Iowa Mental Health and Disability Services System Redesign Interim ...

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IX. REPORT OF THE BRAIN INJURY WORKGROUP (DHS) Introduction Senate File (SF) 525 charged the MHDS Brain Injury (BI) workgroup with: “Reviewing best practices and programs utilized by other states in identifying new approaches for addressing the needs for publicly funded services for persons with brain injury.” Although the timeframe for the BI work product was established as December 2012, the workgroup felt strongly that their work should be considered in conjunction with the entire redesign project. The workgroup translated the identified best practices into specific recommendations as necessary actions for improving Iowa’s system for serving people with brain injuries. The recommendations reflect both a short and long term implementation timeline in recognition of the need to further develop the brain injury service system. According to the Centers for Disease Control and Prevention (CDC), nearly 1.7% of people in Iowa or approximately 50,000 Iowans are living with long-term disabilities caused by a traumatic brain injury (CDC 2008). Brain injury is the most debilitating outcome of injury characterized by the irreversibility of its damages, long-term effects on quality of life, and healthcare costs. Brain injury can be acquired, e.g., stroke, or traumatic in nature and Iowa’s aging population and increasing numbers of military service veterans will drive up the rates of incidence. Prompt and comprehensive continuity of care for people with brain injury decreases expensive and untoward medical outcomes and associated secondary conditions. Secondary conditions can include multi-occurring disorders, defined as “any person of any age with ANY combination of any MH condition (including trauma) and/or developmental or cognitive disability (including Brain Injury) and/or any Substance abuse condition, including gambling and nicotine dependence, whether or not they have already been diagnosed.” (See Section V. B) Continuity of care is the process by which the patient and the physician are cooperatively involved in ongoing health care management toward the goal of high quality, cost-effective medical care (American Academy of Family Physicians). The vision of Olmstead is, “A life in the community for everyone.” The Brain Injury workgroup developed recommendations whose outcomes will help people with brain injury and other disabilities, of any age, receive supports in the most integrated setting consistent with their needs in concert with Iowa’s Olmstead Plan. Recommendations The Brain Injury Workgroup recommendations, based on best practices in Iowa and around the country, are designed to create a continuum of care that is affordable, accessible, available, appropriate and acceptable to all individuals with brain injury in all regions. The recommendations are prioritized based on the degree of impact on improving the existing system (high) and the degree of deployment difficulty (low). Optimized core services, expanded core services, and new core services, are ranked separately. 118
See Appendix F for details of each ranking, including best practice citation, short and long-term implementation, the impact/difficulty score and necessary policy action. Core Services All services currently offered to people with brain injuries should continue to be offered as core services. Current core services are all programs included in the Brain Injury Services Program at the Iowa Department of Public Health (IDPH), and Medicaid State Plan Brain Injury Services, and Home and Community Based Brain Injury Waiver Services at the Iowa Department of Human Service (DHS), as listed below. • Neuro- Resource Facilitation (NRF). (IDPH) • Iowa Brain Injury Resource Network (IBIRN). (IDPH) • Community Based Neurobehavioral Rehabilitation services funded through state Medicaid dollars. (DHS) • Medicaid Home and Community Based Services (HCBS) Brain Injury Waiver program and services. (DHS) • Post-Acute inpatient skilled nursing level of care and outpatient neurorehabilitation. (DHS) • Medicaid-funded intensive neurobehavioral services at the hospital, nursing facilities (including SNF and ICFMR), and community based services, currently unavailable in Iowa to children and adults (PMIC). (DHS) • Other Medicaid Plan Services applicable to Brain Injury, e.g., acute care, NF, etc. (DHS) • Brain Injury Registry Outreach letter. (IDPH) See Appendix E for definitions of Neuro-Resource Facilitation, the Iowa Brain Injury Resource Network, Neurobehavioral and Neurorehabilitation services. Optimized Core Services Optimized core services are modest to relatively low cost, high impact adjustments to current core brain injury services. Prioritized Ranking for Recommendation Optimized Core Services A-1 Determine eligibility at the time of application for Medicaid Waiver funding based on fiscal, functional and diagnostic criteria, immediate referral to NRF and other services regardless of eligibility. A-2 Implement uniform brain injury assessment process and tool across regions. A-3 Prescreen individuals for brain injury at all access points (i.e., MHDD, ID, Substance Abuse, county veterans offices, waiver application, etc.). A-4 Replace current assessment tools for the Brain Injury Waiver with a more sensitive, standardized tool to assess cognitive, psychosocial and functional abilities and needs, to determine initial and ongoing eligibility for state brain injury services. 119
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Iowa Mental Health and Disability S
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E. Process and Timeframes for the F
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The second source of principles is
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order to standardize approaches, re
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Children’s Disability Services Wo
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The Workgroup strived to attain a r
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Psychiatric Medical Institutions fo
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performance measures developed by t
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II. METHODOLOGY Senate File 525 cal
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III. VISION AND PRINCIPLES FOR THE
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Individual Outcomes • People make
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IV. REPORT OF THE INTELLECTUAL AND
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• Financial - Medicaid eligible
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1. Service Coordination Service Coo
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5. Health and Primary Care People w
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- in these difficult budget times -
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D. Outcome Assessment and Performan
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By using the Quality Framework, sta
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The table below illustrates how typ
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• Increased requirements by the C
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of performance data, it is importan
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9. Given the current inclusion of a
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allows supervisors to track a DSP
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Furthermore, this redesign process
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C. Eligibility - Adults The Workgro
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service should be considered for co
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Any current or future state or regi
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1. Peer Run Self-help Centers: The
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areas. ACT teams in rural areas can
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F. Olmstead and System Rebalancing
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continuum, how it should be funded,
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The Workgroup also recommends that
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H. Provider Qualifications and Moni
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Page 69 and 70: • PMIC bed/Residential Services -
Page 71 and 72: • Learning Supports for Students
Page 73 and 74: order to provide a strong system of
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Page 79 and 80: under the Iowa Plan 50 . Services w
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Page 97 and 98: Function Yes No Comments Data colle
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Page 123 and 124: IX. REPORT OF THE PSYCHIATRIC MEDIC
Page 125 and 126: X. INTEGRATION AND TRANSITION PLANN
Page 127 and 128: eligible for Medicaid after 2014, t
Page 129 and 130: XI. CONCLUSION This report presents
Page 131 and 132: Services Currently Provided to Adul
Page 133 and 134: CMS State Balancing Incentive Payme
Page 135 and 136: Appendix C Children’s Disability
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Page 141 and 142: • State plan for college/universi
Page 143 and 144: Appendix D Recommended Definition o
Page 145 and 146: Appendix E Brain Injury Definitions
Page 147 and 148: Appendix F Brain Injury Workgroup R
Page 149 and 150: Corresponding # to narrative recomm
Page 161 and 162: Adult Intellectual and Developmenta
Page 163 and 164: Brain Injury Workgroup Name Agency
Page 165 and 166: Judicial-DHS Workgroup Name Agency
Page 167 and 168: PMIC Transition Workgroup Name Agen
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Regionalization Workgroup Name Agen
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Iowa Mental Health and Disability Services System Redesign Interim ...

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