Making Bidirectional Care a Reality: eSolutions, March 2011
eSolutions is a monthly e-newsletter bringing you practical solutions and resources on primary and behavioral health care integration from across the United States.
Making Bidirectional Care a Reality
Upcoming Integration Webinars
Profiles of Primary and Behavioral Health Care Integration
Quick Tips: Ten Questions to Improve Access to SBIRT
Hot Topics: News and Resources
Q&A Corner: BMI vs. Waist Circumference
The new SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) is run by the National Council for Community Behavioral Healthcare under a cooperative agreement from the U.S. Department of Health and Human Services. CIHS promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings.
Commenting on the significance of CIHS's role, SAMHSA Administrator Pamela S. Hyde, JD, said, "The Substance Abuse and Mental Health Services Administration is excited about the focus on integrated care, which allows us to bring needed healthcare services to patients in a coordinated and convenient manner and can go a long way in helping to improve health status."
Since its launch in October 2010, CIHS has begun to provide training and technical assistance in six core areas to 56 SAMHSA Primary and Behavioral Health Care Integration grantees - workforce development, knowledge application, knowledge development and dissemination, healthcare reform and policy analysis issues, prevention and health promotion, and quality improvement. Over the next four years, CIHS will offer technical assistance and expert consultation in bidirectional care to community health and behavioral health providers nationwide.
"The National Council looks forward to working with the larger healthcare community and with consumers and patients of healthcare services to eliminate barriers between mental, substance use, and physical health. Together, we can ensure people receive the right care at the right time, in all settings," said Linda Rosenberg, MSW, President and CEO of the National Council for Community Behavioral Healthcare.
For more information about CIHS and for assistance with primary and behavioral health integration, contact us at www.CenterforIntegratedHealthSolutions.org, email Integration@thenationalcouncil.org, or call 202.684.7457.
Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Monday, April 25, 2011 1:00 - 2:30 pm EDT
Visit www.CenterforIntegratedHealthSolutions.org for registration, past webinar recordings, and new webinar topics and dates.
The CIHS provides training and technical assistance to SAMHSA's Primary and Behavioral Health Care Integration (PBHCI) grant program. Each issue of eSoutions will profile a grantee with a focus on their grant-funded initiatives.
Center for Families and Children
Shawna Lewis, LISW-S, Project Director, Integrated Health Care Project
The Center for Families and Children serves nearly 4,300 adults with severe mental illness and 500 children with serious emotional disorders each year. We are focusing our SAMHSA Primary and Behavioral Health Care Initiative grant opportunity on the roughly 40 percent of our adult clients without public or private insurance, who are unable to pay for services. These clients are especially at risk because of the complex effects of their mental illness, poverty, and the lack of community-based primary care for the indigent. In addition to the myriad physical health complications that people with serious mental illness face, their capacity to commute and keep scheduled appointments is limited.
We opened the Integrated Health Clinic at CFC on February 1, 2010. In partnership with the Cleveland Clinic, we operate two part-time primary health clinics, which are housed within two of our behavioral health sites. The SAMHSA grant has allowed us the opportunity to hire primary care and administrative staff so that we can provide free services to our uninsured clients.
Patients receive a wide range of care, including health screenings, annual exams, gynecological care, laboratory tests, and management of chronic diseases. Specialty care, including dental, vision, mammography, and podiatry, is made available offsite through various programs and providers. Tertiary care, such as general surgery, ophthalmology, endocrinology, and gynecology, is provided by the Cleveland Clinic. Prevention and wellness care is also offered.
We plan to continue providing these services beyond the grant term and are determining the model of service that will allow us to offer care to our insured as well as uninsured clients.
If you're implementing or planning to start SBIRT - the Screening, Brief Intervention, and Referral to Treatment program designed to help reduce drinking and substance abuse problems - be sure to ask claims payers and state Medicaid officials the following 10 questions:
- Are the codes 99408 and 99409 open for billing under Medicaid or other plans?
- If those codes are not used, has the state has implemented alternative codes for SBIRT?
- If the codes (or alternative codes) are open, what rate will be paid?
- If an Encounter Rate is paid, what is the rate for 99408 and 99409, respectively?
- If a patient is seen by a medical provider for a medical service and then seen on the same day for an SBIRT service (99408 or 99409), will the SBIRT service be paid for in addition to the medical service?
- If services are provided in a Federally Qualified Health Center, is Medicaid wraparound billing applied?
- If both services are billable and both providers can be paid for both services on the same day, what is the correct billing procedure for the SBIRT service?
- Does any specific modifier need to be included on the SBIRT service claim in order to be paid correctly?
- What are the restrictions, if any, on the type of provider providing the SBIRT service? That is, are only licensed psychologists or licensed social workers able to provide and bill for the service, or are other professionals able to bill for these services on the same day as a medical service is provided?
- Is there any requirement for special credentialing by the behavioral health provider prior to the provider's being able to be paid for SBIRT services? That is, does the state use a specific HMO carve-out or other credentialing body?
Questions were developed by the NACHC Tennessee and Virginia SBIRT Learning Collaborative, a SAMHSA funded project.
Visit the CIHS website for up-to-date news and resources
Behavioral Health Services in Federally Qualified Health Centers
The National Association of Community Health Centers' 2010 Assessment of Behavioral Health Services in FQHCs provides an overview of the current landscape in FQHCs and recommendations for the future.
Moving Toward Establishment of Health Homes
To help consumers better understand the concept of health homes and how New York is planning on implementing them, NYAPRS, a statewide coalition of people who use or provide recovery-oriented community-based mental services, focused an issue of its e-news bulletin on the topic. It includes a brief article describing health homes, excerpts from the Governor's office, and proposed budget language.
Mental Disorders and Medical Comorbidity
The Robert Wood Johnson Foundation's new Research Synthesis Report provides an overview of medical and mental comorbidity that considers the associated quality-of-care and cost burdens of comorbidity and the current evidence-based approaches for addressing comorbidity. The paper is authored by Dr. Ben Druss of Emory University.
FREE Wellness Brochures and Posters
The 10x10 Wellness Campaign is offering free brochures and posters for clinicians, community organizations, consumers and survivors, and peers who want to take action to extend the life expectancy of people with behavioral health challenges by 10 years in the next 10 years. The new resources are as follows:
- "Top Three Ways to Promote Wellness" poster (SMA10-4569)
- "Eight Dimensions of Wellness poster" (SMA10-4568)
- Informational brochure for primary care providers that provides strategies for talking about wellness and connecting with patients' behavioral healthcare providers (SMA10-4566)
- Motivational brochure for consumers/survivors/peers that describes how to incorporate the Eight Dimensions of Wellness into everyday life (SMA10-4567)
- Informational brochure to raise awareness about the disparity in early mortality for people with behavioral health problems and gain "champions" for the 10x10 Wellness Campaign(SMA10-4565)
To order or download these free materials, visit http://store.samhsa.gov/product/SMA10-4566 or call toll free 1-877-SAMHSA-7 (877-726-4727).
Each month we will feature a question from the field about making integration work.
Question: We are a behavioral health provider in the process of integrating primary care services. We are assessing which health indicators to track and want to know the value of collecting both body mass index (BMI) and waist circumference.
Response: Providers use BMI and waist circumference to understanding someone's risk for chronic disease in different ways. Measuring both allows for a better picture of health risks, including a person's risk of developing diabetes, heart disease, or other health problems.
To learn how to measure BMI and waist circumference and what they mean for health and wellness, access the "Weight and Waist Measurement: Tools for Adults" fact sheet created by the National Institutes of Health.
To receive this newsletter and other CIHS e-mail updates, click here to enter your e-mail address and select “News from the SAMHSA-HRSA Center for Integrated Health Solutions” from the options listed.
Our free technical assistance services can help primary and behavioral healthcare providers find integrated health solutions that work. To contact CIHS, visit www.centerforintegratedhealthsolutions.org, e-mail Integration@thenationalcouncil.org, or call 202.684.7457.
SAMHSA–HRSA Center for Integrated Health Solutions
Director: Kathy Reynolds; Deputy Directors: Laura Galbreath and Larry Fricks; Editor, eSolutions: Heather Cobb
The SAMHSA–HRSA Center for Integrated Health Solutions, operated by the National Council for Community Behavioral Healthcare under a cooperative agreement from the U.S. Department of Health and Human Services, is funded jointly by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration. The CIHS promotes the development of integrated primary and behavioral healthcare services to better address the needs of people with mental health and substance use conditions, whether seen in specialty behavioral health or primary care settings.