HCA Module 04 - Structure of Behavioral Health Systems Flashcards
Define the term “behavioral health”.
The term “behavioral health” in this context means the promotion of mental health, resilience, and well-being; the treatment of mental and substance use disorders; and the support of those who experience and/or are in recovery from these conditions, along with their families and communities.
What does Integrated Managed Care (IMC) do?
Integrated Managed Care (IMC) coordinates physical health, mental health, and substance use disorder treatment services to help provide whole-person care under one health plan. Integrated managed care is available across Washington State.
What are the levels of funding?
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Federal: The Center for Medicare and Medicaid Services (CMS) administers the bulk of funding for behavioral health services in the public system. Medicaid services are delivered for both mental health and substance use disorders. You may learn more about these in your work.
There are several other behavioral health funding sources, such as limited state dollars (which fund crisis services) and Federal Block Grant funds, but Medicaid is the primary funder of services. - State: CMS authorizes the Health Care Authority/Division of Behavioral Health and Recovery to administer behavioral health services for Medicaid enrollees. Our agreement is called the Medicaid State Plan. There are differences between requirements for mental health and substance use disorders. DBHR receives “state dollars” from the legislature, Federal block grant funds, and competes for other grants to fund behavioral health services and programs that Medicaid doesn’t cover. These funding issues are complex and are subject to change.
- Regional: The Health Care Authority contracts with MCOs to administer Medicaid services to their enrollees. MCOs typically do not administer direct services, but authorize Medicaid services and ensure quality treatment to their enrollees. Enrollees can choose from different MCOs that are available in their regions. BH-ASOs manage the crisis services in their regions. Crisis services are available to all individuals in Washington State.
- Local: At a local level, agencies contract with MCOs to administer direct services. These are typically licensed community behavioral health agencies, such as substance use disorder treatment facilities or behavioral health clinics. The services only apply to agencies that contract with an MCO and are licensed or certified by DOH.
What is resiliency?
Resiliency is the ability of a person or family to rebound from adverse events as well as the ability to develop strengths to respond to challenges in a positive way. Instead of overcoming the challenges of long term behavioral health issues, the focus for children and youth is often to promote positive potential, build on strengths, and learn to adapt to challenges.
Tell me more about FYSPRTs?
- A Family Youth System Partner Round Tables (FYSPRT) is a way to bring family, youth, and system partners to support and sustain a system of care that is inclusive of behavioral health services.
- They come together to bring a collective voice into decisions regarding children’s behavioral health services at the state level, as well as a state FYSPRT.
- FYSPRTs are local collaborations between system partners, such as behavioral health, educators, law enforcement and Children’s Administration. Family and youth leaders are also important members of FYSPRTs.
- Coordinating behavioral health systems help ensure that children and youth do not “fall between the cracks” as they are involved in these different systems.
Tell me more about WISe.
Washington State’s Wraparound with Intensive Services (WISe) is designed to provide comprehensive behavioral health services and supports to Medicaid eligible individuals who are up to 21 years of age with complex behavioral health needs and their families.
All efforts are made to bring supports to children, youth, and their families with the goal of maintaining services within their community. These services are effective in preventing hospitalizations and a breakdown in family care. A parent or youth Certified Peer Counselor is a required member of a WISe team.
Tell me more about peer run organizations.
In some areas of the state, there are peer or family-run organizations that offer ongoing peer support and recovery support. Some of these organizations are licensed and can bill Medicaid, and others rely on grant and independent funding.
Peer-run organizations hire many peer supporters and provide classes, employment support, and peer counseling.
You must have Medicaid to use crisis services in Washington.
* True
* False
- False
Which of the following is correct?
* In July 2019, substance use peer support services became a Medicaid reimbursable service.
* You must give your permission to be hospitalized.
* You can’t do peer support in crisis settings.
* If you have Medicaiad, you can choose a hospital if you tell the crisis worker.
- In July 2019, substance use peer support services became a Medicaid reimbursable service.
Arrange the following terms from the local (smallest) to the federal (largest): CMS, DBHR, Behavioral Health Agency, and Managed Care Organization.
- Behavioral Health Agency
- Managed Care Organization
- DBHR
- CMS
What does DBHR stand for?
Washington State Division of Behavioral Health and Recovery (DBHR)
What does CMS stand for?
Centers for Medicare & Medicaid Services (CMS)
Integrated managed care is available across Washington State.
* True
* False
- True
** Which of the following is NOT true?**
* Children in crisis are usually best helped in the home environment.
* A person can be detained by a designated mental health professional.
* Children arre sometimes hospitalized at Eastern State Hospital.
- Children arre sometimes hospitalized at Eastern State Hospital.
Which of the following is true? Select all that apply.
* You must have Medicaid to receive crisis services.
* Crisis services can be provided in your home.
* Crisis services can be provided by a peer counselor.
* Crisis services can be provided through a crisis line.
- Crisis services can be provided in your home.
- Crisis services can be provided by a peer counselor.
- Crisis services can be provided through a crisis line.
