Nonprofit organizations that care for individuals needing behavioral health and substance abuse treatment in Nebraska would be able to expand access and services under a new payment framework supporters say has seen success in other states.
The Certified Community Behavioral Health Clinic Act (LB276) introduced by Lincoln Sen. Anna Wishart would allow qualifying service providers to seek daily or monthly reimbursements for certain treatments, thereby allowing them to hire more staff and to increase access to timely care.
“I think we would all be hard-pressed to find someone in this room that doesn’t know someone in their life who hasn’t been touched by mental health or substance abuse issues,†Wishart told the Legislature’s Health and Human Services Committee.
Those who found ways to emerge from a mental health crisis or enter recovery did so through “a lot of fortitude,†Wishart added, “but it also took a holistic approach of a lot of different supports in that person’s life.â€
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Backers of the certified community behavioral health clinic plan say patients in the states where they now exist have seen better outcomes in their physical and mental health, reduced hospital or mental health care facility stays and lowered incarceration rates.
The bill would require providers to offer nine community-based services either directly or through referrals to other clinics in the area.
Those services include outpatient mental health and substance abuse services, crisis mental health, outpatient clinic primary care screening, psychiatric rehabilitation services, peer support and counseling, as well as family supports.
Annette Dubas, a former state senator who now serves as the executive director of the Nebraska Association of Behavioral Health Organizations, told the committee the Medicaid-based program also produces data that allows for better tracking of outcomes.
“There truly is an accountability in (certified community behavioral health clinics) that we don’t have in other areas of our health care delivery system,†she said. “We’re going to be able to show you these are the things that are working, these are the things we need to change.â€
The Community Alliance in Omaha has seen success in the community behavioral health framework as one of five pilot sites in Nebraska, president and CEO Carole Boye said.
“It’s not a new program, it’s a framework by which you organize all these services differently and you work to coordinate them based on what this person needs rather than slicing and dicing them based on level of service,†Boye said.
Wishart said the program would be started using some cash funds with a match in federal dollars, with the state gradually assuming its share through the budget over time.
Over the course of six months, Boye said patients enrolled in the program have spent 242 fewer days in the hospital and 54 fewer days in jail — numbers Chris Tonniges, president and CEO of Lutheran Family Services, said were just some of the benefits of the system.
A quarter of those who have been treated through the certified community behavioral health clinic program have reported a decrease in feeling negative thoughts, while there has also been an uptick in patients who have reported better daily functioning and social connectivity.
The proposal also won the backing of Gov. Jim Pillen, who said the integrated care plan would provide key services across Nebraska, particularly in areas that may now be unserved or underserved.
“What I think is important here is the timing and meaningful access of services and the outreach,†Pillen said. “If you’re out and around the state of Nebraska and talk to law enforcement, so much of their time is pulled away because they are helping families that have behavioral health or mental health problems.â€
Several officials from the Nebraska Department of Health and Human Services also spoke in support of the bill.
CEO Dannette Smith said the expansion of early intervention through community-based services would help prevent mental health crises from taking place, while Dr. Kevin Bagley, director of Medicaid and long-term care for the department, said the cost-reimbursement model would give providers added flexibility to address the needs in their communities.
The program would be set up using cash funds and a match from federal Medicaid dollars, before the state’s cost eventually shifts to the general fund budget. Bagley said DHHS believes it could cover the cost inside of its existing budget, meaning there won’t be a need for a special appropriation.
No one testified in opposition to the bill during Thursday’s hearing. The committee did not take any action on the legislation.
Wishart said enacting the program would foster more collaboration between providers, hospitals, schools and law enforcement to address behavioral health and substance abuse needs across the state.
“Now is the time to invest in a modest increase in Medicaid match dollars,†she said. “This new delivery model has proven its effectiveness in savings to government entities across the country.â€