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Abt Single-Sided Body Template Massachusetts General Court Mental Health Advisory Committee Report Phase I and Phase II Final #SCDMH821030H120000 June 30, 2014 Prepared for: Speaker Pro Tempore Patricia A. Haddad, Co-Chair Senator John F. Keenan, Co-Chair Mental Health Advisory Committee The Massachusetts General Court Submitted by: Abt Associates 55 Wheeler Street Cambridge, MA 02138 In Partnership with: The Technical Assistance Collaborative (TAC) 31 St. James Avenue Boston, MA 02116 CONTENTS 1. Acknowledgements .................................................................................................................. v 2. Executive Summary ................................................................................................................ vi 2.1 Introduction, Overview and Purpose of the Study .......................................................... vi 2.2 Key Findings on the Massachusetts Care System ......................................................... vii 2.3 Recommendations ............................................................................................................ x 2.4 Conclusion .................................................................................................................... xii 3. Overview and Background for the Report ............................................................................ 1 3.1 Overview .......................................................................................................................... 1 3.2 Legislative Mandate for the Report .................................................................................. 1 3.3 Purpose of the Study and Objectives for the Report ........................................................ 1 3.4 Principles that Guided the Analysis ................................................................................. 2 3.4.1 Treatment in the Most Integrated Setting ............................................................ 2 3.4.2 Access to a Full Array of Prevention, Treatment, Rehabilitation and Recovery Support Services ................................................................................................. 3 3.4.3 Preservation of Family and Community Ties in Access to Care ........................ 3 3.4.4 Use of Evidence-Based and Quality Care ........................................................... 3 3.4.5 Efficiency in Services Cost and Resource Allocation ......................................... 3 3.5 Study Methods and Approach .......................................................................................... 4 3.5.1 Qualitative Data Collection ................................................................................. 4 3.5.2 Quantitative Data Collection ............................................................................... 4 3.5.3 Integration of Phase I and Phase II Activities ..................................................... 5 4. Massachusetts Context ............................................................................................................ 6 4.1 Massachusetts has a Mature Mental Health System Impacted by Health Care Reform, Economic Conditions and Fragmented Authorities ......................................................... 8 4.2 Massachusetts has a Complex Mental Health System Shaped by Multiple Regulators, Payers and Providers ...................................................................................................... 10 4.3 There are Numerous Data Points and Anecdotes but Little Useful Information Related to the Performance and Effectiveness of Massachusetts’ Overall Mental Health System of Care ............................................................................................................................ 11 4.4 Despite the Relative Maturity and Completeness of Massachusetts’ Mental Health System, Elements of the System Remain Underfunded, and Current Financial Incentives are Somewhat Perverse ................................................................................. 11 5. National Context .................................................................................................................... 13 5.1 Expanded Role of Medicaid as a Payer for Inpatient and Outpatient Services .............. 13 5.2 Budget Cuts at State Mental Health Authorities (SMHAs) ........................................... 14 5.3 Diminished Role and Span of Authority at State Mental Health Authorities (SMHAs) 14 5.4 Changes in the Roles and Functions of State Psychiatric Hospitals .............................. 15 Abt Associates Final MHAC Report: Phase I and Phase II▌pg. i CONTENTS 5.5 Institution for Mental Disease (IMD) Exclusion ............................................................ 16 5.6 Americans with Disabilities Act (ADA) and Olmstead Decision .................................. 17 5.7 Affordable Care Act (ACA) and Mental Health Parity and Addiction Equity Act (MHPAEA) Implementation .......................................................................................... 18 5.8 Impact of National Policy, Legal and Financing Changes on Massachusetts ................ 19 6. Statutory Context ................................................................................................................... 21 6.1 MGL Chapter 19, Section 1 – DMH Enabling Legislation ............................................ 21 6.2 MGL Chapter 123 – Massachusetts Commitment Laws ............................................... 21 6.3 MGL Chapter 80, Acts of 2000, Chapter 256, Acts of 2008 Massachusetts Parity Law and Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 – Federal Parity Law ...................................................................................................................... 22 6.4 ADA Olmstead Decision and Massachusetts’ Community First Initiative .................... 23 6.5 Section 113 of Chapter 58 of the Acts of 2006: Medicaid Managed Care Alignment .. 23 7. Major Observations ............................................................................................................... 25 7.1 Needs of Massachusetts Residents for Mental Health Prevention, Treatment and Recovery Support ........................................................................................................... 25 7.2 Need for Effective, Integrated Care System Response to Complex Health Conditions 26 7.3 Meeting Complex Needs Requires Focused Interagency and Interorganizational Collaboration .................................................................................................................. 27 7.4 Statewide Capacity Concerns and Considerations ......................................................... 27 8. Findings and Recommendations: Inpatient Acute and Continuing Care Bed Need and Implications for Taunton State Hospital ............................................................................. 28 8.1 Overview and Questions to Be Addressed ..................................................................... 28 8.1.1 How does Massachusetts Compare to the Nation with Regard to the Availability of Psychiatric Inpatient Beds? ...................................................... 29 8.1.2 What is the Distribution of Psychiatric Inpatient Beds in Southeastern Massachusetts? .................................................................................................. 30 8.1.3 How are DMH Psychiatric Inpatient Beds Used, and Are There Differences Related to Southeastern Massachusetts? ........................................................... 32 8.2 Findings .......................................................................................................................... 40 8.2.1 Recommendations ............................................................................................. 40 9. Findings and Recommendations: Emergency Services ...................................................... 42 9.1 National Context for Psychiatric Emergency Services .................................................. 42 9.2 Statewide Emergency Service Program Data ................................................................. 43 9.3 Emergency Department Boarding .................................................................................. 44 9.3.1 Data Provided by Hospitals ............................................................................... 45 9.3.2 Massachusetts College of Emergency Physicians ED Wait Time Study .......... 46 9.3.3 Comparison to MBHP and DMH Data ............................................................. 46 Abt Associates Final MHAC Report: Phase I and Phase II▌pg. ii CONTENTS 9.3.4 Diversionary Services Utilization and Capacity ............................................... 47 9.4 Stakeholder Consensus and Divergence of Opinions on Solutions to ED Wait Times . 50 9.4.1 Areas of Consensus ........................................................................................... 50 9.4.2 Areas of Divergence .......................................................................................... 50 9.5 Issue: No Common Metrics across Payers ..................................................................... 52 9.6 Populations of Concern .................................................................................................. 52 9.6.1 Frequent Users of ED Services ......................................................................... 52 9.6.2 Individuals with Substance Use Disorders .......................................................
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