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IOWA COALITION ON
MENTAL HEALTH AND AGING
Policy and Administration
Workgroup
PRIMARY GOALS


Make mental wellness a priority
issue for policy makers
Make mental wellness a priority
among program administrators
OBJECTIVES



Establish the business case for aging
and mental health issues
Support policies & programs that
advance education & training
Support policies & programs that
advance outreach & clinical services
The Business Case

Demographic imperative

Quality of life

Funding Issues
Demographics
Iowa's Older Adult Population
N = 436,000
800
700
104
600
500
Number of People
400
(in thousands)
81
64
65
68
66
582
Population 65-84
452
300
361
367
370
384
1990
1995
2000
2005
200
100
0
Year
US Census of the Population, 2000
Population 85+
2015
2025
The Demographic Imperative
UCSF, 2002
or
ad
o
70
58.8
Io
wa
M
ai
ne
M
ich
ig
an
M
in
ne
Ne sot
a
w
Je
rs
ey
O
re
go
W
n
is
co
ns
in
no
is
In
di
an
a
60
Illi
Co
l
US
Facility
perFacility
%per
Avg.
Avg
Iowa Nursing Home Population
Residents with Mental Illness
80
60.6
50
40
30
20
10
0
Quality of Life
or provide flexible options
for community-based
mental health care
substantiated by evidencedbased treatment.
Warehousing older adults with
mental health issues . . .
Funding Issues
Medicare Expenditures



Total Health Expenditures:
$211.4 Billion
Total Mental Health Expenditures:
$1.2 Billion (0.57%)
Outpatient Mental Health:
$ 718 Million (0.34%)
CMS, 2001
Funding Issues
Medicare Expenditures
Medicare MH Expenditures 1998
1%
99%
0%
All Other Expenditures
Inpatient Psychiatric
Outpatient Mental Health
Outreach & Clinical Services Workgroup
PRIMARY GOALS


Increase public awareness about
aging and mental health issues
Expand the supply of qualified
mental health service providers
Education & Training Workgroup
OBJECTIVES

Facilitate provider training

Conduct public education campaign
Support policies & programs that
advance education & training

Training conferences
–
–
–
–
–


Public Health Conference, June 2006
Family Practice Association August in 2006
Mental Health Issues in Long Term Care, November 2006
Iowa Community Mental Health Centers, March 2007
Iowa Psychological Association, April 2007
Online training administration
–
–
Iowa Geriatric Education Center – University of Iowa
John A. Hartford Center of Geriatric Nursing Excellence – University of Iowa
Online training participation
–
Facilitate use of web-based training programs in mental health and aging
Support policies & programs that
advance education & training

Continuing Education Requirements
– Administer continuing education opportunities for
licensed providers across the state
– Support graduate training in medicine, nursing,
psychology, social work and pharmacology that
focus on mental health and aging.
Education & Training Workgroup
Public Education

Fact Sheets

Conference Displays
–
–
–
–
–


Annual Mental Health Conference, October 2006
Long Term Care Conference, November 2006
Gerontology Society of Iowa, April 2007
Iowa Psychological Association, April 2007
Governor’s Conference on Aging, May 2007
Media
Website Resources
– www.ICMHA.org
Education & Training Workgroup
Primary Objectives



Promote mental wellness among older
Iowans
Increase the number of mental health
providers who are qualified to treat older
Iowans
Integrate qualified mental health service
providers into usual places of care delivery
Support policies & programs
that advance outreach &
clinical services


Increase payments to non-physician
mental health providers (Medicare,
Medicaid, and supplemental insurance)
Support inclusion of older adults in Iowa
Peer Support Training Academy
Support policies & programs
that advance outreach &
clinical services

Screening efforts integrated into other
preventive services
Opportunities:
Mental health screenings at County Fairs, Meal Sites,
Senior Centers, Long-Term Care Institutions, and
Home and Community-Based Care Centers (e.g. Case
Management for Frail Elders Program)
Support policies & programs
that advance outreach &
clinical services

Screening efforts integrated into other
preventive services
Advantages:
•
Reduce ER Admissions
•
Monitor compliance locally
•
Reduce costs and stabilize population
•
Opportunity to serve greater numbers, more
effectively at lower costs (e.g. co-location of care)
Support policies & programs
that advance outreach &
clinical services


Increase payments to non-physician mental
health providers (Medicare and Medicaid) in
long-term care institutions and communitybased settings.
Promote and monitor use of tele-health in longterm care settings
–
IFMC’s Nursing Home Quality Initiative
Nursing Homes
Nursing Home Quality Initiative
IFMC, Iowa’s Medicare Quality Improvement
Organization (QIO) offers assistance at no cost to
nursing homes by providing education, identifying
improvement opportunities and sharing valuable
resources and best practices.
The focus of IFMC’s Nursing Home Quality Initiative
is to assist nursing homes in providing the best
possible care for their residents. These services
include improving care processes and setting
improvement targets for pressure ulcers, restraints,
depression and chronic pain.
Nursing Homes
Nursing Home Quality Initiative (continued)
Additionally, IFMC is working with nursing homes to
increase resident and staff satisfaction through work
on organizational culture change and implementing
person-centered care.
Our Nursing Home Quality Initiative combines this
assistance to improve quality of care with
information for consumers about the quality of care
provided by nursing homes available at
www.medicare.gov.
Ask the Expert
I am a psychologist who services the geriatric population. Can you
direct me to resources which are related to the use of psychotherapy
with mildly demented patients?
Would like Screening questions to be used on an acute care hospital
nurse admission history to screen for suicide. Would appreciate an
evidenced based tool that is quick and easy to use.
I am working with a client who is exhibiting symptoms of depression;
what is the age range criteria to get an adequate score with the
Geriatric Depression Scale?
I am a licensed Psychologist who works in nursing homes and long term
care facilities with geriatric patients. What short screening tests
might you use to measure anxiety with this population?
Support policies & programs
that advance outreach &
clinical services



Establish primary care – mental health care
collaborative models
Collaborate with primary care, aging services,
residential care facilities, and home and
community-based services
Encourage continuity of care between inpatient
and community-based services/preventive
services
Support policies & programs
that advance outreach &
clinical services

Replicate Employee Assistance Programs which
offer mental health screenings and communitybased treatments that have demonstrated
patient success in treatment at significantly
lower costs per patient over inpatient care.
Support policies & programs
that advance outreach &
clinical services


Document successful behavioral interventionsevidence-based for the reimbursement stream
Develop health networks linking mental health
providers and rural populations to primary care,
public health, substance abuse programs, and
nursing care
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
National Initiatives
H.R. 3162 – Children’s Health and Medicare Protection Act of 2007,
Introduced by Rep. John Dingell on 7/24/07, Passed by U.S. House
8/1/07
Highlights:
• Gradually provides parity between Medicare mental health services
and services for physical conditions;
•
•
5% increase for Medicare Part B payments to social workers and
psychologists;
0.5% increase in current physician payment system, impacting
mental health providers;
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
Highlights (H.R. 3162 continued):
•
•
•
•
Medicare reimbursement to services provided by marriage and
family therapists;
Authorizes new benefits for preventive items and services,
including mental health services;
Include benzodiazepines in required coverage under Medicare Part
D prescription drug program;
Reduce over-payments to private Medicare Advantage (MA) plans,
charges limited to costs under original Medicare plan;
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
Highlights (H.R. 3162 continued):
•
Discounted premiums via the Extra Help program for low income
participants (Medicare Savings Plan and Part D);
•
Access to improved drug formularies for name brand and generics;
•
Prevention of marketing fraud by Medicare Advantage plans
Attention is focused in the U.S. Senate which does not have
this legislation.
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
National Initiatives
H.R. 1663 – Medicare Mental Health Modernization Act, introduced
by Rep. Pete Stark, Chair Health Subcommittee of House Ways and
Means with Co-sponsors Rep. Patrick Kennedy and Rep. Jim Ramstad
Highlights:
• Reduce Medicare’s 50% co-payment for mental health care to the
20% level charged for most other Part B medical services;
•
•
Eliminate the 190 day lifetime cap for inpatient services;
Add intensive residential mental health services to Medicare,
including crisis services, psychiatric rehabilitation, substance abuse
intervention, and other non-institutional mental health care
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
Highlights (H.R. 1663 continued):
•
•
•
Cover intensive outpatient services, including psychiatric
rehabilitation; assertive community treatment; intensive case
management; day treatment for individuals under 21 years of age;
and ambulatory detoxification;
Expand the types of mental health professionals eligible to provide
services through Medicare;
Correct a legislative oversight to permit direct payment under the
Medicare program for clinical social worker services provided to
residents of skilled nursing facilities;
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
Highlights (H.R. 1663 continued):
•
Require the Secretary of the Department of Health and Human
Services to conduct a study to examine whether the Medicare
criteria to cover therapeutic services to beneficiaries with
Alzheimer’s Disease and related cognitive disorders discriminates
by being overly restrictive.
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
National Initiatives
H.R. 1669 – Positive Aging Act of 2007, introduced by Rep. Patrick
Kennedy, to amend the Public Health Service Act. (Also S. 982,
Introduced by Senator Clinton, 4/23/07)
Highlights:
• Provide grants to states to integrate mental health services in
primary care settings;
•
•
•
Fund community-based mental health treatment outreach teams;
Designate a Deputy Director for Older Adult Mental Health
Services within the Center for Mental Health Services;
Targeted funds for substance abuse in older adults, homeless, and
rural older adults.
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
National Initiatives
Older Americans Act as Reauthorized September 30, 2006
Highlights:
•
•
Title IV – Activities for Health, Independence, and Longevity,
grants to states for rural caregivers, especially for Alzheimer’s
patients, creating awareness of organic brain syndromes,
depression, and the need for mental health care for older adults;
Funding for mental health screening, prevention, treatment
services, planning for Boomers, and multidisciplinary centers for
mental health screening;
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
Older Americans Act as Reauthorized September 30, 2006
Highlights (continued):
•
•
Title III – Grants for State and Community Programs on Aging,
funding for mental health outreach/screening, health education,
counseling, preventive assessments and health screenings;
Priority for persons caring for MR, DD and persons with
Alzheimer’s Disease.
Congress has not passed the 2008 budget bill funding
amounts pending
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
National Initiatives
American Association for Geriatric Psychiatry and the Substance Abuse
and Mental Health Services Administration (SAMHSA) within HHS,
working on a national behavioral health workforce development
strategy through a public-private partnership with the Annapolis
Coalition on Behavioral Health Workforce Education. These partners
are working to build new competencies among providers and
educators, among health care organizations and academic institutions.
Federal and State agencies, accrediting bodies, health care insurers,
and professional organizations
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
National Initiatives
Institute of Medicine has suggested the following to be included in the
Fiscal Year 2008 Labor/HHS Appropriations bill:
The Committee provides $1 Million for a study by the Institute of Medicine
of the National Academy of Sciences to determine the multi-disciplinary
mental health workforce needed to serve older adults. The initiation of this
study should be not later than 60 days after the date of enactment of this
Act, whereby the Secretary of HHS shall enter into a contact with the
Institute of Medicine to conduct a thorough analysis of the forces that
shape the mental health care workforce for older adults, including
education, training, modes of practice, and reimbursement.
This matter is pending the approval of the Federal Budget for FY 2008.
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
State Initiatives



Iowa Coalition on Mental Health and Aging Legislative Breakfast,
January 31, 2007 – Over 20 legislators attended and received
information on the Coalition and the mental health needs of older
Iowans
H.F. 909 (passed) Health and Human Services Appropriations bill,
includes $60,000 for Dementia-specific education for Direct Care
Workers
S.F. 128 – Tobacco Tax bill, created a Health Care Trust Fund
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
State Initiatives (continued)



State’s Mental Health Systems Improvement Bill, establishes 6
workgroups including Community Mental Health Center Planning
Proposal to conduct a series of regional meetings on the issue of mental
health and aging in cooperation with Area Agencies on Aging
Potential funding via the Older Americans Act mental health and aging
initiatives via the aging network and collaborations with communitybased providers
Iowa Coalition on Mental Health & Aging
2008 Policy Agenda
State Initiatives (continued)


Continue letter writing in support of Federal initiatives, attending
caucus meetings, and planning for the 2008 Iowa Legislative Session
Iowa Coalition on Mental Health and Aging Legislative Breakfast, to be
held January 31, 2008, 7:00-9:00 am, Legislative Dining Room 15