MassHealth Services for People in Need of Behavioral Health Support
Shields, Julia C (EHS)
And I will hand it over to Emily to kick us off.
MassHealth Services for People in Need of Behavioral Health Support (Slide 1)
Eibl, Emily (EHS)
Thank you, Julia.
Hi everyone before I pull up my slides, I just want to introduce myself.
My name is Emily Eibl.
I am the director of Behavioral Health Strategy and Policy here at MassHealth and thank you all for having me. I'm excited to be here today to talk about Behavioral services for our MassHealth members.
So, just give me one second to get the screen sharing going.
OK, Julia, can you see my screen?
Shields, Julia C (EHS)
Yes, we can.
What Behavioral Health Services does MassHealth Cover? (Slide 2)
Eibl, Emily (EHS)
OK, amazing.
So I'm just going to start off with providing some very high-level buckets of the types of behavioral health services MassHealth covers. This isn't an exhaustive list, but just to kind of give an overview, and I just want to highlight that during the presentation today, I'm going to not go into too much detail around substance use disorder services as my understanding is there was a separate webinar on that topic.
However, I do want to acknowledge that both mental health and substance use disorder services are key and integral parts of how we think about behavioral health services for our MassHealth members.
So, just to first to start on high level, what behavioral services MassHealth covers.
We cover a range of outpatient services, so I'll name a few here and we'll go into some more detail later in the presentation on some of these.
But really these vary in the kind of available hours and urgency of services on this list, and also level of intensity of the service.
So, we cover outpatient behavioral services for our Members, you know, think therapy, think, diagnosis and assessment, medication visits, et cetera.
We cover community behavioral health centers and will go into those in a lot more detail in a little bit: behavioral health, urgent care intensive, outpatient treatment, partial hospitalization and day treatment programs.
And then on the mental health/mental health and substance use disorder side here given that a lot of these settings provide services to members with both of those needs.
We also cover overnight services, including inpatient psychiatric care and 24-hour diversionary care settings, such as community crisis stabilization.
On the substance use disorder focused services just highlight a few examples.
We cover outpatient care, including medication assisted treatment, intensive outpatient programs, day treatment programs, recovery support navigators and recovery coaches, along with overnight services such as acute treatment services, clinical stabilization services
to name two examples. and so you know, we cover a wide range of behavior, health services and really suggest that folks direct our Members to the Behavioral health helpline, and we're going to talk a lot more about that.
That is a wonderful place to learn more about services offered and get and understand where to find providers and which providers offer these services.
Another research resource for finding providers of services is the Massachusetts Behavioral Health Access, or MABHA, website, and that link is here and that also is a way to search for different providers in different locations that provide different behavioral health services.
MassHealth Service Access Options Most Helpful to People Experiencing Homelessness (Slide 3)
So turning to think a little bit about which MassHealth service options may be most helpful for our Members experiencing homelessness and then just want to acknowledge there are a variety of services that may be helpful for members experiencing homelessness.
Some, though, may be more accessible or more tailored to those needs.
I'm going to highlight a few here and we'll go into detail about each of these in this presentation but just want to note this is not an exhaustive list of what might be helpful or what is covered, just highlighting some that may be of interest.
And so, since we're going to go into each of these in the presentation, I won't spend too much time explaining them here.
But just to highlight, we'll be talking about the Community Behavioral Health Centers, Community Mental Health Centers, Behavioral Health Urgent Care.
My colleague Jess will be talking about the Community Partners program.
We are going to talk about the Behavioral Health Helpline and Community Support Programs and so I am going to now dive into each of these.
And before kind of getting in, we're going to start actually with the Behavioral Helpline and the Community Mental Health Centers.
But those two services are keystone initiatives as part of an effort called the Behavioral Health Road Map, which is a statewide effort and so just before we kind of dive into what those services are, we want to give a little bit of context and background on that Behavioral Health Road Map and where these services, which are newer, or coming from and why we think they're so important.
Historical and Structural Challenges in Behavioral Health (Slide 4)
So that to start with the historical context.
We have made, you know, recent legislation and policy reforms and public investment in behavioral health, and we acknowledge that, you know, that's one step of the journey. And so just to kind of highlight some of the reasons why we wanted to you to focus on certain elements of behavioral health for this behavioral health road map.
So the State, we engaged almost 700 folks across the state on challenges and gaps in the behavioral health system and some of the big findings we had were that too many people struggled to find the right type of behavioral health treatment and clinical providers that accepted their insurance.
We found that too often hospital emergency rooms were a point of entry for those seeking behavioral health treatment.
We found that individuals often struggled to get mental health and addiction treatment at the same location.
And you know, we acknowledge that mental health conditions and substance use disorders often co-occur.
We have a culturally competent behavioral healthcare for racially, ethnically and linguistically diverse communities can be difficult to find.
And many of these and other challenges, you know, were really exacerbated by the pandemic. And so kind of taking these findings, that is where some of the efforts around the Behavioral Health Road Map came from.
And one of those big efforts was a front door. How do folks find and access behavioral health services?
And so, the road map you know, aims to improve access to care across the treatment system and created some centralized front doors to treatment, really highlighting the behavioral health helpline. We'll go into more detail about what that helpline is, but that is a way to kind of evaluate and triage folks to the right care.
The “Front Door” to Behavioral Health Care (Slide 5)
And so, you know, there's many points of entry: Behavioral Health Help Line, Community Behavioral Health Centers, Outpatient and Behavioral Health
Urgent Cares, Integrated Primary Care and the Emergency Department.
And all of these places can triage folks and assess folks for what they need services for and if necessary, direct them to a different or higher level of care, such as inpatient 24-hour diversionary or other community-based care.
Behavioral Health Helpline (Slide 6)
So kind of starting with the Behavioral Health Help Line. This helpline connects people directly to clinical help anytime, 24-hours a day, through chat and phone lines and trained clinicians help people find the treatment they need, including crisis support.
So on this page, the first really important thing on this page is the website and the phone number. Those are the resources to direct folks to and share broadly and when they go to the website or that phone number, they're going to have access to call, text or chat 24/7/365, anytime any day and when they go there, it’s going to be available and free to anybody in the Commonwealth.
Those resources, folks can get live interpretation in over 200 languages, including resources for individuals who are deaf or hard of hearing.
That helpline, members can receive warm hand offs to immediate crisis intervention, urgent and or routine services, and also outside of kind of you know behavioral health services.
They can learn more about resources for need such as transportation, childcare, and food.
Behavioral Health Help Line: Key Elements (Slide 7)
So just double clicking on some of those key elements of the behavioral health helpline. Just again want to highlight that the service is available 24 hours a day, seven days a week, 365 days a year in multilingual capacity, phone text or chat.
The helpline has really knowledgeable clinicians and clinical team.
So they have master's level and bachelor level clinicians, along with peer specialists and they have an expertise in appropriate crisis identification and action de-escalation and stabilization.
So really good resource. They also have the ability to do clinical assessment and triage, so using assessment tools to support appropriate triage pathways, they're able to rapidly determine if there's immediate need for crisis and complete appropriate handoffs.
The helpline is great for referral match and warm hand off.
The staff can help individuals search for and identify providers with appropriate expertise and conduct warm hand offs to referring providers whenever possible and appropriate and then provide consistent follow up.
There is a process to ensure the individual is successful in connecting with the right services within 48 hours for crisis handoffs and 14 days for outpatient referrals.
So I mean, just so again really great resource to help to give to individuals if they are trying to determine what kind of care is right for them, but also where to get that care and saying a lot of different ways to get in touch with the with the helpline.
So that's kind of one keystone part of the behavioral health road map. I wanted to highlight.
Community Behavioral Health Centers (Slide 8)
The other is community behavioral health centers.
And so, community behavioral health centers are a community location where individuals who have mental health and substance use disorder needs can be assessed.
There are crisis and urgent services provided and ongoing care and an ability to be triaged or referred to other settings if more appropriate, and they can also offer crisis services in real time and urgent care.
So when we think about the services offered at community behavioral health centers, they fall into some buckets, and you know every community center is going to provide services within these buckets.
So I'm just going to go through each of them and talk a little bit about what they mean.
So the first is what we call core services, but these are really kind of outpatient clinic services.
And they are offered for adults and youth.
And so, when we think about kind of the core services, we're thinking about integrated mental health and substance use disorder services and at community-based health centers.
There is also urgent access to those services.
So whether that's a same day or next day appointments and the kinds of services offered are assessment and diagnosis therapy, whether that's individual, group or family.
They have also medication visits and peer supports and services.
And then if we look at the bottom row here, highlighting there are adult and youth mobile crisis interventions and mobile crisis intervention that provide triage, evaluation and assessment intervention and de-escalation and connection to next level of care for individuals who may be in crisis.
The mobile crisis service is available in different kind of multiple locations to meet a Member's individual needs so they can walk into a community behavioral health center also.
The MCI team will travel out into the community to meet a member or provide services via telehealth.
And these services are available regardless of insurance.
And for the mobile crisis intervention, you know, they also come do post crisis follow up after the crisis intervention.
And then the kind of last service again across adult and youth that I want to highlight is the Community Crisis Stabilization, and this is an overnight bedded service, a 24-hour kind of diversionary service, providing care for individuals who do not require inpatient psychiatric level of care.
And on the user side, there's also segmentation by age for that.
Community Behavioral Health Centers: The Basics (Slide 9)
And so just going to go the next slide is also on community behavioral settings.
I touched on a lot of things but just want to kind of re highlight that community behavioral health centers combine a few different services.
So that's mobile crisis, crisis stabilization and outpatient and urgent care for mental health and substance use.
Again, the mobile crisis is a 24/7 service that is provided in multiple locations, whether that's going out into the community, in the clinic or in the Behavioral Health Center or via telehealth.
The Crisis Stabilization Service again is a 24-hour service and there's a version for both youth and adults.
CBH Centers provide same or next day access to evaluation and assessment for psycho pharmacology and medication assisted treatment, offer outpatient services, including using evidence-based practices, and they also connect folks to additional supports including peer and family supports.
Community Behavioral Health Centers and their catchment areas (Slide 10)
So, there are 27 community-based health centers across the state.
They have geographic catchment areas and so this is just a map of the Community Based Health Centers as they fall across the state.
Again, if Members reach out to the Behavioral Health Help Line or the MAHBA website, they'll be able to find easily what is the community or Call center that is in any location that is most convenient for them.
Community Mental Health Centers (Slide 11)
So moving on to a different provider type to highlight a few different services;
Community Mental Health Centers provide a number of outpatient services, including diagnostic services, psychological testing, short- and long-term therapy, including individual group couple and family therapy. They provide medication visits. Kind of your standard array of outpatient behavioral health services.
And they're available to all members.
Behavioral Health Urgent Care (BHUC) (Slide 12)
The next service or provider type I'll highlight is our Behavioral Health Urgent Cares.
So these are our clinics that offer very similar services to the ones on the previous slide, the Community Mental Health Centers, but they are able to offer those services more urgently and with extended hours compared to a traditional or a mental health center clinic.
And you know, an urgent behavioral health need may include when a member is feeling changes in their behaviors or thoughts that cause distress and require immediate support to psychiatric evaluation or therapy
So, to highlight kind of what that that access looks like in behavioral health urgent care they provide same or next day evaluation, they provide psychotherapy appointments and addiction medication evaluation within 72 hours of an initial evaluation, other treatment appointments, including follow-ups, are available within 14 calendar days.
And behavioral health urgent care is for extended hours on weekdays, as well as weekend hours.
And again, they offer similar services to the mental health centers that I highlighted, including diagnostic services and psychological testing, short term and long-term therapy, medication and medication visits.
I want to highlight there are about 70 behavioral health urgent careers across the state and again, the behavioral health helpline or the MABHA website are great resources to kind of find what the closest behavioral health urgent care is to a member who is looking for those services.
Recovery coaches (RC) and recovery support navigators (RSN) (Slide 13)
Just want to highlight again, not trying to cover all substance use disorder services here given the previous presentation but just want to quickly highlight two: Recovery Coaches and Recovery Support Navigators.
Recovery Coaches are individuals currently in recovery but have lived experience with addiction and or co-occurring mental health disorders and they have been trained to help peers with a similar experience and recovery.
Support Navigators are bachelor level paraprofessionals who provide care management and system navigation and support to MassHealth members and accessing treatment services and community resources. They can help with things like accessing treatment services, finding placements, facilitating more hand offs upon referral to other services and supports, and navigating insurance issues.
In both of these, services require a diagnosis of substance use disorder and or co-occurring mental health disorders.
Community Support Program (CSP) (Slide 14)
The final service I want to highlight is the Community Support Program.
And there are a few different flavors I'll say of Community Support Program, and so this is what we think of as like the non-specialized Community Support Program. I'm sure many of you are familiar with the other Community Support Program, especially around housing and tenancy support, but this is just the non-specialized version.
And Community Support Program is part of a larger organization that provides pay for all services and is licensed in the state of Massachusetts, and they provide services delivered by community-based staff, and so the services that are provided within the Community Support Program are resource navigation, so assisting members with obtaining benefits, housing and healthcare, and linking members to support the services.
They can help with transportation by providing referrals to community-based transportation and resources to and from medical and behavioral health appointments, and they can also assist in crisis planning.
So collaborating with providers to develop crisis prevention or safety plans.
And the CSP has an open referral program, and intake and referrals can be sent to the CSP providers.
And so that is just a kind of abbreviated overview of some of the behavioral health services that may be helpful to our members experiencing homelessness.
Again, this is not an exhaustive list, and it really encourages folks to have folks use the Behavioral Health Help Line and the other resources shared to kind of get a better sense of what services might be best for them and where to find those services.
So I will stop sharing my screen and turn it back over to Julia.
Shields, Julia C (EHS)
Thank you, Emily. That was great.
I'm going to pass it over to Jess now for our final part of the presentation.
Community Partners Program 2023-2027 (Slide 15)
Plante, Jessica (EHS)
Thanks Julia.
Let me share my screen.
I'm hold on. I'm making sure I'm sharing the right one.
Can you see this?
Shields, Julia C (EHS)
Yes, we can.
Plante, Jessica (EHS
OK.
I don't care if you see the stuff on the side.
So I'm Jess Plante.
I am the policy program manager on the Community Partners team.
This will look very familiar for those who were there here for the previous webinar on LTSS services, because for the most part fundamentally the same thing.
But I will be voicing over a couple more specific things that have to do with BH services.
What is the Community Partners Program? (Slide 16)
So the CP program is a care coordination program for MassHealth enrollees with complex needs who are enrolled in ACOs, MCOs or are members of the adult Community Clinical Services program through the Department of Mental Health.
Our BHCP program is our larger of the two CP programs, which can support up to 26,000 members and supports MassHealth members from ages 18 to 64 with care management and coordination.
And for members of significant BH needs, including serious mental illness or substance use disorder, typically it is the top 2.6% highest risk members in a given ACO or MCO who are referred to the BHCP program.
So the CP program, since it is a care coordination program, does not actually offer any clinical services.
However, it will connect members to services that they need.
And I will actually be touching on a couple things that Emily referred to in her presentation.
So both CPs, as I mentioned in the previous webinar, a behavioral health CP, can provide LTSS services and vice versa. It is just entirely dependent on what the Members’ highest needs are in that moment, when a comprehensive assessment and hours end screening is performed, but the CP program will be responsible for care planning, care coordination, management, transition of care, support, medication review and connection to social and community resources.
CP Supports (Slide 17)
For the BHCP in particular, they are required to utilize the homeless management information system to identify and connect members who are experiencing homelessness or at risk of homelessness with a provider agency that works with the member, or connect that member to the provider or to a provider agency if they're not already working with one and someone from the provider agency will need to be involved on the members care team which the CP staff would coordinate for them.
They need to ensure that they are actually working with the enrollee regularly, depending on how severe the needs are, and for our behavioral health community partners, if they have a certain number of homeless enrollees, a certain percentage, they're actually entitled to an additional PMPD rate from MassHealth in order to help cover the needs of their homeless enrollees.
So particularly we do have Boston Healthcare for the Homeless, which is one of our behavioral health CPs, and they are one of the primary homelessness providing BHCP in our network.
I also know that Emily touched on CBHCs briefly, and if you actually look closely at the map that she shared of where the CBHCs are across the state, many of them are existing BHCPs, so many of our BHCPs actually have a CBHC integrated into their organization.
But for those who aren't, who do not have a CBHC integrated in, they ask the BHCPs to actually have to hold an agreement with CBHC in the service areas that they serve, and while the CBHCs will provide the core services that Emily described in her presentation, the BHCPs will serve as a care coordination entity to form the care team that will include a member of the CBHC in the care team and will also incorporate any care provided into the members care plan, and we'll actively communicate care and referrals between the CBHC and the BHCP.
BHCPs can assess members for needs to see if they need to be referred to the CP to Community Partners program.
That's really all that I have, just because it was a very quick overview, and I know that Emily had a larger amount of content as well as the fact that I have presented on this briefly before when we talked about the LTSS CP program.
But I can answer any questions that you have on the specifics for the BHCP program as well.
Shields, Julia C (EHS)
Thank you, Emily and Jess.
Those were wonderful presentations and great overviews.
I'm going to stop the recording now.