Minnesota is one of 24 states that have been selected by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Medicare and Medicaid Services (CMS) to participate in a yearlong planning process to develop a network of certified community behavioral health clinics.
Community behavioral health clinics are “one-stop shops,” where people with complex mental and chemical health concerns can get the help they need for the issues that surround these often co-occurring disorders.
Claire Wilson, executive director of the Minnesota Association of Community Mental Health Programs, said the grant is an exciting first step in the process of creating a statewide network of clinics that serve the needs of the whole person.
“Imagine a center where you walked in and you can be screened for any of your mental health concerns or chemical dependency issues and immediately put in touch with primary care and have community support wrapped around you,” she said. The community support would extend beyond physical and chemical health, to include assistance with housing and employment issues and social services.
“These services would all be available to clients in the same location,” Wilson explained. “This approach steps away from the siloed traditional-care model and puts it squarely back in community-based care, which we know is most effective for the population we are serving.”
The planning grant, authorized under Section 223 of the federal Excellence in Mental Health Act of 2014, totals $982,373 over one year. It will fund the development of at least two clinics in the state that will offer comprehensive, holistic care to adults and children seeking assistance for serious mental health and substance abuse concerns.
“These clinics will be set up to serve anyone,” Wilson said, “but the payment model will be for the Medicare population. The clinics will provide services for the uninsured. They will also provide services to veterans in a more formalized way.”
The grant-proposal process was led by a group of Minnesota mental health and substance abuse professionals who convened a steering committee to discuss best ways the state can respond to the Excellence in Mental Health Act, bipartisan legislation that Wilson explained, “was the largest investment in decades in community mental health.”
“We convened a big steering committee of stakeholders, providers, veterans organizations, tribal organizations and state and local officials,” Wilson continued. “We call ourselves the Excellence Act Steering Committee.”
The state’s proposal was approved by the federal government earlier this fall. The 24 states receiving awards were announced in October.
“It is a very quick process,” Wilson said. “It is a one-year planning grant.” The grant’s stipulations require nose-to-the-grindstone work: “During the course of this year, we are preparing at least two clinics to be certified as community behavioral health clinics and hope to prepare more. One clinic will be urban and one will be in Greater Minnesota. The hope is more will be ready in this time period, but we will create criteria and certify at least two.”
The next step
Being awarded this grant, which expires in October 2016, is just the first step in a competitive two-phase process, Wilson explained. In 2017, the 24 states that received the planning grants will also have the opportunity to apply to participate in a fully funded two-year demonstration program. Only eight states will be selected to participate in this second stage.
“By October 2016 we have to be ready to submit the application to become a demonstration project,” Wilson said. “If we are one of the eight states selected, we have to be ready to go on Jan. 1, 2017. We have only a year to get set up to be selected.”
As part of the two-year demonstration program, states will certify one urban and one rural clinic that will offer behavioral health services while being reimbursed at the federal level.
This potential for federal reimbursement is a big attraction for stakeholders, Wilson said.
“This field has been chronically underfunded. Our reimbursement rates are lower than anyone else’s. Nobody is making a margin. This funding will transform not only how we deliver services but also our ability to pay for those services.”
In Minnesota, there is a lot of energy behind the idea of building a network of community behavioral health clinics, Wilson said. Recent legislative victories at the state level help build momentum — and funding — for such projects, which feels heartening and energizing for advocates.
“Right now there’s a lot of energy in the mental health community and the addiction services community,” she said, “but there is still a lot of work to be done if we want to be selected as one of those final eight states.”
The funding that will be funneled to the eight finalists will be key to establishing a community behavioral health clinic network in Minnesota, Wilson said.
“If we are selected as a demonstration state, there will be a federal funding match for two years.” And that could get the network off the ground. But if Minnesota isn’t selected as one of the eight demonstration states, organizers say they still could select to move ahead with the planning process independently, but, Wilson cautioned, “doing the same thing as a state without federal support would require the state to match the funds. But that might create more of a quagmire than we’re prepared to take on.”
With its world-class health-care system and proven legislative commitment to improving mental and chemical health care statewide, Minnesota has a good chance of being selected as one of the final eight demonstration states, Wilson pointed out.
“I think we’re well positioned,” she said. And there are already several clinics across over the state that operate under the community behavioral health model: “Some programs in the Twin Cities get attention, but we also have some high quality multimillion dollar programs across the state that are doing incredible work.”
The grant — and the federal support it provides — could be the key to real, substantive change in the way care is delivered to people facing mental health and addiction challenges, Wilson believes. It’s an exciting prospect.
“I feel like this is a real opportunity to transform the field, because through this process we’ll develop a common set of criteria and a lot of information exchange will be happening,” she said. “I think it will really highlight for the general population just how powerful this treatment model is.”