Presentation to the Olmstead Planning Committee

Presentation to the Olmstead Planning Committee State Operated Services’ Utilization Management Review Notes May 3, 2012

1. On any given day State Operated Services’ Adult Mental Health, Chemical Addiction Recovery Enterprise (C.A.R.E.), Forensic Services and Minnesota Specialty Health System (MSHS) serve approximately 1100 people.

2. Within all State Operated Services programs there were 4,175 patients admitted in FY2011. Of those admissions, C.A.R.E. and the Community Behavioral Health Hospitals admitted 80% of the people served.

3. In FY2011, State Operated Services programs discharged 4,151 patients. Of the 80% of discharges from C.A.R.E. and the Community Behavioral Health Hospitals, C.A.R.E. had an average length of stay (LOS) of 39 days and the Community Behavioral Health Hospitals had an average length of stay of 17.5 days.

4. The Length of Stay varied from one day in the acute care programs to 14 years in the Minnesota Security Hospital.

5. Of the current patients in State Operated Services’ hospital beds, there are 42 people not meeting hospital level of care.

6. Over FY2011 there were over 14,000 bed days not meeting hospital level of care criteria (DNMC). With an average cost of $1100 per bed day, there is $15.4 million of inappropriate care expense.

7. In opening the Minnesota Specialty Health System intensive residential programs (IRTs) for special populations, State Operated Services has developed a medically monitored, subacute level of care for those people who struggle with return to the community because of the lack of community integration skills and/or a history of community treatment failures. 8. Minnesota Specialty Health System--Wadena is designed for people with serious mental illness (SMI) and co-occurring substance abuse; Minnesota Specialty Health System--Willmar is for people with co-occurring serious mental illness and chronic medical problems; Minnesota Specialty Health System--Cambridge is for people with intellectual disabilities and co-occurring serious mental illness causing public safety concerns; and Minnesota Specialty Health System-- Brainerd is for people with co-occurring traumatic brain injury and serious mental illness.

9. The Minnesota Security Hospital has 50 people in the Transition Readiness Program and 82 people in Transition Services, all who could be in the community if supported by the county , recommended by the Special Review Board and approved by the Commissioner. These two programs support 35% of the Minnesota Security Hospital population.

10. State Operated Services’ Competency Restoration Program has 26 beds. The average length of stay is 6 months. Over 40% of the beds are occupied by people who have completed an evaluation and the report has been submitted to the court. Major barrier to disposition is that the criminal court holds jurisdiction and has up to three years to take action.

11. State Operated Services uses the LOCUS (Level of Care Utilization System) to monitor utilization of Anoka-Metro RTC, Child & Adolescent Behavior Health Services, and Community Behavioral Health Hospital beds as well as Minnesota Specialty Health Services Intensive Residential Treatment (IRT) beds.

12. Anoka-Metro RTC averages a third of its patients at LOCUS level 6 (medically managed level of care=acute hospital); 52% at LOCUS level 5 (medically monitored level of care=subacute hospital) and 14% at LOCUS 4 or 3 (community levels of care).

13. Child & Adolescent Behavioral Health Services averages 9 occupied beds with 75% as LOCUS level 6 and 25% as LOCUS level 5.

14. Community Behavioral Health Hospitals average slightly over 50% of their beds as LOCUS level 6; 45% as LOCUS level 5 and 4% as LOCUS levels 4 and 3. 15. Weekly LOCUS reviews allow State Operated Services’ medical directors and administrators to provide oversight of those who are stuck in inappropriate levels of care. Social workers report on progress toward discharge to appropriate levels of care.

16. For people whose disposition is unclear or in dispute State Operated Services has an Assessment and Triage Committee, chaired by the State Operated Services’ Chief Medical Officer and the Administrator of Special Populations to review, who consult and provide liaison to the system providers who are struggling with finding an appropriate disposition.

For additional information, contact:

Alan Q. Radke, M.D., M.P.H.

SOS Chief Medical Officer [email protected]

651.431.3684