The Law:
Earlier this summer (July, 28, 2015), Oregon Governor Kate Brown signed Senate Bill 832, making it law in Oregon.
Oregon’s SB 832 will usher in bidirectional integration across the state’s healthcare system.
Earlier this summer (July, 28, 2015), Oregon Governor Kate Brown signed Senate Bill 832, making it law in Oregon.
Oregon’s SB 832 will usher in bidirectional integration across the state’s healthcare system.
Oregon's Senate Bill 832 has:
o Practitioners: Defined the “Behavioral Health Clinicians” that can independently provide care within these settings to include:
o Billing:
o Model/scope:
o Standards: Directed the Oregon Health Authority to prescribe by rule standards for achieving the integration of behavioral health services and physical health services in patient-centered primary care homes and behavioral health homes.
Review the law in full here -- SB832: https://olis.leg.state.or.us/liz/2015R1/Measures/Overview/SB832.
o Practitioners: Defined the “Behavioral Health Clinicians” that can independently provide care within these settings to include:
- licensed psychologists
- licensed social workers
- licensed professional counselors
- others who are able to treat mental illness within their scope of practice
- interns and residents who are practicing under supervision through a Board contract working their way to licensure
o Billing:
- Allowed patient-centered primary care homes to bill for mental health services provided in primary care and urgent care settings
- Allowed behavioral health homes to bill for primary care services.
o Model/scope:
- Defined “Integrated Care” as "care provided to individuals and their families in a patient centered primary care home by licensed primary care and behavioral health clinicians, working together, to address one or more of the following:
(a) "Mental illness;
(b) "Substance abuse disorders;
(c) "Health behaviors that contribute to chronic illnesses;
(d) "Life stressors and crises;
(e) "Stress related physical symptoms; or
(f) "Ineffective patterns of health care utilization." - Defined a “Behavioral Health Home” as follows: “ 'Behavioral health home' means a mental health disorder or substance use disorder treatment organization, as defined by the Oregon Health Authority by rule, that provides integrated health care to individuals whose primary diagnoses are mental health disorders or substance use disorders."
o Standards: Directed the Oregon Health Authority to prescribe by rule standards for achieving the integration of behavioral health services and physical health services in patient-centered primary care homes and behavioral health homes.
Review the law in full here -- SB832: https://olis.leg.state.or.us/liz/2015R1/Measures/Overview/SB832.
The Context of Oregon:
For context on the passage of SB 832 in Oregon, on the blog of the Collaborative Family Healthcare Association (CFHA), Robin Henderson describes Oregon as, "Home to the largest Medicaid experiment in the country--Coordinated Care Organizations (CCOs)--and at the heart of that experiment is a dedication to integrated care," (Henderson, 2015). Henderson, PsyD, is Chief Behavioral Health Officer and Vice President of Strategic Integration at St. Charles Health System, and was key in getting SB 832 passed. Much of what follows paraphrases key points from her above-linked article.
The idea for CCOs begins in Oregon in 2009, before the Patient Protection and Affordable Care Act (PPACA) of 2010, when those wishing to pursue integration were frustrated by regulatory limitations on the ability to bill for integrated services.
CCOs were a Medicaid experiment to remove restrictions on how Medicaid funds can be used, such as whether or not a psychologist practicing in a medical setting could bill for mental health codes. CCOs became operational in 2013, and there are now 16 of them in the state of Oregon.
CCOs integrate medical, behavioral, and dental care. Seemingly aligned with the PPACA, CCOs have to demonstrate value -- and are tracked regarding progress on Quality Incentive Metrics, and are only able to receive their full allocation of funds if they can show "a decrease in the amount of funds needed to treat the Medicaid population overall," (Henderson, 2015). Henderson says this decrease in Medicaid costs has to continue over time for years, and eventually fully justify the initial investment ($11 billion) (!).
According to Henderson, many of the CCOs did not initially have in-house behavioral health capacity, which had up to then been the domain of the community mental health system. Barriers to integration within CCOs included, "[that the community mental health system had] byzantine requirements to code and bill for mental health visits," for example requiring, "a special 'Certificate of Approval' even for licensed folks," (Henderson, 2015).
Henderson highlights (and credits) these obstacles as the start of SB 832. Henderson says her aim was to get "the practice of integrated primary care" defined in the statutes, because then providers of and advocates for integrated health care in the state could begin dismantling the silos in place to keep budgets for mental healthcare exclusively in the hands of the community mental health system, doing this in the interest of advancing integrated care. Henderson owns she was naive, but it seems she continued to persevere, relying on allies and integrated health care advocates/experts such as C.J. Peek and Ben Miller. She further cites the Agency for Health Research and Quality's (AHRQ's) work and research in defining integrated care as a significant support. The existing collaborative infrastructure of the Integrated Behavioral Health Alliance of Oregon was also of significant support. This alliance brought together real-world experience, and thus could outline the obstacles to integrated health care that could be addressed legislatively.
Robin Henderson does a nail-biting summary of how she ushered SB 832 through the state legislature. That summary begins three-quarters of the way down the blog entry we have been referencing here. The summary begins with, "The true tale of SB 832 is best told over a vodka martini....". It's worth the read: http://www.cfha.net/blogpost/689173/223873/The-State-of-Integration-How-a-Bill-really-does-become-a-Law .
In summary, this background on SB 832 highlights how vital vision and collaboration are to moving integrated health care forward at the state legislature level. As well, this background highlights why it is actually quite thrilling to have a definition of not only integrated care written into state law, but to additionally have "Behavioral Health Homes" defined by law. Not to mention, anyone with experience in the administration of healthcare delivery will be relieved that interns pursuing licensure, when properly supervised, can be reimbursed. What a boon. Lastly, the law has provisions that will continue to promote the standardization of evidence-based integrated health care practices and quality.
For context on the passage of SB 832 in Oregon, on the blog of the Collaborative Family Healthcare Association (CFHA), Robin Henderson describes Oregon as, "Home to the largest Medicaid experiment in the country--Coordinated Care Organizations (CCOs)--and at the heart of that experiment is a dedication to integrated care," (Henderson, 2015). Henderson, PsyD, is Chief Behavioral Health Officer and Vice President of Strategic Integration at St. Charles Health System, and was key in getting SB 832 passed. Much of what follows paraphrases key points from her above-linked article.
The idea for CCOs begins in Oregon in 2009, before the Patient Protection and Affordable Care Act (PPACA) of 2010, when those wishing to pursue integration were frustrated by regulatory limitations on the ability to bill for integrated services.
CCOs were a Medicaid experiment to remove restrictions on how Medicaid funds can be used, such as whether or not a psychologist practicing in a medical setting could bill for mental health codes. CCOs became operational in 2013, and there are now 16 of them in the state of Oregon.
CCOs integrate medical, behavioral, and dental care. Seemingly aligned with the PPACA, CCOs have to demonstrate value -- and are tracked regarding progress on Quality Incentive Metrics, and are only able to receive their full allocation of funds if they can show "a decrease in the amount of funds needed to treat the Medicaid population overall," (Henderson, 2015). Henderson says this decrease in Medicaid costs has to continue over time for years, and eventually fully justify the initial investment ($11 billion) (!).
According to Henderson, many of the CCOs did not initially have in-house behavioral health capacity, which had up to then been the domain of the community mental health system. Barriers to integration within CCOs included, "[that the community mental health system had] byzantine requirements to code and bill for mental health visits," for example requiring, "a special 'Certificate of Approval' even for licensed folks," (Henderson, 2015).
Henderson highlights (and credits) these obstacles as the start of SB 832. Henderson says her aim was to get "the practice of integrated primary care" defined in the statutes, because then providers of and advocates for integrated health care in the state could begin dismantling the silos in place to keep budgets for mental healthcare exclusively in the hands of the community mental health system, doing this in the interest of advancing integrated care. Henderson owns she was naive, but it seems she continued to persevere, relying on allies and integrated health care advocates/experts such as C.J. Peek and Ben Miller. She further cites the Agency for Health Research and Quality's (AHRQ's) work and research in defining integrated care as a significant support. The existing collaborative infrastructure of the Integrated Behavioral Health Alliance of Oregon was also of significant support. This alliance brought together real-world experience, and thus could outline the obstacles to integrated health care that could be addressed legislatively.
Robin Henderson does a nail-biting summary of how she ushered SB 832 through the state legislature. That summary begins three-quarters of the way down the blog entry we have been referencing here. The summary begins with, "The true tale of SB 832 is best told over a vodka martini....". It's worth the read: http://www.cfha.net/blogpost/689173/223873/The-State-of-Integration-How-a-Bill-really-does-become-a-Law .
In summary, this background on SB 832 highlights how vital vision and collaboration are to moving integrated health care forward at the state legislature level. As well, this background highlights why it is actually quite thrilling to have a definition of not only integrated care written into state law, but to additionally have "Behavioral Health Homes" defined by law. Not to mention, anyone with experience in the administration of healthcare delivery will be relieved that interns pursuing licensure, when properly supervised, can be reimbursed. What a boon. Lastly, the law has provisions that will continue to promote the standardization of evidence-based integrated health care practices and quality.
Adapting Oregon's Success to Texas:
Henderson (2015) named key players in the success of this legislation, including researchers, advocates, and collaborations. What are the parallel ingredients for success in Texas, and how can you become more engaged in this work? We recommend:
(1) Support the development of consensus recommendations in Texas: Mental Health America of Greater Houston is working (just launched in August 2015) to "develop and implement consensus recommendations to improve both financing and provider preparation for integrated health care in Texas." Please contact Alejandra Posada, Director of Education and Training at Mental Health America of Greater Houston ([email protected]) for more information or to become involved.
(2) Join a statewide monthly call/networking group focused on integration: The Physical Health/ Behavioral Health Integration (PHBHI) Networking Group, coordinated by the Meadows Mental Health Policy Institute (MMHPI), provides an opportunity for individuals across the state with interest and/or expertise in the integration of primary and behavioral health care services to connect, network and share ideas with other professionals in the PCBHI field. Networking group calls include:
The PHBHI Networking Group is led by Co-Chairs Camille Miller (Texas Health Institute) and Rick Ybarra (Hogg Foundation for Mental Health). Administrative and programmatic support is provided by Dr. Michele Guzmán and Kendal Tolle of the Meadows Mental Health Policy Institute. To join the call, contact Kendal at [email protected].
(3) Attend live trainings on integrated health care hosted by the Greater Houston Behavioral Health Affordable Care Act (BHACA) Initiative and our collaborative partners. To be apprised of upcoming trainings, please join the BHACA Blast newsletter, which goes out every-other-Wednesday. To be added, please send an email to Lauren Pursley, BHACA Program Coordinator, at [email protected]. To access archived BHACA Blasts, please find them online here: http://www.nbhp.org/bhaca-blasts-bimonthly-newsletter.html.
(4) Stay abreast of the work of the Behavioral Health Integration Advisory Committee (BHIAC) of the Texas Health and Human Services Commission (HHSC). Learn more: http://www.hhsc.state.tx.us/about_hhsc/AdvisoryCommittees/bhiac.shtml. Look for opportunities to provide input into that process as opportunity arises.
References:
Henderson, R. (2015). "The State of Integration: How a Bill Really Does Become a Law." Collaborative Family Healthcare Association (CFHA) Blog. Retrieved online (September 11, 2015): http://www.cfha.net/blogpost/689173/223873/The-State-of-Integration-How-a-Bill-really-does-become-a-Law.
Senate Bill 832 C-Engrossed, 78th Oregon Legislative Assembly, § 3-4 (2015). Retrieved online (September 11, 2015): https://olis.leg.state.or.us/liz/2015R1/Downloads/MeasureDocument/SB832/C-Engrossed.
Henderson (2015) named key players in the success of this legislation, including researchers, advocates, and collaborations. What are the parallel ingredients for success in Texas, and how can you become more engaged in this work? We recommend:
(1) Support the development of consensus recommendations in Texas: Mental Health America of Greater Houston is working (just launched in August 2015) to "develop and implement consensus recommendations to improve both financing and provider preparation for integrated health care in Texas." Please contact Alejandra Posada, Director of Education and Training at Mental Health America of Greater Houston ([email protected]) for more information or to become involved.
(2) Join a statewide monthly call/networking group focused on integration: The Physical Health/ Behavioral Health Integration (PHBHI) Networking Group, coordinated by the Meadows Mental Health Policy Institute (MMHPI), provides an opportunity for individuals across the state with interest and/or expertise in the integration of primary and behavioral health care services to connect, network and share ideas with other professionals in the PCBHI field. Networking group calls include:
- introducing best practices both in Texas and across the country;
- sharing lessons learned from innovative work;
- examining policy implications related to integrated care;
- brainstorming possibilities for future collaborations; and
- discussing strategic systems planning.
The PHBHI Networking Group is led by Co-Chairs Camille Miller (Texas Health Institute) and Rick Ybarra (Hogg Foundation for Mental Health). Administrative and programmatic support is provided by Dr. Michele Guzmán and Kendal Tolle of the Meadows Mental Health Policy Institute. To join the call, contact Kendal at [email protected].
(3) Attend live trainings on integrated health care hosted by the Greater Houston Behavioral Health Affordable Care Act (BHACA) Initiative and our collaborative partners. To be apprised of upcoming trainings, please join the BHACA Blast newsletter, which goes out every-other-Wednesday. To be added, please send an email to Lauren Pursley, BHACA Program Coordinator, at [email protected]. To access archived BHACA Blasts, please find them online here: http://www.nbhp.org/bhaca-blasts-bimonthly-newsletter.html.
(4) Stay abreast of the work of the Behavioral Health Integration Advisory Committee (BHIAC) of the Texas Health and Human Services Commission (HHSC). Learn more: http://www.hhsc.state.tx.us/about_hhsc/AdvisoryCommittees/bhiac.shtml. Look for opportunities to provide input into that process as opportunity arises.
References:
Henderson, R. (2015). "The State of Integration: How a Bill Really Does Become a Law." Collaborative Family Healthcare Association (CFHA) Blog. Retrieved online (September 11, 2015): http://www.cfha.net/blogpost/689173/223873/The-State-of-Integration-How-a-Bill-really-does-become-a-Law.
Senate Bill 832 C-Engrossed, 78th Oregon Legislative Assembly, § 3-4 (2015). Retrieved online (September 11, 2015): https://olis.leg.state.or.us/liz/2015R1/Downloads/MeasureDocument/SB832/C-Engrossed.