SERVICES AND FUNDING OVERVIEW PREPARED BY THE FISCAL ANALYSIS - - PowerPoint PPT Presentation

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Aug 19, 2022 5 likes •209 views

STATE PROVIDED BEHAVIORAL HEALTH CARE SERVICES AND FUNDING OVERVIEW PREPARED BY THE FISCAL ANALYSIS DIVISION OF THE LEGISLATIVE COUNSEL BUREAU JANUARY 30, 2019 STATE PROVIDED BEHAVIORAL HEALTH SERVICES CHANGES OVER THE LAST FIVE YEARS 2

SLIDE 1

STATE PROVIDED BEHAVIORAL HEALTH CARE SERVICES AND FUNDING OVERVIEW

PREPARED BY THE FISCAL ANALYSIS DIVISION OF THE LEGISLATIVE COUNSEL BUREAU JANUARY 30, 2019

SLIDE 2

STATE PROVIDED BEHAVIORAL HEALTH SERVICES

CHANGES OVER THE LAST FIVE YEARS

SLIDE 3

STATEWIDE MONTHLY CLIENTS BY FACILITY TYPE

76 80 83 83 74 93 137 134 134 138 137 136 140 134 145 133 137 142 132 213 220 214 204 162 152 137 125 123 126 110 114 113 114 113 115 20 70 120 170 220 270 Average Monthly Clients

Statewide Forensic Clients (Lake's Crossing & Stein Hospital) Statewide Civil Psychiatric Clients (Rawson-Neal & Dini-Townsend)

SLIDE 4

MEDICATION CLINIC AND PHARMACY SERVICES

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES Evaluation & ongoing treatment Prescribing medicine Injectable medicines Dispensing of mediation Full-time clinics in East Las Vegas & Henderson

Prior to the ACA At Present

Evaluation & ongoing treatment Prescribing medicine Injectable medicines Dispensing of mediation (limited) Part-time clinics in East Las Vegas & Henderson

SLIDE 5

OTHER OUTPATIENT SERVICES

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES

Outpatient Counseling Drop-in centers Service coordination Consumer assistance programs Prior to the ACA At Present Outpatient Counseling Drop-in centers Service coordination Consumer assistance programs

SLIDE 6

INTENSIVE SERVICES

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES

Residential Housing Mental Health Court Mobile Crisis Prior to the ACA At Present

Multiple levels of community-based living arrangements and residential supports Mental Health Court Justice Involved Diversion Programs Mobile Crisis Mobile Outreach T eams

SLIDE 7

INPATIENT PSYCHIATRIC CARE

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES

Rawson-Neal

perating 211 civil

beds Forensic services

nly offered in

Sparks at Lake’s Crossing Prior to the ACA At Present Rawson-Neal

perating 88 civil

beds Stein Hospital

perating up to 67

forensic beds in Las Vegas

SLIDE 8

BARRIERS TO CARE REMAIN

Workforce Shortages Access to Care Quality of Care / Sufficient Follow Up Care Supportive Housing Services Intensive Service Demand

Note: Additional information, including statistics and backup documentation, on barriers to care are discussed in LCB’s Regionalizing the Mental Health System in Nevada: Consideration and Options report (Bulletin No. 17-6).

SLIDE 9

INDIVIDUALS SERVED BY PROGRAM

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES

445 465 431 397 298 327 315 286 262 325 303 235 238 241 228 234 227 234 241 229 122 134 218 178 225 181 336 297 405 259 343 751 747 755 770 757 780 781 781 734 627 602

100 200 300 400 500 600 700 800 900 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18

Residential Housing & Support Outpatient Assessment Justice Involved Diversion Mobile Crisis

SLIDE 10

INDIVIDUALS SERVED BY MEDICATION CLINICS

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES

500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Medication Clinic Waitlist

Note: Waitlist information is unavailable for the months of May 2018 to December 2018.

SLIDE 11

STATEWIDE MEDICAID BEHAVIORAL HEALTH SPEND

STATE AND MATCHING FEDERAL SHARE

$48.7 M $46.8 M $51.6 M $225.2 M $199.7 M $247.3 M $ M $50 M $100 M $150 M $200 M $250 M $300 M $350 M FY 2016 FY 2017 FY 2018 State Share Federal Share $273.9 M $246.5 M $298.9 M

SLIDE 12

REVENUE SOURCES FY 2018

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES

General Fund, $77.3 M, 89% Medicaid, $4.8 M, 6% Medicare, $2.1 M, 2% Federal Grants, $1.8 M, 2% Note: Chart excludes state General Fund appropriations of $5.9 million which were reverted back to the state in FY 2018. Other, $0.8 M, 1%

SLIDE 13

HISTORIC FUNDING LEVELS (FY 2013 – FY 2018)

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES

$75M $72M $66M $69M $72M $77M $1M $5M $14M $10M $8M $5M $10M $11M $4M $6M $M $10M $20M $30M $40M $50M $60M $70M $80M $90M $100M

2013 2014 2015 2016 2017 2018

General Fund Medicaid Medicare Federal Grants Other Reversion $8.5M $5M $6.4M $6.7M $4.4M $4.6M $0.0M $0.3M

SLIDE 14

EXPENDITURE TYPES FY 2018

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES

Note: Staffing includes costs associated with state FTEs and contractors.

Staffing, $58.9 M, 74%

Operating, $7.1 M, 9% Food & Medicine, $3.8 M, 5% Housing Assistance, $7.5 M, 10% Diversion Programs, $1.9 M, 2%

SLIDE 15

$50M $54M $55M $55M $59M $59M $6M $7M $6M $6M $7M $7M $13M $8M $5M $2M $4M $4M $9M $12M $7M $7M $7M $8M $. M $10. M $20. M $30. M $40. M $50. M $60. M $70. M $80. M $90. M $100. M 2013 2014 2015 2016 2017 2018 Personnel Operating Food & Medicine Housing Assistance Diversion Programs Other

HISTORIC SPENDING LEVELS (FY 2013 – FY 2018)

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES

$3.9M $610K $1.2M $1.0M $715K $750K

SLIDE 16

MEDICATION EXPENSES (FY 2009 – FY 2018)

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES

$12.7M $12.2M $12.3M $7.1M $3.6M $2.5M $2.5M $M $2M $4M $6M $8M $10M $12M $14M

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

$0.4M $0.7M $0.8M

SLIDE 17

CRIMINAL JUSTICE DIVERSION PROGRAMS

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES

$1.2M $1.2M $1.1M $1.1M $1.9M $2.1M $2.M $2.M $1.9M

$M $1M $1M $2M $2M $3M

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Note: May include housing expenditures.

$0.6M

SLIDE 18

PSYCHIATRIC RESIDENCY PROGRAM

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES

$285,660 $316,642 $478,537 $478,440 $351,739 $365,462 $450,666 $643,850 $701,866 $- $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000 $800,000

2010 2011 2012 2013 2014 2015 2016 2017 2018

SLIDE 19

COMMUNITY TRIAGE SERVICES (FY 2009 – FY 2018)

SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES

$750,000 $750,000 $655,056 $620,685 $609,874 $750,000 $919,400 $892,560 $650,000 $750,000

$- $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000 $800,000 $900,000 $1,000,000 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

SLIDE 20

STATEWIDE RECOMMENDED ENHANCEMENTS FOR THE 2019-21 BIENNIAL BUDGET

Behavioral Health Clinics Caseload Increases Mobile Crisis Expansion Salary Increase

$1.0 million to add 5

Psychiatric Nurses to Rawson-Neal Hospital for civil psychiatric services

$1.9 million to add 6

Psychiatric Nurses and 6 Mental Health T echnicians to Dini-T

wnsend

Hospital

$418,548 to add 2

Psychiatric Nurses to the NNAMHS Medication Clinic

$300,000 to expand
perating hours for the

Mobile Outreach Safety T eam (MOST) to operate 24 hours a day in Clark County

$346,349 for an

Emergency Physician at SNAMHS to assist with commitments

$310,824 to expand
perating hours for

MOST to 24 hours a day in Washoe County

$1.0 million to fund a 2-

grade pay increase for 88 Forensic Specialists in the SNAMHS budget

$720,042 to fund a 2-

grade pay increase for 57 Forensic Specialists in the Lake’s Crossing budget

$40.4 million over the

2019-21 biennium to continue the enhanced reimbursement rates for Certified Community Behavioral Health Clinics at 3 existing clinics, and to expand services to 7 new clinics for a total of 10 clinics