CMH/API 2000 Project

Outcome Notes

Meetings with Mental Health Services Consumers, Family Members, and Providers on the Alaska Community Intensive Services Proposal

 

December 19, 2000, 12 Noon, Computer Connection

 

Participants:  Katsumi Kenastin and David Roquet, Computer Connection; Jill Ramsey and Pat Kouris, NAMI Alaska and Anchorage; and a services consumer.

DHSS staff: Diane DiSanto, DHSS Community Coordinator

CMH/API 2000 Project Staff:  Kathy Carssow, Manager

 

December 20, 2000, 12 Noon, NAMI Alaska

 

 

In early December project staff circulated a draft RFGP and summary report for a new program, Alaska Community Intensive Services, ACIS, replacing the former PACT proposal.  Staff sent letters announcing the new proposal and two scheduled community meetings to service providers, DMHDD regional managers, and consumer advocacy and professional groups throughout the state by e-mail, mail, and hand delivery.  The letter encouraged people to attend the community meetings in person or by phone (NAMI meeting only) and to contact project staff directly to discuss the proposed program.  In addition to the above meetings, project staff met in person or by phone with representatives of the following: Life Quest, Daybreak Apartments, Inc., Assets, Inc., Southcentral Counseling Services, and the Alaska Mental Health Board.  Consumer Connection posted the proposal materials on their web site and provided a forum page where people posted responses to the proposal (www.akmhcweb.org). 

 

This report summarizes the resulting recommendations for changes in the proposed program and the project staff’s responses.  The response of those who use mental health services, family members of consumers, and those who provide mental health services were far more supportive of the ACIS proposal than the PACT proposal it replaces.  This is due to the ACIS proposal addressing the major concerns raised during the PACT review:  consumers’ ability to choose services and service providers, the ability of more and smaller providers to participate in the program, and flexibility in how services are delivered. 

 

Budget and payment process

The primary concern raised by providers and DHSS staff alike is the proposed budget and payment process.  The ACIS draft proposal borrows from the AYI program process now undergoing revision.  The complaint is that the AYI individual cost-center approach is cumbersome in responding to an individual’s changing needs.  As one provider expressed it, “We are submitting budget revision #4 before revision #1 has been approved.”  Further, providers have difficulty forecasting and managing costs across numerous separate individual budgets.

·        Response

Project staff conferred with Developmental Disability and Institutional Discharge Program Plus staffs about their budgeting and payment processes.  Circumstances unique to both programs limit their applicability to the ACIS design.  Project staff is now jointly exploring a fee-for-service alternative with AYI staff.  This approach will consolidate the Medicaid and program budget and billing process without jeopardizing consumer choice and program flexibility.  An initial cross-walk of Medicaid payment rates against ACIS program requirements yielded encouraging results.  Medicaid rates combined with a discretionary fund averaging $2,800 per ACIS participant yielded $1.6 million in revenues, less than $2,000 more than the original itemized budget circulated with the RFGP. 

 

Role of people receiving mental health services in decision making

The proposed composition of the 10- to 15-member ACIS oversight committee to be appointed by the DMHDD director is 51 percent mental health service consumers and family members and no less than 3 consumers.  Mental health services consumers and family members commenting agreed that consumers should outnumber family members.  For example, if it is a 15-member committee, the recommendation is that no fewer than 5 members are to be service consumers, in addition, 3 may be consumers or the family members of consumers.  Meeting participants also asked that Individuals receiving mental health services sit on the Proposal Evaluation Committee.

·        Response

Incorporate change into RFGP to reflect the recommendation.  Include consumer representation on the PEC.

 

The individual’s voice in shaping services received

Provisions are needed for individuals to voice concerns, to critique the services they receive without fear of repercussions, and to change providers in less than a year’s time, if desired.  

·        Response

Revise the RFGP to allow for consumer’s to initiate a change in providers and incorporate Alaska Mental Health Board consumer grievance redress standards.

 

Cost of being on-call and responding to crisis 24 hours a day, 7 days a week

The provider raising this concern is not only worried about the additional costs of paying professionals to be on-call and to respond to people in crisis during off-hours but also about not being able to recruit qualified professionals willing to be on call in a tight market.  While some providers saw this as a major impediment to the program, others did not.

·        Response

Project staff believe that the 24/7 availability requirement is crucial to ACIS succeeding in substantially reducing the number of inpatient days attributable to the target population.  Never-the-less, recruitment of qualified staff is a serious concern in today’s market.  The fact that there are service providers in the health fields in Alaska providing around-the-clock on-call service, including the providers with whom we met, is encouraging.  Project budgeting needs to be scrutinized to ensure the costs of providing on-call services are truly met.  Staff is continuing discussions with providers for purposes of developing realistic budget estimates. 

 

Through scheduling, crisis planning, and the delivery intense services to people with serious mental illness the actual need for crisis response at inconvenient times can be reduced.  We know that PACT programs throughout the nation with staffing ratios of 1 to 10 and higher provide around-the-clock crisis response.  The ACIS program as proposed, in effect, calls for a 1 to 6 staff to ACIS participant ratio to accommodate multiple providers.  Delivery of services in sync with the individual’s natural timing of daily activities as the program requires also provides coverage for hours beyond the traditional 8 AM to 5 PM.  Further, the review of Medicaid rate payments for required services indicated that in addition to payments exceeding costs by almost 40%, an average of $3600 is available within the program budget per ACIS participant for crisis management alone.

 

Start-up Funding

Allocate at least $50,000 in program start-up funds per provider to establish the ACIS program.  Initial billings may be charged against the start-up funds as services are actually rendered.

·        Response

This can be accommodated through the fee-for-service approach under exploration by making advance payments to providers expected to receive referrals for 10 ACIS participants or more over the course of the program period.  The provider will bill against the advance upon delivering services and begin receiving additional payments once the advance is covered.  Project staff are working on the details.

 

Other recommendations

 

·        Relax program requirements for rural providers to what is needed for a specific individual to receive services in their community.

·        Drop “Program” from ACISP.

·        Drop the term “consumer.”

·        Do not require a bachelors degree for the peer specialist.

·        Do not require a masters degree for the vocational rehabilitation specialist.

·        Provide payment for every professional attending team meetings.

·        Do not prescribe how often the professional team must meet.

·        Build in program stability to safeguard it from short-sighted decision-making.

·        Avoid micro-managing providers.

·        Include points for Quality Assurance Review findings in evaluating proposals.

·        Develop guidelines for selecting ACIS participants.

·        Increase discretionary funding.

·        Increase consumer choice to the level of the Florida “Choices” program.

·        Consider the C.H.A.N.G.E. alternative.

·        Come up with a better acronym.