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How to repair Iowa’s broken mental health system

February 20, 2011
Messenger News

Iowa's behavioral health system is in critical condition.

Patients in need of services wait too long for appointments or for beds in treatment facilities. Left on their own, these Iowans often enter the system through hospital emergency rooms or law enforcement. Coupled with a fractured delivery structure that does not provide uniform access or services to citizens in different parts of the state, mental health care in Iowa is tenuous, at best.

Certainly, adequate payment for services remains important to ensuring that behavioral health services remain viable in Iowa. But other structural changes are equally important to consider as Iowa attempts to address this issue.

The Iowa Hospital Association is exploring pragmatic solutions for mental health delivery with the Department of Human Services and other stakeholders. However, without prompt and thoughtful action from legislators, including a commitment to properly fund mental health care across the state, Iowa will find itself in a situation where there will be no appropriate caregivers for behavioral health services, resulting in significant societal costs that will impact everything from hospitals to schools to courts.

In response, Iowa's hospitals have identified several priority initiatives, including:

A need for sub-acute services: Iowa needs more beds for patients who do not require intensive mental health care services provided by hospital inpatient units, but who are not ready to fully transition back into society. The Iowa Mental Health Institute Task Force convened in 2009 concluded that sub-acute care is a necessary portion of the continuum of care that is missing in Iowa and also noted that this is a role that could be filled via one or more of the state's four MHIs. IHA recommends that a pilot project expanding sub-acute care at one of the state's MHIs be developed and funded to address this need, with the potential for expanding the pilot to other communities across the state.

Access to uniform mental health service delivery: Iowa hospitals support the DHS goal of a more coordinated mental health delivery system. However, local mental health providers have created innovative community delivery models. Requiring access to uniform services could still allow for local innovation and eliminate inequitable services and administrative difficulties for regional and statewide providers. This includes hospitals providing inpatient psychiatric care, which must cope with 99 different counties with different benefit plans. IHA supports a uniform system that will increase efficiency, eliminate fragmentation and provide consistent services and outcomes for Iowans. In addition, the Iowa General Assembly should increase county property tax caps for the provision of mental health services.

Expansion of telemedicine for behavioral health services: Faced with a statewide shortage of psychiatrists, broader use of telemedicine services to oversee mid-level mental health practitioners holds great promise in Iowa. The expansion of these services faces two significant hurdles: lack of payment from Medicaid and other third-party payers and issues with state rules governing supervisory authority for some services (such as inpatient mental health services) by out-of-state physicians. Appropriate inpatient telemedicine services for behavioral health should be paid for by Medicaid and the use of telemedicine services should be viewed more liberally by the Board of Medical Examiners and the Department of Inspections and Appeals.

Improved coordination of benefits: Many behavioral health patients have multiple disorders or conditions that must be treated, including substance abuse and physical ailments. Today, there is little benefit coordination between traditional Medicaid (which covers physical health), the Iowa Plan (which covers behavioral health), and substance abuse treatment (through the Iowa Department of Public Health) regarding payment for these services. Hospitals often receive payment from only one funding source, covering only a portion of the overall care costs. The state must better coordinate these services to more accurately reflect the total cost of treatment for Medicaid patients.

Iowa's hospitals are committed to ensuring that all Iowans have access to high-quality care - both physical and mental - and will continue to press state leaders to support an equitable and accessible behavioral health care system.

Kirk Norris is president and chief executive officer of the Iowa Hospital Association.



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