Transcripts For CSPAN HHS Secretary And Others On Behavioral Health Investments 20221018

Have you and lasted nearly 300 billion in investments to Community Behavior Health Clinics around the country by the crisis support. This is just under one hour. Treating Mental Health on par with physical health. Let this be remembered as the year where we laid the gauntlet to everyone. We challenged everyone to join us. Certified Community Behavioral Health Clinics have only been around for a short amount of time. But they have absolutely made a mark. I think there is nothing more fitting then to have the champions and perhaps the instigators, the people that got most in trouble, the most in the way of making sure we got this done, senator roy blunt with us today. I think it is only fitting that they get to talk about the success of really embedding within america what we consider essential health care for all americans. 90 million 90 percent of americans believe that there is a Mental Health crisis. Today, we are talking about providing to americans 24 7 support for crisis care. That is something that has only been available to some in some places but depending on your income and your zip code, you could be totally. That will start to change. We are creating a very Healthy Partnership with our brothers and sisters in Law Enforcement. So that we can Work Together to address the needs of the community and the challenges we all face, not all of them are challenges requiring a Law Enforcement officer. Some of them are just in need of a helping hand, caring face. Think of this as a year will be launched big. 988 is on board. 98 it becomes a place where you get help and if we do it right when you call that three digit number, you will get the support you need. That becomes the glue that really brings together this notion of providing health care to americans. We are connecting the dots to make sure we give everyone the full health care. Here is the best part. Ccd acs are here to stay. From senator stabenow to administrator brooks le sueur, and to sergeant chad matthews of the Montgomery County police, thank you for being part of this. Now let me ask senator stabenow to step forward. It is a wonderful day and when i think that we have been working toward for about 10 years. It is so great to be here. Thank you for your leadership in hhs we thank you so much for the partnership that has gone on for the last number of years. It is wonderful to have people on the frontline making a difference, saving peoples lives. Thank you so much. We have been working this for about 10 years but people have addiction related challenges and have been waiting a lifetime for this. Back in 1963, when you first introduced the Mental Health treatment act and spoke about president john f. Kennedy, the last law that he ever signed before being shot was the law to strengthen and develop community Mental Health. We dont want people being housed without treatment. We are going to close those and provide community treatment. Half of that happened. The hospitals got closed. The community work, the excellent quality efforts that people lead in the community did not happen. It is now going to happen. It is now happening. We are finally going to treat health above the neck the same as health care below the neck. In 2014, our excellence in health and mental treatment act created certified Behavior Health clinics. This is important. We modeled it after and you can get full funding for the work of the clinic through medicaid. We modeled it after that. This is evidencebased which is why when they came and said we want to do something on Mental Health, everybody started to about programs and roy and i went stop, we have an evidencebased program that has been operating and transforming what is happening. That is what we need to do. That is what we did. It is really transformative. The overall funding is the largest investment in Mental Health and Addiction Treatment ever. When you talk on the hotline, Everything Else is in there. It is the largest investment in Mental Health and addiction related services ever in our country. I want to thank President Biden for making this happen with his unity agenda. We are announcing the beginning of that. They will be given an opportunity to put together those high quality standards. And then build from there stepbystep, we are going to take this nationwide. I will bid you one other thing. We want you to get support across the country for this concept in the appropriations process where senator blunt is a key leader. We developed startup grants. Grants to go without medicaid funding. We now have those individual clinics in over 41 states. Here is what we now. This is why we were able to convince colleagues to make this part of this important legislation that was passed. People who receive Services Show a 72 reduction in hospitalization. A 69 reduction in emergency. They spent 60 less time in jail. Jfk said one true measure of a nation is it success in fulfilling the promise of a better life. Let this be the measure of our nation. Today, we fulfill that promise. I want to introduce my partner who what i who i would not have been able to move forward in this with. Senator roy blunt. [applause] we are both glad to be here. We are happy to see what we think its a significant step in the right direction. Almost everybody says the Mental Health system is not working the way it should be. We immediately talked to each other and then we started calling everybody who was working on putting a package together to explain that we did have a system that was working. Thank you for your leadership in this and your friendship and the time that we all three worked together in the congress and working together here. Administrator brooks leisure. In all of our discussions about what could happen here. Places where you can go 24 hours a day, seven days a week, 365 days a year that had the kind of staff that the law requires you to have. Not only that, the complete availability, but also staff thats available to do what needs to be done. You know, nih the National Institute of health for a long time has used a number that generally Something Like one in five adult americans has a diagnosable and almost always treatable Behavioral Health issue. 20 of the adult population. My guess is after the last few years of covid and isolation and other things, that number is probably about the same for the total population. How do we deal with that in a better way than weve been dealing with it. So we started those 10 states, then we decided we could actually expand that units that met all the criteria, the qualified criteria. Uh that could do what those states were doing basically statewide and largely often largely bigger communities. 300 communities now have c c. B. H. C. S in them. 40 states already, including the 10 pilot states have some element of this program. They know its working; they know that the, the finance structure based on the federally qualified Health Center structure works. Its not just for medicaid patients, its for everybody. You know, the way those facilities work is if youve got insurance that covers you in those facilities, you can go there if youre under a Government Program that covers you, you can go there if you dont have any of those things, you can go there and theres a very manageable sliding scale so that if this is a facility thats close to you and available to you, you can use that facility telehealth also works particularly well with Behavioral Health, youre more likely to be further away from your for your behavioral provider than you are your other health provider. Making all of that come together in a way that keeps people in the community that keeps people with their family that keeps people at their job, all that critically possible. And here we are. As senator stabenow mentioned 59 years ago this month, the bill was signed that these big facilities would be replaced with facilities that were in your community that were going to meet your needs in a better way and allow all of those things to happen. We now have the possibility for 50 states and were gonna talk about how that happens in a minute for all 50 states to take this big step forward Law Enforcement for too long in the emergency room, Law Enforcement in the emergency room really for most of that, 50 years after those big facilities got closed in the seventies uh become became the de facto Mental Health Delivery System for the country. Nobody is well served by that Law Enforcement isnt well served by that. The emergency room is not well served by that and certainly the people that need help and that crisis moment arent well served by that brent macguineas here from the missouri Behavioral Health council. Uh theyve kept really good records, not just of the Mental Health efforts going on, but also the difference it makes in peoples other health. Sen stabenow mentioned that hospitalizations were 672 lower. Those hospitalizations are lower are often not lower because they would be in the hospital for Mental Health. Theyre lower. Because if your Mental Health is in a good place, uh you show up for your other appointments, you go to dialysis, you take your medicine, you eat better, sleep better, feel better about yourself and you dont wind up in the hospital for the other Health Concerns that can put you in the hospital. There is a dramatic decline in what happens in peoples overall health. If youre dealing with their Mental Health, thats an awful big part of the 72 reduction in hospital visits arent hospital visits that you would have made hospital stays for Mental Health. But hospital stays, you would have made for your other Health Concerns that you werent dealing with because your Mental Health concern wasnt being dealt with. Um nine years ago, we were talking about that bill that had been signed 50 years earlier. Uh senator stabenow and i both couldnt be more happy to be here to see us at this moment. We know this works, we know the difference it makes in peoples lives and the communities they live in and its a great time and certainly one of the people that will be incredibly important in making this work is dr. Miriam delphin richman who will be here to explain from her point of view the nuts and bolts of how this works of how states can apply, how they can be in that 10 year effort. Were hoping at least 10 states every two years will join the 10 states that are already making this program work and know it works and uh doctor thank you for all youre doing to make this work. Good morning, good morning everyone and thank you senator blunt. You know, i have to say it is just such a pleasure to be here with uh secretary becerra with senator stabenow. Senator blunt administrator brooke slash or uh from the centers for medicare and Medicaid Services uh jennifer and certain charred matthews, thank you everyone for joining us today. Um you know senator blunt and senator stabenow, i want to thank you for your steadfast leadership and support and dedication to all americans. Uh so thank you for the work that you do every day. Um you are tremendous champions for this model of excellence uh in Behavioral Health care and we heard about some of the impacts and outcomes of this model already. Um administrator books for sure. I so appreciate our partnership in this work uh and look forward to our continued partnership as we move this work forward. Um i have to say we are so pleased to announce that hhs through samhsa authorized by the Bipartisan Safer Community act um is expanding for states, uh the opportunity to submit applications for 15 million in planning grants to develop certified Community Behavioral Health Clinics. Um this underscores the biden harris administrations commitment to strengthening Mental Health of all americans. In early 2020 23 will review applications uh and then award 15 states 1 million apiece to begin their planning process. So really excited about this this process. Um in the planning phase what states will do is they will work towards uh federal standards for c. C. B. H. C. Model. Um theyll also establish prospective Payment Systems for medicaid reimbursable services, so again the collaboration with uh connection with cms um and then theyll also prepare an application to be part of a four year demonstration. Uh so wonderful opportunity for states. Um and so let me talk briefly about what this means. Um we know that c. C. B. H. C. S. Are the kind of care that you would want your neighbor to receive, that you would want to receive yourself that you would want a friend to receive or a family member. Let me show you how this works. Within the first six months, we see decreased homelessness, we see decreased amount of time in correctional facilities, we see decreased amount of time spent in Emergency Rooms for Behavior Health care, we see decreased patient hospitalizations as well and we also see an increase in positive functioning for individuals that are struggling with Behavioral Health challenges. This is a model that we know. It is demonstrated to make a meaningful impact. The model is innovative, it is transformative. It provides 24 hour care, crisis care. 21 hours a day, seven days a week. Equally important, the model helps and is available for anybody regardless of their ability to pay or where they live. The access is a real critical component of this model. With this expansion, expansion of eligibility and a recent increase in funds, in just a few short years, we have gone from 70 to over 400 across the country. That is a significant increase in access. A significant feat led by President Biden and members of congress, specifically senator stabenow and senator blunt. They were the original sponsors of this opportunity. I would like to close with this. This is a piece that we want everyone to take away. We know that hope is so important. Just knowing that the care is available and that it is culturally appropriate. Also, hope affirmed by the knowledge that we are demonstrating a commitment to improve the Behavioral Health of the nation. Now, it is my pleasure to introduce our administrator. She is the administrator of cms and she will talk about this model. We are just so thrilled to be here. I would say it is so important for us as a department to make sure people are getting care in the most appropriate setting. Demonstration is to really make sure that people across this country are getting care where they needed. As you have heard, we are deeply appreciative of both senator stabenow and senator blunt for a decade of working to make sure that today would be a reality because as the secretary mentioned, we are now in the midst of a Mental Health crisis in our country and we had hhs are really committed to doing what we can to make sure we turn this around. I will just say that we are working closely with our colleagues on this program that really allows states to test new strategies and deliver and reimburse services in an outpatient setting. Samsara provides the planning grants. Cms is responsible for implementing the enhanced federal medicaid reimbursement authorized for the services that are delivered. This Funding Provides the ongoing investment in these behavioral Health Clinics and helps them continue to provide a wide range of services they offer. I want to mention that this is just part of what we are doing at cms to ensure that people in medicaid, chips or marketplace coverage get quality, affordable, acceptable Behavioral Health care. As the secretary said, this is part of a big package of really making sure people are getting the care they need. In medicaid, we are working with their estate partners to expand support for communitybased mobile crisis innovation intervention services. Thanks to the bipartisan communities act, they are often working to provide Additional Support for schoolbased services for children covered by medicaid. Provided essential health care in schools including Mental Health services can reach children and youth where they are and help them to ensure they get the care they need. That is why the senator said this is the largest investment and Mental Health and Substance Abuse assistance in a generation because of some of these other provisions. And medicare, we are working to expand access to needed Substance Abuse treatment as well as bringing providers to make sure they get the care they need. For private insurance, we are working to vent surprise medical bills. These are just a few of the policies we are focused on and working to implement on behalf of the over 150 Million People were now part of our program. We are so excited about the Certified Community Neighbor Health clinic demonstration and now i look forward to turning it over to two people who are indeed the actual people delivering care and it is so important that we not lose sight of the people who are on the ground and it is my pleasure to turn it over to the clinical director of the Behavioral Health Urgent Care Center. Hello and good morning, everyone. I feel so honored to have been invited here today to speak about my favorite topic, Mental Health. Our Behavioral Health Urgent Care Team consists of administrative assistance, peer support specialists, nurses, therapists and psychiatric Mental Health nurse practitioners. We are skilled at building a quick rapport with their consumers, recognizing their holistic needs, displaying cultural competence, collaborating with their multidisciplinary Treatment Team members and providing patient centered treatment options. Our team has built professional relationships with several local entities. We received referrals from the emergency room from the jake and Mcneil Family center Anne Arundel County Crisis Response team and Anne Arundel County public schools, primary care offices, local therapists, residential crisis providers, Anne Arundel County Mental Health and Substance Abuse Disorder Court and most recently it seems, wordofmouth from our previous consumers has been a great source of referral. Since december of 2021, the Anne Arundel Lodge has served 3016 consumers. Our Behavioral Health Urgent Care Center has served 809 consumers. Those are 809 lives in crisis we have touched. We see individuals with known Behavioral Health disorders. We see those who are seeking help for the first time. On their first visit, we have sent initiated treatment on a walkin basis. We provide psychotropic medications. We also offer Bridge Services for consumers until they have begun ongoing treatment and support services. Our Behavioral Health Urgent Care Center provides consumers with a safe therapeutic base. It is whatever team prefers to call our judgment free zone. Consumer testimony is the best way i can explain how important it is to have a certified Community Behavioral Health Clinic in our community. Here is some of the feedback we have received. This is the first time i have ever felt like anyone really listened to me. Thank you. Thank you for giving me my life back. You gave me hope when i thought there was none left for me. You saved my life. You saved my life. Is there anything else i could mention that would have a greater impact than that . Thank you. I would like to introduce our final speaker. His name is sergeant ted matthews. He is a 19 year veteran of the Police Department and as the Crisis Response support session, he manages a team of officers and licensed clinical social workers who provide essential training to Police Officers in Montgomery County and allied agencies. Good morning. As a supervisor for Montgomery County Crisis Response, i continued to see an expenditure increase in Mental Health related calls for service. These calls while increasing in frequency are also increasing in acuity. Oftentimes, that call for Service Places Law Enforcement in a position to be the first to evaluate and attempt to connect someone with Mental Health treatment. The available options for most ways officers is either a trip to the hospital or a jail cell. The problem for Law Enforcement is simple. How do we help those with a Behavioral Health crisis . We know that Emergency Rooms are not equipped to handle someone with a Mental Health crisis. These two are vital to bridging the gap between Law Enforcement. As a Law Enforcement official, i can say that we welcome the opportunity to increase positive interactions with those experiencing a Mental Health crisis. We want to help those living with Mental Health and their families to continue to be destigmatize Mental Health. It is here that we will do this. We will highlight the positive outcomes. Recently i became involved with a challenging situation not far from where we stand today. The patients were living with some addicts of Mental Illness and nonexistent family or friend support system and several minor interactions with us in Law Enforcement. Coordinating with a licensed clinical social worker from the Montgomery Group and half a dozen public and provided public and private providers, the outcome was a resounding success. We connected the patient to services that help them better manage their illness. This effective model continues today. We will continue to work sidebyside with our friends and partners, thank you. Thank you. Now the fun part, q a. Please stick to the topic at hand. We want to prioritize those questions. That is why we are here. We will call on you and give you a mic so you can introduce yourself and state your question. Lets start with peter sullivan. If you can raise your hand, we will bring you a microphone. Thank you. I want to ask for the senators, obviously we have this effort today to do more on Mental Health, d. C. More on Mental Health happening specifically around Mental Health parity, Insurance Coverage which is sometimes controversial . Obviously, we start with today which is making sure these services are serving the community. But i am also leading a bipartisan workgroup on Workforce Needs because one of the things that everyone will say is that we dont have enough psychologists and social workers and counselors and psychiatrists and so on. The chairman and Ranking Member of the finance committee put out a report and we have a package of bills now that i would love to see move. One of the things were working on is how to take the finance pieces. This is what we pulled up to do in the legislation. There is still a war on telehealth that i think is a huge piece of all of this. As well as other reimbursement issues. I think that we will see something. I am oval we will see something. Mental Health Parity is the law of the land. We reaffirmed in the Affordable Care act as a member of the finance committee. It is frustrating to me to see that it would be viewed by some as controversial when it is actually the law. Insurance companies should not be providing different premiums and links of treatment and so on. The real question is how did we make sure that is happening . Hopefully there is more to come. We hope that this will make a big difference in how we move forward on all of these areas. What we have done over the last five years, adding those Additional Units that were not in the 10 original state, they are at about a billion dollars a year. That is where that expansion has gone. We continue that. We were also talking earlier today about the importance of connecting with governors. The governors in the 40 states that may very well have a big unit. As a texas has four big units in their state. We think those of the stage that will be most likely to step up first and say we know this works, we see it working in a handful of communities in our state. We are talking about ways we can reach out to the governors in particular. I think many of them are watching this conference today. They are reaching out to the governors, reaching out to the brandnew governors. Making sure that they understand this is one of the things that their state has a chance to be a part of. Right now is the time to do your best to be one of those first 15 states to apply to be one of the initial 10 states. That is largely to be sure that the amount of money we are putting in this bill allowed all 40 states that were not there to participate and every two years, we would be adding up to 10 more states. They may need to hear that message. I believe at the end of the day, we will show the original 10 states. They are in a better place when it comes to Mental Health. Correct this might be for the senators as well. One of the things we know is as a result of the pandemic, children and High Schoolers have really suffered. I am wondering if they treat children, are there any special programs developed devoted to improving Mental Health services for young people . Whats the answer to that is yes. There are also some schoolbased opportunities in the same bill that has this expansion. One of the things is we mentioned telehealth. This is a good way to meet with people you met one time. You dont necessarily have to have the Mental Health provider in the school having the kind of professional staff with the previous lack of service and opportunity, this was an area where people would have liked to have gone into fulltime Behavioral Health. This would be to have the big areas right now, largely because of the covid and School Closures and social media has created a number of challenges for that population. I think close to one third of those being served right now are children and young people. Also we have schoolbased health plantings that are much more robustly funded. There is more effort now to partner with the Health Center to run the clinic. I think there is more work and what we have worked on has transformed not just immigrants france but ongoing permanent funding. We have authorized schoolbased Health Centers. We are doing that to make that funding permanent. Grants are great but the grant funds out. Making it more of a part of the Permanent Health care system is on the we can do more in. We are already treating children and also part of the solution right now where schools can reach out to them to operate their Health Centers. I will turn it over to jennifer. I wanted to mention what both of the senators talked about. We were making sure that people understand how to reimburse medicaid. And i just wanted to mention as i said earlier, we have a very good working relationship with Anne Arundel County public schools. The youngest of which was a preschooler. There are 40 states do any of them have any interest in doing so . I will tell you that i have heard from a number of states that want to that are very interested. This is the First Official day. Chris we will be releasing the funding opportunity today. Certainly having the availability to answer any questions and working to get the word out. And just how it can lead to their being eligibility to apply for a four year demonstration grant. 30 of those 40 states have some sort of unit in the state already. We expect those groups to be encouraging others in the state to encourage the state to have a statewide opportunity. Senator braun, we know you have this Substance Abuse component. We are talking about Mental Health but the two of them are sort of intertwined. How does that sort of play into the need for Services Related to Substance Abuse . Did you feel like the bipartisan communities act was an opportunity to expand what you guys already did with this 2014 legislation . We really got engaged at i did not mention my whole staff earlier. Both of our staff worked really well. We have the advantage of having the appropriate or possible staff in education, some of whom are here today who do a great job leading that effort for us. The whole idea of Substance Abuse, if you dont have a Behavioral Health problem this is a place where i think the federally qualified Health Centers who were generally leading the way on Substance Abuse have really reached out to the community Health Centers in a partnership that appears to be working. We had returned to this issue about six years ago and i thought we were making real headway on opioid and Substance Abuse deaths until cocaine created a lot of new challenges. If you had the support system that was working, you would likely be isolated from that support system. We so not 2000 19 or 20 these things are very interrelated. You immediately have one afterwards. Yes. I will answer your question. I do want to thank all of our wonderful staff. We have been living and breathing this for years and years. The whole team has been so wonderful. Let me say before, we did see this as an opportunity. It is challenging because whenever the issue comes up around gun violence, we are also very concerned. We want to destigmatize Mental Health. Mental health is a health care issue. We dont want to somehow say that someone who is bipolar or somebody who is a danger to somebody else are more likely to be a victim than a perpetrator of a crime. We also know that we look at somebody was going in, they are obviously serious issues there. We always try to figure out how to balance that because we want this to be a broader part of health care. We want to encourage people to step forward. It is like you having a chemical imbalance called diabetes and you take insulin. You do that and go on with your life. If you are bipolar, you should be able to take lithium or some other medication and get to help you need and go on with your life. That is the goal longterm. But given what was being talked about and the fact that we had colleagues that say we want to go big and bold on Mental Health, we have to take this moment, we have to take this moment and not we had very wellmeaning colleagues that wanted to make up new grant programs. That is what has always happened. Lets try a new grant program. The whole purpose of this is to institutionalize in the sense of funding quality standards so we know what needs to be done. One other thing i would just say is that the terms get used interchangeably. Really, Behavior Health is Mental Health and addiction, Substance Abuse. People dont always know what Behavioral Health is so they say Mental Health or as a Mental Health and Addiction Services just because we also know that addiction changes your brain pattern. Another form of brain disease. That is what happens. It is all part of the same thing in terms of illnesses in the brain and emotional issues and so on. We absolutely decided this was the moment and we have evidence based data to show people that it worked and the all of our colleagues and the president and everyone joined us. We have time for about two more questions. Carolyn tucker, nbc. There you go. This question is for the secretary. We are just wondering if you could address some of our telemundo stations in spanish. This is connecting the dots for communities on expanding these Mental Health services in other states. [speaking spanish] this is [speaking spanish ] [speaking spanish] thank you. This question is for the doctor. I am wondering how these hebrew Health Centers have been working with the 988 center. One of the things we have read is that once the call is over, people do it for a long time to get what they need. He talked about how it will continue that care . Absolutely. Thank you for that question. It is such an important part of this whole continuum. What we know is that because they offer rises services or they are in tight partnership with ongoing indication with the crisis call centers, what they offer is really an expansion of the communitybased services to ultimately connect people. The crisis continuum is having a place to call but also having a place for people to connect in a place for people to go. They absolutely help with that because they offer 20 crisis services. In some instances they actually have crisis teams and mobile crisis teams themselves as well. There is definitely a tight collaboration and communication between the 988 call centers and the ccv. Particularly the crisis component. This will be our final question. Inside health policy, where are you, dorothy . Correct i did not actually have a question but thank you. We can pass it to someone else. Yes. What about abc . We have abc here . Reuters . Jonathan from reuters . Any more questions . I do think you have asked a question. I just wanted to get a question for verification. I know that the money and resources dedicated for these different clinics would go toward the resources necessary to help with Mental Health resources. I just wanted to know if anybody could answer if part of the funding will also be dedicated to security . Even in average hospital settings, there are issues throughout the country for those that do have health problems. They do lash out against staff and other clinicians. You know that the way the model works which is what we base this on his they take all of their expenses and all of their various sources of income and they have sort of a settlement at the end of the year. Every qualified Health Center feels like they need security, that will be one of the things that would be pulled into that entire equation. Senator stabenow made such a good point let me out one other thing. The senator made a good point about suggesting Behavioral Health is dangerous. We need to get as a society to where you are willing to talk to your friends about somebody who has a Mental Health problem as someone who has another kind of health problem. We should get to where we can talk about Mental Health with the same ease, with an understanding that this is a health problem. It is almost 100 of the time a problem that can be dealt with in a way that people continue to be part of their family and part of their community. That was the goal 59 years ago. It is a goal we are much closer to today than we have ever been before, and a decade from now, hopefully, everybody will be within easy reach of a Behavioral Health the kind of Haverhill Health Mental Health that they need the kind of Behavioral Health, Mental Health that they need. I remember the days when we used to say, [whispers] she has cancer. Now people are openly talking about the kind of cancers and treatments going in. This really is the kind of openness we are talking about. People talking about issues in the brain as well as any other part of the body. One other thing to your security question is that the model here is to fund the entire clinic theres various grants for funding, theres medical funding if it is a severe issue, so it is based on the person, not the cost of the clinic. The difference is being able to provide and we are providing enhanced medicaid so there will be additional dollars to be able to fully fund the clinic, but it is based on the full hunting and the cost of the personnel, the cost of the clinic, so that you are not worried theres not this patchwork approach where you try to figure out how to Keep Services going. Thats why i would call it transformative in the area of Behavioral Health. Thats a wrap. Thank you for coming. [applause] [captions Copyright National cable satellite corp. 2022] [captioning performed by the national captioning institut which is responsible for its caption content and accuracy. Visit ncicap. 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