Training Workgroup Public EducationPublic Education

Fact SheetsFact Sheets

Conference DisplaysConference Displays– Annual Mental Health Conference, October 2006Annual Mental Health Conference, October 2006– Long Term Care Conference, November 2006Long Term Care Conference, November 2006– Gerontology Society of Iowa, April 2007Gerontology Society of Iowa, April 2007– Iowa Psychological Association, April 2007Iowa Psychological Association, April 2007– Governor’s Conference on Aging, May 2007Governor’s Conference on Aging, May 2007

Media Media

Website Resources Website Resources – www.ICMHA.org– www.ICMHA.org

Education & Training WorkgroupEducation & Training Workgroup Primary ObjectivesPrimary Objectives

Promote mental wellness among older Promote mental wellness among older Iowans Iowans

Increase the number of mental health Increase the number of mental health providers who are qualified to treat providers who are qualified to treat older Iowansolder Iowans

Integrate qualified mental health Integrate qualified mental health service providers into usual places of service providers into usual places of care deliverycare delivery

Support policies & Support policies & programs that advance programs that advance

outreach & clinical outreach & clinical servicesservices

Increase payments to non-physician Increase payments to non-physician mental health providers (Medicare, mental health providers (Medicare, Medicaid, and supplemental Medicaid, and supplemental insurance) insurance)

Support inclusion of older adults in Support inclusion of older adults in Iowa Peer Support Training AcademyIowa Peer Support Training Academy



Screening efforts integrated into Screening efforts integrated into other preventive servicesother preventive services

OpportunitiesOpportunities::

Mental health screenings at County Fairs, Mental health screenings at County Fairs, Meal Sites, Senior Centers, Long-Term Care Meal Sites, Senior Centers, Long-Term Care Institutions, and Home and Community-Based Institutions, and Home and Community-Based Care Centers (e.g. Case Management for Frail Care Centers (e.g. Case Management for Frail Elders Program)Elders Program)



Screening efforts integrated into Screening efforts integrated into other preventive servicesother preventive servicesAdvantagesAdvantages::• Reduce ER AdmissionsReduce ER Admissions• Monitor compliance locallyMonitor compliance locally• Reduce costs and stabilize populationReduce costs and stabilize population• Opportunity to serve greater numbers, Opportunity to serve greater numbers,

more more effectively at lower costs (e.g. co-effectively at lower costs (e.g. co-location of care)location of care)



Increase payments to non-physician Increase payments to non-physician mental health providers (Medicare and mental health providers (Medicare and Medicaid) in long-term care institutions Medicaid) in long-term care institutions and community-based settings.and community-based settings.

Promote and monitor use of tele-health in Promote and monitor use of tele-health in long-term care settingslong-term care settings– – IFMC’s Nursing Home Quality InitiativeIFMC’s Nursing Home Quality Initiative

Nursing Homes Nursing Homes

Nursing Home Quality Initiative IFMC, Iowa’s Medicare Quality Improvement Organization (QIO) offers assistance at no cost to nursing homes by providing education, identifying improvement opportunities and sharing valuable resources and best practices.

The focus of IFMC’s Nursing Home Quality Initiative is to assist nursing homes in providing the best possible care for their residents. These services include improving care processes and setting improvement targets for pressure ulcers, restraints, depression and chronic pain.

Nursing Homes Nursing Homes

Nursing Home Quality Initiative (continued)

Additionally, IFMC is working with nursing homes to increase resident and staff satisfaction through work on organizational culture change and implementing person-centered care.

Our Nursing Home Quality Initiative combines this assistance to improve quality of care with information for consumers about the quality of care provided by nursing homes available at www.medicare.gov.

http://www.medicare.gov/

Ask the ExpertAsk the Expert

I am a psychologist who services the geriatric population. Can I am a psychologist who services the geriatric population. Can youyoudirect me to resources which are related to the use of direct me to resources which are related to the use of psychotherapypsychotherapywith mildly demented patients? with mildly demented patients? Would like Screening questions to be used on an acute care Would like Screening questions to be used on an acute care hospitalhospitalnurse admission history to screen for suicide. Would appreciate nurse admission history to screen for suicide. Would appreciate ananevidenced based tool that is quick and easy to use.evidenced based tool that is quick and easy to use.

I am working with a client who is exhibiting symptoms of I am working with a client who is exhibiting symptoms of depression;depression;what is the age range criteria to get an adequate score with thewhat is the age range criteria to get an adequate score with theGeriatric Depression Scale? Geriatric Depression Scale?

I am a licensed Psychologist who works in nursing homes and I am a licensed Psychologist who works in nursing homes and long termlong termcare facilities with geriatric patients. What short screening testscare facilities with geriatric patients. What short screening testsmight you use to measure anxiety with this population?might you use to measure anxiety with this population?


outreach & clinical outreach & clinical servicesservices Establish primary care – mental health Establish primary care – mental health

care collaborative modelscare collaborative models

Collaborate with primary care, aging Collaborate with primary care, aging services, residential care facilities, and services, residential care facilities, and home and community-based serviceshome and community-based services

Encourage continuity of care between Encourage continuity of care between inpatient and community-based inpatient and community-based services/preventive servicesservices/preventive services



Replicate Employee Assistance Programs Replicate Employee Assistance Programs which offer mental health screenings and which offer mental health screenings and community-based treatments that have community-based treatments that have demonstrated patient success in demonstrated patient success in treatment at significantly lower costs per treatment at significantly lower costs per patient over inpatient care.patient over inpatient care.



Document successful behavioral Document successful behavioral interventions-evidence-based for the interventions-evidence-based for the reimbursement streamreimbursement stream

Develop health networks linking mental Develop health networks linking mental health providers and rural populations to health providers and rural populations to primary care, public health, substance abuse primary care, public health, substance abuse programs, and nursing careprograms, and nursing care

Iowa Coalition on Mental Health & Iowa Coalition on Mental Health & AgingAging

2008 Policy Agenda2008 Policy AgendaNational InitiativesNational Initiatives

H.R. 3162H.R. 3162 – Children’s Health and Medicare Protection Act – Children’s Health and Medicare Protection Act of 2007, Introduced by Rep. John Dingell on 7/24/07, Passed of 2007, Introduced by Rep. John Dingell on 7/24/07, Passed by U.S. House 8/1/07by U.S. House 8/1/07

Highlights:Highlights:• Gradually provides parity between Medicare mental Gradually provides parity between Medicare mental

health services and services for physical conditions;health services and services for physical conditions;

• 5% increase for Medicare Part B payments to social 5% increase for Medicare Part B payments to social workers and psychologists;workers and psychologists;

• 0.5% increase in current physician payment system, 0.5% increase in current physician payment system, impacting mental health providers;impacting mental health providers;


2008 Policy Agenda2008 Policy AgendaHighlights (H.R. 3162 continued):Highlights (H.R. 3162 continued):• Medicare reimbursement to services provided by Medicare reimbursement to services provided by

marriage and family therapists;marriage and family therapists;

• Authorizes new benefits for preventive items and services, Authorizes new benefits for preventive items and services, including mental health services;including mental health services;

• Include benzodiazepines in required coverage under Include benzodiazepines in required coverage under Medicare Part D prescription drug program;Medicare Part D prescription drug program;

• Reduce over-payments to private Medicare Advantage Reduce over-payments to private Medicare Advantage (MA) plans, charges limited to costs under original (MA) plans, charges limited to costs under original Medicare plan;Medicare plan;


2008 Policy Agenda2008 Policy AgendaHighlights (H.R. 3162 continued):Highlights (H.R. 3162 continued):• Discounted premiums via the Extra Help program for low Discounted premiums via the Extra Help program for low

income participants (Medicare Savings Plan and Part D);income participants (Medicare Savings Plan and Part D);

• Access to improved drug formularies for name brand and Access to improved drug formularies for name brand and generics;generics;

• Prevention of marketing fraud by Medicare Advantage Prevention of marketing fraud by Medicare Advantage plansplans

Attention is focused in the U.S. Senate which does Attention is focused in the U.S. Senate which does

not have this legislation.not have this legislation.



H.R. 1663H.R. 1663 – Medicare Mental Health Modernization Act, – Medicare Mental Health Modernization Act, introduced by Rep. Pete Stark, Chair Health Subcommittee of introduced by Rep. Pete Stark, Chair Health Subcommittee of House Ways and Means with Co-sponsors Rep. Patrick Kennedy House Ways and Means with Co-sponsors Rep. Patrick Kennedy and Rep. Jim Ramstadand Rep. Jim Ramstad

Highlights:Highlights:• Reduce Medicare’s 50% co-payment for mental health care Reduce Medicare’s 50% co-payment for mental health care

to the 20% level charged for most other Part B medical to the 20% level charged for most other Part B medical services;services;

• Eliminate the 190 day lifetime cap for inpatient services;Eliminate the 190 day lifetime cap for inpatient services;

• Add intensive residential mental health services to Add intensive residential mental health services to Medicare, including crisis services, psychiatric Medicare, including crisis services, psychiatric rehabilitation, substance abuse intervention, and other non-rehabilitation, substance abuse intervention, and other non-institutional mental health careinstitutional mental health care


2008 Policy Agenda2008 Policy AgendaHighlights (H.R. 1663 continued):Highlights (H.R. 1663 continued):• Cover intensive outpatient services, including psychiatric Cover intensive outpatient services, including psychiatric

rehabilitation; assertive community treatment; intensive rehabilitation; assertive community treatment; intensive case management; day treatment for individuals under 21 case management; day treatment for individuals under 21 years of age; and ambulatory detoxification;years of age; and ambulatory detoxification;

• Expand the types of mental health professionals eligible to Expand the types of mental health professionals eligible to provide services through Medicare;provide services through Medicare;

• Correct a legislative oversight to permit direct payment Correct a legislative oversight to permit direct payment under the Medicare program for clinical social worker under the Medicare program for clinical social worker services provided to residents of skilled nursing facilities;services provided to residents of skilled nursing facilities;


2008 Policy Agenda2008 Policy AgendaHighlights (H.R. 1663 continued):Highlights (H.R. 1663 continued):• Require the Secretary of the Department of Health and Require the Secretary of the Department of Health and

Human Services to conduct a study to examine whether Human Services to conduct a study to examine whether the Medicare criteria to cover therapeutic services to the Medicare criteria to cover therapeutic services to beneficiaries with Alzheimer’s Disease and related beneficiaries with Alzheimer’s Disease and related cognitive disorders discriminates by being overly cognitive disorders discriminates by being overly restrictive.restrictive.



H.R. 1669H.R. 1669 – Positive Aging Act of 2007, introduced by Rep. Patrick – Positive Aging Act of 2007, introduced by Rep. Patrick Kennedy, to amend the Public Health Service Act. (Also S. 982, Kennedy, to amend the Public Health Service Act. (Also S. 982, Introduced by Senator Clinton, 4/23/07)Introduced by Senator Clinton, 4/23/07)

Highlights:Highlights:• Provide grants to states to integrate mental health services in Provide grants to states to integrate mental health services in

primary care settings;primary care settings;

• Fund community-based mental health treatment outreach Fund community-based mental health treatment outreach teams;teams;

• Designate a Deputy Director for Older Adult Mental Health Designate a Deputy Director for Older Adult Mental Health Services within the Center for Mental Health Services;Services within the Center for Mental Health Services;

• Targeted funds for substance abuse in older adults, homeless, Targeted funds for substance abuse in older adults, homeless, and rural older adults.and rural older adults.



Older Americans Act as Reauthorized September 30, 2006Older Americans Act as Reauthorized September 30, 2006

Highlights:Highlights:

• Title IV – Activities for Health, Independence, and Longevity, Title IV – Activities for Health, Independence, and Longevity, grants to states for rural caregivers, especially for Alzheimer’s grants to states for rural caregivers, especially for Alzheimer’s patients, creating awareness of organic brain syndromes, patients, creating awareness of organic brain syndromes, depression, and the need for mental health care for older depression, and the need for mental health care for older adults;adults;

• Funding for mental health screening, prevention, treatment Funding for mental health screening, prevention, treatment services, planning for Boomers, and multidisciplinary centers services, planning for Boomers, and multidisciplinary centers for mental health screening;for mental health screening;


2008 Policy Agenda2008 Policy AgendaOlder Americans Act as Reauthorized September 30, Older Americans Act as Reauthorized September 30,

20062006

Highlights (continued):Highlights (continued):

• Title III – Grants for State and Community Programs on Title III – Grants for State and Community Programs on Aging, funding for mental health outreach/screening, Aging, funding for mental health outreach/screening, health education, counseling, preventive assessments and health education, counseling, preventive assessments and health screenings;health screenings;

• Priority for persons caring for MR, DD and persons with Priority for persons caring for MR, DD and persons with Alzheimer’s Disease.Alzheimer’s Disease.

Congress has not passed the 2008 budget bill Congress has not passed the 2008 budget bill funding amounts pendingfunding amounts pending



American Association for Geriatric Psychiatry and the American Association for Geriatric Psychiatry and the Substance Abuse and Mental Health Services Administration Substance Abuse and Mental Health Services Administration (SAMHSA) within HHS, working on a national behavioral health (SAMHSA) within HHS, working on a national behavioral health workforce development strategy through a public-private workforce development strategy through a public-private partnership with the Annapolis Coalition on Behavioral Health partnership with the Annapolis Coalition on Behavioral Health Workforce Education. These partners are working to build new Workforce Education. These partners are working to build new competencies among providers and educators, among health competencies among providers and educators, among health care organizations and academic institutions. Federal and State care organizations and academic institutions. Federal and State agencies, accrediting bodies, health care insurers, and agencies, accrediting bodies, health care insurers, and professional organizationsprofessional organizations



Institute of Medicine has suggested the following to be Institute of Medicine has suggested the following to be included in the Fiscal Year 2008 Labor/HHS Appropriations included in the Fiscal Year 2008 Labor/HHS Appropriations bill:bill:

The Committee provides $1 Million for a study by the Institute of The Committee provides $1 Million for a study by the Institute of Medicine of the National Academy of Sciences to determine the Medicine of the National Academy of Sciences to determine the multi-disciplinary mental health workforce needed to serve older multi-disciplinary mental health workforce needed to serve older adults. The initiation of this study should be not later than 60 days adults. The initiation of this study should be not later than 60 days after the date of enactment of this Act, whereby the Secretary of after the date of enactment of this Act, whereby the Secretary of HHS shall enter into a contact with the Institute of Medicine to HHS shall enter into a contact with the Institute of Medicine to conduct a thorough analysis of the forces that shape the mental conduct a thorough analysis of the forces that shape the mental health care workforce for older adults, including education, health care workforce for older adults, including education, training, modes of practice, and reimbursement.training, modes of practice, and reimbursement.

This matter is pending the approval of the Federal Budget for This matter is pending the approval of the Federal Budget for FY 2008.FY 2008.


2008 Policy Agenda2008 Policy AgendaState InitiativesState Initiatives

Iowa Coalition on Mental Health and Aging Legislative Iowa Coalition on Mental Health and Aging Legislative Breakfast, January 31, 2007 – Over 20 legislators attended Breakfast, January 31, 2007 – Over 20 legislators attended and received information on the Coalition and the mental and received information on the Coalition and the mental health needs of older Iowanshealth needs of older Iowans

H.F. 909 (passed) Health and Human Services H.F. 909 (passed) Health and Human Services Appropriations bill, includes $60,000 for Dementia-specific Appropriations bill, includes $60,000 for Dementia-specific education for Direct Care Workerseducation for Direct Care Workers

S.F. 128 – Tobacco Tax bill, created a Health Care Trust S.F. 128 – Tobacco Tax bill, created a Health Care Trust FundFund


2008 Policy Agenda2008 Policy AgendaState Initiatives (continued)State Initiatives (continued)

State’s Mental Health Systems Improvement Bill, establishes State’s Mental Health Systems Improvement Bill, establishes 6 workgroups including Community Mental Health Center 6 workgroups including Community Mental Health Center PlanningPlanning

Proposal to conduct a series of regional meetings on the Proposal to conduct a series of regional meetings on the issue of mental health and aging in cooperation with Area issue of mental health and aging in cooperation with Area Agencies on AgingAgencies on Aging

Potential funding via the Older Americans Act mental health Potential funding via the Older Americans Act mental health and aging initiatives via the aging network and and aging initiatives via the aging network and collaborations with community-based providerscollaborations with community-based providers


2008 Policy Agenda2008 Policy AgendaState Initiatives (continued)State Initiatives (continued)

Continue letter writing in support of Federal initiatives, Continue letter writing in support of Federal initiatives, attending caucus meetings, and planning for the 2008 Iowa attending caucus meetings, and planning for the 2008 Iowa Legislative SessionLegislative Session

Iowa Coalition on Mental Health and Aging Legislative Iowa Coalition on Mental Health and Aging Legislative Breakfast, to be held January 31, 2008, 7:00-9:00 am, Breakfast, to be held January 31, 2008, 7:00-9:00 am, Legislative Dining Room 15Legislative Dining Room 15

iowa coalition on mental health and aging policy and administration workgroup

Documents

mental health care

outpatient mental health

mental wellness

aging slide

based training programs

iowa coalition

administration workgroup

demographic imperative